Showing posts with label HDL. Show all posts
Showing posts with label HDL. Show all posts

Wednesday, November 4, 2015

Egg or Oatmeal, What's the Less Inflammatory Breakfast? In Diabetics, the Answer Comes (Un-)expected: It's the Egg!

If you cannot decide: Oatmeal or eggs, try oatmeal with sunny-side up eggs, avocado, cheddar and chives | more
In spite of the fact that it's true that epidemiological studies still report controversies on the effects of dietary cholesterol and egg intake on the risk for heart disease in patients with diabetes (Shin. 2013; Qureshi. 2006), you as a waredownloadsoft reader will know that convincing experimental evidence for the causative relation between eating eggs and a worsening of health-relevant lipid-markers is more or less simply "non-existent" (read more).

In fact, more recent evidence suggests that "an egg a day" may keep the doctor away about as reliable as the proverbial "apple" of which Alex taught you that it'll keep the doc away.
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In contrast to average Joes and Janes, though, individuals with type II diabetes (T2DM) whose metabolic state is characterized by impaired glucose metabolism, atherogenic dyslipidemia, and chronic low-grade inflammation, could be at a disadvantage of which some scientists still speculate that it was not compatible with a high(er) cholesterol diet.

To test whether that's correct and diabetics should better stay away from eggs, researchers from the Centro de Investigacion y Desarrollo in Mexico compared two breakfasts with perceived differences in effects on heart disease risk, eggs and oatmeal, by conducting a randomized, crossover clinical trial in subjects with T2DM.
Figure 1: Effects of eggs and oatmeal breakfast on glucose control and inflammation in type II diabetics (Ballesteros. 2015).
We evaluated the effects of consuming one egg per day for a relatively extended period (five weeks) versus 1/2 cup (40 g) of oatmeal per day on plasma glucose and inflammatory markers, our primary endpoints. Our secondary endpoints included plasma lipids, markers of oxidative stress, and parameters of glucose metabolism, such as glycosylated hemoglobin (HbA1c). We hypothesized that eating one egg per day would not adversely affect primary or secondary endpoints when compared to an oatmeal breakfast. 
We further hypothesized that eggs would reduce inflammatory markers in this population, likely due to the presence of highly bioavailable carotenoids" (Ballesteros. 2015).
Twenty-nine subjects, 35–65 years with glycosylated hemoglobin (HbA1c) values <9% (this means they were diabetic, but not really "sick") were recruited and randomly allocated to consume isocaloric breakfasts containing either one egg/day or 40 g of oatmeal with 472 mL of lactose-free milk/day for five weeks.
The cholesterol efflux which improved in response to egg consumption in another study was unfortunately not assessed in the study at hand.
No, there were no negative effects on cholesterol - There were yet also no positive effects. None of the relevant blood lipid makers differed significantly between the two groups. That's in contrast to previous studies, where eggs improve the cholesterol efflux - an important parameter that wasn't assessed in the study at hand. Ah, and before I forget to mention it: The markers of glucose metabolism didn't differ between the groups, either. This is good, but also disappointing, because it implies that the improvements in makers of inflammation did not (immediately) translate to health benefits.
Following a three-week washout period, subjects were assigned to the alternate breakfast. At the end of each period, we measured all primary and secondary endpoints. Subjects completed four-day dietary recalls and one exercise questionnaire for each breakfast period.

Figure 2: Markers of liver health were improved (reduced), as well.
There were no significant differences in plasma glucose, our primary endpoint, plasma lipids, lipoprotein size or subfraction concentrations, insulin, HbA1c, apolipoprotein B, oxidized LDL or C-reactive protein, which is a bummer and would go against the statement that eggs are more than just "less inflammatory" (i.e. actually anti-inflammatory foods).

However, after adjusting for gender, age and body mass index, aspartate amino-transferase (AST) (p < 0.05) and tumor necrosis factor (TNF)-α (p < 0.01), one of our primary endpoints were significantly reduced during the egg period.
There have been more convincing pro-egg studies, if you asked me. Especially those investigating the effects of cholesterol particle size and the different fractions | here's one!
So what? As the authors highlight, the results of the study at hand "suggest that compared to an oatmeal-based breakfast, eggs do not have any detrimental effects on lipoprotein or glucose metabolism in T2DM". In fact, the exact opposite is the case for two auxiliary markers of inflammation: "[E]ggs reduce AST and TNF-α in this population characterized by chronic low-grade inflammation" (Ballesteros. 2015).

One thing that is missing, though, is long(er) term evidence that the reduction in markers of inflammation will also produce meaningful improvements in health, maybe that would have been tested if the study wasn't funded by the egg producers, ... but alas, recent experiments & reviews (Katz. 2015; Rong. 2013) have already acquitted eggs of being "dangerous cholesterol bombs" | Comment on Facebook!
References:
  • Ballesteros, Martha Nydia, et al. "One Egg per Day Improves Inflammation when Compared to an Oatmeal-Based Breakfast without Increasing Other Cardiometabolic Risk Factors in Diabetic Patients." Nutrients 7.5 (2015): 3449-3463.
  • Katz, David L., et al. "Effects of egg ingestion on endothelial function in adults with coronary artery disease: A randomized, controlled, crossover trial." American heart journal 169.1 (2015): 162-169.
  • Rong, Ying, et al. "Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies." Bmj 346 (2013): e8539.
  • Shin, Jang Yel, et al. "Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis." The American journal of clinical nutrition (2013): ajcn-051318.
  • Qureshi, Adnan I., et al. "Regular egg consumption does not increase the risk of stroke and cardiovascular diseases." Medical Science and Technology 13.1 (2006): CR1-CR8.
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Virgin Coconut Oil Minimizes Weight Gain and Improves Blood Lipids (HDL⇈, LDL + VLDL ↘) to Reduce Atherogenic Index by 84% Even in Rats on Non-Atherogenic Diets

There are more than a dozen of options for virgin coconut oil on the market and there's no way the normal custumer can tell which one is actually "virgin" and which is a fraud and maybe even adulterated with palm oil - the technology to identify adulterations is there (Manaf. 2007), but I haven't heard of a label that would prove that the products were tested.
You are probably as fed-up with the hype around coconut oil as I am, right? Coconut oil here, coconut oil there. For this, for that and "did you know that coconut oil will also ..." Yes, you can even argue that a new branch of broscientists and snake oil vendors is dealing with little else than coconut oil.

In spite of that, I consider it at least remotely possible that the data from a recent rodent study that was published in the UK Journal of Pharmaceutical and Biosciences (Sharig. 2015) will catch your attention. I am sure you won't catch fire, though, but maybe at least some sparks, when you read that a relatively low dose of virgin coconut oil slowed down the weight gain, even if the oil was added to a non-obesogenic diet. Not excited? Well what about its triglyceride and total cholesterol lowering prowess and it's ability to keep LDL and VLDL in check while increasing HDL significantly - that's at least news-worthy isn't it?
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But first things first - here's what the scientists did: The scientists bought a bunch of 2 months old rats. After 2 weeks of acclimatization, they randomly assigned them to one of the following diets:
  • Group 1 was fed the normal pellet diet (control),
  • Group 2 was administered normal diet with VCO (1 ml/day),
  • Group 3 named as HCD received bread with pellet,
  • Group 4  animals received HCD bread and pellet with VCO (1 ml/day),
  • Group 5 called as HLD animals received cheese with pellet,
  • Group 6 named HLD animals received cheese and pellet with VCO (1 ml/day)
All groups had free access to diets and water ad libitum for 10 weeks. To make sure the virgin coconut oil was actually consumed, the VCO was administered by oral gavage at a dose of 1.42 ml/kg. That's the rodent equivalent of ~3 tablespoons of coconut oil which is what Fife recommends in "Coconut Cures" (2005) you should take everyday to - as the title of the book says - prevent and treat common health problems with coconut (not all of the claims made in the book can be considered scientifically proven, btw).
How much virgin coconut oil is that? And does it have to be virgin? For most people the approximate equivalent dose you'd have to consume are 3 tablespoons or equal to 45 ml/day. That was the easy part. Whether it has to be virgin coconut oil is a bit harder to explain, but in view of the significant correlation Marina et al. found between the total phenolic content of virgin coconut oil and its scavenging activity (r=0.91), and between the total phenolic content and its reducing power (r=0.96), I would be surprised if the phenol-depleted regular coconut oil would have the same beneficial effects on your atherosclerosis risk.
The rodents remained on their respective diets for 8 weeks before... no, not before they were sacrificed, but before the scientists from the Managemant and Science University in Malaysia used a spectrophotometer and commercial enzymatic kits to determine the lipid parameters by enzymatic endpoint method, as well as the plasma total cholesterol (TC), triglyceride (TG) and high-density lipoprotein (HDL) levels were measured using commercial enzymatic kits.
Figure 1: Effect of Virgin coconut oil on plasma lipid profile of albino Wistar rats after 8 weeks (Shariq. 2015).
A brief glimpse at the data in Figure 1 shows that the addition of virgin coconut oil did in fact have a not exactly life-saving, but still health-relevant effect on the lipid metabolism of the rodents. What I personally consider most intriguing is that this was the case for all diets, including the normal one.
he effect of virgin coconut oil on weight (WT), Atherogenic index (AI) and % of protection in diet-induced atheroscle-rosis after 8 weeks (Shariq. 2015).
So what's the bottom line? If we assume that the effects translate to human beings (this can be assumed, since the use of coconut oil predicts a beneficial lipid profile in pre-menopausal women in the Philippines | Feranil. 2011), virgin coconut oil could in fact exert health-relevant lipid modulating effects of which the data in Table 1 shows that it has a significant anti-atherosclerotic effect even if you consume a normal (=rel. healthy diet). But even though that's impressive, it does not warrant the claim that virgin coconut oil was a "cure-it-all" that would battle cancer, Parkinson's, multiple-sclerosis and what-not. So, if you hear about any of these miracle cures, please remain skeptical: VCO is not the cure for everything.

Now that we are already speaking about healthy skepticism, it may be worth mentioning that it is certainly no coincidence that all the beneficial "coconut research" comes from Malaysia or the Philippines, where people have a vested interest in selling the locally produced VCO at the highest possible prices. For the study at hand, though, no sponsoring or conflict of interest was declared, since there's no funding information that does yet mean very little. Furthermore, in spite of preliminary human studies showing similar effects (e.g. Liau. 2011 | discussed previously), there's no tightly controlled human trial out there that would confirm similar or even identical effects occur in humans | Comment on Facebook!
References:
  • Feranil, Alan B., et al. "Coconut oil predicts a beneficial lipid profile in pre-menopausal women in the Philippines." Asia Pacific journal of clinical nutrition 20.2 (2011): 190.
  • Liau, Kai Ming, et al. "An open-label pilot study to assess the efficacy and safety of virgin coconut oil in reducing visceral adiposity." ISRN pharmacology 2011 (2011).
  • Manaf, Marina Abdul, et al. "Analysis of adulteration of virgin coconut oil by palm kernel olein using Fourier transform infrared spectroscopy." Journal of Food Lipids 14.2 (2007): 111-121.
  • Shariq, B., et al. "Evaluation of Anti-Atherosclerotic Activity of Virgin Coconut Oil in Male Wistar Rats Against High Lipid and High Carbohydrate Diet Induced Atherosclerosis."
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If Buttered (Bulletproof) Coffee Increased Your Cholesterol & Triglycerides, You May Have Forgotten the Coffee Filter

Bulletproof coffee is a bogus fad, but is it also bad for your blood lipids?
You will probably have heard about the (over-)hyped "bulletproof coffee" (=coffee with butter in it) triggering measurable (and in some cases) significant increases in total and LDL cholesterol in bulletproof addicts (case studies + Toklu. 2015).

Now, the most obvious trigger of the cholesterol increase is the butter you put into the coffee to make it "bulletproof". Another possible reason for the increase in cholesterol is yet the coffee itself. A reason that people apparently forgot about ever since van Dusseldorp, Marijke, et al. published their 1991 paper called the "Cholesterol-raising factor from boiled coffee does not pass a paper filter."
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In their study the scientists wanted to test whether filtered coffee would trigger a similarly pronounced increase in serum cholesterol, as it has previously been observed for coffee that was prepared "Scandinavian-style" by boiling ground coffee with water and decanting the fluid into a cup (Arnesen. 1984; Førde. 1985; Aro. 1987).

To test whether the same mess would happen with filtered coffee, the scientists from the University of Nijmegen prepared their coffee as follows:
  • Boiled-type coffee was prepared by pouring 0.5l of boiling water onto 25 g of coarsely ground coffee (Roodmerk, Douwe Egberts, Utrecht, The Netherlands) in an 0.5l Thermos flask. Ten minutes later, the liquid was decanted into a second Thermos flask, from which the coffee beverage was poured out into a cup or beaker just before consumption. One batch provided three cups of 0.15 l (5 fl. oz.), prepared with 8 g of ground coffee per cup. The contents of one bottle were usually consumed within half a day, after which another bottle was prepared. Most of the coffee grounds stayed behind in the first and second Thermos bottles. Those grounds that made their way into the cup were discarded by the study subjects. 
  • Boiled and filtered coffee was prepared like the boiled coffee, but instead the liquid was poured into the second Thermos flask through a white paper filter (Melitta Nederland, Veenendaal, The Netherlands, 1x4, No. 4006508 200016) held in a conical plastic filter holder" (van Dusseldorp. 1991).
Subjects in both groups were allowed to dilute the brew in the second Thermos bottle with hot water if they found it too strong for their taste.
Can you do something to mitigate the effects? No, you don't have to take statins. A promising candidate would be to take 6g of taurine per day. Only 3g which is much less than the equivalent in pertinent rodent studies reduced the artherogenic index (-16% | AI is a measure that's based on the ratio of trigs to HDL) significantly and lead to slight improvements in total cholesterol levels (LDL wasn't measured | Zhang. 2004). In a rodent study, Park et al. observed a 38% reduction of LDL - significantly more than the increase that was seen in any "bulletproof coffee" case report or the boiled coffee study at hand.
The caffeine content, measured by reversed phase high-performance liquid chromatography, was 860 mg/1 for the boiled and 887 mg/1 for the boiled and filtered coffee - a difference that is way too small to explain why the 0.9 l or six cups of coffee brew the subjects were instructed to prepare and drink a day had drastically different effects on the cholesterol levels of the apparently healthy, non-smoking, non-medicated, non-dieting 33 male and 33 female habitual coffee drinker (four to seven cups of regular drip-filtered coffee per day) who participated in van Dusseldorp's study.
Table 1: Effects of Consuming Boiled Coffee, Boiled and Filtered Coffee, and No Coffee on Fasting Serum Lipid and LJpoprotein Levels (van Dusseldorp. 1991).
With three exception, the subjects who had been randomly assigned to the boiled, filtered or no coffee groups, showed an excellent compliance to the coffee regimen and didn't change their diets (this was actually assessed) significantly over the 12-week study period. The changes you see in Table 1 are thus not a result of increased cholesterol intake as it would occur if you consume extra butter in your coffee (in fact, the subjects in the boiled coffee group consumed 4.2g cholesterol/MJ energy less during the trial, so it's not the increase in dietary cholesterol from butter). 
So what's causing the cholesterol increase, then? Rather than any cholesterol you put in form of butter into the coffee, van Dusseldorp et al. speculated back in the 1990s that it is the naturally occurring fats in boiled unfiltered coffee that are responsible for the cholesterol "boosting" effects. In contrast to the filtered coffee which is virtually fat fee (0.02 g/l), the boiled unfiltered coffee contains 1g/l "coffee fats". Fats of which the researchers have previously shown that they are also present in the lipid-rich supernatant of boiled coffee you can obtained after centrifugation. The same supernatant Dusseldorp et al found to trigger a 23% (!) increase in serum cholesterol (this went hand in hand with 55% increases in triglycerides).

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Now, since dietary triglycerides and phospholipids do not raise serum cholesterol when eaten in amounts of 1 g/day, the authors speculate that the cholesterol-raising factor makes up part of the sterol-rich fraction of the lipid. Since both, the markers of the endogenous production and absorption of cholesterol remained the same, these lipids must - in one way or another - decrease the clearance of LDL cholesterol, but as the authors rightly point out the parameters (lathosterol and campesterol) they measured are insufficient to exclude effects of boiled coffee on lipoprotein synthesis and turnover.

Their findings are sufficient, however, to put a "?" behind the significance of the butter, when it comes to the ill effects of bulletproof coffee on your blood lipids... What we would have to know now, is whether the people who report increased cholesterol levels have either started to drink coffee now or increased their coffee intake from capsule machines or other methods of preparation that don't run the coffee through a filter | Comment on Facebook!
References:
  • Arnesen, Egil, Olav H. Førde, and Dag S. Thelle. "Coffee and serum cholesterol." British medical journal (Clinical research ed.) 288.6435 (1984): 1960-1960.
  • Aro, Antti, et al. "Bioled coffee increases serum low density lipoprotein concentration." Metabolism 36.11 (1987): 1027-1030.
  • Førde, Olav Helge, et al. "The Tromsø heart study: coffee consumption and serum lipid concentrations in men with hypercholesterolaemia: an randomised intervention study." BMJ 290.6472 (1985): 893-895.
  • Park, Taesun, Kyungshin Lee, and Youngsook Um. "Dietary taurine supplementation reduces plasma and liver cholesterol and triglyceride concentrations in rats fed a high-cholesterol diet." Nutrition research 18.9 (1998): 1559-1571.
  • van Dusseldorp, Marijke, et al. "Cholesterol-raising factor from boiled coffee does not pass a paper filter." Arteriosclerosis, Thrombosis, and Vascular Biology 11.3 (1991): 586-593.
  • Toklu et al. "Rise in Serum Lipids After Dietary Incorporation of 'Bulletproof Coffee'." Journal of Clinical Lipidology 9.3 (2015): 462.
  • Zhang, M., et al. "Beneficial effects of taurine on serum lipids in overweight or obese non-diabetic subjects." Amino acids 26.3 (2004): 267-271.
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