Saturday, November 29, 2014

The Nutrition Debate #266: “Food Therapy for Metabolic Syndrome”

The banner on my smart phone was, “Food Therapy for Metabolic Syndrome,” but when I read it on my laptop, the title of this Diabetes in Control piece had morphed into “The Impact of Mediterranean Diets on Metabolic Syndrome.” Okay, I don’t shill for the Mediterranean Diet, or any other, but I do support the idea of “food therapy,” and I am very interested in how diet can affect all aspects of Metabolic Syndrome, a dysfunctional metabolic state that is present and unrecognized in increasing numbers in the population. I have written about it numerous times starting with The Nutrition Debate #9.

The piece begins, “Metabolic Syndrome is characterized by risk factors that increase an individual’s chances for cardiovascular disease. These risk factors include obesity, hypertension, high cholesterol and uncontrolled blood glucose. In addition to cardiovascular disease, those with Metabolic Syndrome are at increased risk for type 2 diabetes.” One problem: The digest piece incorrectly shortens to 4 risk factors and mischaracterizes the definition of Metabolic Syndrome; the full text paper correctly describes its components as 5 risk factors and specifically includes high triglycerides and low HDL cholesterol, not “high cholesterol.” By definition, you have Metabolic Syndrome if you present with at least 3 of these risk factors.

What I liked about this digest piece was the clear message the study design sends. The low fat diet, that is the one our government and all our medical societies want us to eat, is the control diet; it is the one that the two different Mediterranean diets are being compared to. And guess what? Both Mediterranean diets fare better than the control. Another nail in the coffin of the low fat diet, folks! Even a diet of “fruits, nuts and seeds,” and that is high in MUFAs, monounsaturated fat (from olive oil and nuts), and low in saturated fat, is better than a low fat diet.

The two Mediterranean diets being compared to the low fat diet were supplemented with olive oil and nuts respectively, provided free by the Spanish producers. Each randomly selected sample of several thousand people consisted of “older participants at high risk of cardiovascular disease,” and each diet group regularly “completed a 14-item questionnaire to assess adherence to the intervention” – eating the free liter per week of olive oil or the 30 grams per day of free walnuts, hazelnuts and almonds, and other “fruits, nuts and seeds.”

“Participants were not advised on calorie restriction, and physical activity was not promoted for any intervention group.” The folks were just “community-dwelling men and women between 55 and 80” years of age with “no previously documented cardiovascular disease and… who had either type 2 diabetes or at least 3 cardiovascular risk factors,” according to the study design published in the Canadian Medical Association Journal. Hmmm, that’s interesting. The patriotic (chauvinistic?) ulterior motive of the Spanish government, the Spanish “medical researchers” (from all over the Iberian peninsula) and the Spanish olive oil and nut producers is clear, but the Canadian Medical Association? I guess they just want to help the Spanish interests promote the Mediterranean diet too.

Okay, let’s take a closer look at the RESULTS: “Over 4.8 years of follow-up, Metabolic Syndrome developed in 960 (50%) of the 1919 participants who did not have the condition at baseline. The risk of developing Metabolic Syndrome did not differ [emphases both added] between participants assigned to the control diet and those assigned to either of the Mediterranean diets.” As stated in the DISCUSSION, “...the recognized protective effect of the Mediterranean diet was not enough to prevent [again, emphasis added] Metabolic Syndrome in our study population.” Hmmm. Then what’s the upside?

However, “Reversion [emphasis added] occurred in 958 (28.2%) of the 3392 participants who had Metabolic Syndrome at baseline. Compared to the control group, participants on either Mediterranean diet were more likely to undergo reversion (control v. olive oil: HR [hazard ratio] 1.35; control v. nuts: HR 1.28).” Reversion is good, right? Well, maybe. It’s a “statistics” thing. Read closely this DISCUSSION in the full text, and you decide.

“(A) Mediterranean diet supplemented with extra-virgin olive oil was associated with a smaller increase in the prevalence of Metabolic Syndrome compared with advice on following a low-fat diet. Thus, the smaller increase in prevalence was likely due to reversion. Because there were no between-group differences in weight loss or energy expenditure, the change is likely attributable to the difference in dietary patterns” [all emphases added].

“We found the Mediterranean diet supplemented with extra virgin olive oil to have the most beneficial effect on central obesity and hyperglycemia.” And, “an isocaloric Mediterranean diet rich in extra-virgin olive oil prevented accumulation of central body fat compared with a low-fat diet, without affecting body weight.” Thus, “Participants assigned to the Mediterranean diets were significantly more likely to no longer meet the criterion of central obesity compared with those in the control group.” In other words, it conferred a benefit: Ergo, give up low-fat; eat more MUFAs and lose belly fat.
Of course, if they had eaten a LCHF diet (including more saturated fat), they would similarly have reduced their truncal obesity, and dramatically raised their HDL cholesterol (#67) and lowered their serum triglycerides (#68) too, both additional risk factors for Metabolic Syndrome. And they’d surely have lost weight and had lower blood glucose. In other words, LCHF confers a benefit with all 5 risk factors!

Wednesday, November 26, 2014

The Nutrition Debate #265: “Let’s Start with Food”

A new TV commercial targeted to people with type 2 diabetes begins, “Now I’m ready for someone to listen to me.” I didn’t get the pitch at first, but it had a few things I can relate to: 1) my goal (and hope) in writing this blog is that people will “listen to me,” 2) I share the speaker’s frustrated tone, and 3) I like the inference that people with type 2 diabetes should “take charge” and be more involved in their own management plan. The pitch all became clear to me, though, with the name of the web site,, and the sponsor of the advertisement, AstraZeneca, a drug maker.

Then the voiceover says, “Let’s start with food.” I like that too. The pitch makes each one of us important…and a unique individual. That’s good marketing, and it picks up on the most recent clinical guidance from the ADA, and I quote: “It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.” The ADA has now declared, in effect, that low-carb diets are an appropriate “eating pattern” for people with type 2 diabetes. Zowee! The Fit2Me folks have obviously read the ADA Position Paper and are attempting to cash in.

So, to learn more, I decided to sign up. It is a well designed interactive website where you provide a little information, and then you pick a “counselor” to choose your style of mentoring. You then choose, with clicks, 1) the foods, 2) activities (exercise) and 3) treatment plan just for you. I answered all their questions and was automatically put into a bi-monthly Sweepstakes program!  I “liked” certain foods and “disliked” others. The result, I was told, was over 1,000 recipes (from over 10k) that fit my “likes.” I “liked” zero (0) “activities,” but that did not seem to deter my mentor.

Then I went back to the food and recipes section. It also is very well designed with a keyword search function and a list of 7 additional search dropdown boxes for things like meal, type of cuisine, type of dish, time to make, serving, style and main ingredient. I searched on “eggs” and got over 100 recipes, 12 (each with picture) on a page. I clicked on #12, “Sweet Southern Egg Salad,” (132 calories, 6 carbs) to get more details. Among my food choices I had previously selected “gluten free,” and the picture showed two brown slices, top and bottom, that looked suspiciously like pumpernickel bread, so I wondered how that could be? And while I was glad to see carbs listed with calories, how could this recipe have only 6?

Well, obviously, it couldn’t. And the “bread” (if that what is was) was not included in the recipe ingredients. Neither was the green leafy veggie under the top slice, but, I said generously, it’s a start-up website, so maybe I should cut them some slack. Then, I read the preparation instructions. It calls for 8 eggs (for 4 servings), but throws out (or sets aside), 4 of the yolks. Yikes! Okay, I’m starting to get the drift here. The secret agenda – well, not so secret if you draw inferences – is that they follow ADA protocol, which follows AHA protocol, which follows the USDA Dietary Guidelines on dietary cholesterol.

Further evidence of that is the choice of “non-fat” plain yogurt and “low-fat” mayonnaise for the recipe. The Nutrition Facts panel has all the required items plus a few more like “exchanges” and “carb servings” for the yo-yo dieters out there who have tried and failed repeatedly to permanently lose weight. Interestingly, the required “Total Fat” and “Saturated Fat” are there, and it also includes “Monounsaturated Fat” which is not required. That no doubt is designed to appeal to the Mediterranean Diet followers. Another clever inclusion, but how about polyunsaturated fats?  They’re not included!!!

You can’t blame AstraZeneca or their diet consultants. It is the USDA that’s way behind the curve here, and they are between a rock and a hard place. How can you constantly demonize saturated fat to the point where red meat is verboten and full-fat dairy is getting harder and harder to find in the store, and not include polyunsaturated fats (PUFAs) in your eating pattern? Besides, the USDA’s Dietary Guidelines expressly extols PUFAs, while strongly condemning saturated fats, linking them like conjoined twins with artificial trans fats. That only leaves monounsaturated fats unscathed. And frankly, how much olive oil can a person eat?! Anyway, this recipe has 3g of PUFA per serving vs. 2g SFA and 2g mono.

So, while this is a very nice interactive website, and it’s easy to get sucked in, it has its limitations. You can, however, change and limit your dietary preferences to select foods and reshuffle the deck for more recipes. And you can also substitute full-fat versions in the recipes you like, but, alas, the software won’t recalculate the calories and grams of fat. ;(
Anyway, it will be interesting to see if they pitch a medication regimen to me as my next doctor’s appointment approaches. They did ask me for the date and offered to remind me. Another feature (I think) of this innovative interactive application.

Saturday, November 22, 2014

The Nutrition Debate #264: “Quiz: Which Foods Affect Diabetes?”

I know I kvetch a lot, but you take this quiz at Medscape Medical News and see if you wouldn’t kvetch about their answers to the 8 questions posed on this “web resource for physicians and medical professionals.” is owned by WebMD and covers news and information for almost 2-dozen specialties, as well as CMEs (Continuing Medical Education).

The first question will illustrate, I think, that my caviling is justified:

Q.   Increasing fruit consumption has been recommended for primary prevention of many chronic diseases.

       Which of these fruits is specifically associated with reducing the risk of developing diabetes?

a.       Blueberries

b.      Strawberries

c.       Oranges

d.      All of the above

e.      None of the above

Okay. Problem #1: Something that is good for “many chronic diseases” doesn’t mean it is good for a type 2 diabetic who is by definition carbohydrate intolerant. Let face it, this medical advice, “increasing fruit consumption,” is what the entire population is told to eat, regardless of medical condition.” It is in conformance with the government’s Dietary Guidelines-one-size-fits-all approach to “healthy eating”. The narrative justifying the “correct” answer (blueberries) goes on to mention grapes (although noting their high glycemic index), as reducing diabetes risk. It also touts apples, bananas and grapefruit. I’m surprised it didn’t include cherries, raisins and figs, all higher still in sugars!

I’ve read the research “associating” certain fruit with lower risk of diabetes, but these observational studies are bad science and just confirm the bias of the researcher’s observations, which taken together with so many other confounding factors, such as socio-economic variables, makes them worthless. (Note - the quiz provides references to the studies, if you want to look into this in more detail.) And while it is true that blueberries do contain phytochemicals, etc., and fiber, they also contain a lot of sugar, much more than strawberries, for instance. I answered the question with “d” (All of the above). It was the “wrong” answer, PC speaking, but I know it was right for me. If you have a problem with giving up most fruit, I urge you to read #138,Fruit, the 3rd Rail for Prospective Low Carbers.”    

The last question in the Medscape quiz confirms the disingenuousness of the whole piece, but at least this answer takes a swipe (by comparison) with the “low-fat diet.” On that, we agree.

Q.    Which of these diets is the most effective for diabetes primary prevention in people with cardiovascular risk?

a.       Mediterranean diet supplemented with extra-virgin olive oil

b.      Mediterranean diet supplemented with nuts

c.       Low-fat diet

d.      All of the above showed similar benefits on diabetes prevention in this population.

The “correct” answer is “a.” Medscape explains: “Among these 3 diets, only the Mediterranean regimen enriched with extra-virgin olive oil reduces significantly the risk for T2DM, and actually cuts it by about one third compared with a low-fat diet.” There’s another nail in the coffin of the low-fat diet, but how much better the study would have been had it compared the “Mediterranean diet supplemented with extra-virgin olive oil” with a LCHF (low-carb, high-fat) diet. Huh?

“In summary,” Medscape concludes, “There is no recommendation for a specific diet to prevent T2DM, although the American Diabetes Association has advised people with diabetes to focus on overall healthy eating patterns and personal preference.” Their foot-noted source for this is another Medscape piece, “New ADA Guidelines focus on ‘eating patterns,’ not ‘diet.’” I wrote about this in The Nutrition Debate, beginning with #155,“Cowabunga, the ADA makes the turn,” but as I noted (#156) it was “written by, for and from the perspective of the Medical Nutrition Therapist; It was not ( #157) prepared by clinicians, though it was commissioned and endorsed by the ADA Executive Committee.

I took another optimistic look at this momentous shift in #167, “An Editorial: ‘Making the Turn.’” As I reread my earlier take, I am reminded that every yin has its yang. The glass is both half full and half empty, depending on how you look at it.
So, perhaps my kvetching is just an attempt to balance the scale – to teach physicians and medical professionals that the foods that affect diabetes are CARBOHYDRATES. And that, It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes (from #155). I am but one of hundreds (1,000s?) of bloggers and millions of adherents to a low-carb Way of Eating, who out of choice or medical necessity have adopted a low-carb “healthy eating pattern” that is now endorsed by the ADA. Don’t believe me? Read their Position Paper.

Wednesday, November 19, 2014

The Nutrition Debate #263: Ice Cream Games

Recently we had company over for dinner. I made Ossobuco alla Milanese. Nancy made risotto using Arborio rice, Brussels sprouts tossed in olive oil and roasted, and roasted cauliflower with melted cheese topping. Nancy insisted we had to have a dessert, so she made an apple crisp and sent me out to the store to buy a pint of ice cream. I thought one pint would not be enough for 4 people, so I bought two. Maybe I was hoping there’d be leftovers…

I bought what I thought were two premium pints: Breyers vanilla and Häagen-Dazs butter pecan. I didn’t pay any attention to the prices. I just made sure I was buying ice cream, not ice milk. After paying, though, I looked at the receipt and noticed that the Breyers was less than half the price of the Häagen-Dazs. Interesting, I thought. Breyers must be on sale. WRONG!

When it came time for dessert, I passed on the apple crisp and served myself a spoonful of vanilla and a spoonful of butter pecan. The Breyers vanilla was light and easy to dig into; the butter pecan was dense and creamy and hard. The vanilla was thin in taste too; the butter pecan was rich. But the distinction passed and the conversation turned to our friend’s recent trip to Tonga to swim with the whales and their pups. I was not until the next day when both containers were emptied – we call this mysterious disappearance of leftover ice cream “evaporation” (tee, hee) – that I learned the real difference.

A 1994 change in United States Food and Drug Administration rules allowed ice milk to be labeled as low-fat ice cream, according to Wikipedia. “…based in part on a petition filed jointly by the Milk Industry Foundation (MIF) and the Center for Science in the Public Interest (CSPI), and a petition filed by the American Dairy Products Institute (ADPI),” designed to “promote honesty and fair dealing in the interest of consumers; increase flexibility for manufacturers of lower-fat dairy products; and increase product choices available to consumers.” See the HHS Final Rule Summary published here.

The problem is the ice cream I bought was NOT labeled low-fat ice cream. It was simply labeled “Ice Cream.” Apparently there has been another, later change in FDA rules, or Breyers is breaking the rule. But the labeling of this product does not “promote honesty and fair dealing” and is not “in the interest of consumers.” I can see, however, where it does “increase flexibility for manufacturers of lower-fat dairy products and increase product choices available to consumers.”

The Breyers container, to be fair, is one full pint in volume (473ml), and it weighs 264 grams. The Häagen-Dazs container, on the other hand, although it has the same rim diameter, has a slightly tapered side and is only 414ml, or <9/10s of a pint. But, the Häagen-Dazs weighs 14 fluid ounces (397 grams), or ~50% more than the bigger Breyers pint. That difference in weight is in large part due to the air that is entrained in this “low-fat ice cream,” making it light and easy to dig into.

The ingredients, and the order listed, tell another part of the story. Breyers vanilla: milk, cream, sugar, natural flavor, tara gum. Note, milk, listed first, is 88-89% water. Häagen-Dazs butter pecan: vanilla ice cream, cream, skim milk, sugar, corn syrup, egg yolks, salt, vanilla extract, roasted pecans, pecans, coconut oil, butter, salt. That explains why, when I finished the vanilla, just 24 hours after first opened, it tasted like hoar frost – like it had been in the freezer for many months.

But the real difference is nutrition. A one half-cup serving (gee, one pint was enough for 4 people, LOL) has the following:

Amount per 1/2 cup
Breyers vanilla
Häagen-Dazs butter pecan
    Calories from fat
Total Fat
    Saturated fat
    Trans fat
Total Carbohydrates
    Dietary Fiber

The Breyers vanilla has only 43% as many calories and only 30% as many calories from fat. The Breyers also has only 32% as many grams from total fat and only 40% as many grams of saturated fat; And only 25% as much dietary cholesterol and only 37% as much sodium. So, if reducing your consumption of saturated fat, dietary cholesterol, and sodium are important to you, and you studied these nutrition facts (and brought your calculator with you to the grocery store), these facts might interest you. But before you make a “product choice,” you should also check out the carbohydrates and sugars.
The Breyers vanilla still had 70% as many carbohydrates and 82% as much sugar as the rich, creamy Häagen-Dazs. In other words, the quality ingredients that made the product so delicious were deleted in larger proportion than the junk sugars and thickening agents (tara gum). But you saved money on your pint, if you like to eat hoar frost for that “special treat.”

Saturday, November 15, 2014

The Nutrition Debate #262: Registered Dietician Nutritionists. Should you see one?

A Reuters Health Information release on my Medscape diabetes alert recently included the recommendation of a registered dietician who led a prediabetes nutritional therapy trial that “doctors should refer their prediabetic patients to a registered dietician nutritionist.” She further suggested, “These results [of the prediabetes nutrition therapy trial] further show that (medical nutrition therapy) should be considered for reimbursement in the treatment of prediabetes to reduce diabetes risk.” NOT SO FAST, I say. Let’s take a careful look at the “medical nutrition therapy” recommended.

“Patients in the intervention group [emphasis added] had been encouraged to follow diets that were calorie-restricted and balanced, so that 60-70% of the energy came from carbohydrates and monounsaturated fat, 15-20% from protein, and less than 7% from saturated fat. They also received a pedometer and diary to record the number of steps taken and minutes of physical activity completed each day,” the release said. In my opinion, you should not waste your money on this brand of medical nutrition therapy. IMHO, you would do much better to listen to your glucometer.

MY CONCLUSION: The medical nutrition therapy recommended in this prediabetes nutritional therapy trial was the same standard, one-size-fits-all, USDA's Dietary Guidelines diet that all Americans eat a balanced diet and exercise more. Ugh!

(Readers may recall that I lambasted this trial’s accomplishments in a recent post #258: “Diagnosed diabetics consumed less sugar and carbohydrates…”. The outcome was a 3% improvement in A1c in the intervention group and a >7% worsening in the “control” group. The worsening in the control group suggests to me an “out-of-control” Epicurean feast of Sybaritic dimensions… BUT it makes the small improvement in the intervention group look so much better, doesn’t it.)

Let’s face it. This RD’s pitch is just a very thinly veiled effort to 1) get doctors to send them more business and 2) for the government and insurance companies to allow Medicare and other reimbursements for “medical nutrition therapy.” You can’t expect them to do otherwise than to recommend the “nutrition therapy” that the government and the medical associations themselves recommend. Such a mutually beneficial relationship – the perfect mother and daughter symbiosis. 

But business is business, after all, and nutritional therapy service providers have to eat too. Currently, the only way that I know of that their patients/clients can get reimbursed by insurance is for them to work in a medical doctor’s office.  That is the case, anyway, for obesity counseling services, and that only since a year ago. See The Nutrition Debate #146: “Medicare to Pay for Obesity Counseling” (9/25/13) for an account of my experience with that. For my cynical take on a closely related matter, see also, #147: “AMA: Obesity is a Disease (for billing purposes)” (9/28/13).

You do have an alternative. If you do your homework, you will seek (and hopefully find) an independent nutrition counselor. My favorite is Franziska Spritzler, RD, CDE, the Low Carb Dietitian, who blogs and has a private nutrition counseling practice on the Southern California coast. She changed careers in mid-life from court reporter to registered dietitian and then discovered she was pre-diabetic. She did her own homework, and then changed her Way of Eating. Now, she says, “I'm 47, and thanks to a low-carb lifestyle and gentle exercise, I feel better than I did in my 30s.”

It’s tough, though. In her first blog post back in 2011, one commenter said, “I'd like to earn a Master's in an ADA-approved program, but am concerned my views about low-carb would create problems with faculty.” Franziska agreed, saying, “Well, I didn't have those views when I went through my didactic nutrition program, so it wasn't an issue for me. But from what I've heard most nutrition professors (and other students) are not open to LC, although there are a few exceptions.”

Kris Gunnars at Authority Nutrition has published a list of 17 Low Carb and Paleo Doctors (MDs) with blogs as well as a list of 11 Paleo and Low-Carb Registered Dietitians (including Franziska). There’s also an organization of CDEs (Certified Diabetes Educators) who reject the American Diabetes Association (ADA) balanced nutrition meme and espouse low-carb nutrition, but I can’t think of their name! Somebody please help me to promote this small band of warriors who believe that “healthy eating” does not include a diet that’s loaded with carbohydrates (both simple sugars and refined complex ones) and highly processed polyunsaturated fats from seed oils, including soy bean oil, corn oil and canola oil.

So, what a person to do? How could someone like me get certified as an RD and hope to reform such an organization from within? It’s a cabal. I’d have to keep my mouth shut and intentionally give wrong answers on every test. Fat chance of that!
Have you seen an RD?

Wednesday, November 12, 2014

The Nutrition Debate #261: Non-Caloric Artificial Sweeteners (NAS)

Bad science writing and poor thinking don’t have to go together, but when they do it’s insulting to the discerning reader, not to mention a waste of time. I read literally dozens of précis and abstracts every week to find good material suitable for my readership. Most don’t cut it – they’re either too arcane or just hum-drum repetition – and I simply pass them over. This one was so bad, on so many counts, that I was about to pass, and then I saw the comment by Richard K. Bernstein, MD

The title in Diabetes-in-Control was, “Non-Caloric Artificial Sweeteners May Induce Glucose Intolerance.” The subject is controversial, so I looked to see if this one had anything new to add to the discussion. The sub-head suggested it did: “Consumption of non-caloric artificial sweeteners seems to induce glucose intolerance in mice and human (sic) by altering gut microbiota.” The gut part – a trendy subject itself – was a new twist, so I decided to read on.

“Many studies has showed…” the third sentence began. Two errors: wrong number (singular) and wrong past particle in the progressive tense. Okay, nobody’s perfect. Maybe the anonymous writer of this particular newsletter piece for medical professionals is not a native English speaker, but don’t they have an editor? I do. Okay, I’m being picky, and a little smug.

How about a lack of clarity? In the second paragraph, try to make sense of these sentences: “Also to correlate findings in obese patients, mice were fed high fat diet while giving them NAS or pure sucrose as a control. This also showed that mice developed glucose intolerance that were on commercial saccharides.” I don’t know where to begin! 1) Correlate humans to mice? 2) Feed mice fat (rather than carbs) to make them fat? 3) “Pure” sucrose? Is there any other kind? 4) And check out the syntax of the second sentence: How about, “Mice that were on commercial saccharides developed glucose tolerance.”

I know. This is not a blog about English grammar, punctuation and syntax. It’s about how “gut microbiota may mediate NAS-induced glucose intolerance.” There’s one short paragraph devoted to that. I quote it here, verbatim, in its entirety:

“Gut microbiota may mediate NAS-induced glucose intolerance. Fecal transplantation was performed to test this theory, where transferring the microbiota configuration from mice on normal-chow diet drinking commercial saccharin or glucose as a control into normal-chow-consuming germ-free mice. Mice consuming commercial saccharin that received microbiota exhibited impaired glucose intolerance compared to mice consuming glucose after 6 days of fecal transplantation (P<0.03).”

Hmmm. “…commercial saccharin or glucose as a control…” This time it’s commercial saccharin or glucose. Last time “NAS or pure sucrose.” Sucrose, as my readers know, is only 50% glucose. The other 50% is fructose. And this time it’s “commercial saccharin” (a specific chemical compound) vs. “commercial saccharides” that was the sweetener tested. And how can “commercial saccharin or glucose” both be controls? And do I understand that the mice who received “commercial saccharin” exhibited IGT while the mice who consumed glucose did not? And do they mean “after 6 days of fecal transplantation” or do they mean “6 days after fecal transplantation.”?

The Diabetes-in-Control piece then goes on to describe two entirely different short and long term experiments of NAS in humans. It doesn’t say how long the long-term study is – only that it is ongoing and involves 381 non-diabetics. The short term study involved 7 people for 7 days. The summation drew an audible chuckle from this reader: “Overall, results from short and long-term human NAS consumer cohorts suggest that individual have personalized response to NAS depending on differences in their microbiota function.” Huh?!! There was no mention whatsoever of fecal implantation in the Diabetes-in-Control write-up of either human experiment.

The last sentence was the pièce de résistance: “NAS consumptions seems to increase in the obesity and glucose intolerance.” That is a verbatim quote. No typos (on my part). Just poor writing, poor editing and poor thinking.

Then I saw the comment by Bernstein, M.D., F.A.C.E., F.A.C.N, C.W.S., FCCWS, author of “Diabetes Solution.”

“They used brand name powdered sweeteners that were all 96% sugars but were labeled zero calories. At least 1 brand (Sweet and Low) used glucose. So they were testing sugars rather than artificial sweeteners.”

So, am I piling on? Maybe so. Do I bask in the reflected glory of the venerable Dr. Bernstein? Sure. We (those of us with impaired glucose tolerance) all venerate him. But would I have bothered to write this up if he had not commented on it. Probably not, because, without a subscription, I only had access to the ABSTRACT on which this précis was based. But I was shocked, shocked, to learn where this paper was published. You will be too: in Nature, a prominent scientific journal.

N.B.: The abstract in Nature is a good read. Its CONCLUSION: “Collectively, our results link NAS consumption, dysbiosis and metabolic abnormalities, thereby calling for a reassessment of massive NAS usage.” That sounds reasonable to me.
If you want to know how your BG reacts to a non-caloric sweetener, use your meter!

Saturday, November 8, 2014

The Nutrition Debate #260: “Weight Loss Tips from Our Experts”

Tired of my griping? So am I. I don’t want the reputation, but it comes with the territory. When your voice is in the minority, and you are trying to educate people (type 2s, pre-diabetics, the overweight and obese, and just about the whole human race) about “healthy eating,” and your message is contrary to what is held as “perceived wisdom” by all the power sources (government, the medical establishment, big pharma and agribusiness), you’re constantly griping about their message. Besides, I am predisposed to be a contrarian. A newspaper editor once asked me to write a “Country Curmudgeon” column.

So, when I read the subject line on my Medscape Medical News feed, I assumed, wrongly as it turns out, that I was being fed more bad advice by “our experts.” Turns out, the 15 tips put together by Laurie Scudder, DNP, NP, Executive Editor of Medscape, are very good. Not once did I see the words “saturated fat” or for that matter “fat,” or “cholesterol.” There was a little of the “more fruits and vegetables” pitch, but it was vestigial, not the central message. So take a look. The slide presentation title is “Weight Loss Pearls: Helping Patients Help Themselves.” I like it already!

#1:  The title page; introduces “the most successful clinical gems to help overweight and obese patients.”

#2:  Strategize for initial success: success at 1 month “was the strongest unique predictor” of 12mo. weight loss.

#3: “The Basics,” they bear repeating: “Eat Real Food, Watch Portions, Turn TV off, Sit Down to Eat.”

#4:  “Eliminate sugary beverages (regular soda & fruit drinks); also white flour snacks (cookies, cakes, pizza).

#5:  “Avoid the middle aisles at the grocery store, where you find ‘junk’ and processed foods.”

#6:  Control portion size; use your hand as a measure. (The examples I called “vestigial” messages are here.)

#7:  Help patients cut 100 daily calories per visit. Focus on between-meal snacking, portion control & satiety (nuts, fruit).

#8:  Write an exercise prescription; “Encourage patients to do any exercise they love on a consistent basis.”

#9:  Don’t forget mental health; Depression is strongly associated with weight gain, often accompanied by carb craving.

#10:  Set a start date that is meaningful, get a partner to do it with you, and announce it to friends and family.

#11:  Don’t leave patients alone; frequent visits, follow-up by nursing staff, and group visits all correlate with success.

#12:  Reinforce the “healthy lifestyle” message: more fruits/veggies; less screen time; more exercise; fewer sugary drinks.

#13:  Dedicate 2 min. each visit to nutrition; pick 1 very specific topic to address, set a goal & follow up. Show you care.

#14:  Each patient is unique so approach each holistically; determine which factors play a role in individual’s weight.

#15: “Remember that your role is to be an assistant to your patient. Do not get discouraged when they do not take your advice to change behavior.”  This “tip” was my favorite. The “expert” was Christopher F. Bolling, MD, Division of General and Community Pediatrics, Cincinnati Children’s Hospital and Medical Center. I think Dr. Bolling missed his calling. He should have specialized in “Non-surgical Bariatric Medicine.” His further excellent expert advice was as follows:

“The major lifestyle change required for weight loss occurs when it reaches a level of importance in someone's life and is accompanied by a level of confidence that this change can actually be accomplished. In other words, change will happen on the patient's timetable, not that of the healthcare provider. He encourages clinicians to think of their role as that of a close friend who doesn't nag. ‘Be there and be helpful when your patient is ready to act. Until then, be patient.’”

Boy, that is a clinical gem! Why do I say that? Because that’s how it was with me. My doctor had nagged me for years. And when he had a registered dietician on staff, she did too, always with “bad” advice, especially for a long-term type 2 diabetic: Eat a restricted calorie, one-size-fits-all, “balanced” diet, as (still) recommended by the entire public health establishment, and exercise more. Needless to say, when I tried it, I failed to lose weight or keep off what weight I did lose. I was hungry.

Then one day 12 years ago, I weighed myself at the Fulton Fish Market (on a commercial scale because my doctor’s scale only went to 350 pounds) and discovered I weighed 375 pounds. “It was a rough day,” as Marie says in the TV commercial. Losing weight finally “reached a level of importance” for me. A few days later, when I walked into my doctor’s office for a regular check-up, he greeted me with, “Have I got a diet for you!” Turns out he had read Gary Taubes’s “What If It's All Been a Big Fat Lie” in the New York Times a few months before and had lost 17 pounds following Atkins Induction. He suggested I try it. I did.  I lost 170 pounds, and I’ve kept most of it off after 12 years.
My motivation to lose weight was “accompanied by a level of confidence that this change can actually be accomplished.” Change happened on my timetable, and my doctor never had to nag me again. He just smiled when I walked in the door.

Wednesday, November 5, 2014

The Nutrition Debate #259: Cognitive Decline: Driven by Metabolic Processes?

“Cognitive decline is a major concern of the aging population, and Alzheimer’s disease is the major cause of age-related cognitive decline,” the research paper in Aging began. It came to my attention through an article at that a good friend sent me. Hmmm. Perhaps it was because of a sentence in the abstract, “The results also suggest that, at least early in the course, cognitive decline may be driven in large part by metabolic processes.” That does interest me.

What interested the journal Neuroscience was that this small, anecdotal and successful trial from UCLA and the Buck Institute used a systems approach to memory disorders. The story: “Memory Loss Associated with Alzheimer’s Reversed for First Time.” Nine of the ten participants in the study “displayed subjective or objective improvement in their memories beginning within 3-to-6 months after the program’s start. Significantly, the abstract states, “Improvements have been sustained, and at this time the longest patient follow-up is two and one-half years from initial treatment, with sustained and marked improvement.” This sustained improvement cannot be overemphasized.

“Since its first description over 100 years ago, Alzheimer’s disease [AD] has been without effective treatment,” the article states. Putting it in ‘medicalese,’ the paper states, “Neurodegenerative disease therapeutics has been, arguably, the field of greatest failure of biomedical therapeutics development.” Dale E. Bredesen, the author of the study, suggests that that is because Alzheimer’s is a complex disease, and a single, target-based pharmacotherapy approach is inadequate. Whereas, Bredesen argued, “Therapeutic success for other chronic illnesses such as cardiovascular disease, cancer and HIV has been improved by the use of combination therapies.” A new approach to treating early AD, therefore, is needed, he says.

Bredesen’s approach is based on the understanding that Alzheimer’s is initiated by an imbalance in nerve cell signaling, a biologic function that could be ameliorated by a systems type approach. “Imagine having a roof with 36 holes in it, and your drug patched one hole very well – the drug may have worked, a single ‘hole’ may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much,” Bredesen analogized. So, he employed a “novel, comprehensive, and personalized therapeutic program…designed to achieve metabolic enhancement…”

The “metabolic enhancement” part, as I said, is what interested me in particular. Bredesen’s therapeutic protocol included, apparently, up to 36 suggestions for the patient to accept (or not). This is where the rubber hits the road since patient participation in this therapeutic program is required. That’s not surprising. Prescribing a pill is one thing. Getting the patient to take it is another, and major lifestyle changes quite another altogether.

Then there’s the issue of one-treatment-fits-all. If it didn’t require individualized testing and diagnosis, and the whole treatment protocol was one that anyone could do (all or part of) without even seeing a doctor, why would one bother to go to the trouble (and expense) of seeing one? Okay, call me cynical. One thing is clear, though: not every patient was either 1) “prescribed” all “36” treatment protocols or 2) agreed to do all that he or she was found to be needing. Patient one, for example, “following an extended discussion of the components of the therapeutic program… began on some but not all the system. Table 1, which patient one followed, included 25 such “Goals,” “Approaches,” and “Rationales and References.”

And what was most interesting to me was that many if not most of the goals and approaches the doctor recommended are ones that I too have either recommended or aspire to myself. Patient one’s included eliminating simple carbohydrates, gluten and processed foods from her diet. She also increased vegetables, fruits and non-farmed fish, and to reduce stress she began yoga and meditation. She fasted a minimum of 12 hours between dinner and breakfast and for a minimum of 3 hours between dinner and bedtime, and increased her sleep to 7-8 hours per night. In addition, she took melatonin, Vitamins B12 and D3, fish oil and CoQ10. She exercised for a minimum of 30 minutes, 4-6 days per week.

Patient two agreed to 12 of the protocols, again including elimination of simple carbohydrates and processed foods from his diet, increasing consumption of vegetable and fruits and limiting consumption of fish to non-farmed and meat to grass-fed beef or organic chicken. He also followed the fasting guidelines with the goal to “increase autophagy and ketogenesis.” And he took a slew of vitamins, minerals and herbals, and exercised strenuously, swimming 3-4 times a week, cycling twice a week, and running once a week.

Altogether, all 10 patients “presented” with slowly progressive memory loss over various durations, and nine of the ten, who adhered to their therapeutic programs, saw sustained “improvement in their memories beginning within 3-to-6 months after the program’s start.”

One commenter summed it up best for me: “When people are used to relying on pills, they often rebel against taking control of their own health. They want simple solutions. Of course the benefits outweigh the hassle of embracing a multi-faceted health regime. But it amazes me (as a practitioner) how difficult it can be for people to understand this. Older people in particular are very attached to dietary habits. It’s a difficult adjustment.” But the benefits outweigh the hassle…

Now, if I could just remember who was that good friend who suggested I read this research, and why…