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


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!



  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.





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.

ENC Sponsored Symposium on Dietary Protein and Diabetes


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.



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

  • 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.