Eggs & Cholesterol: The Effects of Dietary Cholesterol

Disclaimer: Not Medical Advice. Opinions are my own.

In partnership with ​Function Health

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Today's newsletter at a glance:

• Are Eggs Evil?

• The Effects of Dietary Cholesterol

• Hypo & Hyper Responders

• The Main Takeaway

Eggs are repeatedly villainized.

The question is: rightfully or wrongly so?

"Cholesterol" carries a heavy negative connotation due to its association with heart disease, but the reality is more nuanced.

Despite what you may see on social media, LDL-C (low-density lipoprotein - cholesterol) and more specifically ApoB (Apolipoprotein B) are causally linked with atherosclerosis.

And yes, a large egg contains approximately 180mg of cholesterol.

However, the confusion is rooted in the distinction between exogenous cholesterol (the cholesterol you consume from your diet) and endogenous cholesterol (the cholesterol your body produces, primarily in the liver).

Let's explore the distinction between the two.

Dietary Cholesterol: A Quick Lesson

The concern with dietary cholesterol is that the cholesterol-dense foods you ingest would raise your serum cholesterol (the cholesterol in your blood).

When you eat eggs, for example, your small intestine absorbs cholesterol into the cells lining it, and it is then repackaged into triglycerides and chylomicrons. The triglycerides are deposited in muscle and fat cells for energy, and what you have left is chylomicron remnants, which are high in cholesterol.

The remnants are then absorbed in the liver. In healthy individuals, your liver does a fantastic job of regulating cholesterol and keeping levels in balance.

Therefore, the body will downregulate endogenous cholesterol production to accommodate the dietary cholesterol that is being ingested.

The liver's goal is to maintain homeostasis, but not everyone responds in the same manner.

Hypo & Hyper Responders

This abbreviated understanding of dietary cholesterol metabolism suggests that our bodies are remarkably efficient, and a majority (70% of people) will experience only a minor increase in serum cholesterol levels.

So, how much does dietary cholesterol intake affect your cholesterol levels?

​Typically, there is no change; however, serum cholesterol levels may increase by up to 5-8%. ​

These individuals are classified as hypo-responders due to their modest response to dietary cholesterol.

However, there are individuals who are hyper-responders.

These individuals can experience up to three times greater changes in their LDL-C and a 15-20% increase in total cholesterol.

What predispositions increase your chances of being a hyper-responder?

Individuals with the APOE4 genotype have the highest risk of being a hyper-responder. APOE4 also happens to be the most critical risk factor when evaluating risk for Alzheimer's disease.

Additionally, there may be an association with metabolic disorders like Type-2 diabetes, obesity, dyslipidemia, and hyper-responsivity, but the data isn't as strong as the link with APOE4.

If you are a hyper-responder, then being conscious of your cholesterol intake may be appropriate.

The Main Takeaway

By this point, hopefully, you see that eggs aren't as evil as portrayed. You should have a better understanding of how the body processes cholesterol from our diets and recognize that there is individual variation in how we respond to cholesterol.

Where I stand, with the exception of the APOE4 subgroup (which can be identified through genetic testing), the increase in serum ApoB and LDL-C is modest for the majority.

Therefore, I believe it is more beneficial to focus on managing other major risk factors, such as hypertension, obesity, insulin resistance, and smoking, before strictly addressing dietary cholesterol.

We all have our own instruction manuals and risk profiles.

Prioritize the areas of most significant opportunity for you and address them with intention.

If You Don't Test, You Don't Know

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Understanding which biomarkers are in range or, more importantly, out of range will help you personalize and create your own instruction manual.

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Only the best,

Jeremy London, MD

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