Retrospective #258: “Diagnosed diabetics consumed less sugar and carbohydrates…”

The stuff I read online gets my blood boiling sometimes. Example: The headline in Medscape Medical News read, “Diabetes Diagnosis Changes People’s Eating Habits.” Subtitle: “Diagnosed diabetics consumed less sugar and carbohydrates and more protein than their undiagnosed peers, researchers reported in Diabetes Care.”

So, I opened the link to check the source. My finding: This result was entirely self-reported (by 24-hour dietary recall). from among 3725 adults with diagnosed and undiagnosed diabetes or prediabetes who were in a morning fasting group in the 2005-2010 National Health and Nutrition Examinations Survey (NHNES). The diagnosed individuals with diabetes and prediabetes “received a 60-minute session on medical nutrition.” The CDC’s CONCLUSION: “Screening and subsequent knowledge of glycemic status may favorably affect some dietary patterns for people with diabetes.” That’s hardly “conclusive,” but not unreasonable. It certainly would be the hoped-for outcome. Confirmation bias?

What the diagnosed diabetics and prediabetics (who were the only ones who received the “medical nutrition” counseling) said they ate in the self-reported survey became “…may favorably affect some dietary patterns” in the study, and morphed into “Diabetes Diagnosis Changes People’s Eating Habits” in the Medscape headline. Wheew…

“No significant differences in macronutrient intake were found by awareness of prediabetes,” the study concluded. Of course, they meant “self-reported,” not “found,” but the takeaway holds. The medical journalist gets a story, makes a headline, and the “researchers” still get paid to do a worthless, wishy-washy study that concludes “may favorably affect some dietary patterns…” (emphasis added by me) and no doubt calls for more money for further studies.

The headline gives false comfort to practitioners who conclude that counseling patients to eat “healthy foods” as defined by the USDA’s awful Dietary Guidelines – will result in improved health and the avoidance of prediabetes or diabetes. I wish that that were so! In this study, the diagnosed men say they consumed fewer carbohydrates (235g vs. 262g) and more protein (92g vs. 90g) than undiagnosed men.” Those minuscule changes were the outcomes from nutritional counseling based on the government’s guidelines. Diagnosed diabetics still eating 235g of carbs a day!!!

A related study in the Journal of the Academy of Nutrition and Dietetics “shows the importance of nutritional counseling and healthy diets for prediabetics, too.” This research was from a “randomized trial” (RCT), a higher quality study. The RESULT: “People with prediabetes who received a 60-minute session of medical nutrition counseling had significantly lower HbA1c levels 12 weeks later, compared to a usual care group.” Now, that sounds interesting.

“The study involved 76 prediabetic patients with…an HbA1c of 5.7% to 6.4%. The mean values for HbA1c were similar at baseline: 5.99% in the intervention group and 5.95% in the control group. After 12 weeks, however, the mean HbA1c in the nutrition therapy group was 5.79%, compared to 6.4% in the usual care group.”

So, the A1c among those who received “nutritional counseling” decreased from 5.99% to 5.79%, a 0.20% reduction, while the A1c in the control group, who received no nutritional counseling, increased 0.45% from 5.95 to 6.4%. I’m guessing the control group went off on a 12-week Bacchanalian feast, raiding the cookie jar in the name of science.

The results, of course, could have been much more definitive and “conclusive” had the intervention group in both studies been counseled to eat a very different “healthy diet.” As it is, “patients in the intervention group has been encouraged to follow diets that were calorie-restricted and balanced, so that 60-70% of the energy came from carbohydrates and monounsaturated fats, 15-20% from protein, and less than 7% from saturated fat” (my emphasis).

“Carbohydrates and monounsaturated fats” combined? That’s a new one. My editor said, “I think they are trying to creep up on: “fat ‘okay,’ sugar ‘bad’ in a roundabout way to obscure previous errors.” She’s right! And notice which fats are explicitly missing: PUFAs, the vegetable and seed oil polyunsaturated fats that the USDA pushes, that now dominate our processed food supply chain and are increasingly implicated in inflammation and poor health outcomes.

One frustrated Medscape commenter said, “However, I can tell you that a prediabetic diagnosis is discouraging for someone who has exercised regularly for years, has maintained a good diet, and isn’t overweight.” Can you relate?