News, Views & Presentations
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Lectures & Presentations |
| Published Reviews Dietary Cholesterol and Atherosclerosis. Biochim Biophys Acta 1529:310-320, 2000 |
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| American Council on Science and Health What’s the Story? – Eggs |
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| What’s New About Eggs, Cholesterol and Good Nutrition Plasma Lipid and Lipoprotein Responses to Dietary Fat and Cholesterol: A Meta-Analysis Howell WH, McNamara DJ, Tosca MA, Smith BT & Gaines JA. 1997. Am J Clin Nutr 65: 1747-1764. Predictive equations for the average plasma lipid and lipoprotein responses to changes in dietary fat and cholesterol. New evidence that dietary cholesterol has little effect on plasma cholesterol levels in most people. |
| Nutrition Views and Commentaries | Nutrition Close-Up Editorials
Is CHD Risk a Function of What is in Your Diet, or What is Missing from It? Who Voted the Food Police into Power? Egg Consumption and Heart Disease Risk |
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.
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!
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 consistentThere 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.
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.
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.