Wednesday, May 27, 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 SuppVersity 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.
Eggs have a more favorable protein / CHO ratio than oatmeal

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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, though | 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... but alas, it's EGGs. Can eggs really be bad for you if they ain't bad for diabetics? | 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.
  • 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.