THE TRUTH TAKES A DRAMATIC TURN

It’s one of the great ‘about-turn’ stories of our time. After issuing controversial dietary recommendations for 40 years, the world’s top nutrition advisory panels have dropped their caution on eating cholesterol-laden food. Blacklisted by the American Heart Association since the 1960s, cholesterol is not a “nutrient of concern” for overconsumption anymore; fat in moderation, including the ‘bad’ saturated fat, is fine now. The biggest news is, the belittled egg—rich in both cholesterol and fat—is back from exile.

What’s the truth on eggs? Are they good for you, bad for you, or somewhere in between? The truth lies in the plate (or portions): one whole egg is equivalent to 30 gm of meat, poultry, fish, seafood or 1/2 cup of dal in protein power; to an apple in antioxidants; to four ounces of milk. Despite the bad rap for years, an egg is more than just an egg.

Why are eggs so controversial? A lot of it has to do with cholesterol: the yellow of an egg contains about 185 mg. It made sense in early studies, like the Framingham Heart Study from 1949, that a high fat diet may raise blood cholesterol and the risk of heart disease. But cholesterol— the waxy, fat-like substance in every cell—is hardly a monster. It’s an essential part of our metabolism. Your body makes all that you need every day, the rest comes from animal food: meat, poultry and full-fat dairy or eggs (called dietary cholesterol). The point is: when you eat more cholesterol, your body produces less of it. When you consume less, your body produces more.

Research shows that dietary cholesterol has little impact on your blood serum. Eggs have been demonised because they were believed to increase the “bad” LDL (low-density lipoprotein) cholesterol, which raises heart disease risk. But eggs also enhance the “good” HDL (high-density lipoprotein), which reduces risk of heart disease. What’s more, eggs increase the larger cholesterol molecules, less likely (than small ones) to enter artery walls, a major factor in heart attack risk.

Although not a single study links dietary cholesterol to higher heart attack risk, strong recommendations were formulated—without evidence and mostly on reasonable guesswork. Scientists rampantly looked at every food associated with cholesterol and said, “Don’t eat this.” India blindly followed the West.

Measured gram-for-gram, eggs are the best source of daily nutrition. There are many minerals, vitamins, high quality proteins, antioxidants and immunity-enhancing nutrients in eggs: carotenoids that protect the eye, guard against early ageing, some cancers and the heart; vitamin K2, which prevents plaque in arteries; choline, which protects muscles, memory and liver; biotin for hair, skin and nail; calcium, phosphorus and folate for healthy bones, teeth and DNA and panthothenic acid for a healthy nervous system.

It has to be admitted that we were misled for many years. Most of us are not in a rush to admit we were wrong. As Dr Eric J. Topol, former cardiology chairman of the Cleveland Clinic and now director of the Scripps Translational Science Institute, said: “Evidence-based medicine is a fancy buzz term. You’ve got people who draw out guidelines from shaky data and tell the world this is the way it’s got to be…(it’s) eminence-based medicine.”

A word of warning: the pendulum should not swing too far in the opposite direction. Include eggs in your diet, but please do not celebrate with five eggs a day. If you find a correlation between your diet and your blood cholesterol, exercise a bit of caution.

change in the way people eat, from traditional staple cereals to more animal proteins, including eggs. That nutrition transition pushed India towards a whirlwind of chronic disease, says Dr Ramakanta Panda, cardiac surgeons and chairman of Asian Heart Institute, Mumbai. From the 1990s, as USDA tightened its guidelines, doctors everywhere cut down on eating even one egg a day.

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SCIENCE TAKES A U-TURN

What’s going on? “About a dozen large-scale observational studies, followed up over decades on thousands of men and women, connected some of the crucial dots in the 2000s,” says Dr Ambrish Mithal, chairman, division of endocrinology and diabetes, Medanta-The Medicity in Gurgaon. “Taken together, they provided the convincing evidence that eating an egg a day is safe for most people.” A growing body of research now shows that cholesterol-rich foods like eggs do not raise blood cholesterol levels by that much. Consuming sugar, trans fats or excessive saturated fat can be more harmful, he says.

The problem with the old guidelines was it assumed that when you ate more cholesterol, from eggs and other animal foods, your blood cholesterol rose. “Assume that and, of course, it makes sense to eat fewer eggs,” says Dr Nikhil Tandon, professor and head, department of endocrinology and diabetes, All India Institute of Medical Sciences, Delhi. “But your body doesn’t work that way.” The human body makes all the cholesterol—a substance essential for cellular functions—it needs. Every day, the liver produces between 1 and 2 grams, the rest comes from diet. “But when one takes in more cholesterol from food, your body produces less of it,” he explains. The body produces more cholesterol when dietary cholesterol is less.

Research now suggests that the cholesterol you eat has little impact on how much cholesterol you have in your blood serum. In fact, some degree of cholesterol consumption is harmless. Most of the studies do not find higher rates of heart attacks, strokes or other cardiovascular diseases in people who eat up to one egg per day. With all that, the egg’s reputation is gradually returning.

WHAT WE DO (AND DON’T) KNOW ABOUT EGGS

The new cholesterol guidelines have exonerated the egg, with an embarrassed apology. Some food scientists are, however, worried that the softened official line on cholesterol would send out wrong messages, giving people the licence to eat, say, five eggs every morning for breakfast. Avoid sensational food fads, they say. Eat a varied diet of nutrient-rich whole foods. And do include eggs, but don’t misinterpret the data. So here are the highlights, edited for clarity:

An egg a day does not increase the risk of a heart attack, a stroke, or any other type of cardiovascular disease for most people

Don’t have more than three eggs a week if you have diabetes, are at high risk for heart disease from other causes (say, smoking), or already have heart disease

There is no definitive evidence for how many eggs you should eat, but one a day is definitely fine (Emma Morano, who died at age 115 this year, had three eggs a day)

How many eggs you can safely eat per week largely depends on what the rest of your diet looks like

It matters greatly what you eat with your eggs (trans fats, highly-refined “bad carbs” or saturated fats: white flour and rice, potatoes, fried food, processed foods or sweetened drinks)

Have eggs mixed with fresh vegetables, to help your body

take in more healthy antioxidants

THE NEXT BATTLE FOR EGGS

Nothing seems more wholesome than breaking an egg into a frying pan for breakfast now. Wait a minute, the ever-controversial egg has moved on to the next scandal. The 269th report of the Law Commission of India has drawn attention to the treatment of chicken in commercial factory farming this July: the birds are kept in inhumane conditions, starved and manipulated mercilessly for faster production. The suffering and drastic weight loss dramatically increases the risk of a hen’s laying infected eggs.

Who can tell what can hide in an egg, waiting its chance to create havoc? It sent shock waves across the nation when researchers from the Washington-based Center for Disease Dynamics, Economics & Policy and the Public Health Foundation of India, Delhi, found unregulated use of antibiotics and drug-resistant bacteria across 18 poultry farms in Punjab. According to the study reported in Environmental Health Perspectives, July, 2017, with rising incomes and heightened demand for eggs and chicken, consumption of antibiotics could grow more than 300 per cent by 2030 in India. “Antibiotic-resistant microbes can render ineffective the very drugs designed to cure infections,” says Ramanan Laxminarayan, lead author and CDDEP director. No one will be spared if such outbreaks spread, be it a small remote village or the largest of metros.

The next battle to rescue the egg starts now.

RESEARCH NOW SUGGESTS THAT SOME DEGREE OF CHOLESTEROL CONSUMPTION IS HARMLESS