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.

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.

Mythbusters: The Truth About Eggs

Wouldn’t it be fun to do the TV show Mythbusters but focused on Nutrition??

A recent “Eat this Not That” posting from Men’s Health looked at the Egg/Cholesterol myth. Kudos to them for busting the myth (you cannot eat eggs because of the cholesterol). As we say “An Egg a Day is OK!!” There are a multitude of studies showing this same message, but unfortunately consumers and even health professionals are still hesitant to eat eggs. So here’s to hoping these mythbusting messages continue to spread!

Here is an example of a study showing this message:

A study published in Medical Science Monitor including 9,500 people demonstrates that eating one or two eggs a day does not increase the risk of heart disease or stroke among healthy adults. The study notes that eating eggs may actually be associated with a decrease in blood pressure. Qureshi A, et al. “Regular egg consumption does not increase the risk of stroke or cardiovascular diseases. Medical Science Monitor. 2007; 13(1):CR1-8.”

Another parallel message to think about is the additional benefits an egg can offer. In the article they also mention weight management. Satiety/weight management is an area that is being actively researched. Other benefits from the varying 13 essential vitamins and minerals include muscle strength, healthy pregnancy, brain function and more.

Check out the information on “An Egg A Day” to share with patients and fellow health professionals. Also, we will be launching a new cholesterol specific section on our website in the future, so check back.

Taking Sodium with a Grain of Salt

~Marcia

Has sodium been getting a bad rap?  A new study would have you believe so. As a dietitian who has worked with hundreds of people who have diabetes and/or heart disease, I’ve probably talked myself blue about the importance of cutting back on sodium.  The reality is that it’s hard to eat less. Wouldn’t it be great if we could start shaking salt on our foods again or reach for a handful of potato chips without feeling twinges of guilt?

To be fair, sodium isn’t all that bad.  After all, it’s needed to help regulate fluid balance in the body.  And our kidneys do a great job of controlling how much sodium we keep in our bodies, excreting any in the urine.  But in the even that your kidneys aren’t working so well (maybe due to diabetes, for example), sodium tends to stick around, making it harder for your heart to pump and raising blood pressure.

salt

The 2010 Dietary Guidelines for Americans tell us that we’re supposed to reduce our sodium intake to less than 2300 milligrams (mg) per day – that’s about a teaspoon of salt. Most of us consume at least 3400 mg per day.  If you happen to be over the age of 51, and or African American or have high blood pressure, diabetes or chronic kidney disease (which is about half of the American population) your goal is no more than 1500 mg per day.  Most of our sodium comes from processed foods such as cold cuts, hot dogs, canned soup, cheese and pizza.  Even some cereals, salad dressings and desserts are surprisingly high in sodium.

A study published in the May 4 issue of the Journal of the American Medical Association begs to differ with the whole notion that too much sodium can cause problems. The authors of this study followed almost 3,700 European men and women for eight years, measuring urine sodium excretion, blood pressure and cardiac events, such as heart attack, heart failure and stroke. The results? The people who excreted the lowest amount of sodium in their urine were 56% more likely to die from heart disease compared to those excreting higher amounts of sodium.  (Keep in mind that the more sodium you consume, the more you lose in your urine). And the amount of sodium excreted seemed to have little effect on blood pressure.

These findings go against the grain of what dietitians, physicians and other health professionals have been telling us for years: too much sodium may raise blood pressure, which in turn, may increase your risk of having a heart attack or stroke.  But, as with many studies, there were some weaknesses with the study, including a small sample size and the fact that other factors weren’t considered, such as physical activity and calorie intake.

What does this mean for you?  It’s hard to ignore the many other, well-designed studies linking a high sodium intake with high blood pressure.  And since one in three Americans has high blood pressure, it makes sense, at least at this time, to cut back on sodium, along with reaching a healthy weight and fitting in more physical activity. So, as tempting as it may be to reach for the salt, my advice is to keep the salt shaker in the cupboard and grab the pepper mill instead!