Unscrambling the Science

The Way I See It...Breakfast in 2020

The recent newscasts regarding surging food costs and global food scarcity reminded me of an editorial I wrote for Nutrition Close-Up in the fall of 2000. I think it’s time to read part of it again.

I dreamt that in year 2020, I stopped for a quick breakfast of egg and sausage on an English muffin, hash brown potatoes, and glass of milk. The food was fine, but, I was charged $72.54 for breakfast. What an outrage! What happened to America's low-cost, fast food? Frustrated and irritated, I went looking for answers. Somebody was going to explain why I was paying $72.54 for breakfast. Didn't they know I was retired, living on a fixed income. After I yelled and screamed, and ranted and raved, some corporate type sat me down and told me the story.

It seems that over the years our national goal of an abundant, affordable food supply had been diverted from the consumer in favor of those with the loudest voices and most coercive tactics. For example, the wheat used to make the English muffin was 20 times the cost at the turn of the century due to the low yield of pest sensitive strains of wheat. Since genetically engineered wheat was banned in the U.S., and couldn't be imported, grain production on the ever decreasing U.S. agricultural land mass was steadily going down, and getting of poorer and poorer quality. So my little English muffin cost $11.28.

My glass of milk cost $12.88 since there was little milk production in the U.S. and, thanks to the animal rights bunch, all cows were now free to roam the few farms left for dairy production, and by law had to be hand milked. And for sure no one was allowed that artificial hormone to stimulate milk production. Added on top of that was the fat tax, imposed by righteous consumer advocates who wanted to make sure those who sinned paid their dues. And then the cancer tax that another self-important advocate group had used fabricated science to con the government, and many consumers, into believing was true.

The potatoes in my hash browns were all imported due to the demise of the U.S. potato industry following a severe potato blight which wiped out the blight sensitive (no genetically modified resistant strains allowed) strains allowed for U.S. production. The potatoes were now imported from South America but the cost of inspection at the border and the detailed and exhaustive testing for every known human pathogen (required by laws pushed by the food safety advocates) resulted in massive spoilage and refusal of the majority of imports. Oh, and since my hash browns were fried I had to pay the fat tax. Final cost, $14.36.

And the price of eggs had increased a bit too. Thanks to the demands and threats of animal rights groups like PETA, chickens were first given more space (cost increase 20-30%), then the following demand was that only free-range eggs be available in the market place (another 70% increase), and once that was accomplished the animal activists demanded and were awarded with an animal protein tax which, on top of the cholesterol tax, really did help them achieve their goal of imposing a vegetarian life style on everyone. And, since it now required more land, not less, to produce eggs and, since the available land mass for agriculture was disappearing with urban sprawl, egg prices went through the roof. Instead of paying $0.89 a dozen, it was more like $8.90 an egg. And while the consumer kept blaming those dirty rotten egg producers for gouging the market and short supplying the demand, the chickens were said to be happy, and the animal rights gang was euphoric. So to buy it, crack it and cook it, I was charged $12.69.

And finally, the sausage! $21.33! Fat tax, animal protein tax, cancer tax, banned factory farming, banned hog pens, banned breeding pens, banned overfeeding, banned genetic manipulation for disease resistance, limited production land, high cost of imported feed grains, and layer upon layer of oversight and inspection for animal welfare and testing upon testing for food safety. Actually, more people saw that hog, tested that hog and pampered that hog than the number of people who ate that hog.

And then I woke up. What a nightmare! Seemed like every crazy cabal with an agenda had gotten their way making their life-style my life-style. How many more kids would have been hungry if this became true? How many elderly would have food insufficiency if this happened? Surely people wouldn't sit back and let a bunch of loud, pushy, overbearing, self-appointed, self-righteous anointed few dictate and rule their lives.

And back then I didn’t even consider biofuels. And if you’re still not convinced, the HSUS efforts to get legislation passed state-by-state banning conventional egg production is going full force. Times of increased food costs and increased food scarcity is no time to put limits on food production. I believe people are significantly more important than SUVs and vegetarian agendas and that this really is a matter of life or death.

Just the Facts...No Diet for Older, Overweight, Inactive Men Who Smoke and Drink

A study published in the April 2008 issue of The American Journal of Clinical Nutrition [1] suggests an association between high egg consumption and all-cause mortality in male physicians. The researchers did note that there was no relationship between egg consumption and cardiovascular disease risk, as has been shown in a number of previous studies. So what did eggs do? We don’t know since all that was references was total mortality, not any specific cause. But one should note that the men who ate the most eggs were older, fatter, ate more vegetables but less breakfast cereal, and were more likely to drink alcohol, smoke and less likely to exercise -- all factors that can affect one’s risk of death. But the authors did title their paper “Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study.”

As noted in an accompanying editorial by Dr. Robert Eckel, co-chair of the Committee on Cardiovascular and Metabolic Diseases “The study suffers from the lack of detailed dietary information that may confound the interpretation, such as patterns of dietary intake of saturated fat and trans fats.” [2] This is a significant point, given that one might think that doctors who are fatter, ate less breakfast cereal, and were more likely to drink alcohol, smoke and less likely to exercise might eat their eggs with foods high in saturated fat (a finding reported nine years ago in the Health Professionals’ Follow-Up Study by Hu et al. [3]).

The investigators reported that among male physicians with diabetes, any egg consumption was associated with a greater risk of all-cause mortality; however, the researchers did not comment on the level of diabetes control of the subjects. Poor diabetic control is associated with an increased risk of a number of chronic diseases that also effect mortality. Once again, those who are fatter, eat less breakfast cereal, and are more likely to drink alcohol, smoke and less likely to exercise might also be the ones with the poorest diabetes control.

So let me suggest that every older, overweight, inactive, smoking and drinking doctor who doesn’t know how to take care of himself eat only six eggs a week until you get your act together and yourself in better shape. If you are diabetic get your diabetes under control and your A1C levels below 7% so that your plasma lipoproteins aren’t atherogenic and a risk for heart disease. Believe me, if you don’t change you’ve got more to worry about than how many eggs you eat a week.

On the other hand, if you’re healthy then this study says eggs have no effect on heart disease or stroke risk and you can include them in your diet. When you do, you get the choline that’s probably missing from your diet, you get high quality protein, satiety so you’re not so hungry and a spectrum of essential and functional nutrients. The evidence is clear, an egg a day (or 7-10 a week) is not a risk for heart disease.

1. Djoussé L and Gaziano JM. Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. AJCN. 2008; 87;964-9.
2. Eckel R. Egg consumption in relation to cardiovascular disease and mortality: the story gets more complex. AJCN. 2008; 87:799-800.
3. Hu et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women JAMA. 1999;281:1387-1394.

The Way I See It...Start the Day Right.

A recent study in the March 2008 issue of Pediatrics confirmed what grandma already knew – breakfast is important. And its not only important for nutrition and school performance but also for weight control. In this five year study of the eating and exercise habits of 1,007 boys and 1,215 girls with an average age of 15 years at the start of the study, the investigators found a direct relationship between breakfast eating and body mass index (BMI). At the start of the study, consistent breakfast eaters had an average body mass index of 21.7, intermittent eaters 22.5, and rare breakfast eaters 23.4. Over the next five years, BMI increased in the same pattern (5-year increase in BMI, 1.6 kg/m2 among daily breakfast eaters vs. 2.0 and 2.2 among intermittent and never-eaters, respectively). Interestingly, about half the teenagers ate breakfast intermittently, with girls being more likely to consistently skip breakfast and boys being more likely to eat it every day.

Combine these findings with studies showing a better satiety effect of eggs vs. carbohydrate foods for breakfast and you know what you’ve got to do: cook up some eggs in the morning. But who has the time, the patience, the incentive? Here’s a simple idea--Sunday prepare some hard cooked eggs (5 per family member), and put them in the fridge. (If you don’t know how to prepare hard cooked eggs, visit the American Egg Board Web site for a quick lesson ) For the next five days, breakfast is taken care of. Everyone can get a hard cooked egg and maybe a slice of toast or a muffin and head out the door in a flash. Eggs-actly right for you and them, and even easier on the waistline. And of course, on the weekend everyone should get together for a real, sit-down breakfast (wouldn’t that be new and different!). One can long for the good old days when they actually were good.

The Way I See It...Vytorin Study: What “No Effect” Means

The results and subsequent confusion regarding the Vytorin, Zetia ENHANCE Study raise all kinds of questions regarding the use of non-statin drugs for the treatment of high blood cholesterol. I’d like to raise a different issue regarding the researchers’ observations. Although blocking cholesterol absorption from the gut decreased plasma LDL cholesterol levels, it did little to lower heart disease risk. Therefore, it follows that cholesterol from the gut, including dietary cholesterol, must have little effect on heart disease risk.

The makers of Zetia advertise that their product blocks cholesterol absorption “from food” (even though 80% of the cholesterol absorbed from the gut comes from biliary cholesterol and, incidentally, it’s the blockage of this cholesterol that has the real impact on the amount of cholesterol being absorbed). So if blocking the absorption of cholesterol “from food” has no effect on heart disease risk, then conversely it would seem that cholesterol “from food” has no effect on heart disease risk. The experts can’t have it both ways: either dietary cholesterol intake is a risk factor for heart disease and reducing it lowers risk, or it isn’t a risk factor and changing it has no effect, which is what the ENHANCE Study indicates. This is an interesting question as we think about dietary recommendations and their efficacy in actually modifying disease risk. Is dietary cholesterol a risk factor and should intake be limited? Based on this study’s observation that blocking cholesterol absorption in the gut was not effective in reducing heart disease risk, as well as a boat load of previous studies showing that cholesterol intake is unrelated to heart disease incidence, it would seem (as the Canadians decided many years ago) that restricting dietary cholesterol is pretty futile as a risk reduction strategy. How about effective interventions and less confusion?

The Way I See It...An “Innocence Project” for Cholesterol

In 1968 eggs were found guilty of having too much cholesterol and condemned to a life sentence of “dietary exile.” Back then, the evidence against eggs seemed rather convincing:

• Feeding cholesterol to rabbits caused atherosclerosis.
• Epidemiology showed a simple correlation between dietary cholesterol and heart disease.
• Feeding grams of cholesterol to patients increased their blood total cholesterol levels.
  Guilty as charged! A health threat to society! Deserving of banishment from the diet! No more mingling with decent foods. “Out, out damn cholesterol!” they cried. And the “no more than 300 milligrams per day” counterpart of the scarlet letter was burned into our nutritional psyche.

But wait. Have we not learned anything in the past forty years which suggests that maybe dietary cholesterol is not the villain we thought it was?  Have not advances in our understanding of diet and heart disease generated new concepts that might find dietary cholesterol innocent of all charges? Armed with so much new empirical evidence, can the defense not better defend cholesterol against the charges launched so long ago by the prosecution? Isn’t it time for an appeal of the 1968 conviction? Let’s look at the new evidence.

• Rabbits were the first animal models used in cholesterol feeding studies. But rabbits aren’t really the best model for these feeding studies since they don’t normally eat animal products. How about a dog, rat, monkey or baboon? And not those massive doses of cholesterol we used to use. These should be physiological studies, not pharmacological studies. When the studies are done within a physiological range of cholesterol intakes in an animal model that naturally consumes animal products, we find very little effect of dietary cholesterol on either plasma cholesterol levels or atherosclerotic development. A case of “the dose makes the poison” perhaps?
• Thanks to computers, today’s epidemiology uses multivariant analysis to determine the independent effects of dietary factors on disease risk. The fact that saturated fats and dietary cholesterol are found in the same foods and are strongly correlated with each other makes this kind of advanced analytical technology absolutely imperative. Prior to its existence, there was no way for a researcher to determine the independent effects of either saturated fat or cholesterol. And when applied in recent studies, they all show the same thing—saturated fat intake is significantly related to heart disease incidence, while dietary cholesterol falls out of the equation. A case of an overly simplistic answer coming from the simple correlation--simple and wrong.
• “But wait!” the defense cries out, “feeding cholesterol to people raises their blood cholesterol levels!” Well, first it depends on how much you feed them. Four eggs a day for four weeks will elicit a small increase, but lower doses have undetectable effects. And the increase in total serum cholesterol is due to an increase in both the atherogenic LDL cholesterol level and the anti-atherogenic HDL cholesterol with no change in the LDL:HDL ratio. Further, the increase in LDL cholesterol occurs in the large, buoyant less atherogenic particle rather than in the small, dense highly atherogenic particle…All indications that total cholesterol levels are not a very applicable surrogate marker for heart disease risk and that changes in total cholesterol levels are not necessarily predictive of changes in heart disease risk.

In summary, I think we have provided sufficient fresh evidence to justify a new trial…which, I believe, will find dietary cholesterol and eggs innocent of these scurrilous charges and free an innocent food to rejoin the good food society once again.

The defense rests.

Eggs, Easter and Thank You

Just a note to wish everyone a very Happy Easter and to say thanks to Tara Gidus whose blog entry on RDs Weigh In definitely made my Easter happy. Ms. Gidus undeniably got the message about the health benefits of eggs and recommends "an egg a day is OK." I especially liked the comment "Well, wake up and smell the scrambled eggs, because they are good for you!" Her list of the nutritional benefits of eggs shows the power of this nutrient dense symbol of life, and she dispels the outdated notion that eggs cholesterol is harmful.

And did you know that of all the symbols associated with Easter, the egg - the symbol of fertility and new life - is the most identifiable. The customs and traditions of using eggs have been associated with Easter for centuries. Eggs have been used to represent rebirth and new life for hundreds of years with many customs dating back to pagan traditions. So how could an egg be anything but delicious and nutritious? Happy Easter.

The Way I See It...The Truth Shall Set You Job-Free

In 2006 health writer Gina Kolata noted in a New York Times article: “The problem, some medical scientists said, is that many people — researchers included — get so wedded to their beliefs about diet and disease that they will not accept rigorous evidence that contradicts it.” Truer words have never been spoken.

Dr. David B. Allison, the incoming president of the Obesity Society, found this out the hard way. Dr. Allison submitted an affidavit on the science behind New York City’s new rules for menu labels at chain restaurants. In the affidavit, Dr. Allison concluded that there was not sufficient evidence to show the effect of calorie labeling on people who eat in restaurants, and that while it is possible such labels on menus could be helpful, it is equally possible that they could have no effect — or that they might increase obesity, in part by casting high-calorie foods as forbidden fruit. He thought he was not taking a position for or against menu labeling in the document but merely presenting the scientific evidence that the labeling might or might not deter over-eating and, in fact, might be harmful. Thoughtful, judicious, considered, cautionary science speak. Wrong!

He had violated the sensitivities of all those who believe (since there is no evidence) that telling people how many calories are in that Death by Chocolate dessert will stop them from ordering it. [Maybe the name is a clue!] And how many calories are there in my salad with the dressing on the side? Anyway, accusations of “industry ties” [sort of like witchcraft and heresy, or at least the sin of questioning dogma] and the hue and cry of countless members of the nanny state resulted in Dr. Allison resigning his position in the Obesity Society.

So we are back to the dogma of public health officials who believe that individuals might change their ordering habits or restaurants might change their menus if calorie labeling is conspicuous. But then the question is--How many calories per week do average consumers (2/3 of whom are overweight) get from chain restaurants compared with the number of calories they get from their own kitchens, where the majority of calories are consumed? Maybe I can get my wife to start calorie labeling dinner!

The Way I See It...We Must Make Our Schools Safe

The rash of school violence has affected many of us and clearly there is cause for concern. Metal detectors in schools, teachers being assaulted, bullying and violence of those who don’t fit in; all are factors in the deterioration of our educational system. Fortunately one school has taken steps to make its institution safe and secure, and to make sure that no one is above the law. Sheridan Communications and Technology Middle School eighth-grader, Michael Sheridan, was suspended from school for three days, barred from attending an honors student dinner and stripped of his title of class vice president. That’ll teach the little trouble maker. What was he thinking when, in clear violation of school policy, he bought, from another student, a bag of Skittles?

Yes, that’s right, the punishment was for buying a bag of candy from another student. This was a clear violation of the 2003 school policy which states "no candy or junk food fundraisers will be allowed on school grounds" and that only "healthy snacks will be sold in vending machines selling food products." as part of the school wellness policy. How dare he! And just so you know that justice was served, the student who sold the candy was also suspended.

Thank goodness someone is taking action to make our schools safe! Now if we could just get more schools to post “This school is a candy-free zone” signs and enforce them, our kids would be safe from the ravages of sweets addiction.

Just the Facts...Nutrient-Rich Foods are a Good Choice During Pregnancy

Some expectant mothers believe being pregnant is a license to consume whatever they crave. But, the quality of calories consumed is important to ensure the mother’s health and the baby’s growth and development. ”Moms-to-be should choose nutrient-rich foods like eggs, low-fat yogurt and fruits and vegetables, which are high in essential nutrients compared to their calorie count,” says Claudia Gonzalez, MS, RD and mother of three. “Eggs, for example, provide four of the nutrients pregnant women need most—protein, iron, folate and choline—for just 75 calories per large egg.”

Choline is actually one of four nutrients that the March of Dimes emphasizes for healthy pregnancies (the others are protein, calcium, and folate). Why is choline included in this list of important nutrients? “Choline is an essential nutrient for an expectant mother and her developing baby,” said Janis Biermann, Senior Vice President of Education & Health Promotion with the March of Dimes. “Prenatal choline intake may help contribute to a healthy pregnancy and a healthy baby.”

What’s more, a growing body of science demonstrates the role that choline plays in brain development, as well as in the prevention of birth defects. Research suggests that sufficient consumption during pregnancy is vital for proper fetal brain development. Getting enough choline can also help prevent birth defects. The National Academy of Sciences recommends increased choline intake for pregnant (450 milligrams per day) and nursing women (550 milligrams per day).

(Incidentally, two large eggs provide 251 mg choline, which is 56% of the recommended choline intake for pregnant women…)

Just the Facts...Up To Date On Choline

By now, you’re probably aware that choline is not only an essential nutrient, but one that is vitally important in the arsenal of protective prenatal nutrients. Adequate choline intake supports proper fetal brain development and has been shown to prevent some birth defects...But did you know that according to NHANES data, only 10% of the US population consumes enough choline to reach Adequate Intake (AI) levels?  This means that 90% of pregnant woman are falling short of the 450 mg/day recommended to support a healthy pregnancy and 90% of women are not getting the 550 mg/day needed during breastfeeding. To keep you up-to-date on the emerging science surrounding this important nutrient, the Egg Nutrition Center has developed a brochure for you and your patients. Please visit our website to download a printable online version of the brochure.