noun_Search_345985 Created with Sketch.
0 cart-active Created with Sketch. noun_Search_345985 Created with Sketch.

Eggs, cholesterol, and cardiovascular disease

By Casey Thaler, B.A., NASM-CPT, FNS
July 26, 2020
Eggs, cholesterol, and cardiovascular disease image

Eggs are loaded with high quality protein, as well as rich in copper, iron, zinc, vitamin D, and many B vitamins. Additionally, they are low in carbs and, if you buy the right kind, high in beneficial omega-3 fatty acids. At some point, however—whether because of popular media’s simplistic take on nutrition or the influence of some other marketing scheme—eggs acquired a poor reputation. In fact, for a period, the general opinion of eggs seemed to be that they were one of the unhealthiest foods you could consume.

This negative link was based on the theory that dietary cholesterol could lead to terrible health outcomes. Starting with the hypotheses of American physiologist Ancel Keys in the mid-twentieth century, Americans were told they should avoid saturated fat and cholesterol. In turn, and in simplistic terms, rates of obesity, heart disease, and other diseases skyrocketed to previously unseen levels.

Case in point: It was recently announced that the obesity rate in the United States had reached 40 percent. Almost half of Americans are not just overweight, they’re obese. Sad and staggering, this fact contradicts the idea that saturated fat and cholesterol are the sole cause of the many health problems seen in this country.

So, what does the research say about dietary cholesterol and disease? Are eggs really a cause of many of our health woes?

Overall, the pattern points to eggs improving health, not worsening it.

There have been several epidemiological studies showing higher all-cause mortality rates in those who eat the greatest number of eggs per week. But correlation is not cause, and when you dig deeper into these studies, it becomes clear that in the United States, the people with the highest egg consumption also tend to eat the least healthy diets, in general.

To that end, a fairly recent prospective correlational study from Harvard University showed that dietary cholesterol may have an impact on cardiovascular disease. In the study, for every additional 300 mg of dietary cholesterol eaten per day, the risk of CVD and all-cause mortality was higher by 17 percent and 18 percent, respectively. However, these associations became nonsignificant, after adjustment for consumption of eggs and red meat. Likewise, the association between egg consumption and CVD also became nonsignificant after total dietary cholesterol was accounted for. To the study’s credit, it did control for diet quality.

Nevertheless, for every recent study showing a health risk associated with egg consumption, there are many showing either no risk or even health benefits. A 2020 study published in The Journal of the American Heart Association found no association between eggs and mortality. Another published in the European Journal of Nutrition, by Zamora-Ros, et al., found a mild beneficial correlation with egg consumption.

Overall, the pattern points to eggs improving health, not worsening it. Take the following study, which concluded: “People with prediabetes or type-2 diabetes, who consumed a three-month, high-egg, weight-loss diet with a six-month follow-up exhibited no adverse changes in cardiometabolic markers compared with those who consumed a low-egg weight-loss diet. A healthy diet based on population guidelines and including more eggs than currently recommended by some countries may be safely consumed.”

Another scientific study concluded that: “Eating one egg daily is not associated with an increase in CVD or all-cause mortality. The small observed reduction in stroke risk needs to be confirmed. Our findings support current guidelines recommending eggs as part of a healthy diet and should be considered in other dietary recommendations.”

A further study concluded that: “results from these two randomized controlled acute feeding studies indicate that dietary cholesterol contained in whole egg is not well absorbed and does not increase plasma total cholesterol concentration. These findings provide a mechanism to help explain why dietary cholesterol intake may not affect long-term plasma total cholesterol control.” The researchers of this study put this conclusion in the title of the paper.

Sadly, while the scientific data is clear, the misinformation persists. As is often the case for nutrition science news, a misinterpretation of the data leads to a misunderstanding of the conclusions that can be drawn from it.

Ultimately, the key to preventing CVD—as many of the above studies illustrate—is balance. You need to consume a well-rounded diet—rich with vegetables, healthy proteins, good fats—and stay away from refined foods and sugars. In this context, moderate egg consumption is beneficial. No matter how many eggs you consume per week, if you are drinking alcohol, smoking, eating low-quality meats, and consuming too much sugar, you are greatly increasing your odds of developing any disease—not just cardiovascular disease.


Schwarz M., Russell D. W., Dietschy J. M., Turley S. D. Alternate pathways of bile acid synthesis in the cholesterol 7α-hydroxylase knockout mouse are not upregulated by either cholesterol or cholestyramine feeding. Journal of Lipid Research. 2001;42(10):1594–1603.

DiMarco D. M., Norris G. H., Millar C. L., Blesso C. N., Fernandez M. L. Intake of up to 3 Eggs per Day Is Associated with Changes in HDL Function and Increased Plasma Antioxidants in Healthy, Young Adults. Journal of Nutrition. 2017;147(3):323–329. doi: 10.3945/jn.116.241877.

Missimer A., Fernandez M. L., DiMarco D. M., et al. Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations. Journal of the American College of Nutrition. 2018;37(2):140–148. doi: 10.1080/07315724.2017.1365026.

Lemos B. S., Medina-Vera I., Blesso C. N., Fernandez M. L. Intake of 3 eggs per day when compared to a choline bitartrate supplement, downregulates cholesterol synthesis without changing the LDL/HDL ratio. Nutrients. 2018;10(2)

Shin J. Y., Xun P., Nakamura Y., He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. American Journal of Clinical Nutrition. 2013;98(1):146–159.

Tran N. L., Barraj L. M., Heilman J. M., Scrafford C. G. Egg consumption and cardiovascular disease among diabetic individuals: A systematic review of the literature. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2014;7:121–137.

Repa J. J., Lund E. G., Horton J. D., et al. Disruption of the sterol 27-hydroxylase gene in mice results in hepatomegaly and hypertriglyceridemia. The Journal of Biological Chemistry. 2000;275(50):39685–39692. doi: 10.1074/jbc.M007653200.

Wang D. Q.-H., Carey M. C. Measurement of intestinal cholesterol absorption by plasma and fecal dual-isotope ratio, mass balance, and lymph fistula methods in the mouse: An analysis of direct versus indirect methodologies. Journal of Lipid Research. 2003;44(5):1042–1059. doi: 10.1194/jlr.D200041-JLR200.

Ponz de Leon M., Iori R., Barbolini G., Pompei G., Zaniol P., Carulli N. Influence of Small-Bowel Transit Time on Dietary Cholesterol Absorption in Human Beings. The New England Journal of Medicine. 1982;307(2):102–103. doi: 10.1056/NEJM198207083070207.

Wang D. Q.-H., Schmitz F., Kopin A. S., Carey M. C. Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis. The Journal of Clinical Investigation. 2004;114(4):521–528. doi: 10.1172/JCI200416801.

Wang D. Q.-H., Paigen B., Carey M. C. Genetic factors at the enterocyte level account for variations in intestinal cholesterol absorption efficiency among inbred strains of mice. Journal of Lipid Research. 2001;42(11):1820–1830.

Hollander D., Morgan D. Increase in cholesterol intestinal absorption with aging in the rat. Experimental Gerontology. 1979;14(4):201–204. doi: 10.1016/0531-5565(79)90020-2.

Duan L.-P., Wang H. H., Ohashi A., Wang D. Q.-H. Role of intestinal sterol transporters Abcg5, Abcg8, and Npc111 in cholesterol absorption in mice: Gender and age effects. American Journal of Physiology-Gastrointestinal and Liver Physiology. 2006;290(2):G269–G276. doi: 10.1152/ajpgi.00172.2005.

Wang D. Q.-H. Aging per se is an independent risk factor for cholesterol gallstone formation in gallstone susceptible mice. Journal of Lipid Research. 2002;43(11):1950–1959. doi: 10.1194/jlr.m200078-jlr200.

Duan L.-P., Wang H. H., Wang D. Q.-H. Cholesterol absorption is mainly regulated by the jejunal and ileal ATP-binding cassette sterol efflux transporters Abcg5 and Abcg8 in mice. Journal of Lipid Research. 2004;45(7):1312–1323. doi: 10.1194/jlr.M400030-JLR200.

Kelley J. J., Tsai A. C. Effect of pectin, gum arabic and agar on cholesterol absorption, synthesis, and turnover in rats. Journal of Nutrition. 1978;108(4):630–639. doi: 10.1093/jn/108.4.630.

Vahouny G. V., Satchithanandam S., Chen I., et al. Dietary fiber and intestinal adaptation: Effects on lipid absorption and lymphatic transport in the rat. American Journal of Clinical Nutrition. 1988;47(2):201–206. doi: 10.1093/ajcn/47.2.201.

Johnson F. L., St. Clair R. W., Rudel L. L. Effects of the degree of saturation of dietary fat on the hepatic production of lipoproteins in the African green monkey. Journal of Lipid Research. 1985;26(4):403–417.

Chen I. S., Hotta S. S., Ikeda I., Cassidy M. M., Sheppard A. J., Vahouny G. V. Digestion, absorption and effects on cholesterol absorption of menhaden oil, fish oil concentrate and corn oil by rats. Journal of Nutrition. 1987;117(10):1676–1680. doi: 10.1093/jn/117.10.1676.

Alexander D. D., Miller P. E., Vargas A. J., Weed D. L., Cohen S. S. Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke. Journal of the American College of Nutrition. 2016;35(8):704–716. doi: 10.1080/07315724.2016.1152928.

Eckel R. H., Jakicic J. M., Ard J. D., et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American college of cardiology/American heart association task force on practice guidelines. Journal of the American College of Cardiology. 2014;63(25, part B):2960–2984. doi: 10.1016/j.jacc.2013.11.003.

USDA National Nutrient Database for Standard Reference. Beltsville, MD, USA: US Department of Agriculture, Agricultural Research Service, Nutrient Data Laboratory; 2015.

Miranda J. M., Anton X., Redondo-Valbuena C., et al. Egg and egg-derived foods: effects on human health and use as functional foods. Nutrients. 2015;7(1):706–729. doi: 10.3390/nu7010706.

USDA: United States Department of Agriculture. Choice Reviews Online. 2011;48(07):48-3859–48-3859. doi: 10.5860/CHOICE.48-3859.

Rakonjac S., Bogosavljević-Bošković S., Pavlovski Z., et al. Laying hen rearing systems: A review of major production results and egg quality traits. World's Poultry Science Journal. 2014;70(1):93–104. doi: 10.1017/S0043933914000087.

Jung S., Kim D. H., Son J. H., Nam K., Ahn D. U., Jo C. The functional property of egg yolk phosvitin as a melanogenesis inhibitor. Food Chemistry. 2012;135(3):993–998. doi: 10.1016/j.foodchem.2012.05.113.

Natoli S., Markovic T., Lim D., Noakes M., Kostner K. Unscrambling the research: Eggs, serum cholesterol and coronary heart disease. Nutrition & Dietetics. 2007;64(2):105–111. doi: 10.1111/j.1747-0080.2007.00093.x.

Villaume C., Beck B., Rohr R., Pointel J. P., Debry G. Effect of exchange of ham for boiled egg on plasma glucose and insulin responses to breakfast in normal subjects. Diabetes Care. 1986;9(1):46–49. doi: 10.2337/diacare.9.1.46.

Pelletier X., Thouvenot P., Belbraouet S., et al. Effect of egg consumption in healthy volunteers: Influence of yolk, white or whole-egg on gastric emptying and on glycemic and hormonal responses. Annals of Nutrition and Metabolism. 1996;40(2):109–115. doi: 10.1159/000177903.

Vander Wal J. S., Marth J. M., Khosla P., Jen K.-L. C., Dhurandhar N. V. Short-term effect of eggs on satiety in overweight and obese subjects. Journal of the American College of Nutrition. 2005;24(6):510–515. doi: 10.1080/07315724.2005.10719497.

Dhurandhar N. V., Vander Wal J. S., Currier N., Khosla P., Gupta A. K. Egg breakfast enhances weight loss. FASEB Journal. 2007;21(5):A326–A327.

Ratliff J., Leite J. O., de Ogburn R., Puglisi M. J., VanHeest J., Fernandez M. L. Consuming eggs for breakfast influences plasma glucose and ghrelin, while reducing energy intake during the next 24 hours in adult men. Nutrition Research. 2010;30(2):96–103. doi: 10.1016/j.nutres.2010.01.002.

Zhang T. Egg processing. Taipei, Taiwan: Huaxiangyuan Press; 1992.

Li-Chan E. C., Powrie W. D., Nakai S. The chemistry of eggs and egg products. Egg science and technology. 1995;4:105–175.

Anton M., Martinet V., Dalgalarrondo M., Beaumal V., David-Briand E., Rabesona H. Chemical and structural characterisation of low-density lipoproteins purified from hen egg yolk. Food Chemistry. 2003;83(2):175–183. doi: 10.1016/S0308-8146(03)00060-8.

Montserret R., McLeish M. J., Böckmann A., Geourjon C., Penin F. Involvement of electrostatic interactions in the mechanism of peptide folding induced by sodium dodecyl sulfate binding. Biochemistry. 2000;39(29):8362–8373. doi: 10.1021/bi000208x.

Griffin H. D. Manipulation of egg yolk cholesterol: A physiologist's view. World's Poultry Science Journal. 1992;48(2):101–112. doi: 10.1079/WPS19920010.

Ma M. Processing science of egg and egg products. Beijing, China: China Agricultural Press; 2006.

Chi Y., Lin S. Research advance in extraction and application of egg-yolk lecithin. Food and Fermentation Industries. 2002:28–50.

Blesso C. N. Egg phospholipids and cardiovascular health. Nutrients. 2015;7(4):2731–2747. doi: 10.3390/nu7042731.

Yang F., Chen G., Ma M., Qiu N., Zhu L., Li J. Egg-Yolk Sphingomyelin and Phosphatidylcholine Attenuate Cholesterol Absorption in Caco-2 Cells. Lipids. 2018;53(2):217–233. doi: 10.1002/lipd.12018.

Yang F., Chen G., Ma M., Qiu N., Zhu L., Li J. Fatty acids modulate the expression levels of key proteins for cholesterol absorption in Caco-2 monolayer. Lipids in health and disease. 2018;17(1):p. 32.

Zeisel S. H. Choline: critical role during fetal development and dietary requirements in adults. Annual Review of Nutrition. 2006;26:229–250. doi: 10.1146/annurev.nutr.26.061505.111156.

Zazpe I., Beunza J. J., Bes-Rastrollo M., et al. Egg consumption and risk of cardiovascular disease in the SUN Project. European Journal of Clinical Nutrition. 2011;65(6):676–682. doi: 10.1038/ejcn.2011.30.

Shaw G. M., Carmichael S. L., Yang W., Selvin S., Schaffer D. M. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. American Journal of Epidemiology. 2004;160(2):102–109. doi: 10.1093/aje/kwh187.

Skřivan M., Englmaierová M. The deposition of carotenoids and α-tocopherol in hen eggs produced under a combination of sequential feeding and grazing. Animal Feed Science and Technology. 2014;190:79–86. doi: 10.1016/j.anifeedsci.2014.01.009.

Glynn E. L., Fry C. S., Drummond M. J. Excess leucine intake enhances muscle anabolic signaling but not net protein anabolism in young men and women. Journal of Nutrition. 2010;140(11):1970–1976. doi: 10.3945/jn.110.127647.

Iqbal J., Hussain M. M. Intestinal lipid absorption. American Journal of Physiology-Endocrinology and Metabolism. 2009;296(6):E1183–E1194. doi: 10.1152/ajpendo.90899.2008.

Lammert F., Wang D. Q.-H. New insights into the genetic regulation of intestinal cholesterol absorption. Gastroenterology. 2005;129(2):718–734. doi: 10.1016/j.gastro.2004.11.017.

Davis H. R., Jr., Zhu L.-J., Hoos L. M., et al. Niemann-Pick C1 like 1 (NPC1L1) is the intestinal phytosterol and cholesterol transporter and a key modulator of whole-body cholesterol homeostasis. The Journal of Biological Chemistry. 2004;279(32):33586–33592. doi: 10.1074/jbc.M405817200.

Wang D. O., Lammert F., Paigen B., Carey M. C. Hyposecretion of biliary phospholipids (PL) significantly decreases the intestinal absorption of cholesterol (Ch) in Mdr2 (−/−) and (+/−) mice. Gastroenterology. 1998;114:A913.

Eckel, R. H. (2008). Egg consumption in relation to cardiovascular disease and mortality: the story gets more complex. The American Journal of Clinical Nutrition, 87(4), 799–800. Retrieved from

Mazidi, M., Katsiki, N., Mikhailidis, D. P., Pencina, M. J., & Banach, M. (2019). Egg Consumption and Risk of Total and Cause-Specific Mortality: An Individual-Based Cohort Study and Pooling Prospective Studies on Behalf of the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. Journal of the American College of Nutrition, 38(6), 552–563. Retrieved from

Zhong, V. W., Horn, L. V., Cornelis, M. C., Wilkins, J. T., Ning, H., Carnethon, M. R., … Allen, N. B. (2019). Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality. JAMA, 321(11), 1081–1095. Retrieved from

Xia, P.-F., Pan, X.-F., Chen, C., Wang, Y., Ye, Y., & Pan, A. (2020). Dietary Intakes of Eggs and Cholesterol in Relation to All-Cause and Heart Disease Mortality: A Prospective Cohort Study. Journal of the American Heart Association, 9(10), e015743. Retrieved from

Xu, L., Lam, T. H., Jiang, C. Q., Zhang, W. S., Zhu, F., Jin, Y. L., … Thomas, G. N. (2018). Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses. European Journal of Nutrition, 58(2), 785–796. Retrieved from

Zamora-Ros, R., Cayssials, V., Cleries, R., Redondo, M. L., Sánchez, M.-J., Rodríguez-Barranco, M., … Agudo, A. (2018). Moderate egg consumption and all-cause and specific-cause mortality in the Spanish European Prospective into Cancer and Nutrition (EPIC-Spain) study. European Journal of Nutrition, 58(5), 2003–2010. Retrieved from

Even More Articles For You

Rage of Ages: Advanced Glycation End Products
Advanced glycation end products naturally form in our bodies from the chemical reaction of sugars with proteins and are associated with many chronic diseases. How can you limit your AGE intake?
By Loren Cordain, Ph.D.
Yes, Eggs Are High in Cholesterol, But Why Should We Care?
Learn why we should care about eggs & high cholesterol. Browse The Paleo Diet® blog online for the latest Paleo Diet news, recipes, meals & more!
By Casey Thaler
Can You Eat Your Way to a 'Brad Pitt Jawline'?
There has been a major change in the human skeleton since the Paleolithic era. How did we get ourselves into this mess of smaller faces and jawlines?
By Eirik Garnas
Paleo Leadership
Trevor Connor
Trevor Connor

Dr. Loren Cordain’s final graduate student, Trevor Connor, M.S., brings more than a decade of nutrition and physiology expertise to spearhead the new Paleo Diet team.

Mark J Smith
Dr. Mark J. Smith

One of the original members of the Paleo movement, Mark J. Smith, Ph.D., has spent nearly 30 years advocating for the benefits of Paleo nutrition.

Nell Stephenson
Nell Stephenson

Ironman athlete, mom, author, and nutrition blogger Nell Stephenson has been an influential member of the Paleo movement for over a decade.

Loren Cordain
Dr. Loren Cordain

As a professor at Colorado State University, Dr. Loren Cordain developed The Paleo Diet® through decades of research and collaboration with fellow scientists around the world.