A Medical Student Blog

Unofficial thoughts on medicine and medical school

a “new” take on eggs — they’re not bad!

 Today, we had an AWESOME patient management class on syncope, loss of consciousness, with these wonderful clinical vignettes, which I hope to share with you soon.  But for this post, I wanted to make a quick note on eggs, because some of my friends are afraid of eating egg yolks, worrying that by doing so, they will boost their cholesterol levels, and give themselves heart disease.

So the good news: eggs, including egg yolks, in moderation (which is defined as 1 a day or 7 eggs/week) are safe and healthy and you don’t have to be scared of them:

http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/eggs/

 

 

The other important thing to clear up is that, often in health news, you hear about being careful with your cholesterol, HDL, LDL levels — “too high” of LDL, and that’s bad.   

 

It’s then easy then to assume that “eating” cholesterol is bad for you.

 

But there’s surprisingly little evidence to support that assumption.  In fact, it appears that there is no link between eating lots of cholesterol, and giving you heart disease.

 

That is what I concluded after I read a review article written by Harvard professors Frank Hu, Joanne Manson, Walter Willet, who are respected principal investigators of large-scale studies on nutrition, preventive medicine, such as the Women’s Health Initiative, and the Nurses Health Study.  I highlighted some of the passages in that article if you were more interested (for the full article, click here Fat, eggs and heart disease):

 

In controlled metabolic studies conducted in humans, dietary cholesterol raises levels of total and LDL cholesterol in blood, but the effects are relatively small compared with saturated and trans fatty acids, and individuals vary widely in their responses. A significant positive association between dietary cholesterol and CHD was found in some epidemiologic studies, but not in others. In a pooled analysis of four studies [5–7,11], the relative risk of CHD was 1.30 (1.10 –1.50) for a difference of 200 mg/1000 kcal in dietary cholesterol [124]. But this analysis included only those studies with positive findings. The Nurses’ Health Study found a weak and nonsignificant positive association between dietary cholesterol and risk of CHD (relative risk for each increase of 200 mg/1000 kcal 5 1.12, 95% confidence interval 0.91–1.40).

Surprisingly, there is little direct evidence linking higher egg consumption and increased risk of CHD…The null association between egg consumption and risk of CHD observed in these studies may be somewhat surprising, considering the widespread belief that eggs are a major cause of heart disease. One egg contains about 200 mg cholesterol, but also appreciable amounts of protein, unsaturated fats, folate, B vitamins and minerals. It is conceivable that the small adverse effect caused by cholesterol is counterbalanced by potential beneficial effects of other nutrients.

These findings do not suggest that one should go back to the traditional high cholesterol Western diet. Instead, they suggest that among healthy men and women, moderate egg consumption can be part of a nutritious and balanced diet. Because eggs are excellent and relatively inexpensive sources of essential amino acids and certain vitamins, they can substitute for other animal products such as red meat. These results also illustrate the danger of judging health effects of a food by single nutrients or components contained in the food.

 

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June 24, 2008 Posted by | Health news, Nutrition | , , , , , , | 5 Comments

More fish, fish oil, omega 3

Dear All,

Many of you have heard that Tim Russert, a beloved journalist and moderator of Meet the Press, died of sudden cardiac death a few days ago.  When I listened to the interview with Tim Russert’s doctor, I was concerned and worried that he didn’t get a chance to hear about fish oil.  The reason why was because I know from personal experience at clinics and at the hospital, that patients are not often told that fish oil is an absolutely critlcal part of treatment strategy.   And when I heard Mr. Russert passed away, I felt very guilty for not stepping it up and letting more people — you — know of the life-saving effects of taking fish oil everyday.  I know these statements may sound over-the-top, but as you will see in the articles I point out, the data is strong, and the scientific evidence is there to support what I just said.  This is a topic I should have talked about long ago — as soon as I had learned about it, I should have started blogging and started youtubing about it.

You may wonder, Jeff is fish oil really that important?  After all, now that I am a third-year medical student, I’ve gotten a chance to experience the oncology floors at the hospital, urgent care, and family clinics.  I realize how little I do know — it’s a humbling experience — and the interns and residents are truly my role models.  My classmates and I greatly admire many of the doctors in the hospital, and there’s even a bit of hero-worship involved, especially when you see an intern tackling so many cases, from doing lumbar punctures to rescuing patients who can’t breathe — all on 0 hours of sleep, having stayed up for more than 28 hours — while smiling and being patient and compassionate 24/7.

So given how much I do not know, and of all the things I’ve seen and learned, many of which are more dramatic than fish, you may ask, incredulously, “do you really have to tell us about fish oil?”

I respect your skepticism, but I hope you hear me out.  Everything I’ve read seems to point that fish oil, is at least as critical as statins and other drugs in preventing sudden cardiac death and death.  In 2005, JAMA’s Archives of Internal Medicine published a systematic review comparing statins head to head with fish oil.  The review found that statins reduced risk of overall mortality by 13%, whereas fish oil reduced risk of death by 23%.   (You can read the article here: http://archinte.ama-assn.org/cgi/content/full/165/7/725)  There are many other studies showing that fish oil saves lives.  Here’s a link to another study published in Lancet, 1999, showing that fish oil reduces risk of death by 15% and risk of sudden cardiac death (which is what Tim Russert passed away from), by 45%.  (You can read about it here: http://www.ncbi.nlm.nih.gov/pubmed/10465168).  Even the American Heart Association recommends that for patients who have coronary heart disease, they should take 1g of EPA and DHA if you have heart disease: http://www.americanheart.org/presenter.jhtml?identifier=4632

After reading these studes, your next question may be, “well Jeff, if so many people are saying you should take fish oil, why are you rehashing the party line?” 

Again, that is a legitimate question, and to that, I can only sadly say, that in my experience, too many patients do not get prescribed fish oil as part of their treatment plan.  For some reason, it’s considered an optional thing to do.  “Nice, but not necessary.”  It’s also not covered by insurance, and so for patients who cannot afford additional financial burden, they do not get access to this life-saving intervention.

                                                                  —

I wish I could be sharing with you some high-tech discovery that would demonstrate a thorough understanding of complex medical problems.  That would impress not just you, but also the interns and the attendings.  In the hospital, the doctors have their codes of respect: if you know how to read supraventricular tachyarrhythmias in EKGs, you’re cool.  If you know how to treat flash pulmonary edema, you’re cool.  If you know how to handle worrisome V-tach’s — you’re cool.

What’s not cool, is fish or fish oil.   It’s not chique — not exactly the kind of topic that wows my interns and my attendings.    But when I heard about Tim Russert’s sudden cardiac death, I felt compelled to stay on this topic and share with you more information about fish oil.  I hope you can share with many of your family members this information, especially the review that I mentioned above showing that fish oil beats out statins: http://archinte.ama-assn.org/cgi/content/full/165/7/725

(Lastly, I just want you to know that all the sources I cite in this article are from trustworthy, prestigious institutions or journals.  JAMA Archives of Internal Medicine, Lancet, American Heart Association)

 

 

 

 

June 16, 2008 Posted by | Health news | , | 6 Comments