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.

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