General information, not medical advice. If you have high cholesterol, diabetes or heart disease, talk to your GP or cardiologist about your own diet.
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As a geneticist, the egg question I get asked most isn't really about eggs. It's "my dad had high cholesterol, so should I be scared of the yolk?" So, are eggs bad for cholesterol? For most people, the large studies say moderate egg eating isn't linked to heart disease. But there's a genetic catch that the "eggs are fine now" headlines skip, and it's the part worth knowing if heart disease runs in your family.
Why eggs got a bad name
An egg yolk is one of the richest everyday sources of dietary cholesterol. For decades the logic seemed simple: cholesterol in your blood clogs arteries, eggs contain cholesterol, so eggs must raise your risk. Many of us grew up with a "no more than a few eggs a week" rule.
The problem is that blood cholesterol is mostly made by your own liver, and your liver adjusts its output to what you eat. How much a food moves your LDL ("bad") cholesterol depends on the food, the rest of your diet, and your genes. That's why the question had to be tested in people, not just reasoned out on paper.
What the research actually says about eggs and cholesterol
The biggest analysis says moderate eggs are neutral. In 2020, Harvard researchers followed more than 215,000 nurses and health professionals for up to 32 years. After adjusting for lifestyle and the rest of the diet, eating at least one egg a day wasn't linked to higher cardiovascular disease risk compared with eating almost none. They then pooled 33 risk estimates covering 1.7 million people: one extra egg a day made no measurable difference to heart disease or stroke risk overall. In Asian cohorts, egg eaters even had slightly lower risk (Drouin-Chartier et al., BMJ 2020).
But one big study disagreed. A year earlier, a pooled analysis of six US cohorts (almost 30,000 adults) found that every extra 300 mg of dietary cholesterol a day was linked to a 17% higher risk of cardiovascular disease, and every extra half egg a day to a 6% higher risk. When the researchers adjusted for total dietary cholesterol, the egg signal disappeared, which suggests it was the overall cholesterol load, not eggs as such (Zhong et al., JAMA 2019).
The heart experts' summary. The American Heart Association reviewed the human evidence and concluded that observational studies generally don't link dietary cholesterol to heart disease, but that controlled feeding studies show cholesterol intakes well above average can raise LDL. Their advice: stop counting milligrams and focus on the overall eating pattern, such as Mediterranean or DASH-style diets, which leave room for eggs within a mostly plant-forward plate (Carson et al., Circulation 2020).
Put together: an egg a day, inside an otherwise good diet, looks fine for most people. The plate around the egg matters more than the egg.
The genetic catch: familial hypercholesterolaemia
Here's the bit I care about as a geneticist. About 1 in 313 people worldwide carries familial hypercholesterolaemia (FH), an inherited condition where the body can't clear LDL cholesterol properly. In people with premature heart disease, it's around 1 in 15 (Beheshti et al., JACC 2020).
FH isn't caused by eggs, and cutting eggs won't cure it. LDL is high from birth because of a gene variant, and most people with FH need medical treatment, not just diet changes. But it changes the egg question completely. Population studies like the ones above tell you what happens on average. They can't tell you what's right for someone whose LDL handling is genetically different, and many people with FH don't know they have it.
Signs it's worth getting checked:
- A parent, brother or sister had a heart attack or stroke young (roughly before 55 in men or 60 in women).
- A close relative has very high cholesterol or was told it's "genetic".
- You've had a high LDL result on a blood test and were never told why.
If any of those fit, ask your GP for a cholesterol test and mention the family history. That one conversation matters far more than how many eggs you eat this week.
Who should still be careful with eggs
- People with FH or very high LDL: follow your doctor's plan for dietary cholesterol and saturated fat.
- People with type 2 diabetes or existing heart disease: ask your GP or cardiologist how eggs fit, because the general-population averages may not apply to you.
- Anyone whose eggs come with a fry-up: in the Harvard cohorts, bigger egg eaters also ate more red meat and had higher BMI. Bacon, sausages and butter-soaked toast are a bigger issue than the yolk.
Limitations of the evidence
Almost all of this comes from observational studies, where people report their own diets on questionnaires. That can't prove cause and effect, and the results between countries vary a lot. We don't have long-term randomised trials of egg eating with heart attacks as the outcome, and probably never will. So "moderate eggs are fine for most people" is the best current reading, not a guarantee for every body.
Practical takeaways
- Healthy and no family history? Up to an egg a day fits comfortably in a heart-healthy diet.
- Family history of early heart disease? Get your cholesterol checked before worrying about eggs.
- Fix the plate, not just the egg. Pair eggs with vegetables, wholegrains or legumes, and cook in olive oil rather than butter.
- Use eggs for what they're great at: cheap, complete protein that's easy to carry on a long shift. (I wrote about why the yolk matters for protein quality here.)
On 12-hour rosters I use eggs almost daily, and the easiest way is batch-cooking. A simple electric egg cooker does a batch of boiled eggs while you shower, with no pot to watch.
Recipe: roster egg muffins (makes 12)
Bake once, eat for three shifts. Each muffin gives you about 5 g of protein (check your labels) plus some vegetables.
- 8 eggs
- 1 cup baby spinach, chopped
- 1 red capsicum, diced
- 4 spring onions, sliced
- ½ cup cottage cheese
- Pepper, chilli flakes or dried oregano to taste
- Heat the oven to 180°C and lightly oil a 12-hole muffin tray, or use a silicone muffin tray so nothing sticks.
- Divide the vegetables between the holes.
- Whisk the eggs with the cottage cheese and seasoning, then pour over the vegetables.
- Bake 18–22 minutes, until just set in the middle.
- Cool, then store in the fridge for up to 3 days in glass meal-prep containers. Two or three muffins with a piece of fruit make a solid pre-shift breakfast.
If heart health is on your mind more broadly, my plain-English guide to the coronary calcium score explains another test worth asking your GP about.
Eat for your biology, not the headline
Whether eggs suit you depends on your genes, your blood results and the rest of your plate. That's exactly what my BioType Nutrition Blueprint is built around: a plan that fits your biology, your training and your roster. Not sure where to start? Book a free consultation and we'll work it out together.
Hugo Novais, MSc Genetics, BTech Biotechnology, former professional swimmer
Sources
- Drouin-Chartier JP, et al. Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis. BMJ. 2020;368:m513. doi:10.1136/bmj.m513 · PubMed 32132002
- Zhong VW, et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081–1095. doi:10.1001/jama.2019.1572 · PubMed 30874756
- Carson JAS, et al. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2020;141(3):e39–e53. doi:10.1161/CIR.0000000000000743 · PubMed 31838890
- Beheshti SO, et al. Worldwide prevalence of familial hypercholesterolemia: meta-analyses of 11 million subjects. J Am Coll Cardiol. 2020;75(20):2553–2566. doi:10.1016/j.jacc.2020.03.057 · PubMed 32439005
