Received this comment last week from Michael Fedorsky:
The lipid hypothesis is completely valid. Once something reaches the statud (sic) of a theory it has enormous evidence. Cholesterol is a major contributor to cornary (sic) artery disease. The studies are clear on PubMed.
You should never have anymore than about seven eggs per week, if that. Harvard says up to seven eggs a week is harmonious with health. Seven eggs in a single day is terrible for your heart and vasuclar (sic) system. Chris M. is a crank. He knows very little about cholesterol, and chooses to cherry pick studies.
You don’t want to be the smartest man in the cemetery. The American Heart Association. Did you ever hear of it? You Weston A. Price cranks will be sorry you did not listen to Dr. Caldwell Esselstyn. If he is a good enough doctor to advise coronary heart disease patient , former president Bill Clinton, than he is a good enough doctor for anybody.
Mind you this was in a post regarding egg protein availability, which had nothing to do with cholesterol levels. But sure, I’m game, I’ll play.
The problem with lab studies
I have having a discussion with Dallas of the Whole 9 last week regarding how, in some circles, epidemiology gets pissed all over because there aren’t controls. By its very nature it’s not double-blind, condition-controlled study. However, for free living humans, it’s the best thing we have (unless an ethics committee somewhere decides that we can grow a person in a cage and control everything from cradle to grave).
Don’t misunderstand me: lab studies are great for something what happens to the changes in a diet but not necessarily the diet itself. Que? Yes, due to the nature of most studies a person’s free-living diet is being altered via some sort of intervention: high carb becomes high fat, low protein becomes high protein, fat people become less fat, etc. Lab values change as a result of the intervention but these changes do not reflect how the diet might actually react, as far as blood chemistry and a host of other factors are concerned, when maintained for a long period of time in the real world. Its the change in the diet that we see in the results, not of the diet itself.
This is the reason why we must take theory to practice and see how these things pan out in the real world. So with regards to egg consumption let’s take a look at big, fat, stupid Americans and their (apparently, this election cycle) mortal enemy: Mexicans.
Incredible Edible Egg Data
After Michael flew off half-cocked, I investigated a bit of his point in the real world. If you believe the lipid hypothesis (saturated fat and cholesterol intake drive blood cholesterol drives heart disease) then the logical things to look at are:
- Who eats the most eggs per year?
- What is their rate of heart disease?
Michael was adamant that nobody, under any circumstance, should eat more than 7 eggs per week because it is “harmonious with health.” Now the definition of harmonious is “forming a pleasing whole” but I assume that Michael wanted to say that it is harmful to health. So if that’s true than somebody eating more than 7 eggs per week should really be in trouble: health epidemic, people dying in the streets with exploding hearts-kind of trouble. So who eats the most eggs per year? It turns out its Mexico:
Mexico’s National Poultry Institute (INA) announced that Mexicans consume the most eggs worldwide, an average of 438 eggs per year per person.
Awesome, nearly 100 more eggs per year than days in a year! So if all of this cholesterol is truly killing the shit out of the Mexican population, they should lead the world in heart disease right? Well…:
Those patterns mirror the trend past studies have shown in Mexico’s rate of death from heart disease, which nearly doubled between 1970 and 2000. The current rate — about 56 heart disease deaths per 100,000 people…
THAT NUMBER IS HUGE! EPIDEMIC! LOCUS RAINING FROM THE SKY!… wait, there’s no context. Let’s compare that data to us. The United States population consumes, on average, 243.6 eggs per year. So basically half as many eggs per year. And what is our rate of heart disease?
(Mexico) is still lower than that of the U.S., where the rate in 2006 was 135 per 100,000.
So they consume twice as many eggs as we do and yet they have 59% less heart disease? No entidendo!
The Moving Parts
Now I’m not saying that Michael is wrong and I’m right…no that’s exactly what I’m saying. The problem is that there are a lot of moving parts to heart disease and cholesterol intake is one piece of the puzzle. Mexico’s heart disease is on the rise in large part because smoking is on the rise, not because of egg intake.
When you’re in an culture that over-consumes junk at the expense of real, nutritious food reducing cholesterol intake may reduce blood cholesterol numbers which may reduce risk. Maybe. But what about if you’re stressed out and overworked? That minor reduction in cholesterol isn’t going to make up for all those elevated inflammatory cytokines, which are hugely correlated with heart disease, perhaps more directly even. Still smoke? Egg reduction isn’t going to save you from that. Ditto for being overfat or obese. Lots of cardiovascular activity? You’re in trouble and probably avoiding eggs because it’s “healthy.” See the problem with targeting one metric as the shepard of good health?
Mexico is a country of more traditional food preparations, meaning more micronutrients per calorie, thus more satiety per calorie. It also helps that they’re relatively poor meaning eating isn’t done because they’re bored. I also suspect that easily accessible junk taking up a larger chunk of their daily calorie intake is partially to blame for the increase in cardiovascular disease.
For a theory to be valid it must work 100% of the time. When it doesn’t, it is modified to fit new evidence or, if that cannot happen, abandoned to the dustbin of history. There can be no such thing as a “paradox” that refutes the theory; the “paradox” needs to be used to modify your theory. Instead the lipid hypothesis uses “paradox” as a title for “things that ruin our pet theory so we’ll try to ignore them by calling them paradoxes.” France, Iceland, and Mexico are all places that have epidemiological data that makes them fly in the face of the theory. Their existence means the needs to be adjusted or abandoned all together. Being that its easier to build anew than have loads of disjointed, ill-fitting theories coddled together, I suggest a restart.
Don’t believe me? Take a look at this graph and tell me that your pet theory still functions (click to enlarge):
Anyone who says that 1 single thing is THE factor for health and disease is unaware of how little they know. Certain things give greater returns on time invested but no one thing is the main cog in the wheel when it comes to optimizing health and longevity. Context of the population being dealt with, especially their hysteresis, matters. Immensely.
Go get you some cage-free anarchy chickens and worry a little less.