Dispelling nutrition myths, ranting, and occasionally, raving


The real cause of Type 2 Diabetes


The other day someone I follow on Twitter shared a tweet from an MD/PhD student that said that, “excess calories causes diabetes” and that this results from ready availability of palatable food, sedentary lifestyles, and genetics. Apparently anyone who disagrees with this assertion is either trying to sell you something or wants you to think they’re smart. I scrolled back and forth a few times before deciding I really didn’t want to get into a “thing” on twitter but it really got under my skin and I just can’t let it go. I decided that blogging about it would be more productive than arguing with someone who’s already made up their mind about the motives for my disagreement without hearing why I take issue with his sweeping statement. Just to be clear: I have nothing to sell you and I’m not trying to make you think that I’m smart. I just don’t like this simplification of a complicated disease.

To begin, I am assuming that the tweeter was referring to Type 2 Diabetes, not Type 1. A little bit of a pet peeve of mine when people don’t distinguish between the two because despite leading to similar consequences they really are separate diseases with different causes and treatments.

Okay, so my problem with this doctor’s statement is really the implications that it has for people with T2D and the lack of acknowledgement of health inequities that contribute to the development of T2D. Yes, he mentions that it’s the food environment and the inactive lifestyle that is common in our society that’s the problem. This, I will admit, is a step above simply blaming people for eating too much and not exercising enough. However, the implied solution is the same for both messages: don’t eat too many calories and get off your lazy butts and you won’t get T2D. Unfortunately, it’s not that simple. For many, poverty and health inequities are at the root of many chronic diseases, including T2D.

Recent research has highlighted the relationship between the social determinants of health and chronic diseases, such as T2D. This research has shown that, “social determinants (such as income, education, housing, and access to nutritious food) are central to the development and progression of Type 2 diabetes” and, “individuals with lower income and less education are 2 to 4 times more likely to develop diabetes than more advantaged individuals”. That’s right, privilege provides greater protection against developing Type 2 Diabetes than does lifestyle “choices” while poverty greatly increases risk. Not to mention that certain racialized and ethnic groups are often touted as having greater risk for T2D even though much (if not all) of this increased risk can be attributed to inequities and racism experienced by these groups.

We need to stop thinking about T2D as the result of lifestyle choices and start thinking about it as the result of societal structures. If you have the level of privilege where you can choose to eat healthfully and be physically active that’s great and you should absolutely do so. But we need to stop pretending that it’s lifestyle “choices” that are causing this disease when many people do not have that choice.

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Can eating chocolate reduce your risk of developing type 2 diabetes?


A recent study in the British Journal of Nutrition reportedly showed that regular consumption of chocolate could reduce the risk of developing type 2 diabetes. Naturally, I wondered if that was really what the study showed.

Looking at the study, there were a few things that stood out to me. The research was done using a food frequency questionnaire, a notoriously inaccurate measure of diet. Besides the fact that this measure is often inaccurate, is the fact that we couldn’t tell if it distinguished between types of chocolate consumed. While the authors made much of the potential link between polyphenols in chocolate and reduced risk of T2 diabetes, we don’t know if the study actually looked at types of chocolate that were rich in polyphenols. By the article, we can’t tell if they made any distinction between dark chocolate, milk chocolate, white chocolate, chocolate bars, chocolate cake, chocolate ice cream, and so on. Without accounting for different types of chocolate (many of which contain negligible quantities of polyphenols) there’s no way to attribute the reduced risk of T2 diabetes to the consumption of polyphenol-rich chocolate.

Perhaps more importantly though, there’s no way we can draw any conclusions regarding causation. This wasn’t a longitudinal study so we don’t know if people who have T2 diabetes are avoiding eating chocolate (quite plausible) or if there’s some other reason why people who eat chocolate are less likely to have T2 diabetes than people who don’t.

I also wondered about the true significance of the results. For that I consulted with my math expert, Scott. His take was that the sample size wasn’t very large and that it was limited to Luxembourg. This makes it difficult to generalize the results to populations outside of Luxembourg, for example, North America, as there could be other differences between Canadians and Americans and Luxembourgians (is that the right term?) that would make it impossible to apply the findings to our population.

He also said:

Although they followed proper testing and analysis, I’d be concerned about variables that they did not include in this study, such as location and what might be in their environment or particular diet (food items not mentioned) that may distinguish this sample from say a sample in North America. I am also wary anytime the analysis includes a questionnaire or feedback rather than pure conclusions based on observed tests and results. As you well know from interviewing people at stats can, there are more than admitted “fake” stats and responses… Yes, I do see a correlation between the two, I would require further testing to be conclusive on the hypothesis.

I followed up this analysis by asking him if he thought the standard deviations were of concern. To my untrained eye, I thought that it was possible that the range for each result was large enough that there might, in actuality, be no real difference between each group. Scott said:

I would support that claim, you would want the SD to be much closer to the mean than those results. I suspect the SD would fluctuate with any other sample size tested under those conditions.

And there you have it. While it’s possible that there’s a reduced risk of having diabetes to chocolate consuming Luxembourgians, there’s more research to be done before anything definitive, especially for other populations, can be concluded.


Should alcohol have nutrition labels?


I absolutely think that alcoholic beverages should have nutrition information on the labels, and not just calories. Sure the calories are relevant, although I do wonder how useful that information is to most of the population. Perhaps there needs to be more education about what calories mean and how to use nutrition labels. Anyway… That’s another rant. Including more nutrition information than calories would make nutrition labels on alcoholic beverages far more useful. For people with diabetes, for instance, who need to count carbohydrates to ensure effectiveness of medication having this information on bottles would be hugely beneficial.

The argument made by the Health Canada employee in this article is extremely disappointing. Saying that putting a nutrition label on alcoholic beverages shouldn’t be done because it implies that “it can be included as part of a healthy eating plan” is rich. For one thing, low-risk drinking guidelines (supported by many public health and other governmental and health organizations) would suggest that alcohol, when consumed within the guidelines, can be included as part of a healthy diet. If this is the argument being made then shouldn’t nutrition labels be removed from candy, sugar, lard, deli meats, and any other foods that are viewed as “unhealthy”. I think we can all agree that, that’s a ridiculous suggestion.

People have a right to know what they’re ingesting. Alcohol is sold as a beverage. People drink it. Why on earth shouldn’t we be able to access the nutrition information for these beverages? For the people who have specific health concerns and need to have that information to manage their health appropriately. For the people who are constantly trying to lose weight but downing a bottle of wine every night. For those who just want to know what they’re consuming, that information should be directly available on the bottle.


Diabetes management by Huff Post


I found it a little alarming that Huffington Post would publish an article containing medical advice on diabetes management by a naturopath. Not surprising, but alarming.

To be perfectly honest, most of her advice wasn’t terrible (therein lies the worst aspect of naturopathy, it’s often truth laced with completely unscientific bullshit).

Managing carbohydrate intake and cutting back on foods such as white bread can be beneficial. Although, you don’t necessarily have to completely remove all of these foods from your diet and other foods can also lead to spikes in blood sugar.

Getting daily exercise is also great; for anyone, not just someone with type 2 diabetes. Although, touting it as the tool for weight loss is misleading. Most weight loss results from changes in the kitchen, not changes in the gym.

The supplement suggestions make me extremely uncomfortable for several reasons. First of all, naturopaths sell supplements in-house and this is a massive conflict of interest. A medical professional should not profit from the “treatment” they provide to a patient. Secondly, there is insufficient scientific evidence to support supplementation with the remedies she recommends.

The most alarming aspect of this article, in my opinion, is that it’s providing medical advice via a publicly posted article. Treatment of type 2 diabetes (or any other medical condition) should be undertaken with appropriate medical supervision. Without first consulting with your doctor and/or pharmacist there’s no way to know what effect the supplements she recommended might have on an individual. They may be contraindicated for a medication that a person is taking or they may cause other side effects. Even making dietary changes should be done in consultation with your primary healthcare provider. If you’re taking medication for diabetes, making changes to the amount and timing of carbohydrate you’re consuming can affect the way in which your medication works.

If you suspect that you have diabetes, please see your doctor or nurse practitioner for a diagnosis. If you’re currently on medication for diabetes please consult with any/all of the aforementioned medical professionals before making any drastic lifestyle changes and certainly before undergoing any additional supplementation.


The cure for diabetes


I was recently informed that there is a cure for type 2 diabetes. Apparently researchers in Newcastle have found a way to reverse type 2 diabetes. According to their website:

Our work has shown that type 2 diabetes is not inevitably progressive and life-long. We have demonstrated that in people who have had type 2 diabetes for 4 years or less, major weight loss returns insulin secretion to normal.

Obviously, we dietitians have been recommending weight loss, diet, and lifestyle changes for many years. However, these changes rarely result in a complete reversal of the condition. The best case scenario is usually that the patient is able to manage their diabetes without the need for medications. More often though, it means that the progress of type 2 diabetes is slowed and less medication is needed to keep blood sugars reasonably stable. Despite this research having been conducted back in 2008 this was the first that I had heard of it.

For those interested, the complete study Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol is available here. To summarize, they looked at eleven people whom had been diagnosed with type 2 diabetes within the previous four years. Yes, that’s correct, eleven people. That’s a pretty small sample size. That means that no matter how astounding the results, it’s impossible to say if they will be applicable to the majority of people with type 2 diabetes.

The results of the study were quite good. All of the participants saw dramatic improvements in both fasting blood sugar and plasma insulin levels after only one week. In fact, after only one week of the eight week program, these levels were indistinguishable from a non-diabetic control group. Because normalization of beta cell function and insulin levels were seen in the participants, they were deemed “cured” of type 2 diabetes upon completion of the study.

What exactly did the researchers do to “cure” these people? They placed them on strict 600 kcal a day diets. Now, I don’t know about you, but that number shocked me. 600 kcal a day is extremely low. Most medically supervised low-calorie liquid diets for obese patients still have them consuming 800 kcal a day. Most weight management programs recommend patients consume at least 1, 200 kcal a day. For most people, 600 kcal is one meal (for many people, it’s less than one meal). In this study, participants consumed 510 kcal worth of Optifast shakes per day and were encouraged to supplement with non-starchy vegetables and drink at least two litres of water (and other calorie-free beverages) each day.

Because there was no follow-up with participants upon completion of the eight week study, there is no way to know for certain if they were actually cured of their diabetes or if it returned after they completed the program. Even supposing the diet is a cure for type 2 diabetes I can’t help but wonder how many people would be able to adhere to 600 kcal a day for eight weeks. As with any medicine, it doesn’t do any good if patients won’t take it. I suspect that the majority of people would forego the cure of such a strict diet.

All issues with this being touted as a “cure” for type 2 diabetes aside, I would like to see further research in this area. Larger, longer studies would be interesting. I’d also like to see a variety of levels of caloric restriction used as well as different sources of nutrition (not just shakes).