Dispelling nutrition myths, ranting, and occasionally, raving


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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).


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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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Don’t go too nuts for walnuts

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I’ve been seeing a few news reports recently regarding nut consumption, particularly walnuts, and diabetes. The reports are based on a study Walnut Consumption Is Associated with Lower Risk of Type 2 Diabetes in Women. This study used data from the Nurses’ Health Study to determine the effect of nut consumption on diabetes risk.

The news article all proclaim that regular consumption of walnuts can reduce the risk of developing type 2 diabetes. There was a risk reduction shown with consumption of walnuts as little as once a month but the greatest risk reduction (24% in comparison to women who ate few or no nuts) was seen in the women who ate walnuts at least once a week.

Now, as much as I’m a fan of nuts, I’m always a little skeptical of reports such as this. I always wonder if the news reports accurately reflect the study’s findings and if the study is well-designed. So… I went and took a look at the journal article.

I’m immediately wary of any study that uses food frequency questionnaires to obtain data on food consumption. These questionnaires are notoriously inaccurate. Putting that issue aside and looking at the rest of the study, a couple of additional issues popped out at me. While the researchers controlled for things such as physical activity, fruit and vegetable consumption, and obesity, it is impossible to control for all variables and it’s possible that a factor common to the walnut eating group other than their walnut consumption may have reduced their risk of diabetes. Also, after controlling for BMI, the risk reduction afforded by walnut consumption dropped from the reported 24% to 15%. Perhaps if another measure, such as waist-to-hip ratio had been used this percentage would have decreased further.

Most importantly: funding for the study was provided by the California Walnut Commission.

I certainly don’t want to discourage anyone from eating walnuts. However, too much of any one thing can be bad for us and I don’t want anyone reading reports from this study erroneously thinking that they should be consuming unlimited quantities of walnuts to stave off type 2 diabetes. There are benefits to all nuts and they all contain fairly concentrated calories so it’s certainly possible to go overboard with them. Incorporate a variety of nuts in your diet to obtain the maximum health benefits from their consumption.


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Do artificial sweeteners cause type 2 diabetes?

An article published in the latest issue of the American Society for Nutrition stated that women who consumed more than 359 ml of artificially sweetened beverages (e.g. diet pop) were at an increased risk of developing type 2 diabetes. This was in comparison to women who consumed no soda (sugar or artificially sweetened). Women who consumed traditional sugar sweetened beverages were also at increased risk of developing type 2 diabetes (no news here).

The researchers did point out that this was a correlational relationship. This means that with no certainty can we say that consumption of artificially sweetened beverages causes diabetes. However, they also said that: “randomized trials are required to prove a causal link between ASB consumption and T2D”. This, to me, suggests that they believe that artificially sweetened beverages can cause type 2 diabetes.

Personally, I would be quite surprised if it was the artificially sweetened pop causing type 2 diabetes, rather than a combination of genetic and lifestyle factors. I also think that this sort of research (and probably most of us) is looking at the problem from the wrong direction. Rather than looking for a single cause of “lifestyle” illnesses such as type 2 diabetes, we should be looking for the “causes” of health.

Consider this: One in every three American children will develop type 2 diabetes in their lifetime and similar rates are anticipated for Canadian children (1). Type 2 diabetes is just one of many chronic diseases affecting Canadians. I think that we need to shift our focus from seeking a likely non-existent single cause of such diseases and start looking at what we can do to retain our health for as long as possible. It’s the difference between a preventative model of health care rather than our current model which treats only those who are already ill. There is much truth in the adage that “an ounce of prevention is worth a pound of cure.”


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Bariatric surgery and diabetes prevention

A couple of studies published this week showed that bariatric surgery is more effective in preventing type 2 diabetes than is medication, diet, and exercise advice from their doctors. Apparently some doctors are using this as an indication that weight loss surgery should be one of the first avenues explored rather than as a last resort. I’m not so sure. I think it’s great that these positive benefits of bariatric surgery are being found. However, I am not sold on the idea that we should now be turning straight to surgery for obese patients.

There are a number of things to consider. I think it’s important to note that the patients in the studies were morbidly obese and had minimum BMIs of 40. These are not your average person who wants to lose a few pounds. Also, the decreased risk of type 2 diabetes most likely resulted from the weight loss, not from anything inherently related to the procedure itself. This means that, had the patients in the diet and exercise group managed to sustain similar amounts of weight loss, they too would most likely have seen the same improvement in diabetes rates. A final important consideration are the risks and long lasting effects of bariatric surgery. As with any surgery, there are risks of complications, more so with some gastric procedures than with others. Life long side effects may include: dumping syndrome, extremely odorous flatulence and feces, nutrient malabsorption (which can lead to nutrient deficiencies if life long supplementation is not adhered to), changes in food preferences and ability to tolerate. Gastric surgery is not something to be entered into lightly. I’m not saying no one should have surgery, for some people it is the best solution. I’m simply saying that perhaps we shouldn’t be too hasty in picking up the scalpel.

Perhaps we should take a closer look at the lifestyle interventions being provided by doctors. I’m fairly confident that the majority of these efforts are ineffective and could be vastly improved. We should also be looking more at prevention than at treatment. As I’m always going on about, obesity is a result of our environment, not individual choices. We need to remove the onus from the individual and start working on changing the world we live in, and the way we live in it.