Diabetes Archives - Page 2 of 3 - Health Tips From The Professor

Which Diet Is Best For Diabetics?

January 10, 2023 by Dr. Steve Chaney

What Did This Study Show?

Author: Dr. Stephen Chaney

When you were first diagnosed with diabetes, your doctor probably told you that your life will forever be changed. Among other things he or she probably told you that you would need to make some radical changes to your diet.

But what changes? Both the American Diabetes Association (ADA) and Diabetes UK (the British version of ADA) recommend:

An individualized approach. This recognizes that we are all different. What works for some diabetics may not work for others.

A diet that incorporates more non-starchy vegetables and minimizes added sugars and refined grains.

But these recommendations are vague. Most people want a specific diet to follow. It’s here that Diabetes UK and the ADA part ways.

Diabetes UK gives its highest recommendation to the Mediterranean diet.

The ADA gives equal recommendations to the Mediterranean diet and both low-carbohydrate and very-low carbohydrate diets.

But which diet is best? It’s hard to know because most studies compare one of these diets to the standard American diet (SAD), and anything is better than the standard American diet.

Fortunately, one recent study (CD Gardner et al, American Journal of Clinical Nutrition, 116: 640-652, 2022) directly compares the two extremes of ADA-recommended diets, the Mediterranean diet and the Keto diet.

How Was This Study Done?

This study recruited 33 participants with diabetes or prediabetes from the San Francisco Bay area. The participants in the study:

Were between 41 and 77 years old (average age = 60.5).
Were 61% male, 45% non-Hispanic white, and mostly (85%) college educated.
Had either prediabetes (61%) or diabetes (39%).
Had BMIs ranging from 22.7 (normal) to 39.7 (obese) (average BMI = 30 (borderline obese).
Had elevated levels of HbA1c (hemoglobin A1c, a measure of long-term blood sugar control).

People were excluded from the study if they were:

Underweight (<110 pounds) or morbidly obese (BMI ≥40).
Had extremely high cholesterol (LDL cholesterol >190 mg/dL) or blood pressure (>169 mmHg).
On insulin or certain medications to lower blood sugar levels.

This was a randomized, crossover, interventional study. Simply put, that means:

The study started with participants eating a typical American diet. The intervention was either a Keto diet or a Mediterranean diet.

Each patient was randomly assigned to one of the diets for 12 weeks. Then they “crossed over” to the other diet for 12 weeks. In this type of study each patient serves as their own control.

Finally, there was a 12-week follow-up period in which they could choose which of the two diets to follow.

It was a very well-controlled study:

Participants were given detailed guidelines to follow and received weekly individual education sessions by a registered dietitian and certified diabetes educator.

During the first 4 weeks of each diet, participants were provided at no cost all meals and snacks from a local food delivery service.

During the next 8 weeks of each diet, the participants purchased their own foods using the same guidelines they had been given during the first 4 weeks.

- They were also provided with a recipe booklet and suggestions for diet-compliant menu items at local restaurants for each diet.

This was not designed as a weight loss diet. The participants were provided with 2,800 calories of food per day and instructed to eat until they were full.

Compliance with the diet was assessed in three ways:

- During week 4 and week 12 of each diet phase, 3 unannounced 24-hour dietary recalls (2 on weekdays and 1 on a weekend day) were administered over the phone by a trained nutritionist.

- Participants were also given an app to log in their food intake daily.

- Participants on the Keto diet were given blood ketone monitors and strips.

Finally, at the beginning and end of the study and during weeks 4 and 12 of each diet phase participants went to a medical facility for blood work and weight measurements.

The primary focus of this study was measuring the effect of each diet on HbA1c. HbA1c measures blood sugar control over the previous 12 weeks (which is why each diet phase was 12 weeks long). But the study also measured the effect of each diet on LDL cholesterol, HDL cholesterol, and triglycerides.

What Were The Diets Like?

These were not ordinary versions of the Mediterranean and Keto diets:

Sugar and refined flour are often part of the diet in Mediterranean regions. So, this study used the “Mediterranean Plus (Med-Plus)” diet which restricts both sugar and refined grains.

Keto convenience foods are often a witch’s brew of artificial ingredients. So, this study used the “Well-Formulated Keto Diet (WFKD)” which is composed of whole, unprocessed foods. In fact, both diets were whole food diets.

In summary, the two diets were:

Alike in that both emphasized non-starchy vegetables and minimized sugar and refined grains.

Alike in that they were both whole food diets.

Different in that the Keto diet eliminated legumes, fruits, and whole grains while the Mediterranean diet included them.

The macronutrient composition of the two diets was about what you would expect.

	USDA Guidelines	Baseline	Keto (Weeks 1-4)	Keto (Weeks 5-12)	Med (Weeks 1-4)	Med (Weeks 5-12)
Protein	10-35%	18%	25%	22%	19%	21%
Carbs	45-65%	41%	12%	18%	37%	37%
Fat	<30%	41%	63%	60%	44%	42%

The baseline diet was typical of the American diet. It was higher than recommended for fat. While carbohydrate intake appeared to be moderate, it was high in sugar and refined grains.

The Keto and Mediterranean diet interventions were separated into 2 phases. In phase 1 (weeks 1-4) every meal and snack were provided to the participants. In phase 2 (weeks 5-12) they purchased their own food.

As expected, carbohydrate intake was much lower, fat intake much higher, and protein intake slightly higher than baseline for the Keto diet. And this pattern was maintained during the 8 weeks the participants purchased their own food.

Macronutrient composition on the Mediterranean diet was not much different than baseline and did not change much during weeks 5-12.

The fat composition of the two diets was also different.

	Baseline	Keto (Weeks 1-4)	Keto (Weeks 5-12)	Med (Weeks 1-4)	Med (Weeks 5-12)
Monounsaturated	42%	48%	43%	52%	45%
Polyunsaturated	23%	15%	19%	23%	25%
Saturated	35%	37%	38%	25%	30%

The Keto diet was significantly lower in percent polyunsaturated fat and slightly higher in percent monounsaturated and saturated fat than baseline (the typical American diet) in weeks 1-4. However, remember that the Keto diet was 50% higher in total fat than the other diets. This makes it significantly higher in saturated fat than either the baseline or Mediterranean diets.

As expected, the Mediterranean diet was significantly higher in percent monounsaturated fat and lower in percent saturated fat than baseline in weeks 1-4.

Not surprisingly, both diets trended towards the baseline diet in the 8 weeks participants were buying their own food.

Other interesting differences between the two diets:

The Keto diet contained around 12% plant protein and 88% animal protein, while the Mediterranean diet contained about 50% of each.

Fiber intake decreased by 33% compared to baseline on the Keto diet, while fiber intake increased by 50% on the Mediterranean diet.

In terms of nutritional adequacy, the Keto diet was significantly lower in fiber, vitamin C, folate, and magnesium than the Mediterranean diet.

What Did The Study Show?

1. Participants consumed around 300 fewer calories/day and lost about 15 pounds on both diets.

- The authors speculated this was because both diets were more filling than the baseline diet, presumably because both diets were whole food diets while the baseline diet contained lots of processed foods high in sugar and refined grains.

2) Both diets reduced HbA1c (a cumulative measure of how much the diets improved blood sugar control compared to the baseline diet) by about the same extent.

3) LDL cholesterol (bad cholesterol) increased by about 10% on the Keto diet, while it decreased by about 9% on the Mediterranean diet. This difference was highly significant.

4) HDL cholesterol increased by about the same extent on both diets.

5) Triglycerides decreased by around 20% on the Keto diet and by 10% on the Mediterranean diet. This difference was also highly significant.

6) Finally, adherence to the Keto diet was less than for the Mediterranean diet. Plus, more people chose the Mediterranean diet during the follow-up phase when they were allowed to choose their own diet.

The authors concluded, “HbA1c values…improved from baseline on both diets, likely due to several shared dietary aspects. The WFKT [Keto diet] led to a greater decrease in triglycerides, but also had untoward risks from elevated LDL cholesterol and lower nutrient intakes from avoiding legumes, fruits, and whole, intact grains, as well as being less sustainable [easy to follow long-term].

Which Diet Is Best For Diabetics?

Once again, I have covered lots of information in this blog. But if you are diabetic, you are probably wondering, “What does this mean for me?” Let me start by reviewing the purpose of this study.

This study was designed to compare the two extremes of recommended diets (Mediterranean and Keto) with respect to their effectiveness at keeping blood sugar under control.

These were both more restrictive versions of the two diets than most people follow. In this study, both diets:

- Were whole food diets. No sodas, processed, or convenience foods were allowed.

- Minimized the consumption of sugars and refined grains.

Now let me divide the discussion into two sections:

Which diet is best for diabetics in the short term (in this case, 12 weeks)?

- Participants consumed 300 fewer calories and lost about 15 pounds on both diets in spite of being given more than they could eat and not being encouraged to lose weight.

- - The authors attributed this to whole food diets being more filling.

- - However, it is also consistent with my contention that any restrictive diet will lead to short-term weight loss and improvement in blood sugar control. I summarize the 5 reasons for this phenomenon in last week’s “Health Tips From the Professor” article

- Blood sugar control over 12 weeks, as measured by HbA1c, improved by the same amount on both diets.

- - That is consistent with the American Diabetes Association’s position that a variety of diets, ranging from Mediterranean to Keto, are suitable for diabetics.

- - This also means that you can forget the advice that diabetics need to follow a low carb diet and give up fruits, whole grains, and legumes to keep their blood sugar under control.

- - However, this is not a “get out of jail free card”. Diabetics do need to avoid sodas, processed, and convenience foods and minimize sugar and refined grains.

- There was considerable individual variability. Some people did better on the Mediterranean diet. Others did better on the Keto diet.

- This is consistent with the American Diabetes Association’s recommendation that diabetic diets should be individualized.

In short, this study suggests that in the short term (12 weeks) the Med-Plus and WFKD Keto diets are equally effective at promoting weight loss and improved blood sugar control for both diabetics and prediabetics.

However, there is considerable individual variability, meaning that diabetics can chose the diet that works best for them.

2) Which diet is best for diabetics in the long term?

If both diets are equally effective short term, the important question becomes whether they are equally successful and equally healthy long term.

As noted in the author’s conclusion, this study raised several “red flags” which suggest the Keto diet might be less successful and less healthy long term. But this is a short-term study.

You may be wondering, “What do long-term studies show?” Unfortunately, there are very few long-term studies to guide us. But here is what we do know.

- There are multiple studies showing that the Mediterranean diet reduces the risk of diabetes, heart disease, and some cancers long term. There is no evidence that meat-based low carb diets are healthy long term. This includes the Atkins diet, which has been around more than 50 years.

- A 6-year study reported that the group with the lowest carbohydrate intake had an increased risk of premature death – 32% for overall mortality, 50% for cardiovascular mortality, 51% for cerebrovascular mortality, and 36% for cancer mortality.

- A 20-year study reported that women consuming a meat-based low carb diet for 20 years gained just as much weight and had just as high risk of diabetes and heart disease as women consuming a high carbohydrate, low fat diet.

In short, the few long-term studies we do have suggest that the Mediterranean diet is a better choice for long-term health and reduced risk of diabetes than low-carb diets.

The Bottom Line

If you are diabetic or prediabetic, the American Diabetes association recommends a diet that is individualized and ranges from Mediterranean to low carb and very low carb (Keto).

However, low carb and Keto enthusiasts insist that diabetics need to follow a low carb or very low carb diet. And that seems to make sense. After all, aren’t carbs the problem for diabetics?

To resolve this question, a recent study was designed to compare the two extremes of the ADA-recommended diets (Mediterranean and Keto) with respect to their effectiveness at keeping blood sugar under control.

These were not ordinary versions of the Mediterranean and Keto diets:

Sugar and refined flour are often part of the diet in Mediterranean regions. So, this study used the “Mediterranean Plus (Med-Plus)” diet which restricts both sugar and refined grains.

Keto convenience foods are often a witch’s brew of artificial ingredients. So, this study used the “Well-Formulated Keto Diet (WFKD)” which is composed of whole, unprocessed foods. In fact, both diets were whole food diets.

In short, this study found that in the short term (12 weeks) the Med-Plus and WFKD Keto diets are equally effective at promoting weight loss and improved blood sugar control for both diabetics and prediabetics.

If both diets are equally effective short term, the important question becomes whether they are equally successful and equally healthy long term.

As noted in the author’s conclusion, this study raised several “red flags” suggesting that the WFKD Keto diet may be less successful and less healthy long term than the Med-Plus diet. However, this was a short-term study.

So, the question becomes, “What do long-term studies show?” There are few long-term studies of low-carb diets, but the few long-term studies we do have suggest that the Mediterranean diet is a better choice for both long-term health and reduced risk of diabetes than most low-carb diets.

For more details on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Walking Your Way To Health

December 27, 2022 by Dr. Steve Chaney

How Much Should You Walk?

Author: Dr. Stephen Chaney

The new year is almost here. If you are like millions of Americans, you may already be making plans to join a gym, get a personal trainer, or join a spin class.

The problem is these are all expensive options. And a good portion of that money is wasted. To put it into perspective, let’s look at some statistics

Around 6 million Americans buy gym memberships every January.

67% of those memberships are never used.

For those memberships used in January, another 50% are not in use 6 months later.

Americans spend about 1.6 billion dollars on unused gym memberships every year.

And that doesn’t include those gym memberships that are only occasionally used.

If you want to get fit and healthy in the new year, perhaps you should consider a less expensive option – like walking. Your only investments are a good pair of walking shoes and a device that keeps track of the number of steps you take (eg, Fitbit, smart watch, or smart phone).

You still may give up on your New Year’s goal of getting fitter at some point. But you won’t have wasted so much money.

Of course, you probably have some questions about the benefits of walking, such as:

Is walking enough to significantly improve my fitness and health?

2) How far (how many steps) should I walk?

3) How fast should I walk?

Fortunately, two recent studies (B del Pozo-Cruz et al, JAMA Internal Medicine, 182: 1139-1148, 2022; J del Pozo-Cruz et al, Diabetes Care, 45: 2156-2158, 2022) have answered all three questions.

How Were These Studies Done?

The first study (B del Pozo-Cruz et al, JAMA Internal Medicine, 182: 1139-1148, 2022) followed 78,500 participants (average age 61, 55% female, 97% white) enrolled in the UK Biobank study for an average of 7 years.

At the time of enrollment, each participant was given an accelerometer (a device that measures the number and frequency of steps) to wear on their dominant wrist for 24 hours/day for 7 days. The investigators used the accelerometer data to categorize several types of physical activity.

Daily step counts (the average number of steps per day for 7 days). These step counts were further subdivided into two categories:

Incidental steps (It was assumed that ˂40 steps/min represented steps taken that were incidental to normal daily activities).

Purposeful steps (It was assumed that ≥40 steps/min represented steps taken as part of planned exercise).

Stepping intensity (the highest frequency of steps/min averaged over 30 min intervals for all 7 days).

At the end of the study, each of these variables was correlated with the risk of premature deaths due to all causes, cancer, and heart disease.

The second study (J del Pozo-Cruz et al, Diabetes Care, 45: 2156-2158, 2022) was similar except that it:

Used data from 1687 adults (average age = 55, 56% male, with diabetes or prediabetes when the study began) in the 2005-2006 National Health and Nutrition Examination Survey in the US.

Followed participants for 9 years instead of 7.

Only measured total steps/day

Correlated total steps/day with premature death for participants who already had prediabetes or diabetes when they entered the study.

Walking Your Way To Health

Study 1 looked at the effect of walking on health outcomes in multiple ways.

#1: Increase in number of steps/day:

On average study participants took an average of 7200 steps per day, but this ranged from a low of 3,200 steps/day to a high of 12,200 steps/day.

Each increase of 2,000 steps/day was associated with a:

- 8% decrease in all-cause mortality.

- 11% decrease in cancer mortality.

- 10% decrease in heart disease mortality.

Overall, increasing from 3,200 steps/day to 10,000 steps/day decreased all-cause, cancer, and heart disease mortality by around 36%.

There was no minimum threshold to this beneficial effect of walking on the risk of premature death.

The benefits of walking appeared to plateau at 10,000 steps/day.

#2: Increase in number of incidental steps/day (steps taken that are incidental to normal daily activities):

On average study participants took 3240 incidental steps/day, but this ranged from a low of 2,100 steps/day to a high of 4,400 steps/day.

Each 10% increase in incremental steps/day was associated with a:

- 6% decrease in all-cause mortality.

- 6% decrease in cancer mortality.

- 10% decrease in heart disease mortality.

#3: Increase in number of purposeful steps/day (steps taken as part of planned exercise):

On average study participants took 4,600 purposeful steps/day, but this ranged from a low of 1,600 steps/day to a high of 8,600 steps/day.

Each 10% increase in purposeful steps/day was associated with a:

- 7% decrease in all-cause mortality.

- 8% decrease in cancer mortality.

- 10% decrease in heart disease mortality.

#4: Increase in speed of walking or cadence. The measurement they used was “peak-30 cadence” – the highest average steps/min during a 30-minute interval within a day:

On average study participants had a “peak-30 cadence” of 76 steps/min, but this ranged from a low of 47 steps/min to a high of 109 steps/min.

Each 10% increase in “peak-30 cadence” was associated with a:

- 8% decrease in all-cause mortality.

- 9% decrease in cancer mortality.

- 14% decrease in heart disease mortality.

The benefits of walking rapidly (increase in “peak-30 cadence”) were in addition to the benefits seen by increasing the number of steps per day.

Overall, increasing from a “peak-30 cadence” of 47 steps/min to 109 steps/min decreased all-cause, cancer, and heart disease mortality by an additional 34%.

There was no minimum threshold to this beneficial effect of increasing “peak-30 cadence” (the speed of walking) on the risk of premature death.

The benefits of increasing “peak-30 cadence” appeared to plateau at 100 steps/min.

#5 Effect of walking on the prevention of heart disease and cancer: The investigators measured this by looking at the effect of walking on the “incidence” of heart disease and cancer (defined as new diagnoses of heart disease and cancer) during the study. They found.

Each 2,000-step increase in the total number of steps/day decreased the risk of developing heart disease and cancer by 4% during this 7-year study.

Each 10% increase in the number of purposeful steps/day decreased the risk of developing heart disease and cancer by 4% during this study.

Each 10% increase in “peak-30 cadence” decreased the risk of developing heart disease and cancer by 7% during this study.

The authors concluded, “The findings of this population-based…study of 78,500 individuals suggest that up to 10,000 steps/day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.”

Study 2 extended these findings to diabetes. They started with participants that had either prediabetes or diabetes and followed them for 9 years. They found that:

Study participants with prediabetes ranged from a low of 3,800 steps/day to a high of 10,700 steps/day.

- Prediabetic participants walking 10,700 steps/day were 25% less likely to die during the study than participants walking only 3,800 steps/day.

Study participants with diabetes ranged from a low of 2,500 steps/day to a high of 10,200 steps/day.

- Diabetic participants walking 10,200 steps/day were also 25% less likely to die during the study than participants walking only 2,500 steps/day.

Even small increases in the number of steps per day decreased the risk of premature death for both prediabetic and diabetic participants.

Once again, 10,000 steps/day appeared to be the optimal dose to lower the risk of premature death for both diabetic and prediabetic patients.

The authors of this study concluded, “Accumulating more steps/day up to ~10,000 steps/day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.”

How Much Should You Walk?

That was a lot of information. You are probably wondering what it means for you. Let’s start with the big picture:

Going from couch potato to 10,000 steps per day may reduce your risk of premature death due to all causes, cancer, and heart disease by 36% (24% if you are already prediabetic or diabetic).

Increasing the speed with which you walk from 47 steps/min to 109 steps/min sustained for 30 minutes may reduce your risk of premature death by an additional 34%.

In other words, simply walking more and walking faster can have a significant on your health. I am not recommending walking as your only form of exercise. I’m just saying not to consider it inferior to other forms of exercise.

There is no lower limit to the benefits of walking. Even small increases in the number of steps/day you take and the speed with which you walk may have a beneficial effect on your health.

In other words, you don’t need to speed walk 10,000 steps/day to reap a benefit from walking. Even small increases are beneficial. That’s good news for those of you who may not be able to speed walk long distances. It also means that if you are a couch potato, you don’t need to attempt 10,000 steps at high speed from day 1. You can work up to it gradually.

Incidental walking (walking that is incidental to your daily activities) is almost as beneficial as purposeful walking (walking as part of a planned exercise).

That’s good news for those of you who may not have time for long walks. It also means that advice like “park your car at the far end of the parking lot and walk” or “take the stairs rather than the elevator” can have a meaningful impact on your health.

The benefits of walking appear to max out at around 10,000 steps per day and a cadence of 100 steps/min sustained for 30 minutes.

That means once you get to those levels, it’s time to consider adding other kinds of exercise to your regimen. More and faster walking may offer little additional benefit.

Finally, in the words of the authors, “This information could be used to motivate the least active individuals to increase their steps and the more-active individuals to reach the 10,000-step target.”

The Bottom Line

The new year is almost here. If you are like millions of Americans, you may already be making plans to join a gym, get a personal trainer, or join a spin class.

If you want to get fit and healthy in the new year, perhaps you should also consider a less expensive option – like walking.

Of course, you probably have some questions about the benefits of walking, such as:

1) Is walking enough to significantly improve my fitness and health?

2) How far (how many steps) should I walk?

3) How fast should I walk?

Fortunately, two recent studies have answered all three questions. They found:

Going from couch potato to 10,000 steps per day may reduce your risk of premature death due to all causes, cancer, and heart disease by 36% (24% if you are already prediabetic or diabetic).

Increasing the speed with which you walk from 47 steps/min to 109 steps/min sustained for 30 minutes may reduce your risk of premature death by an additional 34%.

There is no lower limit to the benefits of walking. Even small increases in the number of steps/day you take and the speed with which you walk may have a beneficial effect on your health.

Incidental walking (walking that is incidental to your daily activities) is almost as beneficial as purposeful walking (walking as part of a planned exercise).

The benefits of walking appear to max out at around 10,000 steps per day and a cadence of 100 steps/min sustained for 30 minutes.

In the words of the authors of these studies, “This information could be used to motivate the least active individuals to increase their steps and the more-active individuals to reach the 10,000-step target.”

For more details on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

500th Issue Celebration

November 15, 2022 by Dr. Steve Chaney

Nutrition Breakthroughs Over The Last Two Years

Author: Dr. Stephen Chaney

In the nearly ten years that I have been publishing “Health Tips From The Professor”, I have tried to go behind the headlines to provide you with accurate, unbiased health information that you can trust and apply to your everyday life.

The 500^th issue of any publication is a major cause for celebration and reflection – and “Health Tips From The Professor” is no different.

I am dedicating this issue to reviewing some of the major stories I have covered in the past 100 issues. There are lots of topics I could have covered, but I have chosen to focus on three types of articles:

Articles that have debunked long-standing myths about nutrition and health.

Articles that have corrected some of the misinformation that seems to show up on the internet on an almost daily basis.

Articles about the issues that most directly affect your health.

Best Ways To Lose Weight

Since it is almost January, let’s start with a couple of articles about diet and weight loss (or weight gain). I have covered the effectiveness of the Paleo, Keto, Mediterranean, DASH, vegetarian, and Vegan diets for both short and long-term weight loss in my book “Slaying The Food Myths”, so I won’t repeat that information here. Instead, I will share a few updates from the past 100 issues.

My Tips On The Best Approach For Losing Weight: Every health guru has a favorite diet they like to promote. I am different. My book, Slaying the Food Myths, is probably the first “anti-diet” diet book ever written. Based on my years of research I can tell you that we are all different. There is no single diet that is best for everyone. In this article I have summarized my tips for selecting the weight loss diet that is best for you.

The US News & World Report’s Recommendation For the Best Diets: Each year US News & World Report assembles some of the top nutrition experts in the country and asks them to review popular diets and rank them for effectiveness and safety. In this article I summarize their ratings for 2022.

Does Intermittent Fasting Have A Downside? In previous articles in “Health Tips From the Professor” I have reported on studies showing that intermittent fasting is no more effective for weight loss than any other diet that restricts calories to the same extent. But does intermittent fasting have a downside? In this article I reported on a study that suggests it does.

Can A Healthy Diet Help You Lose Weight? Most investigators simply compare their favorite diet to the standard American diet. And any diet looks good compared to the standard American diet. In this article I reported on a study that compared two whole food diets that restricted calories by 25% to the standard American diet. One calorie-restricted diet was more plant-based and the other more meat-based. You may be surprised at the results.

Omega-3s

Omega-3s continue to be an active area of research. Here are just a few of the top studies over the past two years.

Do Omega-3s Oil Your Joints? In this article I reviewed the latest information on omega-3s and arthritis.

Do Omega-3s Add Years To Your Life? In this article I discussed a study that looks at the effect of omega-3s on longevity.

The Omega-3 Pendulum: In this article I discuss why omega-3 studies are so confusing. One day the headlines say they are miracle cures. A few weeks later the headlines say they are worthless. I discuss the flaws in many omega-3 studies and how to identify the high-quality omega-3 studies you can believe.

Do Omega-3s Reduce Congestive Heart Failure? In this article I review a recent study on omega-3s and congestive heart failure and discuss who is most likely to benefit from omega-3 supplementation.

Plant-Based Diets

Will Plant-Based Proteins Help You Live Longer? In this article I review a study that looks at the effect of swapping plant proteins for animal proteins on longevity.

Can Diet Add Years To Your Life? In this article I review a study that takes a broader view and asks which foods add years to your life.

Is A Vegan Diet The Secret To Weight Loss? This is an update of my previous articles on vegan diets. This article asked whether simply changing from a typical American diet to a vegan diet could influence weight loss and health parameters in as little as 16 weeks. The answer may surprise you.

Is A Vegan Diet Bad For Your Bones? No diet is perfect. This article looks at one of the possible downsides to a vegan diet. I also discuss how you can follow a vegan diet AND have strong bones. It’s not that difficult.

Anti-Inflammatory Diets

What Is An Anti-Inflammatory Diet? In this article I discuss the science behind anti-inflammatory diets and what an anti-inflammatory diet looks like.

Can Diet Cause You To Lose Your Mind? In this article I discuss a study looking at the effect of an inflammatory diet on dementia. The study also looks at which foods protect your mind and which ones attack your mind.

Do Whole Grains Reduce Inflammation? You have been told that grains cause inflammation. Refined grains might, but this study shows that whole grains reduce inflammation.

Nutrition And Pregnancy

Here are the latest advances in nutrition for a healthy pregnancy.

The Perils Of Iodine Deficiency For Women. In this article I reviewed the latest data showing that iodine is essential for a healthy pregnancy and discuss where you can get the iodine you need.

Do Omega-3s Reduce The Risk Of Pre-Term Births? You seldom hear experts saying that the data are so definitive that no further studies are needed. In this article I reviewed a study that said just that about omega-3s and pre-term births.

Does Maternal Vitamin D Affect ADHD? In this article I reviewed the evidence that adequate vitamin D status during pregnancy may reduce the risk of ADHD in the offspring.

How Much DHA Should You Take During Pregnancy? In this article I reviewed current guidelines for DHA intake during pregnancy and a recent study suggesting even higher levels might be optimal.

Is Your Prenatal Supplement Adequate? In this article I reviewed two studies that found most prenatal supplements on the market are not adequate for pregnant women or their unborn babies.

Children’s Nutrition

Here are the latest insights into children’s nutrition.

Are We Killing Our Children With Kindness? In this article I reviewed a recent study documenting the increase in ultra-processed food consumption by American children and the effect it is having on their health. I then ask, is it really kindness when we let our children eat all the sugar and ultra-processed food they want?

Is Diabetes Increasing In Our Children? In this article I reviewed a study documenting the dramatic increase in diabetes among American children and its relationship to ultra-processed food consumption and lack of exercise.

How Much Omega-3s Do Children Need? In this article I reviewed an study that attempts to define how much omega-3s are optimal for cognition (ability to learn) in our children.

Diabetes

Here are some insights into nutrition and diabetes that may cause you to rethink your diet.

Does An Apple A Day Keep Diabetes Away? You may have been told to avoid fruits if you are diabetic. In this article I reviewed a study showing that fruit consumption actually decreases your risk of diabetes. Of course, we are all different. If you have diabetes you need to figure out which fruits are your friends and which are your foes.

Do Whole Grains Keep Diabetes Away? You may have also been told to avoid grains if you are diabetic. In this article I reviewed a study showing that whole grain consumption actually decreases your risk of diabetes. Once again, we are all different. If you have diabetes you need to figure out which grains are your friends and which are your foes.

Heart Disease

Here is an interesting insight into nutrition and heart disease that may cause you to rethink your diet.

Is Dairy Bad For Your Heart? You have been told that dairy is bad for your heart AND that it is good for your heart. Which is correct? In this article I discuss some recent studies on the topic and conclude the answer is, “It depends”. It depends on your overall diet, your weight, your lifestyle, and your overall health.

Breast Cancer

Here are some facts about breast cancer every woman should know.

The Best Way To Reduce Your Risk Of Breast Cancer In this article I review two major studies and the American Cancer Guidelines to give you 6 tips for reducing your risk of breast cancer.

The Truth About Soy And Breast Cancer You have been told that soy causes breast cancer, and you should avoid it. In this article I review the science and tell you the truth about soy and breast cancer.

Supplementation

Some “experts” claim everyone should take almost every supplement on the market. Others claim supplementation is worthless. What is the truth about supplementation?

What Do The 2020-2025 Dietary Guidelines Say About Supplements? Every 5 years the USDA updates their Dietary Guidelines for foods and supplements. In this article I discuss what the 2020-2025 Dietary Guidelines say about supplements. Yes, the USDA does recommend supplements for some people.

Who Benefits Most From Supplementation? Not everyone benefits equally from supplementation. In this article I discuss who benefits the most from supplementation.

Should Cancer Patients Take Supplements? Doctors routinely tell their cancer patients not to take supplements. Is that the best advice? In this article I review a study that answers that question.

Can You Trust Supplements Marketed on Amazon? Amazon’s business model is to sell products at the lowest possible price. But do they check the quality of the products marketed on their site? In this article I review a study that answers that question.

Is Your Prenatal Supplement Adequate? In this article I reviewed two studies that found most prenatal supplements on the market are not adequate for pregnant women or their unborn babies.

The Bottom Line

I have just touched on a few of my most popular articles above. You may want to scroll through these articles to find ones of interest to you that you might have missed over the last two years. If you don’t see topics that you are looking for, just go to https://www.chaneyhealth.com/healthtips/ and type the appropriate term in the search box.

In the coming years, you can look for more articles debunking myths, exposing lies and providing balance to the debate about the health topics that affect you directly. As always, I pledge to provide you with scientifically accurate, balanced information that you can trust. I will continue to do my best to present this information in a clear and concise manner so that you can understand it and apply it to your life.

Final Comment: You may wish to share the valuable resources in this article with others. If you do, then copy the link at the top and bottom of this page into your email. If you just forward this email and the recipient unsubscribes, it will unsubscribe you as well.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

What Is The Truth About Low Carb Diets?

August 30, 2022 by Dr. Steve Chaney

Why Is The Cochrane Collaboration The Gold Standard?

Author: Dr. Stephen Chaney

Atkins, South Beach, Whole30, Low Carb, high Fat, Low Carb Paleo, and Keto. Low carb diets come in many forms. But they have these general characteristics:

They restrict carbohydrate intake to <40% of calories.

They restrict grains, cereals, legumes, and other carbohydrate foods such as dairy, fruits, and some vegetables.

They replace these foods with foods higher in fat and protein such as meats, eggs, cheese, butter, cream, and oils.

When recommended for weight loss, they generally restrict calories.

What about the science? Dr. Strangelove and his friends tell you that low carb diets are better for weight loss, blood sugar control, and are more heart healthy than other diets. But these claims are controversial.

Why is that? I have discussed this in previous issues of “Health Tips From The Professor”. Here is the short version.

Most studies on the benefits of low carb diets compare them with the typical American diet.

- The typical American diet is high in fat, sugar and refined flour, and highly processed foods. Anything is better than the typical American diet.

Most low carb diets are whole food diets.

- Any time you replace sodas and highly processed foods with whole foods you will lose weight and improve your health.

Most low carb diets are highly structured. There are rules for which foods to avoid, which foods to eat, and often additional rules to follow.

- Any highly structured diet causes you to focus on what you eat. When you do that, you lose weight. When you lose weight, your health parameters improve.

- As I have noted before, short term weight loss and improvement in health parameters are virtually identical for the very low carb keto diet and the very low-fat vegan diet.

With all this uncertainty you are probably wondering, “What is the truth about low carb diets?”

A recent study by the Cochrane Collaboration (CE Naude et al, Cochrane Database of Systematic Reviews, 28 January 2022) was designed to answer this question.

The Cochrane Collaboration is considered the gold standard of evidence-based medicine. To help you understand why this is, I will repeat a summary of how the Cochrane Collaboration approaches clinical studies that I shared two weeks ago.

Why Is The Cochrane Collaboration The Gold Standard?

Who you gonna call? It’s not Ghostbusters. It’s not Dr. Strangelove’s health blog. It’s a group called the Cochrane Collaboration.

The Cochrane Collaboration consists of 30,000 volunteer scientific experts from across the globe whose sole mission is to analyze the scientific literature and publish reviews of health claims so that health professionals, patients, and policy makers can make evidence-based choices about health interventions.

In one sense, Cochrane reviews are what is called a “meta-analysis”, in which data from numerous studies are grouped together so that a statistically significant conclusion can be reached. However, Cochrane Collaboration reviews differ from most meta-analyses found in the scientific literature in a very significant way.

Many published meta-analyses simply report “statistically significant” conclusions. However, statistics can be misleading. As Mark Twain said: “There are lies. There are damn lies. And then there are statistics”.

The Cochrane Collaboration also reports statistically significant conclusions from their meta-analyses. However, they carefully consider the quality of each individual study in their analysis. They look at possible sources of bias. They look at the design and size of the studies. Finally, they ask whether the conclusions are consistent from one study to the next. They clearly define the quality of evidence that backs up each of their conclusions as follows:

High-quality evidence. Further research is unlikely to change their conclusion. This is generally reserved for conclusions backed by multiple high-quality studies that have all come to the same conclusion. These are the recommendations that are most often adopted into medical practice.

Moderate-quality evidence. This conclusion is very likely to be true, but further research could have an impact on it.

Low-quality evidence. Further research is needed and could alter the conclusion. They are not judging whether the conclusion is true or false. They are simply saying more research is needed to reach a definite conclusion.

This is why their reviews are considered the gold standard of evidence-based medicine. If you are of a certain age, you may remember that TV commercial “When EF Hutton talks, people listen.” It is the same with the Cochrane Collaboration. When they talk, health professionals listen.

How Was The Study Done?

The authors of this Cochrane Collaboration Report included 61 published clinical trials that randomized participants into two groups.

The first group was put on a low carbohydrate diet (carbohydrates = <40% of calories).

The second group was put on a “normal carbohydrate” diet (carbohydrates = 45-65% of calories, as recommended by the USDA and most health authorities).

- The normal carbohydrate diet was matched with the low carbohydrate diet in terms of caloric restriction.

- Both diets were designed by dietitians and were generally whole food diets.

The participants in these studies:

Were middle-aged.
Were overweight or obese.
Did not have diagnosed heart disease or cancer.
May have diagnosed type-2 diabetes. Some studies selected participants that had diagnosed type 2 diabetes. Other studies excluded those patients.

The studies were of 3 types:

Short-term: Participants in these studies followed their assigned diets for 3 to <12 months.

Long-term: Participants in these studies followed their assigned diets for >12 to 24 months.

Short-term with maintenance: Participants in these studies followed their assigned diets for 3 months followed by a 9-month maintenance phase.

What Is The Truth About Low Carb Diets?

All the studies included in the Cochrane Collaboration’s meta-analysis randomly assigned overweight participants to a low carbohydrate diet (carbohydrates = <40% of calories) or to a “normal carbohydrate” diet (carbohydrates = 45-65% of calories) with the same degree of caloric restriction.

If low carb diets have any benefit in terms of weight loss, improving blood sugar control, or reducing heart disease risk, these are the kind of studies that are required to validate that claim.

This is what the Cochrane Collaboration’s meta-analysis showed.

When they analyzed studies done with overweight participants without type 2 diabetes:

Weight loss was not significantly different between low carb and normal carb diets in short-term studies (3 to <12 months), long-term studies (>12 to 24 months), and short-term studies followed by a 9-month maintenance period.

There was also no significant difference in the effect of low carb and normal carb diets on the reduction in diastolic blood pressure and LDL cholesterol.

Since diabetics have trouble controlling blood sugar, you might expect that type 2 diabetics would respond better to low carb diets. However, when they analyzed studies done with overweight participants who had type 2 diabetes:

Weight loss was also not significantly different on low carb and normal carb diets.

There was no significant difference in the effect of low carb and normal carb diets on the reduction in diastolic blood pressure, LDL cholesterol, and hemoglobin A1c, a measure of blood sugar control.

Of course, the reason Cochrane Collaboration analyses are so valuable is they also analyze the strength of the studies that were included in their analysis.

You may remember in my article two weeks ago, I reported on the Cochrane Collaboration’s report supporting the claim that omega-3 supplementation reduces pre-term births. In that report they said that the studies included in their analysis were high quality. Therefore, they said their report was definitive and no more studies were needed.

This analysis was different. The authors of this Cochrane Collaboration report said that the published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

What Does This Study Mean For You?

If you are a bit confused by the preceding section, I understand. That was a lot of information to take in. Let me give you the Cliff Notes version.

In short, this Cochrane Collaboration Report concluded:

Low carb diets (<40% of calories from carbohydrates) are no better than diets with normal carbohydrate content (45-65% of calories from carbohydrates) with respect to weight loss, reduction in heart disease risk factors, and blood sugar control. Dr. Strangelove has been misleading you again.

This finding is equally true for people with and without type 2 diabetes. This calls into question the claim that people with type 2 diabetes will do better on a low carb diet.

The published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

If you are thinking this study can’t be true because low carb diets work for you, that is because you are comparing low carb diets to your customary diet, probably the typical American diet.

Remember that any whole food diet that eliminates sodas and processed foods and restricts the foods you eat will cause you to lose weight. Whole food keto and vegan diets work equally well short-term compared to the typical American diet.

And any diet that allows you to lose weight improves heart health parameters and blood sugar control.

If you are thinking about the blogs, books, and videos you have seen extolling the virtues of low carb diets, remember that the Dr. Strangeloves of the world only select studies comparing low carb diets to the typical American diet to support their claims.

The studies included in this Cochrane Collaboration report randomly assigned participants to the low carb and normal carb diets and followed them for 3 to 24 months.

- Both diets were whole food diets designed by dietitians.

- Both diets reduced caloric intake to the same extent.

What about the claims that low carb diets are better for your long-term health? There are very few studies on that topic. Here are two:

At the 6.4-year mark a recent study reported that the group with the lowest carbohydrate intake had an increased risk of premature death – 32% for overall mortality, 50% for cardiovascular mortality, 51% for cerebrovascular mortality, and 36% for cancer mortality. I will analyze this study in a future issue of “Health Tips From The Professor”.

At the 20-year mark a series of studies reported that:

- Women consuming a meat-based low carb diet for 20 years gained just as much weight and had just as high risk of heart disease and diabetes as women consuming a high carbohydrate, low fat diet.

- However, women consuming a plant-based low carb diet for 20 years gained less weight and had reduced risk of developing heart disease and diabetes as women consuming a high carbohydrate, low fat diet.

My recommendation is to avoid low-carb diets. They have no short-term benefits when compared to a healthy diet that does not eliminate food groups. And they may be bad for you in the long run. Your best bet is a whole food diet that includes all food groups but eliminates sodas, sweets, and processed foods.

However, if you are committed to a low carb diet, my recommendation is to choose the low-carb version of the Mediterranean diet. It is likely to be healthy long term.

The Bottom Line

The Cochrane Collaboration, the gold standard of evidence-based medicine, recently issued a report that evaluated the claims made for low carb diets.

All the studies analyzed in the Cochrane Collaboration’s report randomly assigned overweight participants to a low carbohydrate diet (carbohydrates = <40% of calories) or to a “normal carbohydrate” diet (carbohydrates = 45-65% of calories) with the same degree of caloric restriction.

If low carb diets have any benefit in terms of weight loss, improving blood sugar control, or reducing heart disease risk, these are the kind of studies that are required to validate that claim.

The Cochrane Collaboration Report concluded:

Low carb diets (<40% of calories from carbohydrates) are no better than diets with normal carbohydrate content (45-65% of calories from carbohydrates) with respect to weight loss, reduction in heart disease risk factors, and blood sugar control.

This is equally true for people with and without type 2 diabetes.

The published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

My recommendation is to avoid low carb diets. They have no short-term benefits when compared to a healthy diet that does not eliminate food groups. And they may be bad for you in the long run. Your best bet is a whole food diet that includes all food groups but eliminates sodas, sweets, and processed foods.

However, if you are committed to a low carb diet, my recommendation is to choose the low carb version of the Mediterranean diet. It is likely to be healthy long term.

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Omega-3s And Congestive Heart Failure

May 3, 2022 by Dr. Steve Chaney

We Have Been Asking The Wrong Questions

Author: Dr. Stephen Chaney

Today’s Health Tip is a follow-up to the article I published last month on omega-3s and heart disease risk. In that article I pointed out the reasons why studies of the effect of omega-3s and heart disease risk have been so confusing.

One of the reasons is that many of the studies have been asking the wrong questions.

They were asking whether omega-3s reduced the risk of heart disease for everyone. Instead, they should have been asking who benefited from omega-3 supplementation.

They were asking whether omega-3s reduced the risk of all forms of heart disease combined. Instead, they should have been asking whether omega-3s reduced the risk of specific kinds of heart disease.

I also discussed a large clinical trial, the VITAL study, that was designed to answer those two questions.

The study I will describe today (L Djoussé et al, JACC Heart Failure, 10: 227-234, 2022) mined the data from the VITAL study to evaluate the effect of omega-3 supplementation on congestive heart failure, a form of heart disease that was not discussed in the VITAL study.

Everything You Need To Know About Congestive Heart Failure

Congestive heart failure is a killer. The term congestive heart failure simply means that your heart no longer pumps blood well. The initial symptoms are relatively non-specific and include things like.

Shortness of breath.
Fatigue and weakness.
Reduced ability to exercise.
Rapid or irregular heartbeat.
Persistent cough or wheezing.

However, as it progresses, the symptoms get much worse. Fluid builds up in your tissues.

Fluid buildup in your legs, ankles, and feet can make it difficult to walk.

Fluid buildup in your lungs makes it difficult to breathe. In advanced stages it can feel like you are drowning in a room full of air.

According to the CDC:

4 million Americans have congestive heart failure (CHF).

- It leads to ~380,000 deaths/year.

83% of patients diagnosed with CHF will be hospitalized at least once.

- 67% will be hospitalized two or more times.

CHF costs >$30 billion per year in health care costs and lost wages.

The risk of congestive heart failure is not spread evenly across the American population. Black Americans and Americans with type 2 diabetes are at increased risk.

According to the Framingham Heart Study:

Type 2 diabetes increases the risk of CHF 2-fold in men and 5-fold in women. The reasons are not entirely clear. However:

- High blood sugar is thought to either damage cells in heart muscle, weakening it, or damage small blood vessels within the heart, making it more difficult for the heart to pump blood.

- Some diabetes drugs that lower blood sugar also appear to increase the risk of congestive heart failure.

According to the CDC:

Black Americans are 2-fold more likely to develop CHF than White Americans. Again, the reasons are not clear. However:

- Some experts feel it could be due to the higher incidence of untreated high blood pressure in Black Americans.

In summary:

Congestive heart failure is a serious disease. Its symptoms affect your quality of life, and it can lead to hospitalizations and death.

Black Americans and Americans with type 2 diabetes are at higher risk of developing congestive heart failure.

How Was The Study Done?

The VITAL study, from which these data were extracted, was a placebo-controlled clinical trial designed to measure the effects of 1,000 mg omega-3 supplementation on the risk of developing heart disease. It enrolled 25,871 Americans aged 55 years or older and followed them for an average of 5.3 years.

The participants enrolled in the VITAL study represented a cross-section of the American population. Most were at low risk of heart disease, but there were subsets of the study group who were at higher risk of heart disease. A strength of the VITAL study was that it was designed so the high-risk subgroups could be evaluated separately.

The current study utilized data from the VITAL study to look at the effect of omega-3 supplementation on hospitalizations due to congestive heart failure. It also evaluated the effect of type 2 diabetes and race on the risk of hospitalizations.

Omega-3s And Congestive Heart Failure

When the investigators looked at the whole population, most of whom were at low-risk of congestive heart failure, they did not see any effect of omega-3 supplementation on the risk of hospitalizations due to congestive heart failure.

However, when they looked at high risk groups, the story was much different.

In patients with type-2 diabetes:

Omega-3 supplementation reduced the risk of the initial hospitalization for congestive heart failure by 31%

Omega-3 supplementation reduced the risk of multiple hospitalizations due to congestive heart failure by 47%.

The effect of omega-3 supplementation on hospitalizations was greatest for the Black participants in the study.

In the words of the authors, “Our data show beneficial effects of omega-3 fatty acid supplements on the incidence of heart failure hospitalizations in participants with type 2 diabetes but not in those without type 2 diabetes, and such benefit appeared to be stronger in Black participants with type 2 diabetes.”

We Are Asking The Wrong Questions

As I said above, there is so much confusion about the effect of omega-3s on heart disease because we scientists have been asking the wrong questions:

We have been asking whether omega-3s reduce the risk of heart disease for everyone. Instead, we should have been asking who benefits from omega-3 supplementation.

We have been asking whether omega-3s reduced the risk of all forms of heart disease combined. Instead, we should have been asking whether omega-3s reduced the risk of specific kinds of heart disease.

In my “Health Tip” last month I discussed a large clinical study, the VITAL study, that was specifically designed to answer the right questions. Like so many other studies it found that omega-3 supplementation did not significantly reduce the risk of all kinds of heart disease for everyone.

However, what it did find was more important than what it did not find:

When they looked at the effect of omega-3s on heart disease risk in high-risk groups, they found that major cardiovascular events were reduced by:

- 26% in African Americans.

- 26% in patients with type 2 diabetes.

- 17% in patients with a family history of heart disease.

- 19% in patients with two or more risk factors of heart disease.

When they looked at the effect of omega-3s on heart disease risk in people with low omega-3 intake, they found that omega-3 supplementation reduced major cardiovascular events by:

- 19% in patients with low fish intake.

When they looked at the effect of omega-3s on the risk of different forms of heart disease, they found that omega-3 supplementation reduced:

- Heart attacks by 28% in the general population and by 70% for African Americans.

- Deaths from heart attacks by 50%.

- Deaths from coronary heart disease (primarily heart attacks and ischemic strokes (strokes caused by blood clots)) by 24%.

In other words, when they asked the wrong questions, they got the wrong answer. If they had just looked at the effect of omega-3 supplementation on all forms of heart disease for everyone (like most other omega-3 studies), they would have concluded that omega-3s are worthless.

However, when they asked the right questions, they found that omega-3s were very beneficial for high-risk populations and for certain types of heart disease.

The current study utilized the same data to analyze the effect of omega-3 supplementation on hospitalizations due to congestive heart failure. And the results were similar.

If they had asked the wrong question, “Does omega-3 supplementation reduce congestive heart failure hospitalizations for everyone?”, they would have concluded that omega-3 supplementation was worthless.

However, instead they asked, “Does omega-3 supplementation reduce congestive heart failure hospitalizations for certain high-risk groups” and were able to show that omega-3 supplementation significantly reduced congestive heart failure hospitalizations for people with type 2 diabetes and for Blacks.

We need to change the paradigm for clinical studies of supplements. The old paradigm asks the wrong questions. If we really want to know the role of supplementation for our health, we need to start asking the right questions.

The Bottom Line

There is perhaps nothing more confusing to the average person than the “truth” about omega-3 supplementation and heart disease risk. Much of the confusion is because we have been asking the wrong questions:

We have been asking whether omega-3 supplementation reduces the risk of heart disease for everyone. Instead, we should have been asking who benefits from omega-3 supplementation.

We have been asking whether omega-3 supplementation reduces the risk of all forms of heart disease combined. Instead, we should have been asking whether omega-3 supplementation reduces the risk of specific kinds of heart disease.

A recent study on the effect of omega-3 supplementation on hospitalizations due to heart disease is a perfect example.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Which Diets Are Best In 2022?

February 8, 2022 by Dr. Steve Chaney

Which Diet Should You Choose?

Author: Dr. Stephen Chaney

Many of you started 2022 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only a month ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

Perhaps the diet isn’t working as well as advertised…

Perhaps the diet is too restrictive. You are finding it hard to stick with…

Perhaps you are always hungry or constantly fighting food cravings…

Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…

Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2022”. For the full report, click on this link.

How Was This Report Created?

US News & World Report recruited panel of 27 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 40 most popular diets. The panel is not the same each year. Some experts are rotated off the panel, and others are added. The experts rate each diet in seven categories:

How easy it is to follow.

Its ability to produce short-term weight loss.

Its ability to produce long-term weight loss.

its nutritional completeness.

Its safety.

Its potential for preventing and managing diabetes.

Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct nine sets of Best Diets rankings:

Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.

Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.

Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.

Best Diabetes Diets is based on averaged diabetes ratings.

Best Heart-Healthy Diets uses averaged heart-health ratings.

Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.

Easiest Diets to Follow represents panelists’ averaged judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.

Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.

Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

Which Diets Are Best In 2022?

Are you ready? If this were an awards program I would be saying “Envelop please” and would open the envelop slowly to build suspense.

However, I am not going to do that. Here are the top 5 and bottom 5 diets in each category (If you would like to see where your favorite diet ranked, click on this link). [Note: I excluded commercial diets from this review.]

Best Diets Overall

The Top 5:

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 5 consecutive years.

#2: DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#3: Flexitarian Diet (A flexible semi-vegetarian diet).

#4: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

#5: The TLC Diet (This diet was designed by the NIH to promote heart health.)

The Bottom 5:

#36: Whole 30 Diet (A whole food, restrictive diet, designed for a 30-day jump start to weight loss. It was not designed for long-term use).

#37: Modified Keto Diet (A slightly less restrictive version of the Keto Diet).

#38: Keto Diet (A high protein, high fat, very low carb diet designed to achieve ketosis).

#39: Dukan Diet (High protein, low carb, low fat diet).

#40: GAPS Diet (A diet designed to improve gut health).

Best Weight-Loss Diets

The Top 5:

#1: Flexitarian Diet

#2: Volumetrics Diet (A diet based on the caloric density of foods).

#3: Vegan Diet (A diet that only allows plant foods).

#4: Mayo Clinic Diet (A diet designed to establish lifelong healthy eating habits).

#5: Ornish Diet (A whole food, semi-vegetarian diet designed to promote heart health).

The Bottom 5:

#36: Fertility Diet (A diet designed to improve fertility, but the experts were skeptical that it would increase your chances of becoming pregnant)

#37: Whole 30 Diet

#38: Alkaline Diet (A diet designed to make your blood more alkaline, but the experts were skeptical about that claim)

#39: AIP Diet (A diet designed for people with autoimmune diseases)

#40: GAPS Diet

Best Diabetes Diets

The Top 5:

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: Vegan Diet

#4: Mayo Clinic Diet

#5: DASH Diet

The Bottom 5:

#36: Alkaline Diet

#37: Dukan Diet

#38: GAPS Diet

#39: Sirtfood Diet (a very low calorie, fad diet that emphasizes plant foods rich in sirtuins)

#40: Whole 30 Diet

Best Heart-Healthy Diets

The Top 5:

#1: Mediterranean Diet

#2: Ornish Diet

#3: DASH Diet

#4: Flexitarian Diet

#5: TLC Diet

#6: Vegan Diet

The Bottom 5:

#36: Keto Diet

#37: AIP Diet

#38: Whole 30 Diet

#39: Modified Keto Diet

#40: Dukan Diet

Best Diets for Healthy Eating

The Top 5:

#1: Mediterranean Diet

#2: DASH Diet

#3: Flexitarian Diet

#4: MIND Diet

#5: TLC Diet

The Bottom 5:

#36: Raw Food Diet

#37: Atkins Diet

#38: Dukan Diet

#39: Modified Keto Diet

#40: Keto Diet

Easiest Diets to Follow

The Top 5:

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: Fertility Diet

#4: MIND Diet

#5: DASH Diet

The Bottom 5:

#36: Modified Keto Diet

#37: Keto Diet

#38: Whole 30 Diet

#39: GAPS Diet

#40: Raw Foods Diet

Best Fast Weight-Loss Diets

The Top 5 (Excluding Commercial Diets):

#1: Atkins Diet

#2: Biggest Loser Diet

#3: Keto Diet

#4: Raw Food Diet

#5: Vegan Diet

The Bottom 5

#36: Dr. Weil’s Anti-Inflammatory Diet

#37: The Fertility Diet

#38: AIP Diet

#39: Alkaline Diet

#40: Gaps Diet

Which Diets Are Best For Rapid Weight Loss?

There are 3 take-home lessons from the rapid weight loss category:

1) If you are looking for rapid weight loss, any whole food restrictive diet will do. The top 5 diets are very different. For example, the keto and vegan diets are polar opposites, yet they both are in the top 5 for rapid weight loss.

The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.

The Biggest Loser diet relies on restrictive meal plan and exercise programs.

The restrictions of the raw food diet are obvious.

The vegan diet is a very low-fat diet that eliminates meat, dairy, eggs, and animal fats.

I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

2) We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.

If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.

If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.

3) Don’t pay too much attention to the bottom 5 diets. None of them were designed with weight loss in mind.

Which Diet Should You Choose?

With rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

1) Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.

2) Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.

3) Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian.

4) Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.

5) In case you were wondering, intermittent fasting ranked 26-30 and the Paleo diet ranked 26-33 on most of the list – not the worst diets, but a long way from the best. If you have a favorite diet I didn’t mention, check the US News website to find where it is ranked.

6) Finally, focus on what you have to gain, rather than on foods you have to give up.

On the minus side, none of the diets include sodas, junk foods, and highly processed foods. These foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.

On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

The Bottom Line

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are some general principles:

If you are looking for rapid weight loss, any whole food restrictive diet will do.

We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.

Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.

#2: Which diet should you choose? Here the principles are:

Choose a diet that fits your needs.

Choose diets that are healthy and associated with long term weight loss.

Choose diets that are easy to follow.

Choose diets that fit your lifestyle and dietary preferences.

Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Can Artificial Sweeteners Make You Hungry?

November 30, 2021 by Dr. Steve Chaney

Why Is There So Much Confusion About Artificial Sweeteners?

Author: Dr. Stephen Chaney

When artificial sweeteners were first introduced over 100 years ago, we were promised they would end obesity. We didn’t have to change our diets. We could just substitute calorie-free artificial sweeteners for sugar in all our favorite foods.

Since then, both consumption of artificial sweeteners and obesity have skyrocketed in this country. For example, in just the past 20 years:

The consumption of artificial sweeteners has increased by 54%, and…

The percentage of obese Americans has increased by 41%.

Today, over 40% of Americans are obese, and almost 10% of Americans are severely obese. That is a 4-fold increase since 1960!

Clearly, something isn’t working. Artificial sweeteners are not the magic solution we once thought they would be.

However, as I have told you before, association does not prove causation. Therefore, two important questions are:

Are we consuming more artificially sweetened foods and drinks because more of us have become obese, or…

2) Do artificial sweeteners cause obesity?

Unfortunately, hundreds of clinical studies on this topic have not provided a definitive answer. For example, when we look at studies on diet sodas:

When the studies are tightly controlled by dietitians so that the people consuming diet sodas don’t add any extra calories to their diet, the results are exactly as expected. People consuming diet sodas lose weight compared to people drinking regular sodas.

However, the results are different in the real world where you don’t have a dietitian looking over your shoulder. In these studies, diet sodas are just as likely to cause weight gain as regular sodas.

As Barry Popkin, a colleague at the University of North Carolina, put it” “The problem is that we [Americans] are using diet sodas to wash down our Big Macs and fries.” In short, people drinking diet sodas tend to increase their caloric intake by adding other foods to their diet. Even worse, the added foods aren’t usually fruits and vegetables. They are highly processed junk foods.

In other words, the suspicion is that artificial sweeteners may cause you to overeat. Various mechanisms for this effect have been proposed. For example, it has been proposed that artificial sweeteners may:

Increase your appetite.
Interfere with blood sugar control.
Increase your cravings for sweets.
Alter your gut bacteria.

Unfortunately, clinical studies designed to test these hypotheses have produced inconsistent results. So, we are left with the question:

3) Why are studies on artificial sweeteners so confusing?

A recent clinical study (AG Yunker et al, JAMA Network Open, 4(9):e2126313, 2021) sheds light on all 3 of these important questions.

How Was This Study Done?

This study was called the “Brain Response to Sugar” study. It was designed to test the hypothesis that previous studies of artificial sweeteners may have provided misleading results because they didn’t account for the sex and BMI (a measure of obesity) of the study participants.

Many previous studies had primarily enrolled male, ideal weight participants. This study hypothesized that the response to artificial sweeteners might be different in female, overweight participants.

This study recruited 76 participants from the Southern California area between July 2016 and March 2020, when recruitment was halted because of the COVID-19 pandemic. The characteristics of the participants were:

18-35 years old.
Weight stable for at least 3 months before the study.
Not taking medications and no history of eating disorders, diabetes, or other diseases.
42% male and 58% female.
37% healthy weight, 32% overweight, and 31% obese.
40% included artificial sweeteners in their diet prior to the study, 60% did not.

The study was what is called a “within-participant randomized crossover trial”. Simply put, this means that each participant served as their own control. Here is how it worked:

Each participant came to the Dornsife Cognitive Neuroimaging Center three times. They arrived at the testing center at 8 AM after an overnight fast.

- They drank either 75 grams of sucrose in 300 mL of water, enough sucralose in 300 mL of water to provide equivalent sweetness, or 300 mL of plain water at the beginning of each visit. The order in which the drinks were administered was randomized.

At 20 minutes after each drink, the participants were placed into an MRI machine shown various food and non-food images.

- Four high-calorie food images (2 sweet and 2 savory), 4 low-calorie food images, and 4 non-food images were shown to the participants in random order.

- As the images were shown, the MRI scanned the medial frontal cortex and orbitofrontal cortex, regions of the brain associated with appetite and hunger. Specifically, these are regions of the brain that affect:

- - Conditioned motivation to eat.

- - The reward value associated with food cues.

- - In addition, greater food cue reactivity in these regions of the brain has been shown to be associated with obesity.

At 125 minutes after each drink, the participants were allowed to select their meal from a buffet table, and the calories consumed was recorded.

Can Artificial Sweeteners Make You Hungry?

Here are the results of the study:

There was no overall difference in brain activity in the regions of the brain associated with appetite, hunger, and desire for high-calorie foods following the sucralose and sucrose drinks. However:

- For participants who were obese, high-calorie savory food images elicited greater brain activity in participants who had consumed sucralose than in participants who had consumed sucrose drinks. This difference was not seen in patients who were normal weight or overweight.

- For female participants, high-calorie sweet and savory food images elicited greater brain activity in participants who had consumed sucralose than in participants who had consumed sucrose drinks. This difference was not seen in male patients.

- These differences were not small. The effect of sucralose on brain activity in regions that control appetite and hunger was several-fold greater than the effect sucrose on brain activity in these regions.

- And as you might expect, the different response to sucralose and sucrose was greatest for women who were obese.

Participants consumed more calories at the buffet table after the sucralose drink than after the sucrose drink.

- There was no significant effect of weight on the differential response to sucralose and sucrose. However:

- The differential response to sucralose and sucrose was larger for female participants than for the whole group.

These results are consistent with previous studies suggesting that appetite responses to food cues might be greater in females and individuals with obesity. However, this was the first study designed to directly test this hypothesis.

The authors concluded, “Our findings indicate that female individuals and those who are obese, and especially female individuals with obesity, might be particularly sensitive to greater neural responsivity elicited by sucralose compared to sucrose consumption. This study highlights the need to consider individual biologic factors in research studies and potentially dietary recommendations regarding the use and efficacy of non-nutritive sweeteners [artificial sweeteners] for body weight management.”

[Note: You may have noticed that the authors extrapolated from their data on sucralose to all artificial sweeteners. Is this extrapolation valid? The short answer is, “We don’t know”. Most of the mechanistic studies have been done with sucralose, but some studies suggest these same effects may be seen with other artificial sweeteners.]

Why Is There So Much Confusion About Artificial Sweeteners?

It seems like a “no brainer” that zero calorie drinks and reduced calorie foods would reduce weight gain and promote weight loss. But that just doesn’t seem to happen in the real world. Why is that?

Is it psychological? Do we feel so virtuous about consuming artificially sweetened foods and drinks that we allow ourselves to splurge on high-calorie junk foods?

Or is it physiological? Do artificial sweeteners increase our appetite for high-calorie junk foods?

Unfortunately, clinical studies have not been much help. Some studies suggest that artificial sweeteners increase our appetite for high-calorie foods, while others suggest they don’t. Clinical studies are supposed to resolve questions like these. Why have they been so confusing?

Part of the problem is that some of the studies on artificial sweeteners have been too small and/or too poorly designed to provide clear-cut answers. However, even well-designed clinical studies have two fundamental flaws:

Clinical studies are based on averages. They assume everyone is the same.

- This study, and others like it, show the flaw in that assumption.

- - It appears that artificial sweeteners affect the appetite for high calorie foods more in individuals who are obese than in individuals who are normal weight or slightly overweight.

- - Artificial sweeteners also affect the appetite for high calorie foods more for females than for males.

- - What about age and ethnicity? Is the effect of artificial sweeteners on the appetite for high calorie foods affected by age or ethnicity? No one knows.

- - What about genetics? Is the effect of artificial sweeteners dependent on our genetic background? No one knows.

- - What about our microbiome? Again, no one knows.

Gold standard clinical studies only change one variable at a time. In studies of artificial sweeteners, the variable is artificial sweetener versus sugar. But we don’t eat just artificial sweeteners or sugar. We eat foods containing artificial sweeteners or sugar. Do the foods we eat alter the effect of the artificial sweeteners on appetite?

- One recent study) suggests they might. It found that consumption of sucralose plus easily digested carbohydrate (such as might be found in artificially sweetened junk foods) may increase the craving for sweets more than consumption of either sucralose or sucrose alone.

What Does This Study Mean For You?

Simply put, the initial promise of artificial sweeteners as a solution to the obesity epidemic and the alarming increase in diabetes has not been borne out by either clinical studies or real-life experience.

And I have not addressed the potential risks of artificial sweeteners in this article. However, in my opinion, something that has potential risks, no matter how small, and no proven benefit is something to avoid.

But don’t take my word for it. As I reported in a previous “Health Tips From the Professor” article, an international consortium of scientists recently reviewed all the pertinent literature and published a position paper on whether artificially sweetened beverages were of value in responding to the global obesity crisis. They concluded:

“In summary, the available evidence…does not consistently demonstrate that artificially-sweetened beverages are effective for weight loss or preventing metabolic abnormalities [pre-diabetes and diabetes]. Evidence on the impact of artificially-sweetened beverages on child health is even more limited and inconclusive than in adults.”

“The absence of evidence to support the role of artificially sweetened beverages in preventing weight gain and the lack of studies on their long-term effects on health strengthen the position that artificially-sweetened beverages should not be promoted as part of a healthy diet.”

The Bottom Line

Since then, both consumption of artificial sweeteners and obesity have skyrocketed in this country. Clearly, something isn’t working. Artificial sweeteners are not the magic solution we once thought they would be.

In recent years some studies have suggested that the reason that artificial sweeteners have failed us is that they stimulate our appetite for high calorie foods. However, this idea has been controversial. Some studies have supported it. Others have not.

Why have the clinical studies been so confusing? The study I describe in this article was designed to test the hypothesis that previous studies of artificial sweeteners may have provided misleading results because they didn’t account for the sex and BMI (a measure of obesity) of the study participants.

Many previous studies had primarily enrolled male, ideal weight participants. This study hypothesized that the response to artificial sweeteners might be different in female, overweight participants. The study found:

There was no overall difference in brain activity in the regions of the brain associated with appetite, hunger, and desire for high-calorie foods following consumption of drinks containing sucralose or sucrose. However:

- For participants who were obese, high-calorie savory food images elicited greater brain activity in participants who had consumed sucralose than in participants who had consumed sucrose drinks.

- For female participants, high-calorie sweet and savory food images elicited greater brain activity in participants who had consumed sucralose than in participants who had consumed sucrose drinks.

- These differences were not small. The effect of sucralose on brain activity in regions that control appetite and hunger was several-fold greater than the effect sucrose on brain activity in those regions.

Participants consumed more calories at the buffet table after the sucralose drink than after the sucrose drink.

- The differential response to sucralose and sucrose was larger for female participants than for the whole group.

These results are consistent with previous studies suggesting that appetite responses to food cues might be greater in females and individuals with obesity. However, this was the first study designed to directly test this hypothesis.

The authors concluded, “Our findings indicate that female individuals and those who are obese, and especially female individuals with obesity, might be particularly sensitive to greater neural responsivity elicited by sucralose compared to sucrose consumption. This study highlights the need to consider individual biologic factors in research studies and potentially dietary recommendations regarding the use and efficacy of non-nutritive sweeteners [eg, artificial sweeteners] for body weight management.”

For more details about this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Is Diabetes Increasing In Our Children?

November 9, 2021 by Dr. Steve Chaney

Why Is Diabetes Increasing In Our Children?

Author: Dr. Stephen Chaney

Last week I shared a study documenting the alarming increase in ultraprocessed food consumption by our children and the effect it was having on their health (https://www.chaneyhealth.com/healthtips/are-we-killing-our-children-with-kindness/). For example, childhood obesity is closely linked to ultraprocessed food consumption.

In case you don’t understand why that is, here is what I said last week: “Because ultraprocessed foods are made in a factory, not grown on a farm:

They are high in fat, sugar, and refined carbohydrates. That means they have a high caloric density. Each bite has 2-3 times the calories found in a bite of fresh fruits and vegetables.

Even worse, the food industry has weaponized our natural cravings for sweet, salty, and fatty foods. They feed their prototypes to a series of consumer tasting panels until they find the perfect blend of sugar, salt, and fat to create maximum craving.

And if that weren’t enough, they add additives to create the perfect flavor and “mouth appeal”.

- It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and obesity in both children and adults.

- It is also no wonder that the rate of childhood obesity has almost quadrupled in the last 40 years.”

Unfortunately, whenever you see an increase in obesity, type 2 diabetes is not far behind. Several studies have reported a dramatic increase in type 2 diabetes in our children over the last 20 years.

Because diabetics can manage their blood sugar levels with insulin and/or a variety of drugs, many people consider it as just an inconvenience. Nothing could be further from the truth. Diabetes is a deadly disease, and it is even deadlier when it appears early in life.

You probably already know that long-term complications of diabetes include heart disease and irreversible damage to nerves, kidneys, eyes, and feet. But you may not have known that childhood diabetes is more dangerous than diabetes in adults because:

It is more challenging to manage in children.

The complications of diabetes start to show up much earlier in life and affect quality of life at a much earlier age. For example:

- Cardiovascular events occur 15 years earlier in someone with diabetes.

- On average, a 50-year-old with diabetes will die 6 years earlier than someone without diabetes.

- On average, a 10-year-old with diabetes will die 19 years earlier than a child without diabetes.

The study (JM Lawrence et al, JAMA, 326: 717-727, 2021) I will discuss today is the largest and most comprehensive study of childhood diabetes to date.

How Was This Study Done?

The data for this study were obtained from the SEARCH For Diabetes In Youth Study. This study collected data on physician-diagnosed cases of diabetes in 3.47 million children ages 19 or younger from 6 geographical areas in the US in 2001, 2009, and 2017.

The 6 geographical areas were:

Southern California (7 counties, including Los Angeles).
Colorado (14 counties, including Denver).
Ohio (8 counties, including Cincinnati)
South Carolina (4 counties, including Columbia).
Washington State (5 counties, including Seattle).
Indian Health Service users in select areas of Arizona and New Mexico.

The data on diabetes diagnoses were obtained by creating active surveillance networks composed of pediatric and adult endocrinologists, other clinicians, hospitals, and health plans in the study areas.

Is Diabetes Increasing In Our Children?

To answer this question let’s start with a historical perspective:

In 1950 obesity in US children was rare and type 2 diabetes in children was practically unknown.

- Since then, obesity rates have skyrocketed, and type 2 diabetes has followed along behind it.

Between 1925 and 1950 the prevalence of type 1 diabetes in US children remained constant, but it has been steadily increasing since 1950.

- Type 1 diabetes remains more prevalent than type 2 diabetes in our children, but the prevalence of type 2 diabetes has been increasing faster than type 1 diabetes.

Now let’s look at the results from the SEARCH For Diabetes In Youth Study:

Prevalence of Type 2 Diabetes:

The prevalence of type 2 diabetes in US children aged 10-19 increased from 0.34/1000 youths in 2001, to 0.46/1000 youths in 2009, to 0.67/1000 youths in 2017.

- This is a 94% increase between 2001 and 2017. Put another way, the prevalence of type 2 diabetes in our children has almost doubled in just 16 years!

- The greatest increase was seen among Black (0.85/1000 youths), Hispanic (0.57/1000 youths), and American Indian (0.42/1000 youths) population groups.

These data are consistent with 3 previous studies reporting a doubling of type 2 diabetes in children over similar time periods.

Note: Since data collection ended in 2017, this study does not take into account the increase in type 2 diabetes caused by increased body weight and reduced activity in children during the pandemic. There are no firm data on the increase in type 2 diabetes in children during the pandemic, but some hospitals have reported increases of 50% to 300% in new diagnoses of type 2 diabetes in 2020.

Prevalence of Type 1 Diabetes:

The prevalence of type 1 diabetes in US children aged 19 and younger increased from 1.48/1000 youths in 2001, to 1.93/1000 youths in 2009, to 2.15/1000 youths in 2017.

This is a 45% increase between 2001 and 2017.

- The greatest increase was seen among White (0.93/1000 youths), Black (0.89/1000 youths), and Hispanic (0.59/1000 youths) population groups.

- These data are consistent with a similar study of type 1 diabetes in children in Holland.

In summary:

This study documents a dramatic increase in the prevalence of both type 1 and type 2 diabetes in US children between 2001 and 2017.

Type 2 diabetes is still less prevalent than type 1 diabetes in US children, but it is increasing twice as fast.

Why Is Diabetes Increasing In Our Children?

When it comes to type 2 diabetes, the experts agree:

The increase in type 2 diabetes in children is directly related to the obesity epidemic, which is now impacting our children. The obesity epidemic is, in turn, caused by:

- Increased reliance on highly processed food by our children, as I discussed last week (https://www.chaneyhealth.com/healthtips/are-we-killing-our-children-with-kindness/).

- Decreased exercise. Video games and social media have replaced actual games played outside.

However, when it comes the increase in type 1 diabetes, the experts are perplexed. There is no easy explanation. Let’s start with the basics:

Type 1 diabetes is an autoimmune disease. With type 1 diabetics, their immune system starts attacking the insulin-producing beta cells in their pancreas. Consequently, they lose the ability to produce insulin.

The autoimmune response seen in type 1 diabetes is caused by a combination of genes and environment. Specifically:

- Certain genes predispose to type 1 diabetes. However:

- - Only some people with those genes develop type 1 diabetes.

- - Our genetics doesn’t change with time, so genetics cannot explain the increases in type 1 diabetes we are seeing.

That leaves the environment. There are many hypotheses about how our children’s environment influences their risk of developing type 1 diabetes. However:

- Some of these hypotheses involve things that have not changed over the last 15-20 years. They cannot explain the increase in type1 diabetes we are seeing in children.

- Some of these hypotheses are not supported by good data. They are speculative.

With that in mind, I will list the top 5 current hypotheses and evaluate each of them.

#1: The viral infection hypothesis: Basically, this hypothesis states that type 1 diabetes can be triggered by common viral infections such as the flu.

This is a plausible hypothesis. Whenever our immune system is stimulated by invaders it sometimes goes rogue and triggers autoimmune responses.

It is also supported by good data. The onset of type 1 diabetes is often associated with a viral infection in genetically susceptible children.

However, prior to the pandemic viral infections have been constant. They haven’t changed over time. Therefore, they cannot explain an increase in type 1 diabetes between 2001 and 2017.

#2: The hygiene hypothesis: Basically, this hypothesis states that when we raise our children in a sterile environment, their immune system doesn’t develop normally. Essentially the hypothesis is saying that it’s not a bad thing if your toddler eats some dirt and moldy fruits. However:

The data linking hygiene to food allergies is better than the data linking hygiene to autoimmune responses.

There is no evidence that hygiene practices have changed significantly between 2001 and 2017.

#3: The vitamin D hypothesis: Basically, this hypothesis states that vitamin D deficiency is associated with the autoimmune response that causes type 1 diabetes.

One of the functions of vitamin D is to regulate the immune system.

As I have reported previously, suboptimal vitamin D levels are associated with increased risk of developing type 1 diabetes.

While we know that up to 61% of children in the US have suboptimal vitamin D levels, we don’t know whether that percentage has changed significantly in recent years.

#4: The gut bacteria hypothesis: Basically, this hypothesis suggests that certain populations of gut bacteria increase the risk of developing type 1 diabetes. This is what we know.

Children who develop type 1 diabetes have a unique population of gut bacteria.

This population of gut bacteria also triggers inflammation, and chronic inflammation can lead to autoimmune responses.

A diet rich in highly processed foods supports growth of the same gut bacteria found in children with type 1 diabetes.

Consumption of highly processed foods has increased significantly in the last twenty years.

#5: The obesity hypothesis: Basically, this hypothesis suggests that obesity increases the risk of developing type 1 diabetes.

While the mechanism is not clear, childhood obesity is associated with both inflammatory and autoimmune diseases like type 1 diabetes.

Childhood obesity has increased dramatically in the past few years.

As you may have noticed, there are weaknesses to each of these hypotheses. This is why there is no current agreement among experts as to why type 1 diabetes is increasing in our children.

My guess is that none of these hypotheses can fully explain the increase in type 1 diabetes in our children, but that several of them may contribute to it.

What Can We Do?

Whatever the mechanism, the increase in both type 1 and type 2 diabetes in our children is troubling. Unless this trend is reversed, we may be dooming our children to short, unhealthy lives. So, what can we, as concerned parents and grandparents, do?

For type 2 diabetes, the answer is clear.

1) Reverse the dominance of ultraprocessed foods in children’s diets. Encourage the consumption of whole, unprocessed or minimally processed foods, and include lots of fresh fruits and vegetables. Set a good example as well.

2) Encourage more activity. Get them outside and moving. Create family activities that involve exercise.

3) Reverse the obesity epidemic. If we succeed in reversing the dominance of ultraprocessed foods in their diet and encouraging more activity, we can reverse the obesity epidemic without putting our children on crazy diets.

For type 1 diabetes, the answer is less clear because the cause for the increase in type 1 diabetes is uncertain. However, I will point out that:

1) Increased consumption of fresh fruits and vegetables, whole grains, and legumes supports the growth of friendly gut bacteria that reduce inflammation and the risk of autoimmune diseases. For more detail on an anti-inflammatory diet, click here.

2) Reversing the obesity epidemic also reduces inflammation and the risk of autoimmune diseases.

3) Adequate vitamin D levels reduce the risk of autoimmune diseases, including type 1 diabetes. My recommendation is to get your 25-hydroxyvitamin D levels tested and supplement with vitamin D3 as needed, especially during the winter months.

The Bottom Line

Last week I shared a study documenting the alarming increase in ultraprocessed food consumption by our children and the effect it was having on their health. For example, childhood obesity is closely linked to ultraprocessed food consumption, and the rate of childhood obesity has almost quadrupled in the last 40 years.

Unfortunately, whenever you see an increase in obesity, type 2 diabetes is not far behind. This week’s study looked at the prevalence of childhood diabetes in 3.47 million children from 6 geographical areas of the United States between 2001 and 2017. This study found:

The prevalence of type 2 diabetes in US children increased 94% between 2001 and 2017. It almost doubled.

The prevalence of type 1 diabetes in US children increased 45% between 2001 and 2017.

These statistics are tragic because diabetes is a deadly disease.

It is more challenging to manage in children.

The complications of diabetes start to show up much earlier in life and affect quality of life at a much earlier age. For example:

- Cardiovascular events occur 15 years earlier in someone with diabetes.

- On average, a 50-year-old with diabetes will die 6 years earlier than someone without diabetes.

- On average, a 10-year-old with diabetes will die 19 years earlier than a child without diabetes.

For more details about this study, why the prevalence of diabetes in US children is increasing, and what we can do about it, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease

Are We Killing Our Children With Kindness?

November 2, 2021 by Dr. Steve Chaney

The Danger Of Ultraprocessed Foods

Author: Dr. Stephen Chaney

It breaks my heart when I see a mom and her children in the checkout line of a supermarket with a cart filled with sodas, sweets, and convenience foods and devoid of fresh fruits and vegetables – or when I see fast food restaurants packed with parents and their children.

I get it. Our kids love these foods. It seems like an act of kindness to give them the foods they crave. But are we killing our children with kindness?

Let me explain. The human brain is hardwired to crave sweets, salt, and fat. In prehistoric times each of these cravings had a survival benefit. For example:

Mother’s milk is naturally sweet. It only makes sense that babies should crave the nutrition source that is essential for their early growth and development.

Fruits provide a cornucopia of vitamins, minerals, and phytonutrients. But fruits were scarce and seasonal in prehistoric times. Their sweetness provided an incentive for early man to seek them out.

Some salt is essential for life. Yet in early history it was scare. It was worth its weight in gold.

In prehistoric times it was feast or famine. The human body has an unlimited capacity to store fat in times of plenty, and those fat stores carried early man through times of famine.

Today most Americans live in a time of food abundance. There are fast food restaurants on almost every street corner and in every shopping mall. We think of famine as the days we skipped lunch because we were busy.

Yet these cravings remain, and the food industry has weaponized them. They are churning out an endless supply highly processed foods and beverages. These foods are not being designed to improve their nutritional value. They are designed to satisfy our cravings and lure us and our children into consuming more of them every year.

Scientists have developed a classification system that assigns foods in the American diet to different groups based on the degree of processing of that food. As you might expect, the best classification is unprocessed foods. The worst classification is called “ultraprocessed foods”. [I will describe this classification system in more detail in the next section.]

It is time we asked how much ultraprocessed foods our children are eating and what it is doing to their health. That is the topic of the study (L Wang et al, JAMA, 326: 519-530, 2021) I will discuss today.

How Was This Study Done?

The data for this study were obtained from NHANES (National Health and Nutrition Examination Survey) dietary data collected from 33,795 American children (ages 2-19, average age = 10) between 1999 and 2018.

NHANES is a program conducted by the CDC to survey the health and nutritional status of adults and children in the United States. The survey has been conducted on a continuous, yearly basis since 1999.

The dietary data are collected via 24-hour dietary recalls conducted by trained interviewers, with a second recall administered over the phone 3-10 days later to improve the accuracy of the data.

Children aged 12-19 completed the dietary survey on their own.

For children aged 6-11, a parent or guardian assisted them in filling out the survey.

For children aged 2-5, a parent or guardian filled out the survey for them.

The foods and beverages consumed by the children were divided into 4 major groups based on the extent of processing using a well-established classification system called NOVA. The 4 groups are:

1) Unprocessed Or Minimally Processed Foods.

This includes whole foods and foods that are minimally processed without the addition of oils, fats, sugar, salt, or other ingredients to the food.

Examples of minimally processed foods include things like oatmeal, nut butters, dried fruit, frozen fruits or vegetables, and dried beans.

2) Processed Culinary Ingredients.

This includes recipes from restaurants or in-home cooking that add small amounts of oils, fats, sugar, salt, and seasonings to whole foods.

3) Processed Foods

This includes foods made in factories by the addition of salt, sugar, oil, or other substances added to whole or minimally processed foods.

Examples include tomato paste, canned fruits packed in sugar syrup, cheese, smoked or cured meat.

4) Ultraprocessed Foods

These are industrial formulations created in factories mostly or entirely from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories (flavor enhancers, colors, and food additives).

Examples include sugar sweetened beverages; sweet or savory packaged snacks; chocolates and candies; burgers, hot dogs, and sausages; poultry and fish nuggets, pastries, cakes, and cake mixes.

Are We Killing Our Children With Kindness?

As I said above, the important question is, “Are we killing our children with kindness when we give them the sugary drinks, sweets, convenience foods, and fast foods they crave?” After all, the foods we give them when they are young are the ones they are most likely to select when they get older.

Let’s start by looking at how pervasive these foods have become. That was the purpose of the study I am discussing today, and the results of this study are alarming. When they looked at the changes in food consumption by our children between 1999 and 2018:

The percentage of calories from ultraprocessed foods increased from 61.4% to 67%. That means:

- Today, more than 2/3 of the calories our children consume daily come from ultraprocessed foods!

The percentage of calories from unprocessed and minimally processed foods decreased from 28.8% to 23.5%. That means:

- In the span of just 19 years the diets of our children have gone from bad to worse!

Ultraprocessed foods were more likely to be consumed away from home and at fast food restaurants.

When the investigators looked at individual categories of ultraprocessed foods:

The percentage of calories coming from ready to heat and eat dishes like frozen pizzas and other frozen meals or snacks increased from 2.2% to 11.2%.

The percentage of calories coming from sweet snacks and desserts increased from 10.7% to 12.9%.

The percentage of calories coming from sugar sweetened beverages decreased from 10.8% to 5.3%.

- This is potentially the only good news from this study.

The authors concluded. “Based on NHANES data from 1999 to 2018, the estimated energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.”

“These results suggest that food processing may need to be considered as a food dimension in addition to nutrients and food groups in future dietary recommendations and food policies.”

The Danger Of Ultraprocessed Foods

This study clearly shows that ultraprocessed foods have become the mainstay of our children’s diets. Forget a balanced diet! Forget “Eat your fruits and vegetables”! Our children’s diets have been fundamentally transformed by “Big Food, Inc”.

You might be saying to yourself, “So, they are eating their favorite processed foods. What’s the big deal? How bad can it be?” My answer is, “Pretty Bad”. I chose the title, “Are we killing our children with kindness”, for a reason.

When you look at what happens to children who eat a diet that is mostly ultraprocessed foods:

#1: Their nutrition suffers. When the investigators divided the children into 5 groups based on the percentage of calories coming from ultraprocessed foods, the children consuming the most ultraprocessed food had:

Significantly higher intakes of carbohydrates (mostly refined carbohydrates); total fats; polyunsaturated fats (mostly highly processed omega-6-rich vegetable oils); and added sugars.

Significantly lower intakes of fiber; protein; omega-3 polyunsaturated fatty acids; calcium; magnesium; potassium; zinc; vitamins A, C, D, and folate.

- The low intake of fiber means our children will be less likely to have health-promoting friendly bacteria and more likely to have disease-promoting bad bacteria in their guts.

- The low intake of calcium, magnesium, and vitamin D means they will be less likely to achieve maximum bone density as young adults and will be more likely to suffer from osteoporosis as they age.

#2: They are more likely to become obese. Remember, these are foods that are made in a factory, not grown on a farm.

They are high in fat, sugar, and refined carbohydrates. That means they have a high caloric density. Each bite has 2-3 times the calories found in a bite of fresh fruits and vegetables.

As I said earlier, the food industry has weaponized our natural cravings for sweet, salty, and fatty foods. They feed their prototypes to a series of consumer tasting panels until they find the perfect blend of sugar, salt, and fat to create maximum craving.

And if that weren’t enough, they add additives to create the perfect flavor and “mouth appeal”.

- It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and obesity in both children and adults.

- It is also no wonder that the rate of childhood obesity has almost quadrupled (5% to 18.5%) in the last 40 years.

#3: They are more likely to become sick as adults and die prematurely.

Obesity; high intake of fat, sugar, and refined carbohydrates; and low intake of fiber, omega-3s, and essential nutrients all contribute to an increased risk of diabetes, heart disease, and some cancers.

- It is no wonder that clinical studies have found a strong correlation between high intake of ultraprocessed food and increased risk of diabetes, heart disease, some cancers, and premature death in adults.

- It is also no wonder a recent study found that type 2 diabetes in children has almost doubled between 2001 and 2017.

The data are clear. When we allow our children to subsist on a diet mostly made up of the ultraprocessed foods they crave, we may be giving them, not love, but a lifetime of obesity and declining health instead. And yes, we may be killing them with kindness.

Instead, my recommendations are:

expose your children to a variety of fresh fruits, vegetables, and minimally processed foods at an early age.

They will reject some of them, and that’s OK. Introduce others until you find whole, minimally processed foods they like. Reintroduce them to some of the foods they initially rejected as they get older.

Don’t keep tempting ultraprocessed foods in your house.

You may just succeed in putting your children on the path to a healthier diet and a healthier, longer life.

The Bottom Line

I get it. Our kids love these foods. It seems like an act of kindness to give them the foods they crave. But are we killing our children with kindness?

It is time we asked how much ultraprocessed foods our children are eating and what it is doing to their health. A recent study did just that. When they looked at the changes in food consumption by our children between 1999 and 2018:

The percentage of calories from ultraprocessed foods increased from 61.4% to 67%. That means:

- Today, more than 2/3 of the calories our children consume daily come from ultraprocessed foods!

The percentage of calories from unprocessed and minimally processed foods decreased from 28.8% to 23.5%. That means:

- In the span of just 19 years the diets of our children have gone from bad to worse!

When you look at what happens to children who eat a diet that is mostly ultraprocessed foods:

Their nutrition suffers.

They are more likely to become obese.

They are more likely to become sick as adults and die prematurely.

For more details about this study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Do Whole Grains Keep Diabetes Away?

August 10, 2021 by Dr. Steve Chaney

Are Whole Grains Healthy?

Author: Dr. Stephen Chaney

Low carb enthusiasts will tell you that carbohydrates are the villain. They tell you that cutting carbohydrates out of your diet will reduce your risk of obesity, diabetes, heart disease, and cancer.

If they limited their list of villainous foods to highly processed foods with white flour and/or added sugars, many nutrition experts would agree with them. There is widespread agreement in the nutrition community that we eat far too much of these foods.

However, I don’t have to tell you that many low carb diets also eliminate whole grains, fruits, and beans from their diets based solely on the carbohydrate content of these foods. Is this good advice? Is there any data to back up this claim?

The short answer is no. Last week I shared a study showing that fruits reduced your risk of developing type 2 diabetes.

This week I will review a study looking at the effect of whole grain consumption on the risk of developing type 2 diabetes.

How Was This Study Done?

This study combined data from women in the Nurses’ Health Study (1984-2014) and the Nurses’ Health Study II (1991-2017), and men in the Health Professionals Follow-Up Study (1986-2016). There were 158,259 women and 36,525 men in these three studies.

None of the participants had type 2 diabetes, cardiovascular disease, or cancer at the time they entered the studies.

At the beginning of each study and every 4 years later the participants were asked to fill out a food frequency questionnaire to collect information about their usual diet over the past year. Validation studies showed that the diets of the participants changed little over the interval of the studies. [Note: This is a strength of these studies. Many clinical studies only collect dietary data at the beginning of the study, so there is no way of knowing whether the participant’s diets changed over time.]

The participants in these studies were followed for an average of 24 years. They were sent follow-up questionnaires every two years to collect information on diseases they had been diagnosed with over the past two years. Participants who reported type 2 diabetes were sent a supplementary questionnaire to confirm the diagnosis.

This study measured the effect of whole grain consumption, and frequently consumed whole grain foods, on the long term (24 year) risk of developing type 2 diabetes.

The data were adjusted for multiple possible confounding variables (other factors that might affect the risk of developing type 2 diabetes) including age, ethnicity, smoking status, alcohol intake, multivitamin use, healthy eating index (a measure of how healthy the overall diet was), caloric intake, obesity, family history of diabetes, and use of oral contraceptives or postmenopausal hormones.

In addition, a stratified analysis was performed to assess the extent to which obesity, physical activity, smoking status, and family history of diabetes influenced the outcome.

In short, this was a very rigorous and well-controlled study.

Do Whole Grains Keep Diabetes Away?

Total whole grain consumption was divided into five groups ranging from 2 servings per day to < 0.1 serving per day. When participants with the highest whole grain intake were compared to those with the lowest whole grain intake:

Whole grain consumption was associated with a 29% lower risk of developing type 2 diabetes.

- The association between whole grain consumption and reduced risk of developing type 2 diabetes was stronger for lean individuals (45% reduction in risk) than for overweight (34% reduction in risk) or obese individuals (23% reduction in risk).

- The association between whole grain consumption and reduced risk of developing type 2 diabetes was not affected by physical activity, smoking status, or family history of diabetes.

When they looked at the entire range of whole grain intake among participants in the study:

The risk reduction for developing type 2 diabetes was nonlinear.

- The greatest portion of risk reduction (30% decreased risk) occurred between 0 and 2 servings/day.

- However, the reduction in risk continued to decrease at a slower rate up to 4.5 servings/day (38% decreased risk), the highest intake recorded for participants in this study.

When they looked at the most frequently consumed whole grain foods and compared the risk of developing type 2 diabetes for participants consuming one or more servings per day compared with less than 1 serving per month:

People consuming whole grain cold breakfast cereals were 19% less likely to develop type 2 diabetes.

People consuming whole grain breads were 21% less likely to develop type 2 diabetes.

People consuming popcorn were 8% more likely to develop type 2 diabetes.

Once again, the risk reduction was nonlinear.

For whole grain cold breakfast cereals risk reduction plateaued at around 0.5 servings per day.

For whole grain breads the greatest portion of risk reduction occurred at around 0.5 servings per day (17% decreased risk), but the reduction in risk continued to decrease at a slower rate up to 4 servings/day (28% decreased risk).

For popcorn, the risk reduction curve was non-linear. There was a slight, non-significant, decrease in risk at about 0.2 servings per day, followed by a steady increase in risk up to 1.75 servings per day (24% increased risk).

When they looked at less frequently consumed whole grain foods and compared the risk of developing type 2 diabetes for participants consuming two or more servings per week compared with less than 1 serving per month:

People consuming oatmeal were 21% less likely to develop type 2 diabetes.

People consuming brown rice were 12% less likely to develop type 2 diabetes.

People consuming added bran were 15% less likely to develop type 2 diabetes.

There were not enough people consuming these whole grains for the investigators to determine how many servings were optimal.

The authors concluded, “Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, whole grain bread, brown rice, and added bran, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.”

Are Whole Grains Healthy?

This is a very impressive study. As described above, it is a large (194,784 participants), long lasting (24 years), and well-designed study. With this data in mind, we can answer several important questions.

Are Whole Grains Healthy?

This study explodes the myth that you should avoid whole grains if you want to prevent diabetes. Instead, the study shows that whole grain consumption decreases your risk of developing type-2 diabetes.

I recently reviewed another large, well-designed study showing that whole grain consumption reduces your risk of dying from heart disease, cancer, and all causes combined.

So, clearly whole grains are good for you. They should be an important part of your diet.

Which Whole Grains Are Healthy?

According to this study, whole grain breakfast cereals, whole grain breads, oatmeal, brown rice, and bran are all healthy. All of them significantly reduce your risk of developing type 2 diabetes. Other whole grains are likely to be healthy too, but Americans consume so little of them, they could not be analyzed in this study.

However, there are some caveats:

You have to read labels carefully. Unless it says “100% whole grain”, it probably contains more refined grains than whole grains.

- Yes, food manufacturers are intentionally deceptive. Who knew?

You have to look at the food, not just “whole grain” on the label.

- It is hard to imagine, but Dr. Kellogg originally created breakfast cereals as health food. However, today many “whole grain” cereals are loaded with sugar and artificial ingredients. They are highly processed foods that are anything but healthy.

- The case of popcorn is a perfect example. Popcorn is loaded with fiber. It should reduce your risk of diabetes. However, in this study it increased the risk of diabetes. That’s because 70% of the popcorn that Americans consume is purchased either pre-popped or ready to pop. It contains unhealthy ingredients like salt, butter, sugar, trans fats, and artificial flavors. It is a highly processed food. Air popped popcorn without the added ingredients is probably very healthy.

Why Are Whole Grains Healthy?

Dr. Strangelove and his buddies have told you to avoid all grains because they contain carbohydrates that are converted to sugar. That is good advice for refined grains. Not only are they rapidly converted to sugar. But they are also found in highly processed foods along with sugar, fat, and a witch’s brew of chemicals.

However, whole grains are different. Yes, whole grains are carbohydrate-rich foods, and the carbohydrate is converted to sugar during digestion. But:

They also contain fiber, which slows the digestion of the carbohydrate and delays the absorption of the sugar released during digestion.

The carbohydrate is trapped in a cellular matrix, which must be digested before the carbohydrate can be released.

In addition:

Whole grains contain nutrients and phytonutrients not found in refined grains.

The fiber in whole grains supports the growth of friendly bacteria in the gut.

How Many Whole Grain Foods Should I Be Eating?

This study found that you get the biggest “bang for your buck” when you go from 0 to around 2 servings per day of whole foods.

If you aren’t fond of whole grain foods, that is good news. It is also in line with USDA recommendation that half the grains we eat should be whole grains. You don’t need to eat whole grains with every meal.

If you are a purist, you can reduce your diabetes risk even more by increasing your whole grain intake up to at least 4.5 servings per day, the highest intake measured in this study.

Are Low Carb Diets Healthy?

Low carb diets may be effective for short term weight loss, but there is no evidence that they are healthy long term. And, because they cut out one or more food groups many experts feel they are likely to be unhealthy long term.

My advice is to forget “low carb” and focus on “healthy carb” instead.

Eliminate refined carbs and the highly processed foods they are found in.

Include fruits, whole grains, and beans as part of your diet. They are high carbohydrate foods, but, as this and other studies have shown, the carbohydrates in those foods are healthy carbs.

The Bottom Line

Low carb enthusiasts tell you to eliminate whole grains from your diet if you want to reduce your risk of developing diabetes. Is this true? Is it good advice?

A recent study put this advice to the test. It was a large (194,784 participants), long lasting (24 years), and well-designed study. Here is what the study found.

When participants with the highest whole grain intake were compared to those with the lowest whole grain intake:

Whole grain consumption was associated with a 29% lower risk of developing type 2 diabetes.

When they looked at the entire range of whole grain intake among participants in the study:

The risk reduction for developing type 2 diabetes was nonlinear.

The greatest portion of risk reduction (30% decreased risk) occurred between 0 and 2 servings/day.

But the reduction in risk continued to decrease at a slower rate up to 4.5 servings/day (38% decreased risk), the highest intake recorded for participants in this study.

When they looked at individual foods, whole grain breakfast cereals, whole grain bread, oatmeal, brown rice, and added bran all reduced diabetes risk.

For more details about this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.