Dispelling nutrition myths, ranting, and occasionally, raving


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

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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.

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Diabetes management by Huff Post

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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.


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Is sugar making you go bald?

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My google alerts, alerted me to this clip from The Doctors that says sugar is the surprising food behind your hair loss. While absolutely being sensationalist I do have to give them a little credit for not going full Dr Oz. They made sure to state that sugar, in and of itself, is not inherently evil and that it’s fine to consume it in small quantities. According to them, sugar is leading to expanding waistlines and thinning hairlines. Sweet.

It’s a very short clip, and naturally, there aren’t any references. As far as I can tell, there hasn’t been any new research in this area. I found a few studies from about a decade ago looking at the connection between an alleged male form of PCOS (polycystic ovary syndrome) and premature balding and insulin resistance (1, 2). These studies did not explicitly examine a link between sugar consumption and hair loss.

Insulin resistance is an impaired ability of the body to properly use insulin. The causes of insulin resistance are not yet fully known; however, major contributing factors include diet and lifestyle. High levels of fat around the waist and a sedentary lifestyle may both contribute to insulin resistance. Excessive consumption of sugar and refined carbohydrates may contribute to those high levels of abdominal adiposity. However, excessive consumption of calories in general, regardless of source, may cause accumulation of excessive abdominal fat.

There are many causes of hair loss, including hormonal disruptions. These may go hand-in-hand with insulin resistance and conditions such as PCOS and type 2 diabetes.

To summarize: The Doctors have taken the leap from excessive sugar consumption to hair loss. There are many other factors at play and sugar itself would not be the direct cause of hair loss, even if it is a contributing factor in the development of hormonal disruptions. Because there are many other causes of hair loss, before you go sugar-free, you should book an appointment with your primary health care provider to obtain an accurate diagnosis. That being said, if you watched that video and thought “I’m eating too much sugar” there’s absolutely no harm in cutting back. Too much of anything is bad for you.


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Can yoghurt prevent diabetes?

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A friend of mine recently shared the news of a new study reporting an association between yoghurt consumption and decreased risk of type 2 diabetes.

The study was actually a meta-analysis of three large studies. Meta-analyses always make me a little nervous due to the ease of cherry picking and interpreting the results to yield the desired effect. The results of a meta-analysis can only be as good as the results of the original studies on which they’re based. I’m not saying this was the case here, just that it’s something to bear in mind when reading about meta-analyses. The researchers do have on their side the fact that all three studies had large sample sizes. After examining the results of these three studies, they added an additional 11 prospective-cohort studies for their meta-analysis.

The researchers controlled for a number of potential confounders. However, there’s always a remaining risk that an unaccounted for confounding variable might be the true reason for any observed effect. While the researchers reported a significant decreased risk of type 2 diabetes in regular yoghurt consumers they were also quick to acknowledge that this does not indicate causation. Yes, people who consume yoghurt appear to be less likely to develop type 2 diabetes than people who don’t. However, the studies all relied upon self-reported food frequency questionnaires and they were observational. It is possible that there is some unaccounted for variable that’s reducing the risk of type 2 diabetes in yoghurt consumers other than the yoghurt.

The researchers do make an interesting suggestion that the probiotics in yoghurt may be responsible for the decreased risk of type 2 diabetes. I do wonder about the validity of this as many yoghurts contain limited live bacteria due to their processing. In addition, it’s unlikely that many probiotics in yoghurt survive the acidic stomach environment to make their way to the intestines. Perhaps it’s the by-products of the bacteria in the yoghurt (e.g. vitamins, lactic acid) that are responsible for decreased risk of type 2 diabetes. Just postulating here. I would love to see a study in which participants are prescribed diets containing either yoghurt with live bacteria, yoghurt without live bacteria, and no yoghurt. Yes, it would take a long time to determine if the yoghurt reduced the risk of type 2 diabetes but other effects could be examined as well and it would be interesting to see what the true effects of  regular yoghurt consumption are on health.


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The cure for diabetes

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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).