Tag Archives: cholesterol

Should I Take A Statin Drug? Risks, Benefits and the New Guidelines

StatinsThe skeptical cardiologist just returned from Washington, DC where he attended the American College of Cardiology (ACC) annual conference and visited Ford’s Theatre. I was hoping to gather more information on diet and cardiovascular disease but most of the discussions on prevention of heart disease centered around the new ACC/AHA guidelines for treating cholesterol.

A recently published analysis of the impact of these guidelines found that

As compared with the ATP-III guidelines, the new guidelines would increase the number of U.S. adults receiving or eligible for statin therapy from 43.2 million (37.5%) to 56.0 million (48.6%). Most of this increase in numbers (10.4 million of 12.8 million) would occur among adults without cardiovascular disease.

If you are a man over the age of 59 (which I just became), even without any cardiovascular disease or diabetes, there is an 87% chance the guidelines would suggest you take a statin drug.

This is a startling increase and consequently there has been a lot of criticism and questioning of the validity of these recommendations.

More importantly, for an individual patient, should you take a statin drug if your doctor recommends it? This is an especially good question if you have no evidence of any atherosclerotic cardiovascular disease (so-called primary prevention). At a minimum, you should have a very detailed discussion with your doctor about the risk and benefits of taking the medication in your particular situation.

What are statin drugs?

Statins are the most powerful, safe and effective drugs available for lowering LDL or bad cholesterol levels. They inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, involved in cholesterol biosynthesis. Low density lipoprotein (LDL) cholesterol concentration is lowered by reducing its production in the liver and increasing removal from the circulation. Statins also have anti-inflammatory effects, improve endothelial function, and reduce thrombus formation.

Common examples of statin drugs are Lipitor which is now available as a generic called Atorvastatin , Pravastatin, and Crestor (Rosuvastatin), which is only available in brand name form.

What are the risks of statin drugs?

When large scale randomized trials of statin drug therapy are analyzed, rates of adverse events (17%) or stopping treatment due to adverse events (12%) are similar in the statin compared to placebo/control groups.

The incidence of cancers, liver enzyme elevations, kidney dysfunction or arthritis was the same in the two groups.

There are only two side effects from taking statins I consider significant and mention to my patients:
1. There does appear to be a 9% increase in the risk of developing diabetes. Most of the patients who develop diabetes on statins were at high risk for this to begin with and the overall benefits of lowering CV disease outweighs the development of diabetes in patients who take statins.
2. Statins definitely can cause muscle aches (myalgias) and this seems to happen in about 10% of patients over time. If these develop, we stop the statin and the myalgias go away if they are due to the drug. There are no reliable studies showing any long term residual muscle weakness or ache. A very, very small number of patients develop rhabdomyolysis, in which there is severe muscle damage. These patients are almost always taking multiple medications which interact with the statins and often have kidney failure to begin with.

Some things you don’t need to be concerned with while on statins:

1. That the drug will give you Alzheimer’s or make you stupid. There is much anecdotal misinformation on the web about this, but no solid evidence of any adverse effect on cognition.
2. That the drug will destroy your liver. A small percentage of patients will develop elevations of their liver enzymes (AST or ALT) but this does not lead to liver damage and is considered so insignificant now that the FDA now longer advises checking liver enzymes in patients on statin drugs.

What are the benefits of statins in people without known heart disease?

They lower all-cause mortality by 14%, combined fatal and nonfatal cardiovascular disease by 25%, and stroke by 22%. They lower the chances that you would need a stent or bypass surgery by 38%.
Another way of looking at the benefits of a treatment is the number needed to treat (NNT).
To save one life, you would need to treat 138 patients for 5 years with statin drugs. This means that 137 patients would have done fine without taking the drug.

The higher your risk of developing atherosclerotic cardiovascular disease  (ASCVD (all the disease that occurs as a result of fatty plaque build up in the body, including heart attack and stroke)), the more likely you will benefit from taking a statin drug.
Thus, the new guidelines utilize a risk estimator that takes into account your total and good cholesterol values, your systolic blood pressure, age and whether you smoke, have diabetes or treated hypertension to calculate your risk of developing clinical ASCVD over the next ten years.

If this ten year risk is over 7.5%, statin therapy should be considered.

I’ve looked over the guidelines carefully, read a lot of the original studies and listened to the discussion and I think this is a reasonable approach. I try to present each patient with the risks and benefits and let them make the decision as to whether they want to take the drug.
Each individual has a different perspective, perhaps heavily influenced by their father having died of a heart attack in his fifties or by a close friend who feels that statins ruined his life.

Two important new concepts from the new guidelines

The new guidelines no longer look at the LDL or bad cholesterol level as a goal or as a level for initiating treatment (unless it is super high, above 190). Thus, the only reason to be checking follow up cholesterol panels on patients who are taking good levels of statin drugs is to verify compliance and an effective reduction in LDL from baseline. I will not try to get your LDL below 100 or 70 and you will not have to worry that it is not at that level.

The new guidelines rightly emphasize statin drugs as the only drug therapy that has good outcomes data (meaning they have been show to reduce heart attacks and strokes) supporting their use in primary prevention.
Ezitimibe (Zetia) is a commonly prescribed drug which lowers LDL cholesterol but is expensive and has never been shown to lower heart attack or stroke risk and, in my opinion, should not be prescribed.

Our goal should be prevention of heart disease, not lowering LDL levels or triglyceride levels.

I believe that we can fine tune which patients will and will not benefit from statin therapy by looking for evidence of what is called “subclinical atherosclerosis.” I plan to review this in a future post.
For now, I leave you with the humorous line from the play “Our American Cousin” that caused the distracting laughter during which John Wilkes Booth shot Lincoln in Ford’s Theatre (which is not far from the Washington Convention Center and well worth visiting!)

“Don’t know the manners of good society, eh? Well, I guess I know enough to turn you inside out, old gal — you sockdologizing old man-trap.”

Tell your cardiologist you will sockdologize him if he doesn’t give you a good discussion of the risks and benefits of the statin drug he is recommending.

It’s Time to End the War on Fat: Dietary Fat Doesn’t Make You Fat or Give You Heart disease.

Most cardiologists don’t spend a lot of time talking about diet with their patients. When they do, they usually cite the mainstream maxim that you should cut down on saturated fat by reducing red meat consumption, choosing low-fat or skim dairy products, and lean cuts of meat. Patients are referred to standard recommendations that conform to this advice that comes from the American Heart Association.

This is certainly what I did for 30 years until I started examining the research supporting these recommendations in detail. It’s a lot easier to give advice to your patients when it conforms to what they are hearing from nutritional authorities. If it doesn’t conform, you have a lot of ‘splaining to do. If doctors spend time teaching or discussing diet with our patients, we do not get reimbursed for it.

However, a close examination of the research on dietary fat and heart disease shows that there is no good evidence supporting these recommendations.

The two major fallacies are:

Eating high fat foods will make you fat.

Eating high fat or cholesterol laden foods raises your cholesterol, thereby promoting the development of heart disease

Dietary Fat and Obesity

Although these concepts have become ingrained in the consciousness of Americans, they are not supported by scientific studies; more and more researchers, nutritional scientists, and cardiologists are sounding the warning and trying to change the public’s understanding in this area.

It seems logical that the fat that we consume goes into the body and is then converted into fat that appears on our thighs or belly and lines our arteries. This logic, and weak epidemiologic studies, led to national nutritional recommendations, beginning in 1977, that Americans cut back on fat (particularly saturated fat). The food industry seized on these recommendations and began providing consumers with “low-fat” alternatives to standard foods. To make these low-fat foods palatable, sugar had to be added. Often,  due to a surplus of industrial farm produced corn, sweetening was accomplished with high-fructose corn syrup. This graph shows what happened with weight in the US:
obesity rates

Beginning in the late 1970s, the percentage of people with BMI > 30 (considered obese) increased dramatically.
More and more evidence points to increased consumption of sugar, HFCS, and refined carbohydrates as the root cause of this obesity epidemic.
I tell my overweight patients that reducing sugar and refined starch is the most important thing that they can do to shed excess pounds.  They should avoid processed foods which the food industry have manipulated to make more palatable and less healthy. This means, among other things, avoiding or minimizing drinking sugar-sweetened beverages and avoiding “drinking your calories,” cutting way back on donuts, pastries, and potatoes and when consuming pastas or breads, try to make them whole-grain.

Dietary Fat and Heart Disease

I don’t tell my patients to cut fat consumption; this advice runs counter to everything they have heard about diet and heart disease. I encourage them to consume full fat dairy and this is considered particularly heretical.

However, as I have discussed in previous posts, there is no evidence that dairy fat increases cardiovascular risk. In fact, all studies suggest the opposite: a lower risk of heart disease associated with full fat dairy consumption.

Just as all fats are not the same (consider trans, saturated and unsaturated), all saturated fats are not the same. Some, particularly, the shorter chain fatty acids found in dairy, have beneficial effects on the lipid profile and likely lower overall cardiovascular risk.

What about red meat? All of my patients have received the dogma that they need to cut back on red meat. It hasn’t come from me (not since I began looking at the scientific evidence). When I look at my patients’ cholesterol profile before and after they institute what they perceive as the optimal “heart-healthy“ diet (cutting back on saturated fat and increasing carbohydrates by reducing meat consumption and shifting to skim or low-fat dairy products), their LDL or “bad” cholesterol has dropped a little, but proportionally their HDL or good cholesterol has dropped more and their triglycerides have gone up. What is the overall effect of this dietary change? There are no studies demonstrating that this change improves your heart health.

A recent systematic review and meta-analysis of 20 studies which included 1,218,380 individuals found no relationship between red meat consumption and coronary heart disease, CHD, (or diabetes). Conversely, processed meat intake was associated with a 42% higher rate of CHD and 19% higher risk of diabetes.

Analysis of data from the Multi-Ethnic Study of Atherosclerosis population indicates

After adjustment for demographics, lifestyle, and dietary confounders, a higher intake of dairy saturated fat was associated with lower cardiovascular disease risk [HR (95% CI) for +5 g/d and +5% of energy from dairySF: 0.79 (0.68, 0.92) and 0.62 (0.47, 0.82), respectively].

There also appears to be no association between red meat consumption and mortality in Asian countries

The Womens Health initiative was started in the early 1990s to test the hypothesis that a low fat diet would lower risk of cancer, stroke and heart attacks.Women were aged 50-79 at trial enrollment in 1993-98 and were followed for an average of 8.1 years. By the end of the first year, the low-fat diet group reduced average total fat intakes to 24 percent of calories from fat, but did not meet the study’s goal of 20 percent. At year six, the low-fat diet group was consuming 29 percent of calories from fat. The comparison group averaged 35 percent of calories from fat at year one and 37 percent at year six. Women in both groups started at 35-38 percent of calories from fat. The low fat diet group also increased their consumption of vegetables, fruits, and grains.
The study design reflected a widely believed but untested theory that reduction of total fat would reduce risks of breast or colorectal cancers. Among the 48,835 women who participated in the trial, there were no significant differences in the rates of colorectal cancer, heart disease, or stroke between the group who followed a low-fat dietary plan and the comparison group who followed their normal dietary patterns.

Yes, “widely believed but untested theory” is a great description of the current recommendation to cut saturated fat because no prospective trial has proven any benefit to this approach in reducing cardiovascular disease.

There is some evidence (but still fairly weak) to support the idea that replacing saturated fat with unsaturated fat is beneficial. Thus, the popularity of the Mediterranean diet which utilizes olive oil liberally. There is good evidence that industrially produced trans-fatty acids (from products designed to take the place of inappropriately demonized butter) increase cardiovascular risk. However, this evidence does not extend to natural trans-fatty acids such as those coming from the udders of cows.

Mounting evidence suggests that replacing fat or saturated fat in the diet with carbohydrates, however, contributes to obesity, insulin resistance, diabetes, and thereby may increase your risk of cardiovascular disease.

Egg Nog: Recipe for a Heart Attack or Heart Healthy?

It’s Christmas Eve and you are starting to make merry. Time to break out the egg nog? Or should you eschew this fascinating combination of eggs, dairy and alcohol due to concerns about heart disease?

    eggCardiac deaths increase in frequency in the days around Christmas.

    Could this be related to excessive consumption of egg nog?

    Egg nog is composed of eggs, cream, milk and booze. All of these ingredients have become associated with increased risk of heart disease in the mind of the public.
    Nutritional guidelines advise us to limit egg consumption, especially the yolk, and use low-fat dairy to reduce our risk of heart disease

    A close look at the science, however, suggests that egg nog may actually lower your risk of heart disease.

    Eggs are high in cholesterol but as I’ve discussed in a previous post, cholesterol in the diet is not a major determinant of cholesterol in the blood and eggs have not been shown to increase heart disease risk.

    Full fat dairy contains saturated fat, the fat that nutritional guidelines tell us increases bad cholesterol in the blood and increases risk of heart attacks. But some saturated fats improve your cholesterol profile and organic (grass-fed, see my previous post) milk contains significant amounts of omega-3 fatty acids which are felt to be protective from heart disease.
    Milk and dairy products are associated with a lower risk of vascular disease!

    Whether you mix rum, brandy, or whisky into your egg nog or you drink a glass of wine on the side you are probably lowering your chances of a heart attack compared to your abstemious relatives. Moderate alcohol consumption of any kind is associated with a lower risk of dying from cardiovascular disease compared to no alcohol consumption.

    So, drink your egg nog without guilt this Holiday Season!
    You’re actually engaging in heart healthy behavior.

Breakfast is Not The Most important Meal of the Day: Feel Free to Skip it

It always irritates me when a friend tells me that I should eat breakfast because it is “the most important meal of the day”. Many in the nutritional mainstream have propagated this concept along with the idea that skipping breakfast contributes to obesity. The mechanism proposed seems to be that when you skip breakfast you end up over eating later in the day because you are hungrier.

The skeptical cardiologist is puzzled. Why would i eat breakfast if I am not hungry in order to lose weight? What constitutes breakfast? Is it the first meal you eat after sleeping? If so, wouldn’t any meal eaten after sleeping qualify even it is eaten in the afternoon? Is eating a donut first thing in the morning really healthier than eating nothing? Why would your first meal be more important than the last? isn’t it the content of what we eat that is important more than the timing?

The 2010 dietary guidelines state

eat a nutrient-dense breakfast. Not eating breakfast has been associated with excess body weight, especially among children and adolescents. Consuming breakfast also has been associated with weight loss and weight loss maintenance, as well as improved nutrient intake

The US Surgeon General website advises that we encourage kids to eat only when they are hungry but also states

Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight

A recent study anayzes the data in support of the “proposed effect of breakfast on obesity” (PEBO) and found them lacking.
This is a fascinating paper that analyzes how scientific studies which are inconclusive can be subsequently distorted or spun by biased researchers to support their positions. It has relevance to how we should view all observational studies.

Observational studies abound in the world of nutritional research. The early studies by Ancel Keys establishing a relationship between fat consumption and heart disease are a classic example. These studies cannot establish causality. For example, we know that countries that consume large amounts of chocolate per capita have large numbers of Nobel Prize winners per capitaChocolate Consumption and Nobel Laureates
Common sense tells us that it is not the chocolate consumption causing the Nobel prizes or vice versa but likely some other factor or factors that is not measured.

Most of the studies on PEBO are observational studies and the few, small prospective randomized studies don’t clearly support the hypothesis.

Could the emphasis on eating breakfast come from the “breakfast food industry”?
I’m sure General Mills and Kellogg’s would sell a lot less of their highly-processed, sugar-laden breakfast cereals if people didn’t think that breakfast was the most important meal of the day.

My advice to overweight or obese patients:
Eat when you’re hungry. Skip breakfast if you want.
If you want to eat breakfast, feel free to eat eggs or full-fat dairy (including butter)
These foods are nutrient-dense and do not increase your risk of heart disease, even if you have high cholesterol.
You will be less hungry and can eat less throughout the day than if you were eating sugar-laden, highly processed food-like substances.

.

.

Eggs and Heart Disease

The Wonderful Egg and Your Heart

photoI think eggs are wonderful. They are little balls of nutrition that can be prepared in numerous fascinating ways to make breakfast interesting and delicious. I particularly like omelets.  Alas, when I was training as a medical student the medical establishment had embraced the diet-heart hypothesis. It was felt that dietary cholesterol and fat (subsequently modified to saturated fat) by increasing levels of cholesterol in the blood (subsequently modified to raising levels of bad or LDL cholesterol) were responsible for the increasing rate of coronary heart disease that was being observed.

This certainly made sense at the time: If you eat too much cholesterol, of course it’s going to raise your blood cholesterol levels and contribute to the buildup of those nasty cholesterol plaques that would clog your arteries and give you heart attacks and strokes.

Since egg yolks contain 210 mg of cholesterol on average (more recent data suggest they only contain 184 mg/egg), eggs became a target of the dietary police.

The American Heart Association (AHA, the same organization that until recently endorsed sugar-laden cereals like Cocoa Puffs as  “heart healthy”) had decided decades ago to recommend restricting egg consumption. In 2010, AHA guidelines restricted everybody’s total cholesterol to <300 mg per day on the flimsiest of evidence.  From the AHA guidelines:

“Although there is no precise basis for selecting a target level for dietary cholesterol intake for all individuals, the AHA recommends <300 mg/d on average. By limiting cholesterol intake from foods with a high content of animal fats, individuals can also meet the dietary guidelines for saturated fat intake. This target can be readily achieved, even with periodic consumption of eggs and shellfish. As is the case with saturated fat intake, reduction in cholesterol intake to much lower levels (<200 mg/d, requiring restriction of all dietary sources of cholesterol) is advised for individuals with elevated LDL cholesterol levels, diabetes, and/or cardiovascular disease.”

The official US dietary guidelines on the topic of dietary cholesterol read as follows

“the body uses cholesterol for physiological and structural functions, but it makes more than enough for these purposes. Therefore, people do not need to eat sources of dietary cholesterol. Cholesterol is found only in animal foods. The major sources of cholesterol in the American diet include eggs and egg mixed dishes (25% of total cholesterol intake), chicken and chicken mixed dishes (12%), beef and beef mixed dishes (6%), and all types of beef burgers (5%). Cholesterol intake can be reduced by limiting the consumption of the specific foods that are high in cholesterol. Many of these major sources include foods that can be purchased or prepared in ways that limit the intake of cholesterol (e.g., using egg substitutes). Cholesterol intake by men averages about 350 mg per day, which exceeds the recommended level of less than 300 mg per day. Average cholesterol intake by women is 240 mg per day.

Dietary cholesterol has been shown to raise blood LDL cholesterol levels in some individuals. However, this effect is reduced when saturated fatty acid intake is low, and the potential negative effects of dietary cho- lesterol are relatively small compared to those of saturated and trans fatty acids. Moderate evidence shows a relationship between higher intake of cholesterol and higher risk of cardiovascular disease. Independent of other dietary factors, evidence suggests that one egg (i.e., egg yolk) per day does not result in increased blood cholesterol levels, nor does it increase the risk of cardiovascular disease in healthy people. Consuming less than 300 mg per day of cholesterol can help maintain normal blood cholesterol levels. Consuming less than 200 mg per day can further help individuals at high risk of cardiovascular disease.”

Americans were being told to severely restrict their egg consumption, especially if they had high cholesterol levels, diabetes, or heart disease. Even one egg a day seemed too much. As a cardiologist in training I dutifully took these recommendations to heart. I can’t tell you how many egg beater or egg white omelets I cooked over the next 25 years.

As more evidence accumulated, however, the bulk of the scientific evidence was coming down clearly on the side of eggs and the lack of effect of dietary cholesterol on blood cholesterol levels. As The Skeptical Cardiologist I began embracing the heresy of eating eggs, yolk and all, about two years ago.

Several large epidemiological studies have examined the association of egg consumption and serum cholesterol. The Framingham Heart Study examined the serum cholesterol in high versus low egg consumption and found no significant difference in either men or women. The association between self-reported dietary intake of eggs and serum cholesterol was examined in a population of 12,000 men in the Multiple Risk Factor Intervention Trial. Paradoxically, the men who consumed more eggs had lower serum cholesterol than those who consumed fewer eggs.In the Third National Health and Nutrition Examination Survey (NHANES III), the diets of 20,000 participants were evaluated.

“Compared to egg consumers, nonconsumers  had higher rates of inadequate intake (defined by Estimated Average Requirements (EAR) or < 70% Recommended Dietary Allowance (RDA)) for vitamin B12 (10% vs. 21%), vitamin A (16% vs. 21%), vitamin E (14% vs. 22%) and vitamin C (15% vs. 20%). After adjusting for demographic (age, gender and ethnicity) and lifestyle variables (smoking and physical activity), dietary cholesterol was not related to serum cholesterol concentration. People who reported eating > or = 4 eggs/wk had a significantly lower mean serum cholesterol concentration than those who reported eating < or = 1 egg/wk (193 mg/dL vs. 197 mg/dL, p < 0.01”

Study after study in the next 20 years showed that egg consumption was not associated with coronary heart disease and strokes. A more recent study from Spain shows no association of egg consumption on cardiovascular disease. A meta-analysis of all prospective cohort studies published in 2013 concluded that there was no association between higher egg consumption and coronary heart disease or stroke. Studies (randomized controlled trials) that  actually prove that egg consumption causes cardiovascular disease are totally lacking. Nutritional guidelines should have concluded  that there was no reason to restrict egg consumption in the vast majority of Americans.

Unfortunately, the AHA guidelines (and mainstream nutritional advisors) to this day continue to embrace the 300 mg/ day limit on cholesterol (although most other countries have dropped it). Most of my patients, having heard that eggs are bad for the heart, mistakenly try to restrict the amount they eat or eat egg whites. I see my fellow doctors in the doctors’ lounge taking boiled eggs out of the refrigerator, scooping the yolk out and eating only the egg white.

Why doesn’t more cholesterol in the diet lead to higher blood cholesterol level and subsequently to heart attacks? The answer is complicated, beyond the scope of this blog, but it illustrates how amazingly complex the body’s regulation of lipids and lipoproteins is, as well as how complicated the process of atherosclerosis is.

There are at a very basic level 3 main types of fat that doctors measure in the blood to help us gauge heart disease risk: the low density lipoprotein (LDL)  cholesterol portion or “bad”, the high-density lipoprotein (HDL) cholesterol or “good,” and the triglycerides (esterified fatty acids). On a very simplistic level, we tell patients that higher LDL levels tend to build up fatty plaques, whereas higher HDL levels can be thought of as reducing fatty plaques. When we eat an egg there is a complex reaction to the fats, proteins, sugar, and cholesterol absorbed into the blood stream.cholesterol graphic Although the LDL rises (which might increase coronary artery disease (CAD) risk), the HDL also rises (which might lower CAD risk) and there is a variable response of triglycerides. To further complicate things, each of the cholesterol fractions has  good forms and bad forms. LDL can be in a large, “fluffy” state that is not prone to promoting plaque formation or a small, dense form that does promote plaque formation. Eggs seem to promote the less atherogenic forms of both LDL and HDL. In addition, inflammation plays an important role in the process of atherosclerosis. Certain components of egg yolks may actually reduce inflammation, making plaque formation less likely.

Certain components of eggs may be beneficial and outweigh any theoretical concern about cholesterol consumption.. Eggs are the major sources of lutein and zeaxanthin, two potent anti-oxidants, which in addition to their recognized protective effects against macular degeneration and cataract formation, may also reduce LDL oxidation.

Eggs also contain choline, a nutrient that is needed for membrane formation, methylation and acetylcholine biosynthesis, which plays a major role in normal fetal development. Some studies suggest a role of choline in protecting against Alzheimer’s disease

Eating eggs may contribute to weight loss compared to eating carbohydrates. A recent study compared two different breakfasts, a bagel-based and an egg-based breakfast. During the egg period, men had a significantly lower caloric intake not only in the next meal, but also in the following 24 hours.

To make things more complicated, all eggs are not created equal. Hens that are allowed to range freely on a farm and eat grass, bugs and what might be considered their normal diet, have a different amount of omega-3 fatty acids than those that are fed grain. Given America’s current obsession with fish oil supplements (see my prior post), this makes these eggs perceived as healthier. By manipulating the diet of hens, even those stuck in cages, the omega-3 content of eggs can be increased. Is this healthier?

The limit on dietary cholesterol of 300 mg imposed by the AHA and the USDA in their guidelines, unnecessarily has my patients worrying about cholesterol in all the things that they eat. For example, there is a lot of cholesterol in shellfish. There is no evidence that eating shellfish is bad for the heart or your cholesterol profile. For example, this recent study showed no effect of eating cold water prawns on plasma cholesterol or lipoproteins.

The Bottom Line:

Eggs are an affordable (15 cents/egg) source of high quality protein and fat. Although they contain a lot of cholesterol, there is no evidence (with the possible exception of diabetics) that egg consumption is related to risk of coronary heart disease; they may in fact reduce the risk of stroke.

Since this new evidence has emerged, I regularly enjoy the deliciousness of a three egg omelet with cheese and other ingredients without guilt and I encourage my patients to do the same.photo Personally, especially in my home kitchen, I try to eat eggs that come from hens that are raised under more natural and humane circumstances as I view them as healthier than eggs from factory farms.

Not everyone is an egg lover and I’m fine with that. There is no evidence that you have to eat them. You could feel towards them as did Alfred Hitchcock :

“I’m frightened of eggs, worse than frightened, they revolt me. That white round thing without any holes … have you ever seen anything more revolting than an egg yolk breaking and spilling its yellow liquid? Blood is jolly, red. But egg yolk is yellow, revolting. I’ve never tasted it.”hitch