Does Cholesterol Size Matter?

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How do American Egg Board arguments hold up to scientific scrutiny, such as the concept that large fluffy LDL cholesterol is protective compared to small, dense LDL?

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Maria Fernandez has received nearly a half million dollars from the egg industry and writes papers like this.

She admits eggs can raise LDL, bad cholesterol, but argues that HDL, so-called good cholesterol, also rises maintaining the ratio of bad to good. This is the study she cites to support that assertion. But instead of cherry-picking this one study that she performed with Egg Board money, involving 42 people, if you look at a meta-analysis, if you look at the balance of evidence, the rise in bad with increasing cholesterol intakes is much more than the rise in good. Their meta-analysis of 17 different studies showed that dietary cholesterol increases the ratio of total to HDL-cholesterol ratio, suggesting that the favorable rise in HDL fails to compensate for the adverse rise in total and LDL-cholesterol and, therefore, that increased intake of dietary cholesterol may indeed raise the risk of coronary heart disease. The Egg Board responded by saying the increased heart disease risk associated with eating eggs needs to be put in perspective relative to other risk factors, arguing that it’s worse to be overweight than it is to eat eggs, to which the researchers replied: Be that as it may, it’s easier to cut back on egg intake than it is to permanently lose weight.

Fine, eggs increase LDL, but it’s large LDL, this concept that large fluffy LDL are not as bad as small dense LDL. And indeed large LDL only raises heart disease risk 44%, instead of 63% for the small LDL. Light large buoyant LDL still significantly increases our risk of dying from our #1 killer. This was for women, the same was found for men. Large LDL only increases risk of heart attack or death 31% instead of 44%. Bottomline, as the latest review on the subject concluded, LDL cholesterol has been clearly established as a causal agent in atherosclerosis, regardless of size. Yet check out how the egg board researcher worded it. The formation of larger LDL from eggs is considered protective against heart disease, relative to small LDL. That’s like saying getting stabbed with a knife is protective… relative to getting shot!

Health practitioners should bear in mind, that restricting dietary cholesterol puts a burden on egg intake and leads to the avoidance of a food that contains dietary components like carotenoids and choline. Now she wrote this in 2012 before the landmark 2013 study showing that choline from eggs appears to increase the risk of stroke, heart attack, and death, so she can be excused for that, but what about the carotenoids in eggs, like lutein and zeaxanthin, so important for protecting vision and reducing cholesterol oxidation. As I explored previously, the amounts of these phytonutrients in eggs are miniscule. One spoonful of spinach contains as much as nine eggs. And then compared the predictable effects on eye health: organic free-range eggs versus corn and spinach. But what about the effects of eggs on cholesterol oxidation? We’ve known for decades that LDL cholesterol is bad, but oxidized LDL is even worse. So, her logic goes, since eggs have trace amounts of these antioxidants, the implication is that eggs prevent cholesterol oxidation. But the science shows the exact opposite. Consumption of eggs increases the susceptibility of LDL cholesterol to oxidation. They found that not only does eating eggs raise LDL levels, but also increases LDL oxidizability, in addition to the oxidizability of your entire bloodstream. Was this also just published, so she couldn’t have known differently? No it was published 18 years ago, yet she still tries to insinuate that eggs would reduce oxidation.

She acknowledges receiving funding from the American Egg Board and then claims she has no conflicts of interest.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Nikol Lohr via Flickr.

Maria Fernandez has received nearly a half million dollars from the egg industry and writes papers like this.

She admits eggs can raise LDL, bad cholesterol, but argues that HDL, so-called good cholesterol, also rises maintaining the ratio of bad to good. This is the study she cites to support that assertion. But instead of cherry-picking this one study that she performed with Egg Board money, involving 42 people, if you look at a meta-analysis, if you look at the balance of evidence, the rise in bad with increasing cholesterol intakes is much more than the rise in good. Their meta-analysis of 17 different studies showed that dietary cholesterol increases the ratio of total to HDL-cholesterol ratio, suggesting that the favorable rise in HDL fails to compensate for the adverse rise in total and LDL-cholesterol and, therefore, that increased intake of dietary cholesterol may indeed raise the risk of coronary heart disease. The Egg Board responded by saying the increased heart disease risk associated with eating eggs needs to be put in perspective relative to other risk factors, arguing that it’s worse to be overweight than it is to eat eggs, to which the researchers replied: Be that as it may, it’s easier to cut back on egg intake than it is to permanently lose weight.

Fine, eggs increase LDL, but it’s large LDL, this concept that large fluffy LDL are not as bad as small dense LDL. And indeed large LDL only raises heart disease risk 44%, instead of 63% for the small LDL. Light large buoyant LDL still significantly increases our risk of dying from our #1 killer. This was for women, the same was found for men. Large LDL only increases risk of heart attack or death 31% instead of 44%. Bottomline, as the latest review on the subject concluded, LDL cholesterol has been clearly established as a causal agent in atherosclerosis, regardless of size. Yet check out how the egg board researcher worded it. The formation of larger LDL from eggs is considered protective against heart disease, relative to small LDL. That’s like saying getting stabbed with a knife is protective… relative to getting shot!

Health practitioners should bear in mind, that restricting dietary cholesterol puts a burden on egg intake and leads to the avoidance of a food that contains dietary components like carotenoids and choline. Now she wrote this in 2012 before the landmark 2013 study showing that choline from eggs appears to increase the risk of stroke, heart attack, and death, so she can be excused for that, but what about the carotenoids in eggs, like lutein and zeaxanthin, so important for protecting vision and reducing cholesterol oxidation. As I explored previously, the amounts of these phytonutrients in eggs are miniscule. One spoonful of spinach contains as much as nine eggs. And then compared the predictable effects on eye health: organic free-range eggs versus corn and spinach. But what about the effects of eggs on cholesterol oxidation? We’ve known for decades that LDL cholesterol is bad, but oxidized LDL is even worse. So, her logic goes, since eggs have trace amounts of these antioxidants, the implication is that eggs prevent cholesterol oxidation. But the science shows the exact opposite. Consumption of eggs increases the susceptibility of LDL cholesterol to oxidation. They found that not only does eating eggs raise LDL levels, but also increases LDL oxidizability, in addition to the oxidizability of your entire bloodstream. Was this also just published, so she couldn’t have known differently? No it was published 18 years ago, yet she still tries to insinuate that eggs would reduce oxidation.

She acknowledges receiving funding from the American Egg Board and then claims she has no conflicts of interest.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Nikol Lohr via Flickr.

Doctor's Note

This is why a site like NutritionFacts.org can be so useful, because even when a paper is published in the peer-reviewed medical literature, it can misrepresent the science. But who has time to check the primary sources? I do! If you’d like to support this work, please consider making a tax-deductible donation.

Here are some other videos in which I contrast the available science with what the egg industry asserts:

Only the meat industry may be as bold:

BOLD Indeed: Beef Lowers Cholesterol?

For more on the role of cholesterol, see:

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