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?

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.

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.

Basketball Cards

Are you a fan of the great basketball stars? Then you must be looking for their collectibles like basketball cards. If you are planning to start your own card collection, it helps to know different places where there are basketball cards for sale. If you find it a bother to step inside hobby shops and sports stores, you might want to look for basketball cards online. The internet offers a wide selection of basketball cards from vintage editions to the newest ones available. If you are lucky enough, you can even come across hard to find cards that you have never thought you could own!

2008-09 Upper Deck MVP Basketball Trading Cards
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NBA Basketball Trading Cards. Collection of NBA Basketball Card Set of 30 unopened assorted packs from different years and brands. AUTOGRAPHED SIGNED booklet of Sports Card Mania
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2009 10 Panini Basketball Boston Celtics Complete Team Set of 13 cards including Eddie House, Glen Davis, Kendrick Perkins, Kevin Garnett, Paul Pierce, Rajon Rondo, Rasheed Wallace, Ray Allen, Stephon Marbury, Tony Allen, Marquis Daniels and 2 Lester Hudson Rookies!
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25 Ultra Pro 9 Pocket Page Protectors Fits 3-Ring Binder for Baseball and Other Sports Cards!
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2009 10 Panini Basketball Los Angeles Lakers Complete Team Set of 11 cards including Kobe Bryant, Adam Morrison, Andrew Bynum, Derek Fisher, Jordan Farmar, Josh Powell, Lamar Odom, Luke Walton, Pau Gasol, Ron Artest and Sasha Vujacic !
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Ultra Pro 3-Ring (D-Ring Binder) Basketball Card Album Blue
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2008-09 First Edition Basketball Trading Cards
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2008-09 Fleer Hot Prospects Basketball Trading Cards
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2008-09 Upper Deck Basketball Trading Cards
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NBA Basketball Card Collector Box Over 500 Different Cards. Great Mix of players from the last 30 years. Ships in a new brand new factory sealed white box perfect for gift giving.
Sale Price: $12.85