Podcast Episode 229: Current Research & Recommendations: Clearing Up the Confusion About Eggs & Cholesterol – Dr. Mickey Rubin

Mickey Interview Mixdown 1

 

Melissa 00:00

Welcome to the Sound Bites podcast. Today’s episode is about clearing up the confusion about cholesterol research and recommendations. The history of cholesterol research, as well as what consumer insights are showing about how and why people are still confused about cholesterol recommendations, and what we need to know about cholesterol, eggs, heart health, and more. My guest today is Dr. Mickey Rubin, Vice President of Research at the American Egg Board, who also serves as Executive Director of the Egg Nutrition Center, the Nutrition Science and Education Division of the American Egg Board.

He graduated from Indiana University Bloomington with a Bachelor of Science degree in kinesiology. He then earned a master’s degree in exercise and sport science from the University of Memphis and later earned a PhD in exercise physiology from the University of Connecticut, where his research interests included exercise endocrinology, sports nutrition, and the effects of dietary interventions on cardio metabolic health outcomes. Welcome to the show, Mickey.

Mickey 01:09

Thank you. I’m glad to be here. Again, this is, I think, my third one. Very exciting.

Melissa 01:15

It is. Welcome back. Previous episodes on which you appeared included: The best foods for brain health in August 2021, which was a very popular episode, and The Incredible Egg: cognition, nutrition, and culinary hero in October of 2019. So I’m really excited to have you back. I always enjoy talking with you. And this is a topic that, frankly, I’m kinda confused about sometimes. So if health professionals and dietitians are a little confused, we know the public is as well.

 

Mickey 01:48

Absolutely, yeah.

Melissa 01:49

And I do want to mention that this episode is sponsored by the American Egg Board’s Egg Nutrition Center. Also, we are submitting this episode to the Commission on Dietetic Registration for one free CEU for registered dietitian nutritionists, and dietetic technicians registered and certified diabetes care and education specialists. So if that is of interest to you, stay tuned for that. You can always check my free CEU page at soundbitesrd.com/freeceus to see what episodes are currently available and what’s coming down the pipeline. I have nearly 50 free CEU activities, including about five ethics CEUs. And this episode may also be submitted to include an ethics CEU as well. So, Mickey, for listeners who aren’t familiar with you or haven’t listened to the previous episodes, I’d love for you to share more about your background and how you became interested in nutrition research and cholesterol research specifically.

Mickey 02:48

Well, it’s a good question because I think we all have our own paths of how we got here in our careers. I know no one’s path is the same. As you said, I did my PhD work at the University of Connecticut, really looking at exercise and nutrition as the dual focus of my program, and I’m just really passionate about both areas. But when I decided what I was going to do with my career after I graduated, that’s where I really started my career in the food industry. And my first position was at Kraft Foods here in Chicago as a senior nutrition scientist. Progressed along the way there. Then I worked for a small clinical research organization that did clinical trial design consulting for large food companies as well as research to substantiate nutrition science around specific products. And then, for the better part of the last 13 years, I’ve been working on behalf of farmers.

I spent eight years at the National Dairy Council overseeing their nutrition research program. And now I’m approaching my five-year anniversary here at the American Egg Board, where I work on behalf of egg farmers and oversee our nutrition research work. So to your point about cholesterol, that’s something I’ve always been interested in. Ever since day one, I think all of us who have studied nutrition are interested in the topic of cholesterol metabolism in some way, shape, or form. But really, in order to start doing it as part of my day job, it’s been since I came here to the egg board, back in 2018.

The egg board and egg nutrition center, in particular, has a long and excellent history of supporting strong nutrition science in general, but especially in this area. Long before my time, the egg nutrition center sponsored some of the early egg feeding studies that attempted to understand cholesterol metabolism and the consequences of eating eggs. I certainly can’t take credit for all the things that happened before I arrived. So that’s how I got to this point.

 

Melissa 04:39

Great. Thank you. So we first met at the Dairy Council, when you were there and I was there. And we’ve touched on this in previous episodes, but it always piques my interest when I see exercise endocrinology, as a diabetes educator for 25 years. Tell us a little bit about what that involves.

 

Mickey 04:57

So it all started for me with trying to understand how the endocrine system and all of the hormones, whether growth hormone, testosterone, or estrogen really adapt to an exercise stimulus. And how that impacts, whether it’s protein or muscle homeostasis, and all the different systems involved with that. So I concentrated on the insulin-like growth factor system and how it affects training. Well, how that system is impacted both acutely and chronically, how different dietary factors impact that system, or the macronutrients we eat, and how that impacts us.

 

Melissa 04:57

Interesting. Maybe we’ll have to have you come on and take a deep dive into that, because I just always find that fascinating.

 

Mickey 05:39

It feels like a lifetime ago, actually. So I’d have to study up.

 

Melissa 05:42

There you go. Well, thank you for that. I think the best place to start is with a little bit of history, because there’s quite a long history with cholesterol research, recommendations and a lot of stuff along the way. So could you give us a recap or a summary of cholesterol research over the years, especially pointing out anything specific that helped shape this story over time and how it’s evolved?

 

Mickey 06:12

You can go back a pretty long way; we’re talking 50 or more years. Some of the first population studies looking at heart disease risk and diet in the 1960s and 1970s. It was 1977 when the first dietary goals were set for Americans to follow, like the first iteration of the dietary guidelines before they started calling them dietary guidelines. And that was based on the information available at the time, as well as the research we had. That’s where you start to see that 300-milligram recommendation sort of arise. It’s interesting that, when you read those dietary goals, they actually mentioned eggs. And eggs are a nutrient-rich food and part of a healthy diet. But at the same time, later on, you read a little further and see, “Well, but we always use caution with cholesterol.” And this is where the 300 milligrams per day limit really arises. And to the best that we can tell, it wasn’t based on anything specific; it was really a best guess at the time.

Some of the studies that were going on around that time you think about animal studies in mice, where they were feeding tremendously large amounts of cholesterol just to study the system. Which is what you would do if you were trying to learn about a system, study the extremes. However, cholesterol accounts for 5% of a mouse’s diet, which is equivalent to about 40,000 milligrams for a human or something similar. But that’s what you do when you’re trying to study a system for the first time. And so those weren’t necessarily studies that were applicable in the context of human diets, but that’s where we were at the time. And this 300-milligram  limit, I think, was probably a best guess, based on where we were at the time. But when you think about that best guess, it carried forward for a long time. So that was 1977.

You see it in dietary guidelines throughout the 80s and 90s. You can see it in the dietary reference intakes, from the National Academies of Science. And so it really just goes to show you that once something gets into a guideline, it stays in the guideline until something comes along that changes it. So then you fast-forward to the 1990s. And I spoke about the history of egg nutrition center and that’s where you start seeing, okay, well, wait a second, let’s actually do some studies in humans, where we feed humans eggs, not cholesterol but actually feed humans the food and see what happens. So, that’s when you start seeing these truly elegant, detailed studies of egg feeding studies, to try to understand the system even better. And that’s where we start seeing that, well, okay, when you feed people eggs, we’re not really seeing an increase in blood cholesterol, and especially the way we would think. They discovered that the vast majority of people experienced no increase at all. And there’s a smaller percentage of the population (about 25%) that did experience an increase in blood cholesterol.

But they also saw an increase in both LDL and HDL cholesterol. So also the good cholesterol. So the risk profile wasn’t really impacted from egg feeding, and those groups that did experience an increase so that’s an important thing to know. So those were the randomized trials we started seeing in the 1990s. So that’s when people started to ask, “Well, maybe it’s not as simple as we thought.” And when you think about cholesterol, it’s not an essential nutrient. Your body makes all the cholesterol it needs. We learn from our basic nutrition classes that the essential nutrients you need to get from your diet and nonessential – your body makes it, but when you consume cholesterol in a normal situation, your body’s production systems just down-regulate; they don’t produce as much as they would because you’re getting it from the diet. And I believe that is where individual variation comes into play, and people, particularly those in the 25%. So that’s why we learned in the 1990s, but I’d say 1999, in my view.

When I look back at the history of the research, 1999 was a landmark study. And this was a paper that was published in the Journal of the American Medical Association. The authors were from the Harvard School of Public Health, which all of us in nutrition know very well. They looked at their cohorts, the Nurses’ Health Study and the health professional follow-up study, both very well known, and asked, “What is the link between egg intake and coronary heart disease risk?” And in that study, they discovered no link between “moderate egg intake” and coronary heart disease risk so no association. Didn’t increase risk, didn’t decrease risk. There was just no association for what they were calling moderate intake, which is probably roughly about an egg a day. I think that was a big turn.

Those of us who remember the Time magazine articles with the frowny face eggs in 1984. In 1999, you saw the one with the smiley face eggs. So I think that’s when things really started to take a turn, particularly in public perception and not just in nutrition. So that’s 1999. And then fast forward 16 years later, is when the Dietary Guidelines for Americans first removed that 300 milligram per day limit. The scientists reviewing the literature at that time said, and I’m paraphrasing their review, but the science doesn’t support limiting dietary cholesterol for coronary heart disease risk or blood cholesterol so they removed the 300 milligrams per day limit in 2015. And that’s where we stand right now. We’ve had other recommendations. We’ve had the 2020 guidelines, which carried that forward. The 2020 Guidelines Committee did an outstanding review of the topic and went into a lot more detail. So I’d strongly advise anyone interested in listening to do so. In addition, the American Heart Association has issued some specific recommendations on egg intake as well. So that’s a long history that I’ve put together in just a few short minutes. But it’s been a long time. But really, if you’re a science nerd like me and also a history buff at the same time, it’s really cool to see how it’s evolved.

 

Melissa 11:51

Yeah, thank you for sharing that. It’s important to start from that place. This 300 milligrams, which was somewhat arbitrary for a long time before being removed, as you say, in 2015, persists, the idea of it.

 

Mickey 12:11

Absolutely. Before we got started, I looked at some of the numbers. Go back to the 1970s, when people were consuming about 600 milligrams of cholesterol a day. Diets were very different back then. But the latest data I saw looking at our NHANES database showed that average adult consumption of cholesterol right now is somewhere just below 300. Somewhere in the 290s. Diets evolve and change over time; what we need to focus on also changes over time.

 

Melissa 12:37

And as we’re discussing this topic, we’re also discussing nutrition research in general. So I’m always interested in hearing any clarifications or takeaways that you can share along the way that might help us understand nutrition and cholesterol research better and also apply these learnings in our own lives. And/or communicate them to our patients or the public. So, if there’s anything that stands out right now, but as we continue our conversation, thinking about nutrition research in general, I always learn a lot from you about that.

 

Mickey 13:14

I believe there are numerous things to say about this subject. Let’s use the 1999 Harvard study as an example once more. Well, that was 1999. Just recently, in 2020, they published an update. So they are still following the same people—the same cohort, the same Nurses’ Health Study, and the health professionals follow-up study 2020. They said, “Okay, let’s go back and take a look. How are these people doing?” They found the same exact thing. The take-home message I hear for me is that, especially in these population studies, I really like to see, and I think the data are so much stronger. When we see that longitudinal relationship, we see, “Let’s follow these people over time,” instead of just taking this one snapshot. There are studies out there that say, “Hey, let’s just do a health record.” And then we’ll see where they are in 20 years. The really nice thing about these Harvard cohorts, in particular, is how they follow these people over time and have multiple touch points. That’s an example of nutrition research just getting so much better than it was 50 years ago. We simply have better methods. We know more, and we apply those methods better. I think that’s just really a testament to the field.

 

Melissa 14:18

And replicating the studies and the results. As we’re talking too, feel free to remind us: Are we talking about an observational study? Are we talking about a randomized controlled trial? Because we always like to point out, those are different.

 

Mickey 14:35

Those are different and both controversial in their own way. I believe you’ve heard the terms “randomized controlled trials” are the “gold standard.” If it’s not a randomized controlled trial, then I don’t want to see it. And others say, “Hey, all we need are observational studies,”  – that tells us everything we need to know. For me, I’m always the person in the middle. I like to see both. I think the observational studies tell us a lot. I think when we see randomized controlled trials on the same topic that fills in the picture a little bit. And then, when you start to see those randomized trials and those observational studies going in the same direction and telling the same story, well, now I’m starting to feel really good about what we’re seeing. So to me, there’s not a side to take there. I think the answer is yes. More research is good.

 

Melissa 15:20

Right. And it’s my understanding that observational studies can inform randomized control trials, and vice versa?

 

Mickey 15:27

Yeah, to me, I think the observational studies are great for looking at that population level and identifying those associations, which can then be tested in the randomized control trial. So I think, to me, it’s the observational studies inform the randomized controlled trials, mostly, but I really see them both as important.

 

Melissa 15:47

So let’s talk about some of these common and persistent misconceptions that you are seeing, like in consumer insights about cholesterol and eggs, or eggs in general.

 

Mickey 16:00

Yeah, they are really interesting. So that’s the benefit of working in a place like the American Egg Board, work with some folks who understand consumer research really well. One of the fascinating things that we’ve seen in consumer research. If you were to ask me, “Oh, who’s still not there on the cholesterol-egg story?” I would think people from the older generation who learned in the 1980s should watch it and probably haven’t evolved. That would be my hypothesis. Well, it turns out, I’m completely wrong. So it turns out that in the latest consumer research that we’ve seen, the older generations are there. They’re like, “Oh, yeah,” almost like we knew eggs were good. You guys just didn’t listen to us back then. However, we discovered that the group of people who were most concerned were surprisingly new and expectant moms. That was a big surprise.

I believe that 47% of new and expectant mothers in the most recent consumer research that I’ve seen had concerns about cholesterol from eggs. And if you think about it, any parent, even a young one, is concerned about everything. So when I heard that, I was like, “Oh that makes sense.” My kids are still young. I remember this from not too long ago. They were born, and we were concerned about everything. But I think of all those that were concerned, where do you get information? Why are you concerned? And some say it’s just common knowledge. It’s still sort of common knowledge. It’s not only one source that I’ve heard from. It’s just permeating common knowledge; it’s a little vague in terms of where it came from. That really spoke to us as a nutrition field; don’t stop educating. Also, don’t make assumptions based on who you’re speaking with. It’s always a good idea to share the most recent scientific discoveries because you never know who heard something before you.

 

Melissa 17:42

Right. New and expectant moms, I worked in the maternal fetal medicine clinic as a diabetes educator, and I can tell you that these were the most motivated patients I’ve ever worked with. And being a mom, you know, we are definitely hyper-focused on nutrition. But interestingly, we’ll touch on choline a little bit later. But eggs are an excellent source of choline, is that right?

 

Mickey 18:06

Eggs are an excellent source of choline, correct. Very good. You got your FDA labelling rules down.. Very good.

 

Melissa 18:11

I got it. And this is critical for maternal-fetal health. So there’s a little bit of a contradiction there.

 

Mickey 18:11

Exactly. But an opportunity really exists to provide some additional insight at the same time.

 

Melissa 18:26

What else are you seeing in the consumer research?

 

Mickey 18:28

On the topic of eggs, I think consumers think protein, and that’s great. There’s no better high-quality protein source than eggs. All of the foods derived from animals contain high-quality protein. Either you’re thinking about eggs as sources of cholesterol or you’re thinking about eggs as sources of protein; maybe you’re thinking about them as well. I think that’s good, that everybody knows that you can get a great protein source, or, I should say, under FDA labelling rules, a good protein source, at six grams for an egg. But, as someone who studies eggs and nutrition, what I’d like to see more of and what you’ve mentioned is choline as a complement to the whole package. Eggs are a good source of protein, but they’re also a good or excellent source of seven other additional nutrients in addition to protein. So a total of three or more good or excellent sources of nutrients, whether it’s choline or iodine they are both important for brain health and development. And we see B12, which is something we see with a lot of animal-source foods.

People who are eating animal-sourced food and maybe not getting the B12 that they need. That’s where I’d like to see a little bit more appreciation when we talk to consumers, or just a little more understanding of what else comes to the table with these foods. Nobody’s fault. Look at the protein foods group; it’s the protein foods group. You’re there for protein. But I think all these foods, eggs in particular. All of the other foods and the protein foods bring something unique to the table when it comes to their nutrient profiles. And so that’s why, when we mix everything together in one protein food group, it’s understandable how they get lost.

 

Melissa 19:57

Yes, it is oversimplified and goes beyond the protein. Interesting. So you mentioned that things started to change in 1999. With regard to the recommendations based on research, can you tell us a little bit more about that turning point?

 

Mickey 20:11

So that 2015 dietary guideline really was a big one. There’s a 2013 AHA (American Heart Association) guideline that started talking about how eggs are dietary cholesterol and there’s no link with coronary heart disease risk. But then when the guidelines removed that 300 milligram per day limit in 2015, I would say that was a pretty important moment. Fast forward a few years. And then you have again, from the American Heart Association; I believe it was December of 2019 because it was right around the holidays. I remember when this came out. The American Heart Association’s nutrition committee – many of the American Heart Association’s committees are made up of physicians and cardiologists, but many nutrition scientists sit on the nutrition committee, and they are the true nutrition experts. That’s when they publish a position statement, or I forget exactly what it’s called, on dietary cholesterol and the latest science on dietary cholesterol. And that’s where they really built upon the dietary guidelines of 2015. So now, we’re about four years later. And said, it really does not make sense to design your dietary pattern around a specific cholesterol number.

They stated that dietary patterns were most important while focusing on things like the DASH dietary pattern, saturated fat, and other such things. And in fact, that’s when we start seeing the differentiation of foods that might be higher in cholesterol but lower in saturated fat. And there are really only two of them: eggs and shellfish, which are high in cholesterol but low in saturated fat. And so it was a really excellent review that went into much greater detail than the guidelines did. But this is where we start to see some concrete recommendations around egg intake from the American Heart Association. If you read all the way to the end, it’s a really great review paper. When they really say an egg-a-day diet for healthy people fits into a heart-healthy diet, but then a couple more recommendations, I think, are even more interesting for older individuals. And it doesn’t say what “older” is, but I’m assuming that older, elderly individuals, two eggs per day fit into a heart-healthy pattern for healthy adults. So two eggs per day, bringing more nutrients to the table, bringing more protein to the table, thinking about what the needs of older individuals might be- we talk about protein intake with a little too broad a brush, and I think there are some populations that are not getting enough protein. And so when you think about older individuals, it provides a way for them to get adequate sources of protein. So that’s where healthy people get their two eggs a day. And then a third recommendation is for vegetarians.

They say vegetarians can also incorporate more eggs, without giving an exact number, but they say more eggs in their diets. Because they’re not consuming protein from other animal sources, I thought it was really interesting to see the American Heart Association nutrition recommendations on how to incorporate eggs in a heart-healthy diet. That sort of culminated in all the stuff we’d seen up until that point. The 2020 dietary guidelines, particularly the advisory committee report, closely mirror that AHA recommendation. And you talked a lot about how eggs and shellfish have cholesterol but are not high in saturated fat. And so there’s a difference there, and carried forward that the dietary guidelines should not have a limit. Really, that 2019 American Heart Nutrition Committee position stand is really something that, if you want to go back and read a great paper, that’s what to read right there.

 

Melissa 23:41

Okay, great. And I feel like that was a long time coming because, as an outpatient dietitian in the late 90s, I remember talking with patients about how “saturated fat in the diet is what causes your liver to make more cholesterol.” We had that concept. And we were talking about that. And you mentioned the DASH diet. So I just want to make sure everybody listening knows that those are the Dietary Approaches to Stop Hypertension. Very popular diet; I always say it’s the best kept secret. It’s always near the top of the list of the best diets of the year, right alongside the Mediterranean. And you mentioned the older, healthy individuals. And I think it’s funny that they didn’t define “older.”

 

Mickey 24:25

We will all define “older” differently. We don’t want to judge.

 

Melissa 24:29

Right. You know, I talk a lot about protein on the podcast. And I believe we begin to lose muscle mass as we age, even in our 30s, and that is sarcopenia.

 

Mickey 24:39

Yeah, absolutely.

 

Melissa 24:40

And so it makes sense that older, healthy individuals could have up to two eggs per day. Again, you’re getting more protein. And you alluded to this. We hear a lot that people are not getting enough protein or are getting too much protein. And I really think it’s important to look at the specific population, whether it’s age or the vegetarians that you mentioned as well.

 

Mickey 25:02

Absolutely. I think of the last dietary guidelines – adolescent girls were not meeting protein recommendations. I sometimes get a little frustrated when I hear it just in broad brush: “Oh, we get enough protein.” Well, not everybody. We need to make sure we understand that populations are different, with different ages and different situations. We need to make sure we’re specific.

 

Melissa 25:22

And like the adolescent girls, when you combine increased nutrient needs with decreased intake or maybe a decreased quality of diet, then you’ve got the double whammy. Can you talk a little bit about recommendations for people with cardiovascular disease or diabetes?

 

Mickey 25:39

That’s a really important point, because, as I said, in those summaries of the AHA document, they were very specific; it’s for healthy people. When you look further in that same section, they do urge caution for people at risk – essentially people at risk for heart failure. As you might expect from an American Heart Association of course, some people with cardiovascular disease and significant risk factors are urged to exercise caution. But one of the things that we did when those recommendations first came out was take a deep dive into the literature. And lo and behold, we found that, while perhaps that caution has worked, perhaps that population just hasn’t been studied enough when it comes to egg intake. That was a research gap, I think. So we fund research here at the Egg Nutrition Center, and that’s something we’re looking into. What happens when you give somebody with elevated LDL, one egg a day, two eggs a day?

That is a question that deserves an answer. Who knows what we’ll learn? Obviously, it’s research; we’ll learn what we learn. But I think that there’s certainly a gap; those recommendations are specifically from the AHA for healthy people. But I think we need to know more about those folks who do have risk factors. We do have some indications right now. Some studies have been published in folks that have metabolic syndrome, for example, and they show that eating up to two or three eggs per day does not exacerbate biomarkers for cardiovascular risk in those folks. So there is some indication so far, but we’re also talking. It’s important to understand the metabolic syndrome and type 2 diabetes. That’s one sort of phenotype and one type of risk factor cluster: coronary heart disease and high LDL another phenotype. I think we need to know more about both. Some good research that we’ve seen so far in that metabolic syndrome group, that type 2 diabetes risk group, indicates that including eggs in their diets can still be beneficial and not exacerbate any risk factors. More to come on those with elevated LDL and other coronary heart disease risk factors.

 

Melissa 27:42

Okay, interesting. And this speaks to that general nutrition research topic. Let’s talk a little bit more about the importance of studying different populations. You can’t – is it “extrapolate the results” to different groups? Is that the right phrase?

 

Mickey 27:57

I think that’s exactly what she meant. I think that’s one of those things in nutrition research. Understanding how different populations respond to different diets and dietary interventions is something I’d like to see more of, and something I’ve heard many other leaders in the field say we need to see more of. And here’s another example, going back to that Harvard study: I told you that they published the updated data in 2020, still following the same cohorts, still identifying that there’s no association between egg intake and coronary heart disease risk. So, in that 2020 paper, they decided to take a look – We know what our US cohort looks like. Let’s take a look at some of these other cohorts outside the US and see if we are comparing well? Are we the same, or if it is the same story, and by and large, it was, with one exception. In the Asian population, it wasn’t a no association situation for eggs and coronary heart disease risk; it was actually a benefit. Egg intake in Asian cohorts tended to result in a reduced risk for coronary heart disease.

 

Melissa 28:56

Interesting.

 

Mickey 28:56

We have a lot of potential reasons why that might be, and the authors rightly urge caution in interpreting those results. But one of the things that came to mind was, “Let’s think about how people eat eggs and what dietary patterns and contexts exist.” Consider more Asian cuisine and eggs, particularly in the context of a plant-based diet pattern or something along those lines. I think that might have something to do with it. Certainly, genetics play a role. But consider how eggs have traditionally been consumed as part of a heavy breakfast. And it’s not too far from where eggs are starting to be incorporated into other meals, like vegetables frittatas and things of that nature, that you see a little bit more diversity in how eggs are consumed here in the States.

But I think that tells us a couple of things. Number one. let’s not assume all cohorts, all populations, all cultures, and all genetic profiles respond the same. They don’t necessarily, but also that the background dietary pattern is also crucial in understanding the impact of a food. There are some levels. We need to understand the impact of the nutrients. We need to understand the impact of food. And then we need to understand the impact of that food as part of a whole pattern. It’s not just one or the other. It’s a yes; it’s all three.

 

Melissa 30:11

Right. The dietary patterns – it’s really crucial to view it through that lens. So where is the research now? I think we’ve already talked about some of the gaps, but is there any other future research direction that you can share?

 

Mickey 30:25

No, I think that was really it. Maybe I answered the question before you had a chance to ask it. But I think that’s really where the question lies. I’m always quick to point out that research on cholesterol in eggs is never going to be done. We’re always going to be wanting to know more and asking more questions. But I think this is really important. Seeing where eggs fit, especially since we have so many people who do have risk factors, and I think it’s important for us to know. So we’re probably a couple years away from knowing anything definitive. But I think we’ve got some early studies that indicate we’re on the right track.

 

Melissa 30:59

That’s interesting, too. As diets evolve and different cultural influences on how we eat and what we eat and the incidence of diabetes, obesity, and coronary heart disease, that all affects the whole picture.

 

Mickey 31:14

Yes, it does. That’s important to study, as are all those contexts.

 

Melissa 31:18

I mentioned choline earlier; I would love to hear more. We talked a lot about choline in the brain health episode. And in the previous one as well. But it’s been a while. So I’d love to hear any updates on choline. I know it’s a hotly researched nutrient.

 

Mickey 31:32

Actually, I was hoping you would ask because there have been some interesting developments. As I think we talked about in the last podcast, research has shown that choline intake during pregnancy can have lasting effects on the cognitive outcomes of the child. I think I probably referenced a study from researchers at Cornell that looked at choline supplementation. But I believe the lesson is important: When they doubled the choline recommendation in these pregnant women, they saw significant improvements in cognitive function at one year of age.

And I think they looked at reaction time. Compared to those kids that were just getting the choline recommendation. To say nothing about what would have happened if normal choline intake had been looked at, because nobody is achieving the recommendation. So I think that was a really, really cool study to show that just consuming choline during pregnancy and then measuring the impact of that choline on cognitive function in those kids later on was fascinating. Well, earlier this year—now we’re in 2023—earlier in 2022, the same researchers are still following those kids, and now those kids are seven years old. And guess what? They’re still measuring the benefits in the seven-year-olds from the moms who received the most choline. So, I think this is a really important area, and kudos to those researchers. It’s not easy to pull off. You started when the moms were pregnant, and now the kids are in second grade, third grade, or whatever. So to keep going and following those kids, it’s a challenge, just from a research perspective.

But what an amazing finding that keeps that study going. And to learn that, to me, is so important. And you think back to the 2020 Dietary Guidelines, which were fantastic guidelines if you read them. That’s where you start seeing a lot of discussion about choline. You see an entire section in the maternal health section about choline intake and the importance of choline for neurocognitive developments, and eggs as an easy way to achieve that choline recommendation. But we also saw, as part of their scientific review of what we’re already eating, that nobody is a meeting the recommendation. I mean nobody.

 

Melissa 33:22

What is the recommendation?

 

Mickey 33:51

It’s about 425 milligrams for women and 550 mg/day for men, and it goes up during pregnancy to 450mg/day and 550mg/day for lactation. The Dietary Guidelines Advisory Committee in 2020 identified choline as a nutrient that poses special challenges because most Americans do not consume enough and it’s not found in many foods.

I think the highest I’ve seen is in beef liver, which obviously is not a commonly consumed food. Fish, chicken, and soybeans have some choline too. I would say, in terms of commonly consumed foods, foods that might be in your fridge right now that you might consume every day or most days – eggs are probably at the top of the list.

 

Melissa 34:41

And we talked about that in depth in the brain health segment. And how much does an egg provide?

 

Mickey 34:46

Eggs contain 150 milligrams, or 25% of the recommended amount. So, two eggs, you’re halfway to what you need in a day.

 

Melissa 34:58

Excellent. That is why it is an excellent source. Anything 20 percent or higher.

 

Mickey 35:02

20% or above, exactly.

 

Melissa 35:04

Well, I’d also like to touch briefly on sustainability. I’m always interested in this topic. And eggs come from chickens, and those come from farms; we’ve got egg farmers. So what is the egg industry doing in the realm of sustainability that you can share with us briefly?

 

Mickey 35:22

I think that’s a really important question in every industry, but it’s obviously important to agriculture as well. We see a lot of different commodities working on their sustainability, research, and environmental footprints, and the egg industry is no different. Eggs in general – when we look at other foods -the World Resources Institute which is an NGO that focuses on environmental and sustainability issues. They have a protein scorecard. And when you look at the World Resources Institute protein scorecard, you see that eggs are listed as a low-GHG-emitting protein. The only other animal-source food that’s listed as low is seafood. So eggs already have a pretty good environmental footprint overall, generally. But I don’t think that’s a reason for our industry to rest.

The work we’re doing at American Egg Board, under the umbrella of my research, is sustainability and understanding the environmental footprint aspects of egg production and where we can contribute to the advancement of sustainability. We are in the process of completing a lifecycle assessment on USA production. It’s the first time this has been done in about 10 years  and I call that a new baseline. It’s where we are, and it’ll show us what we’re doing well, where we need to improve, where we need more research, and where we can help our producers make choices that are good for the overall sustainability story and environmental footprint of egg production. So that’s what we’re focusing on right now. I think eggs have a really great story to tell already. But we can’t just rest on that. We need to keep going, keep working, and really understand where we can have the biggest impact.

 

Melissa 37:01

Great, great. You mentioned life cycle assessment, or LCA. For people who are not familiar with that term, can you just give a brief description?

 

Mickey 37:08

So lifecycle assessment, I refer to it just like I refer to any other scientific study, is basically evaluating all the factors that go into producing a particular product, in this case, eggs. So you have to evaluate all the inputs—all the things you do to raise a hen, take care of a hen, and feed a hen. All the things that go into operating a farm and all the energy used to operate a farm. All of these things fall under inputs that have their resources used. So when you do a lifecycle assessment, you add all those up. And then you see where we are utilizing the most resources. Where do we have places where we can improve? Where are we doing really well? So it’s really an opportunity to just evaluate the entire system and understand where the most impact could be.

 

Melissa 37:56

It’s very comprehensive. Thank you for sharing that. It’s something that I’ve talked about with other food products. But I know this term isn’t familiar to some people. And just one more quick question, because we’re seeing a lot in the news lately about the increasing price of eggs. And I’ll add that we’re seeing an increase in all foods at the grocery store. But if you could speak to why we’re seeing an increase in egg prices right now, that would be great.

 

Mickey 38:24

Of course, it’s hard not to notice that. With inflation, the grocery store, and a lot of news articles lately. Obviously, affordable food and affordable nutrition matters to everybody. And when you look at eggs, they remain one of the most affordable, highest quality proteins available, even at these higher prices, there’s still a great nutritional balance, an all-around nutrient powerhouse with high-quality protein, about which I’ve talked about the essential nutrients. But, what we’re seeing in terms of higher costs, the short answer is that it’s a result of a number of different factors, most of which are outside the control of an egg farmer. Like just about everything else, eggs have been impacted by inflation and supply chain challenges. Now, it’s important to know that farmers can’t set the price of their eggs. Like other agricultural products such as wheat, eggs are sold as commodities. So the wholesale price of eggs is set by the market. And the market is impacted by things like supply and demand, as well as the cost of things like fuel, feed, packaging and labor—all the things farmers need to produce eggs have gone up in price, too.

On top of that, all poultry farmers have been grappling with avian influenza for the last year, which has impacted farms in various locations across the country; the good news is that those farms have been quickly recovering, and egg farmers have been working around the clock to ensure eggs are available for everyone who wants them. Right now we have more than 300 million egg laying hens on egg farms in this country—almost one hen for every American—and while we understand that it’s difficult for everybody, especially when we’re talking about the difficulty of affordable nutrition—I can tell you egg farmers are doing everything they can to keep their costs down and make sure the egg supply is strong, which should help stabilize prices.

Melissa 39:51

Thank you. And I talk about eating healthy on a budget all the time. As a former supermarket dietitian, this is just one of my favourite topics. Eggs are always on the list of nutrient-rich foods that are affordable. So I appreciate that. I always ask this question, and I’m sure I’ve asked you before on your previous episodes, but I’d love to hear your answer on what do you say to people who question or criticize industry-funded research?

 

Mickey 40:18

Yeah, that’s a great question and a topic that I actually really enjoy talking about. So I’m glad for you to ask that question. I think people who criticize industry-funded research  – I don’t think industry funded research is above reproach. I think we should be critiqued; I think people should hold our feet to the fire; people should have high expectations of how we operate. To me, there’s nothing wrong with that high expectation, because I think we want to meet that expectation; we want to make sure that we try to do research in the most credible way possible. Every chance we have to reduce opportunities for having our own bias impact the process in a way that it shouldn’t.

Bias can find its way into research from a lot of different points of view. Sponsor is one of them. And we are fully aware of that. But I think we do a lot of things to try to minimize those impacts. First of all, we have all of our research proposals peer reviewed by third-party scientists who have no connection to the study. They give us their unbiased opinion on the quality of that science and whether or not it’s going to make an important contribution to the field. Once we fund a study, that study is in the hands of the researcher, and we don’t have a whole lot of interaction, aside from just saying, “Hey, how are things going, good?” Subject recruitment is going well? Good.

But really, it’s the principal investigator who’s in charge of that study and how that study is being run. And then, in terms of publication, we encourage every study to be published. Whether the results show the arrows pointing up, down, or neutral, we think all studies should be published. Now, it’s not easy to publish; the competition in journals is difficult. And one of my pet peeves, or something I think is an issue, is that it’s difficult to get those studies published that have that sort of “no arrows pointing up, no arrows pointing down,” which is not exciting, so they don’t get published. But I do think that those studies are important and that they help inform the field. In my perfect world, there’s a journal of null findings that can be published. I think that would have a tremendous impact on how we view some research.

But at the end of the day, I think all of those scientists I’ve met and that I’ve known in industry are trying to do exactly that. But I also say, in response to critics or people who have a negative perception of industry-funded research, “Keep critiquing,” because that makes us better. And makes us consider how we go about our work. Because egg research is important. It’s important that we know more about eggs. And I also think it’s our responsibility as somebody who works for the egg industry; our farmers, whose money we spend on research, think that’s their responsibility. They get really excited when they know their dollars are going toward funding good scientific research. So it’s not going to be us. Who’s it going to be?

 

Melissa 43:16

I’m glad you brought up the published aspect, because I was going to ask about that. And I know that’s something I hear a lot about in the field, along with the challenges of getting all research published. We think only the good things are getting published. Or perhaps they are negative and exciting, but the neutral stuff and I agree with you all contributes to the body of research. And I like your idea about the journal of null findings.

 

Mickey 43:44

The journal of null findings. Maybe that’ll be my next career. The journal of null findings.

 

Melissa 43:48

Wel you would think with the internet or something, there could be something like a database or something. I guess they would still need to be peer reviewed and everything. I’m sure it’s much more complex than I’m making it sound. But I think there are enough people who see the value in that. And hopefully, that’s a challenge that we can overcome at some point.

 

Mickey 44:06

I hope so too.

 

Melissa 44:07

Great. Well, as we’re wrapping up, is there anything else we need to know about cholesterol, choline, eggs, or any key takeaways, especially for healthcare professionals and registered dietitians but also the public? Perhaps to address some of the misconceptions we discussed?

 

Mickey 44:25

A couple of things. You said as we started at the very beginning. This is hard. It’s confusing. I get it. It’s confusing to me. And I’ve been doing this for my job. So I think what I would recommend is that, as nutrition professionals, let’s approach this with the understanding that this is really confusing. And we also should approach it from the perspective that research tells us one thing one decade and something else a few decades later, and that’s a good thing. That’s an example of the system working. That’s an example of us learning more as we go. And we get smarter; we have better methods; we learn things, and we apply them to the next study. Those are all good things. So I think it’s okay to be confused because sometimes the field is confused.

And I think if we show a little empathy to those who might be a little like, “Oh, I just don’t get this,” that’s okay. There have been a lot of days where I look at the science and I’m like, “I don’t get this either.” So I think we all just need to give each other a break and try to keep learning. That would be my take-home message. I think the cholesterol story is possibly the best example not just in the history of nutrition science but in the history of science as a whole. How that’s evolved. Nobody, at any given point along that continuum, was ever wrong. It’s just that we learned something today that we didn’t know yesterday, and we applied it to the next thing.

 

Melissa 45:56

I love that.

 

Mickey 45:57

If I can leave you with anything, that’s where we are. It was the best of what we knew at the time. And now we just know more.

 

Melissa 46:03

We know more. In the spirit of addressing these misconceptions, especially among health care professionals, you know I do media trainings and speaker trainings about how to effectively communicate nutrition science, and nutrition news to the public. And a lot of it is what you just explained; although I don’t use those words, I’m going to borrow them if you don’t mind. One study is not the be-all and end-all. And the difference between correlation versus causation and things like that, just to help the public realize it, is that it’s not black and white. It’s not a definitive point in time. The research evolves. But beyond that, is there anything more specific that we can share with healthcare professionals to help communicate to consumers about where you’re getting your information, who to trust, where to get credible resources, and that may actually segue into – Of course, we want to share some resources with our listeners. Where can people find trustworthy information?

 

Mickey 46:59

I think, first of all, I’d be remiss if I didn’t plug the Egg Nutrition Center website. We’ve got lots of good information in blogs, materials, and research, all backed by published scientific studies. There are lots of other sites just like that as well. I think for me, we all obviously look at credentials, and credentials are incredibly important. But I think you also listen to the messages. The messages that tell you that we’ve got the cure-all for everything – those tend to be the ones that I tend to push to the side. But the credentialed people who tell you how things fit into a larger context and tell you what we know as well as a little bit of what we don’t know are a little more credible. So that’s kind of how I do it.

 

Melissa 47:41

Yeah. If it sounds too good to be true or if it’s too absolute, it’s not black and white. So check out The Egg Nutrition Center’s website.

 

Mickey 47:50

Eggnutritioncenter.org.

 

Melissa 47:52

Okay. And I have some articles that I’m going to put in my show notes at soundbitesrd.com. There’s a summary of the recent update on eggs and heart health at incredibleegg.org. And I’ll have the direct link in my show notes. There’s also an article that was recently updated and outlines the current guidance that we’ve talked about. You guys are on Instagram, Facebook, Twitter, LinkedIn. And you’re on LinkedIn and Twitter as well. What’s your Twitter handle?

 

Melissa 48:21

@MickeyRubin.

 

Melissa 48:23

Very good. And I encourage people to connect with you on Twitter and LinkedIn and check out Facebook and Instagram as well. And I’ll also link to the previous episodes that you were on and anything related that we’ve covered in this episode. Any related episodes that I have, I’ll link to those as well.

 

Mickey 48:41

Great.

 

Melissa 48:42

Well, thank you so much for coming on the show again and sharing these updates and this information. I really appreciate it.

 

Mickey 48:49

My pleasure. I’m already looking forward to the next one. It is always great to talk to you.

 

Melissa 48:54

Excellent. For everybody listening, always enjoy your food with health in mind. Till next time.