Thursday, November 7, 2019

Retrospective #264: “Quiz: Which Foods Affect Diabetes?”

I know I kvetch a lot, but you take the food quiz posted at Medscape Medical News and see if you wouldn’t kvetch about their answers on this “web resource for physicians and medical professionals.” Medscape is owned by WebMD and covers news, information and CMEs (Continuing Medical Education) for almost 2-dozen specialties.
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. 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. FRUITS ARE CARBOHYDRATES. Increasing fruit consumption is what the entire population has been told to eat, regardless of medical condition. It is in conformance with the government’s Dietary Guidelines, a 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 fruits with lower risk of diabetes, but these observational studies are bad science and just confirm the “healthy user” bias of the participants, which combined with so many other confounding factors, such as socio-economic variables, makes them worthless. And while it is true that blueberries do contain healthy phytochemicals, they also contain a lot of sugar, much more than strawberries, for instance. If you have a problem with giving up most fruit, read Retrospective #138, “Fruit, the 3rd Rail for Prospective Low Carbers.”    
The last question was just more of the same, but at least it takes a swipe at 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 Low Carb High Fat diet.
“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.” I reported this in Retrospective #155, “Cowabunga, the ADA makes the turn.” It was written by Medical Nutrition Therapists, not clinicians, but it was commissioned and endorsed by the ADA Executive Committee.
So, perhaps my kvetching is just an attempt to balance the scale – to teach physicians and medical professionals that the foods that affect Type 2 diabetics 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.
I took another look at this momentous shift in Retrospective #167, “An Editorial: ‘Making the Turn.’” As I reread it, I was reminded that every yin has its yang. The glass is both half full and half empty, depending on how you look at it.

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