Making Your Holiday Season Healthier

This season of plentiful treats presents weeks and months of challenging food situations. While it was once believed that the average American adult gained as much as five pounds during the holidays, recent studies indicate an average gain of about a pound from Thanksgiving through New Year’s.  Despite only modest weight gain, often individuals’ dietary patterns and lifestyle take a significant hit during the holiday season.  Sugar intake increases.  Among those who drink, alcohol intake also increases.  Many diabetics have worse blood sugar control.  Exercise routines drop off.  Late nights and stress impact sleep quality and duration.  Individuals also report increased social and financial stress levels.  Added stresses coupled with an abundance of sugary foods is a potent trigger for individuals with a history of food-based coping, weight cycling, and/or disordered eating patterns.   

How can you avoid dietary and lifestyle pitfalls during this challenging season?  Here’s some tips.

Check-in with your goals:   Rather than cycling between being on and off the “health wagon”, work toward year-round healthier living.  From the body’s perspective life is a continuum rather than something that resets on Monday or January 1. Aim for balance and positive problem-solving year round.  It is never too soon or too late to aim for balance in your food and lifestyle.  Try to maintain a clear idea about both your mental and physical health goals.  If you have a history of struggling with food, especially when surrounded by sweets, remind yourself your aim is to be nourished in body and spirit -- not saddled with guilt and the discomfort of overeating.  Try not to let small setbacks completely derail progress.   Many times when holiday eating and partying goes south, people throw in the towel and vow to start anew in the New Year.  Such resolutions are usually not realistic and are seldom followed.  Instead, forgive and accept your missteps.  Slip-ups are not failures.  They are information you can apply to proactively problem-solve what you will do differently next time.  Try to be clear and honest with yourself.  For example, it is okay to have some chocolate mini’s that abound during this season but do so with a clear intention.  Whereas in the past you might have discarded wrappers from your view while eating, keep them in front of you and accept your choices.  Imagine you were giving a friend advice and then turn that advice on yourself. 

Savor your favorites: Generally, it is not feasting on one enormous dinner that contributes so much to weight gain, but mindless habitual munching.  Check in with internal cues of hunger and satiety to prevent over-eating.  Research finds that when there are a greater number of foods to choose from, individuals eat more.  In the face of an abundance of choices, identify the special foods you really want. Do not deprive yourself of your favorites.  When we label a food as “off-limits” our desire for the food increases.  In research, this is a very consistent finding regardless of whether you are a toddler or a senior.  A better strategy than completely cutting out certain foods you or your children want, is to enjoy them in small portions. At parties, make a point of sitting down to eat. Truly savor the rich pleasure of the foods you do not get every day. Let the food linger on your tongue. You may discover a sense of satisfaction with half your typical portions when you take time to slow down and notice the sensory experience of eating.  Life is so full of rushing.  We forget that we can slow down with our food.  Modeling slower, more attuned eating is an important way to lead children toward healthier dietary patterns throughout the life span. 

Surround yourself with healthy options: Focus on including healthy choices.  If you are satiated with healthy foods, you are less likely to overdo the treats.  Lean proteins and crunchy fruits and vegetables can especially help you feel full. To avoid going to a holiday party too hungry, eat something high in fiber and/or protein before heading out.  Have ready-to-eat veggies with hummus, a cheese stick with an apple, a cup of veggie soup, a Greek yogurt, or fiber-rich cereal to help curb your hunger later on.  If you are asked to bring something to a gathering, make something healthy, like veggies and dip, fruit kabobs, or green salad.  That way, if there are leftovers, you will go home with a healthy option rather than problem food. 

Minimize liquid calories: Be aware of the calories you are drinking.  A cup of regular eggnog can have as much as 500 calories and that Starbucks white hot chocolate with whipped cream will cost you even more. Factor in alcohol, sugar-loaded punch drinks, hot cider and more and see how liquid calories add up. What to do? Drink lots of water.  Infuse water with seasonal teas, lemon, mint, cucumbers or your flavor of choice.   Choose hot tea or coffee in place of hot chocolate or cider.  Alcohol not only provides empty calories but it depresses satiety hormones and dietary restraint so use moderation when it comes to drinking. Avoid caloric mixers.  Opt instead for seltzer or diet drinks.  Diluting wine with sparkling water can make a tasty wine spritzer.

Channel your holiday spirit in non-food ways: It can also be helpful to steer your holiday spirit toward activities that do not revolve around eating and drinking.  Take this season as an opportunity to focus on reconnecting with your family and your community.  Spend time decorating, making gifts & crafts, sending cards, and singing and dancing along to holiday tunes.  Attend seasonal events such as religious services, holiday bazaars, seasonally themed community service events (such as participating in coat/toy drives, or soup kitchen meals for those in need).  Rather than decorating cookies, involve children in preparing healthy holiday foods.  For the determined baker, consider making treats you do not care for.  Try giving friends with dogs, homemade pet biscuits rather than items you will be tempted to sample. 

Keep moving: Do not put physical activity on hold during the busy holiday months. Instead, try to maintain or even increase activity and exercise levels.  On holidays with big meals, try to get active in the morning.  Go outside with the kids to toss the football around, cue your music and take a brisk walk, or prepare for your shopping by doing some determined walking laps around the space first. Simply moving more can help moderate some of the negative metabolic effects of overeating and work off some of the holiday stress.  No matter what time of year, there is always something you could be doing instead of activity.  Hard wire activity into your schedule, track your steps, and coordinate with others to stay consistent.  Too cold outside?  Try indoor marching or dancing, or check out large indoor spaces like gallerias, malls, and big box stores.  

JUST TWO WEEKS OF INACTIVITY SIGNIFICANTLY WORSENS HEALTH

A new study highlights the negative health effects of even short periods of physical inactivity and stresses the importance of consistently staying physically active on a regular basis.  The study included 28 healthy adults who regularly walked ~10,000 steps per day but did not do vigorous activity such as jogging or gym cardio.  

Researchers found that two weeks of reduced physical activity -- from approximately 10,000 steps (~3 miles) down to 1,500 (~2/3’s of a mile) per day – significantly worsened indicators of type 2 diabetes and cardiovascular disease risk.  .Assessments were performed at baseline, 14 days after adopting a more sedentary lifestyle, and 14 days after resuming their previous activity level.  After 2 weeks of reduced activity, participants’ heart and lung function significantly decreased and their total body fat, waist circumference, and liver fat all significantly increased. Also, their muscles and other cells became much less responsive to the hormone insulin, signaling increased insulin resistance, the hallmark of pre-diabetes.  Fortunately, after participants resumed their normal activity levels for two weeks, the negative effects were completely reversed.

What to do: This study highlights the importance of maintaining a physically active lifestyle.  Even small increases in activity can help a great deal in preventing the onset of type 2 diabetes and heart disease.  With movement, something is better than nothing, so do what you can at an intensity level that is safe for you.  Take advantage of lifestyle activity opportunities such as walking or biking on your commute and neighborhood errands, taking the stairs, marching while watching TV or talking on the phone, dancing at home, breaking up sedentary time, and limiting screen time.  Exercising with someone else, doing something you love, and building activity into the backbone of your schedule all help you stick with regular active. 

Sources:

Bowden Davies K, Osborne J, Giegerich E. Sept. 17, 2019, presentation, European Association for the Study of Diabetes, Barcelona.

Bowden Davies K, Sprung V, et al.  Physical activity and sedentary time: Association with metabolic health and liver fat.  Medicine & Science in Sports & Exercise: 2019; 51(6), 1169-1117.    DOI: 10.1249/MSS.0000000000001901

Adapted from articles available at:

https://consumer.healthday.com/fitness-information-14/misc-health-news-265/just-2-weeks-on-the-couch-starts-to-damage-your-body-750438.html

https://www.eurekalert.org/pub_releases/2019-09/d-sst091619.php

https://www.ncl.ac.uk/press/articles/latest/2019/09/inactivitystudy/

GO NUTS FOR HEART HEALTH

Years ago, nuts were thought to be too high in fat for a heart-healthy diet. Today nuts are widely recognized as being beneficial to heart health. A wealth of data from prospective observational studies and clinical trials suggest that nut and seed consumption reduces the risk of several chronic diseases, including cardiovascular disease, type 2 diabetes, vascular dementia, and some forms of cancer.   It is recommended that we replace less healthy options with 1-1.5 oz. (~150-230 calories) of nuts and seeds most days.

Nuts & Seeds – Nutritional Powerhouses

While each type of nut and seed has unique health properties, nuts and seeds in general are low in carbs while being rich sources of fiber as well as a wide range of essential nutrients, including B vitamins (especially folate), vitamin E, minerals such as calcium, iron, zinc, potassium and magnesium, plant sterols, and antioxidant phytochemicals including flavonoids and resveratrol.

Nuts and seeds contain mixtures of fats, including heart healthy monounsaturated fatty acids, polyunsaturated fatty acids, and essential omega-3 fatty acids.  Omega-3 fatty acids are types of fats that the body cannot make on its own.  Besides fatty fish, nuts and seeds including flax, chia, hemp, and walnuts are some of the best sources of omega 3’s.

To get the full range of nutritional benefits from nuts and seeds choose a variety.  Because they are high in calories it is still good to control portion sizes.  The approximate number of the different kinds of nuts in a 1 oz. portion is as follows: 22 almonds, 7 Brazil nuts, 18 cashews, 12 hazelnuts, 11 macadamia, 49 pistachios, 19 pecan halves, and 14 walnut halves.  Peanuts, (about 35 in 1 oz.) are nutritionally similar to nuts but are actually a legume.  Other roasted legumes such as edamame and chickpeas contain less fat and are very heart healthy options.  Seeds are also very healthy, versatile options and include chia, flax, hemp, pine nuts, sesame, sunflower, and pumpkin seeds. 

Health Benefits of Nuts & Seeds

Improve blood cholesterol profiles.  Several studies indicate that nuts help lower heart disease and stroke risk because the unsaturated fats in nuts help to lower ‘bad’ LDL and raise ‘good’ HDL cholesterol levels.  They also increase LDL particle size making the LDL less damaging to blood vessels.  Nuts, seeds, and legumes also contain plant sterols which are known to help lower cholesterol.  Especially when they are used in substitution for refined flour or sugary products, nuts can significantly reduce triglyceride levels.  Nuts and seeds with omega-3’s including flax, chia, flax, hemp, and walnut also appear to be especially helpful in supporting better triglyceride levels.  

Reduce blood clot risk. Another way nuts & seeds decrease heart disease and stroke risk is by reducing the blood’s affinity to clot.  These effects are thought to be mediated by their anti-inflammatory properties as well as the blood-thinning effects of foods that contain omega-3’s.

Relax blood vessels & support healthy blood pressure. Nuts are rich in arginine, an amino acid the body needs to produce nitric oxide.  Nitric oxide relaxes constricted blood vessels and eases blood flow, contributing to a healthier blood pressure.  Nuts and seeds are also rich in blood pressure-friendly minerals calcium, magnesium, & potassium.

Improve blood sugar.  Nuts and seeds are low in carbs and high in fat and fiber which help to slow digestion and moderate blood sugar spikes after meals.  When substituted for carbs, blood sugar levels rise much less.  Nuts have also been found to increase glucagon-like peptide 1 which is a hormone that helps to control glucose levels and to lower insulin levels in people with pre-diabetes and diabetes.

Better weight management. Nuts, even in small amounts, appear to be especially helpful in adding to satiety. Nuts are rich in fat, fiber, and protein, all of which are known to contribute to fullness. Observational studies have shown that people who eat nuts regularly (especially those who substitute nuts for products with animal fats like butter and meat fat and processed carbs like refined grains and sugars) are less likely to be obese than those who do not eat nuts regularly.  Plus, fiber helps reduce the calories you absorb from meals. Overall, despite their high calorie content, experimental and observational studies find that when nuts are included in dietary patterns, total calories consumed often decreases.

Healthier microbiome.  The fiber in nuts not only supports better regularity and satiety but also provides fodder for healthy intestinal bacteria.  Increasingly it is being recognized the gut microbiome has profound far reaching effects on many aspects of health including regulation of blood sugar, blood pressure, blood cholesterol, immune function, and even mental health. 

How to Use Nuts & Seeds

Opt for plain nuts over those that have been salted or sweetened.  To better preserve the oils of nuts and maximize their shelf life, store them in opaque containers in the refrigerator or freezer.  Here are some suggestions of ways to use nuts and get the recommended daily ounce of nuts and seeds.

Snack on them.  Nuts are the ultimate, easy to pack healthy snack. If you're buying packaged nuts or seeds — either raw or roasted — look for those with no added sodium or sugars. If you want to try flavored nuts or seeds, try sprinkling turmeric, cinnamon, or cocoa powder on raw nuts or seeds and roasting them at 350°F.

Spread them. Many types of nut and seed butters are available.  They can be spread on whole grain bread and crackers but also are tasty on apples, bananas, celery, or carrots.  Nut butters are a convenient way to use nuts but are not as filling as whole nuts and do not keep as well as whole nuts.  It's important to read the labels carefully to avoid added salt or sugar as well as products that have been hydrogenated.  Nuts and seeds are also great incorporated in other spreads such as the sesame seeds in hummus and the pine nuts in pesto.

Scatter them. Seeds and chopped nuts add flavor and texture to salads, yogurt, stir-fries, whole-grain warm and cold breakfast cereals, and much more.  They are a great addition to dressings and sauces for salads, pastas, vegetable sides, and grain pilafs.  They also work well in smoothies, especially chia seeds that gel like tapioca. 

Substitute them. Ground or chopped nuts and seeds can work well as a full or partial substitute for wheat flour in bread, crackers, baked goods, crusted fish fillets or chicken cutlets, and vegetarian burgers and meat balls

UNHEALTHY DIET WORSENS DIABETES BY DAMAGING GUT HEALTH

A recently published, small experimental study reveals new insights into the link between a high-calorie processed diet pattern and leaky gut syndrome.  It revealed that when digestive enzymes leak into circulation, they rapidly break down cellular insulin receptors.  This in turn can contribute to the development of impaired sugar regulation and type 2 diabetes. 

Normally, the intestines is lined with a cellular barrier one cell thick.  This cell layer functions to let dietary nutrients into the bloodstream while keeping almost everything else out. The health and integrity of that intestinal barrier has profound influences on diverse systems of the body, including the cardiovascular, neurological and immune systems.  When unwanted molecules such as digestive enzymes pass through the gut lining and enter the bloodstream, not only can enzymes auto digest important cellular components but they also trigger an inflammatory response by the immune system that in turn promotes chronic systemic inflammation.  Unfortunately, research has also demonstrated that the inflammatory response itself increases gut permeability, creating a vicious cycle.

In this study researchers examined the impact of consuming a McDonald’s breakfast that included an Egg McMuffin, two hash browns, a glass of orange juice and a McCafe hot chocolate.  Participants were either healthy, pre-diabetic or diabetic.  A series of blood samples were taken before and after consumption of the breakfast meals.  When researchers compared gut leakage among the three participant groups, they found that healthy people had the lowest amount of digestive proteases in circulation and levels after the meal returned to pre-meal levels more quickly than those with impaired sugar regulation. Both before and after the meal, the highest blood levels of proteases were found in the diabetics while pre-diabetics’ levels fell in the middle. 

That diabetics have leakier guts than healthy persons has been previously demonstrated.  But, utilizing newly developed technologies, this study was also able to demonstrate that unwanted digestive proteases in circulation break down insulin receptors on the body’s cells.  Insulin is the chemical messenger that causes tissue to take in and utilize sugars in circulation.  Damage to insulin receptors impairs the ability of the body to utilize the sugars released from digestion.  As a result insulin resistance increases and blood sugars remain elevated. 

What to do: There remains much to elucidate in how gut leakage can impact health, but the dietary measures to maintain a healthy gut are essentially the same as a heart healthy dietary pattern and lifestyle. Try to mostly avoid highly processed foods, particularly those with emulsifiers that are believed to be especially damaging to the gut lining.  Emphasize intake of fruits, vegetables, nuts, beans, whole grains, fish while minimizing meat, sugar, and refined flour.  Healthy bacteria in the intestine also play an important role in gut barrier health so be sure to include foods that especially support your microbiome including yogurt, kefir, beans, oatmeal, barley, cooked root vegetables, onions, garlic, beans, avocados, dark leafy greens, bananas (especially green bananas), and asparagus.

Sources:

Guerreiro CS, Calado Â, Sousa J, Fonseca JE.  Diet, microbiota, and gut permeability—the unknown triad in rheumatoid arthritis.  Frontiers in Medicine.  2018; 5(349) 1-6. DOI: 10.3389/fmed.2018.00349   

Lerner A & Matthias T. Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease. Autoimmunity Reviews.   2015; 14(6):479-89. DOI: 15. 10.1016/j.autrev.2015.01.009.

Modestino AE, Skowronski EA, et al.  Elevated resting and postprandial digestive proteolytic activity in peripheral blood of individuals with type-2 diabetes mellitus, with uncontrolled cleavage of insulin receptors. Journal of the American College of Nutrition.  Published online ahead of publication. DOI: 10.1080/07315724.2018.1545611

Information adapted from articles available at:       

https://www.lajollalight.com/news/health-science/sd-cm-ljl-fast-food-study-20190626-story.html

https://jacobsschool.ucsd.edu/news/news_releases/release.sfe?id=2799

https://www.timesofisrael.com/study-shows-how-processed-food-lets-toxins-leak-into-your-gut/

WEIGHT LOSS & SUSTAINED LIFESTYLE CHANGE CAN PREVENT MOST TYPE 2 DIABETES

A large randomized trial in which individuals with pre-diabetes lost weight, improved their diet quality, and maintained regular physical activity illustrates just how remarkably effective lifestyle change is in preventing pre-diabetes from progressing to diabetes. 

In the first phase of the intervention, individuals with pre-diabetes adopted an 800-daily calorie liquid meal replacement diet for two months. Participants lost a minimum of 8% bodyweight.  Following the initial period of weight loss, participants were assigned to one of four treatment groups in which subjects were instructed to increase physical activity to either 75 minutes of high-intensity exercise or 150 minutes of moderate-intensity exercise weekly and to follow either a high protein/low-glycemic index diet or a moderate-protein/moderate-glycemic index diet.  A low glycemic index diet minimizes intake of quickly digested carbohydrates such as those in sweets, refined grains, and some starchy vegetables, and instead focuses on slowly digested whole food sources of carbohydrates such as non-starchy vegetables, most fruits, whole in-tact grains, and beans.  Participants were also provided sustained nutritional and physical activity counseling.  In the study, after 3 years, of the 962 pre-diabetic patients still participating in the study, only 6% had progressed from pre-diabetes to type 2 diabetes.  There was no significant difference between the two dietary treatments nor the activity treatments.  These results highlight the fact that the vast majority of those with pre-diabetes can prevent diabetes if they maintain modest weight loss, make healthier dietary choices, and do regular activity.

Unfortunately, this study also illustrates that even when individuals’ are provided with a lot of support in adopting and maintaining lifestyle changes, many do not stick with these changes over the long-term.   Only about 1.5% of participants did not achieve the initial 8% weight loss cut-off while on the full meal replacement diet but nearly half of study participants did not finish the weight loss maintenance arm of the study.  Thus, the intervention was very effective but only if adhered to, and therein lies the tremendous challenge of behavioral change. 

What to do:  For most individuals, an effective strategy to prevent pre-diabetes from becoming diabetes is to lose a fair amount of weight and then keep the weight off while maintaining regular physical activity.  What can you do to increase your odds of weight loss maintenance?  Lost weight must be proactively defended. Frequent self-monitoring (such as journaling intake, regularly checking weight), integrating food preparation and activity into the fabric of your daily and weekly routines (such as an active commute, structured menu planning, batch cooking & freezing healthy meals), enlisting social support, doing at least 1 hour of regular physical activity daily, eating slowly and mindfully, and utilizing healthy non-food coping techniques are some of the strategies most associated weight loss maintenance.   Also, where medically indicated, bariatric surgery, while no guarantee, significantly increases one’s odds of maintaining substantial weight loss and reversing pre-diabetes. 

Information adapted from articles available at:  https://www.healio.com/endocrinology/diabetes/news/online/%7B996c7f17-b77c-4518-9270-090d2ea074dc%7D/preview-intensive-weight-loss-behavior-change-prevents-conversion-to-type-2-diabetes

https://www.mdmag.com/conference-coverage/ada-2019/preview-data-diabetes-prevention-diet-exercise

Source:

Macdonald I. Prevention of diabetes through lifestyle intervention — results from the multicenter PREVIEW study. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco.

NOT ALL ARTIFICIAL SWEETENERS CREATED EQUAL

Artificial sweeteners, also referred to as “sugar-free”, “low-calorie”, and "calorie-free" sweeteners are substances that taste sweet but add little or no calories to foods and beverages.  Some available  that contain almost no calories in the amounts consumed include aspartame (Equal, NutraSweet), saccharin (Sweet n Low), stevia leaf extract (rebaudioside A, with brands including PurVia, Truvia), monk fruit, and sucralose (Splenda).  Sugar-alcohols such as xylitol, sorbitol have about ½ half the calories of sugars.

While there is solid evidence that intake of full-calorie sweeteners including  table sugar, syrup, fruit juice concentrate, corn syrup, and many others  increases risk of weight gain, insulin resistance and diabetes, fatty liver, heart disease, systemic inflammation, and many other chronic conditions, the role of sugar-free sweeteners on weight and health continues to be a subject of much debate.  Many large observational studies have found associations between sugar-free sweetener intake and weight gain.  At the same time experimental trials have mostly found slight reductions in weight with the use of sugar-free sweeteners.    

A recent study suggests there may be significant differences in how the body responds to the different products.  A randomized controlled trial compared how intake of four different sugar-free sweeteners impacted bodyweight and found bodyweight responded differently depending on which sweetener was consumed.  For the study, 154 adults aged 18-60, who were overweight/obese but otherwise generally healthy and weight stable, were assigned to one of five experimental treatments.   Participants were randomized to drink 5-7 cups (amount varied depending on baseline bodyweight) of a beverage sweetened with one of four sugar-free sweeteners: saccharin (Sweet n’ Low), aspartame (Equal), rebaudioside A (stevia), and sucralose (Splenda), or sucrose (sugar) daily for 12-weeks. Researchers found that those consuming the drinks sweetened with sugar (containing 400-560 calories) gained the most weight, on average 4.1 lbs.  Those consuming Sweet n’ Low gained an average of 2.6 lbs. while those consuming Splenda, Equal, and stevia did not experience significant weight change.  Compared to the other treatments, the Sweet n’ Low consumers reported greater hunger.  Those in the Splenda treatment showed a significant decrease in energy intake and a trend toward weight loss though the amount of change was not statistically significant. 

What to do:  While small, this study suggests that the bodyweight impact of sugar-free sweeteners may differ depending on which sweetener is consumed and that Sweet n’ Low may potentially promote weight gain.  Particularly for diabetics and regular consumers of sweetened drinks, substituting “diet drinks” that contain sugar-free sweeteners rather than caloric sweeteners appears beneficial and outweighs the potential risks of sugar-free sweeteners. Still, in general, it is not known what impact additives and artificial ingredients have on our physiology.  There is some evidence that sugar-free sweeteners increase the appetite for sweet foods and beverages.  Most products containing sugar-free sweeteners contain a mixture of different artificial sweeteners.  While the FDA has approved the available artificial sweeteners as likely safe, some health groups suggest stevia, monk fruit, and sugar alcohols (which contain about ½ the calories of real sugars) are preferable to Equal, Sweet n’ Low, and Splenda because of potential risks of increased rates of cancer at high doses though any increased risk is likely very slight.  Also, there is some evidence that high doses of Equal can worsen mood in vulnerable individuals.    Your best bet is to develop the healthy habit of quenching thirst with beverages that do not taste sweet.     Aim for naturally calorie-free beverages like unsweetened teas, seltzer, water infused with lemon, mint, or cut-up fruit, and just plain water. 

Information adapted from articles available at:

https://www.docwirenews.com/docwire-pick/home-page-picks/low-calorie-sweeteners-increase-body-weight/

https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/

https://www.medicalnewstoday.com/articles/325291.php

https://cspinet.org/new/201312311.html

Source:

KA Higgins, RD Mattes.   A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity, The American Journal of Clinical Nutrition, Volume 109, Issue 5, May 2019, Pages 1288-1301, https://doi.org/10.1093/ajcn/nqy381

UNSCRAMBLING THE LATEST RESEARCH ON EGGS & HEART HEALTH

Americans have significantly increased egg intake over the last decade, consuming on average 3-4 eggs per week. Part of their renewed appeal stems from U.S. Dietary Guidelines that dropped the long standing recommendation to limit dietary cholesterol to less than 300mg.   However, the controversy over eggs, dietary cholesterol, and heart disease was recently reignited by a recent study that found an association between egg and dietary cholesterol consumption and higher rates of heart disease.  

Cholesterol is a waxy substance produced by the body to synthesize hormones, produce bile for digestion, make vitamin D, and maintain healthy cell walls.  Advice to limit dietary cholesterol dates back 50 years, but randomized trials conducted over the last 15 years have indicated healthy human bodies control the amount of cholesterol in the bloodstream, and can detect and adjust the body’s cholesterol production if dietary cholesterol increases or decreases.  It also appears that our systems can excrete unneeded dietary cholesterol, especially if individuals consume adequate dietary fiber.  As a result, even though yokes contain nearly 200 mg of cholesterol, there has been growing consensus that low to moderate egg intake is not significantly associated with a higher risk of CVD.  Eggs also contain nutrients that have been linked to a lower risk of heart disease.  Eggs pack 7g of high-quality protein with about half of this found in the white. Yolks also contain a significant amount of the brain-nutrient choline, plus vitamin B12 and iron. Eggs are also one of the few dietary sources of vitamin D and are a good source of the carotenoids lutein and zeaxanthin that have been linked to lower odds of macular degeneration. 

In terms of dietary drivers of heart disease unhealthy saturated and trans fats have been found to be much more significant that dietary cholesterol.  Recommendations to limit saturated fats (the fats found in meat, chicken skin, and dairy) and completely avoid trans fats (artificial fats used to manufacture baked goods, frosting, and spreads) are still in place.  Most foods high in cholesterol are also high in saturated fats.  However, some foods high in cholesterol are not high in saturated fats including egg yokes, shellfish, and liver.

The new analysis of eggs and heart disease, drawn from the pooled data of six observational studies that followed nearly 30,000 Americans for up to 31 years, found that eating 3-4 eggs per week was associated with a 6% higher risk of cardiovascular disease and an 8% higher risk of any cause of death.  And, eating at least 300mg of dietary cholesterol per day was associated with 17% higher risk of cardiovascular disease and 18% higher risk of all-cause deaths.

Experts caution that the recent analysis has many limitations that may have lead to misleading conclusions.  One shortcoming was participants' long-term eating patterns were not assessed.  Participants self-reported their typical intake at a single visit at the outset of the studies while heart health outcomes were assessed up to 30 years later.  During this time, individuals may have significantly changed their diet. So, this one snapshot may not have accurately captured their eating habits over time.

When evaluating whether or not eggs are healthy, it is also important to look at eggs not only on their own, but in context of the entire diet, especially when compared to foods they may replace.  There is widespread consensus that eggs are a better choice than options high in saturated fat (e.g. butter, pastries, cheese, bacon), refined grains, and/or sugars.  And, eggs are one of the few typical breakfast foods that are not high in carbohydrates.  A recent study illustrates one of the benefits of eating a lower carb breakfast for those with diabetes.  It found that when a person with diabetes takes a low carb breakfast their blood sugar response to meals later in the day is less pronounced than when they have a higher carb breakfast (e.g. oatmeal, cereal, toast).  To the cardiovascular system, scrambled eggs, salsa, and a 100% whole-wheat English muffin is a far different meal than scrambled eggs with cheese, sausages, home fries, and buttered white toast. 

What to do:  Even though cholesterol is still in bold on the nutrition facts labels, focus your gaze more on the amount of saturated and trans fat listed above cholesterol.  To control your blood cholesterol eat a healthy diet rich in plant-derived fats (i.e. olive oil, nuts, avocado), fruits and vegetables, whole grains, and lean proteins. Emphasize foods high in soluble fiber such as beans, oats, barley, and gummier fruits and vegetables including avocado, okra, plums, apples, oranges, green beans, and carrots.  Control your weight, exercise regularly, don’t smoke, and take cholesterol lowering medicine as prescribed by your provider.

As for the eggs, looking at the body of research on this topic, there is not strong evidence that limiting consumption of cholesterol-rich foods lowers the amount of artery-clogging LDL cholesterol that ends up in our blood. For those without heart health problems, average intake of up to 1 egg per day is likely a healthy choice.   Experts still caution diabetics and others at high risk for heart disease to be mindful of cholesterol intake.  Some advise diabetics have no more than 3-4 egg yolks weekly.  The whites, a fantastic source of lean protein contain almost no cholesterol.  Discuss dietary cholesterol intake with your healthcare provider to determine what a safe level of egg consumption is for you given your health situation. 

Sources

Chang CR, Francois ME, Little JP.  Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability.  The American Journal of Clinical Nutrition.  2019;nqy261.  doi.org/10.1093/ajcn/nqy261

Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA.   doi:10.1001/jama.281.15.1387

Jacobson TA, Maki KC, Orringer CE, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 2.  Journal of Clinical Lipidology.  2015; 9 (6): S1-S122.e1. doi.org/10.1016/j.jacl.2015.09.002

Richard C, Cristall L, Fleming E, et al.  Impact of egg consumption on cardiovascular risk factors in individuals with Type 2 diabetes and at risk for developing diabetes: A systematic review of randomized nutritional intervention studies. Canadian Journal of Diabetes.  2017; 41 (4): 453 – 463.   doi.org/10.1016/j.jcjd.2016.12.002

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans; 2015.  Available at: https://health.gov/dietaryguidelines/2015/resources/2015-2020_dietary_guidelines.pdf

Zhong VW, Van Horn L, Cornelis MC, et al. Associations of dietary cholesterol or egg consumption with incident cardiovascular disease and mortality. JAMA. 2019;321(11):1081–1095. doi:10.1001/jama.2019.1572

Adapted from articles available at:

https://www.npr.org/sections/thesalt/2019/03/16/703804493/egg-lovers-new-study-finds-eating-too-many-can-increase-risk-of-heart-disease

www.sciencedaily.com/releases/2019/03/190315110858.htm

https://www.hsph.harvard.edu/nutritionsource/food-features/eggs/

https://www.hsph.harvard.edu/nutritionsource/2019/03/18/eggs-and-cholesterol-back-in-the-spotlight-in-new-jama-study/

https://www.hsph.harvard.edu/nutritionsource/food-features/eggs/

Magnesium Improves Vitamin D Absorption

A recent review builds on previous research indicating Vitamin D cannot be metabolized without sufficient magnesium levels.  Magnesium assists in the activation of vitamin D, which in turn helps regulate calcium and phosphate homeostasis.  All of these nutrients work together to influence the growth and maintenance of bones. All of the enzymes that metabolize vitamin D require magnesium, which acts as a cofactor in the processing of vitamin D in the liver and kidneys. Deficiency in either magnesium and/or vitamin D is associated with various disorders, such as skeletal deformities, cardiovascular diseases, and metabolic syndrome.

Exposure to sunlight is the primary way to get vitamin D.  Deficiency of the vitamin is common with low blood levels found in an estimated 40% of the U.S. population.  In recent years there is a growing recognition of widespread vitamin D deficiency and many providers are prescribing high doses of vitamin D to raise blood levels.  However, in order for vitamin D to be absorbed and utilized individuals also need magnesium and low levels of magnesium are also widespread with an estimated 80% of Americans not getting adequate magnesium in their diet. As a recent study emphasizes, when individuals supplement with vitamin D, it is also important to consume a diet rich in magnesium and for those with very low magnesium intake, supplementation of vitamin D along with magnesium may be indicated.

Vitamin D has many essential functions in the body.  In addition to having a major impact on bone health, vitamin D also plays a role in thyroid and immune health. Beside vitamin D utilization, magnesium also is essential to many cellular functions and is important to supporting a healthy blood pressure and energy utilization.

A recent study found that low magnesium may reduce vitamin D levels. Even when individuals are not clinically deficient in magnesium, supplementation appears to make vitamin D supplementation more effective, especially in persons whose levels have not responded well to prior vitamin D supplementation.

What to do:  Consume a diet rich in magnesium, especially when supplementing with vitamin D.  Good sources of magnesium include dark leafy greens, beans, whole grains, dark chocolate, fatty fish (salmon, for example), milk, nuts (especially almonds, cashews, and Brazil), pumpkin and sunflower seeds, bananas, and avocados. Few foods are naturally rich in vitamin D but many products such as milk, orange juice, and nutritional bars are now fortified with vitamin D.  Some of the few places vitamin D naturally occurs in the food supply include bones (such as those found in sardines), cod liver oil, and mushrooms that are dried with the gills exposed to the sun.  If you are low in magnesium and/or vitamin D discuss supplementation options with your provider.

Adapted from articles available at:

https://www.healthline.com/health-news/how-magnesium-can-help-your-vitamin-d-levels#The-bottom-line

https://www.prnewswire.com/news/american-osteopathic-association

Source:

Uwitonze AM, Razzaque MS.  Role of magnesium in vitamin D activation and Function.   J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189.  doi: 10.7556/jaoa.2018.037.