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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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.

Tackling the Myths Surrounding Cholesterol

rebecca-teal-150x150Today’s post is the start of a series of blogs from our friend Rebecca Scritchfield MA, RD, ACSM HFS. She’s giving us health professionals some tips and tools to be able to discuss cholesterol myths and misinformation with our clients.Disclosure from Rebecca Scritchfield MA, RD, ACSM HFS: I was compensated by Egg Nutrition Center for my time in writing this blog post.

With so much focus on food and healthy eating these days, your patients are probably asking you about what they should eat. Chances are they’re confused because of conflicting information out there. Your poor patients aren’t sure who to believe. An example is with eating whole eggs. One day consumers hear “eggs are good,” only to find out another day “eggs are bad.” So what does the science say? In this blog I’m going to tackle some of the most common cholesterol egg myths your patients are most likely to come across. You, as a health professional, can help them sort fact from fiction.

Top 3 Myths About Eggs and Cholesterol

Myth:  Eating whole eggs will raise your “bad” blood cholesterol levels.

Fact:  Healthy people can enjoy whole eggs daily without negatively impacting their blood cholesterol levels.(1) Current Dietary Guidelines for Americans mention enjoying one egg each day.(2) Dietary cholesterol intake, while once thought to be the culprit in elevated LDL levels, doesn’t usually contribute to blood cholesterol levels. Research has shown that it may actually be saturated fat and trans fats in foods that is correlated with higher LDL cholesterol.(3)

Additionally, egg consumption does not significantly impact the LDL:HDL ratio – one of the best known and scientifically established indicators of heart disease risk. A 2008 review of more than 30 studies published in the Journal of the American College of Nutrition argued that the LDL:HDL ratio is a much better indicator of heart disease risk than either indicator alone. Some research has even shown that egg intake actually decreases levels of LDL.(1)

Finally, it’s important to remember that food is only one of the potential contributors to high blood cholesterol, including genetics, age, gender, and physical activity.

Myth: Egg whites are healthier than egg yolks. If you are watching your cholesterol or weight you should throw out the yolks and eat only the whites.

Fact: Don’t trash the yolks – egg yolks are nutrient goldmines. Yolks have a variety of important vitamins and minerals, including choline and Vitamin D, which are nutrients that tend to be inadequate in the American diet. Yolks also have high-quality protein and antioxidants, and only contain 50 calories each.

Many of the nutrients found in egg yolks, such as choline and folate, are known to support healthy fetal development. When I was pregnant with my daughter I regularly ate 2 whole eggs with a half an avocado and spinach for breakfast. I wanted to be sure I wasn’t missing out on all those vital nutrients to keep her healthy.

Myth: Eating eggs increases your risk for cardiovascular disease.

Fact:  More than 40 years of research have shown that healthy adults can enjoy one egg daily without significantly impacting their risk of heart disease.(4) A prospective cohort study out of Harvard that included more than a hundred thousand subjects found no significant difference in cardiovascular disease risk between those consuming less than one egg per week and those consuming one egg per day.(5)

There is a history of heart disease in my family, so I’m definitely concerned about keeping my heart as healthy as possible. I take good care of myself. I exercise, meditate, sleep well, and eat right. It’s all about balancing good, sensible habits. I consume eggs regularly because they are delicious, healthy, and easy to prepare. I am confident they aren’t contributing to my risk of cardiovascular disease based on the science.

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Get more scientific evidence, including data from a meta-analysis of the research relating to the effects of eggs on cardiovascular health in this article by Dr. Tia Rains. The message about the relationship between eggs and heart-health has been murky for a long time. It’s not surprising patients are confused. I’m sure you have heard at least one of these “egg myths” before and I hope this information helps make it easier for you to update your patients.

Feel free to share information from this blog in your patient communication programs and social media to clear up the myths once and for all.

Here are some “take aways” you can have on hand for your patients:

  • “An egg a day is OK!” You can eat the whole egg. Most important is following an overall heart healthy diet, being physically active, and monitoring your lab values as you age.
  • Go ahead and eat whole eggs if you like them as part of a balanced eating plan.
  • For breakfast think about pairing eggs “your way” with fruit. At lunch, eggs can be delicious on a salad. For dinner, try a veggie stir fry with scrambled egg.
  • Don’t trash the yolks. Egg yolks have a variety of important vitamins and minerals people need for health and wellness.
  • Healthy adults can enjoy one egg daily without significantly impacting their risk of heart disease.

If you’re interested in more information about eggs and cholesterol, along with the latest research, check out this handout from the Egg Nutrition Center. There’s also one developed for patients to clear up the cholesterol myth once and for all.

hp_cholesterol_brochure

References:
1Hu FB, Stampfer MJ, Rimm EB et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA. 1999; 281:1387-94.
2 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.
3 Harman NL, et al. Increased dietary cholesterol does not increase plasma low density lipoprotein when accompanied by an energy-restricted diet and weight loss. European Journal of Nutrition2008;47:287-293.
4 Fernandez ML and Webb D. The LDL to HDL Cholesterol Ratio as a Valuable Tool to Evaluate Coronary Heart Disease Risk. JACN 2008;27 (1):1-5.
5 Hu FB, Stampfer MJ, Rimm EB et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA.1999; 281:1387-94.