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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Re-evaluating What Constitutes a Healthy Diet

The-Big-Fat-Surprise-209x300The ongoing, seemingly endless nutrition debate about what constitutes a healthy diet just got a little hotter. In recent weeks a new book entitled The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet [1] hit bookstore shelves, and was followed by an article in the current issue ofTime magazine called “Ending the War on Fat.” The primary message of both the book and the article is that the past fifty years or so of diet advice dispensed by various health agencies, and countless research studies performed on the diet/heart disease relationship, have been mostly flawed.  And before you discount these two recent sources as the work of lay authors, it should be pointed out that a couple of well-done, albeit controversial, meta analyses out of UC-Berkeley [2] andCambridge University [3] in England largely support the principal conclusions of the book and the Time article -that current evidence does not support low consumption of saturated fats or cholesterol as antidotes to cardiovascular disease (CVD).

How did this change in thinking come about, and where might it lead us in the future? Regarding the former, the realization that fifty years of dietary advice (that was mostly adhered to by a large segment of the population) suggesting we eat less red meat, fewer eggs and less dairy products has done little to limit the rate of CVD in the U.S. and that at the same time we were becoming more and more overweight and obese as a nation, has caused many health experts to re-evaluate the data on which these recommendations were based. And what this re-analysis indicates, among other things, is that the majority of the studies on which macronutrient intake recommendations are based were epidemiological studies, which are great for hypothesis generation but marginal for establishing cause-and-effect. Worse yet, information gleaned from some of these studies have been extrapolated or inferred to help create a story that may not exist. Both the aforementioned book and Time article tell the story of how some of the data from Ancel Keys’ well-known Seven Countries Study was apparently cherry-picked so that only data from countries that supported a saturated fat/CVD relationship were included in Keys’ analysis, and countries that did not fit this paradigm were excluded.

Another point worth noting is the possible unintended consequence of food substitution: if a person adheres to dietary advice suggesting less saturated fat and cholesterol consumption, what would he/she likely add into the diet to make up for the nutritional and caloric shortfall created by removing fats? The answer is, of course, carbohydrates. Primarily refined carbs and sugars. And newer research indicates that many of the consequences of a low fat/high refined carb diet – elevated triglycerides, decreased insulin sensitivity, more small, dense LDL particles, greater vascular inflammation, increased body weight, etc. may be the real culprits in elevated CVD risk. Ironic, isn’t it, that the foods once promoted as a healthier alternative to higher fat fare may turn out to be “the bad guys” after all?

Where will this new information lead? Still too early to tell. As any nutrition professional can tell you, diet research is fickle, and alternative hypotheses on what constitutes the healthiest diet will undoubtedly change many times in the future as new data become available. One thing that seems obvious is our need for more diet-based studies, and less single-nutrient research. When single nutrients are studied outside the context of the entire diet, misinterpretations are bound to occur. For example, dietary cholesterol as a part of a diet loaded with fruits and vegetables, whole grains, and various healthy fats and proteins may be largely innocuous; the same amount of cholesterol in a high calorie, high sugar and refined carb diet may be disease-promoting.

A healthy re-evaluation of the data on which we’ve based many of our dietary beliefs is certainly in order if we’re ever to move closer to understanding what constitutes a truly healthy diet.

 

References:

1.            Teicholz N: The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.Simon & Schuster; 2014.

2.            Siri-Tarino PW, Sun Q, Hu FB, Krauss RM: Saturated fat, carbohydrate, and cardiovascular disease. The American Journal of Clinical Nutrition 2010, 91:502-509.

3.            Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, Franco OH, Butterworth AS, Forouhi NG, Thompson SG, et al: Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Annals of Internal Medicine2014, 160:398-406.

Observations from Experimental Biology 2014

lab-scientist-stock-photo

Today’s post comes from guest blogger, Apeksha Gulvady, PhD. Apeksha holds an MA and PhD in Nutritional Sciences from the University of Texas in Austin, where her research focused on the role of aging and diet-induced obesity on immune cell function. Apeksha previously worked with PepsiCo R&D, where she supported core nutrition business activities and priorities in both global foods and beverages, and has recently joined Edelman Public Relations to pursue her passion for nutrition communications.

For years, a single nutrient paradigm laid the foundation for the efforts of nutrition science to target nutrient deficiencies. As associations between lifestyle factors and chronic diseases became more evident, the focus of research fittingly transitioned from individual nutrients to foods as carriers of these nutrients, and finally to dietary patterns of food intake that can potentially impact health. Studies on protein advanced similarly and earned their way onto the dais at the 2014 Experimental Biology (EB) conference – the world’s largest life sciences annual meeting, comprised of 24,000+ scientific researchers, federal regulators, consumer groups and industry representatives.

After four exciting days at the conference in San Diego this year, attendees’ brains were brimming with information about the power of protein in the diet, among other key topics. Protein sessions were some of the best attended sessions overall, suggesting that protein research remains of prime interest to the nutrition science community. Protein studies, several of which were supported in part or full by the ENC research grant program, pointed to how adjustment of both quality and quantity of this macronutrient can bring about small but meaningful changes in metabolism and body composition.

In one study presented at EB 2014, egg protein, when consumed for breakfast, was shown to affect postprandial energy metabolism and provide increased satiety in overweight children.1 Protein, therefore, may play a key role in weight management. Another study demonstrated that consumption of one egg per day did not influence blood lipid levels in diabetic patients. Egg protein was thus concluded to not increase risk for cardiovascular disease in the study population.2

Beyond protein, evidence from a meta-analysis of dietary cholesterol and heart health suggested that previously declared correlations between dietary cholesterol consumption and heart disease may be unfounded.3 Researchers also investigated the effects of differential macronutrient distribution in the diet and found that lowering carbohydrate intake had the potential to decrease insulin resistance4 and accelerate fat oxidation.5 Exploring the link between diet, diabetes and cardiovascular disease, an animal study found whole egg protein increased blood vitamin D concentrations and favorably affected physiologic diabetic dysfunctions.6 And in another study of nutrient adequacy, eggs were found to potentially positively impact serum levels of certain carotenoids.7

As presented at the 2014 EB conference, current evidence thus suggests that consuming eggs as a source of high-quality protein may assist in weight loss, improve disease risk factors and promote intakes of certain nutrients. However, whether the aforementioned effects can be sustained over time warrants additional investigation.

References:

  1. Binns A, Gray M, Seo H-S, Zhang B, Luckett C, Smith K, Baum JI. Consumption of an egg-based breakfast reduces hunger and increases postprandial energy metabolism in normal weight (NW) and overweight (OW) school-aged children. FASEB J. 2014;28(1S):381.4.
  2. Ballesteros MN, Valenzuela F, Robles A, Artalejo E, Valdez H, Fernandez ML. One egg a day does not increase the risk for cardiovascular disease in diabetic patients. FASEB J. 2014;28(1S):381.5
  3. Berger SE, Raman G, Vishwanathan R, Jacques P, Johnson EJ. Dietary cholesterol and heart health: a systematic review and meta-analysis. FASEB J. 2014;28(1S):267.6.
  4. Watkins BA, Pappan KL, Kim J, Freidenreich D, Kunces L, Volk B, Saenz C, Volek J. Carbohydrate feeding and impact on global metabolomics in relation to insulin sensitivity in men with metabolic syndrome. FASEB J. 2014;28(1S):248.8.
  5. Kunces LJ, Volk B, Freidenreich D, Saenz C, Fernandez ML, Maresh C, Kraemer W, Phinney S, Volek J. Effect of a very low carbohydrate diet followed by incremental increases in carbohydrate on respiratory exchange ratio. FASEB J. 2014;28(1S):LB444.
  6. Van Wyk K, Schalinske K. Whole egg protein markedly increases blood vitamin D concentrations in male Sprague-Dawley rats. FASEB J. 2014;28(1S):1041.9.
  7. Aljohi H, Dopler-Nelson M, Wilson TA. Consumption of 12 eggs per week for 1 year increases serum zeaxanthin concentrations but not other major carotenoids, tocopherols, and retinol in humans. FASEB J. 2014;28(1S):645.25.

April Fools’ Day: Don’t Get Fooled by a Subpar Breakfast

scrambled-eggs-tomato-mozzarella-and-basil-sandwich1

While April Fools’ Day is often filled with memorable pranks, there is one topic that is no laughing matter – your health. Health professionals have a responsibility to advise clients/patients on healthy lifestyle choices, including the importance of a nutritious breakfast. People need to understand that the quality of breakfast is important and that the morning meal should be both healthy and satisfyingto promote tangible health and wellness benefits – benefits that in themselves often encourage clients/patients to continue the breakfast habit.

Unfortunately, many of the typical breakfast options in today’s marketplace contain added sugars and may be lower in the nutrients needed for optimal functioning, such as protein, fiber and essential vitamins and minerals. This April Fools’ Day, don’t allow your patients/clients to be fooled by a subpar breakfast. Educate them on the importance of building a better breakfast. For instance, unlike breakfast pastries and high-sugar breakfast cereals, egg breakfasts are protein-rich and have been associated with a variety of health benefits (1-4). One large egg also contains only 70 calories, varying amounts of 14 essential vitamins and minerals and 6 grams of high-quality protein, making it a great breakfast option that stands out among the crowd.

Studies have indicated that consuming high-quality protein, like the protein in eggs, for breakfast may help individuals feel more satisfied, helping them to consume fewer calories throughout the day, and may also play a role in weight management (1,2). Moreover, another study showed that the protein in eggs provides steady and sustained energy because it does not cause a surge in blood sugar or insulin levels, which can lead to a rebound effect or energy “crash” as blood sugar levels drop (5).

While tricks abound today, don’t allow the readily available and less nutritious breakfast options to mislead your clients/patients into making less than optimal breakfast decisions. Instead, encourage them to choose an option like eggs as part of a balanced breakfast and to pair it with vegetables, whole grain toast, fruit or low-fat dairy. This can help them feel satisfied longer while giving them the boost they need to conquer the day ahead – all with a sense of humor!

 

References:

  1. Leidy HJ, et al. Neural responses to visual food stimuli after a normal vs. higher protein breakfast in breakfast-skipping teens: a pilot fMRI study. Obesity, published online May 5, 2011.
  2. Leidy HJ, et al. Increased dietary protein consumed at breakfast leads to an initial and sustained feeling of fullness during energy restriction compared to other meal times. BJN, published online September 2, 2008.
  3. Rampersaud G, et al. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. JADA 2005; 105:743-760.
  4. Pollitt E, et al. Fasting and cognition in well- and undernourished school children: a review of three experimental studies. AJCN 1998; 67:779S-784S.
  5. Layman DK. Protein quantity and quality at levels above RDA improves adult weight loss. J Am Coll Nutr 2004; 23(6):631S-636S.

Debunking Cholesterol Myths During American Heart Month

cookie-cutter-toad-in-the-holeHearts are a hot topic in February and can be found everywhere, from your clinic to your local grocery store.  Today many celebrate Valentine’s Day, a day full of heart shaped messages, “conversation hearts” and more.  Throughout the month, you may also be continuing the heart (health) conversations through presentations, events and fairs in your community or clinics to celebrate American Heart Month.

American Heart Month brings awareness to the important issue of heart disease.  According to the Centers for Disease Control and Prevention, about one in four deaths in the United States each year are attributable to heart disease.1 Although this statistic is staggering, health professionals can play a role in motivating their clients to choose healthy habits that may lessen the risk of developing heart conditions including cardiovascular disease. In fact, many heart disease risk factors are modifiable lifestyle choices, and behavioral adjustments related to diet, physical activity and smoking.

Heart healthy conversations focus on nutrition as one of the modifiable risk factors.  While health professionals are familiar with heart-healthy diets, some uncertainty still exists regarding the effects of foods containing dietary cholesterol like eggs on heart health. The great news is that more than 40 years of research demonstrates that healthy adults can enjoy eggs without significantly impacting their risk of heart disease.2 In fact, a recently conducted meta-analysis published in The American Journal of Clinical Nutrition found no association between egg consumption and risk for cardiovascular disease.3 Research has also shown that egg consumption does not significantly impact the LDL:HDL ratio – a marker that has been shown to be a predictor of cardiovascular disease risk.

You, as a health practitioner, can help debunk myths regarding dietary cholesterol and cardiovascular disease by encouraging a total diet approach and guiding clients towards heart-healthy choices by recommending fruit, vegetables, whole grains, low- fat dairy and nutrient-rich sources of high-quality protein.

We’re interesting in hearing what heart-healthy conversations you  are having on Valentine’s Day and during Heart Health Month.  Comment below!

New Research Suggests Correlation Between Sugar Consumption and Cardiovascular Disease

Health professionals, particularly nutrition researchers, have long been aware of the need for prudence when it comes to consuming sugar-laden foods and beverages. While a healthy diet can include occasional treats, a growing body of scientific evidence suggests that the consequences of sugar, particularly from sugar-sweetened beverages, may extend beyond the poor nutrient density.

A recent noteworthy study published in JAMA Internal Medicine  reported that participants consuming the highest level of calories from added sugars had three times the risk of dying from cardiovascular disease compared to those consuming the lowest levels of added sugar, independent of other related risk factors such as total calorie consumption, obesity and smoking.1 Further, participants consuming more than 10% but less than 25% of calories from added sugar (the Institute of Medicine recommendation), had a 30% higher risk of cardiovascular mortality.  While refined carbohydrates including processed and prepared foods such as sugar-sweetened beverages, grain-based desserts, fruit drinks, dairy desserts, candy, ready-to-eat cereals and yeast breads have taken much of the blame for what has been called the “epidemic” of overweight and obesity in the US, this new evidence suggests that high intakes of added sugar also impact cardiovascular disease, currently the number one cause of death in our country.

Transition Over the Years

Consumption of added sugars has risen over the past 30 years, at the same time that public health agencies have been recommending lower intakes of saturated fat and cholesterol to lower risk of developing cardiovascular disease and related outcomes. However, the comprehensive body of literature over the past several decades has shown that adults can enjoy cholesterol-containing foods like eggs without significantly impacting their risk of heart disease or stroke.

While the research is still evolving on the health consequences of eating refined carbohydrates and added sugars, emerging studies indicate that protein as an alternative energy source at breakfast, especially when paired with nutrient-rich foods such as vegetables, fruits, low-fat dairy and whole grains, provides a balanced start to the day. Help clients start their day with a healthy, high-quality protein, low-sugar recipe such as this simple and delicious Microwave Egg & Veggie Breakfast Bowl.

microwave-egg-and-veggie-breakfast-bowl

 

 

References:

1)      Yang Q et al. Added sugar intake and cardiovascular diseases mortality among US adults. (JAMA Intern Med; e-pub Feb 3, 2014.) Accessed Feb 5, 2014. https://archinte.jamanetwork.com/article.aspx?articleid=1819573.