Do Processed Foods Increase Your Risk Of Diabetes?

Why Do We Keep Eating Processed Foods?

Fast Food DangersUnless you are Rip Van Winkle and have been asleep for the past 20 years you probably know that the highly processed foods in the typical American diet are bad for your health. But perhaps you didn’t realize just how bad they were.

But first, let’s start with a bit of perspective. Scientists like to be precise. Even healthy foods go through some processing.

  • The oatmeal you ate this morning was either steel-cut or ground. That is processing.
  • The almond butter you put on your whole grain toast this morning was made by roasting and grinding. That is processing.

So, scientists have developed the term “ultra-processed food” to describe the worst of the worse. In short, ultra-processed foods:

  • Usually go through several physical and chemical processes, such as extruding, molding, prefrying, and hydrogenation that can lead to the formation of toxic contaminants. One example you may have heard about recently would be acrylamide in French fries.
  • Typically contain ingredients of no or little nutritive value, such as refined sugar, hydrogenated oils, emulsifiers, artificial sweeteners, thickening agents, and artificial colors. Some of these ingredients have been linked to cancer, heart disease, and premature death.
  • Have long shelf-lives because of added preservatives. This allows migration of chemicals such as bisphenol A from the packaging materials into the food.

Examples of ultra-processed foods include:

  • Sodas
  • Chips
  • Candy and packages of cookies or crackers
  • Most breakfast cereals
  • Boxed cake, cookie, and pancake mix
  • Chicken nuggets and fish sticks
  • Fast food burgers
  • Hot dogs and other processed meats
  • Infant formula
  • Instant noodles
  • Most store-bought ice cream
  • Flavored yogurt

In short, ultra-processed foods include sodas and the junk and convenience foods Americans hold so dear. Even things like infant formula and flavored yogurt make the list.

Evidence of the ill effects of ultra-processed foods on our health is becoming overwhelming. In previous issues of “Health Tips From the Professor” I have shared recent studies that have shown that heavy consumption of ultra-processed foods is linked to increased risk of obesity and cancer. Other studies have linked ultra-processed food consumption with increased risk of depression, heart disease, and premature death.

In this issue of “Health Tips From the Professor” I:

  • Ask the important question, “If we know these foods are so bad for us, why do we still keep eating them?”

How Was The Study Done?

Clinical StudyThe data from this study were taken from an ongoing study in France (the NutriNet-Sante study) looking at associations between nutrition and health. This study began enrolling French adults 18 and older in 2009.

This is a web-based study. Participants are prompted to go to a dedicated website and fill out questionnaires related to things like sex, age, height, weight, smoking status, physical activity, health status, and diet.

With respect to diet, participants filled out a series of 3 nonconsecutive 24-hour dietary records at the time of enrollment and every 6 months. This is a particularly strong feature of this study. Many studies of this type only analyze participant’s diets at the beginning of the study. Those studies have no way of knowing how the participant’s diets may have changed during the study.

Diagnosis of type 2 diabetes for study participants was obtained from the French centralized health records.

The study enrolled 104,708 participants, 20% men and 80% women, and followed them for an average of 6 years. The average age of the participants was 43 years.

Do Processed Foods Increase Your Risk Of Diabetes?

High Blood SugarIn this study the range of ultra-processed foods in the French diet ranged from 7% to 27% (average = 17%). High intake of ultra-processed foods was associated with:

  • Younger participants. Simply put, young people were more likely to drink sodas and eat junk food than older adults.
  • Increased caloric intake. Ultra-processed foods have a higher caloric density than whole, unprocessed foods.
  • No surprise here. Previous studies have shown that ultra-processed food consumption increases the risk of obesity.
  • Poorer diet quality. Again, no surprise. Junk foods tend to crowd healthier foods out of the dirt. Specifically, ultra-processed food consumption was associated with:
    • Higher intake of sugar and salt.
    • Lower intake of fiber.
    • Higher intake of sugary drinks, red and processed meats.
    • Lower intake of whole grains, yogurt, nuts, fruits, and vegetables.

However, even after statistically correcting for all these factors, there was a significant association between ultra-processed food consumption and the onset of type 2 diabetes in the 6-year follow-up period.

  • There was a linear relation between ultra-processed food consumption and the development of type 2 diabetes. Simply put, the more ultra-processed food the participants consumed the more likely they were to be diagnosed with type 2 diabetes.
  • There was a 15% increased risk of developing type 2 diabetes for every 10% increase in ultra-processed food consumption.

The authors concluded:

“In this large observational prospective study, a higher proportion of ultra-processed food in the diet was associated with a higher risk of type 2 diabetes. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting ultra-processed food consumption.”

What Does This Study Mean For You?

Questioning WomanYou might be tempted to say that a 15% increase in the risk of developing diabetes is a small price to pay for continuing to eat the foods you enjoy. However, you should be alarmed by this study. Here is why.

The French diet is much healthier than the American. Remember that ultra-processed foods only comprised 17% of the French Diet. In contrast, a recent survey found that:

  • Ultra-processed foods make up 58% of the average American’s diet.
  • Ultra-processed foods account for 90% of the added sugar in our diet.

It is no wonder that obesity and diabetes are reaching epidemic proportions in our country.

You might also be tempted to think that you can just take some medications and live with type 2 diabetes. However, you should think of type 2 diabetes as a gateway disease. It increases your risk of heart disease, high blood pressure, Alzheimer’s disease, kidney damage, and neuropathy, just to name a few. These are diseases that make your life miserable and ultimately kill you.

More importantly, type 2 diabetes is completely reversible if you catch it early enough. Just lose some weight, exercise more, give up the ultra-processed foods, and eat a healthy diet. I recommend a whole food, primarily plant-based diet.

Why Do We Keep Eating Processed Foods?

Fast FoodsWe all know that ultra-processed foods are bad for us. Study after study show that they make us sick. They kill us prematurely. And, unlike most topics in the field of nutrition, this is not controversial.

For example, there have been lots of bizarre diets that have come and gone over the years. There have been books written on “The Steak Lover’s Diet” and “The Drinking Man’s Diet”. But nobody has written a book on “The Junk Food Lover’s Diet”. It simply would not be believable.

So why do we Americans keep eating such unhealthy foods. Part of the answer is physiological. A preference for sweet, salty, and fatty foods is hardwired into our brain. That’s because they had great survival value in prehistoric times.

If we think back to the time when we were hunters and gatherers:

  • Fruits are healthy foods. They are a great source of antioxidants, phytonutrients, and fiber, but there were no orchards or grocery stores back then. We had to search for fruits in the wild. Our desire for sweet tasting foods provided the motivation to seek them out.
  • Game was seasonal and sometimes scarce. We had to be prepared to go for days or weeks without eating except for the leaves and roots we could gather. Our bodies are designed to store fat as the primary energy source to get us through the lean times. Our preference for fatty foods encouraged us to store as much fat as possible in times of plenty so we would be prepared for times of scarcity.
  • If we fast forward to our early recorded history, salt was scarce. It was worth its weight in gold. Yet some salt is essential for life. Our preference for salty foods encouraged us to search out supplies of salt.

Unfortunately, the food industry has weaponized these food preferences to create the ultra-processed foods we know today. Their ads entice us by associating these foods with youth and good times. And ultra-processed foods have become ubiquitous. There are fast food restaurants on almost every street corner and shopping mall in the country.

Fortunately, we do not have to let the food industry destroy our health. We can retrain our taste buds to appreciate the sweetness of fresh fruits and vegetables. We can substitute healthy fats for the kinds of fat found in most ultra-processed foods. We can also retrain our taste buds to appreciate herbs and spices with just a pinch of salt.

The Bottom Line

Ultra-processed foods, such as sodas, junk foods, and convenience foods have become the biggest food group in the American diet. A recent study found:

  • Ultra-processed foods make up 58% of the average American’s diet.
  • Ultra-processed foods account for 90% of the added sugar in our diet.

That is scary because ultra-processed foods are deadly. Previous studies have shown that consumption of ultra-processed foods is linked to obesity, heart disease, cancer, and Alzheimer’s disease.

The study discussed this week looked at the association between ultra-processed food consumption and type 2 diabetes. It showed:

  • There was a linear relation between ultra-processed food consumption and the development of type 2 diabetes. Simply put, the more ultra-processed food the participants consumed the more likely they were to be diagnosed with type 2 diabetes.
  • There was a 15% increased risk of developing type 2 diabetes for every 10% increase in ultra-processed food consumption.

You might be tempted to think that you can just take some medications and live with type 2 diabetes. However, you should think of type 2 diabetes as a gateway disease. It increases your risk of heart disease, high blood pressure, Alzheimer’s disease, kidney damage, and neuropathy, just to name a few. This are diseases that make your life miserable and ultimately kill you.

More importantly, type 2 diabetes is completely reversible if you catch it early enough. Just lose some weight, exercise more, give up the ultra-processed foods, and eat a healthy diet. I recommend a whole food, primarily plant-based diet.

For more details and a discussion of why Americans continue to eat ultra-processed food even though we know it is bad for us, 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 Nuts Good For Your Heart?

Which Nuts Are Best?

Last week I shared an important study about the benefits of replacing some of the animal protein in your diet with plant protein from whole grains. In case you have forgotten, the study showed replacing just 15 grams of the animal protein in your diet with an equivalent amount of protein from whole grains significantly decreased the risk of premature death from cardiovascular disease, stroke, and from all causes.

This was an important study because whole grains have been maligned in recent years. Low carb diets, keto diets, paleo diets, and low-lectin diets all recommend cutting whole grains out of your diet. Dr. Strangelove and his friends have been telling us to avoid whole grains, and too many Americans have been doing just that.

The study I shared last week reminds us that whole grains are good for our hearts. They are a great source of antioxidants, B vitamins, minerals, and phytonutrients. More importantly, they contain a unique type of fiber called resistant starch that supports the growth of heart-healthy gut bacteria. There are a few other foods that are a good source of resistant starch, but they are also on Dr. Strangelove’s “naughty list” of foods to avoid.

Unfortunately, you might have come away from last week’s article thinking that other plant protein sources, like beans, legumes, nuts, and seeds, weren’t important for reducing your risk of heart disease. However, the fact that they didn’t reduce the risk of premature death from heart disease in that study was likely an artifact of the way the study was designed.

The study asked what happens when you change 15 grams of the protein in your diet from red meat protein to different kinds of plant protein. That question was easy to answer for grains because they are a major source of protein in the American diet. However, Americans don’t get enough protein from either beans and legumes or nuts and seeds to provide a statistically valid answer to that question.

To correct any misconceptions from last week’s article I thought it might be valuable to review a study (M Guasch-Ferré et al, Journal Of The American Journal Of Cardiology, 70: 2519-2532) from a few years ago that looked at the effect of nut consumption on the risk of heart disease.

How Was The Study Done?

Clinical StudyThis study started by combining the data from three major clinical trials:

  • The first Nurse’s Health Study, which ran from 1980 to 2012,
  • The second Nurse’s Health Study, which ran from 1991-2013, and
  • The Health Professional’s Follow-Up Study, which ran from 1986-2012.

These studies combined enrolled 169,310 women and 41,526 men and followed them for an average of 32 years. All the participants were free of heart disease and cancer at the time they were enrolled. The design of these studies was extraordinary.

  • A detailed food frequency questionnaire was administered every 4 years. This allowed the investigators to calculate cumulative averages of all dietary variables, including nuts. This assured that the effects of nut consumption and diet represented the participant’s average diet over the 32-year duration of the study, not just their diet when they entered the study.
  • Participants also filled out questionnaires that captured information on disease diagnosis, disease risk factors, medicines taken, weight, and lifestyle characteristics every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of heart disease for each participant during the study. More importantly, 32 years is long enough to measure the onset of diseases like heart disease, which requires decades to develop.
  • The primary endpoint of the study was “cardiovascular disease”, which the investigators defined as fatal and non-fatal heart attacks, fatal and non-fatal strokes, and deaths from all types of heart disease. During this study, 14,136 participants developed cardiovascular disease. This was a large enough number for a detailed statistical analysis of the data.
  • Secondary endpoints were heart disease (fatal and non-fatal heart attacks) and stroke (fatal and non-fatal strokes).

Are Nuts Good For Your Heart?

strong heartWhen the authors compared people who consumed 5 or more one ounce servings of nuts per week with people who never or almost never consumed nuts, they found that nut consumption decreased:

  • Cardiovascular disease by 14%.
  • Heart attacks by 20%.
  • Strokes by a non-significant 2%.

This part of the study merely confirms what other studies have shown. What makes this study unique is that it identifies the relative heart health benefits of different kinds of nuts.

Which Nuts Are Best?

Nuts are an excellent source of vitamins, minerals, phytonutrients, and fiber. But what makes them particularly heart healthy is the healthy fats they provide.

  • Peanuts (which are actually legumes rather than true nuts) are rich in monounsaturated fats.
  • Tree nuts in general are an excellent source of polyunsaturated fats.

    Walnuts
  • Walnuts are particularly rich in omega-3 polyunsaturated fats.

When they looked at individual nuts:

  • Consuming a serving of peanuts (35 peanuts) 2 or more times per week decreased:
    • Cardiovascular disease by 13%.
    • Heart attacks by 15%.
    • Stroke by 10%.
    • Peanut butter had no effect on cardiovascular outcomes, probably because many commercial brands of peanut butter add saturated fats to reduce separation of the oil and make their product creamier.
  • Consuming a serving of tree nuts (12-15 nuts) 2 or more times per week decreased:
    • Cardiovascular disease by 15%.
    • Heart attacks by 23%.
  • Consuming a serving of walnuts (14 walnut halves) one or more times per week decreased:
    • Cardiovascular disease by 19%.
    • Heart attacks by 21%.
    • Stroke by 17%.

In case you missed it, walnuts were the superstars of the nut family. One serving/week of walnuts was more effective than two or more servings/week of peanuts or other tree nuts at reducing the risk of heart attacks, stroke, and overall cardiovascular disease. This is probably because walnuts are a particularly good source of omega-3 fats.

[Professor’s note: I include a serving of walnuts with my breakfast every morning.]

The authors concluded: “Findings from 3 large prospective cohort studies indicate that frequent intake of nuts, tree nuts, peanuts, and walnuts was associated with a lower risk of cardiovascular disease, independently from other cardiovascular risk, lifestyle, and dietary factors. Our findings support recommendations of increasing the intake of a variety of nuts as part of healthy dietary patterns to reduce the risk of chronic diseases in the general population.”

What Does This Study Mean For You?

Questioning WomanI have consistently shared the evidence that primarily plant-based diets are associated with the best long-term health outcomes, especially when we look at chronic diseases like heart disease, diabetes, and cancer.

I have also consistently shared the message that “We have 5 food groups for a reason”. All 5 food groups are part of a healthy diet.

Unfortunately, Dr. Strangelove and his friends have been telling us that whole grains are bad for us. We should eliminate them from our diet. And too many Americans have been following that advice. That’s why last week’s “Health Tips From the Professor” article reviewed the evidence for heart health benefits from whole grain consumption.

The situation with nuts and seeds is a little different. Most people recognize them as healthy. They just don’t eat enough of them. That’s why this week’s article emphasized the heart health benefits from nut consumption. Here is the take home message I hope you get from this article:

  • Two or more servings/week of peanuts or tree nuts significantly reduces your risk of heart attack, stroke, and other cardiovascular diseases.
  • Walnuts are the superstars of the nut family. One serving/week of walnuts (14 walnut halves) was more effective at reducing the risk of heart attack, stroke, and other cardiovascular diseases than two or more servings/week of the other nuts.
  • This study was based on unprocessed nuts. Nuts coated with salt, sugar, or chocolate probably don’t qualify as heart healthy.
  • Processed foods made from nuts also may not be heart healthy. For example, peanut butter had no effect at decreasing heart disease risk in this study.

Finally, in closing I want to revisit my statement that “We have 5 food groups for a reason”.

  • The studies I shared this week and last week show that whole grains and nuts are important components of a heart healthy diet. But it doesn’t stop there.
  • All plant food groups are part of a heart healthy diet. In previous issues of “Health Tips From the Professor” I have shared studies showing beans, fruits, and vegetables are all important components of a heart healthy diet.
  • I have also shared recent studies showing that adding small amounts of eggs and dairy may make a vegetarian diet more heart healthy.
  • Finally, I have shared a study showing that small amounts of red meat can be heart healthy in the context of a primarily plant-based diet such as the Mediterranean diet.

Of course, we are talking about whole food diets. If you include sodas and highly processed foods in the diet, all bets are off.

The Bottom Line

I have consistently shared the evidence that primarily plant-based diets are associated with the best long-term health outcomes, especially when we look at chronic diseases like heart disease, diabetes, and cancer.

I have also consistently shared the message that “We have 5 food groups for a reason”. All 5 food groups are part of a healthy diet.

Unfortunately, Dr. Strangelove and his friends have been telling us that whole grains are bad for us. We should eliminate them from our diet. And too many Americans have been following that advice. That’s why last week’s “Health Tips From the Professor” article reviewed the evidence for heart health benefits from whole grain consumption.

The situation with nuts and seeds is a little different. Most people recognize them as healthy. They just don’t eat enough of them. That’s why this week’s article emphasized the heart health benefits of nut consumption. Here is the take home message I hope you get from this article:

  • Two or more servings/week of peanuts or tree nuts significantly reduces your risk of heart attack, stroke, and other cardiovascular diseases.
  • Walnuts are the superstars of the nut family. One serving/week of walnuts (14 walnut halves) was more effective at reducing the risk of heart attack, stroke, and other cardiovascular diseases than two or more servings/week of the other nuts.
  • This study was based on unprocessed nuts. Nuts coated with salt, sugar, or chocolate probably don’t qualify as heart healthy.
  • Processed foods made from nuts also may not be heart healthy. For example, peanut butter had no effect at decreasing heart disease risk in this study.

Finally, in closing I want to revisit my statement that “We have 5 food groups for a reason”.

  • The studies I shared this week and last week show that whole grains and nuts are important components of a heart healthy diet. But it doesn’t stop there.
  • All plant food groups are part of a heart healthy diet. In previous issues of “Health Tips From the Professor” I have shared studies showing beans, fruits, and vegetables are all important components of a heart healthy diet.
  • I have also shared recent studies showing that adding small amounts of eggs and dairy may make a vegetarian diet more heart healthy.
  • Finally, I have shared a study showing that small amounts of red meat can be heart healthy in the context of a primarily plant-based diet such as the Mediterranean diet.

Of course, we are talking about whole food diets. If you include sodas and highly processed foods in the diet, all bets are off.

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.

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