Particle Size & LCAT Analysis Shows: Three Whole Eggs per Day Improve Lipid Profile in Men & Women W/ MetSyn. Plus: Up to 700% Increased Lipid Oxidation in Hardboiled vs. Fresh Omega-3 Eggs From Hens on Fish Oil Diet

"Not the yellow part of the egg!", is the literal translation of "Nicht das Gelbe vom Ei!", which is German and means "not exactly brilliant" - telling isn't it?

As a regular here at the SuppVersity you will probably have come across a line like "make sure to get at least 20g of quality protein (meats, poultry, eggs, fish, dairy) with every meal!" at least once. If we discard the fish, which is, outside of the occasional discussions about mercury and other heavy metals in our food chain, about the only of these highly nourishing foods, the various experts appear to agree is healthy for you, all of them are to be consumed only "on occasion", "in moderation" and preferably in their "lean" or "low-fat" varieties. And while you (should ;-) have read about the beneficial effects of full-fat dairy, yesterday, and about the actually not so bad "bad meats" in the "Meat-O-Logy" post from August 17, 2012, I thought I'd take the forthcoming publication of a paper by Christopher N. Blesso, Jeff Volek et al. as incentive to remind you not to make the mistake and flush the yolk, the best part of the egg, down the toilette.

Recipe for disaster? Take 20 men and women with metabolic syndrome, 5040 whole eggs...

With 40 men and women aged 30–70 years who had been classified with metabolic syndrome the researchers from the University of Connecticut and University of Antioquia in Medellin, Columbia, intentionally picked a representative sample from the ever-increasing number of people with metabolic syndrome for their 12-week dietary intervention trial. I mean, who if not the men and women in this high risk group should suffer from the negative side effects of the cholesterol-laden yellowy, orange-yellow heart killers in disguise?

AHA Definition of Metabolic syndrome

according to Grundy. 2004

Abdominal obesity (waist)
Men	>102 cm
Women	>88 cm
Triglycerides	≥150 mg/dL
HDL cholesterol
Men	40 mg/dL
Women	50 mg/dL
Blood pressure	≥130/≥85
Fasting glucose	≥110 mg/dL

The assumption that subjects with established metabolic syndrome (for the "official" criteria check out the table on the right) is however one of the very few things the study at hand and studies like the one that triggered such an upheaval in August (see Sciencedaily. 2012) have in common. Instead of relying on total, low density and high density lipoprotein levels in the sera of their study participants, Blesso et al. conducted a differential analysis that included paricle number, size (measured by nuclear magnetic resonance spectroscopy), apolipoproteins (apos), oxidized LDL (oxLDL), cholesteryl ester transfer protein (CETP) and lecithin-cholesterol acyltransferase (LCAT) activities at baseline and after 12-weeks on a carbohydrate-restricted diet (25%–30% energy) that contained either  3 regular whole eggs/day (EGG, n = 20) or the volume equivalent in form of a yolk-free egg substitute (manufactured by Sysco Corporation, Houston, TX).

Accordingly, the subjects in the "real egg group" (EGG) consumed approximately 534 mg cholesterol, 0 g carbohydrate, 16 g protein, 12 g fat per day (186 kcal) from hole eggs, while a single serving of the cholesterol and fat-free substitute (SUB) contained approximately 2 g carbohydrate, 14 g protein, no fat, no cholesterol and only 60 kcal.

To minimize possible confounding factors and allow for "blinding" (you can't tell me you don't taste the difference between egg whites and whole eggs, but alas...), the eggs / egg supplements were prepared in advance.

"Compliance was monitored by use of weekly questionnaires and collection of empty product containers. Participants were asked to maintain their normal physical activity, medications, and dietary supplement usage upon starting the 12-week study." (Blesso. 2012)

To be able to track the dietary intake of the subjects, all participants had to fill out 5-day dietary intake records (3 weekdays + 2 weekend days) at baseline, week 6 and week 12 of the study period. Based on the analysis of the respective data, the scientists determined that

• increased relative protein intake from 17.3%± 3.0% to 23.9%± 4.1%
• increased relative fat intake from 38.6%± 6.4% to 45.7%± 7.4%

• reduced total energy intake of -24% for all participants
• reduced relative CHO intake from 40.9 ± 7.4 to 28.3 ± 9.5% of total energy 
• reduced absolute CHO intake from 211.9 ± 51.8 to 114.5 ± 55.0 g/d 

Moreover, there were "significant differences between groups for dietary cholesterol intake (EGG vs. SUB, P < 0.0001) and dietary choline intake (EGG vs. SUB, P < 0.0001)"

• Δ cholesterol intake +106% in EGG vs. -38% in SUB
• Δ choline intake +52% in EGG vs. -12% in SUB

In that, it is important to point out that these changes and their metabolic effect should not be seen in isolation, because choline plays a major role in the metabolism, transport and incorporation of cholesterol into the cell membrane (read more about choline in "Old School Supplements - Choline: Stronger, Faster, Leaner & More Muscular, or Just Another Dumb-and-Barbell Story?").

"So, the men and women in the egg-group did not die?"

Not exactly, no. Rather than being as bad as cigarettes (as the aforementioned "study" that was published roughly 2 months ago would make us believe; Spence. 2012), the consumption of three eggs per day lead to rather favorable changes in the lipoprofile of the EGG consumers:

Figure 1: Lipoprotein serum levels (left), particle size and ratio of LDL to HDL count (right) of the 37 participants who completed the 12-week trial (data expressed relative to baseline; calculated based on Blesso. 2012)

Contrary to the lipoprotein metabolism, which showed differential (and general positive) effects in response to whole egg consumption, the reductions in circulating insulin, HOMA-IR and triglycerides did not show statistical significant inter-group differences:

triglycerides: -29% vs. -18%
• insulin: -21% vs. -14%
• HOMA-IR: -22% vs. -18%

The existing changes were yet on average still somewhat more pronounced in the EGG group, which is an observation you could interpret as joint effect of low carb dieting + egg eating.

The same goes for the increase in LCAT activity the researchers observed only in the EGG group. Since LCAT is critically important in facilitating HDL particle stability and HDL maturation, its elevation in the EGG group

"[...] could be indicative of an enhanced capacity for HDL maturation and may help explain the shift towards larger HDL particles seen with egg feeding" (Blesso. 2012; my emphasis)

and would thus favor enhanced HDL-mediated reverse cholesterol transport from (e.g. the endothelium of your coronary heart arteries) back to the liver.

What about the lipid oxidation?

If we assume that part of the negative effects that have been ascribed to the consumption of egg(-yolks) are brought about by oxidized fatty acids and respective byproducts, it appears wise not to hard-boil your eggs, because the prolonged heat exposure during hard-boiling increases the oxidation of fatty acids. Aside from temperature and duration of the heat exposure, Cortinas et al. also identified the fatty acid composition of the eggs and their vitamin E content as crucial factors that will influence the formation of oxidized lipids. Since the fatty acid composition of the eggs depends on the diet the hens are fed, you would be particularly ill-advised to hard-boil eggs from hens who were fed a diet enriched in fish oil.

As you can see in the figure above the "fish oil eggs" with their readily oxidized long-chain PUFAs had by far the highest  TBA values (expressed as ng MDA/g dry matter) - specifically, if the hens did not receive additional vitamin E that would be transfered to the eggs and reduce the heat-induced oxidation of the long-chain PUFAs in the "omega-3 eggs" during cooking.

So what's the verdict? In conjunction with the aforementioned additive effects on glucose management and the slightly more pronounced decrease in oxidized LDL (both are probably rather a result of the -12% reduction in carbohydrate content of the participants' diets than the effect of the eggs), the statistically significant improvements in LCAT activity in the EGG eater group speak in favor of the notion that three whole eggs a day will still help you keep the doctor away. Whether they will suffice to throw his statins away, as well (see "Eat Whole Eggs All Day and Throw Your Statins Away?"), will yet have to be elucidated and appears overall questionable - and this goes regardless of whether you belong or don't belong to the relatively small subgroup of people who actually benefit from taking a statin, or not.

What stands out of question, however, is that the "side effects" of three egg yolks per day are quite distinct from those of cigarettes, the consumption of which the headline of the aforementioned ScienceDaily.com article implicitly equates with "egg yolk consumption". And just like smoking and eating eggs are two very different pairs of shoes, there is a huge difference between this well-controlled trial, on the one hand, and the undifferentiated observational hokum that got Spence et al. so much media attention back in August, when they concluded "Our findings suggest that regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease." (Spence. 2012), on the other hand.

References:

• Blesso CN, Andersen CJ, Barona J, Volek JS, Fernandez ML. Whole egg consumption improves lipoprotein profiles and insulin sensitivity to a greater extent than yolk-free egg substitute in individuals with metabolic syndrome. Metabolism. 2012 Sep 26.
• Cortinas L, Galobart J, Barroeta AC, Baucells MD, Grashorn MA. Change in α-tocopherol contents, lipid oxidation and fatty acid profile in eggs enriched with linolenic acid or very long-chain ω3 polyunsaturated fatty acids after different processing methods. J. Sci. Food Agric. 2003; 83: 820–829.
• Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004 Jan 27;109(3):433-8.
• ScienceDaily. Egg yolk consumption almost as bad as smoking when it comes to atherosclerosis, study suggests. August 13, 2012 < http://www.sciencedaily.com­ /releases/2012/08/120813155640.htm > accessed on October 03, 2012.
• Spence JD, Jenkins DJ, Davignon J. Egg yolk consumption and carotid plaque. Atherosclerosis. 2012 Oct;224(2):469-73.

Eat Whole Eggs All Day and Throw Your Statins Away? 375x Increased Dietary Cholesterol Intake From Eggs Reduces Visceral Fat & Promotes Healthy Cholesterol Metabolism

Image 1: You better make sure you don't miss out on these delicious heart- and brain-healthy cholesterol bombs.

Most of you will probably be familiar with the good old saying "An apple a day, keeps the doctor away!", right? And if you are an otherwise healthy individual the micronutrients from the apple will probably really help you maintain this status. But what if the doctor was already there to put you on the healthy low fat diet, the negative health consequences of which I have addressed in yesterday's blogpost? In that case, whole eggs probably provide a more promising escape route from that low-fat, high-carb trap - at least this is what the the results of a soon to be published study from the Huazhong Agricultural University in Wuhan, China would suggest (Yang. 2012).

Surprising(?) -9% belly-fat reduction on whole egg diet

In their 60 to 90 day experiment, the Chinese researchers put a group of 8-week old Sprague-Dawley rats (n=18 for each group) on dietary regimen which differed in either cholesterol content (control vs. experimental groups) or the source of dietary cholesterol, i.e. 17.5% lard + synthetic cholesterol, 31.25% freeze dried egg yolk or 55.56% whole egg powder.

Figure 1: Composition of the control and the three experimental diets (adapted from Yang. 2012)

If you take a closer look at the exact composition of the diets in figure 1 the you will probably notice that macronutrient-wise the three standard-chow + lard/yolk/whole egg "high cholesterol" diets are miles-apart from what the average "low carber" would consider a healthy high fat diet. Still, the idea of choosing whole eggs as a major constituent (>55%) of one's diet should ring a bell for everyone who is familiar with the practical realization of the so-called "induction phase" of the purportedly (from the perspective of the same people who recommend the purportedly "heart-healthy low-fat diet") artery-clogging Atkins diet.

Figure 2: Body weight gain, food intake, food efficiency (food intake / weight gain) and relative visceral fat weight (per body weight) in Sprague Dawley rats after 60 and 90 days on experimental diets; data expressed relative to control group on standard rodent chow (data calculated based on Yang. 2012)

Interestingly, the data in figure 2 shows that even this version of "Atkins gone wrong", with a 40% carbohydrate content in the whole egg group (cf. figure 1) lead to significant reductions in weight gain and food efficiency (weight gain per gram of chow) and, more importantly, produced statistically significant reductions in the visceral fat / total body weight ratio at the end of the 90day study period (at 60 days there were no statistical significant inter-group differences).

55.56% whole egg diet kickstarts healthy cholesterol metabolism

In view of the fact that it has never been the notion that eggs would make you fat, but rather their purported negative effect on cholesterol levels due to which eggs, in general, and yolks, in particular, have gotten a bad rep over the last years, I guess that the visceral fat argument, alone, won't suffice to convince the egg-white consumer that they are missing out on the best part of the egg. After all, it was and unfortunately still is their purported negative effect on cholesterol that is literally at the heart of the egg(yolk)-scare.

Figure 3: Triglyceride, total, low density (LDL) and high desnity (HDL) cholesterol in Sprague Dawley rats after 60 and 90 days on experimental diets; data expressed relative to control group on standard rodent chow (data calculated based on Yang. 2012)

If you do yet take a look at the actual effects the natural cholesterol from the egg-containing diets had on the blood lipids of the rodents (cf figure 3), you will notice that those were statistically non-existent. In other words, only the lard + synthetic cholesterol diet had a statistically significant negative impact on the plasma lipids of the rats.

Figure 4: mRNA expression of hydroxymethylglutaryl CoA reductase (HMG-CoA R), LDL receptor (LDL-r), cholesterol 7a -hydroxylase (CYP71A), acyl-CoA:cholesterol acyltransferase (ACAT) lecithin cholesterol acyltransferase (LCAT) expressed relative to control (data adapted from Yang. 2012)

The 375x higher dietary cholesterol intake in the egg-groups, on the other hand, did not only shut down the endogenous cholesterol synthesis, as evidenced by the reduction in hydroxymethylglutaryl CoA reductase expression (HMG-CoA R, cf. figure 4) and increase its metabolization into bile acid via cholesterol 7a -hydroxylase (CYP71A), it also increased the LDL receptor expression in the liver (lack of LDL-r expression in the brain is associated with increased plaque formation in Alzheimer's, cf. Katsouri. 2011), lowered the formation and storage of cholesterol esterified cholesterol in the tissue by reducing acyl-CoA:cholesterol acyltransferase (ACAT) and increased the maturation of HDL and peripheral tissue cholesterol efflux via increased lecithin cholesterol acyltransferase (LCAT) expression.

In case you doubt that this rodent data has any significance for human beings, I just want to remind you that a 2008 study by Mayurasakorn et al., which found that "[i]n the majority of healthy adults" the addition of one egg per day to a "normal fat diet" lead to increases in HDL-c and decreases of the total cholesterol to HDL ratio (Mayurasakorn. 2008). Their conclusion that "egg consumption might benefit blood cholesterol" was however similarly ignored as the absence of scientific data to support the "eggs = increased risk of heart disease"-myth.

It is thusly not surprising that the Chinese scientists conclude that contrary to the "conventional approach to weight reduction", of which the scientists state that it is "a high-carbohydrate, low-fat, energy-deficient diet" that "has not proven to be very effective for many obese and over-weight individuals [I am not making that up, it is the exact wording from the study ;-]", an "egg diet", which "theoretically [...] would be more likely to cause obesity", could not only help those individuals finally shed unhealthy visceral fat, it could also lead to significant improvements in their lipid metabolism. If it were not for the statement that

[...] the mechanisms by which an egg diet lowers plasma cholesterol need to be further characterized and the special functional factors in egg need to be identified

one could be led to believe that Yang et al. had finally grasped the notion that just eating the right (whole) foods could solve the problem... the term "functional factors" does yet tell me that they are probably just trying to developing an "egg in a pill" that will soon be patented and sold as an adjunct to the standard statin therapy,