May Newsletter
In This Issue
An Egg a Day Keeps the Doctor Away?
Can Eating Fish Get You Pregnant?
Diet and Menopause
A Better Model of Medical Care
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. Memorial Day has passed which is the unofficial start of summer but more importantly, a day of remembrance and thanks. For the past few years I have done a special work out on Memorial Day along with many Cross-Fitters called the "Murph Challenge". This is to commemorate LT. Michael P. Murphy, who posthumously received the Medal of Honor for actions in Afghanistan. The workout consists of a 1 mile run, 100 pull-ups, 200 push-ups, 300 squats and another 1 mile run. Some will do this wearing body armor or a 20 lb vest. This year, I chose to do this in silence. I wanted to focus on the men and women who have gone through so much so that my family and I can live in freedom. It seems that at times, when many feel so far apart, focusing on what others have given can help us to look past our differences and remember that we are all Americans. 

I also saw an article in our local Milwaukee paper on Memorial Day. Over 5000 dogs went to Vietnam and served in our military. None of them came home. There is a new Vietnam memorial being dedicated on June 2nd at The Highground Veterans Memorial Park in Neillsville, WI to the military dogs who served in Vietnam. This really hit home for me as my father served in Vietnam as a veterinarian caring for these special animals. Thankfully, our military dogs are now treated as true veterans and get to come home too. To all who serve, have served, and their families who sacrifice as well, thank you. 

Eggs have been maligned for decades. We were told the cholesterol in the egg was clogging our arteries and the fat of the yolk was making us fat. Some people have given up eggs for years based on these concerns. The first article this month shows us that people consuming eggs actually have lower rates of cardiovascular disease than people who abstain. Looks like it is fine to enjoy that omelet!

Many couples struggle to conceive and this can be a stressful and heartbreaking time. The second article shows us that what people eat (yes, men too) can be beneficial in achieving a successful pregnancy. Even people not trying to conceive may be interested in one of the findings of this study.

Menopause is a time of change for women and postmenopausal women are at higher risk of heart disease and osteoporosis. Every woman is different and the timing varies between women. The third study shows us that what we are eating on a regular basis may help determine the timing of menopause. 

Click on the links the the left to check out our  web site ...
An Egg a Day Keeps the Doctor Away
Daily egg consumption decreases risk of cardiovascular disease
The much maligned egg. Banished due to fears of dietary cholesterol causing heart  disease since the 70's, it has now been found to be a high quality protein containing many vitamins and bioactive components such as phospholipids and carotenoids which are beneficial for health. This large study of over 500,000 subjects over almost 9 years looked at egg intake and rates of cardiovascular disease, including heart disease, thrombotic and ischemic strokes. The researchers found that the egg consumers were at significantly lower risk of cardiovascular disease.   
  • Objective: To examine the associations between egg consumption and cardiovascular disease (CVD), ischaemic heart disease (IHD), major coronary events (MCE), haemorrhagic stroke as well as ischaemic stroke.  
  • Methods: During 2004-2008, over 0.5 million adults aged 30-79 years were recruited from 10 diverse survey sites in China. Participants were asked about the frequency of egg consumption and were followed up via linkages to multiple registries and active investigation. Among 461,213 participants free of prior cancer, CVD and diabetes, a total of 83,977 CVD incident cases and 9,985 CVD deaths were documented, as well as 5,103 MCE. Stratified Cox regression was performed to yield adjusted hazard ratios for CVD endpoints associated with egg consumption.
  • Results: At baseline, 13.1% of participants reported daily consumption (usual amount 0.76 egg/day) and 9.1% reported never or very rare consumption (usual amount 0.29 egg/day). Compared with non-consumers, daily egg consumption was associated with lower risk of CVD (HR 0.089, 95% CI 0.87 to 0.92). Corresponding multivariate-adjusted HRs (95% CI) for IHD, MCE, haemorrhagic stroke and ischaemic stroke were 0.88 (0.84 to 0.93), 0.86 (0.76 to 0.97), 0.74 (0.67 to 0.82) and 0.90 (0.85 to 0.95), respectively. There were significant dose-response relationships of egg consumption with morbidity of all CVD endpoints (P for linear trend <0.05). Daily consumers also had an 18% lower risk of CVD death and a 28% lower risk of haemorrhagic stroke death compared to non-consumers.
  • Conclusion:  Among Chinese adults, a moderate level of egg consumption (up to <1 egg/day) was significantly associated with lower risk of CVD, largely independent of other risk factors.

Eggs are a source of dietary cholesterol. This study found that daily consumers of eggs had an 18% lower risk of death from cardiovascular disease and a 28% lower risk of hemorrhagic stroke death. Consuming eggs may increase total cholesterol and LDL (bad cholesterol), but it also increases HDL (good cholesterol) levels and has no causal effect on cardiovascular disease risk in multiple studies. If fact, eggs have been shown to have a favorable effect on cardiovascular health. The higher HDL levels slow atherosclerosis. Egg protein is a high quality protein that causes higher satiety and lower after meal glucose spikes, thus lower insulin levels. Intake of eggs also increases lutein and zeaxanthin which are antioxidants, protecting us from inflammation and atherosclerosis. These antioxidants are more available through eggs than they are from fruits and vegetables and egg intake actually promotes increased availability of antioxidants from vegetables and fruits. Don't be afraid to crack an egg! 

Can Eating Fish Get You Pregnant?
Higher intake of seafood may decrease time to pregnancy

This study, from the Journal of Clinical Endocrinology & Metabolism found that a higher intake of seafood was linked to a shorter time to pregnancy. The researchers examined the relationship of seafood intake in men and women planning pregnancy. Couples where the male and female partners consumed at least eight seafood servings per cycle had 47% and 60% shorter time to pregnancy than those who consumed no more than 1 serving of seafood/cycle. When both partners consumed 8 or more servings of seafood they had a 61% shorter time to pregnancy. 

  • Objective:  To examine the relationship of male and female seafood intake with time to pregnancy (TTP).
  • Design:  Our prospective cohort study included 501 couples planning pregnancy who participated in the Longitudinal Investigation of Fertility and the Environment Study (2005-2009) and were followed for up to1 year or until pregnancy was detected. Seafood intake was collected daily during follow-up in journals.
  • Setting:  Couples residing in Michigan and Texas were recruited using population-based sampling frameworks.
  • Main Outcome Measures:  The primary outcome was time to pregnancy as determined by an in-home pregnancy test. A secondary outcome was sexual intercourse frequency (SIF) as recorded in daily journals.
  • Results:  Couples where the male and female partners consumed ≥8 seafood servings/cycle had 47% (95% CI 7, 103%) and 60% (95% CI 15, 122%) higher fecundity (shorter TTP) compared to couples with male and female partners who consumed ≤1 seafood serving/cycle, respectively. Couples in which both partners consumed ≥8 seafood servings/cycle had 61% (95% CI 17, 122%) higher fecundity compared to couples consuming less. Male and female partners with the highest seafood intake (≥8 servings/cycle) also had 22% higher SIF.
  • Conclusions:  Higher male and female seafood intake was associated with higher frequency of sexual intercourse and fecundity among a large prospective cohort of couples attempting pregnancy.

Over 10% of couples struggle to get pregnant and anything that can increase the chance of pregnancy is certainly welcome. This study shows a simple way to increase probability of getting pregnant - eat seafood. Both partners consuming a seafood meal twice a week can increase chances of pregnancy by 61%! So yes guys, what you are eating matters too! Interestingly, couples consuming high levels of seafood were also more sexually active (22%). Maybe we all should consider more seafood. Although this study didn't specify, I recommend fatty fish high in omega-3 fatty acids like wild salmon, mackerel, or sardines preferentially. Additionally, eating vegetables, fruits, nuts and fiber can be beneficial. Avoid processed foods, sugar and artificial sweeteners for healthy conception and pregnancy. Getting plenty of B vitamins (especially folic acid for women) is important for both men and women so consider a supplement for this. Men may want to also consider a zinc supplement.      
Diet and Menopause 
Age of menopause affected by diet
The average age at menopause is 51 years. Women who experience natural menopause (permanent cessation of menstrual periods for at least 12 consecutive months) at earlier ages may have increased risk for osteoporosis, depression, and cardiovascular disease, whereas women with late menopause may have increased risk for ovarian, breast, and endometrial cancers. This  
study looked at the effects of diet on the age of menopause. The researchers found that w
omen who consumed more oily fish and fresh legumes had later menopause, and those whose intake consisted of refined pasta/rice had earlier menopause. Vitamin B6 and zinc were also associated with later menopause.


  • BACKGROUND: Age at natural menopause is a matter of concern for women of reproductive age as both an early or late menopause may have implications for health outcomes.
  • METHODS: Study participants were women aged 40-65 years who had experienced a natural menopause from the UK Women's Cohort Study between baseline and first follow-up. Natural menopause was defined as the permanent cessation of menstrual periods for at least 12 consecutive months. A food frequency questionnaire was used to estimate diet at baseline. Reproductive history of participants was also recorded. Regression modelling, adjusting for confounders, was used to assess associations between diet and age at natural menopause.
  • RESULTS: During the 4-year follow-up period, 914 women experienced a natural menopause. A high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day (99% CI 0.8 to 5.8) and 0.9 years per portion/day (99% CI 0.0 to 1.8), respectively. Refined pasta and rice was associated with earlier menopause (per portion/day: -1.5 years, 99% CI -2.8 to -0.2). A higher intake of vitamin B6 (per mg/day: 0.6 years, 99% CI 0.1 to 1.2) and zinc (per mg/day: 0.3 years, 99% CI -0.0 to 0.6) was also associated with later age at menopause. Stratification by age at baseline led to attenuated results.
  • CONCLUSION: Our results suggest that some food groups (oily fish, fresh legumes, refined pasta and rice) and specific nutrients are individually predictive of age at natural menopause.

There are pros and cons to later menopause. On the one hand, women with later menopause tend to have lower rates of osteoporosis and cardiovascular disease. Longer exposure to estrogen may slightly increase risk of breast, ovarian and endometrial cancers. However, noting that women with diabetes tend to have earlier menopause makes me think that perhaps lower insulin resistance is associated with a later menopause and may be a good thing for overall health. Women with earlier menopause also tend to have more weight gain which would fit with these findings. In this study, women who consumed more white rice and pasta had earlier menopause (and likely more insulin resistance). Increasing natural phenolic antioxidants from vegetables and omega-3 fatty acids (fish) in the diet may decrease follicular atresia and delay the onset of menopause. Higher intake of refined carbohydrates increases insulin resistance and may result in higher estrogen levels, causing greater release of luteinizing hormone, increased number of cycles, faster depletion of oocytes, and subsequent earlier menopause. The lowering of osteoporosis and cardiovascular disease (#1 killer in women) through delayed menopause (lowered insulin resistance) seems to suggest that in most women, this is a favorable outcome.    

Dietary Intake and Age at Natural Menopause: Results From the UK Women's Cohort Study J Epidemiol Community Health 2018 Apr 30;[EPub Ahead of Print]
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. Feel free to pass this on to anyone you think would benefit from this information. 

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As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email , phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.