Host: Abigail Trafford

Labeled a bad food because of its high cholesterol content, the egg has been in a shadow for decades. But egg consumption is going up as researchers reexamine the evidence on dietary cholesterol.

Post Health reporter Marc Kaufman is our guest for this week's "Health Talk" with Abigail Trafford on Tuesday, September 21, from 2 to 3 p.m. EDT.

Please send us your questions on eggs and your health.

Abigail Trafford: Hello and Welcome! The egg is back! Eggs are good for you. Once branded a health hazard because of a high colesterol content, eggs are now being rehabilitated. Turns out that fears about heart-clogging cholesterol from eggs may be exaggerated. Instead, the experts say, the egg is a low calorie package of lots of protein and nutrients. How did the egg make a comback? What does it mean for you? Send us your questions. My guest is Marc Kaufman who wrote the cover story in Health today on the New Good Egg.

Abigail Trafford: Marc, what's the new message from the scientific community on eggs. Can I now eat eggs more than three times a week? What happened? For years the docs told us that eggs were heart-attack city food.

Marc Kaufman: The evolving new message is that eggs are a high-protein nutritious food that were perhaps unfairly targetted back in the 1970s and 1980s because of their cholesterol content. The evidence has gradually suggested that the cholesterol in eggs -- and there is about 215 mgs. per eggs -- does not necessarily become cholesterol in the blood of the people who eat the eggs. And since the blood cholesterol is what has been associated with heart disease, that is the important form of cholesterol for this discussion. This is not exactly new information -- there has been an active debate about the role of dietary cholesterol for some time. But now the weight of evidence seems to be falling more and more on the side of those who argue dietary cholesterol from eggs -- and shellfish -- need not be a great worry to most Americans. Of course for those 15 to 25 percent of Americans who have difficulty stabilizing cholesterol levels in their bodies, eggs and other high cholesterol foods still should be avoided or limited.

Abigail Trafford: The American Heart Association led the charge against eggs. Now they are reviewing their recommendation that people limit the number of eggs they eat. Why? When will they issue new guidelines?

Marc Kaufman: The American Heart Association has long held that high dietary cholesterol is a risk for heart disease. But the group reviews its recommendations regularly and is doing so now. As a result of the last review, the group changed its recommendation on eggs to say people should eat three to four egg yolks per week, rather than their earlier position that 3 egg yolks was preferable. They changed then because new and finer measuring techniques allowed researchers to conclude their was less cholesterol in eggs than previously believed.
The issue now is more complex: In effect, is the cholesterol from eggs (and shellfish, too) sufficiently benign that it should be put in a different category by the AHA than cholesterol from other sources, especially those high in saturated fats? And should an individual's overall diet be taken into account when recommending egg consumption? In other words, if a person is already eating a diet high in frutis and vegetables and grains, and low in saturated fats from meat and cheese, than do they really have to be careful about eggs?

Abigail Trafford: Let's get specific. Can I eat two eggs over easy, some bacon or sausage, and three pancakes with maple syrup. Will the science ever go that far to exonerate the old egg-eating habits?

Marc Kaufman: While the science is evolving about eggs, it is pretty clear about the risks of eating foods like bacon or sausages high in saturated fats. The risk of heart disease from eating a lot of those kinds of food is high, scientists are quite confident. Indeed, some of the criticism of the early studies that linked a high cholesterol diet with heart disease focused on the possiblity that those people eating a lot of eggs back in the 1960s and 70s were probably eating a lot of bacon and biscuits along with the eggs, and so were showing up with high cholesterol as a result. What researchers now believe is that the saturated fats in meats make it difficiult for the body to regulate cholesterol, and consequently can contribute to very high blood cholesterol counts.

Washington, D.C.: When I eat eggs they are often hard-boiled and I eat just the whites, because that has most of the protein and nutrients. Doesn't that get around this issue of cholesterol? That way you can have your egg without the bad effects.

Abigail Trafford: What about that, Marc? But doesn't the yolk have some good stuff too that you want to consume?

Marc Kaufman: While it is true that the yolk contains almost all of the cholesterol in an egg, it is also true that the yolk contains some of the other good protein and other nutrients in an egg. But as a general rule, nutritionists do say that egg whites are very good nutritionally, and that you can eat them with little worry about possibly bad consequences. In fact, in the AHA recommendation about eggs, they specify that eggs yolks are to be limited, but not necessarily egg whites.

Bethesda, MD: Biochemistry students fifteen years ago -like myself- learned that most peoples' livers compensate for changes in dietary cholesterol. Why is this a newsworthy story?

Abigail Trafford: Maybe you knew this, but the general public was having a total cholesterol freak-out. There is good data that some people can handle dietary cholesterol. Only a minority are "cholesterol-sensitive" and cannot handle cholesterol in the diet. But Marc, what is the story about how people metabolize cholesterol? And how do you know if you can handle a lot of dietary cholesterol?

Marc Kaufman: We think this is a newsworthy story now because so few people know what you as a biochemisty student learned. I think that health officials were very worried about cholesterol several decades ago and demonized the egg as they tried to explain its possible dangers. These things do tend to go in large pendulum swings, and perhaps the swing against eggs went too far. It is also only in recent years that obesity and overweight have become such a major issue in the U.S. -- with the CDC calling it recently "an epidemic." Well, eggs have a lot of protein and not very many calories, and so might be useful in putting together a diet that tries to attack the eating patterns that result in so much overweight.

Arlington, Virginia : I hear so many bad things about the salmonella in eggs. How much do they have to be cooked to kill the germ?

Abigail Trafford: And now for the bad news. . . .

Marc Kaufman: Salmonella in eggs has definitely become a significant issue in the past decade, and will continue to be in the future. Nobody knows exactly why it became more widespread when it did, though many believe the crowded conditions in which hens live now may well play a role. But understanding that consumers were becoming wary of salmonella, the egg industry has now gotten motivated to find answers. They are now working with government and consumer groups to put together a federal inspection/monitoring system that should dramatically reduce the threat of salmonella. The big issue for the future is this: who should pay for this potentially expensive new level of federal regulation. The egg industry says that the taxpayers should, but there will surely be others who disagree.

Washington, D.C.: Some of my favorite desserts use eggs, but the desserts are never cooked. I have been staying away from those recipes because of fears of salmonella. Do I still need to do that?

Marc Kaufman: The Egg Nutrition Center, which is affiliated with the American Egg Board, recommends that consumers not consume raw eggs. Most of the salmonella cases involving eggs have been traced back to eggs that were not cooked sufficiently, or were not properly refrigerated before cooking.

Washington, D.C.: These new types of eggs that you mention in your story this morning have added oils that the body needs. But do they also have less cholesterol. What is the total dietary improvement in these eggs?

Marc Kaufman: While some of the new "designer eggs" have lower cholesterol levels, the reduction is not great and will probably never get too much greater. Scientists who have worked to lower cholesterol in eggs told me that hens simply stop laying eggs if the cholesterol available to them falls below a certain level. However, researchers are looking for ways to better balance the fats and cholesterol in eggs. This is what the Omega-3 issue is all about. Proponents say that eggs high in Omega-3 fatty acids do not increase cholesterol levels because they do not interfere with the body's ability to break down cholesterol. In some ways, the designing of these new eggs is a step back to the future. When hens used to roam free and eat what they wanted, their eggs had a different (and many would argue preferable) array of fats. So the high Omega-3 diets now are , in some ways, an effort to compensate for what was lost when egg production became more like an industry.

Rockville, MD: Is there any estimate of what percentage of cholesterol from eggs and shellfish contribute to total cholesterol in the blood? I love eggs and shellfish, but I don't want to overdo it.

Abigail Trafford: Marc, you write that some experts think that cholesterol from eggs and shellfish should be put in a different category than general dietary cholesterol. Why? That would allow people to go over the recommended daily amount of 300 milligrams of cholesterol. (An egg contains 215 milligrams) Mark, what is the new story on how much shellfish and eggs people can eat?

Marc Kaufman: Research over the past decade has suggested that only a small amount of the cholesterol in food is translated into serum, or blood, cholesterol. A meta-analysis of the subject several years ago concluded that between 2 and 3 percent of dietary cholesterol becomes serum cholesterol. However, if that cholesterol is consumed with lots of saturated fats -- from meats, cheese, etc -- then the body's ability to regulate its cholesterol levels gets compromised. In other words, a diet high in eggs and shellfish is not necessarily a risk, but that kind of diet that also includes a lot of steak and creamy cheeses is more of a risk for heart disease. It should be rememberred, however, that some Americans -- perhaps 15 to 25 percent -- do have difficulty adjusting their cholesterol levels . Whether because of genetic factors or as a result of overweight, this inability to break down choelsterol can be a significant problem, and doctors say that those who know they have high cholesterol levels need to remain wary. of dietary cholesterol.

Washington, D.C.: In France, they eat a lot of eggs and other foods like cheese that we limit here. Yet their rates of heart disease are lower than here. How does this happen?

Abigail Trafford: It's not fair that the French get to eat all the good stuff and not suffer the consequences. Eggs Benedict. All those sauces thickened with egg yolks. The egg is an icon in French cooking. Does the so-called "French Paradox" (lots of dairy products and eggs, yet low rates of heart disease)provide even more evidence for the rehabilitation of the egg? Was the anti-egg campaign limited to the U.S.?

Marc Kaufman: While it is true that the French diet is rich in eggs, cheese and other foods high in cholesterol, it also features more fresh fruits, leafy vegetablies, whole grains and yes, red wine than the American diet. And all of those other features are very heart-healthy additions. What's more, I don't believe France has quite the overweight problem that we do in the U.S. I believe the message that groups such as the American Heart Association will be increasingly delivering is that no foods are bad per se, and all foods can be enjoyed if done so in moderation. The problem here is that many Americans do not eat foods from steak to ice cream to Coke in moderation.
It is not only the French who eat a lot of eggs yet still have low rates of heart disease. Japan, Mexico, Spain and France are all among the top egg-consuming nations. And all four have low rates of heart disease.

Washington, D.C.: It seems like these questions about food poisoning in eggs are a recent development. Is there something different in the way eggs are produced today that causes this?

Marc Kaufman: One of the most contentious issues regarding salmonella involves so called forced moulting -- a process by which hens are denied food so they will continue laying eggs. It is a rather complex process, but suffice it to say that hens near the end of their egg-laying cycles who have not eaten in days or weeks will begin laying eggs again. Opponents of this practice say it is not humane, but also that it makes the hens less healthy and more prone to carry the salmonella bacteria. What's more, as the hens lose their feathers, some argue, the hen house as a whole becomes a less healthy place where it is easier for bacteria to spread. This issue will be thrashed out as part of the battle over egg industry regulation.

Abigail Trafford: Marc, is it better to get eggs from free-range chickens? Why? should you tell your kids to consider a couple of chickens for pets and let them run around the backyard, laying healthy eggs for breakfast. . . .

Marc Kaufman: I'm not sure if neighbors in Kensington or McLean will like hens running around the neighborhood, but there certainly are good reasons to consider paying the addition cost to buy eggs from free-range chickens. Artemis Simopolous, a former nutrition official at NIH who has been studying the fat make-up of eggs for years, has found that eggs from free-ranging chicken from the island of Crete are very different from generic eggs here, and she says are far more nutritious. She also says they do not raise cholesterol levels at all. It makes a certain sense that chicken fed a better and more varied diet will produce healthier eggs. Most organic and "nutritionally enhanced" eggs cost 1 or 2 dollars more than generic eggs. However, they remain a relatively cheap form of protein. Marketers of these eggs tell me their popularity is growing fast, especially on the East Coast and the West Coast. They also say that it is largely urban and some suburban shoppers who are buying them .

Abigail Trafford: I can't wait to get back to my old Sunday morning habit of an egg, once over easy. . . without the bacon and pancakes, I guess. Unless it's a special occasion. Sometimes you just have to indulge yourself. Many thanks, Marc, for helping us understand the return of the "Good Egg." And thank you all for your questions. Next week: the new SMART BRAIN. It's not true that you lose brain cells and get dumber with age. Your brain is actally capable of great regeneration and flexibility. In fact, there is a scientific base to wisdom. Join us next week, same time, same place.

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