A controversial subject for sure....as I am slightly reactive to eggs (both yolk and white) I tend to eat them once or twice a week and try to stay away from too many baked goods, containing eggs, therefore I cannot comment on this from personal experience...

I do, however wish to point out that research is subjective and many of the variants are not covered here, like were the people eating organic or conventional eggs....there is a difference between what free range chickens and conventional chickens eat and are fed. The linoleic acid content in conventional eggs will be way higher etc. (more inflammatory)

I always recommend eating eggs from free range chickens that have not been consuming GMO corn and I also like to know where my organic eggs are coming from.

Having said that....

You decide how this fits or feels for you.

A Beloved Food That Surprisingly Has Been Found to Contribute to Diabetes

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

Over the last few years I started seeing an unanticipated trend that totally took me by surprise. The trend was totally fit individuals who were eating three to six eggs a day were developing Type 2 Diabetes (T2D) confirmed with an elevated Hemoglobin A1c levels ranging from 5.8 to 6.2.!

 

Ha1c Readings from Two Very Fit Patients Eating 3-6 Eggs Per Day

The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months. It's one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and your health care team manage your diabetes.

My Research And Discovery on The Relationship Between Increased Egg Consumption and the Trend Toward Diabetes

According to a study published 2021 in the British Journal of Nutrition, consuming one or more eggs per day may increase the risk of diabetes by 60%!.

Researchers compared egg consumption with blood glucose levels in more than 8,000 participants from the China Health and Nutrition Survey. Those who habitually consumed the most eggs increased their risk for diabetes when compared to those who ate the fewest eggs. 

A study published in Nutrition found an increased risk for diabetes and high cholesterol among Chinese women, while research published in Circulation found a link between higher egg consumption and prevalence of diabetes mellitus and hypertension.

Although an older study, the medical journal, Circulation from a meta-analysis and data from the Physicians' Health Study and Women's Health Study showed an increased risk for diabetes of up to 77% with seven or more eggs consumed per week.

Higher egg consumption was associated with higher blood glucose in subjects with T2D.

What the Medical Literature is Leaning Toward as it Relates to Diabetes and Eggs

Many studies, including meta-analyses, systematic reviews, case-control studies, and large-scale epidemiological studies, all point in the same direction. 

Eating eggs increases your risk for the development of type 2 diabetes, heart disease, diabetes complications, and all-cause mortality. 

Whether you are currently living with diabetes, consuming an increased number of eggs per week can significantly elevate your risk for developing diabetes and its health related complications such as cardiovascular disease and kidney disease.

Dr. Grisanti's Comments:

My analysis of the research was an eye-opener and to be quite honest if it wasn't for the fact that I was seeing what appeared to be perfectly fit patients exhibiting elevated Ha1c with a possible correlation of increased egg consumption, I would have been doubtful on the conclusions of these studies.

I suggest limiting egg consumption to three eggs per week

I found the following short video from Michael Greger M.D. FACLM (author of How Not to Die and his most recent book, How Not to Age) a good summary on this important topic.

https://nutritionfacts.org/video/eggs-and-diabetes/

** As a side note, I realize that there will be egg proponents that will debate me and show me other peer reviewed studies negating the contents of my article. My response will be the fact that I see the true evidence with real patients and not simply some conflicting studies. I prefer to err on the side of being cautious and do no harm. 

This is a controversial topic with two opposing sides and I have done my due diligence and weighed out the evidence and I believe over abundance of egg consumption should be carefully curtailed as to be 100% certain you are doing no metabolic damage to yourself and your patients.

If you are staunch advocate of increased egg consumption, I simply say, do the benefits out weigh the risk.

Again what I have observed in clinical practice with real patients, the lab tests do not lie and with no evidence of other reasons for compromised glucose metabolism (diabetes), I report that eggs may indeed be the culprit.

I will continue to report on my findings as I continue to monitor my patients.

References:

https://pubmed.ncbi.nlm.nih.gov/33028452/
https://pubmed.ncbi.nlm.nih.gov/20471806/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861752/
https://europepmc.org/article/med/33028452
https://pubmed.ncbi.nlm.nih.gov/26739035/
https://pubmed.ncbi.nlm.nih.gov/19017774/
https://link.springer.com/article/10.1007/s00394-017-1566-0
//www.functionalmedicineuniversity.com/Harvard-egg-diabetes.pdf

** Always consult with a physician or healthcare practitioner with significant integrative or functional medicine training before starting any of the above recommendations.

You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com for more information on our training in functional medicine. Look for practitioners who have successfully completed the Functional Medicine University's Certification Program (CFMP) www.functionalmedicinedoctors.com. This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Grisanti is required

Highly processed foods as Addictive as Tobacco

 Highly Processed Foods 'as Addictive' as Tobacco: <https://www.medscape.com/viewarticle/984600>

LONDON — Highly processed foods meet the same criteria as tobacco for addiction, and labeling them as such might benefit public health, according to a new US study that proposes a set of criteria to assess the addictive potential of some foods.

The research suggests that healthcare professionals are taking steps towards framing food addiction as a clinical entity in its own right; it currently lacks validated treatment protocols and recognition as a clinical diagnosis.

Meanwhile, other data, reported by researchers last week at the Diabetes Professional Care (DPC) 2022 conference in London, UK, also add support to the clinical recognition of food addiction.

Clinical psychologist Jen Unwin, PhD, from Southport, UK, showed that a 3-month online program of low carbohydrate diet together with psychoeducational support significantly reduced food addiction symptoms among a varied group of individuals, not all of whom were overweight or had obesity.

Unwin said her new data represent the first widescale clinical audit of its kind, other than a prior report of three patients with food addiction who were successfully treated with a ketogenic diet. 

"Food addiction explains so much of what we see in clinical practice, where intelligent people understand what we tell them about the physiology associated with a low-carb diet, and they follow it for a while, but then they relapse," said Unwin, explaining the difficulties faced by around 20% of her patients who are considered to have food addiction.

Meanwhile, the authors of the US study, led by Ashley N. Gearhardt, PhD, a psychologist from the University of Michigan, Ann Arbor, write that the ability of highly processed foods (HPFs) "to rapidly deliver high doses of refined carbohydrates and/or fat appear key to their addictive potential. Thus, we conclude that HPFs can be considered addictive substances based on scientifically established criteria."

They assert that the contribution to preventable deaths by a diet dominated by highly processed foods is comparable to that of tobacco products, and as such, like Unwin, the authors seek clinical recognition and a more formalized protocol to manage food addiction.

"Understanding whether addiction contributes to HPF intake may lead to new treatments, as preliminary research finds that behavioral and pharmacological interventions that target addictive mechanisms may reduce compulsive HPF intake," they state

The study led by Gearhardt was published this month in the journal Addiction, and the study led by Unwin was also recently published in Frontiers in Psychiatry.

Addiction Criteria Similar to Tobacco

HPFs can be associated with an eating phenotype "that reflects the hallmarks of addiction," say Gearhardt and co-authors; typically, loss of control over intake, intense cravings, inability to cut down, and continued use despite negative consequences.

Acknowledging the lack of a single addictive agent, they explain that food addiction reflects mechanisms implicated in other addictive disorders such as smoking.

As such, in their study, Gearhardt and colleagues propose a set of scientifically based criteria for the evaluation of whether certain foods are addictive. "Specifically, we propose the primary criteria used to resolve one of the last major controversies over whether a substance, tobacco products, was addictive."

They consider certain foods according to the primary criteria that have stood the test of time after being proposed in 1988 by the US Surgeon General to establish the addictive potential of tobacco: (1) they trigger compulsive use, (2) they have psychoactive effects, and (3) they are reinforcing.

They have updated these criteria to include the ability to trigger urges and cravings, and add that "both these products [tobacco and HPFs] are legal, easily accessible, inexpensive, lack an intoxication syndrome, and are major causes of preventable death."

For example, with compulsive use, tobacco meets this criterion because evidence suggests that most smokers would like to quit but are unable to do so.

Likewise, write Gearhardt and colleagues, even "in the face of significant diet-related health consequences (eg, diabetes and cardiovascular disease), the majority of patients are unable to adhere to medically recommended dietary plans that require a reduction in HPF intake.”

Reinforcement, through tobacco use, is demonstrated by its 'being sufficiently rewarding to maintain self-administration" due to its ability to deliver nicotine, they say, quoting the Surgeon General's report, and likewise, with food addiction, "both adults and children will self-administer HPFs (eg, potato chips, candy, and cookies) even when satiated."

Online Group Food Addiction Intervention Study

Unwin and co-authors want people with food addiction to be able to access a validated treatment protocol. Their study aimed to evaluate an online group intervention across multiple sites in the United States, Canada, and the UK, involving an abstinent, low-carbohydrate diet and biopsychosocial education focused on addiction and recovery in people self-identifying as having food addiction.

"Lots of people with food addiction go to GPs who don't clinically recognize this, or if they attend addiction services and psychiatry, then they tend to only specialize in drugs, alcohol, and gambling. Eating disorder services are linked but their programs mostly don't work for a food addict," Unwin remarked in an interview with Medscape Medical News.

"We feel running groups, as well as training professionals to run groups, is the best way to manage food addiction," she said, reflecting on the scale of the problem, with around 10% of adults in the UK general population considered to have food addiction. In Unwin's study, some people had type 2 diabetes and some overweight/obesity, but she added that some participants were underweight or of normal weight.

Initially, the 103 participants received weekly group (8-24 people) sessions for 10-14 weeks, and then monthly maintenance comprising follow-up that involved coaching participants on how to cope with relapse and get back on track.

Food addiction symptoms were assessed pre- and post-program using the modified Yale Food Addiction Scale (mYFAS) 2.0; ICD-10 symptoms of food-related substance use disorder (CRAVED); and mental health well-being measured using the short version of the Warwick Edinburgh Mental Wellbeing scale and body weight.

"The program eliminates processed foods with a personalized, abstinence food plan that involves education around mechanisms involved," said Unwin, who explained that processed foods deliver a dopamine high, and in response to this, the brain lowers the number of dopamine receptors to effectively counteract the increase in dopamine. This drop in dopamine receptors explains the depression often associated with food addiction.

Unwin reported that food addiction symptoms were significantly reduced, with the mYFAS dropping by 1.52, the CRAVED score by 1.53, and body weight by 2.34 kg (5.2 lb). Mental health, as measured by the Warwick Edinburgh Mental Wellbeing scale, improved by 2.37 points.

"We were very interested in mental health and well-being because it impacts so much across our lives, and we saw significant improvements here, but we were less interested in weight because food addicts come in all shapes and sizes with some people underweight," remarked Unwin. "Food addiction symptoms were significantly improved in the group, but we now need to look at the longer-term outcomes."

Unwin runs a low-carbohydrate program for type 2 diabetes with her husband David Unwin, MD, who is a GP in Southport, UK. She said that they ask patients if they think they have food addiction, and most say they do.

"I always try to explain to patients about the dopamine high, and how this starts the craving which makes people wonder when and where they can find the next sugar hit. Just thinking about the next chocolate bar gets the dopamine running for many people, and the more they tread this path then the worse it gets because the dopamine receptors keep reducing."

Lorraine Avery, RN, a diabetes nurse specialist for Solent NHS Trust, UK, who attended the DPC conference, welcomed Unwin's presentation.

"My concern as a diabetes nurse specialist is that I'm unsure all our patients recognize their food addiction, and there are often more drivers to eating than just the food in front of them," she told Medscape Medical News. "I think there's an emotional element, too. These people are often 'yo-yo' dieters, and they join lots of expert companies to help them lose weight, but these companies want them to regain and re-join their programs," she said.

"I think there is something about helping patients recognize they have a food addiction and they need to consider that other approaches might be helpful."

Addiction. Published online November 9, 2022. Full text

Front Psychiatry. Published online September 28, 2022. Full text

Unwin has reported no relevant financial relationships; some other authors have fee-paying clients with food addiction. Gearhardt and Avery have reported no relevant financial relationships.

 

Are Artificial Sweeteners Really Harmless?

Medscape Medical News - August 19, 2022

New research discounts the long-held notion that aspartame and other nonnutritive sweeteners (NNS) have no effect on the human body.

In a study, researchers found that these sugar substitutes are not metabolically inert and can alter the gut microbiome in a way that can influence blood glucose levels.

The study was published online August 19,20-22 in the journal Cell.

Gut Reaction? 

Several years ago, a team led by Eran Elinav, MD, PhD, an immunologist and microbiome researcher at the Weizmann Institute of Science, Rehovot, Israel, observed that NNS affect the microbiome of mice in ways that could affect glycemic responses.

They have now confirmed this observation in a randomized controlled trial with 120 healthy adults.

Before the study, all participants strictly avoided NNS. During the trial, some remained NNS-free, while others used saccharin, sucralose, aspartame, or stevia daily for 2 weeks in doses lower than the acceptable daily intake.

Each NNS "significantly and distinctly" altered stool and oral microbiome, and two of the sweeteners (saccharin and sucralose) significantly impaired glucose tolerance, the researchers report.

"Importantly, by performing extensive fecal transplantation of human microbiomes into germ-free mice, we demonstrate a causal and individualized link between NNS-altered microbiomes and glucose intolerance developing in non-NNS-consuming recipient mice," they say.

They note that the effects of these sweeteners will likely vary from person to person because of the unique composition of an individual's microbiome.

"We need to raise awareness of the fact that NNS are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies," Elinav said in a news release.

For now, Elinav says it's his personal view that "drinking only water seems to be the best solution.”

Weighing the Evidence 

Several experts weighed in on the results in a statement from the UK nonprofit organization, Science Media Centre.

Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow, Aston University, Birmingham, United Kingdom, notes that the study does not show a link between all NNS and higher blood glucose levels in the long term (only after a glucose tolerance test).

"It did suggest, though, that some individuals who do not normally consume sweeteners may not tolerate glucose as well after consuming six sachets of either saccharin or sucralose mixed with glucose per day," Mellor says.

Kim Barrett, PhD, distinguished professor of physiology and membrane biology, University of California, Davis, School of Medicine, concurs, saying, "this well-designed study indicates the potential for NNS to have adverse effects in at least some individuals."

The study also does not provide any information about how people who normally consume sweeteners or people with either type 1 or type 2 diabetes respond to NNS.

"Therefore, for some people, it is likely to be a better option and more sustainable approach to use sweeteners as a 'stepping stone,' allowing them to reduce the amount of added sugar in foods and drinks, to reduce their sugar intake, and still enjoy what they eat and drink, on the way to reducing both added sugar and sweeteners in their diet," Mellor suggests.

Kevin McConway, PhD, with the Open University, Milton Keynes, United Kingdom, says it's "important to understand that the research is not saying that these sweeteners are worse for us, in heath terms, than sugar.

"But exactly what the health consequences of all this, if any, might be is a subject for future research," McConway adds.

Kathy Redfern, PhD, lecturer in human nutrition, University of Plymouth, UK, agrees.

"We still have a lot to learn about the human microbiome, and although this study suggests two of the sweeteners tested in this study (sucralose and saccharin) significantly affected glucose tolerance, these deviations were small," she says.

The International Sweeteners Association also weighs in, saying, "No conclusions about the effects of low/no calorie sweeteners on glucose control or overall health can be extrapolated from this study for the general population or for people who typically consume sweeteners, including people living with diabetes."

They add that "a recent review of the literature concluded that there is clear evidence that changes in the diet unrelated to low/no calorie sweeteners consumption are likely the major determinants of change in gut microbiota."

Nevertheless, Redfern says the results "warrant further investigation to assess how small changes in glucose tolerance in response to NNS consumption may influence longer term glucose tolerance and risk for metabolic complications, such as type 2 diabetes."

The study had no specific funding. Elinav is a scientific founder of DayTwo and BiomX, a paid consultant to Hello Inside and Aposense, and a member of the scientific advisory board of Cell. Mellor has provided consultancy to the International Sweetener Agency and has worked on projects funded by the Food Standards Agency that investigated the health effects of aspartame. Barrett, McConway, and Redfern report no relevant financial relationships. 

Cell. Published online August 19, 2022. <https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9>