bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Eggs: Nature’s deadliest weapon?

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Another study on eggs and heart disease risk has been published. Well, sort of. It’s a meta-analysis of 16 previously published studies. As soon as I see that an article was based on a meta-analysis I can’t help but question the conclusions it reaches. There are a number of issues to consider when looking at meta-analyses and I feel like there’s a huge opportunity for bias and misinterpretation of results. It’s far too easy to be selective about inclusion of research and implications of results. Oftentimes the original studies are flawed and those flaws are carried through into the meta-analysis but they’re not as apparent when you’re not looking at the entire study. That being said, let’s look at the present meta-analysis.

It appears that the authors don’t have any conflicts of interest (always the first thing to check when looking at research: where did the funding come from?). A quick Google search of each of the authors didn’t reveal any obvious affiliations that could have impacted their research. It doesn’t appear that they had any ulterior motives.

The study actually found no relationship between egg consumption and cardiovascular disease in the general population. Did you catch that behind the headlines suggesting that egg yolks are bad for you?: healthy individuals who eat eggs once a day are no more likely to die from a heart attack or stroke than healthy individuals who don’t eat eggs at all. However, the part that’s getting the most attention is the finding that egg consumption may be associated with an increased incidence of type 2 diabetes and those egg-eaters who have diabetes are at greater risk of dying from cardiovascular disease. Before you start freaking out and getting on the egg-white omelette bandwagon please note the presence of the words incidence and associated. These words tell us that people who regularly eat eggs may be at greater risk of developing type 2 diabetes than those who don’t. It also tells us that people who have diabetes and eat eggs may be at greater risk of dying from cardiovascular disease (CVD). This is assuming that all of the studies they looked at were sound and that all relevant studies were included (big assumptions). However, it doesn’t tell us that eating eggs was the reason for the increased risks. There could have been some other commonality among the egg-eaters that raised their risk for type 2 diabetes and there may have been something other than egg-consumption that increased their risk of dying from CVD.

Now, if you have diabetes, not knowing for certain if eggs may increase your risk of dying from CVD you may want to minimize your consumption of them. Better safe than sorry. And, while most of us can safely consume up to an egg a day, I think it’s important to bear in mind that variety is an important component to a healthy diet.


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Non-nutritive sweeteners and blood sugar

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I’m starting to think that the sharing of research results is like the telephone game. Researchers publish their articles in journals, slightly (or more so) misleading press releases are issued, news articles are published, these are then shared via social media. Frequently, by the time the information has filtered through these channels, you’re left with a much different message than the original study provided.

I recently read this article that stated “artificial sweeteners affect metabolism and insulin levels”. Now, if you go back to the original journal article, you’ll see that this is quite misleading. The authors found that sucralose (not all non-nutritive or “artificial” sweeteners) had an impact on blood sugar levels and blood insulin levels following a glucose challenge.

Seventeen participants who were not regular consumers of non-nutritive beverages, did not have diabetes, and were classified as obese were given a glucose tolerance test following the consumption of water on one occasion and sucralose sweetened water on another. Increased levels of blood sugar and insulin were observed following the glucose challenge given after the sucralose consumption. However, the blood glucose levels were not all that different (4.2 + 0.2 and 4.8 + 0.3 mmol/L). The insulin levels were about 20% higher following the ingestion of sucralose. 

Other things that I would like to note about this study: there were only 17 participants. This is quite a small sample size (although slightly better than the ones Dr Oz was basing his recommendation to consume vinegar to prevent diabetes) which means that we can’t be certain that the results seen were all that meaningful. There is power in numbers and to be sure that a treatment is truly having the effect you’re observing you need lots of participants. In addition, these participants were not regular consumers of sucralose. Perhaps a different result would have been obtained had they tested individuals who regularly consume sucralose sweetened products. Finally, the study only included obese individuals (the average BMI was 42.3). Would the results be the same for healthy or overweight individuals? What would the results be had tests been done on participants who had type 2 diabetes?

Yes, it’s interesting that sucralose may have an effect on blood sugar but this study is not definitive and it’s definitely not reasonable to extrapolate the results to include all non-nutritive sweeteners.


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Something sour: Vinegar and blood sugar control

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I saw this tweet: “Add 4 teaspoons of vinegar to your diet daily to lower your blood sugar. This may help prevent diabetes #OzTip” from Dr Oz the other day and I immediately thought “blog fodder!”

Googling the subject of vinegar and blood sugar and diabetes, I thought maybe there was something to this lower effect of vinegar on blood sugar after all. WebMD said:

The effect of vinegar on blood sugar levels is perhaps the best researched and the most promising of apple cider vinegar’s possible health benefits. Several studies have found that vinegar may help lower glucose levels.

However, they carry on to state that:

a 2007 study of 11 people with type 2 diabetes found that taking two tablespoons of apple cider vinegar before bed lowered glucose levels in the morning by 4%-6%.

Umm… if this is the best evidence they could come up with then I’m not so sure about using vinegar to lower blood sugar. 11 is an extremely small sample size. As it turns out, most of the evidence supporting the use of vinegar for blood sugar control comes from very small studies. I found one study that compared the consumption of vinegar, vinegar pills, and pickles in 27 people (so, only nine in each treatment group). They found that vinegar had a modest (0.16% in HbA1c) lowering effect on the morning blood sugar of participants while those consuming pickles and vinegar pills actually saw a slight increase in HbA1c. The other study I found was even worse. It included only 11 participants (I think that this is the one the WebMD article was referring to). They found that fasting blood sugar was reduced by 2% in the control group and 4% in the group ingesting vinegar at bedtime. I also think it’s interesting to note that this footnote accompanied the study:

The costs of publication of this article were defrayed in part by the payment of page
charges. This article must therefore be hereby marked “advertisement” in accordance
with 18 U.S.C Section 1734 solely to indicate this fact.

Yes, these results are interesting but with such small sample sizes they’re essentially meaningless. Until larger studies are able to produce similar results I don’t think that advising anyone to consume vinegar at bedtime for blood sugar control is prudent.


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Hypoallergenic apples

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Continuing on with the apple-theme from yesterday; researchers have been working on growing hypoallergenic apples. One group has been working on genetically modifying apple trees so that they produce apples containing fewer allergens. Another team has been working on breeding apple trees so that they produce similarly hypoallergenic apples.

Honestly, I think this is kind of ridiculous. Putting aside the potential issues stemming from genetic modification, I still have quibbles with the efforts ti develop hypoallergenic apples. For one thing, apples are not a commonly allergenic food. For another, I think this is taking the wrong approach to the problem. I think research would be better put into determining why people develop allergies and figuring out how to prevent or cure the allergy itself. It’s similar to treating symptoms rather than the root cause of an illness. The problem is not the apple.


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A realist’s view on the antioxidant and optimism study

I’ve recently seen a few references to a study about vegetable consumption and optimism. Full disclosure: I am not an optimist; I’m a realist. As such, there are a few things about this study that bother me:

1. I’m unsure how much this study really tells us about the relationship between vegetable consumption and optimism. The researchers measured blood levels of antioxidants in 982 men and women and compared them to self-reported optimism (as assessed with the revised Life Orientation Test). We all know that self-reports tend to be inaccurate. I also wonder how accurate a marker of fruit and vegetable consumption blood levels of antioxidants is. As the researchers point out, there is no way to determine causality. Thus, eating more fruit and vegetables is not necessarily going to make your disposition any more positive.

Please, don’t think that I’m implying you shouldn’t eat your fruits and vegetables. Nearly all of us could stand to eat more veggies. I suppose if the belief that eating more of these foods is going to improve your outlook on the world then I really shouldn’t complain.

2. What’s so great about being an optimist anyway? Personally, I think that those who are blindly optimistic are delusional.

3. Why are research dollars being wasted on such banal topics? I’d much rather see funding going to research that is going to improve the healthspan of the population.

 

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