Eggs, heart healthy superfood or a cholesterol bomb? Today, we're cracking open one of the biggest myths in nutrition, and the answers might surprise you. A single egg has about 2 and a half times the cholesterol content of a Big Mac. Yes. A Big Mac. Yeah. For some people, eating eggs barely affects their blood cholesterol. While for others, perhaps you, eggs significantly raises cholesterol levels. The difference, primarily your genes, your genetic makeup.

In the next 20 minutes, I'm going to unpack this by walking you through how we absorb and excrete cholesterol in our diet from the foods that we eat. And I'll share with you 2 simple, but oddly not very commonly spoken about, blood tests that you can use to determine if eggs are problematic for your heart health based on your genes. Are you a cholesterol hyper absorber or not? Personalized nutrition. Exactly. Now, let me just say upfront here, I get it. Cholesterol talk can sound like a snooze fest. But trust me, understanding this could be a game changer for your health. When you understand this information, it makes it much easier to know if you should eat eggs or perhaps avoid them altogether.

Plus, who doesn't want to know if they're genetically blessed? Let's be honest. 1st, let's start with the difference between dietary cholesterol and cholesterol in our blood. After all, they are not the same thing. And so often, I see people conflating the 2. Cholesterol in our blood, just like fats or triglycerides, is shuttled through our blood bound to proteins. Together, cholesterol, fats, and these proteins are called lipoproteins. The cholesterol within these lipoproteins comes from 2 main sources, our liver and all peripheral cells, which accounts for about 75 to 80% of cholesterol in circulation, with the rest primarily from our gut, a mix of cholesterol from the food we eat and cholesterol in bile, which is sent to the gut from the liver to help with the digestion of fats. In a typical person's diet, about 20% of the cholesterol absorbed in their gut is from the foods they've eaten, also known as ingested cholesterol.

And the other 80% is from bile, also known as hepatobiliary delivered cholesterol. A quick little side note and myth buster for the geeks out there like me, When I say peripheral cells, I'm referring to all cells in the body that have the capacity to produce cholesterol outside of the liver and the brain. Excess cholesterol produced by these cells ends up in circulation and is taken back to the liver. This is a huge point of confusion online. Lipoproteins like LDL or low density lipoprotein are not, except in very rare circumstances, taking cholesterol out to cells. All cells produce their own cholesterol and usually produce excess cholesterol that then needs to be carried back to the liver by low density lipoproteins. Thus, the primary role of these lipoproteins is 1st and foremost to carry triglycerides or fats to cells for energy production and to carry cholesterol back from cells to the liver. Already, I hope you can appreciate that cholesterol in circulation is not simply the cholesterol we eat.

The majority of the cholesterol in circulation or in our blood is produced by the liver and our peripheral cells that produce cholesterol. Then of the cholesterol absorbed into circulation from our gut, only 1 5th of this is actually from our diet. The rest is from bile. So when I say dietary cholesterol, I mean the cholesterol that is in our food. Whereas when I say cholesterol in the blood or cholesterol in circulation, two ways of essentially saying the same thing, I'm referring to the total pool of cholesterol in our blood, which is a mix of cholesterol produced by the liver, peripheral cells, and cholesterol absorbed in our gut from the food we eat and the bile that's reabsorbed. For this reason, you can't simply measure blood cholesterol and attribute that to dietary cholesterol, Which means if you eat a lot of eggs, and therefore a lot of dietary cholesterol, and have high cholesterol, it may not be the eggs that are to blame. Now let's dive into how cholesterol is absorbed. It's crucial to understand this process to see how foods like eggs can affect our blood cholesterol levels.

In our small intestine, we have 2 types of transporters that control cholesterol absorption. Think of them as doorways. The Niemann Pick C1 like 1 transporters, these are like the entrance doors letting cholesterol, and also some plant sterols, phytosterols, into our intestinal cells where they can then be absorbed into circulation. And the G5, G8 transporters. These act like exit doors, pushing cholesterol and especially phytosterols back into the gut for excretion. How well these doors work varies from person to person due to their genetics. Some people have very efficient entrance doors, but faulty exit doors. We call these folks hyper absorbers.

They absorb more cholesterol from their diet than others. If all of that sounded like a lot of mumbo jumbo, allow me to simplify. Imagine your body as a nightclub. The bounces on the door of the club are like these cholesterol doors in our gut, working meticulously to only let patrons in when there's room and kicking patrons out as needed. For 70% of humans, these bounces are doing a great job, preventing too many patrons from entering the club, preventing over absorption of cholesterol in your gut. For the other 30% of humans, these bounces aren't doing such a good job, allowing too many patrons in, too much cholesterol to be absorbed. These people are cholesterol hyper absorbers. Then there are other people who have a loss of function of the Niemann Pick c one like one gene, which results in transporters that are not as good at pulling cholesterol and, to a lesser extent, phytosterols into the small intestinal cells for absorption into the blood.

These people are genetically blessed. Foods rich in dietary cholesterol have much less effect on their blood cholesterol than the average person and significantly less effect than hyper absorbers who have loss of function of those g 5g8 transporters or exit doors. It's this variability in genes which accounts for a lot of the variability in study results looking at how eggs affect blood cholesterol levels. On the aggregate, a single egg consumed per day, providing roughly 200 milligrams of cholesterol, will increase LDL cholesterol by about 7 milligrams per deciliter. But as shown by Vincent et al in 2018 in the American Journal of Clinical Nutrition, this is not a linear relationship. It's not as simple as saying if you average 1 egg per day, your LDL cholesterol goes up by about 7 milligrams per deciliter. So, therefore, 2 eggs per day, it would be up by 14 milligrams per deciliter. And 3 eggs per day, up by 21 milligrams per deciliter.

That's not exactly how it works. What we see is that once you go above 300 to 400 milligrams of dietary cholesterol, your body says, that's enough, and stops absorbing more. It's like trying to pour water into a full glass. The excess just spills over the top. So on average, removing eggs from someone's diet would lower their LDL cholesterol by about 7 milligrams per deciliter, whether that was removing 1 egg a day, 5 eggs a day, or 10 eggs a day. Now before a few of you go off in the comments, that will somewhat depend on the rest of their diet and what they eat instead. But it's accurate at a high level. If someone is already getting 400 milligrams of dietary cholesterol from other foods like meat and shellfish per day, then reducing eggs is likely to have negligible effect on their blood cholesterol levels.

Because, again, it's the first 3 to 400 milligrams of dietary cholesterol that someone's having, which has the greatest effect on their blood cholesterol. But you might not be average. You might be a hyper absorber, and in that case, removing cholesterol rich foods in your diet would be much more impactful. You could also be in the minority of the population who have severe loss of function of the Niemann Pick c one like one gene, the gene that controls the door that allows dietary cholesterol in, and as a result, could eat 25 eggs per day, like 1 88 year old man who was the focus of a case study in the New England Journal of Medicine, and have no major increase in your blood cholesterol. Lucky you. It's this genetic variability that is, at least in part, responsible for the whiplash we're all suffering from. One day eggs are heart healthy, the next they cause heart disease. Okay.

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Most of the cholesterol in your blood is not from your diet. It's like trying to figure out how many visitors a city has by counting all of the people on the streets. You'd be counting a lot of locals, so whatever result you came to would be a huge overestimation. Instead, we measure blood levels of phytosterols. Our body doesn't make them. They only get into our blood from the plant foods we eat, And just how many phytosterols end up in your blood depends on those doors we talked about earlier, the name and pick c one like 1 and g 5g8 transporters. Because these same transporters also control cholesterol absorption, we can measure phytosterols in the blood as a proxy for dietary cholesterol absorption. If your blood levels of phytosterols are normal or low, you are not a hyper absorber of cholesterol.

If they are markedly high, then you are a hyper absorber. Now that you know why phytosterol testing is important, let's talk about how you can personally get this test done. Ordering a phytosterol level test isn't exactly a routine blood test, but there are a few online companies offering it. The tests that you want to order are campestrol and beta cytosterol, or just cytosterol as it's often called. I found labs in the US, Canada, Australia, and the UK that offer both or one of these phytosterol tests. Importantly, I'd like to make it clear I have no affiliations with any of these labs. I'm simply listing them here to make it easier for you if you wanna test for yourself. If you're based in the USA, you can use Empower DX in Canada, Dynacare in the UK, Newcastle Laboratories, and in Australia, Austin Health.

I'll put a link to each of these in the show notes, and you can also find them listed in the lipid series cheat sheet that I made after my lipid series with doctor Thomas Dayspring, which you can download at the proof.comforward/lipidseries. And while we're here, quick shout out to doctor Dayspring too. Not only have we recorded almost 10 hours of podcasts together date and counting, but he reviewed slash fact checked my research for this episode and provided several images that those watching on YouTube will have seen. To have someone as esteemed as doctor Dayspring as a resource to lean on is something that I value greatly. So, Tom, thank you very much. If you're from another country other than those that I mentioned, well, bad luck. Just kidding. Speak with your physician or simply Google campestrol and cytosterol blood test and your town name, and hopefully something comes up local to you.

If you've tested your levels and don't mind sharing, I'd love for you to comment on YouTube with the country that you're from and the lab you use. I think that will be very helpful for the community. Okay. So you get your test. The results come back. What is a high level? How do you know if you're a hyper absorber or not? Different labs use different units. I'm going to use the units that are used most commonly, which is milligrams per liter. For beta cytosterol, or cytosterol for short, anything above 3 point 2 milligrams per deciliter is considered in the top 80th percentile.

For campestorol, anything above 4.7 milligrams per deciliter is considered in the top 80th percentile. Typically, if you're high in 1, you will be high in the other, which is why it's fine to just measure 1 if that's all your lab offers. If you fall into this 80th percentile or higher range, this indicates you are a cholesterol hyper absorber. This means your body absorbs more cholesterol from your diet than most people. A quick note here, doctor Dayspring told me that some labs report ratios of the sterile concentration to cholesterol concentration in molar units. According to doctor Dayspring, these ratios should be ignored, especially if taking a cholesterol modifying drug. Instead, you just wanna know the levels of the phytosterols themselves, campesterol and cytosterol, and if they're markedly elevated or normal. Recently, I've been working with friend of the pod, doctor Will Balsowitz, on his new brand 38Terra, an evidence based prebiotic supplement to optimise gut health.

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Okay. Let's say you get tested and you are a cholesterol hyperabsorber. What should you do? Here's what you need to consider based on your cardiovascular disease risk, including your current cholesterol levels. If you are generally healthy, no smoking history, moderate alcohol consumption, regular exercise, normal blood pressure, healthy body weight, and your APOB is at or below 80 milligrams per deciliter, you likely don't need to worry much here. However, if your apo b is over 80 milligrams per deciliter, which suggests a higher risk of developing arterial plaque, you might want to reconsider your diet. Reducing cholesterol rich foods like eggs, shellfish, dairy, meat, and organ meats, brain, liver, kidney, etcetera, in favor of cholesterol free options like tofu, tempeh, chickpeas, beans, lentils, etcetera, could be beneficial. Take my friend as an example, a fit and healthy 41 year old guy who works out 5 to 6 days a week, has no chronic diseases, and takes no prescription medications. He used to eat a whopping 21 eggs per week.

After discovering his phytosterol levels were in the ninetieth percentile, he made a switch, replacing eggs and bacon with tofu scramble, smoked salmon, and other cholesterol free breakfast like oatmeal. The result, his ABOB dropped from 116 milligrams per deciliter to 82 milligrams per deciliter in just 1 month, representing a significant reduction in his risk of cardiovascular disease. On the topic of diet swaps, there are several substitution analyses now whereby scientists looking at long term human population studies have observed that swapping calories from eggs in exchange for calories from various sources of plant protein is associated with significantly lower risk of both cardiovascular disease and premature death. For example, a 2016 study by Song et al that included over 130,000 American men and women followed for over 20 years, which observed a 19% reduction in risk of premature death when 3% of energy was substituted into the diet from plant protein in exchange for the same calories from eggs. For cholesterol hyper absorbers that are at high risk of cardiovascular disease, you still wanna be replacing foods rich in saturated fats with foods rich in unsaturated fats, especially polyunsaturated fats, and increasing fiber intake. All things I've discussed on this channel before. This means swapping fatty meats for salmon and plant based proteins, like tofu and lentils, and choosing olive oil over butter. As a hyper absorber, these changes are crucial, but you'll also need to be extra cautious with cholesterol rich foods.

They can spike your cholesterol levels more than they do for 70% of the population. A more plant based diet with low amounts of dietary cholesterol might be your best bet. If not, working with your physician to find the right dose of lipid lowering medications is key. In many cases, combining dietary changes with medication is necessary. This approach not only lowers the required dose of drugs, but also provides additional benefits, like lower blood pressure, improved blood glucose control, and reduced inflammation. Remember, dietary changes do not just affect cholesterol. They affect other aspects of our physiology too. Knowing you're a cholesterol hyper absorber can be a real game changer, especially when discussing treatment options like ezetimibe with your doctor.

Unlike statins, ezetimibe blocks cholesterol absorption from both food and bile, making it particularly effective at lowering cholesterol for hyper absorbers. I should mention, as often people with elevated cholesterol are told to supplement with phytosterol supplements to lower their cholesterol. If you are a cholesterol hyper absorber, avoid supplementing with phytosterols. Because of your high absorption rate, these compounds could circulate at dangerous levels in your bloodstream, potentially damaging your arteries and accelerating plaque buildup. Okay. Let's bring this home with a summary. The 5 key takeaways. Number 1, eggs, while low in saturated fat, making up just 2 a half percent of the saturated fat in the average American diet, do contain a significant amount of cholesterol, about 200 milligrams of dietary cholesterol per egg.

This can affect blood cholesterol levels differently depending on the individual. About 30% of the population are considered cholesterol hyper absorbers, meaning they absorb a larger amount of cholesterol from their diet, potentially leading to higher blood cholesterol levels. Number 2. To determine if you're a hyper absorber of dietary cholesterol, consider testing your phytosterol levels, particularly beta cytosterol and campesterol. This can be done at various labs worldwide, and the results will help you tailor your dietary and health strategies. Number 3, if you're identified as a hyper absorber and have high APO B, lowering cholesterol rich foods in your diet can make a big difference. For some, especially those at low risk of cardiovascular disease, simply reducing animal based proteins, like eggs, shellfish, meat, and organ meats, and increasing plant based foods, such as tempeh, tofu, chickpeas, lentils, beans, etcetera, will be enough to get you to your target Apo B level. Number 4, for those that moderate to high risk of cardiovascular disease, dietary changes alone may not be suffice.

In these cases, discussing lipid lowering medications like ezetimibe with your physician is important. Ezetimibe is particularly effective for hyper absorbers as it blocks cholesterol absorption from both food and bile, essentially offsetting the function of those genes that are working against you. Number 5, if you are not a hyper absorber, so about 70% of the population, that means foods like eggs and shellfish that are rich in cholesterol, but relatively low in saturated fat at the same time, probably aren't affecting your APOB dramatically. They'll still have some effect, but the lever that you're going to wanna focus mostly on is lowering saturated fat in your diet in exchange for mono and polyunsaturated fats if your cholesterol levels, or more specifically, ApoB is high. I would focus here initially, and then look at dietary cholesterol and foods like eggs if you can't get to an ApoB of 80 milligrams per deciliter or lower. I go through how saturated fat affects cholesterol and these dietary swaps in more detail in a recent video I did on dietary fats that you can watch here. I'll put the link to that in the show notes for those listening on audio. For people with healthy blood cholesterol levels, 1 to 2 eggs a day can feature within a healthy high fiber plant, predominant dietary pattern, Mediterranean diet, pescatarian diet, vegetarian diet, etcetera.

But equally speaking, eggs don't have to feature. And one of the inevitable questions that comes up here is, but what about choline? Eggs are rich in choline, and choline's important for the brain. So what happens to your brain health if you remove eggs completely? I've added choline to my list to tackle in an upcoming video. So hit subscribe and follow if you're listening on audio on Spotify or Apple, and you can tune to that in the not too distant future. There we go. I think we did it. Thank you again for hanging out with me. If you found this helpful, please remember to click the thumbs up button on YouTube and drop a comment below, be it feedback about this episode or a topic recommendation for a future episode.

I read them all and do my best to reply to as many as possible. If you can't think of anything to write, maybe you can tell us how many eggs you eat per day, and whether or not your cholesterol is high. Also, a reminder to please share this episode with friends and family interested in nutrition and healthy living. And if you do get your phytosterol levels tested and feel like sharing them on social media, please tag me on the socials. Bye for now. Still here? Alright. You guessed it. I'll leave you with a dad joke, if I must.

Why don't skeletons fight each other? They don't have the guts. Okay. This time, I'm serious. See you next time. Thank you for watching. And I'll catch you in the comments.