Nutritious Dietary Patterns

The journal Cancer Prevention Research recently published a study online ahead of print examining the link between dietary factors and risk of fatal prostate cancer. Among other things, the researchers concluded that consumption of eggs may increase the risk of fatal prostate cancer. Given the large body of research supporting the health and nutritional benefits of egg consumption, this finding is unexpected. However, statistical associations do not prove cause and effect. Rather, they show relationships and are best used in guiding the direction of future research. In this study, it is important to note that researchers only looked at a specific population – predominantly Caucasian, adult men – and that there were few cases of lethal prostate cancer overall. This finding in and of itself calls into question the rather bold claims made in the press regarding the study results.

Additionally, certain dietary factors were not taken into account, such as foods commonly eaten with eggs like bacon, sausage, fried potatoes, cheese and various refined carbohydrates. According to the recently released 2010 Dietary Guidelines, eating an egg a day is safe and healthy for most individuals. Nevertheless, it is important to pair eggs with other good-for-you foods, such as fruits, vegetables, low-fat dairy and whole grains as part of a balanced diet.

If you are interested in further information about the study, here are some of the specifics:
• Study participants included 27,607 male health professionals from the Health Professional Follow-up Study (HPFS) followed from 1994 to 2008. Typical dietary intake was measured using a semi-quantitative food frequency questionnaire to determine how often each participant consumed red meat (processed and unprocessed), poultry and eggs (with yolk).
• The outcome studied was fatal prostate cancer, which included death from prostate cancer or organ metastases.
• A total of 199 events of lethal prostate cancer were observed among the 27,607 men over the follow-up period. In other words, only 0.7% of subjects developed lethal prostate cancer.
• The researchers concluded that men who consumed 2.5 or more eggs per week had an 81% increased risk of lethal prostate cancer compared to men who consumed less than half an egg per week.
• The study did not find a significant association between egg intake and progression of prostate cancer after diagnosis.
• Researchers adjusted for age, body mass index (BMI), smoking and physical activity. No adjustments for other dietary factors were made.

What constitutes a healthy diet has been up for debate probably since the Stone age. The US government began to advise us about what makes a healthy diet prior to World War II when our nation needed to ration food and the need for a healthy armed services became a concern. Since then, dietary guidance has been provided as a joint effort by the US Health and Human Services and Agriculture departments every 5 years based on the most current recommendations from a panel of nutrition experts and known as the US Dietary Guidelines.

Communicating the US Dietary Guidelines has been just as difficult as establishing the criteria for a healthy diet. When the 2010 US Dietary Guidelines were released, the USDA Center for Nutrition Policy and Promotion was tasked with making the dietary guidance document applicable for public usage. The expectation for the communication program was that not only should the latest dietary guidance be understood by everyone in the country but also followed.

Prior to June 2011, the Food Guide Pyramid was an attempt to put dietary planning into a context of meeting daily nutritional goals. One basic weakness of this tool for communicating a healthy diet was that most consumers plan their meals not diets, so it was hard to adapt the messages into daily life. Since June 2011, the release of the ChooseMyPlate.gov program suggests that a healthy meal involves eating a balanced intake of foods from each of the 5 food groups; fruits, vegetables, grains, protein and dairy. A plan to extend the reach of the ChooseMyPlate.gov program was developed by USDA to invite partners from the community which will use the MyPlate icon and 7 accompanying messages (*see below). It is hoped that a high visibility of the MyPlate icon will serve as a reminder, endorsed by all members of the local community including its business members, to eat a healthy meal and include exercise daily. If we all become familiar with the concepts represented by the MyPlate icon, it will serve to show our support for improving the health of our nation and will help build our national, community and individual pride at a time when it is so sorely needed.

The Egg Nutrition Center is a Strategic Partner of the ChooseMyPlate.gov program and collaborates with other partners to incorporate the MyPlate messages into educational tools which are shared with health professionals and their patients or clients around the nation.

*● Enjoy your food, but eat less. ● Avoid oversized portions. ● Make half your plate fruits and vegetables. ● Make at least half your grains whole grains. ● Switch to fat-free or low-fat (1%) milk. ● Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers. ● Drink water instead of sugary drinks.

Hi Readers –  I’m honored to let you know that Dr. Heather Leidy is blogging today regarding research .

– Mitch

Two key forces exist which act against our desire to be healthy and manage body weight.  First, we have internal ‘physiological’ signals which respond to energy restriction, dieting, and weight loss and lead to increased hunger and reductions in fullness (satiety).   Many individuals respond to these signals and eat in excess, leading to the prevention of sustained weight loss and/or obesity.  We are also constantly bombarded by the modern food environment containing food-centered advertisements and easy access to highly palatable, energy dense, sugar-laden snacks.  This type of environment shifts our eating away from physiological need towards reward-driven over-eating.

To add to the problem, many Americans follow unhealthy dietary practices further intensifying these behaviors.  One in particular is the now-common habit of skipping breakfast which is strongly associated with over-eating/snacking (especially in the evening), weight gain, and obesity.  Fortunately, there are several dietary strategies that have been implemented to target and prevent both types of eating behavior.  These include increased dietary protein and breakfast consumption.

We’ve published several articles focusing on the beneficial effects of a modest increase in protein intake ^(1-4).   Through these studies, we found that an increase in protein consumption from 15% of daily intake to 25-30% of intake leads to improvements in appetite control and satiety^(1-4).  In fact, a higher protein diet, containing lean meat and eggs, leads to increased fullness throughout the day and reduced desire to eat and preoccupation with thoughts of food throughout the evening hours compared to a normal protein diet—even during weight loss^(1,3).   It is quite clear that a diet containing an increase in dietary protein, still well-within the dietary guidelines, is beneficial for appetite control.

Based on this data as well as the negative outcomes associated with breakfast skipping, we are now focusing on the daily addition of a protein-rich breakfast in those who skip the morning meal.  We recently report that  skipping breakfast leads to greater hunger and reduced satiety (i.e., fullness) throughout the morning hours, leading to a greater amount of food consumed at lunch time compared to a normal protein breakfast⁵.  We also found that eating a higher protein breakfast (38% of the meal as high quality dairy and egg protein, 49 g) leads to even greater benefits by further reducing appetite and subsequent food intake.

In our most recent study⁶, we focused on whether breakfast would actually alter food-related brain activation known to stimulate reward-driven eating behavior.  In this study, ‘breakfast skippers’ consumed meals containing either normal quantities of protein or higher protein (i.e., 40% of the meal as dairy and egg protein).  Compared to breakfast skipping, the consumption of both types of breakfast meals led to reductions in brain activation patterns in regions controlling appetite, motivation to eat, and food reward.  The higher protein breakfast led to even greater reductions in these activations compared to the normal protein breakfast.  These data suggest that incorporating a healthy breakfast containing protein-rich foods may be a simple dietary strategy to improve appetite control and prevent over-eating.

References:

¹Leidy HJ, et al.  2007  Higher protein intake preserves lean mass & satiety with weight loss in pre-obese & obese women.  Obesity 15:421-429.

²Leidy HJ, et al.   2007 Effects of acute & chronic protein intake on metabolism, appetite & ghrelin during weight loss. Obesity.  15:1215-25.

³Leidy HJ, et al.  2011 The effects of consuming frequent, higher protein meals on appetite and satiety during weight loss in overweight/obese men.  Obesity; 19 (4):  818-824.

⁴Leidy HJ, et al.  2010 The influence of higher protein intake and greater eating frequency on appetite control in overweight and obese men.  Obesity;  18(9):  1725-1732.

⁵Leidy HJ & Racki EM.  2010  The addition of a protein-rich breakfast and its effects on acute appetite control and food intake in `breakfast-skipping’ adolescents.  International Journal of Obesity.  34(7):  1125-1133.

⁶Leidy HJ, et al. 2011 Neural responses to visual food stimuli after normal vs. higher protein breakfast in breakfast-skipping teens-a pilot fMRI study.  Obesity; EPUB ahead of Print.  doi:10.1038/oby.2011.108

Hi Readers!  Today we have one of our Registered Dietitian Advisors, Keith Ayoob, blogging.  Enjoy!

~Marcia

You’ve heard that breakfast is the most important meal of the day.  It’s true for everyone, and especially for kids.  There’s also plenty of science to back it up.  Kids who eat breakfast do better in school.  They also miss fewer days from school and are more likely to have a normal body weight.

Many adults skip breakfast and even when they don’t, their breakfast tends to run more towards coffee and a roll and butter.  Not much protein at all and that’s how they’re starting their day, setting themselves up for a possible crash mid-morning and real hunger pangs by lunch, which may also be skipped.

Biggest complaint about not eating breakfast is a lack of time.  As a nutritionist working with families and kids, honestly, I have a rough time with this one.  Breakfast is just too important to dismiss casually like that.  Funny – parents cringe at the thought of their child going to bed without eating dinner but they often have no problem with a child who skips breakfast.

This needs to change, but so does the way we think of breakfast in general.  Research on adults has shown that people tend to eat about two-thirds of their protein at dinner and only about 10% of it at breakfast.  That’s a concern, because the first meal of the day should contain at least as much protein as the dinner meal.  Not to say that people should be eating more protein overall, just spreading it out more evenly.  A third of your day’s protein should come at breakfast.  There’s evidence showing that people will utilize protein more efficiently, that is, for muscle growth and repair, if protein is more evenly distributed.  About a third of a day’s supply at each meal would do it.

Protein: Nature’s Appetite Regulator

Protein tends to help you feel full and satisfied, less hungry.  It does this in two ways: by blunting the rise in blood sugar and by staying in your stomach for longer, because it takes the body longer to digest it.

I have a hectic life, too.  I don’t always know when I’m going to get to lunch but I’m sensitive to hunger pangs like anyone else.  As long as I get enough protein in the morning, the timing of my next meal can be a bit more flexible – as it may need to be.

Recommendations are for between 10-35% of your calories from protein, so it’s not likely you’ll get too much protein, especially if you think of just shifting some of your protein from dinner to breakfast.  Aim for leaner protein foods to keep calories reasonable.

My Favorites at Breakfast

Cereal is often a typical at breakfast food and you don’t have to give it up to get more protein.  Indeed, whole grain cereal is a good way to get fresh fruit and low-fat milk into your diet and you need these foods.  I think of this breakfast as only a start however.  That’s right.  Add at least an ounce of lean protein to kick this breakfast into full steam.  Here are some of my favorite protein-boosting breakfast foods:

• Hard-cooked eggs.  A total go-to food.  They’re fast, easy, and give me great protein and nutrition in the morning.  I keep a bowl in the fridge at all times and it’s a top-notch grab-and-go protein boost.  Yes, they’re absolutely OK every day.
• Non-fat Greek yogurt.  Another great lean protein food, just pricier.
• Low-fat cottage cheese.  It’s not “girl food”.  Check the label.  It’s protein-loaded and ready when you are.
• Leftover dinner.  Not a big meal, just add that leftover chicken drumstick or slice of roast beef.

If you add one of the above to your usual bowl of cereal/fruit/milk, you’ll not only stay full for longer, you’ll get protein when your body actually needs more of it – first thing in the morning.

– Keith