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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Health Experts Share Insights on Recent Egg Research

As discussed in a previous post, the recent study on egg consumption published in Atherosclerosis was surprising and contradicts more than 40 years of research demonstrating that healthy adults can enjoy eggs without significantly impacting their risk of heart disease. As we continued watching news on the topic unfold, we saw that many health professionals had independently reviewed the study and voiced their interpretations of the study’s results on news, health and social media websites.

If you are interested in a detailed analysis of the study and what it means to you as a health professional, check out some of these insights from notable health and nutrition experts:

  • Sports dietitian Chris Mohr PhD, RD, explains on MohrResults.com, “With this study there were a ton of controllable factors, which all can play a role in atherosclerosis, that weren’t examined.”
  • Further insights are provided by Sheah Rarback, MS, RD, in the Miami Herald. “Saturated and trans fatty acids are the primary culprits in raising blood cholesterol levels. Recent clinical studies on the effect of dietary cholesterol on plasma lipid levels have shown that it has a measurable — but mostly clinically insignificant — effect on plasma cholesterol levels.”
  • Dr. Briffa continues on DrBriffa.com, “Another fundamental problem with research of this nature as it relies on individuals reporting how much and/or often they eat of specific foods.”
  • Susan Dopart, MS, RD, CDE agrees with this position on SusanDopart.com. “Research shows that when you have patients ‘recall’ what they ate, especially over many years like this study did, the accuracy is quite questionable.”
  • Taking a closer look at the data on Health Goes Strong, Robyn Flipse, MS, RD, points out, “What the research did show is that eating eggs improves the overall blood cholesterol profile, but that was nowhere to be found in the headline.”
  • When asked about the study by ABC News, Dr. Steve Nissen of the Cleveland Clinic cautioned, “It is extremely important to understand the differences between ‘association’ and ‘causation’.”
  • Putting things into perspective, Elizabeth Ward, MS, RD blogged on WebMD, “This is a single, observational study that does not prove cause and effect and does not change the fact that more than 40 years of research suggests that healthy people can eat eggs without having a significant impact on their risk for heart disease.”
  • Martha McKittrick, RD, CDN, CDE offers a good piece of advice for consumers on City Girl Bites, “The majority of studies have shown that eggs can fit into a healthy diet. The key is moderation. The effect of the cholesterol found in eggs on blood cholesterol will vary from individual to individual.”
  • Concluding her article in the Clarion Ledger, Kathy Warwick, RD, CDE states, “Eggs are a nutritious low-calorie, high protein food that provide 13 essential vitamins and minerals. As with all things dietary, eggs can be part of healthy balanced diet. Daily exercise and maintaining a healthy weight are crucial for preventing heart disease.”

Obviously, many health experts agree there are several limitations to the study and the results should be interpreted in light of the entire body of research on eggs, cholesterol and heart disease. We would like to thank the many health professionals who have shared their insights and continue to inform consumers about the nutritional benefits of eggs!

Egg Research Update: Atherosclerosis Study

A study published in the journal Atherosclerosis last week suggested that eating eggs can be almost as damaging to you heart as smoking cigarettes. Maybe you’ve seen the press coverage? It was all over the media last week and, needless to say, it kept us pretty busy at the Egg Nutrition Center. First thing we did was contact seven cardiovascular researchers for their perspectives on the study; three of the seven are among the leading epidemiology researchers in the country. All pointed out a number of flaws in the study design, ranging from:

  • “this was a cross sectional study and, as such, it is impossible to reach a case-and-effect conclusion”
  • “there didn’t appear to be any dietary control for other dietary constituents (besides eggs)—a fatal flaw”
  • “the failure (of the researchers) to adjust…for age is a major if not fatal flaw”
  • “the subjects were already sick…this is the classic setup for reporting bias that could lead to exactly the results that they found in that those who were sickest reported the highest egg intakes…”.

And on and on. Most of the researchers we queried wondered how the study was accepted for publication considering its flaws.
It should be noted that the lead researcher on this project has had issues with eggs before. A couple of years ago he was quoted as saying that an egg was worse for you than a Kentucky Fried Chicken Double Down sandwich (a breadless sandwich with three pieces of fried chicken; 540 kcals; almost 40 gms fat; 1400 mg sodium). A dubious statement, to say the least, but one that may help explain a pre-conception the author has about eggs that may have carried over into the recent study.

It is always a shame when studies of this nature garner so much media attention. While it would have been nice for reporters to have done their homework first and uncovered some of the flaws and biases associated with this study before running with it, I suppose that the headline (Eggs are as Bad as Cigarettes) was just too tantalizing to pass up.

At the Egg Nutrition Center we’ll continue to study the effects of eggs on human health as we’ve always done, and we’ll let the chips fall where they may regarding the results of the projects we fund. We adhere to the Guidelines for Industry Funded Research and request that all investigators who work with us do the same. We realize that not every study will yield a positive result; that’s the nature of science. The key is to support well- designed, well-controlled studies so that you can feel good about the results, whatever they happen to be. In the case of the recent Atherosclerosis paper, I’m not so sure that’s what we got.

Advances in Protein Research

Is it just me or is there growing interest in understanding the importance of the long overlooked macronutrient protein? Protein has always seemed like the Cinderella of diet planning. Carbohydrates and fats always commanded much more attention in dietary guidance, including protein as only afterthought.

As the baby boomer generation enters their senior years there seems to be a growing concern about keeping healthy through diet and exercise. Baby boomers are seeing that the high carbohydrate/low fat meals they were advised to prepare left them perpetually hungry and often at risk of cardiovascular disease related to the unattractive spare tire around their abdomen.  It’s time to ask why have the last 20 years seen an epic growth of obesity, metabolic syndrome and little change in the cardiovascular disease rates despite this supposedly healthy dietary advice?

Enter the shocking success of the Atkins/South Beach diets that found followers experienced more sustained relief from hunger and improved cardiovascular risk factors resulting from a reduction in carbohydrates and an increase in both fat and protein intake. People who previously sacrificed their favorite full fat meat, cheese and chicken dishes found that they could eat these foods again if they gave up white rice, bagels and pasta and surprisingly, were rewarded with increased high density lipoprotein levels along with reduced triglycerides and body weight garnering praise from their physician.

Now the scientific community appears to be catching up with the success of the higher protein intake. Two published studies1,2 looked at the effect of high protein intake on diabetes control.  In the Why WAIT (Weight Achievement and Intensive Treatment) Program, developed at the Joslin Diabetes Center for diabetes weight management in clinical practice, a high protein-low carbohydrate (30% protein [1.5–2 g/kg] and 40% carbohydrates) energy–restricted diet was tried within a multidisciplinary diabetes weight management program for 12 weeks. The authors conclude that an intake of 1.0-1.5 gm/kg of protein is appropriate for diabetics, helping to improve many health risk factors including a lower HbA1c in addition to a reducing total serum cholesterol, LDL cholesterol, triglycerides, blood pressure and markers of inflammation. The researchers reported diabetic patients were less hungry after meals, which contributes to their lower calorie intake and subsequent reduced body weight while maintaining muscle mass. The authors do however make the point that a higher protein intake may be contra- indicated in patients with diabetes accompanied by chronic kidney disease.

More recently, a study published in Advances in Nutrition 3 suggests the brain’s control of appetite is greatly affected by protein intake. From both animal and human research the authors conclude that after protein consumption, peptide hormones are released from the gastrointestinal tract that communicates information about the peripheral energy status to the brain. These hormones control food intake by acting on brain regions involved in energy homeostasis such as the brainstem and the hypothalamus.  High-protein diets lead to greater activation than a normal-protein diet in the regions of the brain responsible for satiety. These areas are triggered particularly by leucine, a branched chain amino acid that influences the reward and motivation aspects of eating behavior and plays an important role in the reduced hedonic response associated with a high-protein intake.

1         Hamdy, O. Issues in Nutritional Treatment of Type 2 Diabetes Mellitus and Obesity, Current Diabetes Reports, April 2011, 11(2):75-6.

2         Hamdy, O. and Norton E.S. Protein Content in Diabetes Nutrition Plan, Current Diabetes Reports, April 2011, 11(2):111-9.

3         Journel, M. et. al. Brain Responses to High Protein Diets, Advances in Nutrition, 2012, 3:322-9.

Bite Into Breakfast and You May Also Take a Bite Out of Diabetes

Today’s blog post is written by Allison Fischer, Dietetic Intern at Loyola University.

Enjoy!

By now you have most certainly heard that breakfast is the most important meal of the day. There are many benefits to eating breakfast – positive impacts on learning and memory, increased likelihood of meeting daily nutrient intake recommendations, lower BMI, and avoiding weight gain. Another study area is relationship between breakfast consumption and decreased risk of Type 2 Diabetes (TD2).

A recent study published in the American Journal of Clinical Nutrition examined the relationship between eating patterns and T2D risk in men. Almost 30,000 health professionals were followed twenty years and provided information regarding their medical histories, lifestyles and health related behaviors. Their diets were assessed according to reported foods eaten and dietary patterns based on when and how often they ate daily. Diet quality was reflected as a prudent diet (increased fruit, vegetable, fish, poultry, and whole grain consumption) or a Western diet (increased red and processed meats, French fries, high-fat dairy, refined grains, sweets, and dessert consumption). This information was then synthesized to evaluate health habits and diabetes risks.

Out of all the men in the study, 83% consumed breakfast. These men generally had healthier lifestyle factors – slightly lower BMIs, smoked less, exercised more, better diet quality, consumed less alcohol and more cereal fiber, and drank less coffee. After adjusting for age, there was a 50% greater risk for T2D in men who did not eat breakfast versus the men who did. This was significant even after adjusting for other dietary and T2D risk factors. Even after adjusting for BMI (well known to correlate with T2D risk), skipping breakfast resulted in a 21% greater risk. The most significant increased risk came from skipping breakfast and having a Western dietary pattern, than for each factor separately.

While there is still work to be done to better understand the link between breakfast and diabetes, here is just one more reason to encourage getting the day off to a healthful start. Be sure to fill your plate with healthy foods, including a quality protein, fruits or vegetables, low or no fat dairy and complex carbohydrates. Fuel yourself for a healthy day and a healthy future!

The Egg is Incredible

What makes them incredible? Eggs are one of nature’s most nourishing creations and an Egg A Day is OK for everyone! Eggs are an affordable, convenient source of high quality protein with varying amounts of the 13 essential vitamins and minerals. To top it off they are only 70 calories, so it is considered a nutrient dense food meaning a high amount of nutrition compared to their calorie content. In addition, scientists often use egg protein as the standard against which they judge all other proteins. Based on the essential amino acids it provides, egg protein is second only to mother’s milk for human nutrition. All this great nutrition for only 15 cents an egg!

Where are the nutrients in an egg-the white or an egg yolk? Here are some highlights: 60 % of the protein is found in the white and 40 % of the protein is in the yolk. However, many of the other key vitamins and minerals are found primarily in the yolk-choline, vitamin D, selenium, riboflavin, phosphorus, B12 and more. Cholesterol is also found in the yolk, but more than 40 years of research has shown that healthy adults can eat eggs without significantly affecting their risk for heart disease.

Happy Friday and check out the Facebook post from Incredible Edible Egg for a review of the lower cholesterol information as well as a recipe for mini breakfast pizzas.