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News, Views & Presentations
Is CHD Risk a Function of What is in Your Diet,
or What is Missing from It?
[Nutrition Close-Up 13(1), 1996]
Some of the most interesting findings in
epidemiology today suggest that non- lipid, non-fiber dietary factors
play significant roles in determining an individual's CHD risk.
These findings raise the question of whether much of our current
perceptions regarding dietary factors which we think increase CHD
risk, such as total and saturated fat calories, actually do so
not only by effects of their inclusion in the diet on risk factors
but also through their replacement of foods with nutrients which
protect against CHD. Some examples would be the B vitamins to lower
plasma homocysteine levels, fiber to increase fecal excretion of
steroids, antioxidants to reduce production of oxidized LDL, and
other, as yet undefined phytochemical constituents of fruits and
vegetables.
If in fact this is the case then
our national obsession with retaining our dietary pattern through
use of low fat products will have only a marginal effect on our
CHD risk profile because we only succeed in removing the fat from
the diet rather than incorporating the fruits and vegetables which
contain the beneficial nutrients. Our cholesterol and fat conscious
society may be headed down the dead-end road of low- fat, low-calorie
foods without the CHD risk reduction benefits of the low-fat, high
fruit and vegetable diets we attempt to mimic. Diets are funny
things; if you change one thing for another you must consider not
only the effects of not only what is in the new diet, but also
what was reduced compared to the old diet. Are the health effects
of our western diet due to what it has too much of, or possibly
what it has too little of? Those compounds in red wine and tomato
sauces, which seem to confer health benefits on the partaker, are
only the beginning of a new awareness in nutritional epidemiology
of the importance of dietary additions and subtractions in assessing
the role of dietary patterns in health promotion - disease prevention.
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Who Voted the Food Police into Power?
[Nutrition Close-Up 13(2) 1996]
Somehow I missed my opportunity to elect my
representative for the position of nutrition "consumer advocate." Actually,
I'm not sure I ever really knew when they had the elections for
such a post. But I think I can at least be confident that all the
dietitians, nutritional scientists, clinical nutrition specialists,
and public health professionals got to vote to make sure that these "consumer
advocates" represent the opinions and attitudes of nutrition
professionals. Otherwise you would have to wonder how these people
became so important with all the media attention and political
influence on government agencies and policy development. Maybe
it's just that too often these "consumer advocates" promote
opinions and foster policies that this consumer finds unreasonable
and alarmist, and besides which I simply don't agree.
I get puzzled as to why they keep saying such
nasty things about our diets and certain foods and some types of
cuisines and all those fast food chains and restaurants. But we
should trust them, shouldn't we, since they are representing the
consumer and they come from nonprofit organizations with none of
those nasty, devious, untrustworthy "for profit" agendas
to foster. Of course, I assume that by "nonprofit" this
means that the individuals involved are volunteers and that they
do not accept any salary or compensation from the generous contributions
of their benefactors. And, of course, all the media hype and "good
food, bad food" demarcations have nothing to do with maintaining
and expanding the number and enthusiasm of contributors. I'm sure
that in good faith it's being done solely to educate the public
as to the evils of its dietary ways. And maybe, just maybe, with
enough media attention and enough political pressure and enough
hysterical attacks, these "consumer advocates" will save
us from those high-fat, high-cholesterol dietary demons and get
all of us to live our low-fat, high-fiber lives to the fullest,
without the salivary temptations we seem to so readily succumb
to today. Only when all restaurants and fast food chains serve
only low-fat, low-cholesterol, low-salt, low-caffeine, low-sugar
foods can we really be assured that the consumer will, in fact,
support and live by the beliefs that the "consumer advocates" tell
us we believe. Then, when finally we all see eye-to-eye on the "good-food,
bad-food" issues, can we be as one in that dietary nirvana
which will lead us to everlasting nutritional well-being. Sorry
to say, it just doesn't sound like either good nutrition or a whole
lot of fun to me. Next time, I want my vote counted!
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Egg Consumption and Heart Disease Risk
[Nutrition Close-Up 13(3), 1996]
A recurrent theme in discussions of the dietary
cholesterol-heart disease question is the hypothesis that dietary
cholesterol has an effect on heart disease risk independent of
effects on plasma cholesterol levels. Recently reported epidemiological
studies have provided data contradicting this hypothesis yet it
continues to be an argument for population-based restrictions on
dietary cholesterol (and egg) intake. While the science of epidemiology
can apply various statistical adjustments and multivariant analyses
to test such questions we applied a more simplistic approach to
the question. We simply asked whether there was any relationship
between international per capita egg consumption patterns and rates
of cardiovascular disease (CVD) mortality. Using the most recent
data on CVD mortality rates published by the American Heart Association
(AHA) and the international per capita egg consumption data from
the International Egg Commission (IEC), we looked for a relationship
between egg consumption and CVD death rates in twenty-two different
countries.
It is clear from the figures that there is
no positive relationships between egg consumption and CVD mortality
in male or female populations in these countries. Thus, the predicted
dietary cholesterol-heart disease hypothesis is not supported by
these data. [In fact, the relationship has a negative correlation
with an r = 0.40 and a P value of 0.063.] In evaluating the data
some comparisons are very interesting. For example, weekly per
capita egg consumption in France, the United State and England
are 5.1, 4.5 and 3.3 eggs per week whereas the CVD mortality rate
per 100,000 per year are 250, 460 and 516 respectively. Interestingly,
Japan has the lowest CVD mortality rate associated with the highest
per capita egg consumption (6.5 eggs per person per week).
From the most sophisticated inter- and intra-national
epidemiological studies to the simplest analysis of CVD mortality
and per capita egg consumption the data are consistent—There
is no evidence for a plasma lipid independent effect of dietary
cholesterol on heart disease risk. Worldwide the majority of dietary
recommendations do not include restrictions on dietary cholesterol
intakes based on the absence of compelling data of a significant
effect of dietary cholesterol on plasma cholesterol levels. In
part, support for such restrictions have been based on the hypothesis
that dietary cholesterol can be atherogenic in spite of having
little effect on plasma cholesterol levels. From a variety of data
sources it is clear that this hypothesis is not standing up very
well to the test of time. The questions now becomes how much evidence
is going to be needed before the null hypothesis is accepted and
we can do away with this unsupported and obsolete concept.
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Throwing out the Baby with the Bath
Water
[Nutrition Close-Up 13(4), 1996]
A recurring comment hard at the Egg Nutrition
Center exhibit at national conferences of health care organizations
is that "eggs are okay, just don't eat the yolks." While
this effort to get rid of the fat and cholesterol in the egg is
consistent with our national fat-phobia, there is a nutritional,
and economic, cost to such extravagance. Most health professionals
are well aware of the high nutrient density of eggs and the broad
range of vitamins and minerals eggs contain. What many seem not
aware of, however, is that the majority of these essential nutrients
are actually concentrated in the yolk. As shown in the adjacent
table, the majority of water soluble vitamins and minerals, all
of the fat soluble vitamins, and 45% of the high quality protein
are localized in that too often discarded yolk. From a nutritional
perspective this seems to be a case of throwing the baby out with
the bath water; a prime example of quality nutrition being sacrificed
in the name of those dietary demons "fat and cholesterol." Given
the nutritional value of those yolks, even with 4.5 gm of fat and
213 mg of cholesterol, for the elderly, for low-income families
and for growing children it doesn't make much sense to so carefully
remove and discard those yellow globes, unless of course there
is no need to be concerned about nutrient density. And there is
also a cost base for this effort. At a dollar a dozen, throwing
away the yolks takes the price per pound from roughly $0.66 per
pound to $1.21 per pound. So for good nutrition, and good economics,
don't advise people throw away those yolks unless absolutely it's
absolutely necessary, otherwise a lot of those needing it really
wouldn't get the full nutritional value eggs have to offer.
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Nutrition Made Simple: Just Tell Them What
They Can Eat.
[Nutrition Close-Up 14(1), 1997]
A recent notice in a national newspaper informed
me that grapefruit juice has now been certified as a component
of a heart healthy diet. While not terribly surprised by this statement,
I must admit to being rather perplexed as to who thought grapefruit
juice wasn't particularly heart healthy, or more simply, just plain
healthy and nutritious in the first place. That started me wondering
about the practice of health agencies accrediting which foods should
and should not be part of a heart healthy, or cancer reducing,
or weight maintaining diet. It's unsettling to think that today's
consumers are so uninformed about basic nutritional facts that
they need health promotion agencies to sanction the food items
they should, and by inference items they should not, include in
their diet. When a leading health agency vouches for the assumed
health benefits of this food item, but not that food item, it isn't
surprising that many consumers believe that the absence of such
endorsements equates to unhealthiness. The programing and perpetuation
of this "good-food, bad-food" mind set no doubt makes
the consumers life less complicated. Compared to interpreting a
Nutrition Facts label, they can be told what to eat based on an
agency seal of nutritional health authenticity. So if a food item
fits the current dietary dogma (low in total and saturated fat,
sodium, and cholesterol; high in complex carbohydrates and fiber)
then the notice of acceptance assures the concerned consumer that
they are in compliance and following the nutritional high ground.
And while nutrition educators struggle to get the public to think
about fat, cholesterol, and sodium in terms of averages, and consumption
patterns over days and weeks, this endorsement of specific food
items effectively obscures the concept of eating patterns behind
a rather large stamp of approval.
One must naturally wonder whether such endorsement
programs are in the best interest of the consumer, or of the agency
marketing its reputation. Clearly commodity groups exist because
of the need for research and promotion related to a specific food
item. It now seems that healthy agencies have their version of
a commodity: the set of nutritional guidelines for which, with
a small fee, one can get the agency's seal of approval. I understand
that it will be a long time, if ever, before eggs and other items
from the so called "bad food group" will ever be considered
eligible for such nutrient quality recognition. But the fact is
that I can readily put together a week's worth of meals which include
eggs, red meats, dairy products, fruits and vegetables, and grains
which fit into whatever diet formula is currently enshrined by
health promotion agencies. All one needs to do is adjust the portion
sizes, balance the nutrient pattern over meals and days, and use
those old time nutritional concepts of balance, variety and moderation.
As clinical and epidemiological research put more emphasis on dietary
diversity and variety as an essential in good health, it seems
a shame to suggest that consumers limit their food choices to those
sanctioned by the self-appointed police of the American diet. The
nutritional community should thank the American Heart Association
Nutrition Committee for so clearly stating in their 1996 dietary
recommendations that one should have flexibility in food choices,
consider average eating patterns for defining goals, and recognize
individual variability in the responses to dietary patterns. Recurring
public messages on the importance of the nutrient value of foods,
in contrast to simply fat gram counting, are essential if effective
and healthful changes are to be made in the American diet. There
is more to good nutrition than just telling them what they can
eat.
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