Nutrition Unscrambled

Egg consumption as part of an energy-restricted high-protein diet improves

By Marcia Greenblum, MS, RD
July 28th, 2011

Many health professionals and consumers have upon occasion admitted to me that they thought “the egg got a bad rap” during the 1980s and 90s, when eggs were seen as an icon for dietary and serum cholesterol. They are often proud to say that they personally defied common wisdom by continuing to consume eggs. As scientific technology improved and confounding variables were better controlled, scientific findings and dietary guidance moved away from looking at egg intake as a risk factor and now focuses on the many nutritional benefits of consuming eggs. However, one curious association has continued to plague the egg. Epidemiological findings have shown, at times, an association between egg intake and cardiovascular disease in the diabetic population. No mechanism has been identified to explain this association however, the fact that eggs are often accompanied by a high saturated fat, high refined carbohydrate and sedentary lifestyle may have made egg intake in this population an artifact or marker of poorly controlled diabetes.

Fortunately, a recently published study in the British Journal of Nutrition by Pearce, Clifton and Noakes (Br J Nutr, Feb 2011, 105(4):584-92) attempted to assess the effect of egg intake on biomarkers of cardiovascular disease in free living overweight diabetic adults who have been instructed to eat a high protein, calorie restricted diet with either 2 eggs a day or a substitute source of animal protein. Sixty five subjects, average age of 60 years completed the 12 week study. All consumed 1400 calories/d with a macronutrient distribution of 40% carbohydrate, 30% protein, 30% fat. Subjects were allowed to continue taking diabetic and lipid lowering medication as prescribed by their physician. The treatment group received 2 eggs/day with an average cholesterol intake of 590mg of cholesterol while the control group received a similar quantity of protein from chicken, meat or fish without eggs and an average cholesterol intake of 214mg/day.

As one would expect, both groups that consumed a high protein, calorie restricted diet, lost an average of about 6 kg or 13 pounds. The key finding was that a diet high in dietary cholesterol from eggs did not adversely affect blood lipids or cardiovascular disease risk in adults with type 2 diabetes. In fact, a diet high in dietary cholesterol from eggs improved several biomarkers of health including increased blood levels of HDL, lutein and folate more effectively than the isoenergetic diet which included alternative animal sources of protein. The authors conclude “These results suggest that a high protein energy restricted diet high in cholesterol from eggs may have nutritional benefits and assist in metabolic control in individuals with type 2 diabetes.” Many of us knew it all along.

ENC at Pri-Med

By Marcia Greenblum, MS, RD
June 29th, 2011

Last week I returned from exhibiting at the Pri-med Conference in New York City. This is not the first time I have exhibited at this conference and I’m always pleased with the result.

The attendees to this conference are health professionals from all realms of the medical field. Pri-Med delivers 3 days of medical updates at a remarkably low price which attracts many health professionals who work with low income patients in a community setting. It was very rewarding for us to bring the good news to all these health professionals that eggs are now 14% lower in dietary cholesterol.

In addition, current research shows that there are many health related benefits of consuming an egg; relating to its high quality protein yet low carbohydrate and calorie content, coupled with its 13 essential vitamins and minerals all for approximately 14 cents an egg.

Anna and I were very busy throughout the 3 days talking with physicians, nurses, dietitians and physician assistants about how they can now tell their patients to go back to eating an egg a day, as recommended by the US Dietary Guidelines. We were able to sign up nearly 250 health professionals who were interested in receiving the ENC newsletter, Nutrition CloseUp, as well as completing a survey which entered them into a contest to win a year’s worth of eggs for themselves and a donation to a local NYC food bank. Not surprisingly, most HPs enjoy eggs themselves and have been advising their patients that eggs are a healthful food all along.

Crab & Asparagus Frittata

By Marcia Greenblum, MS, RD
May 19th, 2011

This week as the weather on the east coast gets warmer and school lets out, it’s time for coming out from our shelters and reuniting with the people who you share either a street address, an end of the year school celebration or just catching up with friends. I plan to join some neighbors this weekend at their open house/barbeque and have been asked to bring something to share.

 Usually I bring some vegetable dish because they are generally in short supply when the focus at the barbeque is the much loved hot dog/hamburger. However, this year I’m thinking it may be more appreciated if I brought some alternative to the high fat meats. Although we always think of eggs as a breakfast food too often accompanied by high fat sausage or bacon, I think an attractive frittata Crab & Asparagus Frittata  that can be cut into wedges makes the perfect food to compliment the usual potato salads and beans that are ubiquitous at outdoor barbeques.

 This is a great time of year to capitalize on the availability of asparagus, loaded with fiber and vitamin C to balance the 13 other vitamins and minerals in the eggs.

 My favorite recipe is a crab and asparagus frittata which makes an attractive dish, incorporates a Maryland favorite- crab which is a low calorie, low fat, tasty source of protein. This recipe adds a vegetable such as red pepper and green onions, rich in vitamin A and C, for a delicious and nutrient dense alternative to the plain old hot dog/hamburger fare that others will be eating.  At 224 calories per serving, I’m happy to offer this to my neighbors as a healthier change of pace to the usual barbeque fare.

D.C. Area Dietetic Association Meeting

By Marcia Greenblum, MS, RD
May 13th, 2011

Just when you feel you’ve been to enough meetings one last meeting makes it all worthwhile. Last weekend I attended the DCMADA (DC Metro Area Dietetic Association) 2011 annual meeting held in Bethesda, Maryland. The obvious benefit of networking with colleagues and visiting sponsor’s table top presentations needs no further discussion. However, the opportunities for learning from an impressive lineup of speakers may not be so obvious.

Despite the fact that I am not currently employed in a clinical setting I found the presentation from Leigh-Anne Wooten about her experiences getting order writing privileges for dietitians at Georgetown University Hospital gave me a picture of how the appreciation for RD professionalism has increased and how strong willed characters can move mountains when they believe in their cause.

On a very different note, Dr. Patsy Brannon from Cornell University who served on the IOM committee to determine a DRI for vitamin D gave a riveting discussion about the research that was considered in making the new vitamin recommendations that were released this past fall. Dr. Brannon explained the obstacles for establishing appropriate level of intake for vitamin D which are unique to this hormone because it is endogenously produced, yet conditionally dependent on varying levels of sun exposure. She presented a slide which got my attention when she pointed out that an egg is one of the few natural sources of vitamin D.

Unfortunately, she did not have the most recent nutrient data for eggs which found a large egg provides 41IU of vitamin D making a good source. I did speak with her after her presentation and promised to share this USDA data with her.

Later in the day, there was a very interesting presentation from Ellen Karlin, a registered dietitian who counsels patients with allergies in her practice at the Comprehensive Asthma and Allergy Center in Owings Mills, MD. She offered insights into how difficult it is for patients who cannot control or get accurate information about the ingredients in foods in their environments. She did discuss the latest recommendations about allergies, which suggests that no food should be avoided after weaning at 4-6 months unless there is documented evidence of allergic reaction. This contradicts the old wisdom which in the case of eggs were not generally considered safe to include in an infant’s diet until 1-2yrs.

I also learned a lot from speakers who participated in panel discussions about Nutrition and Food Policy as well as communication differences between generations in the workplace. I’m very glad I took the opportunity to spend my Saturday learning from others in my profession who practice so differently than where I’m currently employed.

Experimental Biology – Washington, D.C.

By Mitch Kanter, Ph.D.
April 18th, 2011

I just returned from the Experimental Biology meetings, which were held in Washington D.C. Experimental Biology is one of the largest biology/nutrition research meeting of its kind in the world. It’s an excellent way to stay abreast of current research, a good deal of which will ultimately lead to tomorrow’s health and nutrition recommendations.

 At this year’s meeting the Egg Nutrition Center sponsored a symposium on dietary cholesterol. The key issue we delved into at the session was the true health implications of dietary cholesterol, and whether or not the cholesterol that we eat is as harmful as many health care professionals have been suggesting for the past 50 years or so. I was pleased to chair the session. Our four presenters were Dr. Penny Kris-Etherton from Penn State University; Dr. David Katz from Yale University, Dr. Maria Luz-Fernandez from the University of Connecticut; and Dr. Kasey Vickers, a post doctoral research fellow from the National Heart, Lung, and Blood Institute (NHLBI) at the NIH. All four are well published, acknowledged experts in the areas of disease prevention, nutrition, cholesterol metabolism and health.

 Among other key points, Dr. Fernandez brought up the fact that the original dietary recommendation for daily cholesterol intake (<300 mg/d) was based largely on extrapolations from animal studies and human epidemiologic data, and that few studies have actually demonstrated significantly adverse health effects when cholesterol is consumed in that range. Dr. Katz made similar assertions, and he indicated that his research has shown that higher than average daily cholesterol intake does not have negative effects on the vasculature or on other markers of cardiovascular disease, even in patients with existing coronary artery disease.

Our ultimate goal is to generate a manuscript based on the presentations that we submit for publication to a medical journal sometime in the near future.

The symposium generated a lot of spirited discussion and questions from the researchers in the audience. All-in-all, it was an informative and enjoyable session that I was happy to have had the opportunity to participate in



National Nutrition Month Mini-Symposium* “Communicating Nutrition Messages: Strategies for Diverse Audiences”

By Marcia Greenblum, MS, RD
March 11th, 2011

In honor of National Nutrition Month, NIH Division of Nutrition Research Coordination (DNRC) sponsored a very informative discussion: “Communicating Nutrition Messages: Strategies for Diverse Audiences”.  Speakers included Kay Loughrey, who spoke about Health Communications, Cheryl Toner, discussing Gender Considerations, Sonya Grier presented an update on Digital Media and Youth, Stephanie Dailey spoke about Communicating with Older Adults and Eileen Newman concluded with Cross Cultural communication strategies.

It really made me reflect on the ways we health communicators typically communicate; a brochure, a newsletter, a press release or a website entry. These are all unidirectional which we believe to be outreach but to really communicate, I now realize, our messages must be interactive and targeted to learning styles. Some of the speakers discussed games and video competitions that challenge target audiences to not only hear but adopt the message into their own style.

I also learned about the challenges of aging, something I am becoming all too familiar with, which makes communicating messages more difficult. But what impressed me most was that the central theme for communicating to all groups was that messages must be simple and short. Everyone including physicians and highly educated professionals want messages in bullets with only the important facts that are relevant to their needs.

No one wants to spend time evaluating an issue anymore. This was a lesson that we gained at our focus groups with health professionals. If a message is corroborated by others, it becomes truth. This is what was referred to as Illusion of Truth (Skutnick). In fact, this theory says that repetition makes people remember an issue to be true even if the issue was proven to be false. I find this very relevant to the perception of dietary cholesterol’s effect on heart disease. The association was repeated so often that even though it’s been disproven, it is still remembered as true.

Additionally, good communication tools include chunking information, speaking in an active voice, presenting information within interactive discussion in bulleted or a Q&A format. I learned a lot from this meeting and appreciate NIH DNRC for sponsoring this practical forum.


ADA Times Highlights the Egg

By Marcia Greenblum, MS, RD
February 15th, 2011

It was a pleasant surprise last week when I browsed through my most recent issue of the ADA Times and found the Love Food 2 page spread on eggs.  Eggs have had quite a wild ride with dietitians, first being used clinically in beverages to boost nutrient intake when patients couldn’t or wouldn’t chew or needed a ready source of high quality protein. Then the egg’s reputation went into a tailspin both because of the misunderstanding regarding an association between egg intake and cardiovascular disease risk compounded by the fear of Salmonella Enteritidis which although is a concern, only affects 1 in 20,000 eggs and can be completely prevented if care is taken to avoid temperature abuse and prepared correctly.  At long last the egg appears to be making a comeback, although the ADA Times authors seem to qualify their enthusiasm.

I’m hoping that the newly published data from USDA finding that a large egg now has 14% less cholesterol, 186mg in fact, will help dietitians to overcome their skepticism about recommending eggs again. The contributing author Tejal Pathak MS,RD, LD makes the point that for individuals at risk for CVD or T2D including an egg in their daily diet is difficult. Hopefully, this will now appear to be less problematic and the many valuable nutrients one consumes when eating an egg yolk make it a highly worthwhile 70 calories. In addition, the author mentions that genetics should be considered when discussing egg intake. In fact, only 1/3 of the population responds at all by increasing blood lipids following egg intake. Those hyper-responders increase both LDL and HDL particles so there is no increase in CHD risk. (Fernandez  ML and Webb D, Am Coll Nutr, 2008, 27 (1) 1-5)

Carol White MS,RD offered some nice suggestions about the versatility of eggs and the amazing functionality of eggs in baked and cooked dishes and Amorette Hinely Reid a recent graduate of Johnson and Wales University discussed eggs used in food service. It is appropriate to use pasteurized eggs when serving vulnerable populations but to the extent that eggs can be thoroughly safe if thoroughly cooked, I don’t think it is necessary to suggest using pasteurized eggs for the average consumer. It is good to have the egg back in our arsenal of healthy foods and to have ADA recognize their value in the ADA Times publication.


Whole Foods nutrient-profiling system

By Marcia Greenblum, MS, RD
January 21st, 2011

Last week, the AP posted an article detailing some changes Whole Foods will be making this year to emphasize health in their stores. The article, Whole Foods makes changes to emphasize health, indicates that they will be posting nutritional scorecards around the markets to help consumers with their food purchase decisions.

On the surface a healthy food score seems like a great help for the hurried and health concerned shopper. The problem is that foods are not inherently healthy but should be put together in a meal to supply most of the individual’s nutrient needs. From the point of view of selling products, foods can be made healthier if they contain more beneficial nutrients and less of the nutrients most people in the US consume in excess which is associated with increased disease risk. What doesn’t connect is the use of food rating systems based on population health risk statistics applied to an individual’s health. For example, I happen to have low blood pressure, a family inheritance. Sodium may not be a nutrient of concern for my personal health. However, a supermarket score includes negative and positive factors relating to population health can mislead me into thinking that my personal health would be improved by consuming a low sodium product. In this case, I may avoid cheese when in fact, I may benefit from the calcium in cheese. This is especially true for another nutrient rich food like an egg. No one disputes that egg protein is one of the highest quality proteins of any food. However, recent research findings indicate that there are hyper-responders and hypo-responders to dietary cholesterol. Hypo-responders (2/3 the population) don’t have any serum cholesterol response when they consume eggs. The hyper-responders (1/3 the population) do appear to have some small elevation of their serum cholesterol however, not enough to significantly increase health disease risk. So, should we all avoid the nutrient benefits of an egg because some members of the population see an increase in their serum cholesterol levels? Wouldn’t my health suffer by missing out on the high quality protein in an egg? In the Whole Foods scoring system eggs receive (27 out of 1000) in relation to egg whites (29 out of 1000) and egg substitute (30 out of 1000). In fact, there are many more nutrients which are needed for proper functioning of our bodies in the whole egg than if we extract the egg yolk and simply eat the egg white or egg substitute.

The fact is we all do need to eat, and eating a balance of nutrients from all foods in a moderate amount is healthy. Do food ratings based on a public health statistical advantage really relate to an individual’s health? And, by depriving yourself of the other nutrients that may also be needed and are found in the lower scoring foods are you really doing yourself good? (By the way, do we know what nutrients the Whole Foods experts consider healthy or unhealthy? What health outcomes do they use to decide how healthy a food is?)

A better way to approach meal planning is to seek balance and concentrate on the positive. Enjoy eating foods that have the most nutrients known to be needed by our bodies. Try to include members of all food groups in every meal and enjoy new foods and combinations of foods regularly but in a moderate portion size. For those who do want a guide for selecting the most nutrient rich foods I recommend The Nutrient Rich Foods Coalition profiling system:

Nutrition profiling of foods is defined as the science of ranking or classifying foods based on their nutrient composition5. Adam Drewnowski, PhD of the University of Washington, and Victor Fulgoni, PhD of Nutrition Impact, LLC, defined six guiding principles to develop and evaluate nutrient profiling systems, based on their work published in Nutrition Reviews 5. The principles include:

  1. Objective: Based on accepted nutrition science and labeling practices.
  2. Simple: Based on published daily values and meaningful amounts of food.
  3. Balanced: Based on nutrients to encourage and nutrients to limit.
  4. Validated: Tested against an objective measure of a healthful diet.
  5. Transparent: Based on published formulas and open-source data.
  6. Consumer-driven: Based on consumer research to help guide better food choices and help people build more healthful diets.

Published Research Review the extensive scientific research studies and reports in support of the Nutrient Rich Foods approach and have been published in peer-reviewed journals. You can view videos and presentations from experts who support the Nutrient Rich Foods approach and participated in the 2008 Nutrient Rich Foods Coalition Scientific Forum and the 2009 “Achieve Better Health with Nutrient Rich Foods Symposium”


Nutrition Unscrambled  is written by nutrition experts with the Egg Nutrition Center, which is funded by the American Egg Board. It is monitored and maintained by the public relations agency of record. The mission of the Egg Nutrition Center is to be a credible source of nutrition and health science information and the acknowledged leader in research and education related to eggs. For more information, click here.

About the Bloggers

Mitch Kanter, Ph.D. is the Executive Director of the Egg Nutrition Center. For more information about
Mitch, click here.
Marcia Greenblum, MS, RD is the Senior Director, Nutrition Education at the Egg Nutrition Center. For more information about Marcia, click here.
Anna Shlachter, MS, RD, LDN is the Program Manager, Nutrition Research and Communications at the Egg Nutrition Center. For more information about Anna, click here.

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All information provided within this blog is for informational and educational purposes only and it is not to be construed as medical advice or instruction. Please consult your physician or a qualified health professional on any matters regarding your health or before making changes to your diet or health behaviors.