Category Archives: Nutrition

World Diabetes Day 2019

Today is World Diabetes Day, and our post today is the third in our series of diabetes topics this week. Today’s post looks at research on the Dietary Inflammatory Index.

Statistics on diabetes from the World Health Organization are startling, the number of people with diabetes worldwide in 2014 was four times higher than the number of those with diabetes in 1980. It is projected that the number of those with diabetes will increase by 48% by 2045. It is estimated that there are 425 million people with diabetes worldwide. The Marshall Islands have the highest prevalence of diabetes. In the U.S., West Virginia has the highest prevalence of diabetes. Research indicates that obesity, physical inactivity, and poor dietary choices are closely associated with the development of diabetes type 2.

The Dietary Inflammatory Index (DII) was developed in 2009, as a way to measure the role of inflammation induced by diet and nutrition. The DII was updated in 2014. The index was designed to measure a particular individual’s diet with regard to it’s inflammatory potential. The effect of 45 different food and nutrient parameters on inflammatory biomarkers such as IL-4, IL-6, IL-10, and c-reactive protein was analyzed, with inflammatory scores assigned based on extensive research.

A research group from the West Virginia University Department of Family Medicine recently looked at the relationship between the Dietary Inflammatory Index and the presence of diabetes in a sample of adults from the National Health and Nutrition Survey (NHANES). In addition, they examined the relationship between DII and the severity of diabetes.

Over 4400 subjects from the NHANES (2013-2014) were included, 53.5% women and 46.5% men. The results were adjusted for age, alcohol use, BMI, gender, physical activity level, smoking status, and socioeconomic status.

The researchers discovered a significant association between the incidence of diabetes and Dietary Inflammatory Index scores, In addition, there was significant association between the severity of diabetes, and the Dietary Inflammatory Index scores.

High inflammatory diets have been shown to be associated with cardiovascular disease and arthritis. It should probably not surprise anyone that a pro-inflammatory diet is associated with a higher incidence of diabetes as well. The CDC estimates that nearly 1/4 of those with diabetes are not yet diagnosed. Perhaps future research will examine using the Dietary Inflammatory Index to identify those at higher risk for developing diabetes, so that a dietary intervention could be implemented.

Diabetes is one of the leading causes of vision loss among those age 20 and older, and is also one of the leading causes of kidney failure. Perhaps the best way to recognize World Diabetes Day is to carefully consider what one’s daily diet is comprised of, and make some changes going forward to lower the inflammatory potential of the diet. If you are overweight, or have a family history of diabetes, take the step of getting tested for diabetes. 

“I think I can wipe out diabetes.”–  Robert Atkins

(Source- Journal of the American Board of Family Medicine 2019;32:801-806)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Fried Foods Bad for Prostate

September is designated National Prostate Cancer Awareness Month, and September 24th is Prostate Cancer Awareness Day. In recognition of this, today’s post will discuss research which examines the intake of deep fried foods and risk of prostate cancer.

Data from the National Cancer Institute estimates that there will be nearly 175,000 new cases of prostate cancer in the U.S. in 2019, and nearly 32,000 deaths. It is the 2nd most common cancer among men, second only to lung and bronchus cancers. The most common risk factor for prostate cancer is advancing age. Prostate cancer is more common among African-American men, who are twice as likely to die from prostate cancer as white men are.

It has been documented that when immigrants from Asian countries, which generally have low prostate cancer incidence, move to the U.S., their prostate cancer rates increase significantly within one generation, indicating perhaps some dietary or environmental exposure at work.

A group of researchers affiliated with the Fred Hutchinson Cancer Research Center and the School of Public Health at the University of Washington performed an interesting study, examining the relationship between intake of deep fried foods and subsequent risk of prostate cancer. Researchers used data from two population-based case-control studies, comprised of residents of Kings County, Washington. There were slightly over 1500 cases, and nearly as many in the control group. The two groups were similar in age, body mass index, education level, and race.

Participants in the study were given a food frequency questionnaire, which assessed the use of butter, margarine, oil or other fat in cooking. The food frequency questionnaire also queried about intake of doughnuts, french fries, fried chicken, fried fish, and snack chips.

The researchers discovered that compared with the reference intake (less than once per month), intake of doughnuts once per week or more was associated with a 35% increased risk of prostate cancer, while intake of french fries once per week or more was associated with a 37% increased risk of prostate cancer. Similarly, intake of fried chicken once per week or more was associated with a 30% increased risk of prostate cancer, and fried fish had a 32% increased risk.

In addition, the researchers discovered that increased fried food intake was associated with more aggressive prostate cancer. Compared to the reference intake of less than once per month, intake of doughnuts once per week or more was associated with a 38% increased risk of more aggressive prostate cancer, while the intake of french fries weekly or more was associated with a 41% increased risk of aggressive prostate cancer. Similarly, the intake of fried chicken once per week or more was associated with a 30% increased risk of aggressive prostate cancer, while fried fish had a 41% increased risk of aggressive prostate cancer.

Interestingly, there did not appear to be a relationship between intake of snack chips and development of prostate cancer. However, intake of snack chips once a week or more was associated with a 14% increased risk of more aggressive prostate cancer.

It is not entirely clear what is the mechanism between fried foods and prostate cancer. Certainly fried foods are pro-inflammatory, which could be a possible mechanism. Deep fried foods have high levels of advanced glycation endproducts, which are also pro-inflammatory. Another possibility is the substance acrylamide, a known carcinogen, which is found after deep frying common foods. 

It should be no surprise that the foods we eat regularly have an effect on our health, as the old adage “You are what you eat” suggested. This is not a new concept. For instance in traditional Chinese Medicine food is thought to be a form of medicine. So, next time you are reaching for that doughnut, go for something healthy instead.

“Don’t eat fried food, it angries up the blood”– Satchel Paige

(Source- The Prostate, 2013)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

High Glucose a Risk Factor for Dementia

September 21st is designated World Alzheimer’s Day. In recognition of this today’s post will review research on the effects of glucose on dementia.

Alzheimer’s disease is the most common form of dementia. Statistics from the CDC indicate as many as 5 million Americans are currently living with Alzheimer’s disease. This number is expected to reach 14 million people by 2060.

It is important to consider that Alzheimer’s disease is not a normal part of aging. There is currently no cure for Alzheimer’s, so recognition of risk factors as a potential strategy for prevention is important.

A research group affiliated with the University of Washington, the Swedish Neuroscience Institute, Harvard Medical School and Harvard School of Public Health and Wake Forest School of Medicine performed a study examining the relationship between glucose levels and risk of dementia.

Enrollees for the study were selected from the Adult Changes in Thought study, which consisted of randomly selected members from Group Health Cooperative in Washington State. These members were all considered to be dementia-free. There were 2067 participants, 839 men and 1228 women, whose mean age was 76 years.

Study subjects were assessed every two years to look for incident cases of dementia. The Cognitive Abilities Screening Instrument was used. Average glucose levels were calculated for each subject at initiation into the study, and then in 5 year rolling periods thereafter. Mean follow-up period was nearly 7 years.

The researchers discovered that among those subjects with diabetes, those with higher levels of glucose had increased risk for dementia. For example, the risk for dementia was 40% higher in those with average glucose of 190 mg/dl compared to 160 mg/dl. 

Even more important, among the subjects without diabetes, those with an average glucose level of 115 mg/dl had an 18% higher risk of dementia compared to those with an average 100 mg/dl glucose level.

The last result bears repeating, in participants WITHOUT diabetes, a 15 mg/dl difference in glucose (115 vs 100) led to an 18% increased risk of dementia. This particular result may indicate that early interventions to lower blood glucose, while one is still in the insulin resistance stage and not advanced into full blown diabetes, may lower the risk of dementia.

At this time there is no cure for dementia. Alzheimer’s disease and dementia in general have a profound impact not only at the individual level, but also on the individual’s caregivers. Perhaps incorporating a low-carb lifestyle may be a strategy to prevent future dementia.

“The power of intuitive understanding will protect you from harm until the end of your days.”–     Lao Tzu

(Source- New England Journal of Medicine, 369.6)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Triglyceride/HDL Ratio Predicts Diabetes in Men

September is National Cholesterol Education Month, and in recognition of this today’s post will discuss research examining the relationship between certain lipid parameters and the development of diabetes.

Statistics from the CDC indicate more than 100 million American adults have total cholesterol levels above 200 mg/dl , with more than 35 million having total cholesterol levels above 240 mg/dl.

A research group from China examined the triglyceride to high density lipoprotein cholesterol (TG/HDL-C) ratio as a possible independent predictor for development of diabetes.

There were nearly 12,000 participants enrolled in the retrospective study, 53% men, 47% women, with a mean age of 44 years. The participants were followed on average for three years.

The research revealed that a high TG/HDL-C ratio has a positive correlation with risk of diabetes in men. Interestingly this ratio did not show correlation with the female subjects

This is a large study, with a huge number of subjects. It shows that the TG/HDL-C ratio may well be an independent predictor of diabetes, at least among men. Triglyceride and HDL levels are commonly measured during routine lab work, and are therefore easy to obtain. As this study was undertaken in a relatively homogeneous population in China, it would be helpful to undertake a similar study among a more diverse population, such as in the U.S. 

A high TG/HDL-C ratio provides us with another parameter to consider as we analyze routinely ordered lipid panels, and perhaps gives an early indication of those who may be at risk for diabetes.

“The devil has put a penalty on all things we enjoy in life. Either we suffer in health or we suffer in soul or we get fat.”– Albert Einstein

(Source- Journal of Diabetes Investigation, 2019)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discus any health concerns with your personal physician.

 

Sugary Drinks Increase Risk of Cancer

In a study published three weeks ago, researchers from France looked at the relationship between the consumption of sugary drinks and the risk of cancer.

The average American consumes about 45 gallons of soda each year. An average 12 ounce can of soda contains upwards of 40 grams of total sugar, or about nine teaspoons of sugar.

A population-based prospective cohort study was completed with over 100,000 subjects from the French NutriNet-Sante study. Participants were 18 years of age and older, with a predominance of women (79%) to men (21%). Mean age at baseline was 42 years.

The sugary drink group consisted of energy drinks, fruit drinks, sodas, sports drinks, 100% juice drinks, among others. Consumption of sugary beverages was assessed by 24 hour dietary records. Association of beverage intake and risk of overall, breast, colorectal, and prostate cancer was assessed.

The researchers found that there was a positive association between the amount of sugary drink intake, and risk of overall cancer and breast cancer. Also, when looking specifically at 100% fruit juices these were also positively associated with risk of overall cancer.

Interestingly, the researchers did not find an association between artificially sweetened beverage consumption and the risk of cancer.

The researchers suggest several possible mechanisms by which sugary drinks may increase cancers risks. These include obesity, increased visceral fat, higher glycemic index, and increased pro-inflammatory markers.

This is a solid study, which included nearly 80,000 women. This study demonstrates how a simple dietary intervention, in this case limiting sugary beverages including 100% juices, may potentially have a meaningful impact on our health. Perhaps next time you are reaching for a soda, grab a glass of water instead.

“I can remember a reporter asking me for a quote, and I didn’t know what a quote was. I thought it was some kind of soft drink.” –  Joe DiMaggio

(Source- BMJ 2019; 365:12408)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Blueberry Juice May Lower Blood Pressure

July 8th is National Blueberry Day, and out of respect for this tasty fruit today’s post will review a study which examined the effects of wild blueberry juice in a group of adult women at high risk for diabetes mellitus type 2.

Both wild and cultivated blueberries are native to North America. Depending on altitude, latitude and weather the peak of the blueberry crop can vary from May to August. In the US there are many blueberry festivals which celebrate this delicious fruit. In places like Bethlehem PA, Burgaw NC and South Haven MI, among many others, blueberry lovers gather to celebrate.

The skins of the blueberries contain anthocyanins, which have anti-oxidant properties. Wild blueberries have one of the highest levels of anti-oxidants among fruits and vegetables. In the U.S., Maine is the largest producer of lowbush or wild blueberries, and produces over 100 million pounds annually.

A group from Canada and the U.S. performed a study examining the effects of wild blueberry juice on various cardiometabolic markers. The study population had at least two risk factors for type 2 diabetes, and thus were higher risk.

The study design was a randomized trial, with a placebo control. The subjects drank 240 ml of juice made from lowbush (wild) blueberries, while the control group drank a placebo beverage which was color and flavor matched to the blueberry juice. The blueberries were harvested from Prince Edward Island, Canada. Participants drank the blueberry juice daily for a week, followed by an eight day washout period. Following that workout period, the study group became the control group and vice versa.

Several cardiometabolic markers were monitored during the course of the study, such as serum cholesterol, HDL, LDL, triglycerides, glucose, endothelial function, c-reactive protein, serum amyloid, among others. Vital signs included blood pressure were also monitored.

19 participants, all women, completed the study. The researchers discovered that while the wild blueberry juice did not significantly change cardiometabolic markers, it did lower systolic blood pressure 4.8 mm Hg (4%) compared to the placebo group. While a 4.8 mm Hg reduction in systolic blood pressure may not sound substantial, it is estimated that a reduction of only 3 mm Hg may reduce mortality from heart disease and stroke by 5-8%. 

Drinking the blueberry juice for only 7 days was probably not long enough to effect any significant change on metabolic markers. A longer study seems reasonable given the promising results of this study. This does appear to be a low-risk way to improve one’s health. 

“The smallest seed of faith is better than the largest fruit of happiness.”– Henry David Thoreau

(Source- BMC Nutrition 2017 3:45)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Blueberries and Metabolic Syndrome

July 8th is designated National Blueberry Day, and in recognition of this delicious fruit today’s post will examine a study just published in June on the effect of blueberry consumption on cardiovascular risk factors.

The US is the world’s largest producer of blueberries, producing more that twice the tonnage of blueberries annually than the 2nd largest producer, Canada. The largest blueberry producing state is Washington, followed by Georgia, Michigan and Oregon. Low bush or wild blueberries, and high bush or cultivated blueberries, are all native to North America. Many of the beneficial properties of blueberries are thought to be due to their anthocyanins. Anthocyanins are water-soluble pigments which may appear black, blue, purple or red. Plants rich in anthocyanins include black rice, blueberries and raspberries. Anthocyanins have anti-oxidant properties.

A research group from the UK and Harvard looked at the relationship between blueberry consumption and its effect if any on insulin resistance and markers of cardiometabolic function. A random controlled double blind study was performed, with 138 enrollees, randomly assigned to one of three groups- a group which consumed the dietary equivalent of one cup of fresh blueberries each day, a second group which consumed a dietary equivalent of 1/2 cup of fresh blueberries each day, while the third group consumed a placebo. It is important to note that the study subjects had all been diagnosed with metabolic syndrome and were overweight or obese. The study enrolled both men and women, ages 50-75.

The study lasted six months. The researchers discovered that while metabolic syndrome markers were not significantly changed by blueberry consumption, the group that consumed one cup of blueberries per day did show improvements in HDL (“good cholesterol”), endothelial function, and systemic arterial stiffness. It was estimated that a 13% reduction in future cardiovascular events was possible in the one cup per day group.

This is an important study, with one of the longer study periods (six months) completed to date. The study population had significant health issues, including metabolic syndrome and was older. Although the intervention did not change the insulin resistance numbers, it is possible that the study intervention was simply not long enough.

Metabolic syndrome is a cluster of conditions including elevated blood pressure, excessive fat around the waist, elevated triglyceride levels, and decreased HDL. Individuals with metabolic syndrome are at higher risk for heart attack and stroke, and metabolic syndrome is thought to be a precursor for Diabetes Mellitus Type 2.

Here is a well-designed study showing the benefits of a simple dietary intervention on metabolic syndrome. Next time you are considering something for dessert or a snack, put the cake, cookies and ice cream away and reach for blueberries instead. And buy local if possible, and support our farmers and propagators.

“There are eyes, to be sure, that give no more admission into the man than blueberries.”-    Ralph Waldo Emerson

(Source- American Journal of Clinical Nutrition 2019; 109)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Eat Your Veggies- Help Your Heart

In recognition of registered dietician nutritionist day, our post today will look at how some dietary factors impact cardiovascular health.

A recent study examined a group of Swedish women and their dietary habits. Nearly 39,000 women completed a 96 item food frequency questionnaire. The questionnaire asked about how certain food or beverages had been consumed over the prior year. Researchers then calculated estimates of the total antioxidant capacity of each respondents diet. Four categories including fruit and vegetable consumption, whole grain consumption, and coffee consumption were used. The participants in the study were followed for approximately ten years. Women in the highest ranking group of total antioxidant capacity of diet, compared to the lowest ranking group, had a 20% lower risk of a heart attack.

This study is an interesting one as it examines a group of women. Women have been typically underrepresented in medical research. This was also a large study of nearly 39,000 subjects, and large is better in this regard.

Finally, which one of us has not encouraged our children to “eat more vegetables”? Now we can add that it is good for their heart as well!

“I eat more vegetables than the average vegetarian.”– Dr. Robert Atkins

(Source- American Journal of Medicine, Vol 125, No. 10, Oct. 2012)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Worried About Your Heart? Don’t Skip Breakfast!

Today’s post is another in recognition of American Heart Month. Many of us can recall being reminded by our mother to “eat your breakfast” when we were young, usually as teenagers. It turns out that as is usually the case, mom was giving us good advice.

An interesting study from a research group primarily located in Spain and the US used data from PESA (Progression of Early Subclinical Atherosclerosis) and looked at the association of breakfast styles and cardiovascular risk factors and the presence of subclinical atherosclerosis.

The PESA study is an ongoing observational investigation of over 4000 employees who work at the Bank Santander Headquarters in Madrid, Spain. Female and male participants in the study were ages 40-54, and were free from cardiovascular disease at the time of enrollment in the study. The participants were asked to complete a computerized food questionnaire, which included over 800 food items. Based on this data the “energy consumed during breakfast” was calculated.

Three different categories of breakfast patterns were established. First were the “breakfast skippers”, whose breakfast intake did not exceed 5% of the their total daily energy intake. The next category was the “low energy” breakfast group, who consumed between 5% and 20% of their total daily energy intake at breakfast. The third group was the “high energy” breakfast group which consisted of those who consumed more than 20% of their total energy intake at breakfast. Of the over 4000 study subjects, 3% were in the “breakfast skipper” group, 69% were in the “low energy” group, and 28% were in the “high energy” breakfast group.

Ultrasound was used to assess for atherosclerotic plaques in the carotids, the abdominal aorta, and the illiofemoral arteries. The prevalence of subclinical atherosclerosis for the PESA subjects was 62.5% in the “breakfast skippers” group, 60.3% in the “low energy” group, and 13.4% in the “high energy” group.

Importantly, regularly skipping breakfast was associated with 2.57 higher odds for generalized atherosclerosis, and 1.55 higher odds for noncoronary atherosclerosis, independent of traditional cardiovascular risk factors (such as diabetes, high cholesterol, high blood pressure, and smoking).

So, make some time in the morning for breakfast. It turns out mom was right, again.

“Sometimes I’ve believed as many as six impossible things before breakfast”. Lewis Carroll

(Source- Journal of the American College of Cardiology, Vol. 70, No. 15, 2017)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Adding Sugar Increases Cardiovascular Events

February is National Heart Health Month. In honor of heart health, and Valentine’s Day, this post is about cardiovascular disease

In this study published in JAMA Internal Medicine in 2014 researchers looked at the effect of added sugar in the American diet and its relationship to cardiovascular disease. Participants who consumed 17-21% of calories from added sugar had a 38% higher risk of cardiovascular mortality, compared to those who only consumed 8% of calories from added sugar. For those who consumed 21% or more of calories from added sugar, the relative risk was doubled.

Much of the added sugar in the American diet is from soda, other sources include desserts, fruit juices and candy. Just one soda a day constitutes 7% of the total calories of a 2000 kcal/day diet.

The reason for increased cardiovascular risk with increasing sugar intake is probably due to several causes, such as obesity, increased blood pressure, worsening cholesterol, and higher inflammation in the body.

This is a robust study which looked at data from the National Health and Nutrition Examination Survey (NHANES) which is felt to be a nationally representative sample of US adults. It provides more solid evidence of the harms of sugar and simple carbs to cardiovascular health. Happy Valentine’s!

“Wherever you go, go with all your heart.”  Confucius

(Source- JAMA Internal Medicine, April 2014, Volume 174, Number 4)