Diabetes Archives - Health Tips From The Professor

The Importance Of Family History For Maternal Health

May 20, 2025 by Dr. Steve Chaney

How Does This Relate To Pregnancy, Labor, Birth, And The Postpartum Period?

Author: Carolyn Curtis, MSN, CNM, RN, FACNM, FAAN

Editor: Dr. Steve Chaney

Family History And Pregnancy

On the first prenatal appointment, an extensive history is taken that includes family history, personal medical history, gynecological history, pregnancy history; sexual history, social history.

Due to the many physiological changes that occur during pregnancy, birth and the postpartum period, one can be placed at increased risk for the development of health conditions that may not have been present prior to pregnancy.

A properly collected and granular family history may determine if a woman is at increased risk for disease, identify early warning signs of disease; and assist the provider in recommending treatments for reducing a woman’s risk for developing serious problems in during pregnancy, labor, birth and the postpartum period.

A recent study (D Rasooly et al, J Am Heart Assoc, 12(22): e030779, 2023) published in 2023 presents findings on the association between a comprehensive family history that includes parents, siblings and the self-reported personal history of obesity, diabetes, and heart and blood conditions.

How Was This Study Done?

The study involved 125,430 participants; 66.3% were women; 33.75 were men; 75.7% were White; 10.4% were Hispanic; 3.3% were Asian; 8.3% were Black and 2.4% were Other.

The study provided information on the possibility of someone developing a health problem based upon their family history. It also reported odds ratio (statistical probability) of other conditions developing when one health condition was present.

The Importance Of Family History For Maternal Health

The findings of the study were as follows. Of the 125,430 participants:

A family history of hypertension or high blood pressure was reported by 51.6% of the participants. When this was disaggregated by race, 60% of Blacks reported having a family history of hypertension and 54.4% of Asians reported having hypertension compared to 48.6% of Whites.

A family history of high cholesterol was reported by 38.7% of the participants.

A family history of heart attack was reported by 23.6% of the participants.

A family history of Type 2 diabetes was reported by 21.4% of the participants.

If one has a family history of a certain medical condition, there is an increased likelihood that this same condition can be passed on to the next generation (in this case, the pregnant mother). The statistical term “odds ratio” means the likelihood of this same condition occurring in the next generation when there is a family history vs when there is not a family history.

Passing the Same Disease Down To The Pregnant Mother

Compared to those who do not have a family history, here are the odds for passing down these same conditions to the mother.

Hypertension – 2.56 times the odds it can be passed down.

High cholesterol – 2.89 times the odds. If there is a family history of high cholesterol, there is 2.44 odds of Asians developing high cholesterol compared to 2.16 odds in the Black population.

Coronary Artery Disease – 3.54 the odds.

Type 2 diabetes – 3.79 times the odds.

Anemia – 2.66 times the odds.

Peripheral vascular disease – 6.60 times the odds.

Pulmonary embolism/deep vein thrombosis – 5.60 times the odds.

Obesity – 1.2 times the odds. If there is a family history of obesity, for Asian populations, there is 2.93 odds that obesity will be passed down to son or daughter. This ratio is 4.57 in the Black population.

Passing Another Disease Down To The Pregnant Mother

The study also reported the association of family history to someone’s personal health condition and the odds of the pregnant mother developing a different health condition pertaining to obesity, diabetes and heart and blood. On average there was 1.5 odds of developing a different condition from the condition reported in the family history. For example:

When there is a family history of Type 2 diabetes, there is 2.04 odds of developing obesity.

When there is a family history of pulmonary embolism/deep vein thrombosis; there is 3.25 odds of developing a bleeding disorder.

The two family health conditions that had the most evidence of association with other conditions were family history of stroke and heart attack.

When there is a family history of stroke, the odds of the pregnant mother developing other conditions are as follows:

Obesity (1.35).

Heart attack (1.7). There was almost double the odds ratio in the Hispanic population with 3.34 odds.

Hypertension (1.40). Whites reported 1.37 odds for developing hypertension compared to 1.55 for Blacks and 1.43 for underrepresented populations.

High cholesterol (1.33). When disaggregated by race, Whites had a 1.29 odds ratio; Black a 1.60 odds ratio and those underrepresented in biomedical research had a 1.33 odds ratio.

When there is a family history of heart attack, the odds of the pregnant mother developing related conditions are as follows:

Heart attack (2.17). These odds are decreased for Asians (1.92) and Hispanics (1.27).

Coronary artery disease (1.97).

Congestive heart failure (1.54).

High cholesterol (1.44).

When there is a family history of Type 2 diabetes, the odds of the pregnant mother developing other conditions are:

Heart attack (1.32).

Congestive heart failure (1.44).

Bleeding disorder (1.26).

Coronary artery disease (1.37 odds).

Asians with a family history of Type 2 diabetes have a 1.79 odds of developing heart valve disease.

How Does This Relate To Pregnancy, Labor, Birth, And The Postpartum Period?

The five main causes for pregnancy related death in the United States (defined as maternal death up until 12 months after giving birth) are:

Mental Health – 24%.

Hemorrhage – 14%.

Cardiovascular Disease – 13%.

Cardiomegaly (enlarged heart) – 9%.

Blood Clots – 9%

Many of these causes are related to the cardiovascular system. Based upon the data in this study, a family history of any of the following can contribute to the increased odds of developing health problems during pregnancy:

Stroke
Type 2 diabetes
Pulmonary embolism/deep vein thrombosis
Hypertension
Anemia

Once someone knows their family history, when planning for a pregnancy, they can work on any nutrition or lifestyle changes needed to reduce the incidence of problematic health conditions occurring during pregnancy and the health of the newborn.

The US Surgeon General has published My Family Health Portrait which will allow individuals to record and share their family history. It can be accessed at https://cbiit.github.io/FHH/html/index.html

The Bottom Line

When planning a pregnancy, a thorough family health and personal history is important.

Obesity, diabetes and heart and blood conditions can be passed from parents to children. Some of these conditions include anemia, peripheral vascular disease, pulmonary embolism/deep vein thrombosis, Type 2 diabetes, hypertension, coronary artery disease, and high cholesterol.

There is an association between a family history of stroke and heart attack and numerous other health conditions.

One’s family history can impact health conditions experienced during pregnancy that can result in pregnancy-related death up to 12 months after the baby is born.

The US Surgeon General’s My Family Health Portrait is an online tool that can help families to record their family health history and share with other family members.

For More Information

Feel free to visit my website, subscribe to my YouTube channel and learn more about my online coaching program, “Mastering Pregnancy and Birth”.

You-Tube Channel (https://www.youtube.com/channel/UCPMch7GamgUYYd9H3GonJZQ) – Over 80 videos exploring pregnancy, labor, birth, postpartum and contraception

www.thecarabcompany.com (https://www.thecarabcompany.com/) – Website with free downloadable pregnancy and birth information

Mastering Pregnancy and Birth Coaching Program (https://www.thecarabcompany.com/healthy-pregnancy-to-healthy-birth-accelerator) – A program that prepares Dads and Mom’s-to-be for a healthier pregnancy and safer birth. This course also provides information for Doulas to provide enhanced support to families.

Carolyn Curtis

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

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The posts on this website and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author

Carolyn Curtis, MSN, CNM, RN, FACNM, FAAN, has:

More than 40 years’ experience in the oversight of domestic and international programs and the provision of nursing and midwifery integrated service delivery in maternal child health, family planning, reproductive and women’s health care.

Twenty years’ experience in teaching, mentoring, and providing clinical oversight to undergraduate and graduate public health, medical, nursing and midwifery students.

About The Editor

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

How Much Should You Walk?

January 28, 2025 by Dr. Steve Chaney

Walking Your Way To Health

Author: Dr. Stephen Chaney

You’ve made your New Year’s resolutions. And if you are like millions of Americans, you may already be making plans to join a gym, get a personal trainer, or join a spin class.

The problem is these are all expensive options. And a good portion of that money is wasted. To put it into perspective, let’s look at some statistics

Around 6 million Americans buy gym memberships every January.

- 67% of those memberships are never used.

- For those memberships used in January, another 50% are not in use 6 months later.

Americans spend about 1.6 billion dollars on unused gym memberships every year.

- And that doesn’t include those gym memberships that are only occasionally used.

If you want to get fit and healthy in the new year, perhaps you should consider a less expensive option – like walking. Your only investments are a good pair of walking shoes and a device that keeps track of the number of steps you take (eg, Fitbit, smart watch, or smart phone).

You still may give up on your New Year’s goal of getting fitter at some point. But you won’t have wasted so much money.

Of course, you probably have some questions about the benefits of walking, such as:

1) Is walking enough to significantly improve my fitness and health?

2) How far (how many steps) should I walk?

3) How fast should I walk?

Fortunately, two recent studies (B del Pozo-Cruz et al, JAMA Internal Medicine, 182: 1139-1148, 2022) and (J del Pozo-Cruz et al, Diabetes Care, 45: 2156-2158, 2022) have answered all three questions.

How Were These Studies Done?

The first study (B del Pozo-Cruz et al, JAMA Internal Medicine, 182: 1139-1148, 2022) followed 78,500 participants (average age 61, 55% female, 97% white) enrolled in the UK Biobank study for an average of 7 years.

At the time of enrollment, each participant was given an accelerometer (a device that measures the number and frequency of steps) to wear on their dominant wrist for 24 hours/day for 7 days. The investigators used the accelerometer data to categorize several types of physical activity.

Daily step counts (the average number of steps per day for 7 days). These step counts were further subdivided into two categories:

- Incidental steps (It was assumed that ˂40 steps/min represented steps taken that were incidental to normal daily activities).

- Purposeful steps (It was assumed that ≥40 steps/min represented steps taken as part of planned exercise).

Stepping intensity (the highest frequency of steps/min averaged over 30 min intervals for all 7 days).

At the end of the study, each of these variables was correlated with the risk of premature deaths due to all causes, cancer, and heart disease.

The second study (J del Pozo-Cruz et al, Diabetes Care, 45: 2156-2158, 2022) was similar except that it:

Used data from 1687 adults (average age = 55, 56% male, with diabetes or prediabetes when the study began) in the 2005-2006 National Health and Nutrition Examination Survey in the US.

Followed participants for 9 years instead of 7.

Only measured total steps/day.

Correlated total steps per day with premature death for participants who already had prediabetes or diabetes when they entered the study.

Walking Your Way To Health

Study 1 looked at the effect of walking on health outcomes in multiple ways.

#1: Increase in number of steps/day:

On average study participants took an average of 7200 steps per day, but this ranged from a low of 3,200 steps/day to a high of 12,200 steps/day.

Each increase of 2,000 steps/day was associated with a:
- 8% decrease in all-cause mortality.
- 11% decrease in cancer mortality.
- 10% decrease in heart disease mortality.

Overall, increasing from 3,200 steps/day to 10,000 steps/day decreased all-cause, cancer, and heart disease mortality by around 36%.

There was no minimum threshold to this beneficial effect of walking on the risk of premature death.

The benefits of walking appeared to plateau at 10,000 steps/day.

#2: Increase in number of incidental steps/day (steps taken that are incidental to normal daily activities):

On average study participants took 3240 incidental steps/day, but this ranged from a low of 2,100 steps/day to a high of 4,400 steps/day.

Each 10% increase in incremental steps/day was associated with a:
- 6% decrease in all-cause mortality.
- 6% decrease in cancer mortality.
- 10% decrease in heart disease mortality.

#3: Increase in number of purposeful steps/day (steps taken as part of planned exercise):

On average study participants took 4,600 purposeful steps/day, but this ranged from a low of 1,600 steps/day to a high of 8,600 steps/day.

Each 10% increase in purposeful steps/day was associated with a:
- 7% decrease in all-cause mortality.
- 8% decrease in cancer mortality.
- 10% decrease in heart disease mortality.

#4: Increase in speed of walking or cadence. The measurement they used was “peak-30 cadence” – the highest average steps/min during a 30-minute interval within a day:

On average study participants had a “peak-30 cadence” of 76 steps/min, but this ranged from a low of 47 steps/min to a high of 109 steps/min.

Each 10% increase in “peak-30 cadence” was associated with a:
- 8% decrease in all-cause mortality.
- 9% decrease in cancer mortality.
- 14% decrease in heart disease mortality.

The benefits of walking rapidly (increase in “peak-30 cadence”) were in addition to the benefits seen by increasing the number of steps per day.

Overall, increasing from a “peak-30 cadence” of 47 steps/min to 109 steps/min decreased all-cause, cancer, and heart disease mortality by an additional 34%.

There was no minimum threshold to this beneficial effect of increasing “peak-30 cadence” (the speed of walking) on the risk of premature death.

The benefits of increasing “peak-30 cadence” appeared to plateau at 100 steps/min.

#5 Effect of walking on the prevention of heart disease and cancer: The investigators measured this by looking at the effect of walking on the “incidence” of heart disease and cancer (defined as new diagnoses of heart disease and cancer) during the study. They found.

Each 2,000-step increase in the total number of steps/day decreased the risk of developing heart disease and cancer by 4% during this 7-year study.

Each 10% increase in the number of purposeful steps/day decreased the risk of developing heart disease and cancer by 4% during this study.

Each 10% increase in “peak-30 cadence” decreased the risk of developing heart disease and cancer by 7% during this study.

The authors concluded, “The findings of this population-based…study of 78,500 individuals suggest that up to 10,000 steps/day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.”

Study 2 extended these findings to diabetes. They started with participants that had either prediabetes or diabetes and followed them for 9 years. They found that:

Study participants with prediabetes ranged from a low of 3,800 steps/day to a high of 10,700 steps/day.
- Prediabetic participants walking 10,700 steps/day were 25% less likely to die during the study than participants walking only 3,800 steps/day.

Study participants with diabetes ranged from a low of 2,500 steps/day to a high of 10,200 steps/day.
- Diabetic participants walking 10,200 steps/day were also 25% less likely to die during the study than participants walking only 2,500 steps/day.

Even small increases in the number of steps per day decreased the risk of premature death for both prediabetic and diabetic participants.

Once again, 10,000 steps/day appeared to be the optimal dose to lower the risk of premature death for both diabetic and prediabetic patients.

The authors of this study concluded, “Accumulating more steps/day up to ~10,000 steps/day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.”

How Much Should You Walk?

That was a lot of information. You are probably wondering what it means for you. Let’s start with the big picture:

Going from couch potato to 10,000 steps per day may reduce your risk of premature death due to all causes, cancer, and heart disease by 36% (24% if you are already prediabetic or diabetic).

Increasing the speed with which you walk from 47 steps/min to 109 steps/min sustained for 30 minutes may reduce your risk of premature death by an additional 34%.

In other words, simply walking more and walking faster can have a significant effect on your health. I am not recommending walking as your only form of exercise. I’m just saying not to consider it inferior to other forms of exercise.

There is no lower limit to the benefits of walking. Even small increases in the number of steps/day you take and the speed with which you walk may have a beneficial effect on your health.

In other words, you don’t need to speed walk 10,000 steps/day to reap a benefit from walking. Even small increases are beneficial. That’s good news for those of you who may not be able to speed-walk long distances. It also means that if you are a couch potato, you don’t need to attempt 10,000 steps at high speed from day 1. You can work up to it gradually.

Incidental walking (walking that is incidental to your daily activities) is almost as beneficial as purposeful walking (walking as part of a planned exercise).

That’s good news for those of you who may not have time for long walks. It also means that advice like “park your car at the far end of the parking lot and walk” or “take the stairs rather than the elevator” can have a meaningful impact on your health.

The benefits of walking appear to max out at around 10,000 steps per day and a cadence of 100 steps/min sustained for 30 minutes.

That means once you get to those levels, it’s time to consider adding other kinds of exercise to your regimen. More and faster walking may offer little additional benefit.

Finally, in the words of the authors, “This information could be used to motivate the least active individuals to increase their steps and the more-active individuals to reach the 10,000-step target.”

The Bottom Line

You’ve made your New Year’s resolutions. And if you are like millions of Americans, you may already be making plans to join a gym, get a personal trainer, or join a spin class.

If you want to get fit and healthy in the new year, perhaps you should also consider a less expensive option – like walking.

Of course, you probably have some questions about the benefits of walking, such as:

Is walking enough to significantly improve my fitness and health?

2) How far (how many steps) should I walk?

3) How fast should I walk?

Fortunately, two recent studies have answered all three questions. They found:

Going from couch potato to 10,000 steps per day may reduce your risk of premature death due to all causes, cancer, and heart disease by 36% (24% if you are already prediabetic or diabetic).

Increasing the speed with which you walk from 47 steps/min to 109 steps/min sustained for 30 minutes may reduce your risk of premature death by an additional 34%.

There is no lower limit to the benefits of walking. Even small increases in the number of steps/day you take and the speed with which you walk may have a beneficial effect on your health.

Incidental walking (walking that is incidental to your daily activities) is almost as beneficial as purposeful walking (walking as part of a planned exercise).

The benefits of walking appear to max out at around 10,000 steps per day and a cadence of 100 steps/min sustained for 30 minutes.

In the words of the authors of these studies, “This information could be used to motivate the least active individuals to increase their steps and the more-active individuals to reach the 10,000-step target.”

For more details on these studies and what they mean for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

_____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Are Our Teens Getting Sicker?

January 14, 2025 by Dr. Steve Chaney

What Does This Mean For Us?

Author: Dr. Stephen Chaney

The increase of prediabetes and type 2 diabetes in the US adult population has been well documented. And these conditions have severe health consequences.

Nearly 70% of people with prediabetes will go on to develop type 2 diabetes.

- Without a change in lifestyle and/or medical intervention, many people with prediabetes develop type 2 diabetes within 5 years.

Type 2 diabetes is highly correlated with increased risk for heart disease and stroke, vision loss, kidney disease, nerve damage, and cognitive decline.

And as we learned during COVID, diabetes suppresses the immune system, making us much more likely to die from viral infections ranging from flu to RSV and coronaviruses like SARS-CoV-2.

Because both prediabetes and type-2 diabetes are highly correlated with obesity, the US Preventative Services Task Force has recently recommended regular screening of adults aged 35-70 who are overweight or obese for prediabetes and type-2 diabetes.

But what about our teenagers? Are they at risk? Should they be screened also? Recent reports have documented an alarming increase in overweight and obesity in this population group.

The prevalence of type-2 diabetes is low in this group, but previous studies have reported that approximately 1 in 5 US teenagers have prediabetes. Is this a ticking time bomb that will affect their health as adults? More importantly, is the prevalence of prediabetes getting worse, just as it is for the adult population?

The expectation is that the prevalence of prediabetes in US teens is increasing, just as it is for US adults. But scientists and health organizations like the Preventive Services task force require hard data, not just expectations.

So, the study (J Liu et al, JAMA Prediabetes, 176: 608-610, 2022) I will describe today was designed to determine the prevalence trend over the past 20 years for prediabetes in US teenagers.

How Was The Study Done?

The study used data from the NHANES database from 1999 to 2018. NHANES (National Health and Nutritional Examination Survey) is a program administered by the CDC that collects health and nutrition information from adults and children in the United States on a biennial basis.

Among the data collected are demographic information (sex, age, race, economic status, etc.), physical exam information (BMI, blood chemistry, etc.), and health information (prediabetes, diabetes, etc.).

To have enough participants in each time period for statistically significant results, the data were combined for each two consecutive 2-year surveys. (For example, the 2000-2001 and 2001-2002 NHANES surveys were combined into a single dataset from 1999 to 2002.)

The time periods included in this study were 1999-2002, 2003-2006, 2007-2010, 2011-2014, and 2015-2018. A total of 6598 teenagers were included in this study, for an average of around 1,300 per time-period.

The main comparison was prediabetes prevalence among US teens in each time period. The study also looked at the effect of obesity and various sociodemographic classifications on prediabetes prevalence in teens.

Are Our Teens Getting Sicker?

When the 2015-2018 time period was compared to the 1999-2002 time period, the prevalence of prediabetes:

Increased from 11.6% to 28.2% – a 2.43-fold increase.

When broken down by age groups, the increase was:

2.35-fold for ages 12-15.
2.56-fold for ages 16-19.

When broken down by gender, the increase was:

2.76-fold for females.
2.30-fold for males.

When broken down by race and ethnicity, the increase was:

2.10-fold for Hispanics.
2.76-fold for Blacks.
2.33-fold for Whites.

None of these differences were statistically significant, but they might have been had the sample size been larger.

In short, there has been more than a 2-fold increase in the prevalence of prediabetes in US teenagers over the last 20 years. And this increase was seen in young teenagers, older teenagers, male and female teenagers, and in every racial and ethnic category surveyed.

Why Is Prediabetes Increasing In Our Teens?

Knowing the trend is important. But if you want to reverse the trend, it’s much more important to know what is causing it.

Of course, obesity is an obvious villain. Obesity is highly associated with prediabetes and type 2 diabetes, and we know that obesity is increasing in our teens. The data from this study suggests that obesity may contribute to the increase in prediabetes prevalence. But it’s not likely to be the sole cause.

For example:

Obesity in our teens has only increased 1.3-fold over the last 20 years.

More importantly, the difference in prediabetes prevalence between normal weight and overweight teens was not significant in this study.

The authors of this study also found no significant effect of educational level of the parents, family income level, or food security on the increased prevalence of prediabetes prevalence in teens.

So, what else might be contributing to the increased prevalence of prediabetes in our teens? I have two suggestions:

Decreased physical activity. Teens today are spending more hours staring at screens and less time exercising. Lack of exercise contributes to obesity, but there is also emerging evidence that it may independently contribute to diseases like prediabetes and diabetes.

Increased junk food consumption. Teenager’s diets have never been great, but multiple studies have shown that consumption of highly processed food has skyrocketed over the past 20 years.

Obviously, more work needs to be done on proving the causes of increased prediabetes prevalence in our teens, but we know enough already to start making some needed changes.

What Does This Study Mean For Us?

If you are a parent or grandparent, this study is a wake-up call. It’s not that we didn’t already suspect it was happening. After all, the increasing prevalence of type 2 diabetes in young US adults had to come from somewhere.

But this study makes it clear that prediabetes is increasing at an alarming rate in our teenage children (and grandchildren). This is a ticking time bomb.

As I said above, prediabetes leads to diabetes. And diabetes leads to heart disease and other debilitating diseases. Unless we reverse this trend, we may be dooming our teens to poor health and a shortened lifespan as adults.

So, the important questions become, “What can we do about it?” and “What can we do to reverse this trend?”

The top three things we can do are clear. We need to encourage our teens to:

Exercise more. Only 1 in 4 high school students get the recommended amount of daily activity.

Eat a healthier diet. Today more than 2/3 of the calories our teens consume come from ultraprocessed foods.

And we know the changes they need to make. Previous studies have shown that whole food, primarily plant-based diets reduce the risk of developing prediabetes and type 2 diabetes and can even reverse both conditions as effectively as medications.

Maintain a healthier weight. The prevalence of obesity in our teens has increased dramatically in the last 40 years. Of course, the secret is that if they get the diet and exercise part right, weight control is much easier.

But none of these changes are easy. This can’t be a, “Do as I say, not as I do” change. This needs to be a whole family change. We need to set the example.

Of course, I know some teens like to rebel against anything their parents do or recommend. We had a teenager once.

Setting the example doesn’t necessarily mean they will accept it right away. But with time they may come around. They are listening to what you say and watching what you do even when they are doing the opposite.

And I can guarantee if you aren’t willing to make these changes, they won’t be either.

The Bottom Line

A recent study looked at the prevalence of prediabetes in US teenagers over the past 20 years. The results were alarming.

The prevalence of prediabetes in US teens has more than doubled over the past 20 years.

In 2018, the last year in this study, the prevalence of prediabetes was in the 25-30% range.

The increased prevalence of diabetes was independent of gender, income, food security, ethnicity, and education level of the parents.

If you are a parent or grandparent, this is a ticking time bomb because 70% of people with prediabetes go on to develop type 2 diabetes within the next 5 years. And type 2 diabetes dramatically increases the risk of heart disease, stroke, kidney disease, vision loss, and cognitive decline. We may be dooming our teens to poor health and a shortened life span as adults.

For more details about this study, the causes of the increased prevalence of prediabetes in teens, and what you can do to reverse this trend for your teens, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

_____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_____________________________________________________________________

About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Are Our Healthy Years Getting Shorter?

December 10, 2024 by Dr. Steve Chaney

What Does This Mean For You?

Author: Dr. Stephen Chaney

If you’ve ever traveled the subway system in London, you can’t have missed the “Mind the Gap” signs warning not to put your foot in the gap between the subway and the platform.

That warning is more important than ever in an age where people look at their cell phones rather than where they are walking. Of course, if they are looking at their cell phones, they might miss the sign and…

But today’s “Health Tip” is not about subway gaps. It’s about a far more important gap – the gap between our healthspan (how many years we enjoy good health) and our lifespan (how many years we live).

A recent study (L Gimeno et al, The Journals of Gerontology, Series B, 79(8), gbae113, 2024) suggesting that our healthy years are getting shorter caught my attention.

All of us imagine that our golden years will be ones of vibrant health. We’ll travel to exotic places. We’ll take long walks in the mountains. We’ll play with our grandchildren. Life will be wonderful.

But if this study is correct, none of that will happen for many young Americans. They will be too frail and sick to enjoy their golden years. They will be surviving rather than thriving.

So, in today’s “Health Tips From the Professor” I will review the study and tell you what it means for you.

How Was The Study Done?

The investigators used data on 114,526 adults >50 (average age = 63) from developed countries (the United States, England, and continental Europe). Specifically, they used data from people who participated in the Healthy and Retirement Study (26,939 people in the United States), the English Longitudinal Study on Ageing (14,992 people in England), and the Survey of Health, Ageing, and Retirement (72,595 people in continental Europe) between 2004 and 2018.

These surveys collected data on health-related outcomes every 2 years. The outcomes measured were:

Six activities of daily living (ADLs) such as eating, bathing, and walking.

Four instrumental activities of daily living (IADLs) related to essential tasks such as grocery shopping or preparing a hot meal.

Seven measures of mobility difficulties and motor coordination tasks such as walking one block, lifting 10 pounds, or picking up a small coin from a flat surface.

The assumption was that the severity of limitations was ADL > IADL > mobility difficulties. This is based on previous research showing that a person with ADL limitations is likely to have IADL limitations and mobility difficulties. And a person with IADL limitations is likely to have mobility difficulties. Based on this assumption, they classified participants in this study into 4 disability categories:

Mild disability: ≥1 IADL limitations and any number of mobility difficulties.

Moderate disability: 1-2 ADL limitations with any number of IADL limitations and mobility difficulties.

Severe disability: ≥3 ADL limitations with any number of IADL limitations and mobility difficulties.

The study also measured the prevalence (percent of the population) with:

Obesity
Heart disease.
Diabetes
Cancer
Lung disease.
High blood pressure.
High cholesterol.

Finally, the study also measured grip strength because loss of grip strength is considered an indicator of future disabilities.

The unique feature of this study is it compared the health and disability of people who were at the same age when tested but were born in different decades ranging from 1925 to 1955.

Because of the rapid change in diet and lifestyle following World War II, the health and disability of people born in the 1936-1945 decade encompassing World War II was used as the standard to which all other decades were compared.

Are Our Healthy Years Getting Shorter?

Some of you may have skipped over the previous section, so I will repeat the way these data were analyzed because it is crucial to your understanding of the study.

“The unique feature of this study is it compared the health and disability of people who were at the same age when tested but were born in different decades ranging from 1925 to 1955.

When looking at data from the United States, there were two distinct patterns.

The vertical line in the center of the graph represents the health and disability status of people born during World War II because all comparisons in this study were to people born in the decade encompassing World War II. A worsening of health and disabilities is indicated in red and an improvement in health and disabilities is shown in green.

Pattern A was characteristic of a constant worsening of health and disabilities from people born in the decade starting in 1925 to people born in the decade starting in 1955.

This pattern was seen for:

Obesity
Heart disease.
Diabetes
Lung disease.
High blood pressure.
High cholesterol.
Severe disabilities.
Reduction in grip strength.

Remember, this study is measuring health and disability of people at the same age. The only difference is when they were born. It tells us people in their 50s, 60s, or 70s born in 1955 or later are in poorer health than people of the same age who were born in 1925.

And it’s not just the United States. For obesity and health parameters the pattern was the same for England and Europe. For severe disabilities the pattern was the same for England but was not as clear for Europe.

Two things should be noted for this pattern:

The worsening of health and the increase in severe disabilities comes despite the vast improvements in the health care systems in these countries and improved understanding of the causes of these diseases.

Obesity is likely a major driver of our declining health and increased disability. However, it is not the only driver. If the investigators had graphed the percentage of highly processed foods in the diet or the decline in regular exercise, the pattern would have been similar.

Pattern B shows an improvement in the period leading up to World War II and a deterioration in the period after World War II. The authors interpreted the improvement prior to World War II as due to improvements in health care and the deterioration after World War II as due to changes in diet and lifestyle.

This is the pattern seen for mild and moderate disabilities in the United States. The pattern for mild and moderate disabilities was not as clear for England and Europe.

The authors concluded, “In all regions, we found evidence for worsening health across cohorts [groups of people born in successive decades], particularly for those born after 1945.”

What Does This Study Mean For You?

I don’t want to overinterpret this study. This study breaks new ground, but it has some limitations that I would characterize with three statements:

It is a very difficult study to do perfectly.

There are several factors that could affect the interpretation of the data and the outcome of the study.

The authors made a valiant effort to correct for any factors that could have affected the outcome.

For more details about the factors that might affect the outcome of the study and how the authors corrected for them, read the study.

However, this is the first study to use this approach to gauge the decrease in healthy years (healthspan) in developed countries over the past 40 years. It has its flaws, but it is consistent with several other studies documenting declining health in the current generation of young adults. For example, in a recent issue of “Health Tips From the Professor” I reviewed a study showing that colon cancer rates are increasing at an alarming rate for young adults in this country.

At the beginning of this article, I talked about the gap between our healthspan (how many years we enjoy good health) and our lifespan (how many years we live).

This study suggests that the onset of significant health issues and disabilities is occurring at a younger age today than for people born before World War II. In short, it suggests that our healthspan (the number of healthy years) is getting shorter.

This study did not look at lifespan, but numerous studies show that our lifespan is still increasing. So, the gap between healthspan and lifespan appears to be getting larger. In simple terms this means that when today’s young adults reach their “golden years”, they may spend more of those years in poor health than those of us born in the 1940’s.

But, what does this mean for you? The take home lesson should be, “This doesn’t have to be. You don’t have to be frail and sickly in your golden years. We know how to prevent this.”

It starts with a healthy diet – a whole food, primarily plant-based diet with lots of colorful fruits and vegetables, whole grains, nuts and seeds.

Add in a regular exercise program with a mixture of aerobic and resistance exercises.

Include an individualized supplement program.

You notice I didn’t list weight control as one of the top three prevention strategies. That’s because I don’t recommend fad diets and rapid weight loss programs. If you do the first three things well, your weight will come off naturally – a little bit at a time.

And once you have mastered all four things, you will increase your healthy years and narrow the gap between your healthspan and your lifespan. You can look forward to golden years filled with vitality and adventure.

The Bottom Line

A recent study used an innovative approach to quantify the deterioration in health and the physical ability to function well in daily activities as we age. The unique feature of this study is it compared the health and disability of people who were at the same age when tested but were born in different decades ranging from 1925 to 1955.

The study found a constant worsening of health and disabilities from people born in the decade starting in 1925 to people born in the decade starting in 1955 for:

Obesity
Heart disease.
Diabetes
Lung disease.
High blood pressure.
High cholesterol.
Severe disabilities.

The authors concluded, “We found evidence for worsening health across cohorts [groups of people born in successive decades], particularly for those born since 1945.”

In short, people born in recent years have fewer healthy years (a shorter healthspan) than people born before World War II. And since our lifespans are getting longer, this means the gap between our healthspan and our lifespan is increasing.

But if this study is correct, none of that will happen for many of today’s young adults. They will be too frail and sick to enjoy their golden years.

For more details about this study and how you can increase your healthy years, narrow the gap between your healthspan and your lifespan, and look forward to golden years filled with vitality and adventure, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

______________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author

Do Bad Genes Doom You To Bad Health?

October 1, 2024 by Dr. Steve Chaney

The Influence Of Genetics And Diet On Type 2 Diabetes

Author: Dr. Stephen Chaney

Does it ever feel like you have drawn the short straw?

Everyone in your family has succumbed to heart disease, diabetes, or cancer at a young age. Are you doomed to the same fate?

You ordered a DNA test. It sounded like fun. But when the gene report came back it said you had a “bad” genetic profile. You were told you are at high risk of diabetes, heart attack, stroke, cancer, or dementia. Are you doomed to a short and sickly life?

In both cases, you are probably wondering, “Is there anything I can do to improve my odds of a healthy life? What if I lost some of those extra pounds, exercised more, and ate a healthier diet? Would that make a difference?”

The study (J Merino et al, PLoS Medicine 19(4): e1003972, April 26, 2022) I will describe today was designed to answer these questions.

But before I describe the study, I should probably cover what I call Genetics 101: “How Genes Affect Your Health”.

Genetics 101: How Genes Affect Your Health

If you studied genetics in school, you probably learned about diseases like sickle cell anemia, which is caused by a single mutation in a single gene. If you get two copies of the “bad” gene, you will have sickle cell anemia. If you get one copy of the “bad” gene and one copy of the normal gene, you have sickle cell trait, which is much less severe.

Simply put, you either have the disease or you don’t. It’s dependent on your genetics, and you can’t do much about it.

If you know someone who has been treated for breast cancer, you are probably familiar with a more complex relationship between genetics and health. There are several “bad” genes that increase the risk of breast cancer. And knowing which gene is involved is important for selecting the best treatment regimen.

But most of the diseases that shorten our lives (like diabetes, heart disease, most cancers, and dementia) are what we call polygenetic diseases. Simply put, that means that there are dozens of genes that increase the risk of these diseases. Each gene makes a small contribution to the increased risk. So, we can only measure the genetic contribution to these diseases by measuring hundreds of mutations in dozens of genes, something called a polygenetic risk score.

The study I will be describing today looked at the relative effect of genetics (measured as the type 2 diabetes polygenic risk score) and diet quality (measured as the Alternative Healthy Eating Index (AHEI)) on the risk of developing type 2 diabetes.

How Was This Study Done?

The data for this study were obtained from 3 long-term clinical studies conducted in the United States – the Nurses’ Health Study (121,700 participants), the Nurses’ Health Study II (116,340 participants), and the Health Professionals Follow-Up Study (51,529 participants).

These studies measured lifestyle factors (including diet) every 4 years and correlated them with disease outcomes over 20+ years.

The study I will be discussing today was performed with 35,759 participants in these 3 studies for whom DNA sequencing data was available.

The DNA sequence data were used to generate a type 2 diabetes polygenic risk score for each participant in this study.

Food frequency questionnaires obtained every 4 years in these studies were used to calculate the Alternative Healthy Eating Index (AHEI) score for each participant.

- The AHEI is based on higher intake of fruits, whole grains, vegetables, nuts and legumes, polyunsaturated fatty acids, long-chain omega-3 fatty acids, moderate intake of alcohol, and lower intake of red and processed meats, sugar sweetened drinks and fruit juice, sodium, and trans-fat).

The investigators used these measurements to estimate the relative effect of genetics and diet quality on the risk of developing type 2 diabetes.

The Influence Of Genetics And Diet On Type 2 Diabetes

The participants were divided into low, intermediate, and high genetic risk based on their type 2 diabetes polygenic risk score.

Compared with low genetic risk:

Intermediate genetic risk increased the risk of developing type 2 diabetes by 26%.

High genetic risk increased the risk of developing type 2 diabetes by 75%.

Put another way, each 1 standard deviation increase in the polygenetic risk score:

Increased the risk of developing type 2 diabetes by 42%.

Simply put, bad genes can significantly increase your risk of developing type 2 diabetes. That’s the bad news. But that doesn’t mean you should think, “Diabetes is in my genes. There is nothing I can do.”

The investigators also divided the participants into those who had a high-quality diet, those who had an intermediate quality diet, and those who had a low-quality diet based on their AHEI (Alternative Healthy Eating Index) score.

Finally, they divided the participants into groups depending on their BMI, a measure of obesity.

Compared to an obese person consuming a low-quality diet, a lean person consuming a high-quality diet:

Reduced their risk of developing type 2 diabetes by around 43% for each category of genetic risk.

More specifically, a lean person consuming a high-quality diet reduced their risk of developing type 2 diabetes:

- By 41% if they were at low genetic risk.

- By 50% if they were at intermediate genetic risk.

- By 38% if they were at high genetic risk.

The investigators then made a statistical adjustment to remove BMI from their calculations, so they could focus on the effect of diet alone on the risk of developing type 2 diabetes.

Compared to a low-quality diet, a high-quality diet:

Reduced the risk of developing type 2 diabetes by around 33% for each category of genetic risk.

More specifically, a high-quality diet reduced the risk of developing type 2 diabetes:

- By 31% for those at low genetic risk.

- By 39% for those at intermediate genetic risk.

- By 29% for those at high genetic risk.

Looking at it another way:

When people at high genetic risk consumed a high-quality diet, their risk of developing type 2 diabetes was only 13% higher than people at intermediate genetic risk who consumed a low-quality diet (such as the typical American diet).

When people at intermediate genetic risk consumed a high-quality diet, their risk of developing type 2 diabetes was 5% less than people at low genetic risk who consumed a low-quality diet.

Simply put:

If you are at intermediate genetic risk, a high-quality diet may completely reverse your risk of developing type 2 diabetes.

If you are at high genetic risk, a high-quality diet can partially reverse your risk of developing type 2 diabetes.

In short, the good news is that bad genes do not doom you to type 2 diabetes.

The investigators did not provide similar information for the effect of an ideal weight on the risk of developing type 2 diabetes, but it is likely that the combination of diet plus weight management would result in an even more significant reduction in risk of developing type 2 diabetes for individuals in the even the highest risk category.

The authors concluded, “These data provide evidence for the independent associations of genetic risk and diet quality with incident type 2 diabetes and suggest that a healthy diet is associated with lower diabetes risk across all levels of genetic risk.”

Do Bad Genes Doom You To Bad Health?

At the beginning of this article I posed the question, “Do bad genes doom you to bad health?”

Based on this study, the good news is that bad genes don’t doom you type 2 diabetes. And just because most of your relatives are diabetic doesn’t mean that must be your fate.

This study shows that a healthy diet significantly reduces your risk of developing type 2 diabetes at every genetic risk level.

And the study suggests that a healthy diet plus a healthy weight is even more beneficial at reducing your risk of type 2 diabetes.

While not included in this study, other studies have shown that exercise also plays a role in reducing type 2 diabetes risk.

None of this information is new. What is new is that a healthy diet is equally beneficial at reducing type 2 diabetes risk even in individuals with a high genetic risk of developing the disease. Simply put, you can reverse the effects of bad genes.

“And what is this magic diet?”, you might ask. In this study, it was based on AHEI score. Someone with a high AHEI score consumes:

Lots of fruits, whole grains, vegetables, nuts and legumes, polyunsaturated fatty acids, and long-chain omega-3 fatty acids.

Moderate or no amounts of alcohol.

Little or no red and processed meats, sugar sweetened drinks, fruit juices, sodium, and foods with trans-fat.

Any whole food, primarily plant-based diet from vegan to Mediterranean or DASH fits the bill.

Finally, while this study focused just on type 2 diabetes, other studies have come to similar conclusions for other diseases.

Should You Get Your DNA Tested?

If you are looking for guidance on how to reduce your risks, the answer is, “No”. In this study, the same diet and lifestyle changes lowered the risk of type diabetes at every genetic risk level. Despite what some charlatans may tell you, there is no special diet or magic potion for people with a high genetic risk for developing type 2 diabetes.

If you are looking for motivation, the answer may be, “Yes”. If knowing you are at high risk makes it more likely that you will make the diet and lifestyle changes needed to lower your risk of type 2 diabetes, a DNA test may be just what you need

The Bottom Line

If a serious disease runs in your family or if you have had your DNA tested and found out you are at high risk for some disease, you are probably wondering whether there is anything you can do or whether your bad genes have doomed you to a short and sickly life.

A recent study answered that question for type 2 diabetes. It showed a healthy diet significantly reduces the risk of type 2 diabetes even in people at high genetic risk of developing the disease.

Other studies have come to similar conclusions for other diseases. In short, bad genes don’t doom you to bad health.

For more details about the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

_____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author

Are All Plant-Based Diets Healthy?

September 10, 2024 by Dr. Steve Chaney

Why Are Plant-Based Diets Healthy?

Author: Dr. Stephen Chaney

Unless you are like Rip van Winkle and have been asleep for the past 30 years, you have probably heard that plant-based diets are good for you. In fact, that advice is sound. It is based on multiple long-term studies.

But you may still be hesitant to make the switch. You are probably wondering if you have to be a vegan purist to benefit from a plant-based diet. If so, you are wondering whether you can make that drastic a change in your diet. Or, you may have already decided “that is a bridge too far” and don’t want to even consider it.

So, one important question is, “Do you have to go vegan to benefit from a plant-based diet?”

On the other hand, “Big Food, Inc” has made it easier than ever to switch to more “plant-based” eating. After all, sugar comes from plants. And highly processed grains come from plants. Add a few chemicals and you can come up with an endless supply of highly processed plant-based foods.

So, another important question is, “Can a diet of highly processed plant-based foods be as healthy as a diet of whole, unprocessed plant-foods?”

The study (Y. Wang et al., Nutrition Journal, 22: 46, 2023) I am reviewing today was designed to answer these two questions. It also represents the first meta-analysis to combine data from studies on the effects of plant-based diets on diabetes, heart disease, cancer, and mortality into a single study.

How Was The Study Done?

The investigators performed a meta-analysis of 76 studies with 2,230,443 participants that looked at the associations of plant-based dietary patterns and the incidence of type 2 diabetes, cardiovascular disease, cancer, and mortality among adults 18 years or older.

The characteristics of study participants ranged from:

25 to 87 years old.
BMI of 20 to 30.

And the duration of the studies within the meta-analysis ranged from 2 to 36 years.

The adherence to plant-based diets was defined as higher consumption of plant-based foods and lower consumption or exclusion of animal-based foods.

The meta-analysis also included studies looking at the effect of changing from a more animal-based to a more plant-based dietary pattern.

The meta-analysis included studies looking at the benefit of vegan and vegetarian diets. In terms of participants these studies represented just over 50% of the data in the meta-analysis. So, this meta-analysis was ideally positioned to determine whether vegan and vegetarian diets were more beneficial than other primarily plant-based dietary patterns that included some animal foods.

The methodology used to classify diets as primarily plant-based varied from study to study. But in each case the study participants were divided into quartiles ranging from consuming the most plant-based diet to consuming the least plant-based diet.

The study then compared study participants with the highest adherence to plant-based diets to those with the lowest adherence to plant-based diets with respect to type 2 diabetes, cardiovascular disease, cancer, and mortality.

Finally, the study also compared adherence to healthy plant-based dietary patterns (whole or minimally processed fruits, vegetables, whole grains, beans, nuts, and seeds) to unhealthy plant-based dietary patterns (foods and drinks with added sugar, highly processed plant foods, and starchy vegetables).

Are Plant-Based Diets Healthy?

When comparing highest to lowest adherence to plant-based dietary patterns the risk of:

Type-2 diabetes was reduced by 18%.

Cardiovascular disease was reduced by 10%.

Cancer was reduced by 12%.

Mortality was reduced by 16%.

In short, all the news was good for primarily plant-based dietary patterns.

Are All Plant-Based Diets Healthy?

Increased adherence to a healthy plant-based dietary pattern (That term is defined in the methods section above) was associated with an even better reduction in disease risk. For example:

Type-2 diabetes was reduced by 21%.

Cardiovascular disease was reduced by 15%.

Cancer was reduced by 13%.

Mortality was reduced by 14%, which was statistically indistinguishable from the reduction in mortality associated with all plant-based dietary patterns above.

In contrast, increased adherence to an unhealthy plant-based dietary pattern was associated with increased risks of disease. For example:

The risk of type 2 diabetes increased by 8%.

The risk of cardiovascular disease increased by 14%.

The risk of cancer increased by 7%.

The risk of mortality increased by 16%.

In short, plant-based dietary patterns consisting of whole or minimally processed plant foods are good for you. Plant-based dietary patterns consisting of highly processed plant foods are not.

Are Vegan and Vegetarian Diets More Beneficial Than Other Plant-Based Dietary Patterns?

Twenty seven of the studies within this meta-analysis compared vegetarian or vegan dietary patterns with animal-based dietary patterns. These studies had 1,343,967 participants, which amounts to 57% of the participants in the meta-analysis.

Thus, this meta-analysis was well positioned to determine relative benefits of vegan and vegetarian diets compared to other primarily plant-based dietary patterns that include some animal foods. The investigators reported that:

The risk reduction for type 2 diabetes was greater in studies with vegan and vegetarian diets than in studies with other primarily plant-based diets.

No other statistically significant benefits were observed for vegan and vegetarian diets compared to other primarily plant-based diets.

In short, you don’t need to become a vegan to experience the health benefits of a plant-based diet.

In contrast, increased adherence to an unhealthy plant-based dietary pattern was associated with increased risks of disease. For example:

The risk of type 2 diabetes increased by 8%.

The risk of cardiovascular disease increased by 14%.

The risk of cancer increased by 7%.

The risk of mortality increased by 16%.

In short, plant-based dietary patterns consisting of whole or minimally processed plant foods are good for you. Plant-based dietary patterns consisting of highly processed plant foods are not.

What If You Change From An Animal-Based To A Plant-Based Diet?

If you have been consuming an animal-based diet for years, you may be wondering whether it is too late to change. Has the damage already been done?

Six studies within this meta-analysis examined the effect of changing from an animal-based diet to a plant-based diet on type 2 diabetes and mortality. Changing to a more plant-based dietary pattern:

Reduced diabetes by 17% and mortality by 5%.

In short, it’s never too late to switch to a more plant-based dietary pattern.

Why Are Plant-Based Diets Healthy?

The short answer is that we don’t know for sure, but the authors mentioned several popular hypotheses.

Obesity is a risk factor for type 2 diabetes, cardiovascular disease, and certain types of cancer. And studies have shown that people consuming plant-based diets tend to weigh less.

The increased fiber content and higher ratio of polyunsaturated fats to saturated fats lower cholesterol levels and improve blood lipid profiles, which are associated with a lower risk of cardiovascular disease.

Plant-based diets are anti-inflammatory, which reduces the risk of all three diseases.

Plant foods are rich in polyphenols and other phytonutrients that are associated with reduced risk of cardiovascular disease, lower blood pressure, and improvements in insulin sensitivity.

Plant foods are metabolized by gut bacteria to metabolites that are associated with reduced risk of type 2 diabetes and cardiovascular disease.

Plant foods support healthy gut bacteria associated with a reduced risk of several diseases.

Finally, plant-based dietary patterns are associated with no or reduced consumption of red and processed meats, which increase the risk of type 2 diabetes, cardiovascular disease, and certain types of cancer.

For a more detailed discussion read the article).

What Does This Study Mean For You?

The authors of this study concluded, “Higher adherence to plant-based dietary patterns, especially from healthy sources, may be universally beneficial for the primary prevention of type 2 diabetes, cardiovascular disease, cancer, and mortality. The current study provides further evidence in support of current recommendations that emphasize consuming high-quality plant-based foods for achieving optimal health.”

“Future studies are needed to elucidate…mechanistic pathways linking plant-based diets with multiple disease outcomes.”

I would just like to emphasize a few points:

These are all association studies. It takes decades for diseases like diabetes, heart disease, and cancer to develop. So, it is impossible to confirm these findings with double blind, placebo-controlled studies. However, when you have 76 studies with over 2 million participants all pointing to the same conclusion, it is hard to ignore the findings.

The good news is that you don’t have to become a vegan to experience these benefits. There are many healthy primarily plant-based diets available. Choose the one that best fits your food preferences and lifestyle.

Be aware that whatever diet you choose, Big Food Inc is only too happy to provide you with highly processed foods that fit that dietary pattern. Don’t fall for that trap. Stick with whole or minimally processed plant foods.

If your current diet isn’t the best, it is never too late to switch to a healthier primarily plant-based diet.

The Bottom Line

A recent meta-analysis of 76 studies with 2,230,443 participants looked at the associations of plant-based dietary patterns and the incidence of type 2 diabetes, cardiovascular disease, cancer, and mortality among adults 18 years or older.

The authors of the study concluded, “Higher adherence to plant-based dietary patterns, especially from healthy sources, may be universally beneficial for the primary prevention of type 2 diabetes, cardiovascular disease, cancer, and mortality. The current study provides further evidence in support of current recommendations that emphasize consuminh high-quality plant-based foods for achieving optimal health.”

Other key points from the study are:

These are all association studies. It takes decades for diseases like diabetes, heart disease, and cancer to develop. So, it is impossible to confirm these findings with double blind, placebo-controlled studies. However, when you have 76 studies with over 2 million participants all pointing to the same conclusion, it is hard to ignore the findings.

The good news is that you don’t have to become a vegan to experience these benefits. There are many healthy primarily plant-based diets available. Choose the one that best fits your food preferences and lifestyle.

Be aware that whatever diet you choose, Big Food Inc is only too happy to provide you with highly processed foods that fit that dietary pattern. Don’t fall for that trap. Stick with whole or minimally processed plant foods.

If your current diet isn’t the best, it is never too late to switch to a healthier primarily plant-based diet.

For more details about how the authors came to these conclusions and what they mean for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

_______________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author

Can Personalized Diets Help Control Blood Sugar?

April 30, 2024 by Dr. Steve Chaney

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

Personalized diets are highly advertised. We are told to forget the old “one size fits all” diets of the past. We are told we are all different, so diets should be individualized to us.

We are promised that by collecting DNA samples from our tissue or bacteria in our gut, blood samples, and personal medical history, a personalized diet can be created that “fits us like a glove”.

But are those promises true, or are they hype? Diets to control blood sugar spikes should be a perfect topic for testing those claims. Millions of Americans have trouble controlling their blood sugar levels. Specifically:

1 million adults (14.7% of US adults) have diabetes, mostly type 2 diabetes.

6 million adults (38.0% of US adults) have prediabetes.

- That amounts to 52% of the US population who have trouble controlling blood sugar levels.

Previous studies have shown that prediabetes and type 2 diabetes are largely reversible with diet and lifestyle change.

Recent studies have shown tremendous inter-person variability in the blood sugar response to any given food.

Previous studies have shown that our gut bacteria influence our blood sugar response to foods.

In theory, blood sugar control should be the perfect candidate for personalized diets. With that in mind, the authors of this study have created an algorithm called PNP (Personal Nutrition Program) that combines continuous blood glucose monitoring, HbA1c measurement (a measure of blood sugar control), personal characteristics (physical activities, sleep times, stress, and hunger), and a DNA analysis of stool samples to identify the species of gut bacteria. They also created a PNP app to allow participants to monitor and modify the foods they ate on a continuous basis.

In this study (AY Kharmats et al, The American Journal of Clinical Nutrition, 118: 443-451, 2023) the authors compared the effectiveness of their Personalized Nutrition Program algorithm with a standard, one-size-fits-all, low fat diet for improving blood sugar control in patients with prediabetes and type 2 diabetes.

Note: They used a low fat diet because, despite what you may have heard, low fat diets are better than low carb diets for diabetics. Of course, the low fat diet they used was created by dietitians. The carbohydrates came from whole foods rather than added sugars.

How Was The Study Done?

The investigators recruited 156 participants from the NYU Langone Health Center between January 2018 and March 2021. The participants selected were overweight with prediabetes or moderately controlled type 2 diabetes. For participants with type 2 diabetes, it was managed with lifestyle alone or lifestyle plus metformin. Other characteristic of the study participants were:

Gender: 33.5% male, 66.5% female.
Race & Ethnicity: 55.7% white, 24.1% black, 16.5% Hispanic.
Education: 69.5% with a college degree.
Baseline BMI: 33 (Obese).
Baseline HbA1c: 5.8% (prediabetic range) with 12% of participants ≥6.5% (diabetic range).

The participants were randomly divided into two groups that were matched with respect to weight and blood sugar control. One group was put on a diet based on the investigator’s PNP algorithm. The other group was put on a standardized low fat (< 25% of calories from fat) diet that is often used with diabetic patients.

Upon admission to the study, blood samples were drawn for HbA1c, a detailed questionnaire was filled out, and stool samples were obtained for DNA analysis to identify the species of bacteria in their gut.

Each participant was given a continuous glucose monitoring device to wear during the study. This allowed the investigators to monitor the participants blood sugar control throughout the study.

All this information was used to provide individual diet recommendations for the personalized diet group using the PNP algorithm developed by the investigators.

The study lasted 6 months and measured improvements in blood sugar control as assessed by a decrease in blood sugar spikes and a reduction in HbA1c.

Both Groups were put on a registered dietitian-led behavioral intervention program targeting 7% weight loss and a calorie deficit goal of 500 calories per day. The 1-hour sessions were conducted by Webex weekly for 4 weeks and then every other week for the remaining 5 months. The sessions included:

Education (e.g., obesity risks, benefits of weight loss, strategies for restricting calories, protocols for aerobic exercise and strength training, and dealing with weight loss plateaus)

Behavioral change (e.g., importance of behavioral change, goal setting, self-reward, and problem-solving around common barriers to weight loss success)

The participants were advised to gradually build up to 150 min/week of moderate intensity exercise.

Each participant was given access to the PNP mobile app designed by the investigators. The app provided real-time feedback regarding their dietary intake relative to the target specific to their group (low fat diet or personalized diet). Participants were asked to use the app to:

Enter their dietary intake and self-monitor their meals (If the meal did not match the target specific to their group, the participants were trained how to substitute other foods, so their meal better matched their target.)

For the Standardized Low Fat Group, the PNP app provided real-time feedback regarding calorie intake and macronutrient distribution for meals and snacks logged in by the participants.

For the Personalized Group the PNP app scored meals as excellent, very good, good, bad, or very bad based on the PNP algorithm developed by the investigators.

Can Personalized Diets Help Control Blood Sugar?

The results were clear-cut:

Weight loss was identical on both diets. This is no surprise. The study design included an exceptionally well-designed weight loss protocol for both groups.

The decrease in HbA1c was identical on both diets.

The improvement in blood sugar control was identical on both diets.

The investigators concluded, “[The] personalized diet did not result in an increased reduction in GV [blood sugar control] or HbA1c in patients with prediabetes or moderately controlled type 2 diabetes compared to a standardized diet.”

Since the investigators had designed the algorithm used to create personalized diets for this study, this was probably not the result they wanted.

So, they added, “Additional subgroup analyses may help to identify patients who are more likely to benefit from this personalized intervention.”

What Does This Study Mean For You?

This first takeaway from this study was obvious:

The personally designed diet did not perform any better than a standard, one size fits all, diet at improving blood sugar control.

Of course, this was not any standard diet. It was a diet that has been used successfully with diabetics for years. However, a lot of research had gone into developing the personalized diet. One might have expected it to perform better.

This is not the first study in which a personalized diet has performed no better than a standard diet. It doesn’t mean that the concept behind personalized diets is faulty. It just means we don’t yet know enough to design a personalized diet that really works.

The second takeaway from this study might be less obvious:

Weight loss is the most important factor for improving blood sugar control. Any diet that reduces weight will improve blood sugar control. This is also true for many other health issues such as high cholesterol, high blood pressure, high triglycerides, and osteoarthritis.

However, this should not come as a surprise either.

- Vegan and keto diets are polar opposites. Yet both give similar short-term weight loss and provide similar short-term health benefits.

- Studies have shown that intermittent fasting gives no better weight loss and health benefits than any diet that cuts calories to a similar extent.

- In other words, the diet you choose or the way you choose to restrict calories doesn’t matter. It is weight loss that provides the health benefits.

However, diet does appear to matter in the long term. If you look at studies ranging from 10 to 30 years, primarily plant-based diets provide better health benefits than primarily meat-based diets. And diets consisting primarily of whole, unprocessed foods provide better health benefits than diets high in processed foods.

Finally, there is an important corollary to this study showing that a personalized diet performed no better than a standardized diet at controlling blood sugar.

Some companies are trying to sell you expensive personalized diets with extravagant claims about the health benefits of their diet. Be wary of those diets. The science supporting their diets is premature. Their claims may be misleading.

And if the companies claim their diet is supported by published clinical studies, you should evaluate those studies carefully. The study I reviewed in this article was an exceptionally well-designed study. Any study that does not control for weight loss is likely to provide misleading results.

The Bottom Line

A recent study compared the effectiveness of a personalized diet and a standardized diet in improving blood sugar control for patients with prediabetes or type 2 diabetes. The results were clear-cut:

Weight loss was identical on both diets. This is no surprise. The study design included an exceptionally well-designed weight loss protocol for both groups.

The decrease in HbA1c was identical on both diets.

The improvement in blood sugar control was identical on both diets.

This doesn’t mean that the concept behind personalized diets is faulty. It just means we don’t yet know enough to design a personalized diet that really works.

For more information on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

______________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_____________________________________________________________________

About The Author

What Can Twins Tell Us About Diet?

January 30, 2024 by Dr. Steve Chaney

What Are The Pros And Cons Of Twin Studies?

Author: Dr. Stephen Chaney

Why is the advice on healthy diets so confusing? One blog claims the vegan diet is best. Another says it is the keto diet is best. The Mediterranean diet is popular, but other experts claim the DASH or MIND diet might be better. Blogs champion diets ranging from the familiar to downright weird.

If you try to keep up with the science, it seems like the science is constantly changing. Each week you see headlines saying the latest study shows diet “X” is best – and “X” keeps changing. Why is that? Why do studies on healthy diets keep coming up with conflicting conclusions?

I have discussed the strengths and weaknesses of clinical studies and why they provide conflicting results in detail in previous issues of “Health Tips From the Professor”. However, one factor I have not discussed in detail is the effect of genetics on how we utilize foods, something called nutrigenomics.

Simply put, we are all genetically different. The way we utilize foods is different. The effect that foods have on our bodies is different. I have touched on that briefly in a previous article discussing individual difference in blood sugar response to various foods. But that is just one of many examples.

We do not yet know enough about gene-nutrient interactions to use genomic data to accurately predict which diets are best. Again, I have covered that topic in a previous issue of “Health Tips From the Professor”. However, we do know that genetic differences have a big influence on which diet is best for us. And most clinical studies on diets do not even attempt to take genetic differences into account.

That is where twin studies come in. Identical twins (monozygotic twins) have an identical genetic makeup and usually have an identical environment until they become adults. So, when I saw an identical twin study (MJ Landry et al, JAMA Network Open, 6(11):e2344457, 2023) comparing a vegan diet (only plant foods) with an omnivorous diet (both animal and plant foods), I wanted to review it and share it with you.

How Was The Study Done?

Identical twins were recruited from the Stanford Twin Registry. Twenty-two identical twin pairs were chosen for this study. Their characteristics were average age = 40, BMI = 26% (moderately overweight), sex = 77% female, ethnicity = 73% white, followed by an approximately equal representation of Asian, black, multiracial, and Pacific Islander.

One unanticipated characteristic of this group of twins was that 70% of them still lived together and cooked together, so their environment was also very similar.

One twin of each pair was put on a healthy vegan diet and the other on a healthy omnivorous diet for 8 weeks. Both diets were designed by dietitians. The diets emphasized fruits, vegetables, and whole grains while limiting added sugars and refined grains.

Both diets were healthier than the diets the twins were eating prior to the study. Finally, the participants were not told how much to eat, and were not instructed to lose weight.

For the first four weeks the participants were provided with all their meals by a nationwide food delivery company. The participants were also provided with training on purchasing and preparing healthy foods for their diet. This prepared them for the last 4 weeks of the study in which they purchased and prepared their own meals.

Participants visited the Stanford Clinical and Translational Science Research Unit at the beginning of the study and at the end of weeks 4 and 8 for weight measurement and a fasting blood draw.

Adherence to the diets was measured by a series of unannounced interviews to administer a 24-hour dietary recall questionnaire. These were scheduled for the weeks they visited the clinic.

What Can Twins Tell Us About Diet?

Even though the sample size was small, there were three statistically significant results.

LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.

The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.

The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less nor to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet (See my discussion of caloric density in last week’s issue of “Health Tips From the Professor”.

The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

The authors of this study concluded, “In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.”

[Let me decipher the term cardiometabolic for you. The decrease in LDL-cholesterol is associated with heart health – the cardio portion of the term. The decrease in fasting insulin is associated with decreased risk of diabetes. Since diabetes is considered a metabolic disease, this is the metabolic portion of the term.]

Were There Any Downsides To The Vegan Diet?

This study also highlighted two well-known limitations of vegan diets.

Although the differences were not statistically significant, the authors expressed concern that vitamin B12 intake was less for twins on the vegan diet than twins on the omnivorous diet even though the vegan diet was designed by dietitians.

The authors noted that B12 deficiency among vegans is well known, and said, “Long-term vegans are typically encouraged to take a cyanocobalamin (vitamin B12) supplement.

Although both groups had excellent adherence to their assigned diets, those assigned to the vegan diet expressed a lower satisfaction with the diet, which suggests long-term adherence to the diet after the study ended was unlikely.

The authors said, “Although our findings suggest that vegan diets offer a protective cardiometabolic advantage compared with a healthy omnivorous diet, excluding all meats and/or dairy products may not be necessary because research suggests that cardiometabolic benefits can be achieved with modest reduction in animal foods and increases in healthy plant-based foods compared with typical diets.”

“We believe that lower dietary satisfaction in the vegan group may have been attributable to the strictness of the vegan diet…Some people may find a less restrictive diet preferable for LDL-cholesterol-lowering effects.”

I concur.

What Are The Pros And Cons Of Twin Studies?

The Pros are obvious. Most dietary studies cannot take genetic differences into account and have difficulty accounting for environmental differences. In this study genetics was identical for each twin pair and their environment was very similar. It offers a unique advantage over other studies.

But the strength of this study is also its greatest weakness. Because the general population is genetically and environmentally diverse, it is difficult to extrapolate the results to the general population.

If this were the only study to show cardiometabolic benefits of a plant-based diet, it would simply be an interesting observation.

But there are several studies showing that the vegan diet is associated with lower weight and reduced risk of heart disease and diabetes.

And there are dozens of studies showing that primarily plant-based omnivorous diets reduce the risk of heart disease and diabetes.

This study is fully consistent with those studies.

The Bottom Line

A recent study put identical twins on either a healthy vegan diet (only plant foods) or a healthy omnivorous diet (both animal and plant foods) for 8 weeks. At the end of 8 weeks:

LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.

The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.

The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less or to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet.

The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

For more information on the pros and cons of this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

_____________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author

For the past 35 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Are All Carbs Bad?

August 1, 2023 by Dr. Steve Chaney

Are Low Carb Enthusiasts Right About The Dangers Of Carbohydrates?

Author: Dr. Stephen Chaney

Low carb enthusiasts have been on the warpath against carbohydrates for years.

Almost everyone agrees that sugar-sweetened sodas and highly processed, refined foods with added sugar are bad for us. But low carb enthusiasts claim that we should also avoid fruits, grains, and starchy vegetables. Have they gone too far?

Several recent studies suggest they have. For example, both association studies and randomized controlled studies suggest that total carbohydrate intake is neither harmful nor beneficial for heart health.

In addition, recent studies suggest that free sugar intake is associated with both elevated triglyceride levels and an increase in heart disease risk.

But those studies have mostly looked at free sugar intake from sugar-sweetened sodas. The authors of this study (RK Kelley et al, BMC Medicine, 21:34, 2023) decided to look more carefully at the effect of all free sugars and other types of carbohydrates on triglyceride levels and heart disease risk.

How Was This Study Done?

The 110,497 people chosen for this study were a subgroup of participants in the UK Biobank Study, a large, long-term study looking at the contributions of genetic predisposition and environmental exposure (including diet) to the development of disease in England, Scotland, and Wales.

The participants in this study were aged between 37 and 73 (average age = 56) on enrollment and were followed for an average of 9.4 years. None of them had a history of heart disease or diabetes or were taking diabetic medications at the time of enrollment.

During the 9.4-year follow-up, five 24-hour dietary recalls were performed, so that usual dietary intake could be measured rather than dietary intake at a single time point. The people in this study participated in an average of 2.9 diet surveys, and none of them had less than two diet surveys.

The averaged data from the dietary recalls were analyzed for the amount and kinds of carbohydrate in the diet. With respect to the types of carbohydrate, the following definitions would be useful.

The term free sugars includes all monosaccharides and disaccharides added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and unsweetened fruit juices.

The term non-free sugars includes all sugars not in the free sugar category, mostly sugars naturally occurring in fruits, vegetables, and dairy products.

The term refined grains includes white bread, white pasta, white rice, most crackers and cereals, pizza, and grain dishes with added fat.

The term whole grains includes wholegrain bread, wholegrain pasta, brown rice, bran cereal, wholegrain cereals, oat cereal, and muesli.

Finally, the study looked at the association of total carbohydrate and each class of carbohydrate defined above with all heart disease, heart attacks, stroke, and triglyceride levels.

Are All Carbs Bad?

The study looked at total carbohydrate intake, free sugar intake, and fiber intake. In each case, the study divided the participants into quartiles and compared those in the highest quartile with those in the lowest quartile.

Using this criterion:

Total carbohydrate intake was not associated with any cardiovascular outcome measured (total heart disease risk, heart attack risk, and stroke risk).

Free sugar intake was positively associated with all cardiovascular outcomes measured. Each 5% increase in caloric intake from free sugars was associated with a:

- 7% increase in total heart disease risk.

- 6% increase in heart attack risk.

- 10% increase in stroke risk.

- 3% increase in triglyceride levels.

Fiber intake was inversely associated with total heart disease risk. Specifically, each 5 gram/day increase in fiber was associated with a:

- 4% decrease in total heart disease risk.

The investigators also looked at the effect of replacing less healthy carbohydrates with healthier carbohydrates. They found that:

Replacing 5% of caloric intake from refined grains with whole grains reduced both total heart disease risk and stroke risk by 6%.

Replacing 5% of caloric intake from free sugars (mostly sugar-sweetened beverages, fruit juices, and processed foods with added sugar) with non-free sugars (mostly fruits, vegetables, and dairy products) reduced total heart disease risk by 5% and stroke risk by 9%.

Are Low Carb Enthusiasts Right About The Dangers Of Carbohydrates?

With these data in mind let’s look at the claims of the low-carb enthusiasts.

Claim #1: Carbohydrates raise triglyceride levels. This study shows:

This claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake (fruits, vegetables, and whole grains. This study did not measure intake of beans, nuts, and seeds, but they would likely be in the same category).

However, this claim is true with respect to foods high in free sugars (sugar-sweetened beverages, fruit juices, and processed foods with added sugar).

Claim #2: Carbohydrates increase heart disease risk. This study shows:

That claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake.

However, this claim is true with respect to foods high in free sugars.

Claim #3: Carbohydrates cause weight gain [Note: Low carb enthusiasts usually word it differently. Their claim is that eliminating carbohydrates will help you lose weight. But that claim doesn’t make sense unless you believed eating carbohydrates caused you to gain weight.] This study shows:

This claim is false with respect to total carbohydrate intake and high fiber carbohydrate intake.

Once again, this claim is true with respect to foods high in free sugars.

The data with high fiber carbohydrates was particularly interesting. When the authors compared the group with the highest fiber intake to the group with the lowest fiber intake, the high-fiber group:

Consumed 33% more calories per day.

But had lower BMI and waste circumference (measures of obesity) than the low-carbohydrate group.

This suggests that you don’t need to starve yourself to lose weight. You just need to eat healthier foods.

And, in case you were wondering, the high fiber group ate:

5 more servings of fruits and vegetables and…

2 more servings of whole grain foods than the low fiber group.

This is consistent with several previous studies showing that diets containing a lot of fruits, vegetables, and whole grains are associated with a healthier weight.

The authors concluded, “Higher free sugar intake was associated with higher cardiovascular disease incidence and higher triglyceride concentrations…Higher fiber intake and replacement of refined grain starch and free sugars with wholegrain starch and non-free sugars, respectively, may be protective for incident heart disease.”

In short, with respect to heart disease, the type, not the amount of dietary carbohydrate is the important risk factor.

What Does This Mean For You?

Forget the low carb “mumbo jumbo”.

Carbohydrates aren’t the problem. The wrong kind of carbohydrates are the problem. Fruit juice, sugar-sweetened sodas, and processed foods with added sugar:

- Increase triglyceride levels.

- Are associated with weight gain.

- Increase the risk for heart disease.

In other words, they are the villains. They are responsible for the bad effects that low carb enthusiasts ascribe to all carbohydrates.

Don’t fear whole fruits, vegetables, dairy, and whole grain foods. They are the good guys.

- They have minimal effect on triglyceride levels.

- They are associated with healthier weight.

- They are associated with a lower risk of heart disease and diabetes.

So, the bottom line for you is simple. Not all carbs are created equal.

Your mother was right. Eat your fruits, vegetables, and whole grains.

Avoid fruit juice, sodas and other sugar-sweetened beverages, and processed foods with added sugar. [Note: Artificially sweetened beverages are no better than sugar-sweetened beverages, but that’s another story for another day.]

And, if you were wondering why low carb diets appear to work for weight loss, it’s because any restrictive diet works short term. As I have noted previously, keto and vegan diets work equally well for short-term weight loss.

The Bottom Line

Low carb enthusiasts have been telling us for years to avoid all carbohydrates (including fruits, starchy vegetables, and whole grains) because carbohydrates:

Increase triglyceride levels.

Cause weight gain.

Increase our risk for heart disease.

A recent study has shown that these claims are only true for some carbohydrates, namely fruit juices, sodas and other sugar-sweetened beverages, and processed foods with added sugar.

Whole fruits, vegetables, and whole grain foods have the opposite effect. They:

Have a minimal effect on triglyceride levels.

Are associated with a healthier weight.

Are associated with a lower risk of heart disease and diabetes.

So, forget the low carb “mumbo jumbo” and be sure to eat your fruits, vegetables, and whole grains.

For more information on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

___________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Are Low Carb Diets Healthier?

April 25, 2023 by Dr. Steve Chaney

The “Goldilocks Effect”

Author: Dr. Stephen Chaney

The low-carb wars rage on. Low-carb enthusiasts claim that low-carb diets are healthy. Many health experts warn about the dangers of low-carb diets. Several studies have reported that low-carb diets increase risk of mortality (shorten lifespan).

However, two recent studies have come to the opposite conclusion. Those studies reported that high carbohydrate intake increased mortality, and low carbohydrate intake was associated with the lowest mortality.

One of those studies, called the Prospective Urban Rural Epidemiology (PURE) study was published a few years ago. It included data from 135,335 participants from 18 countries across 5 continents. That’s a very large study, and normally we expect very large studies to be accurate. The results from the PURE study had low-carb enthusiasts doing a victory lap and claiming it was time to rewrite nutritional guidelines to favor low-carb diets.

Whenever controversies like this arise, reputable scientists are motivated to take another look at the question. They understand that all studies have their weaknesses and biases. So, they look at previous studies very carefully and try to design a study that eliminates the weaknesses and biases of those studies. Their goal is to design a stronger study that reconciles the differences between the previous studies.

A third study published a year later (SB Seidelmann et al, The Lancet, doi.org/10.1016/S2468-2667(18)30135-X was such a study. This study resolved the conflicting data and finally answered the question: “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough”.

I call this “The Goldilocks Effect”. You may remember “Goldilocks And The Three Bears”. One bed was too hard. One bed was too soft. But one bed was “just right”. One bowl of porridge was too hot. One was two cold. But one was “just right”. According to this study, the same is true for carbohydrate intake. High carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But moderate carbohydrate intake is “just right”.

How Was The Study Done?

This study was performed in two parts. This first part drew on data from the Atherosclerosis Risk in Communities (ARIC) study. That study enrolled 15,428 men and women, aged 45-64, from four US communities between 1987 and 1989. This group was followed for an average of 25 years, during which time 6283 people died. Carbohydrate intake was calculated based on food frequency questionnaires administered when participants enrolled in the study and again 6 years later. The study evaluated the association between carbohydrate intake and mortality.

The second part was a meta-analysis that combined the data from the ARIC study with all major clinical studies since 2007 that measured carbohydrate intake and mortality and lasted 5 years or more. The total number of participants included in this meta-analysis was 432,179, and it included data from previous studies that claimed low-carbohydrate intake was associated with decreased mortality.

Are Low Carb Diets Healthier?

The results from the ARIC study were:

The relationship between mortality and carbohydrate intake was a U-shaped curve.

- The lowest risk of death was observed with a moderate carbohydrate intake (50-55%). This is the intake recommended by current nutrition guidelines.

- The highest risk of death was observed with a low carbohydrate intake (<40%).

- The risk of death also increased with very high carbohydrate intake (>70%).

When the investigators used the mortality data to estimate life expectancy, they predicted a 50-year old participant would have a projected life expectancy of:

- 33.1 years if they had a moderate intake of carbohydrates.

- 4 years less if they had a low carbohydrate intake.

- 1.1 year less if they had a very high carbohydrate intake.

The risk associated with low carbohydrate intake was affected by what the carbohydrate was replaced with.

- When carbohydrates were replaced with animal protein and animal fat there was an increased risk of mortality on a low-carb diet. The animal-based low-carb diet contained more beef, pork, lamb, chicken, and fish. It was also higher in saturated fat.
- When carbohydrates were replaced with plant protein and plant fats, there was a decreased risk of mortality on a low-carb diet. The plant-based low-carb diet contained more nuts, peanut butter, dark or whole grain breads, chocolate, and white bread. It was also higher in polyunsaturated fats.

The effect of carbohydrate intake on mortality was virtually the same for all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality.

There was no significant effect of carbohydrate intake on long-term weight gain (another myth busted).

The results from the dueling meta-analyses were actually very similar. When the data from all studies were combined:

Both very low carbohydrate diets and very high carbohydrate diets were associated with increased mortality.

Meat-based low-carb diets increased mortality, and plant-based low-carb diets decreased mortality.

Once again, the results were the same for total mortality, cardiovascular mortality, and non-cardiovascular mortality.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy and both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged. Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to healthy aging.”

Simply put, that means if a low carb diet works best for you, it is healthier to replace the carbs with plant-based fats and protein rather than animal-based fats and protein.

The “Goldilocks Effect”

This study also resolved the discrepancies between previous studies. The authors pointed out that the average carbohydrate intake is very different in Europe and the US than in Asian countries and low-income countries.

In the US and Europe mean carbohydrate intake is about 50% of calories and it ranges from 25% to 70% of calories. With that range of carbohydrate intake, it is possible to observe the increase in mortality associated with both very low and very high carbohydrate intakes.

The US and European countries are affluent, which means that low-carb enthusiasts can afford diets high in animal protein.

White rice is a staple in Asian countries, and protein is a garnish rather than a main course. Consequently, overall carbohydrate intake is greater in Asian countries and very few Asians eat a truly low carbohydrate diet. High protein foods tend to be more expensive than high carbohydrate foods. Thus, very few people in developing countries can afford to follow a very low carbohydrate diet, and overall carbohydrate intake also tends to be higher.

Therefore, in Asian and developing countries the average carbohydrate intake is greater (~61%) than in the US and Europe, and the range of carbohydrate intake is from 45% to 80% of calories. With that range of intake, it is only possible to see the increase in mortality associated with very high carbohydrate intake.

Both the studies that low-carb enthusiasts quote to support their claim that low-carb diets are healthy relied heavily on data from Asian and developing countries.

In fact, when the authors of the current study overlaid the data from the PURE study with their ARIC data, there was an almost perfect fit. The only difference was that their ARIC data covered both low and high carbohydrate intake while the PURE study touted by low-carb enthusiasts only covered moderate to high carbohydrate intake.

[I have given you my rendition of the graph on the right. If you would like to see the data yourself, look at the paper.]

Basically, low-carb advocates are telling you that diets with carbohydrate intakes of 30% or less are healthy based on studies that did not include carbohydrate intakes below 40%. That is misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

What Does This Study Mean For You?

There are several important take-home lessons from this study:

All major studies agree that very high carbohydrate intake is unhealthy. In part, that reflects the fact that diets with high carbohydrate intake are likely to be high in sodas and sugary junk foods. It may also reflect the fact that diets which are high in carbohydrate are often low in plant protein or healthy fats or both.

All studies that cover the full range of carbohydrate intake agree that very low carbohydrate intake is also unhealthy. It shortens the life expectancy of a 50-year-old by about 4 years.

The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

Meat-based low-carb diets decrease life expectancy while plant-based low carb diets increase life expectancy. This is consistent with previous studies. For more details on those studies, see my article, “Are Any Low-Carb Diets Healthy?”, in “Health Tips From The Professor” or my book, “Slaying The Food Myths”.

The health risks of meat-based low-carb diets may be due to the saturated fat content or the heavy reliance on red meat. However, the risks are just as likely to be due to the foods these diets leave out – typically fruits, whole grains, legumes, and some vegetables.

Proponents of low-carb diets assume that you can make up for the missing nutrients by just taking multivitamins. However, each food group also provides a unique combination of phytonutrients and fibers. The fibers, in turn, influence your microbiome. Simply put, whenever you leave out whole food groups, you put your health at risk.

The Bottom Line

The low-carb wars are raging. Several studies have reported that low-carb diets increase risk of mortality (shorten lifespan). However, two studies published a few years ago have come to the opposite conclusion. Those studies have low-carb enthusiasts doing a victory lap and claiming it is time to rewrite nutritional guidelines to favor low-carb diets.

However, a study published a year later resolves the conflicting data and finally answers the question: “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough”.

I call this “The Goldilocks Effect”. According to this study, high carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But, moderate carbohydrate intake is “just right”.

Specifically, this study reported:

Moderate carbohydrate intake (50-55%) is healthiest. This is also the carbohydrate intake recommended by current nutritional guidelines.

2) All major studies agree that very high carbohydrate intake (60-70%) is unhealthy. It shortens life expectancy of a 50-year old by about a year.

3) All studies that cover the full range of carbohydrate intake agree that low carbohydrate intake (<40%) is also unhealthy. It shortens life expectancy of a 50-year old by about 4 years.

4) The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

5) Meat-based low-carb diets decrease life expectancy while plant-based low carb diets increase life expectancy. This is consistent with the results of previous studies.

Simply put, that means if a low carb diet works best for you, it is healthier to replace the carbs with plant-based fats and protein rather than animal-based fats and protein.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.