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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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.

ENC Sponsored Symposium on Dietary Protein and Diabetes

program

Last week ENC sponsored a symposium titled, “The Controversial Role of Dietary Protein in Diabetes and Related Disorders” as part of a scientific meeting hosted by the American Society of Nutrition in Washington DC. Attended by almost 100 health professionals, this event was designed to bring together researchers and clinicians to review the available evidence on macronutrient composition and specifically, dietary protein, in the prevention and management of diabetes and diabetes-related risk factors.

The presenters included Kevin Maki, Ph.D., Biofortis/Midwest Center for Metabolic and Cardiovascular Health; Theresa Nicklas, DrPH, Baylor College of Medicine; Barbara Gower, Ph.D., University of Alabama; and Amy Campbell, MS, RD, LDN, CDE, Joslin Diabetes Center. Campbell. Mitch Kanter Ph.D., Executive Director of ENC, moderated the event.

ENC also talked with attendees during the exhibit hours and passed out research reprints and education materials. People were also able to sign up for the Nutrition Research Update (NRU). Do you receive the NRU? If not, sign up here.

 

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Being “Diabetes Aware”

Amy-Campbell_2Today’s post comes from Amy Campbell, MS, RD, LDN, CDE. Campbell is a registered dietitian and certified diabetes educator at Joslin Diabetes Center. She is actively involved in education initiatives, both at Joslin and with the American Association of Diabetes Educators, the American Diabetes Association and the Academy of Nutrition and Dietetics. She has authored several books published by the American Diabetes Association and recently received the 2012 Will Solimene Award for Excellence in Medical Communication. Campbell is also a member of the Egg Nutrition Center’s Health Professional Advisor panel.

We’re in the midst of November now and the winter holidays are encroaching upon us.   Very likely, your mind is busy focusing on what to cook for Thanksgiving dinner, your son or daughter coming home for break, raking leaves or getting a head start on some holiday shopping.  What often doesn’t come to mind is diabetes.  A little known fact is that November is known as diabetes awareness month (with World Diabetes Day falling on November 14).

If you’re a healthcare professional, no doubt, your career has been touched in some way by diabetes, whether by counseling patients who have diabetes, writing articles or teaching classes.  Diabetes touches all of us in some way or another, either professionally or personally.  And the grim reality is that diabetes prevalence keeps growing and growing.   Check out the latest statistics about diabetes from the 2011 National Diabetes Fact Sheet which you can find on the American Diabetes Association’s website at www.diabetes.org/diabetes-basics/diabetes-statistics/.

  • 26 million Americans have diabetes (about 8% of the population)
  • 7 million Americans don’t know that they have diabetes
  • 79 million Americans have prediabetes
  • 366 million people, worldwide, have diabetes
  • $245 billion dollars was spent on diabetes in the U.S. in 2012

You probably know that the rate of diabetes continues to increase, both in the U.S. and across the world.    The International Diabetes Federation (IDF, for short) aptly describes diabetes as being a “global burden”, predicting that by the year 2030, 552 million people worldwide will have diabetes (one third of Americans are predicted to have diabetes by 2050).   The numbers are staggering.  We have enough of a “diabetes burden” in the U.S., let alone worldwide.  Being a certified diabetes educator (CDE), what comes to mind when I see these numbers is that there’s no way that there are enough CDE’s in this country to handle the enormous number of people who have diabetes.  Everyone has to play a part in helping to combat this disease.

There’s no cure for diabetes at this time.  Until there is one, we need to focus on two things:  preventing diabetes from occurring in the first place and effectively treating diabetes to lessen the risk of potentially devastating complications, such as retinopathy, kidney disease and nerve damage.

What every healthcare provider can do is spread the message of being “diabetes aware.”  Most people know something about diabetes, but many people don’t realize just how serious it is.  It’s much more than having a “touch of sugar.”  And it doesn’t really matter if a person has type 1 or type 2 diabetes; both are equally serious.  Most people with diabetes have type 2 diabetes, with type 1 diabetes accounting for about 5 percent of the cases.

Let’s not forget about those who have prediabetes, either.  Prediabetes is defined as having blood glucose (sugar) levels that are higher than normal but not high enough to be diagnosed as diabetes.  Remember that almost 80 million Americans have prediabetes.  What can we do to help them lower the chance of developing type 2 diabetes?

Know the Risks

One of the ways that healthcare providers can increase diabetes awareness is to assess for risk.  Helping patients to know their risk factors is a first step.  The list below can help. Explain that risk for type 2 diabetes is increased if the patient:

  • Is overweight or obese (with a body mass index of 25 or higher and/or a waist circumference of greater than 35 inches if female or greater than 40 inches if male)
  • Has a parent or sibling with diabetes
  • Is African American, Hispanic American, Asian American, Native American or Pacific Islander
  • Has had gestational diabetes (diabetes that occurs during pregnancy) or has given birth to a baby weighing more than nine pounds
  • Is not physically active
  • Has a blood pressure of 140/90 mmHg or higher or has been told that he or she has high blood pressure
  • Has a HDL (good) cholesterol of less than 35 mg/dl and/or triglycerides (blood fats) higher than 250 mg/dl
  • Has been told by their healthcare provider that they have impaired glucose tolerance,  impaired fasting glucose or an A1C of 5.7 percent or higher
  • Has a history of heart disease
  • Has polycystic ovary syndrome (PCOS) – which applies only to women
  • Has acanthosis nigricans, which are dark, velvety markings on the neck or under the arms

If the patient has any of the risk factors on the above list, he or she needs to talk with their primary care provider and get checked for prediabetes or diabetes.

Getting Checked

Testing for prediabetes or diabetes involves one of the tests below. These tests should be repeated to confirm a diagnosis.  It’s important to reiterate with patients that prediabetes or diabetes cannot be diagnosed using a home blood glucose meter or via a fingerstick at, say, a health fair.

  • Fasting plasma glucose (FPG):  blood glucose is measured in a lab first thing in the morning after not eating or drinking anything (except water) for at least 8 hours.
    • Results:  a FPG of 100 to 125 mg/dl is pre-diabetes; 126 mg/dl or higher is diabetes.
  • Oral glucose tolerance test (OGTT):  the patient drinks a beverage containing 75 grams of glucose. The blood glucose is measured before and two hours after drinking the drink.
    • Results:  a two-hour glucose of 140 and 199 mg/dl means pre-diabetes; 200 mg/dl or higher is diabetes.
  • Hemoglobin A1C:  this is a blood test that measures the average blood glucose levels over the past 2-3 months.
    • Results:  an A1C of 5.7 to 6.4 percent is prediabetes; 6.5 percent or higher is diabetes.

If prediabetes or diabetes is confirmed, the next step is to refer the patient to a diabetes educator or education program so that they can learn how to effectively self-manage their condition.

The Message of Hope

Receiving a diagnosis of prediabetes or diabetes is frightening.  It’s not uncommon for people recall a family member or friend who had diabetes and suffered from complications as a result.   Unfortunately, there is still no cure for diabetes. Fortunately, there are many ways to treat this condition.  There are newer and more effective medications.  Evidence shows that lifestyle interventions (healthy eating, weight management and physical activity) can help prevent diabetes and make it easier to manage existing diabetes.

People with diabetes need to know that there is hope – and that they can live long, healthy lives with diabetes.   We know this thanks to Joslin Diabetes Center’s 50-Year Medalist Study, a program that recognizes individuals who have lived with type 1 diabetes with 50 or more years.  Recently, an individual was just recognized for having lived 75 years with diabetes!  So, until there’s a cure, there’s hope.  Help spread the message of diabetes awareness this (and every)November.

Balancing Act: Tools for Diabetes Menu Planning

IMG_2772-21-150x150Today’s post is from Carla Schmitz, one of our former dietetic interns. Carla is completing her final rotation in order to sit for the exam to become a registered dietitian nutritionist.

Planning healthy menus can be a daunting task for clients with diabetes. As health professionals we strive to make this process more manageable for our clients. ENC has partnered with the Joslin Diabetes Center to develop several tools for you to use when working with diabetic clients. This great Eating Well with Diabetes handout is accompanied by a Health Professional Teaching Guide that outlines specific learning objectives for the handout as well as provides helpful teaching tips.

Remember, successful menu planning takes practice. This can be very frustrating for clients, which is why it is beneficial to have an arsenal of techniques to help your clients develop healthy menus that also control blood glucose levels.  Here are a few tools that can be useful for clients in learning to eat a well-balanced diabetes meal pattern.

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  • Food diary: Keeping track of food intake is one of the most enlightening exercises for patients. This helps clients to take stock of their eating patterns, keep track of carbs, and see areas for potential improvement.
  • Carb counting: Using this method of calculating the carbs consumed in meals and snacks is a helpful method for diabetics to monitor their carb intake or determine insulin dosing.
  •  MyPlate: A basic and helpful tool, MyPlate is readily accessible and generally well-received by clients. The American Diabetes Association’s tips for creating a healthful plate can be found here.
  • Excellent cookbooks and recipes: Clients consistently ask for recipes and cooking tips to manage their diabetes, so it is helpful to have a list of great resources handy. Here are Joslin Diabetes Center cookbooks and recipes. You can suggest recipes that you use and enjoy. The client will realize you are eating the same foods as them and they won’t feel like they are on a special diet!

Tell us your favorite diabetes resources.

Balancing Act: Nutrition and Diabetes – Don’t Forget to Pair the Protein

Lentils and Poached Egg

When trying to manage or help patients manage type 2 diabetes, it’s easy to focus directly on carbohydrates. After all, that’s the root of the issue, right? Eating fruit, bread and other types of carbohydrates leads to a rise in blood glucose, and high blood glucose is characteristic of the condition. However, the development of type 2 diabetes is not that simple, and nutritional treatment goes far beyond carb control. Let’s steal carbohydrates’ spotlight for a moment and showcase the power of protein in blood glucose control.

In the battle of diabetes, nutrition is our knight in shining armor, and with diabetes affecting nearly 26 million Americans, it’s time for nutrition to take hold (1). Of those with diabetes, 90-95 percent have type 2 diabetes (1). It’s an issue that is not going to fade fast; we need to continue to tackle it from all sides, especially at the level of lifestyle modifications- like diet and exercise. It is critical to recognize that nutritional management of diabetes isn’t only about regimenting carbohydrate intake.  The great thing is that components of foods interact in ways that can meaningfully impact their individual and collective effects. Such is the case with carbohydrates and protein, and we can use this to our benefit when managing type 2 diabetes.

pepper By definition, carbohydrates raise blood glucose, and diabetes results from the body’s misregulation of blood glucose levels. Nutritional control therefore involves aiding the body in glucose regulation. We can do this by controlling portions and spacing of carbohydrate intake, but a crucially important addition to this approach is strategically pairing carbohydrate-containing foods with protein-containing foods. Studies have shown multiple positive effects on management of type 2 diabetes of diets that are higher in protein (2). Consumption of protein leads to increased insulin secretion, which helps the body level off the rise in blood glucose stimulated by eating. Blood glucose therefore tends to rise less after high-protein meals than meals that are particularly heavy in carbohydrates. Including protein in meals and snacks can also reduce fasting blood glucose and glycated hemoglobin, an indicator of glucose control over time (2).

Spreading carbohydrate intake over the course of the day and always pairing it with a high-quality source of protein can help diminish unwanted fluctuations in blood glucose (2). Eggs are a versatile and easy option for including protein with meals and snacks, and we can also look to Greek yogurt, low-fat cottage cheese, nuts and seeds to pair with carbohydrates. Especially in the management of type 2 diabetes, consider these options for partnering protein and carbohydrates at meals and snacks:

Snacks

  • Grab a hardboiled egg to have with veggies or whole grain crackers
  • Pair your fruit with cheese, Greek yogurt, nuts or nut butters
  • Add a dollop of hummus to carrots, peppers or other raw veggies

Meals

For more great information on managing diabetes through nutrition, check out the Joslin Teaching Guide for Health Professionals and the Patient Guide. And remember- pair it with protein!

References:

1)      Diabetes. Center for Disease Control and Prevention Web site.http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm. Published August 1, 2011. Accessed November 5, 2013.

2)      Layman DK, Clifton P, Gannon MC, et al. Protein in optimal health: heart disease and type 2 diabetes. Am J Clin Nutr. 2008; 87(5):15715-55. http://ajcn.nutrition.org/content/87/5/1571S.full. Accessed November 5, 2013.

3)      Recipes & more. American Egg Board. www.incredibleegg.org. Updated 2013. Accessed November 5, 2013.