Preventing a second, or a first, heart attack: Part 3

Eating the right type of fat.

Our dietary fat intake has actually decreased over the years... but heart attack and strokes have increased.

Obviously, fat isn't the enemy and, in fact, including the right type of fat in your diet can help decrease your risk of having a first, or a second, heart attack or stroke.

Unsaturated fats include:

Monounsaturated fat- Olives, olive oil, canola oil, peanut oil, nuts, seeds, natural peanut and seed butters and avocadoes.

Polyunsaturated- Fish and corn, soybean, safflower, sunflower, soybean and cottonseed oils.

Replace the Bad with the Good:

Replacing saturated fats or carbs in your diet with unsaturated fats has been shown to decrease the 'lousy' LDL cholesterol (the one that clogs up your arteries), prevent the increase in triglycerides (the fat that's in your blood) that has been linked to heart disease and that increases with high refined carb intake (sweets, desserts, white bread, white pasta, white rice etc.), reduces the risk of blood clot formation, and decreases erratic heartbeats- the main cause of sudden cardiac death.

Dr. Willett and his team at the Harvard School of Public Health calculated that replacing 5% of calories as saturated fat with unsaturated fat reduces the risk of heart attack by 40%!

Assuming you eat 2000 calories, that would means replacing 11g saturated fat with 11g unsaturated fat.

For example, eat 1 oz nuts (about 1/4 cup) instead of 1/2 cup ice cream or eat 2 Tbsp peanut butter instead of 2Tbsp cream cheese or 1 oz hard cheese.

Speaking of nuts, the Nurses' Health Study, published in the British Medical Journal in 1998, looked at the health of more than 86,000 women. It found that those who ate 142 grams (five ounces) of nuts per week were 35% less likely to develop heart disease than women who ate less than one ounce per week.
The 2002 U.S Physicians Health Study found that men who ate nuts two or more times per week were 47% less likely to die of a heart attack and 30% less likely to die of heart disease than men who rarely ate nuts.

Bottom Line

Make sure that every day you replace some of the saturated fat in your diet- found in animal products like meat, milk products, eggs, lard, shortening and butter- and excess refined carbs with various sources of unsaturated fat, including fish, vegetable oils, nuts, seeds, avocadoes, peanut butter, olives and non-hydrogenated margarine.

Want to read more?

Click here for Part 1
Click here for Part 2

Coconut oil: Good fat or bad fat?

Saturated fat is a bad fat- it increases your "lousy" LDL cholesterol that transports cholesterol to the arteries, causing plaque to form on your artery walls, increasing your risk of a heart attack or stroke.

In general, foods from animals sources contain mostly saturated fat (ie. meat, milk, cheese, butter, lard) whereas foods from plant sources contain mostly unsaturated fats (olive oil, canola oil, nuts, avocadoes).

There is one main exception though: tropical oils. These so-called tropical oils, like palm oil and coconut oil, are mostly saturated. In fact, coconut oil is 92% saturated! As such, it has generally been recommended to limit intake of coconut oil, along with animal fats, to reduce your risk of heart disease.

That said, recent studies have indicated that coconut oil may not be as bad as we had thought.

In a 1995 study, 28 people with high cholesterol followed a diet providing 36% of total calories from fat, 50% of which came from either butter, coconut oil or safflower oil (only about 10% saturated). After 6 weeks, total cholesterol and the "lousy" LDL cholesterol were significantly higher in those on the butter diet compared to the coconut oil diet. The safflower oil diet was associated with significantly lower total cholesterol and LDL cholesterol levels compared to the butter and coconut oil groups. The same researchers confirmed the above results on healthy subjects as well.

Although coconut oil is more saturated, the saturated fat in butter comes from palmitic acid whereas the one in coconut oil comes from lauric acid. Palmitic acid (also the main fat in palm oil) has been found to have a greater negative effect on cholesterol and is therefore more conducive to heart disease than lauric acid.

So... what does this mean?

It means that non-hydrogenated coconut oil can be an alternative to butter or hydrogenated or partially-hydrogenated vegetable oils that are high in trans fats, but it shouldn't replace other more healthful, mainly unsaturted, oils such as olive, canola, soybean, corn, safflower or sunflower oils.

Tomatoes: Lycopene, Cancer & Heart Attacks

Tomatoes are rich in the antioxidant lycopene that's been linked to reduced rates of cancers, especially lung, stomach and prostate cancers.

A study by the Harvard School of Public Health showed that men that ate 10 or more servings of tomato-based foods a week had a 45% reduced prostate cancer rate.

Lycopene is bound inside cell walls, making it difficult for the body to extract it from raw tomatoes. This explains why cooked tomatoes (ie tomato sauce) seem to be more protective than raw tomatoes or tomato juice- the heat seems to release the lycopene.

Lycopene is also fat-soluble so cooking tomatoes in oil (ie. tomato sauce!) enhances the absorption of the antioxidant.

What's causing some confusion is a study conducted at the Ohio State University on about 200 rats (a good model for human prostate cancer, supposedly). Some rats were fed diets containing whole tomato powder and others were fed rat food fortified with pure lycopene (and, consequently, received more lycopene than the tomato powder group). Reserachers caused prostate cancer in these rats.The rats fed the pure lycopene actually had more tumors and a significantly greater risk of death!

What this study suggests is that there seems to be other components in tomatoes that have a protective effect- the whole food is beneficial whereas isolated lycopene may not be.

It seems that tomatoes may also protect the heart. An Itailan study looked at the diets of 507 heart attack victims and of 478 controls- one of the items on the food frequency questionnaire was pizza. Surprisingly, regular pizza eaters (eating about 500g or just over 1/2lbs pizza a week) were 40% less likely to suffer a heart attack than those who never ate pizza!

Maybe the pizza eaters were eating less high saturated fat hamburgers. Remember that real Italian pizzas are not like the North American meat-lovers-pepperoni-3 cheese- stuffed crust ones- they have a thin crust and are dressed with olive oil, a lot of tomato sauce and some cheese. Another possibility that Dr. Schwarcz proposes is that the tomatoes may be responsible: That yellow stuff around the seeds of tomatoes contain flavonoids that have anti-clotting properties... possibly reducing the risk of heart attacks!


Bottom line: Aim to treat yourself to tomatoes, processed tomatoes or tomato products cooked in oil every day. Stay away from lycopene supplements until more research is done.

Red meat linked with death

A study published in March’s Archives of Internal Medicine looked at the meat intake of half a million Americans aged 50-71 for 10 years.

After controlling for age, race, BMI, education, smoking history, alcohol intake, caloric intake, fruit and vegetable intake, vitamin intake, hormone therapy and physical activity, researchers found that the more red meat and processed meat people ate, the higher the mortality risk- in fact, they had a 20-40% increased risk of death. They also had a higher risk of heart disease and cancer.

The participants that ate the most meat were more likely to be of white (non-Hispanic) ethnicity, married, smokers, have a higher BMI, higher caloric, fat and saturated fat intake, have lower education and physical activity levels and lower intakes of fibre, fruits and veggies. Remember, that all these factors were controlled for though.

So, how much meat were they eating? The subjects that are the most meat were eating about 160g red meat or processed meat per day- the equivalent of about a 5 oz steak a day. The ones getting the least meat were eating just under 1 oz a day.

This study adds to what we’ve already known: red meat and processed meat are major sources of saturated fat which have been associated with high blood cholesterol, heart disease and cancer. Meat has also been shown to be a source of cancer-causing agents which are formed during high-temperature cooking. Processed meats also contain carcinogenic nitrosamines.

Since it's pretty clear that eating a diet rich in red meat and processed meat puts your health at risk, try to limit your intake- there are so many delicious vegetarians options available now... try them! Also replace your red meat with beans and lentil-based meals, fish and/or white meat as often as possible.

Paula Deen's Heart Attack on a Plate

This is horrible!



Using Calorie King’s Food Database, I calculated that this meal has approximately:
907 calories- which is about half of your daily requirement, 60% of which comes from fat (and 25% of which comes from saturated fat)!
It also has a total of 350 mg of cholesterol which exceeds your day's requirement.

Eating this burger is equivalent to eating 15 pats of butter or 3/4 of a stick of butter!


Bon Appétit!

Can creatine help you build muscle?

Usually, when it comes to ergogenic supplements, most health professionals will dissuade athletes from taking them citing lack of research, questionable safety, unwanted side effects. For this reason, it surprised me to read about creatine. Turns out that creatine is one of the best researched ergogenic aids on the market, was called by one well-known sport dietitian as "the most important natural fuel-enhancing supplement yet to be discovered for strength trainers" and can produce significant improvement in sports requiring high levels of power and strength.

What is creatine?

Creatine is a compound naturally found in meat and fish. We also synthesize it in our liver and kidney from amino acids. 95% of creatine is stored in our muscles where it becomes creatine phosphate, the primary fuel for short, high-intensity bursts of activity lasting 1-10 seconds like weight lifting, sprinting, ice hockey etc.
Just like endurance athletes carb-load to increase muscle glycogen stores, creatine-loading can increase muscle creatine stores. Creatine won't build muscle directly but will allow you to increase the duration and intensity of your workout, resulting in muscle gain.

How much?

We get about 1-2 g creatine from food daily (vegetarians get less) but supposedly that's not enough to improve strength training performance. Creatine supplements usually come in the form of powder under the name creatine monohydrate. Studies show that taking four to five 5 gram (1 tsp) doses a day for 5 days- or 0.3g/kg body weight per day- will result in rapid loading. From there, 2 grams (1/2 tsp) a day will keep muscles saturated. A more gentle loading regimen is 2 grams a day for 28 days. Taking more than 40grams daily may cause possible liver and kidney damage. .

Creatine stays in the muscles for 4-5 weeks after a loading phase without extra supplementation. Coordinate creatine supplementation with your training schedule, starting just before you begin a high intensity training session.

20-30% of people don't respond to creatine-loading. Interestingly, creatine works best in combination with a liquid carbohydrate supplement and this may help non-responders to get creatine into their muscles. Ingesting 75-100 grams carbohydrates can boost the amount of creatine loaded in muscles by up to 60%.
75 grams carbohydrate = 3 cups orange juice or 5 cups gatorade.

Side Effects

Creatine is non-toxic and so far there is no evidence to suggest that it's unsafe when taken by healthy adults in the recommended doses for a short term period of ~8 weeks (safety of prolonged use has not been determined yet). Nonetheless, the American College of Sports Medicine recommends that all athletes check with their doctor before taking creatine.

Creatine supplementation is not advised for people with pre-existing kidney disease. There's also no research done on the effect of creatine supplementation on growing kids under the age of 18.

Weight gain of 2-5 lbs is commonly seen in creatine users and is partly due to water weight but evidence now shows that much of the weight gain is a result of increased muscle mass. Anecdotal reports suggest that creatine may cause cramping, nausea, GI problems and higher rates of muscle tearing. The cramping may be the result of dehydration therefore it's recommended that athletes supplementing with creatine drink more water than usual.

As with any supplement, quality of the product is poorly controlled- what you buy is not necessarily what you get.

Creatine and Endurance

Creatine supplementation has been shown to have no effect on VO2max or to improve endurance. However, some researchers believe that creatine supplementation can indirectly improve endurance performance by lifting the lactate threshhold, allowing a more intensive interval-type training. Moreover, increasing muscle mass can potentially help certain endurance athletes like swimmer and rowers... but may hinder others that don't want extra muscle mass, like marathoners and long-distance cyclists.

Is it Legal?

Yes. Creatine actually became public when it was reported that Linford Christie, 100m gold-medal winner, used creatine during the 1992 Barcelona Olympics. Sally Gunnell, 400m hurdle gold-medalist and many British rowers used creatine in preparation for the Barcelona games as well. However, there is concern for cross-contamination since athletes taking creatine have tested positive for banned prohormone products.
The NCAA does not condone the use of creatine.

Sources

Kleiner SM, Greenwood-Robinson M. Power Eating: Build muscle, boost energy, cut fat, 2nd ed. Human Kinetics. 2001.

Ryan, M. Sports Nutrition for Endurance Athletes, 2nd ed. VeloPress 2007.

Girard-Eberle S. Endurance Sports Nutrition. Human Kinetics 2000.

Clark N. Sports Nutrition Guidebook, 3rd ed. Human Kinetics 2003.

Creatine supplements. http://en.wikipedia.org/wiki/Creatine_supplements

Soy, Sperm and other Stuff

While I was away on holidays in July, a study was published that made the news headlines. The study, conducted by researchers from the Harvard School of Public Health (funded by National Institute of Environmental Health Sciences and the National Institute of Diabetes and Digestive and Kidney Diseases), found an inverse relationship between consumption of soy foods and sperm concentration.

That is, the men that ate the most soy products had a lower sperm concentration.

First, some background.

A Surplus of Soy

Soybeans were once grown almost exclusively for animal feed but Americans started eating it in ~1915 and have been consuming more and more of it, in higher and higher quantities, ever since.

Corn and soybean crops are subsidized by the government but up until the 1970s, policies and programs were put in place to prevent overproduction on the farms, to help farmers get fair prices for their crops. However, in the 1970s, Nixon's administration successfully dismantled these programs in their efforts to drive down costs of these crops, resulting in an overproduction of corn and soybeans. The more corn and soybeans the farmers produced the more money they could make… but this backfired on them since production was so high that it drove the cost down. As a result, farmers were getting paid less than it cost them to grow their crops! This, of course, led to unhappy farmers as well as a surplus of soybeans (and corn) available for human consumption (after exporting some, turning some into animal feed and converting some into oil used in margarines, cooking and salad oils).

Enter USDA-sponsored 'research and education' programs- basically government money to market soybeans to human consumers. Someone had to eat this surplus…

Asians eat soy: A marketing strategy

The reductive logic below has been used many times to explain the benefits of soy:

Asians have fewer heart attacks and less breast and prostate cancer than Americans and Asian women report fewer hot flashes and other symptoms of menopause.

Asians eat soybeans.

Soybeans must be responsible for all these health benefits.

Of course, this ignores the fact that over 1 billion people are considered 'Asian' and they don't all have the same lifestyles of diets. In fact, soy isn't even a staple in all Asian people's diets. Asians also have other things in common (apart from eating soybeans) that may contribute to their overall better health: genetics, weight- Asians generally have lower BMIs than Americans and less sedentary lifestyles, to name a few.

Soy & Cholesterol

One soy research found that eating 50 grams of soy protein versus animal protein a day reduced total cholesterol levels by 9.3%, the lousy LDL-cholesterol by 12.9% and triglycerides by 10.5%. If sustained over time, you could potentially reduce your risk of having a heart attack by 20%.

However, remember that soy is just one food and it's very hard to figure out the effect of one food from everything else you eat and do. If you eat soy because you think it's healthy, maybe you're also following other healthy habits.

Without adopting a healthier lifestyle (less saturated fat, more physical activity, quit smoking), soy will do nothing. Moreover, other studies have shown no link between soy protein and cholesterol levels.

Nonetheless, The FDA was under a lot of pressure from the government and food companies and relied heavily on that one study mentioned above to come out with their health claim that:
"Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease".
Foods that contain 6.25 grams of soy per serving can carry this claim on their label (in the States, not in Canada).

Isoflavones, aka Phytoestrogens

Complicating issues a bit more is that independent research suggests that it's the combination of isoflavones and the soy protein, not just the soy protein, that is responsible for the health benefits. The isoflavones in soy are phytoestrogens, weak estrogen-like substances made by plants.

25 grams of soy protein contains about 45mg isoflavones.

A Japanese person who eats a traditional soy-based diet consumes an average of 25-50mg soy isoflavones a day.

According to a Penn State College of Agricultural Sciences publication, the safe range of intake is 35–55mg isoflavones a day and it should not exceed 100 milligrams per day.

Average isoflavone content of various soy foods
per 100 grams (3.3 ounces) serving (unless indicated)

Boiled soybeans- 54 mg
Tempeh- 53mg
Tofu- 28 mg
Soy hot dogs- 15 mg
Soy milk- 10 mg
Soy mozzarella- 8 mg
Soy sausage- 4 mg
Soy nuts- 9 mg or 79 mg per 28 ounces
Gardenburger Lifeburger- 50 mg in 6 ounces
Soy Sensations Nutrition Bar- 60 mg in 2 ounces
Soy flour- 0.1–0.4 mg/g or 20 mg per half cup (50 grams)
Soy protein concentrate- 0.01– 0.2 mg/g
Soy oil- none
Soy sauce- none

Phytoestrogens and Breast Cancer

Again, using the same reductive logic as above, Japanese women have lower breast cancer rates and Japanese women eat more soy.
Therefore eating soy can help reduce breast cancer rates. Right?

Well, this makes sense because phytoestrogens act like estrogen but don't have the same effect. So these phytoestrogens can bind to our estrogen receptors, thus blocking the real estrogen, high levels of which have been known to increase breast cancer risk.

However, the reductive logic above is wrong; mainly because, as I mentioned previously, soy is actually not a staple in many Asian countries. The lower breast cancer rates are most probably due to other factors such as genetics, physical activity, weight, other dietary factors, childbirth patterns etc.

The research on soy and breast cancer is contradictory. A large study in China found that women with breast cancer ate the same amount of soy as those without cancer. Another Japanese study found the same thing in a 10-year follow-up study. However, another large Japanese study found that those that ate more soy had a lower risk of breast cancer.

There is also the possibility that soy can actually cause more harm: Although the estrogen-blocking activity of phytoestrogens may possibly be beneficial to younger women, in later years when estrogen levels are lower, these same phytoestrogens may actually mimic real estrogen and cause breast cancer cells to grow. The most abundant isoflavone in soy is called genistein and it has been found to possibly stimulate growth of estrogen-receptor positive breast cancer cells. This isoflavone can also interfere with the cancer-killing drug tamoxifen.

Hot Flashes

Again, the results are contradictory. Some studies showed that women who ate more soy had fewer hot flashes whereas others showed no differences.

Hot flashes are more likely to occur when you're stressed and less likely to occur if you exercise… perhaps the women who ate more soy were also more active and less stressed?

Soy and sperm

Now for the most recently published study:

99 men that presented at an infertility clinic for evaluation (these were the male partners in a subfertile couple) provided a semen sample and completed a food frequency questionnaire that assessed the frequency and quantity of soy foods they ate. These men were categorized into 4 groups: men who never ate soy products, ate soy products <2 times a month, 2 times/month to 2 times a week and ≥2 times a week.

After correcting for factors possibly affecting sperm concentration- smoking, caffeine intake, alcohol intake, BMI and age- it was found that men who ate the most soy had 41 million sperm/ml less than those that ate no soy. No association was found with soy food intake and sperm count, sperm movement or shape or ejaculation volume.
It's important to note that a reduced sperm concentration does not result necessarily in infertility.

Included in this group were men with potential infertility problems (10% had a sperm concentration below 20 million/mL; normal concentration is 80-120 million/mL) but the inverse association between soy and sperm concentration was greater in the men with higher sperm concentration. The association was also higher in the men that were overweight and obese (BMIs greater than 25) and 72% of the men in this study were in fact overweight or obese.

According to Jorge Chavarro, lead researcher of this study, the hypothesis is that because isoflavone found in soy products are phytoestrogens (weak estrogen-like substances) they may be harmful to male fertility. We know that the more overweight a man is, the higher his estrogen level is. As a result, it's possible that additional estrogen-like compounds in the diet can become an issue for these overweight and obese men.

The European Natural Soyfoods Manufacturers Association have disputed this study's findings stating the familiar: "Generations of Asians have regularly consumed soya without fertility disorders, and Asian countries have prodigiously produced very healthy, highly functioning children for centuries".

As we now know, soy isn't a staple in all Asian people's diets and other lifestyle factors may better explain the differences between the ethnic groups, ie. perhaps the fact that overweight and obesity rates are much lower in the Asian compared to the American population has something to do with it. 90% of the subjects in Chavarro's study were Caucasian.

Another small human study has looked at the association between soy and sperm count and found no change in semen quality with soy intake whereas another actually found a positive effect on sperm count with isoflavone intake.

Evidently, more research needs to be done. Chavarro himself says that it's too soon to draw conclusions about whether soy consumption affects male fertility but experts caution that if your sperm count is low, and especially if you're overweight, it may be a good idea to limit your soy intake.

Bottom Line:

Even healthy things should be eaten in moderation.

If you're a woman with breast cancer, taking tamoxifen or who has had ER+ breast cancer, stay away from soy.

If you're a man with fertility issues, especially if you're overweight, limit your soy intake.

Stay away from soy pills and powders since they may contain very high levels of isoflavones and the effects of taking these are unknown.

Soy foods are a great substitute for animal protein and dairy foods and a great source of protein, but vary your protein. If most of your protein comes from plants, make sure you get a good variety of beans and legumes, nuts and seeds as well as whole grains and vegetables.

Soybeans and the less processed foods made from them are good to have in moderation. Some sources say 2-3 servings of soy foods a day is fine whereas others suggest 2-4 servings a week. Use your judgment.

A product that contains soy is not necessarily healthy, You can now find a huge variety of processed soy foods- anything from dairy substitutes, cereals, power bars, drinks, snack foods- that can probably be categorized as junk food.

Sources:

Chavarro JE, Toth TL, Sadio SM, Hauser R. Soy foods and isoflavone intake in relation to semen quality parameters among men from an infertility clinic. Oxford University Press: Human Reproduction. July 23 2008. http://humrep.oxfordjournals.org/cgi/content/abstract/den243v1

Reinberg, S. Soy linked to low sperm count. July 24 2008. http://www.businessweek.com/lifestyle/content/healthday/617728.html?chan=top+news_top+news+index_lifestyle

On Soya, Sperm and Men. July 24 2008. http://www.newscientist.com/blog/shortsharpscience/2008/07/on-soya-sperm-and-men.html

Agrell, S. Tofu a day, sperm goes away: study. http://www.theglobeandmail.com/servlet/story/RTGAM.20080724.wlsoy24/BNStory/specialScienceandHealth/home

US soy producers dispute low sperm count study. Jul 30 2008. http://afp.google.com/article/ALeqM5jtGitNfaC7W7IJ0kINoqfTwShasA

Willett, WC. Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. NY: Free Press. 2001.

Nestle, Marion. What To Eat. NY: North Point Press, 2006.

Pollan, Michael. The Omnivore's Dilemma: A Natural History of Four Meals. Penguin Books. 2006.

Brown, J Lynne, PhD, RD. Functional Ingredients: Soy Protein and Soy Isoflavones. Penn State College of Agricultural Sciences. http://pubs.cas.psu.edu/freepubs/pdfs/uk094.pdf

Liebman, Bonnie. The Soy Story. Center for Science in the Public Interest: Nutrition Action Healthletter. Sept 1998. http://www.cspinet.org/nah/soy/soy.html

Henkel, J. Soy: Health Claims for Soy Protein, Questions About Other Components. USDA Consumer Magazine. May-June 2000. http://www.fda.gov/Fdac/features/2000/300_soy.html

Schardt, David. Phytoestrogens for Menopause. Center for Science in the Public Interest: Nutrition Action Healthletter. Jan/Feb 2000. http://www.cspinet.org/nah/soy/phytoestrogen.html

What is Tempeh? http://www.soya.be/what-is-tempeh.php

http://www.istockphoto.com/file_thumbview_approve/2956027/2/istockphoto_2956027_sperm.jpg

http://images.glam.com/glampress/health/food_allergies/Food_Allergies_Soy.jpg

http://www.squidoo.com/menolaugh

http://rubygurl.blogspot.com/2008/03/funny-pictures.html

Eggs related to mortality, more so in diabetics

The Confusion

According to the Heart and Stroke Foundation of Canada, “Most people can eat eggs in moderation without concern for any harmful effects on blood cholesterol. However, those with high blood cholesterol, are advised to limit their intake of eggs to two per week”.

But wasn’t the recommendation to reduce egg intake to less than 4 a week? Or was it 2 a week? Or was it "an egg a day is ok"?

The egg recommendations keep changing and the research behind the effects of eggs on our health is as confusing.

Cholesterol in our Food and in our Blood

Eggs have more cholesterol than any other single food- all of it in its yolk. The white has no cholesterol. There's around ~210mg cholesterol per egg.

It’s true that saturated and trans fats increase blood cholesterol to a greater extent than cholesterol found in foods, but dietary cholesterol still plays an important role and shouldn’t be dismissed.

Our body makes cholesterol naturally, so we actually don’t need to get any from our diet. But we do. Foods from animal sources have cholesterol- like egg yolks, meat, poultry, milk, dairy products…

The Scientific committee behind the 2004 Dietary Guidelines for Americans said: “the relationship between cholesterol intake and cholesterol concentration is direct and progressive, increasing the risk of coronary heart disease”.

According to the American Heart Association, the average man consumes 337mg cholesterol a day and the average woman, 217mg. The American Heart Association and The Heart and Stroke Foundation of Canada recommends limiting cholesterol to less than 300mg.day, less than 200mg if you’ve had a heart attack or stroke, if you have diabetes and if you have high LDL (bad) cholesterol.

Now, it gets a bit confusing because the amount of cholesterol in your blood doesn’t necessarily reflect the amount of cholesterol you’re eating. Saturated and trans fats increase your blood cholesterol level more effectively than cholesterol in food. Moreover, unsaturated fats, fibre found in fruits, vegetables, lentils and whole grains help lower cholesterol levels. Exercise also helps lower your bad cholesterol (but helps increase your good HDL cholesterol). When researchers study the effect of eggs on blood cholesterol, they need to be taking all these other factors into account… not very easy to do!
On top of that, some people can eat a lot of cholesterol with no effect on their blood cholesterol- others are not so lucky!

The Research

A recent study published in the American Journal of Clinical Nutrition looked at egg intake of 21 327 men from the Physicians’ Health Study, excluding those that had a history of heart disease, heart attack, stroke, cancer and other serious health problems.
Egg intake was self-reported at baseline, 2 years, 4 years, 6 years. 8 years and 10 years.
Average egg consumption was 1 egg a week.
Egg consumption of up to 6 eggs a week was not associated with increased risk of death but, compared with those that ate eggs less than 1 time a week, those that at eggs more than 7 times a week had a 22% greater risk of death (excluding those that had diabetes and after adjusting for confounders).
Risk of death when diabetes was present was 100% (2 times) greater for those that ate more eggs!

Unfortunately, this study didn’t collect much dietary information, including intake of saturated fat, trans fats, fibre (fruits, veggies, whole grains), fish, unsaturated fats- all factors that could influence blood cholesterol levels and mortality.

However, this isn’t the first study to report an increased risk for diabetics that eat eggs.

Harvard investigators looked at egg consumption of 120 000 people and found that those that ate up to one egg a day had no increase in risk of heart disease or stroke. However, those with diabetes doubled their risk of heart disease with one or more egg/day.

A 1999 study published in JAMA showed a 2 time greater risk of heart disease with consumption of more than 1 egg a week compared to less than 1 egg a week in 37851 diabetic men from the Health Professionals Follow-up Study.

Explanation

It’s known that type 1 diabetics absorb more cholesterol but this has not yet been shown in type 2 diabetics. Nonetheless, it can be assumed that dietary cholesterol leads to a less favourable lipid profile in diabetics- meaning that when they eat foods that have cholesterol, it has more of an effect on their blood cholesterol, increasing their bad or "lousy" LDL cholesterol, than for non-diabetics.

Bottom line

If you must have eggs with the yolks, eat them in moderation, ideally less than 4 a week. If you do eat an egg a day, be careful to reduce your intake of other cholesterol-containing foods (foods made with eggs, meat, dairy, etc.)
If you have diabetes, limit your egg intake even more.

Sources:
http://ww1.heartandstroke.ca/Page.asp?PageID=1562&ArticleID=1363&Src=&From=SubCategory#what_if_high
http://www.americanheart.org/presenter.jhtml?identifier=4488
Djoussé, L; Gaziano, JM. Egg consumption in relation to cardiovascular disease and mortality: the Physicians Health Study. Am J Clin Nutr 2008. 87:964-69.
Eckel, RH. Egg consumption in relation to cardiovascular disease and mortality: the story gets more complex.
Nestle, M. What to Eat. North Point Press 2006.
Willett, WC. Eat, Drink and Be Healthy: The Harvard Medical School Guide to Healthy Eating. Free Press 2005.

Trans vs. Saturated Fats

Trans fats act like saturated fat by increasing "lousy" LDL cholesterol but it also decreases the "healthy" HDL cholesterol.
So, we know that trans fats are worse than saturated fats, but how much worse?
Two times.
Trans fats increase the total cholesterol to HDL cholesterol ratio (a higher cholesterol to HDL ratio is bad) nearly two times more than saturated fats.
Avoid them!

Source: Ascherio, A, Willett, WC. Health effects of trans fatty acids. Am J Clin Nutr. 66 (4 suppl). Oct 1997.

DHA + EPA in some foods

From my Fish vs Flax blog, we learned that all omega 3s aren’t created equally. It’s the DHA and EPA that are linked to a lower risk of heart disease, cancer, Alzheimer’s disease, eye disorders and other health problems. ALA (alpha-linolenic acid), although high in fibre, isn’t as beneficial. The conversion from ALA to EPA is low but is better than the conversion of ALA to DHA.

Generally, you should be aiming for 500mg (0.5g) DHA and EPA a day. Remember that intakes of 650-700mg DHA and EPA a day has been correlated with a reduced risk of coronary heart disease. If you have heart disease, you should be aiming for 900mg/day. If you’re pregnant or breastfeeding, aim for a minimum of 300mg a day.

Included below is the amount of DHA and EPA in different fish and other products if you don’t eat fish. I’ll talk about some of the Brand-name products below. Note that considerable differences may exist with respect to the reported levels of DHA and EPA, even for a given fish source, due to various factors (ie. geographical origin).

FOOD (170g for fish unless noted)	DHA+EPA (mg)	FOOD (170g for fish unless noted)	DHA+EPA (mg)
Atlantic salmon, farmed	3650	Scallops	620
Atlantic salmon, wild	3130	Skipjack tuna, fresh	560
Gold Seal Pacific Sockeye Salmon (100g)	2900	Pacific cod or yellowfin tuna, fresh	470
Compliments Sliced Smoked Atlantic Salmon (55g)	2450	Blue crab (85g) or haddock	400
Gold Seal Pacific Pink Salmon (100g)	2400	Catfish, wild	400
Coho salmon, farmed	2180	V-Pure algae supplements (3)**	270 mg DHA/89 mg EPA
Rainbow trout, farmed	1960	Shrimp (85g) or Atlantic cod	270
Coho Salmon, wild	1800	Naturegg Break-Free Omega 3 Liquid Eggs (50mL, 1 egg)	250
Rainbow trout, wild	1670	Clams (85g)	240
Swordfish	1390	Naturegg Omega Pro Large Eggs (1)	130*
Sardines (in tomato sauce) (85g)	1190	Naturegg Omega 3 Large Eggs (1)	80
Pacific oysters (85g)	1170	Lobster (85g)	70
Mackerel, canned (85g)	1050	Becel Omega 3plus margarine 2tsp	50
Compliments Smoked Wild Sockeye Salmon (55g)	900	President’s Choice Blue Menu Oh Mega j Orange Juice (1cup)	50
Pollock or whiting	900	Danone Danino Yogourt with DHA (100g)	40*
Flounder or sole	850	Silk Plus Omega 3 DHA Fortified Soy beverage (1cup)	30*
Sardines in vegetable oil, drained (85g)	840	Egg (1 large)	20
Halibut	790	Minute Maid Fruit Solutions Omega-3 Orange juice	20*
Rockfish	750	Tropicana Essentials Omega-3 Orange juice (1 cup)	20*
Fish sticks (6)	680	Neilson Dairy Oh! 1% milk with DHA	10*

* DHA only.
** V-Pure supplement is the first vegan source of DHA and EPA, is made from algae and is recommended by Vesanto Melina, RD specializing in vegetarian and vegan nutrition.

Many brand name products are jumping onto the omega-3 bandwagon and claiming their products are great sources of omega 3. Maybe... but remember to read the ingredient list and NOT the nutrition facts table to find out the omega 3 source. This will tell you if the product has any DHA.

If you see fish oil or algal oil, the product has DHA. We'll look at 2 products today:

Silk Plus Omega-3 DHA Fortified soy milk: The ingredient list show the product has both flaxseed oil and algal oil. So the product contains some DHA. The nutrition facts table says that 1 cup provides 400mg of omega 3- but the small print indicates that only 300mg of that is DHA. Many other ‘Omega-3’ soymilks have no DHA so be aware.

Omega 3 eggs. Many eggs now have omega 3- the chickens are fed flaxseeds and they actually convert some of that ALA to DHA. Some packages tell you how much DHA is present in one egg, some don’t. On average, omega 3 eggs have about 75mg of DHA. However, this DHA doesn’t compensate for the high cholesterol found in the egg yolks (average of 210mg/yolk). Omega 3 eggs have pretty much the same amount of fat and cholesterol than regular eggs and cost 3 times as much. Although recent research has found that total fat and saturated fat have a greater impact on our cholesterol than cholesterol, the Heart and Stroke Foundation of Canada still recommends 2 egg yolks/week. These omega-3 eggs are not worth it, in my opinion.

Sources: http://dhaomega3.org/ ; Liebman, B. Omega Medicine: is fish oil good for what ails you? Nutrition Action Health Letter. Vol 34: 8, Oct 2007 ; http://www.nutrispeak.com/omega_3s__epa___dha.htm ; http://www.lesliebeck.com/ingredient_index.php?featured_food=21