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 3^rd 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.

Retrospective #263: Ice Cream Games

Some time ago we had company over for dinner. I made Ossobuco alla Milanese. Nancy made risotto, Brussels sprouts tossed in olive oil and roasted, and instead of a salad, roasted cauliflower with melted cheese topping. Nancy insisted we 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 look at the prices but I did make sure I was buying ice cream, NOT ice milk. Later, 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. I noticed that the Breyers vanilla was light and easy to dig into; the butter pecan was dense and creamy. The vanilla was thin in taste too; the butter pecan was rich. But the difference passed and the conversation turned to our friend’s recent trip to Tonga to swim with the whales. I was not until next day when I found both containers empty – we call this mysterious disappearance during the night “evaporation” – that I learned the real difference.

According to Wikipedia, a 1994 change in United States Food and Drug Administration rules allowed ice milk to be labeled as low-fat ice cream, “…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.”

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

The Breyers container, it turned out, was one full pint in volume (473ml), but it weighed only 264 grams. The Häagen-Dazs container, on the other hand, although it had the same rim diameter, had a slightly tapered side and was only 414ml, or <9/10s of a pint, but the smaller Häagen-Dazs weighed 397 grams (14 fluid ounces), an astonishing ~50% more than the bigger (by volume) Breyers pint. That difference in weight is in large part due to the air (an ingredient that is not listed on the container) that is entrained in this “low-fat ice cream,” making it light and so 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.

But the real difference is in nutrition. A one half-cup serving of Breyers Vanilla (BV) has 130kcal, Häagen-Dazs butter pecan (HDBP) 300kcal. Thus, 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 37% as much sodium.

So, if reducing your total calories, saturated fat, dietary cholesterol, and sodium are important to you, and you brought your calculator with you to the grocery store, these facts might interest you. But before you make a “product choice,” you should also compare the carbohydrates and sugars and other ingredients (air, water and tara gum).

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 Häagen-Dazs so delicious were deleted in the Breyers in larger proportion than the junk sugars, air, water and thickening agents that were added to Breyers. But you saved money on your “pint.”

Retrospective #262: Should You See a Registered Dietitian Nutritionist?

A Reuters Health Information release I received included the recommendation (of a registered dietitian nutritionist) that “doctors should refer their prediabetic patients to a registered dietitian nutritionist.” She further suggested, “These results [of a prediabetes nutrition therapy trial she led and reported on] further show that medical nutrition therapy should be considered for reimbursement in the treatment of prediabetes to reduce diabetes risk.” A very good idea, I thought, but NOT SO FAST. Let’s first take a look at the “medical nutrition therapy” that she recommended.

“Patients in the INTERVENTION GROUP 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 humble opinion, you should not waste your money on this type of “medical nutrition therapy”. You would do much better to “listen” to your glucometer.

Why? 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 very trial’s accomplishments in a recent post, Retrospective #258. The trial’s 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. The 10% delta does, however, make the very small improvement in the INTERVENTION GROUP look better.

Let’s face it. This RD’s pitch is just an effort to advocate 1) for the government and insurance companies to allow Medicare and other reimbursements for “medical nutrition therapy” and 2) get doctors to send them more business. And under those circumstances, you can’t expect Registered Nutrition Therapists to not follow the “nutrition therapy” that the government and the medical associations recommend, even if they believed otherwise, which they do not!

Business is business, after all, and nutritional therapy service providers have to eat too. Currently, the only way that I know of for patients/clients to get reimbursed by insurance is for the registered dietitian nutritionist to work in a medical doctor’s office.  That is the case, anyway, for obesity counseling services, and that only since 2013. See the Nutrition Debate #146: “Medicare to Pay for Obesity Counseling” for an account of my experience with that. For my cynical take on a related subject, see also, Retrospective #147: “AMA: Obesity is a Disease (for billing purposes).”

You do have an alternative though. If you do your homework, you will seek and find an independent nutrition counselor. My favorite was Franziska Spritzler, RD, CDE, previously blogging as the “Low Carb Dietitian.”  She has since taken full-time work with the Diet Doctor. Franziska in mid-life had changed careers from court reporter to Registered Dietitian and then discovered she was pre-diabetic. She then did her homework and changed her Way of Eating. Afterwards she said, “I'm 47, and thanks to a low-carb lifestyle and gentle exercise, I feel better than I did in my 30s.”

In Franziska’s first blog post back in 2011, one commenter told her, “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 are not open to LC, although there are a few exceptions.”

So, what’s a person to do? There’s no way that a person like me could get certified as an RD. It’s a cabal. I’d have to keep my mouth shut and intentionally give wrong answers to virtually every question on the test. Fat chance of that!  

My advice is to find an on-line group, join it and read the “sticky” post at the beginning to understand the principles they follow and their rules. And then lurk for a few months. Then, after you’ve acquired a basic understanding, join in the questioning. That’s how I got started almost 19 years ago. Most of these groups are very friendly and supportive. The moderators and participants are all living the low-carb and very low carb experience. They know what it’s about.

Retrospective #261: Bad Science Writing (and Editing)

Bad science writing and poor editing doesn’t happen often, but when it does it’s insulting to the discerning reader, not to mention a waste of time. I read maybe a dozen abstracts every week to find good material suitable for my readers. 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 that I was about to pass on it when I saw a comment by the esteemed diabetologist Richard K. Bernstein, MD.

The title in Diabetes-in-Control was, “Non-Caloric Artificial Sweeteners May Induce Glucose Intolerance.” The subject article was in Nature, so I opened the link to see it 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?  Okay, I’m being too picky.

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 was one 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 with additives!) 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 next 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 thinking, poor writing and poor editing.

Then I saw the comment by Bernstein, M.D., F.A.C.E., F.A.C.N, C.W.S., F.C.C.W.S., 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 I was shocked that this awful paper was published in Nature, a highly respected scientific journal, and that Diabetes-in-Control would write it up.

P.S.: If you want to know how your blood glucose reacts to a non-caloric artificial sweetener, use your meter!

Retrospective #260: “Weight Loss Tips from Our Experts”

Tired of my griping? So am I, but it comes with the territory. When your voice is in the minority, and you are trying to educate 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-that-be (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 tips put together by Laurie Scudder, DNP, NP, Executive Editor of Medscape, were pretty good. Not once did I see the words “saturated fat” or “fat,” or “cholesterol.” There was a little more of the “fruits and vegetables” pitch than I would have liked, but it was not her central message. So, take a look at the list. Her slide title was, “Weight Loss Pearls: Helping Patients Help Themselves.” I like it already!

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

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

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

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

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

#5:  Control portion size; use your hand as a measure.

#6:  Help patients cut 100 daily calories per visit. Focus on between-meal snacking, portion control & satiety.

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

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

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

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

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

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

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

#14: “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 last “tip” was my favorite. The “expert” was Christopher F. Bolling, MD, Division of General and Community Pediatrics, Cincinnati Children’s Hospital and Medical Center. 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 I can relate to! That’s how it was with me. My doctor had nagged me for years. His Registered Dietician did too, always with “bad” advice, especially for a long-term Type 2 diabetic: Eat a restricted calorie, one-size-fits-all, “balanced” diet, they told me. This is still the advice of the 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, 17 years ago, I weighed myself at the Fulton Fish Market and discovered I weighed 375 pounds. It was a rough day. 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!” He had read Gary Taubes’s “What If It’s All Been a Big Fat Lie,” a 2002 New York Times Sunday Magazine cover story, tried the diet and lost 17 pounds strictly doing Very Low Carb. He suggested I try it too, so I did, and over a few years I lost 170 pounds.

My motivation to lose weight was “accompanied by a level of confidence that this can actually be accomplished.” Change happened on my timetable. My doctor never had to nag me again. He just smiled when I walked in the door.

Retrospective #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 paper in Aging began. It came to my attention from a link to neurosciencenews.com that a good friend sent me. Hmmm. I wonder why? (LOL) Maybe it was because of this sentence in the abstract, “The results also suggest that cognitive decline may be driven in large part by metabolic processes.” That does interest me.

The successful trial from UCLA and the Buck Institute used a systems approach to memory disorders. 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 is what’s remarkable here. That is indeed rare among MCI patients.

“Since its first description over 100 years ago, Alzheimer’s disease [AD] has been without effective treatment,” the article begins. 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, “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, the authors say.

The 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,” the lead author analogized. So, he used a “novel, comprehensive, and personalized therapeutic program…designed to achieve metabolic enhancement.”

The “metabolic enhancement” part is what interested me. The therapeutic protocol included up to 36 suggestions for the patient to accept (or not). Patient participation in this 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 are quite another thing altogether.

Then there’s the issue of one-treatment-fits-all. The protocol required individualized testing and diagnosis, and the whole treatment protocol was one that anyone could do all or part of. Not every patient was 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. She agreed to follow 25 of the 36 “Goals,” “Approaches,” and “Rationales and References.”

Most of the goals and approaches the doctor recommended are ones that I too have either recommended or aspire to follow myself. Patient One’s included eliminating simple carbohydrates, gluten and processed foods. She also increased vegetables, fruits and non-farmed fish. She fasted a minimum of 12 hours between dinner and breakfast and for a minimum of 3 hours before 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 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 and cycling twice a week.

All 10 patients “presented” with slowly progressive memory loss over various durations, and nine of the ten 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. 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.”

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

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?