Associations of Egg Consumption with Cardiovascular Disease and Mortality | Hacker News Reader

Associations of Egg Consumption with Cardiovascular Disease and Mortality

jamanetwork.com

15 pointsmathoff55 comments

Oh great, another one of those bs self reporting nutritional studies over super long periods of time. 17.5 years and they only followed up once from what I can tell. Can you accurately report what you ate over the last 17.5 years?

Even over the past week can be difficult as I realized when I started tracking my food in MyFitnessPal. Unless consistently tracking, it's pretty easy to be very far off from what you actually eat.

That's assuming people are even trying to be accurate. Many look on the past with rose tinted glasses and forget about indulgences and snacks.

These studies are plague on the industry and need to go away.

A single follow up 17.5 years later and then just asking what people ate? I can't even believe the premise made it to the stages of doing the study. Is there ANY value in conducting a study framed in this way? Is any of the data reliable at all? Someone might say it's not possible to get accurate measured data over that time span, but that doesn't mean it's right to get junk data instead.

Are you suggesting that they didn't actually eat more eggs / cholesterol, but some other factor that makes people statistically significantly more likely to have CVD and die also makes people more likely to falsely report egg / cholesterol consumption?

An obvious factor to look at among the subjects would be body fat level.

Maybe many of those who consumed more eggs or cholesterol simply just ate more.

If the study simply tracked calories, maybe calories would be found to be correlated with CVD risk.

Problem with that, you can't really track what some people eat for 30 years.

100% this. They don't control for lean mass or anything like that, so it's hard to say if it's the cholesterol or simply overeating that is the problem. I want to see a study where Calories and Macros are held the same but one group eats more cholesterol than the other and see what those results look like. Sadly those kinds of studies are very hard to do in the nutritional space.

This study has lots of problems. I'm not totally convinced the results are statistically significant. The problem with using non-linear models and not showing P values is it is open to interpretation what a statistically significant result is. To me, these results don't seem that compelling. For the cholesterol question, the Adjusted Risk for CVD at the 95% confidence level is between 1.39% and 5.09%, and for All-Cause Mortality, it is 2.51%-6.36%. That means according to this study cholesterol consumption is more highly correlated with all-cause mortality than it is with CVD. That seems hard to believe, but might be true.

The biggest issue I have is with using non-linear models. I don't have access to the full article so I don't know why they chose the statistical methods they did, but I'm suspicious that they don't report P values for what it seems should be linear relationships. I don't buy the non-linearity argument in the summary. Once you get into non-linear regression models the risk of overfitting gets worse. There is a lot of work that has to be done to show you've accounted for this, and it's hard to tell from the summary if that was done.

They also didn't control for some things I would have liked to see. Namely, calories and weight gain. So, it could be that all this study is really showing is a relationship between overeating, weight gain, and CVD and all-cause mortality. It may simply be that people who eat more calories and end up being overweight are also more likely to eat a lot of eggs and cholesterol. In this case, it's gaining weight that causes health issues, not the eggs. It's just the case that people who eat too much and are overweight also happen to eat a lot of eggs. What I'd like to see is a study where they control for calories consumed, weight gain, lean mass etc. and then see how a diet with more cholesterol performed against a diet with less cholesterol.

Choline is an extremely important element for health. Recent studies have shown that it has a dramatic positive effect on fatty liver disease, other ailments.

Egg yolk is a major source of choline. Fatty liver disease has seen a dramatic increase since people have removed eggs from their diets.

This study is questionable as other commenters have mentioned. I'm not buying the "eggs are bad" sentiment again.

Eggs. Every decade 180° turn. If you don't like this paper just wait.

180° is no exaggeration!

Eggs are often consumed with a heaping order of carbohydrates.

Are we talking eggs here? Or Egg McMuffins with side orders of hash browns, drizzled with ketchup?

I wonder who funded this research?

Did it also account for frequent egg-eaters tendencies to maintain a particular kind of diet regarding other foods, and other similar associations?

Right? Sausage and bacon seem likely culprits.

"Associations of Dietary Cholesterol or Egg Consumption"

Yes, eggs are good way to ingest cholesterol, but in the classic American diet, they are certainly not the only way. It feels suspect for them to pull eggs, and only eggs, into the spotlight.

Here's another study reaching the opposite conclusion: https://heart.bmj.com/content/104/21/1756

The key difference is "Among US adults..." versus "Among Chinese adults..."

Hmmm, maybe it's not the eggs?

But I like eggs damnit.

Edit 1. My comment was made on a submission, which I did not think would gain much notice. Oops. Low quality comment to the fore!

Edit 2. Really though, I eat a couple of eggs a day. I should scale it back anyway, as a hedge, and eat non-traditional (In USA) breakfasts, like rice and beans.

How many times have they flip-flopped back and forth on eggs alone? It's easy to get the impression that the people running these studies are either biased or simply don't know what they're doing.

Beyond the prevalent bias, nutritional science is just hard. I doubt we'll ever really get a handle on it.

It isn't ethical to lock people up and feed them a steady diet of something we might thing is going to cause them to develop some disease. So we have to rely on mostly self-reported data collected over extended periods of time.

That being said, I think the first pushback against eggs had to do with their high amounts of cholesterol. It was original assumed that dietary cholesterol intake was related to blood cholesterol levels. Which is something we now know to be false.

However, eggs are very high in saturated fats. The American Heart Associate still recommends that these be limited (from all sources) because there is a good deal of evidence that saturated fat intake contributes to elevated LDL cholesterol.

I generally trust AHA recommendations, but they are not free from bias, as they have food companies as "corporate supporters."

I agree. Eat what you want. Don't overdo any one thing. Prefer natural to processed food. Watch your weight. Enjoy life and don't worry so much.

A famous anecdote for all egg-lovers: Albert Hofmann (inventor of LSD) claimed that he owed his health to eating two raw eggs for breakfast everyday. He lived to the impressive age of 102.

and you can pry the bacon out of my cold dead hands!

I used to be that way. 100% hardcore gimme that delicious bacon.

An article by Glenn Greenwald (of interviewing Snowden fame) on Ag Gag laws [1] made me realize that, at least in the US, eating bacon meant I was supporting some real fucked up shit.

I'm not opposed to meat, I just bought a whole beef, but I definitely took a hard look at where my meat was coming from.

[1] https://theintercept.com/2017/10/05/factory-farms-fbi-missin...

Also getting an (un)healthy dose of Ractopamine with that bacon if you’re in the US.

Not to mention bacon is a recognized type 1 carcinogen.

Totally commonsensical theory. Just have eggs and coffee together. The effects negate each other and while you are at it toss some garlic and olive oil in the egg scramble. No need to thank me.

So, wait...the theory, then is to have...breakfast?

Sign me up.

Amid the neverending diet controversy it seems safest to do low carb (non-keto), medium high-quality fat of which a majority is monounsaturated, medium protein - and be aware not to reduce saturated fat too much as it's not that scary after all, but also don't go overboard like some of the somewhat extreme saturated fat advocates that have appeared in the last few years.

Where's the controversy? Virtually every nation's broad dietary recommendations are the same, and are largely unchanged over the last 100 years. There are individual studies about specific foods (like eggs, butters, trans fats, etc) that have some turbulence. But "Eat whole grains, legumes, vegetables, greens, and fruits. Limit meats, saturated fats, sugars, and processed foods." is pretty much only disputed by bro-science and a handful of carefully cherry-picked studies.

Most national dietary guidelines seem to be fairly high in carbs imho.

There is a huge debate currently, between government endorsed diets, plant-based, and keto, and each group is able to cite numerous studies that contradict the others'.

> Most national dietary guidelines seem to be fairly high in carbs imho

Yes. I agree. I can't recall seeing any modern country's dietary guides suggest a low-carb / keto diet.

I also wanted to say in my last comment that most government endorsed diets only recommend limiting added sugar.

Also, much of that bro-science is now being promoted by many MDs and there's a good chance you'll see some of it become officially adopted in the coming years (and I say this as someone who sees this as a pendulum swing instead of adopting what we learned moderation).

Speaking of bro-science, added sugar is chemically equal to naturally occurring sugars and you can't discriminate against one with out the other (either it's healthy or it is not). Hint: It's not. That fruit may have vitamins, but they are basically embedded in a candy bar nutrition wise. Actually, it's worse than a candy bar because it lacks protein and fat which keep you satiated.

Humans evolved to crave sugar for a reason. It's not bad for you. But, as with anything, too much is absolutely bad for you. Fruit has this really great built-in mechanism for stopping you from eating too much: fiber. Added sugar (or removed fiber, in e.g., juice) makes it easy to exceed the healthy amount.

Yes. Dr. Atkins was singing this tune in 1989. Then after having several heart attacks, he died 14 years later of another heart attack.

So, even if this was true, the plural of anecdote is not data. His heart disease could have been the result of genetic factors or a number of other factors not related to his diet. There is also no guaranty he was taking his own advice. Dr. Atkins had one heart attack and it was caused by an infection. The thing that killed him was traumatic brain injury as the result of a fall.

> A medical report issued by the New York medical examiner's office a year after his death showed that Atkins had a history of heart attack, congestive heart failure and hypertension.[10][12] His widow refused to allow an autopsy

https://en.wikipedia.org/wiki/Robert_Atkins_(physician)

My point was mainly that there have been out-of-the-mainstream doctors advocating for this diet for 3 decades. They continue to be out-of-the-mainstream.

Low refined carb definitely, but most of the diet patterns with a long track record of health (e.g. think blue zones) contain plenty of complex carbs. Sweet potatoes, whole grains, and vegetables all feature prominently.

IMO what's "safest" right now is to follow empirical observation and cleave to a pattern that is successful, rather than trying to break down the important parts and construct your own diet from those pieces.

Someday I'd like to see a cost-benefit analysis of eating salads in place of something like bacon and eggs. It seems to me that the uptick in cardiovascular health would be swallowed up by the increased risk of food poisoning.

And for me, salads are horrid and ALWAYS make me sick. I only eat vegetables very well cooked, or not at all.

Why low carb?

Carbs = Sugar. Period, end of story. The key to good body composition is a high protein, low carb (low sugar) diet. Avoid foods that spike insulin.

Anything else is hogwash, because calories are not calories.

And before I get someone saying "just run at an 'energy deficit' - consume less calories than you burn" - I say, if you want to look and FEEL good, the person who eats 1,500 calories a day of carbohydrates vs 1,500 calories a day of protein, vegetables (carbohydrates largely bound by fiber), etc - will look and feel vastly different. This is why it's not just as simple as calories in - calories out.

Some amino acids are potent insulin secretogogues; proteins induce a fairly robust insulin response.

A high protein diet can also spike insulin, it is more important to eat healthy fats.

"because calories are not calories"

What are/were they then?

[needs citation]

Most people seriously interested in this topic should already be familiar with the "insulin index" paper (was reposted to HN within the last couple weeks).

EDIT: Or maybe just 3 days ago? Seems like longer. https://news.ycombinator.com/item?id=19369743

How do you get fibre then?

a large number of vegetables are low carb.

By weight maybe, but by relative composition, 80% of the calories in broccoli come from carbs.

What about fruit?

Largely fruit has too much sugar. Berries are okay (blue and black and red)

What! I surrender. Are people really not eating fruit because of the carbs? Oh my. It's fruit! One of the healthiest snacks you can have!

Because metabolic insulinemia is out of control these days and I find the keto people's studies quite convincing (look into Ivor Cummins' presentations on YouTube), in addition to hearing similar points of view even in some anti-keto diets. It seems pretty likely to me that sugar is very easy for us to over-consume in modern lifestyles.

Less convincing to me is the full-on keto diet itself. It's great that it exists as it started an excellent conversation on diet, but I rule it out because most cultures' dietary staples have been starchy carbs.

The problem imho is:

- It's too easy to overconsume carbs in modern lifestyles, and some of the carbs we consume spike our insulin too much (certain GMO crops in particular).

- It's too easy to consume non-whole-food carbs. Whole foods come with things that reduce the metabolic burden of eating them (fiber, antinutrients like phytates, antioxidants).

- The people who subsisted on carb-based staple foods led significantly more active lifestyles in the past than most people today, and did not have the abundance of food that we do now.

I call bullshit. Classic case of correlation != causation.

I wonder if statins remove the additional risk.

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