Cardiometabolic Health

Cardiometabolic health is a relatively new term that encompasses cardiovascular and metabolic diseases, including type 2 diabetes and metabolic syndrome. Collectively, such conditions are the leading cause of preventable death worldwide. They all share similar risk factors (e.g., overweight/obesity, elevated blood pressure) which can be modified by diet and lifestyle choices. The available evidence indicates that eggs, when consumed as part of an overall healthy diet pattern, do not affect risk factors for cardiometabolic disease. Recent recommendations from the American Heart Association, American College of Cardiology and American Diabetes Association do not limit egg or cholesterol intake, a change from earlier guidance from these organizations. In fact, several global health organizations, including Health Canada, the Canadian Heart and Stroke Foundation, the Australian Heart Foundation and the Irish Heart Foundation, promote eggs as part of a heart-healthy diet.

Given the public health significance of understanding cardiometabolic diseases, research on risk reduction remains an active area of pursuit. For example:

  • A randomized controlled study in people with metabolic syndrome showed that those consuming three whole eggs per day as part of a reduced carbohydrate diet experienced favorable changes in HDL-cholesterol, insulin sensitivity, and other aspects of the lipoprotein lipid profile
  • A randomized controlled weight loss trial in people with diagnosed type 2 diabetes showed improved lipid and glucose markers following consumption of 2 eggs per day for 12 weeks.
  • An egg-based breakfast, rich in protein (35% energy; 26.1 g egg protein), promoted glycemic control in people with type 2 diabetes and pre-diabetes relative to a high-carbohydrate breakfast.

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Omega-3 fatty acids: are we getting enough

Featured article in the Winter 2015 Issue of Nutrition Close-Up; written by James D. House, PhD

The Food and Nutrition Board of the Institute of Medicine published in 2002 official estimates of the human requirements for fatty acids.1 At that time, only two fatty acids, the major constituents of fats and oils, were deemed to be essential for the healthy, adult human population: linoleic acid (18:2n-6), an omega-6 fatty acid; and α-linolenic acid (18:3n-3), an omega-3 fatty acid. These fatty acids are considered essential because they cannot be synthesized by the body, and must therefore be supplied through the diet. Linoleic acid, a polyunsaturated fatty acid, is found in most dietary fats and oils, and is particularly high in corn and soybean oils. α-linolenic acid (ALA) is less prevalent in the diet, with potential sources including flaxseed and flax oil, hemp oil and canola oil, as well as certain animal products, including eggs (Table 1). With respect to requirement estimates, the current Adequate Intake (AI) values for linoleic acid are 12 and 17 g/d for young women and men, respectively. The Adequate Intake values for ALA are 1.1 and 1.6 g/d for young women and men, respectively.  Continue reading “Omega-3 fatty acids: are we getting enough”

Read Papers from The Controversial Role of Macronutrient Composition in Diabetes and Related Disorders

In 2013, ENC sponsored and organized a satellite symposium “The Controversial Role of Dietary Protein in Diabetes and Related Disorders” chaired by Mitch Kanter, PhD, Executive Director, ENC, held in conjunction with the American Society for Nutrition’s 2013 Advances and Controversies in Clinical Nutrition Conference (December 5-7,2013) in Washington, DC.

The program featured presentations which provided an overview of the available evidence on macronutrient composition and specifically, dietary protein, in the prevention and management of diabetes and diabetes-related risk factors. Coordinated by Tia Rains, PhD, Senior Director, Nutrition Research & Communications, ENC, proceedings were recently published in a supplement within Journal of Nutrition titled: The Controversial Role of Macronutrient Composition in Diabetes andRelated Disorders of the Journal of Nutrition.

Click below to access the online reprint of each article:

Kevin C Maki and Alyssa K Phillips. Dietary Substitutions for Refined Carbohydrate That Show Promise for Reducing Risk of Type 2 Diabetes in Men and Women

Amy P Campbell and Tia M Rains. Dietary Protein Is Important in the Practical Management of Prediabetes and Type 2 Diabetes

Theresa A Nicklas, Carol E O’Neil, and Victor L Fulgoni III. Differing Statistical Approaches Affect the Relation between Egg Consumption, Adiposity, and Cardiovascular Risk Factors in Adults

Barbara A Gower and Amy M Goss. A Lower-Carbohydrate,Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes

Can People with Heart Disease Start Eating Eggs Again?

Eggs-One-CrackedFor the past several decades, individuals with heart disease or at high risk for the development of heart disease have been advised to consume <200 mg/day of dietary cholesterol, whereas healthy adults are advised to consume <300 mg/day. Such recommendations are based on the assumption that dietary cholesterol produces harmful increases in blood cholesterol, which increases risk for developing atherosclerosis.

However, this simplistic thinking of A (i.e., dietary cholesterol) increases B (i.e., blood cholesterol) which increases C (i.e., heart disease risk) has been challenged in recent years as advances in diet and cardiovascular disease (CVD) research have revealed that the story is not that straight forward .  We now know that there are other risk factors that influence heart disease risk potentially as much as or more so than elevated blood cholesterol (e.g., inflammation, vascular function, etc.). And with regards to blood cholesterol, not all types of “bad” cholesterol (LDL-cholesterol) may be atherogenic.  Finally, dietary patterns may be more important for influencing CVD risk markers than isolated components, like dietary cholesterol.  And dietary cholesterol may not adversely affect CVD risk factors to the same degree as was previously thought.

Consistent with this thinking is a recently published paper by Dr. David Katz from the Yale University School of Medicine.  His laboratory evaluated 32 patients with documented coronary artery disease who consumed one of three daily breakfast treatments for 6 weeks each: 2 eggs/day; ½ cup of Egg Beaters/day; high-carbohydrate meals such as a bagel, waffles, pancakes, and cereal with milk.  Each treatment period was separated by a 4-week washout.

A number of different cardiovascular risk markers were measured before and after each 6-week intervention period.  Compared to the high-carbohydrate condition, 2 eggs/d did not adversely affect flow-mediated dilatation (an indicator of vascular function), blood cholesterol, blood pressure, or body weight. Further, there were no differences between the 2 egg/day and Egg Beaters conditions.  This despite the fact that cholesterol intake was 742 mg/d in the egg group versus ~200 mg/d in the Egg Beaters and high-carbohydrate breakfast conditions.

This is the first clinical intervention study to evaluate the effects of cholesterol/egg intake on multiple cardiovascular risk markers, including endothelial function, in patients with diagnosed CVD.  The investigators state in the paper that, “Excluding eggs from the diets of patients with CVD as per the AHA dietary recommendations could potentially lead to alternate choices high in starch and sugar, potentially associated with increased CVD morbidity and mortality.”

Although this study was small and relatively short in duration, the results certainly challenge the current thinking around cholesterol restrictions for those with CVD.  As is always the case in nutrition science, additional research is needed to better understand the role of dietary cholesterol in disease risk and progression.

What’s New in the World of Diabetes Research?

Amy-Campbell_2Today’s post comes from Amy Campbell, MS, RD, LDN, CDE. Campbell is a nationally-known dietitian, author, blogger and lecturer specializing in nutrition and diabetes management. As a certified diabetes educator, she was a diabetes educator and program manager at Joslin Diabetes Center in Boston, MA for over 19 years. She is a contributing author to Diabetes Self-Management and Walgreens’ Diabetes & You magazines, where she also serves on the editorial board, and writes a weekly blog for the Diabetes Self-Management website. In addition, she co-authored a book entitled 16 Myths of a “Diabetic Diet”, published by the American Diabetes Association, for which she received both the Will Solimene Award of Excellence in Medical Communication and the 2000 National Health Information Award. Campbell is a Health Professional Advisor for the Egg Nutrition Center, serves on the expert panel for US News’ “Best Diets,” is a Sharecare.com expert and has been an advisor for Calorie King, America’s leading provider of calorie-centric education tools and programs.

The landscape of diabetes research is constantly changing.  As a certified diabetes educator, I admit that I often have a hard time keeping up with the latest developments that are coming (or that have come) down the pipeline. The race for a diabetes cure is still going full throttle, but in the meantime, researchers are busy looking for other ways to treat a chronic condition that currently affects 29 million Americans and that could potentially affect another 86 million who are at risk for developing type 2 diabetes.

A Bionic Pancreas

It sounds so “new-agey,” but researchers at Boston University and Massachusetts General Hospital have created and are currently testing a bionic pancreas for people with type 1 diabetes. People with type 1 diabetes must inject insulin to survive. Most people with type 1 inject insulin anywhere from 2 to 4 times daily, or use an insulin pump to infuse insulin, and check their blood glucose up to 10 times (or more) every day. Obviously, this is a very labor-intensive disease. The bionic pancreas consists of a tiny sensor that’s inserted underneath the skin. This sensor monitors the level of glucose in the tissue and based on that level, can deliver insulin or glucagon via two automatic pumps.  In one instance, twenty adults wore the bionic pancreas and carried a wireless monitor for five days, doing and eating what they wanted, and following no particular schedule.  In another instance, 32 children wore the pancreas for five days while at a camp for children with type 1 diabetes.  The findings? There were 37 percent fewer interventions for hypoglycemia and more than a twofold reduction in time spent in hypoglycemia. Overall, blood glucose levels were significantly improved, particularly during the overnight hours1. The diabetes community is excited about this new technology, but it’s not yet ready for prime-time. The technology needs refining, and larger-scale clinical trials are necessary to show efficacy and safety before the bionic pancreas is suitable for home use.  Stay tuned!

Good Fat, Bad Fat, White Fat, Brown Fat

Chances are you don’t think too much about the type or color of the fat in your body. Well, maybe it’s time to give your fat a second look! When we think about fat, we generally think in terms of having too much of it and ways that we can reduce the amount. But researchers are looking at fat in a different light; specifically, they’re looking at the color of the fat in the body. White fat, which is the most abundant type of body fat, is found throughout the body, and it cushions and protects internal organs. Too much of it can raise the risk of metabolic syndrome, type 2 diabetes and heart disease. Brown fat, on the other hand, is packed with mitochondria, which produce energy for cells. This type of fat actually burns calories to generate heat. It’s found in just a few spots in the body: in the front and back of the neck, between the shoulders, and around the heart and kidneys. Scientists are trying to figure out how to expand the amount of brown fat in the body as a possible treatment for obesity. In addition, newer research shows that brown fat can increase the uptake of glucose from the bloodstream2. Harnessing the dual power of brown fat could prove to be a boon for those with type 2 diabetes, especially as 85 percent of those with type 2 are overweight or obese.

Creating Beta Cells from Stem Cells

We’ve heard a lot about stem cells over the past few years, and while it may seem like the hype has died down a bit, in the field of diabetes, stems cells are hot! A team at Harvard has figured out how to transform embryonic stem cells into beta cells, which are the cells in the pancreas that produce insulin. These cells could then be injected into the pancreas to work their magic. The researchers have developed a method that converts the stem cells into beta cells within 30 days. When the new beta cells were injected into mice with diabetes, they went to work right away and essentially cured the mice’s diabetes within 10 days3. More research is needed, but this methodology will hopefully result in the same effect in humans.

Google’s Contact Lens

Google is more than just a search engine. Google scientists have forayed into the healthcare arena and are busy creating contact lenses that contain special sensors. These sensors can detect levels of glucose in tears. Currently, there are two ways that people with diabetes can monitor their blood glucose levels: with a blood glucose meter, which requires finger sticks, and with a continuous glucose monitor, which involves inserting a sensor underneath the skin that measures interstitial glucose. Both methods are invasive. Google has teamed up with Alcon, a division of Novartis, to develop the contact lenses which will contain a microchip and a low-powered circuit. Information about the glucose level in tears (which will be checked once a second), as well as warnings for impending hypoglycemia, will be sent to a mobile device4. Once again, stay tuned!

 

References

  1. Russell, SJ, El-Khatib FH, Sinha M et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med 2014; 371:313-325.
  1. Olsen JM, Sato M, Dallner OS. Glucose uptake in brown fat cells is dependent on mTOR complex2-promoted GLUT1 translocation. J Cell Biol 2014; 207:365-374.
  1. Pagliuca FW, Millman JR, Gurtler M et al. Generation of functional human pancreatic B cells in vitro. Cell 2014; 159:428-439.
  1. Otis B and Parvis B. (2014, January 16). Introducing our smart contact lens project. Accessed November 18, 2014 from http://googleblog.blogspot.com/2014/01/introducing-our-smart-contact-lens.html.