I was talking to a patient this week, and we were on the topic of breakfast. Here’s how the conversation went...
Me:"I had a healthy breakfast this morning."
Patient: "What, like yogurt?"
Me: "No, actually I had bacon, eggs, and a lot of veggies."
Patient:"Oh bacon and eggs, real healthy (insert eye roll) … I wish I could get away with that."
So many people are so afraid of fat and cholesterol that it makes me sad! I’m trying to educate people one at a time, but maybe writing this blog will help to do it faster.
Bacon and eggs have gotten a bad reputation over the years. Ever since this picture appeared on the cover of Time Magazine on March 24, 1984, almost everyone in our country has been afraid of fat and cholesterol.
What is Cholesterol?
Cholesterol is a sterol (combination of a steroid and an alcohol). Because it is fat soluble (and blood is mostly water), it has to be carried around in the blood by special proteins called lipoproteins. When your "Cholesterol" is measured by most doctors, it is really the concentration of cholesterol in these lipoproteins that is being measured. You have probably heard of these in terms of HDL (high density lipoproteins) and LDLs (low density lipoproteins). These are simply what I just explained- TRANSPORT molecules. They are neither good nor bad, they just transport molecules (like fat and cholesterol) around. Until the last 35 years or so, cholesterol was not measured. There was no such thing as “high cholesterol.“
Why Would Lab Values for These Cholesterol Transport Molecules Go Up?
If you have more fat to be transported, you need more transport molecules in your blood to do this job. Similarly, if you are in a chronic state of inflammation, your body NEEDS cholesterol to help repair damaged cells throughout your body and "clean up" the inflammation.
Which Came First, The Chicken or the Egg?
Back in the 1980’s, many scientists assumed that when overweight and unhealthy people had high cholesterol lab values, it was the cholesterol itself that caused the problem.
New research attributes high cholesterol to inflammation. Like I mentioned above, when our bodies are inflamed, they produces more cholesterol to try to clean up that inflammation. Therefore, we get "high cholesterol" because we are unhealthy, and not the other way around. Whoa!!
You can check your inflammatory markers (such as CRP) to see what your inflammatory state is. This will give you a much better idea of your risk for heart disease than your cholesterol numbers (source). If you'd like to learn more about this, let me know and we can run your labs to see what your inflammatory markers look like.
I’m not going to get into cholesterol drugs right now, I’ll just let you think about what the implications of this could be if you are given drugs to strictly lower the cholesterol levels. One of the analogies that I like to use to explain this to patients is that taking a drug to lower cholesterol is like blaming the firefighters for setting a fire just because they are found at the scene of the fire. If you want to learn more about the implications of cholesterol lowering drugs, check out the link to the source in the previous paragraph.
What Else Does Cholesterol Do?
Cholesterol is found in the cell membrane of every cell in our bodies and helps maintain the integrity of the cell wall. Cholesterol helps us to make bile acids (for digesting fat). We use cholesterol in our skin to help make Vitamin D from sunlight. Cholesterol is also a key component in hormones (estrogen, testosterone etc.) Clearly those are all very important processes that we want working! We do not want our cholesterol to be too low. Having LOW levels of cholesterol is actually linked to increased rates of depression and suicide (source).
What happens when you consume cholesterol in your diet?
Typically, about 25% of the cholesterol in our bodies comes from our diet. About 75% is made by our bodies. Because cholesterol is so important for all of the processes I just mentioned, if we aren't consuming cholesterol, our bodies will make more. Similarly, if we consume an abundance, our bodies will make less. This article presents that in 75% of the population, dietary cholesterol intake had almost no impact on total cholesterol levels. In the other 25% of the population (known as "hyper-responders,") HDL and LDL did modestly increase, but their ratio didn't change, and there was no increase in risk of heart disease.
Is it okay to eat bacon and eggs?
There is no reason to avoid them because of their cholesterol content. I would recommend paying attention to the QUALITY of the bacon and eggs that you are consuming.
Ideally bacon and eggs would be from pigs and chickens that ate their natural diets and were raised on pasture outdoors. (and chickens are not vegetarians- so be worried when you hear that Perdue Chicken commercial boasting about their awesome vegetarian fed chickens).
• Bacon - Avoid super processed bacon with lots of additives (nitrates, sugar, etc). If you can, find a farmer to buy your meat from who pasture raises their pigs.
• Eggs - Please, eat the whole egg- especially the yolk. Did you know that all 13 of the essential nutrients found in eggs are in the yolk and not the white? I get upset when I see an "egg white" omelet in the "healthy" section of a restaurant menu since the yolks are the most nutrient dense and therefore healthiest part of the egg! There is a lot of good healthy protein and fat in that yolk, it is a waste to toss it. The best way to prepare it is to keep the yolk intact (e.g. poached, over easy). A hard scramble may denature (scramble up) some of those good proteins.
What about egg beaters? I just googled the label. The ingredients are Egg Whites, then water, followed by too many chemicals to count. Need I say more? (hint…They are way over processed and I would not consider them "real food")
What about those veggies you mentioned in your healthy breakfast? Veggies are my way of life. Add them to everything. They provide great nutrients, and make you feel full! Cook your bacon first, then cook the veggies in the bacon grease (awesome cooking fat), and then throw your eggs over the top! Delicious!!
Do you have comments or feedback for me? Come chat with me over on facebook.
Dr. Jamie
image credit: Time magazine and Andrew Unangst