North American Pharmacal

Re: O Bars & cholesterol

Posted By: Greg Kelly, ND
Date: Monday, 6 December 1999, at 4:28 p.m.

In Response To: O Bars & cholesterol (Cate G.)

First and foremost, Dr D'Adamo routinely finds O's following the O diet (which includes eggs) experience a decrease in cholesterol and an improvement in HDL (good cholesterol) resulting in a lower heart risk profile.

The O bars have cholesterol because we use whole DHA rich (an essential fat) eggs as the protein source. It is a side effect of using a great food for the base of the bar instead of an isolated protein extracted from a food. A welcome side-effect though since eggs are actually a very healthy food. The yoke is high in lecithin, vitamins, minerals, good oils, etc.

A large egg contains about 215 milligrams of cholesterol (about equal to 2 1/2 O bars). Based on what studies show (that 1-2 eggs per day has an insignificant impact on cholesterol levels) you would need to eat more than about 3-5 O bars a day to even begin to slightly effect your cholesterol levels.

Eggs have gotten a bad rap as a forbidden food because of their cholesterol content. This bad rap is basically undeserved. You might say that the egg industry has a bad PR person because studies just don't show that they do much to cholesterol in the body.

If eggs were so bad for you you would expect lots of studies showing this to be true. And if there were not lots of studies on this, we would expect lots of studies showing that they substantially raise cholesterol. The reality is that studies don't exist on either of these. What studies actually show is that most people can eat one or two eggs a day without changing their blood cholesterol levels.

For example, two recent studies published in an American Heart Association journal showed that 20 healthy young men and 13 healthy young women with normal blood cholesterol levels were able to consume up to two eggs per day while on a low-fat diet without significantly raising their blood cholesterol levels. The outcome of these studies support results from several other studies published in the last decade, and suggests that an egg or two daily is fine for people with normal blood cholesterol levels.

Lets clear up a couple of important and confused matters with cholesterol.

1. Cholesterol is an absolute requirement for good health. Without it you cannot make sex hormones, some stress hormones, vitamin D etc. We all hear that high cholesterol is associated with heart disease but low cholesterol is associated with cancer and suicide. The reality is that cholesterol between 180-200 is probably ideal, but even with higher cholesterol, it is the ratio with HDL cholesterol that matters for heart risk.

2. Cholesterol either comes from the diet or is made in the body or is a combination of both. Of these two sources, it is almost always the case that the cholesterol made in the body is the problem. Medicine and Pharmaceutical companies have known this for years. How can I make the claim that they know this? Ask one question. What do the most used cholesterol lowering drugs do? They block an enzyme called HMG CoA which makes cholesterol in your body (essentially from a surplus of dietary carbohydrates). This is basic biochemistry. If dietary cholesterol was the problem, do you think these drugs would work as well? I can assure you they would not. So the level of the problem for most people with high cholesterol has nothing to do with what is found in eggs. It is the excess sugars and carbs in conjunction with a high fat diet.

3. It is almost unheard of for O's to worsen their cardiovascular risk profile by eating even alot of eggs.

Now people with high cholesterol aside (and they are not the majority), the rest of us have no problem with cholesterol so should not be concerned about it in the diet to start with. If we don't get it from our diet, we make more of it in our body instead.

I am placing some abstracts on the most recent studies below for you to read, but essentially they show eggs and the cholesterol found in a few eggs does not increase risk for heart disease. In general, eggs raise the good cholesterol at least as much or more than they raise the bad cholesterol. Basically they show that the majority of study subjects have relatively small plasma cholesterol changes in response to changes in dietary cholesterol intake. These findings are consistent with data from over thirty years of clinical investigations on this question and indicate that the average response to a 100 mg/day change in dietary cholesterol intake is 2.5 mg/dl or less change in plasma cholesterol levels (and some of this is a result of good cholesterol increasing). While some individuals are more sensitive to the effects of dietary cholesterol (15-20% of the population), the dose adjusted response factor in this group is still relatively small (3.2 vs 1.6 for sensitive vs resistant study subjects). For example, it can be estimated that reducing dietary cholesterol intake from 400 mg/day to 300 mg/day results in a plasma cholesterol reduction of 3.2 mg/dl in cholesterol sensitive individuals and as little as 1.6 mg/dl in cholesterol insensitive individuals.

Ginsberg et al. 1994. A dose-response study of the effects of dietary cholesterol on fasting and postprandial lipid and
lipoprotein metabolism in healthy young men. Arterioscler. Thrombosis 14:576-586.
For these controlled feeding studies twenty-four young men were fed 30% fat diets (NCEP Step I) with addition of zero (128 mg cholesterol/day), one (283 mg/day), two (468 mg/day) or four (858 mg/day) eggs per day to the basal diet. Each diet was fed for eight weeks. Average plasma cholesterol levels in the twenty-four subjects were 155, 161, 162, and 166 mg/dl for the zero, one, two and four eggs per day feeding periods. Plasma total cholesterol increased 1.5 mg/dl per 100 mg/day added dietary cholesterol. There was no evidence that changes in dietary cholesterol intakes altered the postprandial plasma lipoprotein profile (lipoproteins thought to be involved in the development of atherosclerosis) and thus did not alter the atherogenic potential of the plasma lipoproteins. The data indicate that in the majority of healthy young men addition of two eggs per day to a low-fat diet has little effect on plasma cholesterol levels.

Schnohr et al. 1994. Egg consumption and high-density-lipoprotein cholesterol. J. Intern. Med. 235:249-251.
To determine the effects of egg consumption on plasma HDL cholesterol levels, twenty-four adults added two eggs per day to their usual diets for six weeks. Total cholesterol levels were increased by 4% while HDL cholesterol levels
increased 10%. The dose adjusted response to the change in dietary cholesterol was 2.4 mg/dl per 100 mg/day. The
authors concluded that "a moderate egg intake should not be rigorously restricted in healthy individuals."

McComb et al. 1994. Attenuated hypercholesterolemic response to a high-cholesterol diet in subjects heterozygous for the apolipoprotein A-IV-2 allele.N. Engl. J. Med. 331:706-710.
Genetic factors contribute to the variability of the plasma lipid responses to dietary cholesterol and in this study it was
shown that subjects with the apolipoprotein A-IV-2 allele have an attenuated response to a dietary cholesterol challenge. Subjects were fed a low-cholesterol diet and one with 1100 mg/day added cholesterol. The change in plasma cholesterol in subjects without the apo A-IV-2 allele (n=12) was 22 mg/dl (dose adjusted: 2.3 mg/dl per 100 mg/day) while for those with the apo A-IV-2 allele (n=11) the change was 6 mg/dl (dose adjusted: 0.7 mg/dl per 100 mg/day). It is estimated that one in every seven individuals in the United States has the apo A-IV-2 allele and, based on the data from this study, has a genetic resistance to the plasma cholesterol raising effects of very high intakes of dietary cholesterol. These findings are a breakthrough in beginning to understand the role of genetic factors in the variability of plasma lipid responses to dietary cholesterol.

Vuoristo & Miettinen. 1994. Absorption, metabolism, and serum concentrations of cholesterol in vegetarians: effects of cholesterol feeding. Am. J. Clin. Nutr. 59:1325-1331.
Dietary cholesterol feeding studies were carried out in five vegetarians to determine if there were any differences in
responses as compared to non-vegetarians. Addition of three egg yolks per day (690 mg cholesterol) to the diet for two months increased the average plasma cholesterol level by 23 mg/dl (dose adjusted: 3.4 mg/dl per 100 mg/day).
Surprisingly, HDL cholesterol levels were increased by 10 mg/dl with addition of egg yolks to the diet and the LDL:HDL ratio was unaffected by cholesterol feeding. The authors concluded that the metabolic responses to dietary cholesterol are similar for vegetarians and non-vegetarian subjects.

Lichtenstein et al. 1994. Hypercholesterolemic effect of dietary cholesterol in diets enriched in polyunsaturated and
saturated fat. Dietary cholesterol, fat saturation, and plasma lipids. Arterioscler. Thromb. 14:168-175.
Studies in fourteen men (n=8) and women (n=6) fed either corn oil (polyunsaturated fat) or beef tallow (saturated fat) with or without addition of 197-226 mg cholesterol per 1000 kcal, documented little effect of dietary fat saturation on the plasma cholesterol response to dietary cholesterol. In the corn oil fed group the addition of cholesterol increased plasma cholesterol 11 mg/dl (dose adjusted: 3.9 mg/dl per 100 mg/day) and in the beef tallow group the increase was the same, 11 mg/dl (dose adjusted: 3.8 mg/dl per 100 mg/day). The findings are consistent with other studies which indicate that with a 30% fat diet, the plasma cholesterol response to dietary cholesterol is independent of the fatty acid composition of the diet. The study also provides evidence which suggests that resistance to the effects of dietary cholesterol occurs in older men and women and is not limited to only young, healthy volunteers.

Ginsberg et al. 1995. Increases in dietary cholesterol are associated with modest increases in both LDL and HDL
cholesterol in healthy young women. Arterioscler. Thromb. Vasc. Biol. 15:169-178.
A controlled dietary cholesterol feeding study in thirteen young women tested the effects of feeding zero, one, or three eggs per day on plasma lipids and lipoproteins. The data indicated that the dose adjusted plasma cholesterol response was 2.8 mg/dl per 100 mg/day dietary cholesterol (a value higher than that obtained in males in the 1994 study). In women, however, the increase in total plasma cholesterol with dietary cholesterol occurred in both the atherogenic LDL cholesterol (2.1 mg/dl per 100 mg/day) and the anti-atherogenic HDL cholesterol (0.6 mg/dl per 100 mg/day). As found in the previous study in healthy young men, young women have the ability to compensate for an increased intake of cholesterol by adjusting the way cholesterol is handled by the body. The data show that addition of two eggs per day to the diet of healthy young women has little effect on plasma cholesterol levels in the majority of study subjects.

Ferrier et al. 1995. Alpha-linolenic acid- and docosahexanaenoic acid-enriched eggs from hens fed flaxseed: influence on blood lipids and platelet phospholipid fatty acids in humans. Am. J. Clin. Nutr. 62:81-86.
This study compared the effects of feeding four regular or omega-3 fatty acid enriched eggs per day for two weeks on
plasma lipids in twenty-eight males. Eggs were obtained from hens fed either zero, ten or twenty percent flax seed diets. Addition of four eggs per day (720 mg of cholesterol) to the diet increased plasma total cholesterol levels an average of 13 mg/dl and there were no differences between the sources of eggs tested. The dose adjusted change in plasma cholesterol levels was 1.9 mg/dl per 100 mg/day change in dietary cholesterol. HDL cholesterol levels were increased 2 mg/dl with the addition of eggs. It would appear from this study that the fatty acid composition of the egg has no relationship to the effects of dietary cholesterol on plasma cholesterol levels.