Sugar and Diabetes

Introduction

It seems as if many theories about nutrition take hold in popular culture as a function of our human tendency towards word association.

The old belief, held by many even today, that eating fat will lead a person to become fat is probably partly rooted in the words we use. However this belief is somewhat misguided (calories are the main dietary determinant of weight loss, not fat), so why did it catch on? Well, would so many people have clung fervently to the idea that a low-fat diet should be the go to for weight loss had we called the fat on our bodies “adipose tissue” as it is so often referred to in the medical field? What if we called the fat in our diet “lipids”, or some other interchangeable term? In an alternate universe following a different lexicon would there have been as many people following a low-lipid diet for the purpose of adipose tissue reduction?

Phrased like that I kind of doubt it.

A similar example can probably be noted in the widespread idea that sugar causes diabetes. Diabetes is a disease characterized by high blood sugar. Even though the sugar in this scenario is in fact glucose, the use of the word “sugar” has almost certainly established in the minds of people a connection between this “sugar” in the blood and your basic dietary sugar, made up of glucose and fructose.

Were our colloquialisms more accurate we would say diabetics have high blood glucose and call “sugar” either sucrose or a mixture of glucose and fructose, whichever was more appropriate in the situation. This may have alleviated some of the unscientific condemnation of “sugar” as a cause of diabetes and the inevitable recommendation that diabetics avoid sugar at all costs.

Clearly I am beginning this post with some critical pronouncements. However, this issue is, in my opinion, one of the most complex, misunderstood, and important topics in nutrition today. The vilification of fructose is an increasingly popular dogma which I strongly oppose not just because I disagree with it, but because of the ramifications of this belief. Some health “professionals” have gone so far as to make the obstructive claim that fruit is contraindicated in people with diabetes and a risky food in general given the fructose it contains.

Bullshit.

In this post I will be evaluating the belief that “sugar causes diabetes” primarily by critically evaluating the claim that fructose adversely affects insulin sensitivity.

Continue reading

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Diet and Acne: Zinc

The relationship between acne and nutrition is not well determined. Although many theories abound regarding the role of things like chocolate, milk, fat, sugar, and numerous other food and food compounds on acne development none of these have actually been confirmed in controlled trials.

Perhaps this issue was best summarized by Apostolos Pappas in a recent review (1) of the scientific literature on diet and acne:

“We did not realize how daunting it would be to write an article dedicated to making sense of the relationship of acne to foods. It turns out that there are no meta-analyses, randomized controlled clinical studies, or well-designed scientific trials that follow evidence-based guidelines for providing solid proof…We reviewed the updated arguments, facts, and relevant data on this ancient debate, but we warn the truth-seekers among you that the jury is still out.”

However, one possible dietary factor is zinc. Several studies have investigated the ability of zinc to improve acne. A number of these studies reported some degree of benefit (2-7), although some reported no effect (8,9).

This treatment most likely works correct a zinc deficiency, so be aware that in the absence of a deficiency a high zinc intake, especially from supplements, may cause toxic effects such as nausea, tiredness, and copper deficiency as well as disregulated appetite and glucose control. The safest course of obtaining enough zinc in the absence of a medically diagnosed deficiency may be by increasing foods rich in it, such as red meat, shellfish and, to a lesser extent, white meats. Plant sources include many types of seeds, beans and lentils. However, these sources typically provide less absorbable zinc than from meat, so they may be less preferable in this regard.
References:

1. Pappas A. The relationship of diet and acne: A review. Dermatoendocrinol. 2009 Sep;1(5):262-7.

2. Göransson K, Lidén S, Odsell L. Oral zinc in acne vulgaris: a clinical and methodological study. Acta Derm Venereol. 1978;58(5):443-8.

3. Hillström L, Pettersson L, Hellbe L, Kjellin A, Leczinsky CG, Nordwall C. Comparison of oral treatment with zinc sulphate and placebo in acne vulgaris. Br J Dermatol. 1977 Dec;97(6):681-4.

4. Verma KC, Saini AS, Dhamija SK. Oral zinc sulphate therapy in acne vulgaris: a double-blind trial. Acta Derm Venereol. 1980;60(4):337-40.

5. Michaëlsson G, Juhlin L, Vahlquist A. Effects of oral zinc and vitamin A in acne. Arch Dermatol. 1977 Jan;113(1):31-6.

6. Michaëlsson G, Juhlin L, Ljunghall K. A double-blind study of the effect of zinc and oxytetracycline in acne vulgaris. Br J Dermatol. 1977 Nov;97(5):561-6.

7. Weimar VM, Puhl SC, Smith WH, ten Broeke JE. Zinc sulfate in acne vulgaris. Arch Dermatol. 1978 Dec;114(12):1776-8.

8. Orris L, Shalita AR, Sibulkin D, London SJ, Gans EH. Oral Zinc Therapy of Acne: Absorption and Clinical Effect. Arch Dermatol. 1978;114(7):1018-1020.

9. Weismann K, Wadskov S, Sondergaard J. Oral zinc sulphate therapy for acne vulgaris. Acta Derm Venereol. 1977;57(4):357-60.

Glutathione: What It Is and How You Can Eat to Maximize It, Part 1: Coffee

With the popularity of “detox” diets today being what is I’m hoping some people actually want to learn how to increase their body’s natural defenses against toxins using scientifically sound dietary methods, rather than just following one of the many silly “detox juice cleanse” clogging up the internet.

With that said let me talk a little about glutathione. Glutathione is a neat little chemical made of 3 amino acids; cysteine, glutamic acid, and glycine. In addition to its role as a strong antioxidant, glutathione plays a very important role in the detoxification process by attaching to various electrophilic toxins, wherein it typically reduces their chemical reactivity and increases their polarity, causing the chemical to be excreted from the body at a greater rate. Continue reading

Studies suggesting calcium supplements may increase heart disease risk

The following papers include a number of randomized trials in which calcium supplements increased the risk of cardiovascular disease events, including heart attacks:

Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011 Apr 19;342:d2040.

Bolland MJ ,Barber PA ,Doughty RN ,Mason B ,Horne A ,Ames R ,et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008;336:262

Li S, Na L, Li Y, Gong L, Yuan F, Niu Y, Zhao Y, Sun C. Long-term calcium supplementation may have adverse effects on serum cholesterol and carotid intima-media thickness in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2013 Nov;98(5):1353-9.

Bolland M.J., Avenell A., Baron J.A. et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010; 341:c3691.

Avoiding Fiber: A Counterintuitive Solution to Constipation?

I’ve posted on this blog about fiber and colon cancer, noting a lack of evidence supporting a protection by fiber on this disease. But what about the effect of fiber on other maladies? What about the condition fiber is supposed to be most effective at treating? Yep, I’m talking about constipation. Here’s a study I came across recently:

Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012 Sep 7;18(33):4593-6.

In this trial, researcher recruited 63 people with constipation. All participants were asked to reduce their fiber intake as low as they could for 6 months. By 6 months 41 subjects were eating almost no fiber, 16 were eating a low fiber diet, and 6 were eating a comparatively high fiber diet. Thus, this was not technically a randomized trial, although the different groups were compared with each other in the style of a controlled trial.

The high fiber group saw no relief of symptoms at all, but they were small in numbers, older, and were clearly poor compliers. Let’s ignore them and look at the low versus almost no fiber groups.

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Among those on the low fiber diet, there was a 20 to 30% reduction in the number of people with constipation, anal bleeding, bloating, and abdominal pain. Among the 41 people on the nearly no fiber diets, not a single person had any of these aforementioned symptoms. Everyone who followed this fiber free diet was free from constipation.

This type of study demands further investigation, since it is clearly weak on its own. Still, the results seem incredible. Hopefully future studies will help us determine how legitimate these results are by using a well randomized control group and, ideally, isolating fiber sources (e.g. Soluble and insoluble).

Magnesium, Heart Attacks, and Electrolytes

Magnesium appears to be an incredibly popular nutrient amongst many in the nutrition community. It’s nearly unfettered acclaim is almost odd, given that for nearly every food or nutrient there seems to be some group, however small, that disputes what the majority believes its health effects to be. Surely magnesium produces profound improvements to insulin sensitivity and, to some degree, brings about other health benefits. Magnesium is even one of the few supplements I take from time to time. However, is magnesium’s good reputation truly without reproach?

Today let’s look at a study from 1993:

Galløe AM, Rasmussen HS, Jørgensen LN, Aurup P, Balsløv S, Cintin C, Graudal N, McNair P. Influence of oral magnesium supplementation on cardiac events among survivors of an acute myocardial infarction. BMJ. 1993 Sep 4;307(6904):585-7.

This is one of the few long term studies on oral magnesium. 468 heart attack survivors were given either 360 mg of magnesium or a placebo for one year. Did this mineral help prevent future heart problems?

No. In fact, although not statistically significant, those taking the magnesium supplement had roughly 30-40% more heart attacks and about 40-50% more “cardiac events”.

The question is, why? Honestly, I don’t know. Personally, I think an imbalance of electrolytes (magnesium, sodium, calcium, potassium, etc.) can be problematic. I hope to explore this in the future.

Changing Up This Blog (Also Niacin, LDL, and Atherosclerosis)

This blog doesn’t get much activity these days, so I’ve decided to use it to post about studies I find interesting. These will be brief and not very in depth. First up, a clinical trial published in the NEJM in 2009:

Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, Weissman NJ, Turco M. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med. 2009 Nov 26;361(22):2113-22. Continue reading

Is ketosis and carbohydrate restriction a viable diet for brain cancer?

The idea that a ketogenic diet might have utility in the treatment of cancer is becoming increasing popular. A ketogenic diet, for those unfamiliar, is a diet which is low enough in insulin stimulating macronutrients (I.E. carbohydrates and protein) to lead to he production of “ketone bodies”, specifically 3-hydroxybutyrate, acetoacetate, and acetone. Continue reading