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.

Nutrition Research Update – Special Cholesterol Edition

Dietary cholesterol has long been a hot topic surrounded with interest and confusion among consumers and health professionals alike. For this reason, ENC’s latest issue of Nutrition Research Update (NRU) focuses specifically on the theme of dietary cholesterol, exploring recent research and news related to cardiovascular disease, metabolic syndrome and lipoprotein metabolism. 

Click here to view the full Nutrition Research Update – Special Cholesterol Edition.

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The NRU e-newsletter comes out three times a year and features studies on hot nutrition topics as well as ENC news and activities. If you’d like to receive issues of NRU in the future, simply sign up here.

Happy reading!

Promoting Health Through November And Beyond

Today’s post comes from Dixie Harms, DNP, ARNP, FNP-C, BC-ADM, FAANP. Dixie is a family nurse practitioner at Family Medicine of Urbandale in Urbandale, IA and also serves as Adjunct Clinical Faculty at the University of Iowa College of Nursing. She specializes in diabetes care and bio-identical hormone replacement therapy. Dixie is also a member of ENC’s Health Professional Advisor panel.

There are a few important events happening during the month of November.  First of all, it is American Diabetes Month.  Did you know that there are almost 26 million children and adults in the U.S. that have diabetes? What seems to be even more astounding is that there are another 79 million Americans who have prediabetes.  So what is prediabetes? According to the American Diabetes Association, prediabetes exists when a person’s blood glucose is slightly higher than normal but not high enough to be diagnosed with diabetes.

The important message here is that individuals with prediabetes are at higher risk for developing diabetes. However, a person can help prevent prediabetes from progressing to diabetes by implementing “therapeutic lifestyle changes” or TLC.  We all know that TLC is usually thought of as “tender loving care”.  In some respects, tender loving care is very similar to “therapeutic lifestyle changes”.  A person with prediabetes really needs to practice tender loving care for their personal self to prevent diabetes, especially since complications include increased risk of heart attack or stroke, kidney damage, vision loss or blindness, chronic nerve pain and increased risk of infections to name a few.

TLC includes dietary and lifestyle changes that promote improved blood glucose and weight management, like increasing physical activity.  A person can reduce their risk of diabetes by 58% by increasing their physical activity to 30 minutes per day along with a 7% reduction in body
Thanksgiving is also right around the corner and can be a tricky time for those managing diabetes.  For anyone with diabetes, consuming a Thanksgiving meal means having some of the foods you love but remembering to practice portion control.  While turkey will not raise your blood glucose, it’s important to think about limiting the potatoes and gravy, dressing, and definitely the pie. I’m not saying you can’t have these foods, but be sure to keep portions in check, since they are high in carbohydrates that affect blood glucose levels. Exercise is also important around the holidays, as increased physical activity can actually make the insulin produced by the body work more efficiently and help maintain lower blood glucose levels.weight.  For example, a person who weighs 175 pounds can reduce their risk with a 12-pound weight loss in addition to exercising 30 minutes daily.

The last important occurrence in November is National Nurse Practitioner Week (November 11-17).  Nurse Practitioners (NPs) are members of the health care team, and there are over 155,000 NPs in the United States.  NPs are expert clinicians with advanced training who provide primary, acute and specialty health care.  NPs have master’s and doctoral degrees and can offer a full range of services such as ordering, performing and interpreting diagnostic tests; diagnosing and treating acute and chronic conditions; prescribing medications and treatments; and managing overall health care.  NPs are your Partner in Health.  If you see a nurse practitioner, tell him or her “thanks” for being involved in your health.

 

Happy Thanksgiving,

Dr. Dixie Harms, DNP, ARNP, FNP-C, BC-ADM, FAANP

Family Nurse Practitioner

Nutrition Guidelines for Type 2 Diabetes: Dispelling the “Myths and Mysteries”

Today’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.
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I recently had the pleasure recently of speaking at the Food & Nutrition Conference and Expo (FNCE) in Philadelphia along with Osama Hamdy, MD, Medical Director of Joslin Diabetes Center’s Obesity Clinical Program. Our presentation was titled Myths and Mysteries: Dietary Intake and Diabetes.

Dr. Hamdy spoke first, laying the groundwork and scientific framework for current nutrition recommendations for people with type 2 diabetes. Almost 26 million people in the United States have diabetes and most of them have type 2 diabetes. In addition, many, although certainly not all, of people with type 2 diabetes are overweight or obese. Dr. Hamdy’s research has led to the development of Joslin’s Clinical Nutrition Guideline for Overweight and Obese Adults with Type 2 Diabetes or Pre-Diabetes, and these guidelines are the basis for Joslin’s premier weight management program entitled Why WAIT. One of the myths that Dr. Hamdy helped to dispel is that more, not less, dietary protein is beneficial in the diabetes meal plan. Higher-protein intakes can actually improve glycemic control, improve cardiovascular outcomes and lower urine albumin excretion levels.

Here are the key “take home” messages from Dr. Hamdy’s presentation:
• Dietary protein can be increased (generally, 1.2 to 1.5 grams per kilogram adjusted body weight, or approximately 20 to 30% of total calories) in patients with type 2 diabetes who have normal kidney function. A higher protein intake can improve glycemic and cardiovascular outcomes, preserve lean body mass, and increase satiety.
• Dietary carbohydrate should be capped at 40 to 45% of total calories to improve glucose and lipid levels and reduce visceral (belly) fat.
• Dietary cholesterol has only a modest effect on blood cholesterol levels and is primarily affected by the amount of saturated fat one eats. Saturated fat is a type of unhealthy fat found in butter, stick margarine, shortening, red meat, cheese, whole milk and ice cream, for example.

  • I presented during the second half of Myths and Mysteries. As a dietitian and diabetes educator, I know first-hand how confusing and often frustrating it is for both clinicians and patients alike to translate research into realistic recommendations that are sustainable. Dietitians know that there is no “one size fits all” when it comes to helping people manage a chronic health condition like diabetes. No two people are alike. But there continue to be certain “myths” about diabetes that prevail. Here’s a synopsis of the five common myths and suggestions for dispelling them, hopefully for good:
    Based on Diabetes Self-Management Education standards, a qualified healthcare professional can provide medical nutrition therapy (MNT). The reality is that only a registered dietitian can provide and be reimbursed for MNT. However, all members of the healthcare team should be able to provide general nutrition messages to people with diabetes until he or she is able to meet with a dietitian. By the way, MNT is reimbursable by Medicare. All you need is a doctor’s referral to see a dietitian.
    There is a standard diabetic diet. We know this isn’t true. In fact, there is no “diabetic diet.” Instead, a “diet” for diabetes is an eating plan that is individualized and tailored to a person’s lifestyle, food preferences and health goals.
    People with diabetes should only eat low glycemic index foods. In theory, this would seem to be correct, but we know that the glycemic index (GI) is a ranking of all carbohydrate foods regardless of their nutritional quality. So, healthy foods, like watermelon and potatoes have a high GI, whereas not-so-healthy foods like peanut M&M’s have a low GI. In addition, the GI of a food is affected by so many factors, such as variety, ripeness and cooking time. The point here is to choose fewer refined and processed foods, to control carbohydrate intake of all foods, and to use blood glucose results as a guide for making better food choices.
    Always include protein at a snack to prevent low blood glucose. Despite the long-standing belief that a diabetes snack should include “one bread and one meat,” there’s little scientific evidence to support this. Studies show that including protein, particularly at a bedtime snack, does not prevent hypoglycemia. However, there’s nothing wrong with having a protein source, like a boiled egg or a slice of turkey breast, as part of a snack. In fact, doing so may help curb your appetite so that you end up eating less later on.
    Fat doesn’t affect blood glucose levels. Fat is a slowly digested nutrient, and a small amount at a meal can not only help make you feel full, it can help slow the rise in blood glucose after a meal by slowing down digestion. However, while some fat is good, too much isn’t so good. Too much fat at a meal can increase insulin resistance and lead to blood glucose spikes hours after the meal. Aiming for less than 35% of calories from fat is a general goal to aim for.

My final take-home message: Nutrition for diabetes need not be a mystery. Recognize that what may work for one person may not work for another. If you have diabetes, ask your doctor for a referral to a dietitian who specializes in diabetes, or attend a diabetes education program.

Unscrambling the Latest Egg Controversy

Today’s post comes from Katherine Brooking, MS, RD.* Brooking is a nutrition communications consultant, appearing regularly in national and local media to discuss nutrition topics. She is also co-author of the popular website and blog, Appetite for Health.kbrooking-150x150

As an RD, I was surprised to see the headlines in August claiming that eating egg yolks may be as bad for your health as smoking cigarettes.  This claim runs directly counter to decades of sound research demonstrating that healthy adults can enjoy an egg a day without increasing their risk for heart disease. I decided to dig a bit deeper to understand the latest controversy.

The news reports comparing egg consumption with cigarette smoking emerged as a result of a study published in the August 13 issue of the journal Atherosclerosis. (Spence et. al)  In this study, researchers examined data on 1,231 men and women, average age of about 62, who were patients at vascular prevention clinic at London Health Sciences Centre in Canada.

The authors asked study participants about lifestyle practices — including such things as smoking and egg ingestion. People with more plaque in their arteries reported eating more eggs, and researchers concluded that so-called “egg-yolk-years” (that is, the number of eggs eaten per week times the number of years in the study) were a significant predictor of heart disease and that “regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease.”

There are multiple problems with this recent study, the most obvious of which may remind you of one of the first things you heard in stats class: correlation does not mean causation. Although study participants were asked about egg consumption, the authors failed to control for other aspects of diet. Foods other than eggs (including foods high in saturated fat, a known contributor to heart disease) may have lead to the increases in arterial plaque.

In addition, the study relied on patient dietary recall and patient self-reporting on a yearly basis. As most RDs can attest, dietary recall can be highly inaccurate.  Few patients can remember what they ate last week, never mind how many eggs consumed in a year.

At the same time, we have a wealth of data that contradicts the findings of the Spence study. Years of epidemiological evidence indicate that dietary cholesterol does not increase the risk of heart disease in healthy individuals. Clinical studies have shown that two thirds or more of the population do not have a considerable increase in blood cholesterol after a dietary cholesterol challenge for extended periods of time, whereas in those who do respond, both LDL-C and HDLC increase, and therefore they maintain their LDL-C/HDL-C ratio. (Kanter et al.)

Further, in urging some segments of the population to avoid eggs, the Spence study ignores the nutritional contribution of eggs to a healthy, balanced diet.  Eggs are a naturally nutrient-dense food, containing varying amounts of 13 essential nutrients in a package with a relatively low number of calories: just 70 for a large 50 gram egg. Eggs are one of the few natural sources of vitamin D and provide an excellent source of choline and selenium and a good source of vitamin B12, phosphorus and riboflavin.

The nutrients in eggs can play a role in weight management, muscle strength, healthy pregnancy, brain function, eye health and more. The high-quality protein in eggs has been shown to contribute to satiety and can help individuals maintain a healthy weight.

Similar thoughts were also expressed in an earlier post by Mitch Kanter, Ph.D and executive director of the Egg Nutrition Center.

The media is often quick to demonize specific food or food groups and slow to find flaws with individual studies.  In the case of eggs, the evidence-to-date falls heavily in favor of consuming eggs on a regular basis, as part of a healthy and balanced diet.

*Disclaimer: This post is sponsored by the Egg Nutrition Center. However the views and opinions expressed in this post are my own.

Happy National Cholesterol Education Month!

As mentioned in Mary Donkersloot’s post earlier this month, September is National Cholesterol Education Month. Here at ENC, we think this is the perfect time for health professionals to clarify misconceptions surrounding dietary cholesterol and also educate consumers about optimizing lipid profiles through healthy lifestyle choices.

Given the confusion among consumers surrounding cholesterol and egg yolk from the recent Atherosclerosis study, we wanted to highlight an invited commentary from Antonis Zampelas, nutrition professor at the Agricultural University of Athens in Greece, which will also be published in an upcoming issue of the journal. Zampelas explains the greater body of research supports the notion that egg consumption is unlikely to have clinically significant effects on cardiovascular disease risk among healthy individuals, and may in fact be anti-atherogenic by increasing LDL-particle size. Eggs also contain the antioxidants lutein and zeaxanthin, which may decrease LDL oxidation. Ultimately, Zampelas concludes that the study results should be viewed with caution since important confounders, such as saturated fat, were not controlled.

As health professionals, we are uniquely positioned to clarify these misconceptions and provide our clients with evidence-based recommendations regarding cholesterol and heart health. This is a fitting month to make that your goal.

Over 65 million Americans have high cholesterol, and many may not even know it. Join the cause to raise consumer awareness and education about high cholesterol and the dietary and lifestyle choices associated with a healthy lipid profile. Be sure to check out the many helpful resources provided by the National Heart Lung and Blood Institute for health professionals to participate in the National Cholesterol Education Month campaign, including individual and group teaching tools, heart healthy recipes, fact sheets, bulletin boards and more.

How are you participating in the campaign this month?