Moving Beyond Price-Per-Dose In The Pharmaceutical Industry..

By Dana Goldman and Darius Lakdawalla

The United States has experienced extraordinary gains in treating cardiovascular disease over the last few decades. Statins, introduced in the 1980’s, are an important part of the story. Hundreds of thousands of deaths, heart attacks, and strokes have been prevented due to lower cholesterol, and the health benefits—appropriately valued—exceed $1.2 trillion. Evidence suggests there are around 40,000 fewer deaths and 60,000 fewer heart attacks annually because of these drugs. With sales that peaked around $30 billion annually, this makes statins—many of which are now generic—a very good deal.

A new generation of lipid-lowering therapies, PCSK9-inhibitors, will soon reach the market and could further extend these gains. These drugs significantly lower bad cholesterol levels (LDL) in the blood. For those who have exhausted other treatment options, PCSK9-inhibitors may reduce cardiovascular events by as much as 50 percent. However, given their announced prices, some payers are nervous about their use. And, given the benefits of statins, some might ask why PCSK9-inhibitors (PCSK9i) are needed.

Surprisingly, almost one-third of high-risk statin users are not reaching recommended lipid-lowering goals. Thus, while we have come a long way, many patients are still missing out on the benefits of lipid-lowering therapies.

The problem here is our creaky model of pharmaceutical pricing, which now threatens to deprive patients of these and other breakthroughs to come. For decades, the vast majority of drug manufacturers and payers have relied on pricing per dose, be it a pill, a milligram, or the like. While simple and convenient, the “price-per-dose” (PPD) model produces a number of well-known side effects that are now becoming increasingly severe.

PPD Limits Access To Novel Drugs

Setting a single unit price for a drug may be straightforward when it produces reliable and known clinical benefits in patients — in other words, when its mechanism of action has been observed for years in trials and real-world settings. The clinical benefits of novel drugs, however, remain inherently more uncertain.

Payers often respond to this uncertainty by delaying access to novel agents until convincing evidence arrives — sometimes years after product launch. In the case of PCSK9i, payers already seem poised to delay widespread access until clear and definitive evidence of cardiovascular event risk-reduction arrives. Unfortunately, this is likely to take another 2-4 years, which could mean thousands of adverse cardiovascular events in the meantime.

PPD Drives Up Prices For Patients That Derive Moderate Clinical Benefit

When manufacturers must set a single price for each dose, they predictably focus on patients with the very most to gain. This may sound appealing, but in many cases, the clinical benefits of new drugs vary across patient groups. Large numbers of patients stand to gain moderate amounts from a new drug, and added up over an entire population, these gains can be substantial.

With PCSK9-inhibitors, few doubt that patients with familial hypercholesterolemia whose LDL exceeds 500 mg/dL will get the new drugs. However, what about other high-risk patients whose LDL continues to exceed the recommended threshold of 70 mg/dL? The value created for these patients almost surely outweighs the cost of manufacturing the drugs. Failure to provide access thus represents a wasteful and inefficient outcome.

PPD Distorts The Dosing Decisions Of Physicians And Patients

Buying two bunches of bananas naturally costs twice as much as one bunch. Twice as many bananas can feed twice as many people. However, why should a patient who responds best to a 100 mg injection pay twice as much as another who happens to need a 50 mg version?

The 100 mg patient rarely receives twice as much value as her 50 mg peer. Even worse, charging more to patients on higher doses discourages physicians from titrating dosage upward, even when it is clinically warranted. What’s more, PPD forces us into a copayment model where patients are penalized for better adherence.

The Solution Is To Tie Reimbursement To Value

So what is the answer? We need to sever the link between price and doses for everyone, including patients. The best solution may be to reimburse pharmaceutical companies for PCSK9i therapies on the basis of heart disease risk—something cardiologists are already good at classifying—and to eliminate copayments per prescription regardless of patient risk. The highest risk group includes those with genetic disorders that elevate their cholesterol to dangerous levels, and who develop heart disease at a very early age. For these patients, the currently announced price of about $13,000/annually is a great deal.

But the answer is not to restrict the drugs just to this group. For other high-risk patients with less elevated cholesterol—e.g., atherosclerotic cardiovascular disease patients for whom statins lower LDL significantly, but not all the way to goal—a different, lower price should apply. With this differential pricing, payers would no longer have incentives to limit coverage. And, prescribing decisions would focus on the clinically optimal way to lower LDL, instead of on the least expensive dosing strategy.

Plans should pay manufacturers relatively more when the patient’s diagnosis warrants it, and less when the evidence base does not support such a price. This will also mean higher patient cost-sharing in the latter case.

We Need To Remove Barriers To Novel Pricing

Such economic arrangements face many obstacles, in spite of the obvious benefits. The first challenge is regulatory: how will such pricing arrangements be viewed by Medicaid?

Medicaid best-price rules make drug manufacturers reluctant to offer pricing schedules that could, in theory, result in very low unit prices for some groups of patients. The appearance of low unit prices in one or two market segments could theoretically drive down the prices paid by all state Medicaid agencies. As a result of this risk, Medicaid best-price rules have transformed the private insurance market in the US into one of the world’s least innovative testing grounds for new pricing strategies, even compared to public-sector payers overseas.

The second challenge concerns outcomes measurement. Who will assess the LDL reduction, or cardiovascular event-reduction, and how will it be measured? This problem, and its solution, is more common than it appears — for instance, acquisitions and mergers often depend on measuring financial performance. The typical solution is the use of a third-party auditor to verify measurement claims by, in this case, the payer. If we can develop protocols to monitor nuclear facilities in places like Iran, we can probably figure this one out.

Progress in biology and science has outstripped our economic institutions. Innovation in the pricing and reimbursement of pharmaceutical therapy is long overdue. Many challenges remain, but denying patients access to efficacious products is not the “safe” solution. The real risk lies in continuing business as usual, while patients bear the costs of delays and denials. If we price it right, perhaps we can make the next few decades as productive as the last few.

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The Most Commonly Prescribed Drugs in America

by Napala Pratini

We remain a prescription nation. Nearly 70 percent of Americans take one prescription drug and more than half take two, according to researchers at the Mayo Clinic and Olmsted Medical Center. What’s more, about 20 percent of Americans use at least five prescription medications. That same research shows that prescription drug use has been increasing steadily in the U.S. for the past decade. With such a vast swath of the population relying on prescriptions, what drugs are being prescribed and why?

The most recent data available, an April 2014 study by the IMS Institute for Healthcare Informatics, a company that tracks sales at the pharmacy level for drug companies, shows that the top five medicines prescribed in the U.S. in 2013 were:

1. Hydrocodone/acetaminophen

2. Levothyroxine sodium

3. Lisinopril

4. Metoprolol

5. Simvastatin

These drugs are being prescribed in the millions, according to the IMS Institute. The numbers of prescriptions for each range from a high of 129 million for hydrocodone/acetaminophen, 115 million for levothyroxine sodium, 102 million for lisinopril, 84 million for metoprolol , and 79 million for simvastatin,

Uses for the most commonly prescribed drugs

The top drugs are used to treat a variety of ailments — from pain to high blood pressure and high cholesterol. Here’s a breakdown of the use of each drug:

Hydrocodone/acetaminophen is the nation’s most popular painkiller used to treat moderate to severe pain. Hydrocodone, a narcotic analgesic, relieves pain through the central nervous system, and it also is used to stop or prevent coughing. This drug’s reputation precedes it, as it can become habit-forming when used over an extended period of time.

Levothyroxine sodium is used to treat hypothyroidism, a condition where the thyroid gland doesn’t produce enough of the thyroid hormone. This drug also is used to treat thyroid cancer and to help shrink an enlarged thyroid gland.

Lisinopril (which used to be sold under the brand names Zestril and Prinivil) is a high blood pressure medication. Its main function is to block chemicals in the body that trigger the tightening of blood vessels. Lisinopril also is used to help treat heart failure.

Metoprolol is the generic version of Lopressor, is used to treat high blood pressure, and also helps reduce the risk of repeated heart attacks. Metoprolol also treats heart failure and heart pain, or angina.

Simvastatin (generic Zocor) is prescribed to treat high cholesterol and is typically recommended in conjunction with diet changes. This drug is believed to have a variety of benefits including helping to prevent heart attacks and strokes.

Cost of the drugs

The cost of each of these drugs is a slippery subject as the price varies depending on where you buy them and on your insurance coverage. Factors that influence cost include such things as how many tablets are in a prescription or how many milligrams are in each tablet. If you are prescribed a brand name drug, be sure to ask if there is a generic, since brand names tend to be 80-85% more expensive than generics, which legally cannot differ in efficacy, potency, quality or safety.

Here are some cash price estimates for the five drugs at CVS based on GoodRx searches in San Francisco. Keep in mind that your costs will differ based on your insurance status and drug co-pays associated with your plan.

Hydrocodone/acetaminophen: $47

Levothyroxine sodium: $12

Lisinopril: $14

Metoprolol: $17

Simvastatin: $38

Discount programs

There are a variety of ways to save money on prescription drugs. If you’re paying cash for your prescription medications, look into drug coupons — from a website like GoodRx — or in weekly discount fliers and direct mailings from major pharmacies.

Another way to save money on prescriptions is to shop through an online pharmacy, which can shave 35% or more off the cost of your medication. If you go this route, your doctor can fax or mail the prescription to the online pharmacy, then the medicine is mailed to you.

Some states, such as Washington and Kentucky, also offer drug discount cards for those who meet age and income requirements. Another resource is the non-profit NeedyMeds, an organization that maintains a website about programs that can help people who can’t afford medication. In addition, the U.S. Department of Health and Human Services has a website to help connect people with prescription discount programs. Many pharmaceutical companies offer patient assistance programs for individuals who cannot afford their medications, so look into your options before making a purchase — especially if it’s for a pricey brand name drug.

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What is biofeedback therapy?

Biofeedback therapy involves training patients to control physiological processes such as muscle tension, blood pressure, or heart rate.

These processes usually occur involuntarily, however, patients who receive help from a biofeedback therapist can learn how to completely manipulate them at will.

Biofeedback is typically used to treat chronic pain, urinary incontinence, high blood pressure, tension headache, and migraine headache.

The three most common types of biofeedback therapy are:

• Thermal biofeedback – which measures skin temperature
• Electromyography – measures muscle tension
• Neurofeedback – measures brain wave activity

Biofeedback is particularly effective at treating conditions brought on by severe stress. When a person is stressed, their internal processes such as blood pressure can become irregular. Biofeedback therapy teaches these patients certain relaxation and mental exercises which can alleviate their symptoms.

Therapists can measure a patient’s performance by attaching electrodes to their skin and displaying the processes on a monitor. Eventually patients learn how to control these processes without the need to be monitored.

During a biofeedback session electrodes will be attached to the patient’s skin, which sends information to a monitoring box. The biofeedback therapist reads the measurements and through trial and error singles out mental activities that help regulate the patient’s bodily processes.

Sessions are typically less than an hour long – most people will begin to see positive results after 8 sessions. However, some patients may need a as many as 50 sessions.

Biofeedback for Post-Traumatic Stress Disorder (PTSD). A team at East Carolina University is working toward a portable biofeedback training program that could prevent or reduce PTSD.

What is biofeedback used for?

There is a whole range of health conditions that experts believe can be treated with biofeedback therapy. In fact, it is a very popular choice over drugs, because it does not have any significant risks or cause undesirable side effects.

Other benefits of biofeedback therapy are that it is noninvasive and can be an alternative to medications, which is particularly useful for pregnant women.

Below are some examples of conditions and illnesses that may benefit from biofeedback therapy:

Urinary incontinence

The Agency for Health Care Policy and Research currently recommends biofeedback therapy as an effective form of treatment for urinary incontinence, based on very promising findings in clinical studies.

Children’s anxiety at the dentist’s

Researchers at the Narayana Dental College and Hospital in India set out to determine whether biofeedback therapy might help control children’s anxiety when receiving dental restorations. In the journal European Archives of Paediatric Dentistry they concluded “Biofeedback can be used in the initial visits for dentally anxious children and the usage of simpler biofeedback machines for these appointments in dental setup is suggested.”

Raynaud’s disease

Raynaud’s disease is a condition that causes some parts of the body to feel numb and cool in response to cold temperatures or emotional stress. It is caused by a problem of blood supply to the skin.

Some studies also indicate that thermal biofeedback can help alleviate symptoms of Raynaud’s disease, with reports revealing that 80-90% of patients experienced improved circulation and a reduced frequency of symptoms after therapy.

Chronic constipation

Findings published in the Clinical Gastroenterology and Hepatology, found that biofeedback treatment can successfully retrain muscles which cause chronic constipation.

The lead author of the study said “the study results show that bowel movement improvement is possible in nearly 80 percent of patients through biofeedback.”

Fecal incontinence

Scientists at the University of Lübeck in Germany found that electrical stimulation combined with biofeedback therapy helped patients with fecal incontinence.

They reported in the International Journal of Colorectal Disease that “There is sufficient evidence for the efficacy of BF (biofeedback) plus ES (electrical stimulation) combined in treating fecal incontinence. AM-MF (Amplitude-modulated medium-frequency) stimulation plus BF seems to be the most effective and safe treatment.”

Cognitive and behavioral therapies

Dr. John Krystal, Editor of Biological Psychiatry, said biofeedback may open new avenues for cognitive and behavioral therapies; he was referring to a study that found people can control the activity of certain regions of the brain when they receive feedback signals by functional magnetic resonance brain imaging (fMRI).

Chronic rectal pain

Biofeedback is also more effective than two other treatments for a type of chronic rectal pain called levator ani syndrome, according to researchers at the University of North Carolina at Chapel Hill.

Nocturnal bruxism

Nocturnal bruxism is the clenching, bracing, grinding or gnashing of the teeth and jaws during sleep.

A team at The Turner Dental Hospital, Manchester, UK, explained in the British Dental Journalthat a range of treatment strategies have been used to control nocturnal bruxism, including hypnosis, splint therapy, acupuncture, occlusal equilibration and physical therapy.

Drs. R. Needham and S. J. Davies set out to determine what effect biofeedback might have on nocturnal bruxism. Trial participants were given the Grindcare device, a biofeedback device made by Medotech, and told to wear it every night for five weeks.

Out of the 19 patients in the study, eleven (58%) reported a significant reduction in the occurrence of headaches and jaw-muscle discomfort on waking up in the morning.

The study authors concluded “The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement. No adverse effects occurred throughout the study period.”

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How can we prevent or delay Alzheimer’s?

How can we push back or prevent Alzheimer’s?” asks Claudette in Quebec City. As with most health-related issues, the answer is we can do our best with diet and exercise. The Globe’s dietitian wrote a piece this week that outlined a new diet that may help stave off Alzheimer’s:

According to a study, a hybrid of these two eating plans – called the MIND diet – is associated with a significantly lower risk of developing Alzheimer’s disease. That’s true even if you don’t follow the diet strictly.

Along with elements from the Mediterranean and DASH diets, the MIND diet includes specific foods and nutrients found in past studies to be linked to optimal brain health. The diet’s 10 “brain-healthy food groups” include green leafy vegetables, other vegetables, berries, nuts, beans, whole grains, fish, poultry, olive oil and wine.

The plan also advises that five unhealthy food groups – red meat, butter and stick margarine, cheese (because of its high saturated-fat content), pastries and sweets, and fried or fast food – be limited.

The findings also hinted that the longer a person follows the MIND diet, the greater the protection from Alzheimer’s disease.

While this observational study shows promise for reducing the risk of Alzheimer’s, it doesn’t prove cause and effect. The results need to be confirmed by randomized controlled trials, the gold-standard evidence for a cause-and-effect relationship.

These new findings add to a growing body of evidence that strongly suggests your overall dietary pattern matters more than single nutrients when it comes to Alzheimer’s prevention.

Eating a combination of healthful foods that deliver a wide range of protective nutrients while, at the same time, minimizing your intake of foods that may harm brain cells is what counts.

Read the entire article – including the specifics o the MIND diet – here.  In a December 2014 article, The Globe’s fitness expert Alex Hutchison wrote about U.S. research that studied 150,000 participants and showed, “regular exercise lowers the risk of dying from Alzheimer’s by as much as 40 per cent – an indication that the disease’s progression is not unchangeable.”

“Currently, doctors do not screen for Alzheimer’s disease susceptibility because of the belief that nothing can be done for those at risk,” says Dr. Paul Williams, a staff scientist at Lawrence Berkeley National Laboratory in California and the author of the study. “However, our results add to the growing body of scientific evidence suggesting that people can be proactive in lowering Alzheimer’s disease risk.”

The results also showed that running and walking are equally effective as long as you burn the same amount of energy overall. That means you need to spend about twice as much time (or cover 50 per cent more distance) walking briskly compared to running, Williams says.

That doesn’t mean that lesser amounts of exercise are useless, cautions Dr. Jordan Antflick of the Ontario Brain Institute, who co-ordinated a 2013 report on the role of exercise in Alzheimer’s prevention and treatment.

“You don’t have to run a marathon,” he says. “Even raking the leaves or going for a walk after dinner can help.”

After reviewing more than 800 studies and selecting the 45 highest-quality trials, Antflick and his colleagues concluded that more than one in seven cases of Alzheimer’s could be prevented if everyone simply met the minimum guidelines of 150 minutes of exercise per week, in doses as short as 10 minutes at a time. Given that approximately 10 per cent of Canadians over 65 have Alzheimer’s, that would save tens or even hundreds of millions of dollars in health-care costs.

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How much naturally-occurring sugar (i.e. from fruit or milk) is healthy to eat?

How much naturally-occurring sugar (i.e. from fruit or milk) is healthy to eat?

There are no guidelines to limit natural sugars in fresh fruits and vegetables and milk because there is simply no evidence that consuming these sugars is harmful to our health.

Earlier this year, the World Health Organization (WHO) released strict limits for added sugars – those that are added to foods during processing. WHO called for adults to cut their intake to less then 10 per cent of daily calories or, even better, less than 5 per cent. For a standard 2000-calorie diet, these limits translate to no more than 50 grams (10 per cent calories) and 25 grams (5 per cent calories).

These new guidelines are based on evidence reducing added sugar intake to less than 10 per cent of daily calories helps guards against overweight and obesity. The WHO defined added sugars as those “added during processing, at home, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.

But unlike added sugars, there are no specific intake guidelines for natural sugars which occur in fresh fruit and vegetables (called fructose) and milk and yogurt (called lactose).

You might wonder why fruit juice, which contains naturally-occurring sugar (not added sugar) needs to be limited along with other added sugars.  While pure fruit juice does deliver vitamins and minerals, it can be high in natural sugar. One cup of orange juice has 23 grams of sugar while one medium orange has 12 grams. And fruit juice has none of the fibre whole fruit does, so it doesn’t fill you up.  The extra calories from sugar in fruit juice can, therefore, lead to unwanted weight gain if you drink it regularly to quench your thirst.

Current dietary guidelines recommend that total carbohydrates can make up 45 to 65 per cent of your total daily calories.  If you eat, say, 1800 calories per day that means you can consume 202 to 292 grams of carbohydrates each day.

The majority of your carb grams will come from naturally-occurring sugars in fruit and vegetables and starches in foods like whole grains, starchy vegetables and beans and lentils.

The smallest contributor to your total carbohydrate intake – less than 10 per cent of your daily calories – should be added sugars.

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There’s an apple that will never brown for sale in Canada. What health risks do GMO foods pose?

There’s an apple that will never brown for sale in Canada. What health risks do GMO foods pose?

The Arctic apple, engineered to be non-browning, became the latest genetically modified food to be approved by Health Canada this week. We’ll likely start seeing it in stores in 2017, according to Neal Carter, founder of Okanagan Specialty Fruits Inc., the British Columbia-based company that created the apple.

While there are a small number of scientific studies suggesting that these foods pose risks to human health and the environment, the overwhelming scientific consensus is that they are as safe as any other conventional food. Health Canada, the World Health Organization, the U.S. Academy of Sciences and the American Medical Association all endorse that view.

GMO crops have been part of our lives for more than two decades. The first such crop was approved by the U.S. Food and Drug Administration in 1994.

They have proliferated ever since. More than 120 genetically modified foods have been approved for sale in Canada. These range from insect resistant soy to virus resistant squash. (The complete list of “Novel Foods” approved by Health Canada can be found here.)

In explaining its approval of the Arctic apple, Health Canada provided this statement: “A gene was introduced into the Arctic apple that results in reduction in the levels of enzymes that make apples turn brown when sliced. In every other way, the Arctic apple tree and its fruits are identical to any other apple.”

The statement goes on to say that a thorough review was conducted by scientists with expertise in molecular biology, microbiology, toxicology, chemistry and nutrition.

“Following this assessment, it was determined that the changes made to the apple did not pose a greater risk to human health than apples currently available on the Canadian market,” it said. “In addition, Health Canada also concluded that the Arctic apple would have no impact on allergies, and that there are no differences in the nutritional value of the Arctic apple compared to other traditional apple varieties available for consumption.”

While there are a small number of studies that have suggested GMO foods do pose health risks, including linking GM corn to cancer in rats, or that DNA from GM crops can be transferred to humans who eat them, most of these studies have either been retracted, published in non-peer reviewed journals or questioned by independent scientists.

Meanwhile, there are more than 2, 000 studies that have concluded GMO foods pose no greater health risk than convention or organic foods.

“In order to maintain the position that GMOs are not adequately tested, or that they are harmful or risky, you have to either highly selectively cherry pick a few outliers of low scientific quality, or you have to simply deny the science,” Steven Novella, an assistant professor at the Yale University school of medicine, has written.

However, there is evidence to suggest that genes from GMO crops can migrate to non-GMO crops, as noted by the World Health Organization. (The WHO and other organizations refer to this as “outcrossing,” rather than the loaded term “contaminate.”) Separating GM crops from conventional crops is one way to address this problem.

Many people who oppose genetically modified food, including David Suzuki, argue that we still do not know their long term health effects. After all, these foods have only been part of our diet since 1994.

By its very nature, this is objection is difficult if not impossible to address without getting caught in an unproductive line of reasoning: Thousands of studies say these foods don’t pose a health risk, but on a long enough timeline they just might. Okay, but thousands of studies say they’re fine.

One way out of this is to label GMO foods. That way, supporters of labelling argue, those who are skeptical or simply don’t wish to consume GMOs would be able to exercise choice at the grocery store. Suzuki has called this a “basic right to choice.”

More than 60 countries currently require such labelling – and Canada is not one of them. Why? The government has said it does not mandate labelling because there are no known health risks to eating GM foods.

Do consumers nevertheless deserve labels in order to make informed decisions? That is a whole other question.

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What’s the current recommendation about eggs? How many should I eat per day?

What’s the current recommendation about eggs? How many should I eat per day?

A 2013 report, published online in the American Journal of Clinical Nutrition, concluded that eating an egg a day – yolk included – did not increase the risk of cardiovascular disease in healthy people.The bad news: Egg eaters were more likely to develop type 2 diabetes. And among people who already had diabetes, an egg-a-day habit substantially upped the likelihood of a heart attack or stroke. That said: Cholesterol is essential for life. It’s needed to build cell membranes, form healthy nerve fibers and make vitamin D and hormones such as estrogen and testosterone.Although high blood cholesterol is an established risk factor for a heart attack and stroke, the link between cholesterol in foods and cardiovascular disease remains unclear. Most studies have found that dietary cholesterol has little, if any, impact on blood-cholesterol levels.

While eggs may have little effect on your fasting blood-cholesterol level, that may not be the case for your “after-meal”, or postprandial, blood cholesterol. (Fasting blood cholesterol is measured after consuming no food or drinks, with the exception of water, for nine to 12 hours.)

There is mounting evidence that, depending on what you eat, postprandial blood fats can damage blood vessels and promote atherosclerosis (hardening and narrowing of the arteries). Small studies have shown that eating a cholesterol-rich meal can enhance the blood-cholesterol-raising effects of saturated (animal) fat and increase the chance that your LDL (bad) blood cholesterol becomes oxidized.So what are we to make of all this? Are eggs off the menu? Most people don’t have to worry about eating an egg yolk to two each day; the evidence that the amount of cholesterol you eat raises LDL blood cholesterol is weak.

So weak, in fact, that scientific advisory panel for the 2015 iteration of the Dietary Guidelines for Americans is recommending the decades-long recommendation to avoid eating foods high in cholesterol be dropped.Some people, though, are sensitive to the blood cholesterol-raising effect of food cholesterol. People with diabetes and those with heart disease should limit their intake of egg yolks to four per week (some experts advise avoidance).

Instead of eating a two-egg omelette with 266 milligrams of cholesterol, have a cholesterol-free white-only omelette for a good source of protein, riboflavin (a B vitamin) and selenium. Try a cholesterol-free egg product sold in the egg case at grocery stores.Keep in mind that there are variables we do not yet know. It’s possible that consuming antioxidant-rich foods (e.g. berries, citrus fruit, red peppers, spinach, green tea) or anti-inflammatory foods (e.g. salmon, chia seeds, ground flax, walnuts) with an egg could mitigate the harmful postprandial blood fat effects.

But most of all, let’s not forget that preventing cardiovascular disease is about a whole lot more that cutting back on egg yolks. Limiting refined (white) starchy foods and added sugars, reducing trans fats, emphasizing monounsaturated fats (e.g. olive oil, avocado, almonds), increasing omega-3 fats from fish oil, limiting sodium intake, getting regular exercise and maintaining a healthy weight are key strategies to guard against heart disease and stroke.

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