January 7, 2017

Price Influences Healthy vs Unhealthy Food

Now that 2017 is here, many people will be patrolling the aisles of grocery stores in search of healthful foods to assist them in losing weight. Hopefully this post will give you something to think about in your search for healthful foods and how to stay away from junk foods claiming to be healthy.

This is something I have already done and this study just confirms my actions. I always do several things when I shop with my wife and I sometimes irritate her in doing so, but after we read the nutritional label and the ingredients section, we often agree what to leave on the shelf and the items we will eat that are healthy. Often the price is best on those we select and the higher priced products remain on the shelf.

Study co-author Rebecca Reczek, from the Fisher College of Business at Ohio State University, and colleagues found that people often perceive healthful foods to be more expensive, despite there being no evidence to support this view.

The team found that consumers make food choices based on this belief, and the price of foods may also influence how important we perceive certain health conditions to be.

Reczek and colleagues came to their findings - published in the Journal of Consumer Research - by conducting five experiments on different groups of participants.

The aim of the study was to get a better understanding of "lay theories" in relation to the cost of healthful foods. In simple terms, lay theories are ideologies that people use to make sense of their social environment.

One common lay theory is that healthful foods are more expensive than less healthful foods. The researchers point to one example of this popular theory - the nickname given to the health foods store Whole Foods, which is "Whole Paycheck."

While there are certain types of health foods that are more expensive - such as organic and gluten-free products - Reczek notes that it does not always cost more to eat healthily.

All in all, Reczek and team believe that their results are a worry for consumers.
"It's concerning. The findings suggest that price of food alone can impact our perceptions of what is healthy and even what health issues we should be concerned about."

However, the researchers suggest that by being aware of the common misconception that healthful foods are always more expensive and by using "objective evidence" to assess food products, we can overcome this lay theory.

"It makes it easier for us when we're shopping to use this lay theory, and just assume we're getting something healthier when we pay more. But we don't have to be led astray," says Reczek. "We can compare nutrition labels and we can do research before we go to the grocery store. We can use facts rather than our intuition."

Please read the full article here for facts that were part of the study.

January 6, 2017

Carbohydrate Restricted Diet May Prevent Type 2

According to a new comprehensive financial analysis reported in the Journal of the American Medical Association and The Washington Post by the University of Alabama at Birmingham, diabetes leads a list of just 20 diseases and conditions that account for more than half of all spending on healthcare in the United States.

U.S. spending on diabetes diagnosis and treatment totaled $101 billion in 2013, and has grown 36 times faster than spending on heart disease, the country's No. 1 cause of death, researchers reported.

University of Alabama at Birmingham Professor of Nutrition Barbara Gower, Ph.D., conducts research on diet composition and disease risk and says that diabetes can both be prevented and reversed with a carbohydrate restricted diet.

Type 2 diabetes (Bold is my emphasis) can be managed with diet alone in many cases. However, this message is not getting to the patients; they are told to take drugs. A clinic at UAB treats diabetics with a diet that dramatically reduces carbohydrates. In most cases, patients can eliminate all medication.

"They are thrilled to stop injecting insulin, and they question why "no one ever told them" they could control their diabetes diet alone," Gower said. "The conventional advise to diabetics is to eat carbs, and then inject insulin - or take other drugs.

"The medication is needed because diabetes is a disease of carbohydrate intolerance; if the patient does not eat carbs, they do not have to use medication," she said.

"I use the 'cigarette' analogy. We know it is bad to smoke, so we tell patents not to smoke. Why don't we do the same thing with sugar and processed starches? The excuse I hear is that 'people won't stop eating sugar and starches.' However, by the same analogy, we could have thrown up our hands and said, 'people can't give up smoking.'"

"We need to treat diabetes like lung cancer and COPD; all of these diseases are preventable with lifestyle," Gower said. "Further, even with established, long-term, type 2 diabetes, it can be managed with diet. It is not impossible to eat a low-carb diet that is healthful and satisfying. We do it all the time, and we teach our patients to do it. They love it.

"Carbohydrates are not essential nutrients for the human body, and with proper instruction, patients can adjust their diets to minimize them."

What I believe may not agree in total with the above, but I do believe this - In nutrition there is always more than one solution and our bodies all react differently - even if people are fed identical meals. Hopefully the above study does help people as described.

January 5, 2017

Dietitians Role in Diabetes and Obesity

It is becoming clearer that the Academy of Nutrition and Dietetics (AND) is increasingly complicit in the epidemic in the United States of diabetes and obesity.

With about 70 million people in the United States either with or undiagnosed with type 2 diabetes, it is undeniable that they have great influence in the dietary guidelines published every five years by the Department of Agriculture and the Department of Health and Human Services.

The number of times staff and officers of AND have been discovered promoting junk food is surprising.

Recently, the AND organization has stopped showing who they receive funds from on their website. They list a few sponsors, but leave most off the list. Now they want us to believe they are not shills for Big Food.

The other problem AND has created is a problem for diabetes education when a person has two titles – Certified Diabetes Educator (CDE) and Registered Dietitian (RD). When they are supposed to be teaching diabetes education, the RD is instead instructed to teach nutrition as the education and then they attempt to double bill insurance, Medicare, or Medicaid for both.

All dietitian advice is brought to you by their sponsors and has been for a very long time. Now that it’s becoming more blatant, maybe the public will finally figure out that being a dietitian is akin to being a corporate big food representative. During the months of February and March, 2015, AND started promoting Kraft Singles, the individually wrapped slices of “cheese product” popular in school lunches. This is the first product to boast the AND’s new “Kids Eat Right” label. Kraft Singles are not cheese, but a combination of chemicals that represents fake cheese.

Then the Associated Press recently broke a story showing how dietitians were promoting small cans of Coca-Cola as a snack. Ben Sheidler, a Coca-Cola spokesman, compared the February, 2015, posts to product placement deals a company might have with TV shows. "We have a network of dietitians we work with," said Sheidler, who declined to say how much the company pays experts. "Every big brand works with bloggers or has paid talent."

With the current atmosphere within AND, I don't see much success coming from a group called Dietitians for Professional Integrity. The group has called for sharper lines to be drawn between dietitians and companies. Andy Bellatti, one of its founders, said companies court dietitians because they help validate corporate messages. And without corporate money, AND will continue to function as it will have complete control in the messages it allows and the dissenting group will be banned from AND.

Other companies including Kellogg and General Mills have used strategies like providing continuing education classes for dietitians, funding studies that burnish the nutritional images of their products and offering newsletters for health experts. PepsiCo Inc. has also worked with dietitians who suggest its Frito-Lay and Tostito chips in local TV segments on healthy eating. Others use nutrition experts in sponsored content, the American Pistachio Growers has quoted a dietitian for the New England Patriots in a piece on healthy snacks and recipes and Nestle has quoted its own executive in a post about infant nutrition.

If you are looking for safe nutrition advice, do not look to the members of AND or the Academy for safe nutritional information. They are a tool of big food and have been for many years, even before the name change. Maybe they are becoming too self-confident and will continue to throw any good reputation they may have out the window.

January 4, 2017

An American Cardiologist Against Statins

I hope more doctors will learn from this doctor and follow her. Dr. Barbara Roberts, director of the Women’s Cardiac Center at The Miriam Hospital, is angry – and she’s speaking out.

Roberts, a cardiologist who is associate clinical professor of Medicine at the Alpert Medical School of Brown University, is the author of “The Truth about Statins: Risks and Alternatives to Cholesterol-Lowering Drugs.”

She does not mince her words when it comes to the new cholesterol guidelines recently published by the American Heart Association and the American College of Cardiology – which have suggested that millions of healthy Americans should start taking statins.

The new guidelines are based on shoddy science and misinterpretation of the data,” she told ConvergenceRI in a recent interview. “This is a gift to Big Pharma. The American Heart Association has become little more than a propaganda arm of Big Pharma and Big Food. It’s a disgrace.”
Expanding the number of healthy people who take statins by the tens of millions, Roberts continued, “is going to reap a holocaust of adverse effects.”

Holocaust? Isn’t that too strong a word to use?

No,” countered Roberts. “I will stand by that. For example, we may see upward of more than a quarter-million new cases of diabetes as a result. At a minimum, about 10 percent of new users of statins will suffer serious muscle side effects.” In addition, Roberts continued, “We will see increased instances of cognitive dysfunction, nerve damage, liver damage and an increased risk of kidney injury.”

Worse, Roberts said, “Nobody’s life is going to be extended; nobody’s life is going to be saved [by having healthy people taking statins].”

Roberts is not alone in debunking the new guidelines. She pointed to a Nov. 13 op-ed in The New York Times, written by John D. Abramson, a lecturer at Harvard Medical School, and Dr. Rita F. Redberg, a cardiologist at the University of California, San Francisco Medical Center and the editor of JAMA Internal Medicine.

Statins are effective for people with known heart disease. But for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness,” Abramson and Redberg wrote. Based upon the same data the guideline writers relied on, they continued, “140 people in this risk group would need to be treated with statins in order to prevent a single heart attack or stroke, without any overall reduction in death or serious illness.”

Roberts said: “We have a saying in medicine. If you torture the data long enough, it will confess to anything.”

An alternative to statins

Roberts promotes an alternative to statins for most of her patients – a Mediterranean diet that is high in monounsaturated fats from olive oil and is low in red meat. “Adhering to the plant-based Mediterranean diet will lower your risk of heart disease just as much as any use of statins – without any side effects,” she said.

Very few physicians, Roberts continued, will read all 85 pages of the new guidelines. “What people have to do is to become informed patients. They have to read both points of view and come to a decision on their own,” she said. But it’s very important, Roberts said, for people to know that statins are not as innocuous as people have been led to believe.

The numbers in the studies, she reiterated, show that you would need “to treat more than 100 people for a number of years to prevent one event [of a heart attack].”

Further, she argued, “cholesterol is misunderstood. It’s not the villain it’s been said to be. Every cell has cholesterol; 25 percent of cholesterol is in your brain. It’s absolutely crucial to the function of the brain.”

Heart disease is still the number-one cause of death in adults, according to the Centers for Disease Control and Prevention, with more than 597,000 deaths in 2011, according to statistics released in January 2013.

Changes in diet and lifestyle -- as well as what Roberts’ terms “primordial” interventions are the best ways to address chronic heart disease – rather than prescribing statins.

We need to stop subsidizing the production of corn and soy, which are the ingredients in many of the unhealthy foods that are foisted on people,” she said. “We need to try to limit the advertising to children of unhealthy food products such as Cocoa Puffs. We need to raise cigarette taxes even more. And we need to stop eliminating physical education classes.”

Most doctors have swallowed the Kool-Aid

Roberts is been an outspoken advocate against the misuse of statins. “I’ve never turned down a speaking engagement – from Pawtucket to Reykjavík, Iceland.”

Many doctors, she continued, don’t want to hear what she has to say. “They don’t want to hear it so much,” she said.


Because they’ve swallowed the Kool-Aid, most of them,” she said. “I would be happy to talk with them and give them my perspective, that the use of statins is not supported by the medical literature.”

Further, Roberts continued, the fact remains that “we really don’t know the truth about statins. The reason I say that is because we know that a lot of studies that are undertaken never get published.”

Roberts cited a recent British Medical Journal article that showed that for all registered clinical studies, 29 percent of those trials never are published.

It’s much more common for an industry-sponsored study not to be published,” she said. “Industry-sponsored clinical trials are four times more likely to report positive results than non-industry sponsored clinical trials. There could be a lot of studies that showed statins were not efficacious that we don’t know about because they have never been published.”

According to an email received AM of 01/06/17 a representative of Miriam Hospital says that Dr. Barbara Roberts is no longer associated with the hospital.  No reason was given and no other details were offered. 

January 3, 2017

Dietary Sugar Guidelines Based on Low Quality Evidence

Nutritional guidelines restricting sugar intake are not based on high quality science, finds new study led by McMaster University and the Hospital for Sick Children (SickKids). The paper is published in the Annals of Internal Medicine.

The research team conducted a systematic review of nine public health guidelines on sugar recommendations, including those by the influential U.S. Dietary Guidelines for Americans and the World Health Organization (WHO) and found that the recommendations for limiting sugar are based on low to very low quality evidence.

"Although our findings question the recommendations from guidelines produced by leading authorities, the findings should not be used to justify high or increased consumption of nutrient-poor, energy-dense foods and beverages like candy and sugar-sweetened beverages," says Bradley Johnston, principal investigator of the review. Limited sugar consumption still advisable.

"We know that it is healthy and advisable to limit our sugar intake, the question remains to what degree, and if we are limiting our sugar intake what are we replacing the sugar with?"

Official caps on sugars vary widely, from less than five per cent of total daily calories, as recommended by the WHO, to advice from the Institute of Medicine, which suggests the public to limit sugars to less than 25 per cent of total daily calories.

"When respected organizations issue conflicting recommendations it can result in public confusion, and this raises concerns about the quality of the guidelines, and the quality of the evidence that informed the guidelines," says Johnston. He is an assistant professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University; an assistant professor of health policy, management and evaluation at the University of Toronto; and scientist in Child Health Evaluative Sciences at SickKids.

Johnston uses former "low-fat" guidelines as an example: "For 40 years it was advised to eat a low fat diet and, as a result, the food industry and the public looked for ways to lower fat content in foods. What happened is that the fat was typically replaced by simple carbohydrates, which included sugar creating a less than optimal outcome including an associated rise in obesity and diabetes.

"In the case of lowering sugar intake, what is happening is that sugars are often replaced with starches and other food additives like maltodextrine, providing the same calorie count, but often accompanied by an increased glycemic index (and blood glucose levels)."

The research team identified problems with the nutritional guidelines and in particular problems with the research that supported the guidelines' recommendations such as; the inclusion of imprecise or small studies; a high risk of bias from uncontrolled studies; the use of outcome measures such as "nutrient displacement, tooth decay and limited weight gain" that are of lower priority to the public, compared to arguably more important outcomes such as obesity and diabetes; a lack of transparency regarding financial conflicts of interest among groups members who developed the guidelines, and a failure to include patient and public representatives in the panels drawing up the guidelines.

Co-first author, Behnam Sadeghirad, a McMaster PhD student in health research methodology, said, "At present, there does not appear to be reliable evidence indicating that any of the recommended daily caloric thresholds for sugar intake are strongly associated with negative health effects. The results from this review should be used to promote improvement in the development of trustworthy guidelines on sugar intake."

January 2, 2017

Don't Wait to Treat Prediabetes

Prediabetes is defined as impaired glucose tolerance or impaired fasting glucose. Prediabetes is associated with an increased risk of cardiovascular disease and all-cause mortality. This is not something that doctors wish to recognize or discuss, as they are hesitant to give their patients concern about prediabetes.

The risk increased in people with a fasting glucose concentration as low as 100 mg/dl (5.55 mmol/L). A1C of 5.7%-6.5% (39-47 mmol/mol) or A1C of 6%-6.5% (42-47 mmol/mol) was associated with an increased risk of composite cardiovascular disease and coronary heart disease. Lifestyle modification is now the main management for people with prediabetes.

The question comes up after reviewing these studies as to whether we need to lower the cut-off point for defining prediabetes and that we might want to change the definition of prediabetes to a single number and not a range. Most doctors won't even consider this in a discussion of prediabetes.

The health risks and mortality associated with prediabetes seem to increase at the lower cut-off point for blood sugar levels recommended by some guidelines, finds a large study published in The BMJ. Prediabetes is a “pre-diagnosis” of diabetes — when a person’s blood glucose level is higher than normal, but not high enough to be considered diabetes. If left untreated, prediabetes can develop into type 2 diabetes. An estimated 79 million people in the U.S. are thought to be affected.

Doctors define prediabetes as impaired fasting glucose (higher than normal blood sugar levels after a period of fasting), impaired glucose tolerance (higher than normal blood sugar levels after eating), or raised hemoglobin levels. But the cut-off points vary across different guidelines and remain controversial.

For example, the World Health Organization (WHO) defines prediabetes as fasting plasma glucose of 110-125 mg/dl.(6.1-6.9 mmol/L), while the American Diabetes Association (ADA) guideline recommends a cut-off point of 100-125 mg/dl.(5.6-6.9 mmol/L.)

Results of studies on the association between prediabetes and the risk of cardiovascular disease and all-cause mortality are also inconsistent. Furthermore, whether raised hemoglobin A1C levels for defining prediabetes is useful for predicting future cardiovascular disease is unclear.

So, a team of researchers from the affiliated Hospital at Shunde, Southern Medical University in China analyzed the results of 53 studies involving over 1.6 million individuals to shed more light on associations between different definitions of prediabetes and the risk of cardiovascular disease, coronary heart disease, stroke, and all-cause mortality. They found that prediabetes, defined as impaired fasting glucose or impaired glucose tolerance, was associated with an increased risk of cardiovascular disease and all-cause mortality. The risk increased in people with a fasting glucose concentration as low as 100 mg/dl.(5.6 mmol/L) — the lower cut-off point according to ADA criteria.

Raised hemoglobin A1C levels were also associated with an increased risk of cardiovascular disease and coronary heart disease, but not with an increased risk of stroke and all-cause mortality.

The authors point to some study limitations that could have influenced their results, and say pulling observational evidence together in a systematic review and meta-analysis is a good way to consider all the evidence at once, “but we cannot make statements about cause and effect. We would need to look at experimental evidence for that.” However, they say their findings “strongly support” the lower cut-off point for impaired fasting glucose and raised hemoglobin A1C levels proposed by the ADA guideline.

They conclude that lifestyle change — eating a healthy balanced diet, keeping weight under control, and doing regular physical activity — is the most effective treatment at this time.

In conclusion, researchers found that prediabetes defined as impaired fasting glucose or impaired glucose tolerance is associated with an increased risk of composite cardiovascular events, coronary heart disease, stroke, and all-cause mortality. There was an increased risk in people with fasting plasma glucose as low as 100 mg/dl (5.6 mmol/L). Additionally, the risk of composite cardiovascular events and coronary heart disease increased in people with raised A1c, over 5.6%. These results support the lower cut-off point for impaired fasting glucose according to ADA criteria as well as the incorporation A1C in defining prediabetes. At present, lifestyle modification is the mainstay management for people with prediabetes. High risk subpopulations with prediabetes, especially combined with other cardiovascular risk factors, should be selected for controlled trials of pharmacological treatment because at this time we have no FDA-approved medications for prediabetes.

Chief investigator Yunzhao Hu, MD, PhD, professor in the department of cardiology at First People’s Hospital of Shunde in Foshan, China, added that, “The risk increased in people with fasting glucose levels as low as 100 mg/dl and with HbA1c of 5.7%…. So, we believe people with prediabetes should be followed up clinically and keep a healthy lifestyle. Plus, we need to develop models for risk stratification in people with prediabetes, and we need to find a drug treatment that can prevent CVDs in them.”

January 1, 2017

The Internet May Be What the Doctor Ordered

A doctor ordering you to use the Internet? Well, things are changing, some doctors are suggesting this and giving out sites for patients to explore. Several members of our diabetes support group are on the receiving end, and from what I am hearing, the websites are of value. Some of us had visited the sites before the two doctors included them on their list, and we feel much better that the members that did not accept the sites from us are now accepting them.

The sites are a good variety, from nutrition to medications and habits for developing better diabetes management. At least the doctors are not limiting nutrition to only one type, but are promoting several types, but mainly low carb and medium carb. Allen and Barry were surprised when during our last meeting, they heard from two members that had been very set against medium carb and were talking about how they were going lower on medium carb and asked Allen how they could go even lower.

Allen just asked them what they were presently eating and what they wanted to eat. He was surprised when he added up the carbs as they described what they ate and when they stopped, they were about 80 grams and both said they wanted to get to about 50 to 60 grams. Barry said Allen was rather close and he suggested they remove the corn from the menu for both meals and this could bring them to about 55 grams. Allen agreed that would get them to about 55 grams and the small amount of peas from the evening meal could easily have them at about 50 grams.

Allen asked them if they used a scale for the foods and both said they did and said this is the way they calculated to the grams of carbohydrates they were eating. Barry suggested that they should increase the amount of fat when they lowered the amount of carbohydrates. One of the fellows said he would be, but may not increase the amount as much as the other fellow. When Allen asked his why, he said that too much fat caused diarrhea for him and Allen said then he should keep the fat level manageable for his system. Barry also suggested if they went lower they needed to consider increasing their salt intake for about two weeks.

Barry also suggested that they should schedule a nutrition session with Allison to make sure that they had a balanced food plan and not be missing vitamins and minerals the body might become short of in the long term. One said he had done this when they had gone below 100 grams per day and he agreed this would be a good idea when they went below 60 grams per day. Allen thanked them for asking questions and hoped they were happy with the plans. The fellows asked Barry and Allen what the number of grams of carbohydrates they were consuming. Allen said he was eating between 50 and 60 grams per day and Barry said he was between 60 and 70 grams per day.

Then one fellow asked if anyone was eating what is Dr. Bernstein's level at thirty grams. Allen said he had been that low for about six months and found he could not maintain this low a food plan. Not only was he becoming deficient in some vitamins and minerals, but also he was not feeling well near the end of the trial and needs to increase his daily carb intake. Barry said that after Allen's experience, many of the members were very hesitant to go lower than 80 grams of carbohydrates.

The other fellow said this is the explanation he needed and why they ignored us when we were promoting medium and low carb before the doctors had provided them with reading material.