Monday, October 29, 2012

The man who ate 25 eggs per day: What does this case really tell us?

Many readers of this blog have probably heard about the case of the man who ate approximately 25 eggs (20 to 30) per day for over 15 years (probably well over), was almost 90 years old (88) when the case was published in the prestigious The New England Journal of Medicine, and was in surprisingly good health ().

The case was authored by the late Dr. Fred Kern, Jr., a widely published lipid researcher after whom the Kern Lipid Conference is named (). One of Kern’s research interests was bile, a bitter-tasting fluid produced by the liver (and stored in the gallbladder) that helps with the digestion of lipids in the small intestine. He frames the man’s case in terms of a compensatory adaptation tied to bile secretion, arguing that this man was rather unique in his ability to deal with a lethal daily dose of dietary cholesterol.

Kern seemed to believe that dietary cholesterol was harmful, but that this man was somehow “immune” to it. This is ironic, because often this case is presented as evidence against the hypothesis that dietary cholesterol can be harmful. The table below shows the general nutrient content of the man’s daily diet of eggs. The numbers in this and other tables are based on data from Nutritiondata.com (), in some cases triangulated with other data. The 5.3 g of cholesterol in the table (i.e., 5,300 mg) is 1,775 percent the daily value recommended by the Institute of Medicine of the U.S. National Academy of Sciences ().



As you can see, the man was on a very low carbohydrate diet with a high daily intake of fat and protein. The man is described as an: “… 88-year-old man who lived in a retirement community [and] complained only of loneliness since his wife's death. He was an articulate, well-educated elderly man, healthy except for an extremely poor memory without other specific neurologic deficits … His general health had been excellent, without notable symptoms. He had mild constipation.”

The description does not suggest inherited high longevity: “His weight had been constant at 82 to 86 kg (height, 1.87 m). He had no history (according to the patient and his personal physician of 15 years) of heart disease, stroke, or kidney disease … The patient had never smoked and never drank excessively. His father died of unknown causes at the age of 40, and his mother died at 76 … He kept a careful record, egg by egg, of the number ingested each day …”

The table below shows the fat content of the man’s daily diet of eggs. With over 14 g of omega-6 fat intake every day, this man was probably close to or in “industrial seed oils territory” (), as far as daily omega-6 fat intake is concerned. And the intake of omega-3 fats, at less than 1 g, was not nearly enough to balance it. However, here is a relevant fact – this man was not consuming any industrial seed oils. He liked his eggs soft-boiled, which is why the numbers in this post refer to boiled eggs.



This man weighed between 82 to 86 kg, which is about 180 to 190 lbs. His height was 1.87 m, or about 6 ft 1 in. Therefore his body mass index varied between approximately 23 and 25, which is in the normal range. In other words, this person was not even close to obese during the many years he consumed 25 eggs or so per day. In the comments section of a previous post, on the sharp increase in obesity since the 1980s (), several readers argued that the sharp increase in obesity was very likely caused by an increase in omega-6 fat consumption.

I am open to the idea that industrialized omega-6 fats played a role in the sharp increase in obesity observed since the 1980s. When it comes to omega-6 fat consumption in general, including that in “more natural” foods (e.g., poultry and eggs), I am more skeptical. Still, it is quite possible that a diet high in omega-6 fats in general is unhealthy primarily if it is devoid of other nutrients. This man’s overall diet might have been protective not because of what he was not eating, but because of what he was eating.

The current debates pitting one diet against another often revolve around the ability of one diet or another to eliminate or reduce the intake of a “bad thing” (e.g., cholesterol, saturated fat, carbohydrates). Perhaps the discussion should be more focused on, or at least not completely ignore, what one diet or another include as protective factors. This would help better explain “odd findings”, such as the lowest-mortality body mass index of 26 in urban populations (). It would also help better explain “surprising cases”; such as this 25-eggs-a-day man’s, vegetarian-vegan “ageless woman” Annette Larkins’s (), and the decidedly carnivore De Vany couple’s ().

The table below shows the vitamin content of the man’s daily diet of eggs. The vitamin K2 content provided by Nutritiondata.com was incorrect; I had to get what seems to be the right number by triangulating values taken from various publications. And here we see something interesting. This man was consuming approximately the equivalent in vitamin K2 that one would get by eating 4 ounces of foie gras () every day. Foie gras, the fatty liver of overfed geese, is the richest known animal source of vitamin K2. This man’s diet was also high in vitamin A, which is believed to act synergistically with vitamin K2 – see Chris Masterjohn’s article on Weston Price’s “activator X” ().



Kern argued that the very high intake of dietary cholesterol led to a sharp increase in bile secretion, as the body tried to “get rid” of cholesterol (which is used in the synthesis of bile). However, the increased bile secretion might have been also been due to the high fat content of this man’s diet, since one of the main functions of bile is digestion of fats. Whatever the case may be, increased bile secretion leads to increased absorption of fat-soluble vitamins, and vitamins K2 and A are fat-soluble vitamins that seem to be protective against cardiovascular disease, cancer and other degenerative diseases.

Finally, the table below shows the mineral content of the man’s daily diet of eggs. As you can see, this man consumed 550 percent the officially recommended daily intake of selenium. This intake was slightly lower than the 400 micrograms per day purported to cause selenosis in adults (). Similarly to vitamins K2 and A, selenium seems to be protective against cardiovascular disease, cancer and other degenerative diseases. This man’s diet was also rich in phosphorus, needed for healthy teeth and bones.



Not too many people live to be 88 years of age; many fewer reach that age in fairly good health. The country with the highest average life expectancy in the world at the time of this writing is Japan, with a life expectancy of about 82 years (79 for men, and 86 for women). Those who think that they need a high HDL cholesterol and a low LDL cholesterol to be in good health, and thus live long lives, may be surprised at this man’s lipid profile: “The patient's plasma lipid levels were normal: total cholesterol, 5.18 mmol per liter (200 mg per deciliter); LDL, 3.68 mmol per liter (142 mg per deciliter); and HDL, 1.17 mmol per liter (45 mg per deciliter). The ratio of LDL to HDL cholesterol was 3.15.”

If we assume that this man is at least somewhat representative of the human species, and not a major exception as Kern argued, this case tells us that a diet of 25 eggs per day followed by over 15 years may actually be healthy for humans. Such diet has the following features:

- It is very high in dietary cholesterol.

- It involves a high intake of omega-6 fats from animal sources, with none coming from industrial seed oils.

- It involves a high overall intake of fats, including saturated fats.

- It is fairly high in protein, all of which from animal sources.

- It is a very low carbohydrate diet, with no sugar in it.

- It is a nutritious diet, rich in vitamins K2 and A, as well as in selenium and phosphorus.

This man ate 25 eggs per day apparently due to an obsession tied to mental problems. Repeated attempts at changing his behavior were unsuccessful. He said: “Eating these eggs ruins my life, but I can't help it.”

27 comments:

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Kindke said...

Interesting about the omega6:omega3 ratio, I will take it in good faith that his mental problems were unrelated to this imbalanced ratio. Then again you need a mental issue to eat that many eggs per day, it sounds very unpalatable :)

I suppose we could approach the omega6 issue like that of fructose, if it comes from whole foods ( fruit,honey ) then it appears to be much less harmful.



Charles Grashow said...

Why not just assume that he's an outlier?

Chuck said...

based on his diet and what we think we know about alzheimer's, i am surprised he got this neurologic disease.

Chuck Currie said...

Why should we take it on good faith that his mental issues were not caused by an imbalanced n-3/n-6 ratio?

collins okafor said...

Very Informative and quite educating i must say!

Anonymous said...

The article says the man felt lonely. Emotional and mental stress probably are the primary contributors to his mental health, more so than his diet.

Ed Terry said...

I came across the article "The Intestinal Absorption of Dietary Cholesterol by Hypercholesterolemic (Type II) and Normocholesterolemic Humans" by Connor & Lin (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC333091/) and they observed there may be an upper limit to the amount of dietary cholesterol that can be absorbed (2,000 mg day).

I suppose the Niemann-Pick C1-Like 1 NPC1L1) protein may be a saturable pathway that does exhibit an upper limit.

George Henderson said...

This is great Ned, a post I will read and reread.
I love this kind of thing - if I saw a book about this guy I would read it cover to cover.
Check the biography of Otto von Bismark some time, interesting case study in high-fat, meat protein over-eating.

George Henderson said...

If 400 mcg selenium causes selenosis, why are there no recorded cases from eating brazil nuts?
I think you need closer to 850mcg for some time (see below).
But it would be more toxic to people on low protein diets. (selenocysteine competes with cysteine)
Some supplemental forms may be more toxic than others, but food may be relatively safe.
http://lpi.oregonstate.edu/infocenter/minerals/selenium/

Toxicity

Although selenium is required for health, like other nutrients, high doses of selenium can be toxic. Acute and fatal toxicities have occurred with accidental or suicidal ingestion of gram quantities of selenium. Clinically significant selenium toxicity was reported in 13 individuals after taking supplements that contained 27.3 milligrams (27,300 mcg) per tablet due to a manufacturing error. Chronic selenium toxicity (selenosis) may occur with smaller doses of selenium over long periods of time. The most frequently reported symptoms of selenosis are hair and nail brittleness and loss. Other symptoms may include gastrointestinal disturbances, skin rashes, a garlic breath odor, fatigue, irritability, and nervous system abnormalities. In an area of China with a high prevalence of selenosis, toxic effects occurred with increasing frequency when blood selenium concentrations reached a level corresponding to an intake of 850 mcg/day. The Food and Nutrition Board (FNB) of the Institute of Medicine recently set the tolerable upper intake level (UL) for selenium at 400 mcg/day in adults based on the prevention of hair and nail brittleness and loss and early signs of chronic selenium toxicity (15). The UL of 400 mcg/day for adults (see table below) includes selenium obtained from food, which averages about 100 mcg/day for adults in the U.S., as well as selenium from supplements.

Jack C said...

Ned, Based on USDA data for eggs the LA content of 25 medium eggs per day is about 6% of calorie intake which approximates average LA intake in 1991 when the study was written. Obesity prevalence in 1991 was 22% which means that 78% were not obese. If excessive intake of LA is a significant cause of obesity, then it makes sense that those with above average LA intake would be the ones most likely to become obese.

It therefor seems that the egg story is not related to the association between LA intake and obesity. The egg story does suggest that there is no correlation between dietary cholesterol and heart disease.

It seems that at the time that Kern did his study it was not known that elevated serum cholesterol results in an increase in the number LDL receptors in the liver which removes cholesterol from the bloodstream and turns it into bile, thereby modulating serum cholesterol.

Ned Kock said...

Kern’s own description seems pretty dismissive of the man’s “prior diagnosis” of Alzheimer's disease, almost suggesting a misdiagnosis.

Ned Kock said...

Since the man’s mental disorder(s) were believed to cause the exaggerated egg consumption, it stands to reason that they were not caused by it.

Nils said...

One of the better blogs I know, keep it up Ned :).

Imagine if the guy would eat pastured eggs, he would probably be in even better state! The omega ratios would be far better.

And while it's true his diet is high in animal omega-6, I do believe the arachidonic acid in eggs is potenially more harmful than it's seed counterpart LA.

George Henderson said...

Because the egg has to produce a healthy chicken, is it likely that more of the omega 3 is in phospholipid form? Thus the omega 3s are more likely to be taken up by cells that require them?
The ratio of 6:3 in the eggs phospholipids (lecithin) may be different from that of its triglycerides.

Rob said...
This comment has been removed by the author.
Rob said...

Sounds like he had ocd if he was compelled to eat them and it distressed him.

To think his mental issues (ocd or not) ruined his life for making him eat all those eggs as he says yet it may be a key factor to his longevity! That and him avoiding smoking, drinking, etc.

js290 said...

I asked Dr. Emily Deans the same question: What if the omega 3/6 imbalance is a symptom of disease and not the cause of it?

dearieme said...

"He had mild constipation": I did laugh.

On a more general point, isn't it possible that for many people their health isn't terribly dependent on their diet, within a pretty wide range of diets? If so, it might be useful if the medical profession were to attempt to learn how to identify that minority who are diet-sensitive.

Ned Kock said...

I don’t think this man would have done well on a diet of 25 slices of bread per day.

dearieme said...

One of the papers (the Mail?) had a story in the last couple of years about a teenager who had lived for a few years entirely (it was alleged) on raspberry jam sandwiches.

Paul N said...

Well, 25 eggs a day sure sounds more healthy than 30 bananas a day!

An "out of balance" ratio of n6-n3, but two major differences to most people;
1) the n6 is mostly arachidonic acid, which has different effects from linoleic acid, it is an important brain food. This is my understanding as to why bacon and eggs are a great hangover cure - the AA gets to work repairing the brain after alcohol.

which leads to 2) the diet had virtually no sugar.
Is an excess of n6-n3, in the absence of sugar, as much of a problem as when there is lots of sugar?

In any case, I'd like to see the "cholesterol will kill you" people, like Essylstyn, MacDougall etc, explain this one.

Calgary Orthotics said...

Wow! I never thought that egg is such a power food. I'll eat more of it from now on.

thorough male enhancement blog site said...

Wow, that was unbelievable, I thought it is only one egg every week.

Ed Terry said...

An excerpt from From "Human Atherosclerosis and the Diet" ANCEL KEYS, Circulation 1952, 5:115-118

The cholesterol levels in the diets used to induce atherosclerosis in animals range from 0.5 to 5 per cent by weight of the dry food, the most popular level being 2 per cent. This means something like 1000 to 10,000 mg. of cholesterol per 1000 Calories of food, the 2 per cent cholesterol level being equivalent to about 4000 mg. per 1000 Calories if 30 per cent of the calories are derived from fats. We should have to provide some 10,000 to 15,000 mg. of cholesterol daily to a man to be comparable. Moreover, there is reason to believe that man has a greater power of cholesterol regulation than does the rabbit or the chicken. From the animal experiments alone the most reasonable conclusion would be that the cholesterol content of human diets is unimportant in human atherosclerosis

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