The Obesity/Diabesity Pandemic – Solutions?

Obesity is a major risk factor for the development of the most common form of diabetes mellitus, type 2, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system. It has now become a pandemic since it meets the definition: (of a disease) prevalent over a whole country or the world.

Globally: Source: Lancet

• Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
• Diabetes is fast becoming a major problem in low and middle-income countries.
• From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
• Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.
  

So what are some possible solutions for the future?  

The standard American diet (SAD) is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking. .

Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half; In people over 60, the reduction was 70%.

Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why healthy foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high school levels by returning to a totally revamped and modernized home economics course in the curriculum. Involving students in their nutrition education is key.

A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.

Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program. If the medical community was more involved in increasing access to prevention programs or other options, more attention might be paid by individuals in seeking these treatments. In other words, people listen to their doctors.

There should be an increased number and access to professional treatments. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or a new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced.

We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.

Educate the public on food labeling, ingredient lists and marketing techniques. Beware of food companies that promote products with a “health halo” meaning exaggerated claims are made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling. For example they may include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.

Stop corporate-government partnerships and lobbying influences.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by a myriad of food companies including Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another annual fee. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may contain high levels of sodium. Researchers from the Harvard School of Public Health (HSPH) found that eating processed meat, such as bacon, sausage or processed deli meats, was associated with a 42% higher risk of heart disease and a 19% higher risk of type 2 diabetes. May 17, 2010

Bottom Line: It will take a concerted effort from government, politics, industry, communities, and other perpetrators of our obesigenic culture to begin to change this disturbing trend and prevention is the key. It may take decades; however, there has to be a beginning.

Preventing Diabetes Type 2

English: The blue circle is the global symbol for diabetes, introduced by the International Diabetes Federation with the aim of giving diabetes a common identity, supporting existing efforts to raise awareness of diabetes and placing the diabetes epidemic firmly in the public spotlight. (Photo credit: Wikipedia)

Do you have pre-diabetes?  A lot of people do not know they do.   Many can prevent full-blown diabetes type 2 by making some lifestyle changes in diet and exercise habits.  For more information, see the article HERE. 

See my previous post HERE.

 

Bringing Back Cooking?


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If only more people would be able to cook, think of the healthy benefits that would bring to our food culture.  Highly processed and convenience foods have invaded our food supply since the  middle 20th century and have grown in into a giant we now refer to as “BIG FOOD”.  Just visit the local supermarket and visit the vast section of freezer cases.  It used to be that frozen vegetables were the main component but now there are so many complete dinners of every kind – many loaded with fat, sugar and salt and boasting a list of ingredients  that fills most of the product label.  A closer look at these packages allows us to have an almost unlimited choice of Chinese, Italian, vegan, Thai and Indian cuisines.  But what have these highly processed culinary “delights” done to our health?  We now have the highest rates of obesity in history and along with this comes expanding rates of diabetes type 2, liver abnormalities (fatty liver disease), a set of symptoms now referred to the “metabolic syndrome” and expanding waistlines.  It’s not just fast food to blame, but our food production has gone out of  control.    We buy cookbooks, watch cooking shows, but end up buying the very kinds of food that only require heating with the microwave oven. Cooking at home can help to reverse some of these trends.

Here is an interesting article discussing some of the reasons we don’t home cook more often.  Good lessons HERE.

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• Can’t Lose Weight? You May Have Metabolic Dysfunction

Artificial Sweetener Dangers?

diet coke, diet soda, diet pepsi, diet drinks

English: Diet Coke Products (Photo credit: Wikipedia)

I used to think that a diet drink was harmless but no more.  I must admit to consuming one for breakfast (shameful for a nutritionist), but that habit stopped years ago.  Now I am extra glad I did.  No one knows just how many of these drinks contribute to metabolic derangement including diabetes type 2 discussed in the article below.  I just received a research briefing from the Pancreatic Cancer Action Network with the following news:  “Up to two-thirds of pancreatic cancer patients experience the onset of diabetes in the three years prior to their cancer diagnosis.” Therefore, it may be prudent to check your intake and limit them considerably, i.e., moderation, moderation, moderation!

CLICK HERE.

The Mediterranean Diet and Diabetes Prevention?

Large olive tree – Portugal (Photo credit: Wikipedia)

Does the Mediterranean Diet reduce the risk of developing diabetes type 2?
A new study published in the Annals of Internal Medicine suggests that it might. The Mediterranean Diet has been extensively studied for its health benefits which include reducing heart disease, cancer, dementia,  hypertension and stroke risks.

Researchers studied 3,541 men and women without diabetes who ranged in age from 55 – 80 years old.  They were however, at a high risk for heart disease.  All participants were assigned to either a Mediterranean diet with 50 ml of extra – virgin olive oil (EVOO), a Mediterranean diet with 30 grams of mixed nuts, or a low-fat diet each day. Those consuming the Mediterranean diets were counseled by dietitians.  All participants were not told to reduce their calories or to increase exercise.

After 4 years of follow-up, it was determined that 273 of the patients had developed diabetes type 2.  Of these, 101 were  from the low-fat group; 80 were from the Mediterranean diet with extra EVOO and 92 were from the Mediterranean diet with extra nuts.  There were only slight changes in body weight, waist circumference, and physical activity between the groups.

The authors concluded: Following a Mediterranean diet is “palatable and sustainable”, therefore it could have public health implications for the prevention of diabetes.

There is no one particular Mediterranean diet, but can include diets that emphasize increased consumption of fruits and vegetables, beans and fish while decreasing consumption of red meats, processed meats, butter and sweets.  A previous post of mine graphically shows how to eat a more Mediterranean-type diet.  Enjoy!!

Best and Worst of Food Marketing to Our Children

Obesity (Photo credit: Paulo Fehlauer)

If you’re interested in food policy in relation to our national eating disorder, obestiy, visit the Yale Rudd Center website for all kinds of news and information.  Food marketing to children is a hot topic these days. For specifics, follow the link in a news item called “Food Marketing to Youth: The Best and the Worst of 2012”.

Childhood obesity has both immediate and long-term effects on health and

Immediate health effects:

• Obesity in childhood increases the risk factors for heart disease such as  high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease.
• Prediabetes is more prevalent in obese adolescents increasing the risk for full-blown diabetes, type 2.
• There is a greater risk for bone and joint problems, sleep apnea, and social and psychological problems leading to a low level of self-esteem.

Long-term health effects:

• Obese children and teens tend to be obese adults. One study showed that children who became obese as early as age 2 were more likely to be obese as and obese adults are more at risk for heart disease, type 2 diabetes, stroke, some cancers, and osteoarthritis.
• Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma  and Hodgkin’s lymphoma.

CLICK HERE.

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Diabetes Type 3? A Serious Concern

Diabetes Mellitus (Photo credit: anaxolotl)

A report on a new study raises some more concerns about our current diabetes epidemic.  Not only do we need to treat effectively  those diagnosed with diabetes, but pay more attention to those with pre-diabetes, in other words, diabetes type 2 prevention.   Diane Kress, RD, CDE has an interesting approach to this problem and offers some good advice to those who want some practical suggestions.

CLICK HERE.

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• FYI: Diabetes Facts

Brain Food?

Dementia or what is called cognitive decline becomes more common with age. Nutrition research on diet and brain health has been sparse until now.   It is generally assumed that what is good for the heart is also good for the brain. So what else do we know so far?  It is thought that dementia of any type begin or are exacerbated either by one or more of the following processes:

• Chronic inflammation
• Damage by free radicals
• Excess blood glucose levels that fuel high insulin levels

Inflammation:  Do Fats Matter?  

The healthier fats such as monounsaturated and some polyunsaturated fats such as omega-3 fats  help improve brain function and have anti-inflammatory properties.  So olive oil, sesame oil, walnut oil and flax seed oil are the preferred oils.  Fish, avocado, and all nuts and seeds such as ground flax seed also contain a high percentage of mono-and polyunsaturated fats.   Some research has found that the healthier fats may also be protective against Parkinson’s disease.

A study of 270 older adults and found those who ate fish at least once a week – baked or broiled, not fried – had a greater volume of gray matter in the brain in areas important in Alzheimer’s disease.  Fish consumption was also associated with sharply lower rates of developing mild cognitive impairment or dementia.  Only 3.2% of those with the highest fish intake and greatest preservation of gray matter were found to have developed mild cognitive impairment or dementia compared to the 30.8% of non-fish eaters who’d suffered cognitive decline

Free Radicals – Bring on the Antioxidants

Consuming more antioxidants in foods may reducing the damaging effects of free radicals – supplements have not produced their promised results.  We meet free radicals every day from our own bodies (immune system, energy production, iron reactions, exercise) as well as from the environment (cigarette smoke, pollutants and pesticides, radiation, UV light, ozone).

Antioxidants are best found in highly colored fruits and vegetables and most plant foods. In the Nurses Health Study, women who ate the most fruits and vegetables had a slower rate of cognitive decline than women who were not eating many of either.

Reducing Blood Sugar and Insulin – Go Complex, Avoid the Simple (Carbs)

If the blood sugar remains high (hyperglycemia), diabetes type 2 will cause long-term damage to eyes, kidneys, heart and blood vessels.  People with type 2 diabetes have a greater risk of developing cognitive decline and dementia.

Choose unrefined carbohydrates (whole grains) and limit refined carbohydrates (white foods – rice, pasta, white bread). These foods generally cause a rapid rise in blood sugar and insulin pours into the blood.  Excess levels of either blood glucose or insulin can damage nerve cells and promote fat storage.

There are other areas of research in diet and brain health worth noting.

Homocysteine is an amino acid and its involvement in brain health is still a topic of ongoing research since results have been inconsistent.   High levels have been linked to heart disease, stroke and dementia.  Eating foods higher in folate and vitamin B12 assist in DNA synthesis and ultimately help to maintain healthy nerve cells.

Calorie Restriction.  Ongoing research on calorie restriction may yield some clues to keeping the brain young.   Italian researchers found a molecule called CREB1 that was triggered by calorie restriction and that it mediates the beneficial effects of the diet by turning on another group of molecules linked to longevity, the “sirtuins”.  This finding is consistent with the fact that CREB1 is known to regulate important brain functions as memory, learning and anxiety control.  The bottom line: overeating may cause brain aging and eating less may help keep the brain young.

Choline Could Help Keep Your Brain Sharp .  Choline is a nutrient related to the B vitamins and is found in egg yolks, chicken, milk, fish, peanut butter, potatoes, cauliflower, tomatoes, banana, oranges, whole gains, sesame and flax seeds along with the food additive lecithin.  Tufts researchers analyzed data on 1400 people aged 36 to 83 from the Framingham study.  They completed questionnaires and then took memory and cognitive tests and underwent MRI scans.  Those with the highest dietary choline intake did better on the tests and were less likely to show areas of “white-matter hypersensitivity” in the brain, possible signs of blood vessel damage linked to dementia.

Research on diet and dementia needs to be increased;  however, it is becoming increasingly hopeful that dietary factors although not curative can play a role in maintaining brain health as we age.

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Small Lifestyle Changes Reduce Heart Disease

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Metabolic syndrome is a condition in which the person has poor blood glucose regulation, hypertension, increased blood triglycerides, and other health problems.  This condition is usually accompanied by obesity, lack of physical activity, and a diet high in refined carbohydrates.  

Causes, incidence, and risk factors

Metabolic syndrome is becoming more and more common in the United States. Researchers are not sure whether the syndrome is due to one single cause, but all of the risks for the syndrome are related to obesity.

The two most important risk factors for metabolic syndrome are:

• Extra weight around the middle and upper parts of the body (central obesity). The body may be described as “apple-shaped.”
• Insulin resistance, in which the body cannot use insulin effectively. Insulin is needed to help control the amount of sugar in the body. As a result, blood sugar and fat levels rise.

Peole who have metabolic syndrome often have two other problems that can either cause the condition or make it worse:

• Excess blood clotting
• Low levels of inflammation throughout the body

This profile raises the risk of heart disease and diabetes type 2 and about 20-25% of Americans are so affected.  On a positive side, premature heart disease is rare in people who have low LDL-cholesterol, have normal blood pressure, and do no smoke or have diabetes.  In other words, develop and follow a total lifestyle plan.

Making simple dietary changes, losing a few pounds, and adding a little light exercise to our daily routine can significantly lower your risk factors for diabetes and heart disease. A Finnish study found that even small lifestyle changes helped reduce abdominal obesity and metabolic syndrome by as much as 15%.

The researchers looked at data on 522 overweight men and women, average age 55 at the start of the study, who also showed impaired glucose tolerance – indicating a risk for diabetes.

Half of the participants received regular, individualized advice designed to help them reduce their weight by at least 5% – through increasing their intake of whole grains, vegetables, fruits, and low fat diary and meats.  They were also counseled to spend at least 30 minutes a day in light exercise such as walking, jogging, swimming, aerobics and/or weight training.

The other participants were only given written and oral advice about diet and exercise at the start of the study and at their annual check-ups only.

The subjects were followed for an average of almost four years.  The men and women who received the more rigourous ndividualized counseling and follow-up reduced their abdominal fat and metabolic syndrome occurrence by 15%, an especially promising result among a population already overweight and showing signs of elevated diabetes risk.

Those who received just general diet and exercise advice, however, did not reduce their flab at all, and decreased their rate of metabolic syndrome by just 4%.

These results highlight the importance of “individualized, patient-centered counseling and regular follow-up, easily provided by a a qualified nutritionist. To read more about diabetes prevention in the community, click here.

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From Fish to Nuts – Controlling Diabetes

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Diabetes Facts:

• In contrast to the 2007 National Diabetes Fact Sheet, which used fasting glucose data to estimate undiagnosed diabetes and prediabetes, the 2011 National Diabetes Fact Sheet uses both fasting glucose and A1C levels to derive estimates for undiagnosed diabetes and prediabetes. These tests were chosen because they are most frequently used in clinical practice.
• Among U.S. residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010.
• About 215,000 people younger than 20 years had diabetes—type 1 or type 2—in the United States in 2010.
• About 1.9 million people ages 20 years or older were newly diagnosed with diabetes in 2010 in the United States.
• In 2005–2008, based on fasting glucose or hemoglobin A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had pre-diabetes—50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults ages 20 years or older with pre-diabetes.
• Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the United States.
• Diabetes is a major cause of heart disease and stroke.
• Diabetes is the seventh leading cause of death in the United States.

Two recent studies investigated specific diet components – one nut intake and one fish intake on the risk of developing diabetes and controlling blood glucose levels.

Nuts as a Replacement for Carbohydrates in the Diabetic Diet.

OBJECTIVE Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA_1c in type 2 diabetes.

RESEARCH DESIGN AND METHODS A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA_1c.

The mixed nuts were a combination of raw almonds, pistachios, walnuts, pecans, hazelnuts, peanuts, cashews, and macadamian nuts.  The mixed nut group had the greatest improvement in blood glucose control when measured by the glycosylated hemoglobin (Hb1c) test.  They also had a significant decline in LDL (“bad” cholesterol).  The other two groups had no significant improvement in Hb1C, but the muffin-nut mixture significantly reduced LDL cholesterol in the blood.

Dr. Jenkins, the lead author of they study said: “Those receiving the full dose of nuts reduced their HbA1c (the long-term marker of glycemic control) by two thirds of what the FDA recognizes as being clinically meaningful for therapeutic agents.  Furthermore, neither in the current study nor in previous reports has nut consumption been associated with weight gain.”

D. J. A. Jenkins, C. W. C. Kendall, M. S. Banach, K. Srichaikul, E. Vidgen, S. Mitchell, T. Parker, S. Nishi, B. Bashyam, R. de Souza, C. Ireland, R. G. Josse. Nuts as a Replacement for Carbohydrates in the Diabetic Diet. Diabetes Care, 2011; DOI: 10.2337/dc11-0338

Dietary Fish Linked to Lower Risk for Type 2 Diabetes in Men

The second study was a prospective study to see if there was an association between fish intake and type 2 diabetes in Japanese adults.  22, 921 men and 29, 759 women aged 45-70 years old non-diabetics completed a survey and a food frequency questionnaire (147 food items).  Over a 5-year period, 971 new cases of type 2 diabetes were self-reported (572 men and 399 women).  Fish intake as significantly associated with a reduced risk for the development of type 2 diabetes in men but not for women.

Previous studies have linked the presence of environmental contaminants to an increased risk of diabetes.  The authors proposed that the women in this study had a higher body fat mass, which can accumulate these contaminants and possibly negate the benefits of fish intake on glucose control.

There were some obvious limitations in this study, the authors noted.  There was a lack of data concerning the cooking methods of the fish or the contamination level of the fish consumed.  There was only a one time dietary recall and all the data was self-reported as often found in diet studies of this type.

Nevertheless, study results often find gender differences.  If this is truly the case in this study, it suggests that one-diet-fits-all approach is not always the answer.  Future diet recommendations will hopefully be able to be more individualized and personalized to take into consideration the variety of confounding biological factors affecting diet and health.

American Journal of Clinical Nutrition; Published online July 20, 2011.