Eggs Across The Lifespan

Eggs contain a number of nutrients that are essential throughout the lifespan:

  • High-quality protein contains building blocks needed to support healthy bones and muscles. Research suggests that exercise, along with optimal protein intake, can slow the effects of sarcopenia or chronic age-related muscle loss.
  • Choline is essential for normal liver function and brain health. It is especially important during pregnancy to support normal fetal growth and development, and most pregnant women do not consume adequate amounts of choline. Consuming eggs during pregnancy is one solution to choline consumption issues.
  • Lutein and zeaxanthin are antioxidants that are believed to reduce the risk of developing cataracts and slow the progression of age-related macular degeneration, a disease that develops with age.

Choline Intakes and Recommendations in the U.S. May Be Suboptimal


Dr.-Taylor-C.-WallaceToday’s post comes from Taylor C. Wallace, PhD, CFS, FACN. Dr. Wallace is an accomplished food and nutrition expert, residing in the Washington, DC area.  He has published numerous peer-reviewed articles in addition to three academic textbooks.  Dr. Wallace has a doctorate degree in Food Science & Nutrition from The Ohio State University and frequently serves as a media spokesperson on hot topic nutrition, food safety and food technology issues.  Visit Dr. Taylor Wallace’s blog at www.drtaylorwallace.com.

Choline is a nutrient similar to B-vitamins, often lumped in with them, but not officially a B-vitamin.  It helps our livers avoid accumulating fat, aids in neurotransmission and is a structural component of our cell membranes.

Have you ever considered how much choline is in your diet?  The fact is that most consumers and even health professionals are “in the dark” when it comes to knowledge on this vital nutrient.  Choline has several important functions in the body; it is essential for proper liver and brain function across the lifespan.  Deficiency typically results in liver and muscle damage in adults.  Women with lower intakes of choline have a much higher chance of having a baby with a neural tube defect, since choline is highly involved in fetal growth and brain development.  Achieving adequate choline intake during pregnancy and lactation is even more important since the mother’s reserves may be easily depleted (i.e. low intake by mom equals low intake by baby).1

The U.S. Institute of Medicine (IOM) last reviewed and established Dietary Reference Intakes for choline over 15 years ago (see table).2  The Adequate Intake (AI) is a calculated “target value” to achieve for optimal health.  The Tolerable Upper Intake Level (UL) is the value a healthy individual should not exceed.  When these values were established by IOM in 1998, it was assumed that less than 5% of the population needed more than the established AI, due to genetic differences among individuals.  Since then, it has been reported that as much as 50% of the population may require a higher level of choline.3

Table 1: Dietary Reference Intakes for Choline as defined by IOM in 1998.

Population AI1 UL2
     
Infants
0-6 months6-12 months
125 mg/d (18 mg/kg)
150 mg/d
Not possible to establish
 
Children
1-3 years
4-8 years
9-13 years
200 mg/d
250 mg/d
375 mg/d
1000 mg/d
1000 mg/d
2000 mg/d
 
Males
14- 18 years
≥19 years
550 mg/d
550 mg/d
3000 mg/d
3500 mg/d
 
Females
14-18 years
≥19 years
400 mg/d
425 mg/d
3000 mg/d
3500 mg/d
 
Pregnancy
All ages
450 mg/d Age-appropriate UL
 
Lactation
All ages
550 mg/d Age-appropriate UL
 

1 AI = Adequate Intake
2 UL = Tolerable Upper Intake Level

According to my recent research, over 91% of the population does not meet the current recommended intake (i.e. the AI) for choline, even when the use of multivitamins are considered.4  This is because most mainstream multivitamins do not contain choline (SHOCKING given the widespread insufficiency across the population and the link to neural tube defects in infants).  Choline is found in a number of food products, but it is most common in animal-derived products.  Eggs, beef and pork are among the best sources of dietary choline.  One egg provides about 125 mg of choline5 or about 1/3 of the daily recommendation.  Also note that choline is present in the egg yolk and not egg whites! Whole eggs, therefore, can be a great option for health professionals to suggest to their clients to help them achieve desirable choline intakes.

 

References:

1. Yan J, Jiang X, West AA, Perry CA, Malysheva OV, Brenna JT, Stabler SP, Allen RH, Gregory JF 3rd, Caudill MA. Pregnancy alters choline dynamics: results of a randomized trial using stable isotope methodology in pregnant and nonpregnant women. Am J Clin Nutr. 2013; 98:1459-67.
2. Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington, DC: National Academy Press, 1998.
3. Kohlmeier M, da Costa KA, Fischer LM, Zeisel SH. Genetic variation of folate-mediated one-carbon transfer pathway predicts susceptibility to choline deficiency in humans. Proc Natl Acad Sci USA. 2005; 102:16025-16030.
4. Wallace TC, McBurney M, Fulgoni VL III. Multivitamin/mineral supplement contribution to micronutrient intakes in the United States, 2007-2010. J Am Coll Nutr. 2014; 33(2):94-102.
5. U.S. Department of Agriculture, Agriculture Research Service.  USDA National Nutrient Database for Standard Reference.  Available at: http://ndb.nal.usda.gov/.  Accessed on April 25, 2014.

Concentrating on Choline During National Birth Defects Prevention Month

Eighteen babies in the US die every day as a result of a birth defect. Unfortunately, birth defects are much more common than many might think, affecting 1 in 33 babies every year and causing 1 in 5 infant deaths. They have been the cause of over 139,000 hospital stays over the course of a year, resulting in $2.5 billion in hospital costs (1).

Mothers play an essential role in ensuring the healthy growth of their babies, and nutrition during pregnancy and lactation is particularly critical. During development, fetuses and infants have high needs for a range of nutrients, among which choline is notable for its role in reducing the risk for birth defects. In addition, choline is an essential nutrient required for life’s most basic functions, such as normal cell activity, liver function and transporting nutrients throughout the body. The nutrient is so important that the Food and Nutrition Board of the Institute of Medicine has set daily choline recommendations for all life stages (2):

Population Adequate Intake (AI) of Choline
Birth to 6 months 125 milligrams (mg)/day
7 – 12 months 150 mg/day
1 – 3 years 200 mg/day
4 – 8 years 250 mg/day
9 – 13 years 375 mg/day
14 – 18 years 400 mg/day (Females); 550 mg/day (Males)
Adults:(19 and older) 425 mg/day (Females); 550 mg/day (Males)
Pregnant women 450 mg/day
Breastfeeding women 550 mg/day

Pregnant and breastfeeding women merit some of the highest recommendations for daily choline intake. In January, National Birth Defects Prevention Month, this is particularly meaningful. In a previous blog post by Dr. Tia Rains, PhD, highlighted recent research that found during pregnancy, and particularly during the third trimester, large amounts of choline may be needed to support fetal development.  Researchers therefore concluded that while they are higher than those of other life stages, the current choline recommendations for pregnant and breastfeeding women might be below what is truly optimal for the health of mothers and their infants.

This study, suggesting a potential need to increase choline recommendations, adds to an already impressive body of evidence supporting the importance of dietary choline for pregnant and breastfeeding women. Research has shown that choline may help prevent neural tube defects, among the most grave of birth defects. Choline has been shown to play an important role in fetal and infant brain development, affecting the areas of the brain responsible for memory and life-long learning ability, and compared with women who get sufficient choline in their diets, women with diets low in choline have a four times greater risk of having babies with neural tube defects such as spina bifida (3).

Fortunately, modest nutritional adjustment can help minimize this risk. The best way to meet your needs is to eat foods with choline, and eggs have one of the highest amounts of choline of any food. One large egg – including the yolk – contains about 147 milligrams of choline. Two large eggs contain more than half of the recommended intake for pregnant women and can help them meet their needs Most prenatal and regular multivitamins provide far less than the Adequate Intake for choline, so including eggs as part of a healthy eating pattern is a simple and effective solution. If your clients are looking for easy ways to increase their choline intake, offer appealing egg recipes like this Creamy Pasta & Egg Skillet for the whole family to enjoy.

Creamy-Pasta-and-Egg-Skillet-150x150

What nutritional tips do you provide to your pregnant and breastfeeding clients? Does your practice recognize National Birth Defects Month? Please share your thoughts in the comments section below.

References:

1)      National birth defects prevention month. National Birth Defects Prevention Network Web site. Updated 2014. Accessed Jan 21, 2014.http://www.nbdpn.org/national_birth_defects_prevent.php

2)      Institute of Medicine and National Academy of Sciences USA. Dietary Reference Intakes for Folate, Thiamin, Riboflavin, Niacin, Vitamin B12, Panthothenic Acid, Biotin, and Choline. National Academy Press; Washington, DC: 1998.

3)      Shaw GM, et al. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol 2004; 160:102-9.

Are the Current Choline Recommendations for Pregnant Women Suboptimal?

Choline is an essential nutrient, particularly during pregnancy, due to its important role in brain development. It is a precursor of phosphatidylcholine (PC), a component of all cell membranes, as well as several other key metabolites critical to supporting increased cell division, tissue expansion, and lipoprotein synthesis during fetal development. In addition to dietary intake, choline can be synthesized within the body, however not at levels sufficient to meet increased demands during pregnancy and lactation.

The current Dietary Reference Intake (DRI), established in 1998, is 450 mg/day for pregnant women, although it is noted in the DRI documentation that “data were not sufficient” for deriving a true requirement and that “the estimate is uncertain,” and may be revised when more data become available.1 Several studies have been conducted since then, the most recent of which was published in The American Journal of Clinical Nutrition which suggests that the current DRI may be suboptimal during pregnancy.2

Researchers from Cornell University studied healthy third-trimester pregnant and non-pregnant women who were randomly assigned to receive either 480 or 930 mg choline/day for 12 weeks. Choline was obtained both from the diet (primarily from eggs) and a supplement. During the last 6 weeks of the study, a special stable isotope form of choline was provided, which allowed the investigators to track choline metabolism in the participants as well as in the fetus by studying placenta tissue and cord blood following delivery.

Results showed that there was a substantial demand for choline during pregnancy, as predicted. However, in those women consuming 930 mg choline/day, biomarkers of placental function and levels of the stress hormone cortisol in cord blood were improved compared to those consuming 480 mg choline/day. Further, several functions of choline were maximized in women consuming the higher versus the lower dosage, leading the scientists to conclude that “current recommendations may be suboptimal” during pregnancy.

Dietary choline is one of several nutritional factors associated with the occurrence of neural tube defects during pregnancy. Although folate intake from foods and supplements is well known to reduce the risk of a pregnancy being affected by neural tube defects, choline and methionine may also be important independent of folate intake. One study found that women consuming low levels of dietary choline have four times the risk of giving birth to a child with a neural tube defect.3

Although the majority of choline consumed in the aforementioned study was derived from supplements, dietary sources can also contribute to total choline intake, as well as provide other essential nutrients important during pregnancy. While dietary choline is found in a wide variety of foods, many foods do not have high quantities of the nutrient. Eggs have one of the highest amounts of choline of any food, providing 147 mg/large egg.

Whether findings from this study and others will lead to a re-visitation of the choline DRI for pregnant women remains to be determined.
____________________
1. IOM (Institute of Medicine). 1998. Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: The National Academies Press.

2. Yan J, Jiang X, West AA, Perry CA, Malysheva OV, Brenna JT, Stabler SP, Allen RH, Gregory JF 3rd, Caudill MA. Pregnancy alters choline dynamics: results of a randomized trial using stable isotope methodology in pregnant and nonpregnant women. Am J Clin Nutr. 2013;98:1459-67.

3. Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol. 2004;160:102-9.

Lunch Prep Tips for Back to School

Today’s post is a part two for Mary Donkersloot’s tips on successful and tasty lunches for kids heading back to school.

Yesterday we chatted about what foods I packed (and didn’t pack in my son’s lunch). Today, I’ll share more about how to make successful lunches.

The first trick to a successful lunch is to find foods kids enjoy. The second trick is to avoid repeating any one food so often that he no longer enjoys it!  (“Mom – I’m sick of that!!”)  Here are some of my strategies:

Brown bag sandwiches ideas: Egg salad, chicken salad, sliced turkey, roast beef, ham or peanut butter Add an apple, yogurt, veggies sticks or other nutrient-rich choices (pack separately, so foods don’t get mushy).

What could be easier than two pieces of bread with something in the middle?  Even at 6 AM, it’s not that difficult to manage.

Bread:  Of course, it’s best to look for a whole grain as the first ingredient.  You’re doing even better, if it says stoneground, wheat berry, sprouted or flourless.  If you start your kids on whole grains early in life, they’ll be accustomed to the taste and texture.  If not, you may have a battle on your hands.  Compromise– send a baguette or sourdough bread one day and whole grain bread the next.  Keep it interesting by using tortillas, English muffins or whole grain crackers. If the whole grain is never going to happen, don’t go to war over it. Make a trade-white bread instead of chips or grains containing added sugars, like muffins or bars.

Spreads:   Give your sandwich a little moisture from a variety of spreads – bbq sauce, pesto, ketchup, canola oil mayonnaise, or vinaigrette dressing.  Guacamole is great with chicken — mashed avocado with lime and freshly chopped garlic with a little salt.  Hummus works well with cheese or vegetables.

Buy at your market, premade ideas:

  • Meatloaf with a side of ketchup, a bowl of corn, and a bit of bread with olive oil
  • Bean and cheese, chicken, beef burritos
  • Pot stickers, side of peas, toasted bread, hard-boiled egg
  • Chicken, beef or veggie taquitos with side of guacamole. Serve with a bag of baby carrots and a fruit

Other premade ideas with a little prep:

  • Veggie burger – In nonstick pan, fry patty in vegetable oil till slightly browned on each side. Pack the condiments and bread separately. Serve with edamame beans, peas or corn, and a side of cherry tomatoes.
  • Chicken tenders, side of cooked vegetable – cooked carrots drizzled with olive oil and thyme, and a side of mashed potatoes leftover from last night’s dinner
  • BBQ chicken roll-up:  In a tortilla, place chopped chicken, bbq sauce, a bit of mayo mixed with yogurt, green onions, and white, red or green cabbage.
  • Soups:  chili, lentil, split pea, tomato, butternut squash, carrot, minestrone with whole grain crackers and a few slices of cheese.
  • Leftover chicken breast sliced and placed into plastic storage container, with a side of bbq sauce.  Serve with apple, and crispy corn tortilla, that has been cut into strips and fried in canola oil on a pan.  Wrap in paper towel and then in foil.
  • Make your own “bistro” snack boxes:  hard-boiled egg, small pita with individual peanut butter or hummus, grapes, apple slices, and a bit of cheese, nuts, veggies and more. Make it fun!

If my son has an after school activity, I send a snack in his lunch, often one he would share with his pals.  Their favorite is a ziplock bag of cashews mixed with chocolate chips.  Remind your child they’ve had their sweet treat for the day, and serve fruit as your nighttime snack.  If you’re at a nut free school, try whole grain crackers with cheese.

 

 

The Power of Vitamin A

Vitamin A Eggs

Vitamin A is most commonly recognized for its beneficial effects on eye health, while its other important functions are often overlooked.  As with other vitamins, there are different forms of vitamin A – one form that is most readily absorbed in the body is known as retinol, which is found in liver, eggs, and milk. Retinoids (including retinol) have many important and diverse functions throughout the body including roles in vision, regulation of cell proliferation and differentiation, growth of bone tissue, immune function, and activation of tumor suppressor genes.  These functions are especially important with respect to pregnancy and childbirth, infancy, childhood growth, night vision, red blood cell production, and resistance to infectious disease.1

Another way for the body to get the vitamin A it needs it to convert pro-vitamin A carotenoids like beta carotene to retinol. Beta carotene is found in yellow and orange fruits and vegetables including carrots, sweet potatoes, spinach and cantaloupe.  The carotenoid form of vitamin A also provides unique health benefits. Most carotenoid forms of vitamin A function as antioxidant and anti-inflammatory nutrients. There are two forms of carotenoids that play a specific role in eye health which are known as the xanthophylls lutein and zeaxanthin.2 Foods such as spinach, kale and Swiss chard are sources of foods that contain both forms of carotenoid for optimal eye health.1 Eggs provide small amounts of lutein and zeaxanthin and research shows these nutrients in eggs may be more bioavailable (better utilized by the body) than that from sources with higher content including supplements.2

While vitamin A provides the body with many benefits, it’s important to remind clients that too much of a good thing can turn into a bad thing. Vitamin A is fat soluble which means the body stores it most often in the liver. This also means that vitamin A can build up to toxic levels in the body. This rarely happens from food sources because, if the body builds up supplies of vitamin A, it will slow down the conversion of beta carotene. Vitamin A toxicity usually occurs when people take too much in supplement or pill form. Toxic levels can cause liver problems, central nervous system problems, deterioration of bone density, and birth defects.4  Below is a chart that outlines the Recommended Daily Allowance (RDA) for Vitamin A as well as the upper limits.3

RDA   for Preformed Vitamin A (Retinol)

Age Males: mcg/day (IU/day) Females: mcg/day (IU/day)
0-6 months 400 (1,333 IU) 400 (1,333 IU)
7-12 months 500 (1,667 IU) 500 (1,667 IU)
1-3 years 300 (1,000 IU) 300 (1,000 IU)
4-8 years 400 (1,333 IU) 400 (1,333 IU)
9-13 years 600 (2,000 IU) 600 (2,000 IU)
14-18 years 900 (3,000 IU) 700 (2,333 IU)
19 years and older 900 (3,000 IU) 700 (2,333 IU)
Pregnancy (18 years  and   younger) 750 (2,500 IU)
Pregnancy (19 years and older) 770 (2,567 IU)
Breastfeeding (18 years and younger 1,200 (4,000 IU)
Breastfeeding (19 years and older) 1,300 (4,333 IU)

 

Tolerable Upper Intake Level   (UL) for Preformed Vitamin A (Retinol)

Age Group UL in mcg/day (IU/day)
Infants 0-12 months 600 (2,000 IU)
Children 1-3 years 600 (2,000 IU)
Children 4-8 years 900 (3,000 IU)
Children 9-13 years 1,700 (5,667 IU)
Adolescents 14-18 years 2,800 (9,333 IU)
Adults 19 years and older 3,000 (10,000 IU)

 

 

 

 

 

 

 

In addition to lutein and zeaxanthin, eggs contain the retinoid form of vitamin A and in fact, butter, cheese, and eggs are among the top 10 sources of vitamin A for U.S. adults.  Carrots, tomatoes, leafy greens, and sweet potatoes are also found in the top 10 pro vitamin A-containing foods in the U.S.4Try this recipe that perfectly pairs eggs with kale and sweet potatoes and get all the benefits vitamin A provides.

Eggs over Kale and Sweet Potato Grits

Servings: 4
Ingredients:

  • 1 large sweet potato
  • 2 cups fresh kale, chopped
  • 1 tbsp vegetable oil, divided
  • 1 ½ cups water
  • 1 cup nonfat milk
  • ¾ cup grits, quick cooking
  • ¼ tsp salt
  • 4 eggs

Directions

  • Step 1: Heat oven to 350°F. Coat 4 individual soufflé dishes (or 2-quart casserole dish) with 1 tsp. vegetable oil. Make 3-4 slits in sweet potato; cook in microwave until just soft. When cool enough to handle, peel, cut into chunks, and puree in a food processor.
  • Step 2: Heat remaining vegetable oil in sauce pan, and sauté kale about 5 minutes. In a medium sauce pan, boil water and milk, add grits and sweet potatoes; cook 5 minutes
  • Step 3: Remove from heat; stir in sautéed kale. Divide grits mixture evening among 4 soufflé dishes (or place all in casserole dish). Make 4 depressions in the grits mixture with the back of a large spoon. Carefully break one egg into each hollow. Bake uncovered for 30 minutes until eggs are cooked. Let cool 10 minutes before serving

Nutrition information per serving:

Calories: 280; Total fat: 9g; Saturated fat: 2g; Protein: 12g; Carbohydrates: 38g; Cholesterol: 185g; Dietary Fiber 4g; Sodium: 410mg

Each serving provides: An excellent source of vitamin A, vitamin C, thiamine, niacin, folate, phosphorus, and iodine, and a good source of protein, fiber, vitamin D, riboflavin, vitamin B6, vitamin B12, pantothenic acid, potassium, calcium, iron, and magnesium

References

1)       Evert, A. (2013, February 18). Vitamin a: Medlineplus medical encyclopedia. Retrieved fromhttp://www.nlm.nih.gov/medlineplus/ency/article/002400.html

2)       Goodrow EF, et al. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations.JN 2006; 136(25):19-24.

3)       Higdon, J. (2007, November). Vitamin a: Micronutrient information center. Retrieved fromhttp://lpi.oregonstate.edu/infocenter/vitamins/vitaminA/index.html

4)       USDA Database of Vitamin A (mcg RAE) and Vitamin E (mg AT) for National Health and Nutrition Examination Survey 1999-2000. 2006. Beltsville, MD: Agricultural Research Service, Food Surveys Research Group.