In the latest edition of Nutrition Action from Center for Science in the Public Interest, December 2022, there is a very comprehensive article on Diabetes type 2. Here are the important takeaways. The article was written by Bonnie Liebman.
“Fifteen percent of U.S. adults have diabetes. Another 38% have prediabetes (and 8 out of 10 of them don’t know it). The good news: Many cases can be prevented and, in some people, even reversed.”
Prevention is the key with the practice of lifestyle changes in diet and exercise.
The Bottom Line:
“The best way to dodge prediabetes is to lose (or not gain) extra pounds.
Cutting carbs – especially white flour, potatoes, juice and sugary drinks- may help lower blood sugar even if you don’t lose weight.
Replace unhealthy carbs with unsaturated fats like olive oil or canola oil, nuts, avocado, and fatty fish.
Fill half of your plate with nonstarchy vegetables.
Aim for at last 30 minutes of brisk walking or other aerobic exercise daily.
If you have type 2 diabetes, don’t try a very-low-calorie or a low-carb diet without a doctor’s or dietitian’s help. They may cause dangerously low blood sugar, and your doctor may need to adjust your medications.
If you have prediabetes, find a CDC-recognized-in-person or online Diabetes Prevention Program. (Go to cdc.gov/diabetes/prevention.)”
Every year, the average American eats 33 pounds of cheese and 70 pounds of sugar. Every day, we ingest 8,500 milligrams of salt, double the recommended amount, almost none of which comes from shakers on our table. It comes from processed food, an industry that hauls in $1 trillion in annual sales.
Michael Moss, Salt, Sugar, Fat: How the Food Giants Hooked Us.
Plant based diets are increasingly becoming the new trend in nutrition these days. Plant based diets are also currently thought of as being environmentally friendly with increased attention paid to animal welfare, lower levels of greenhouse gases, land degradation and less water use that are also thought as having a myriad of health benefits. However, some foods are what many people call “junk” foods or ultra—processed foods and not considered “products of nature”.
“All foods according to some standards or sold in supermarkets would be classified as “processed.” The USDA defines a processed food as one that has undergone any changes to its natural state, e.g. cutting or washing. The NOVA classification assigns a group to food products based on how much processing they have been through: Group 1 – Unprocessed or minimally processed foods Group 2 – Processed culinary ingredients Group 3 – Processed foods Group 4 might include ultra-processed foods.” The Institute of Food Technologists includes additional processing terms like storing, filtering, fermenting, extracting, concentrating, microwaving, and packaging.”
“Ultra- processed foods,” contain minimal whole foods, are high in calories, added sugar, salt and fats. They offer little nutritional value” and have been processed with a list of additives that are difficult to pronounce and would not be recognized as food by our ancestors. The NOVA classification often used to determine the extent of industrial processes as mentioned above may include the following:
Commercially produced breads, pastries, cakes, and cookies
Flavored dairy drinks
Instant soups , noodles, and desserts
A study in 2019 followed 105,159 adults for 5 years. They reported that even a 10% increase in the consumption of ultra–processed foods was associated with a negative health outcome like higher risks of heart disease, stroke, type 2 diabetes and some cancers. (Associations do not reflect causes). The associations found showed that some vegans and vegetarians often have lower levels of iron, vitamin B 12, calcium, vitamin D and omega-3 fats.
Plant-based diets still may have a health advantage. This can occur if the diet in question also provides the needed nutrients for nutritional health such as adequate fruits and vegetables, non- starchy vegetables, eggs, plant protein, seafood and whole grains (fiber) on a regular basis. However, on the other hand, the bottom line is that a bag of potato chips although plant based, provides few nutrients and should be limited on a healthier plant based diet.
Be sure to read nutrition labels to become aware of the calories, added sugars, salt saturated fats, trans fats and other essential nutrients in one serving.
Monitor fiber and carbohydrate portions. Be sure to check the fiber content of many cereal products.
Focus on proteins, meat substitutions -peas, beans, nuts, seeds, tofu, tempeh, eggs, milk, cheese, yogurt, and seafood.
If possible, anyone beginning a new eating pattern should consult a dietitian or physician with nutrition knowledge.
Limit your intake of processed foods in general, especially ultra-processed.
As Michael Pollan says in his book, In Defense of Food. “Because most of what we’re consuming today is not food, and how we’re consuming it…in the car, in front of the TV — is not really eating. Instead of food, we’re consuming “edible foodlike substances” – no longer the products of nature but of food science.”
What caused the obesity epidemic? What are the consequences?
HOUSTON – When it comes to the childhood obesity epidemic, the prevailing narrative is that overweight children — and their parents — lack the collective will power to put down the potato chips, pick up a jump rope and work at losing weight.
“… doctors specializing in obesity and weight loss say certain scientific and societal factors — including genetics, the rise of processed foods that include soybean oil and national overconsumption of sugar-sweetened beverages — are more likely to blame for childhood obesity than lazy kids or indulgent parents.
“Obesity is a disorder which, like venereal disease, is blamed upon the patient,” says obesity researcher Dr. George Bray, the opening lecturer at the first annual U.S. News Combating Childhood Obesity summit, held at Texas Children’s Hospital.
It’s the blame issue that stands in the way of progress in fighting obesity as a disease, when larger factors that can’t be controlled may be at the heart of the issue, says Bray, professor emeritus of the Pennington Biomedical Research Center at Louisiana State University, who has been studying obesity among children for several decades.
“Obesity isn’t a disease of willpower — it’s a biological problem,” he says. “Genes load the gun, and environment pulls the trigger.”
In a panel analyzing why weight is difficult to lose, Kevin Hall, an obesity and diabetes researcher, says a new study he co-produced points the finger at highly processed food.
His study, published Thursday in the medical journal Cell Metabolism, showed that patients who ate minimally-processed food with easily identifiable ingredients ate less, and lost weight without trying, when compared with a group that had highly-processed, prepackaged, ready-to-eat food, even though the diets prepared for both groups had the same number of calories and macronutrients.
“What we saw, on average, was that people consumed 500 calories more” on the processed-food diet than those who ate food that didn’t go through a factory, says Hall, chief of the integrated physiology section at the National Institute of Diabetes and Digestive and Kidney Diseases. “The ones on the unprocessed diet — they spontaneously lost weight.” It has been proposed that eating a diet for health (whole, “real” foods) can cause weight loss and maintenance of the loss compared to those who primary goal was simply weight loss alone.
In opening the summit, presenters tackled a question doctors and obesity researchers have grappled with a difficult question in fighting the disease: How did we get here?
Bray says studies trace the epidemic back to the ’60s and ’70s, when U.S consumption of soybean oil, most likely through processed-food production, spiked and, around the same time, Americans, including children, started to weigh more. Fats found in soybean oil, he says, were found in breast milk samples from the era.
“The fats in our food supply may well be playing a part in our inability to regulate” food intake, Bray says. However, this is just the tip of the iceburg. Likewise food portions have been shown graphically to double the size of those served beginning inn the 1970’s.
Meanwhile, the consumption of sugary soft drinks like Coke and Pepsi increased from just a few gallons per person per year to more than triple that by the end of the century. The rise of soft drink consumption between 1950 and 2000, he says, paralleled the increase in obesity; pregnant women who drank sugary soft drinks, Bray added, ended up passing the sugar on to their unborn children.
“It’s kind of maternal abuse of the fetus” where “the child has no control, only the mother has,” he says.
The U.S. News Combating Obesity summit convened top medical experts, hospital executives, pediatricians, community health leaders, advocates to exchange ideas and share practices that are helping to combat the nationwide obesity epidemic.
The percentage of children and adolescents affected by obesity “has more than tripled since the 1970s,” according to the Centers for Disease Control and Prevention. According to data from 2015-2016, the CDC reports, “nearly 1 in 5 school age children and young people (6 to 19 years) in the United States has obesity.”
Experts say the epidemic has long-term ramifications: Obese children who carry the weight can exhibit heart disease and type 2 diabetes as well as mobility and self-esteem issues. Unfortunately in order to reverse this trend, cultural changes will be required at many levels, to say the least. Can it happen?
U.S. News and World Report
Joseph P. Williams, Senior Editor
May 16, 2109
Scientific, Societal Factors to Blame for the Obesity Epidemic
“A good predictor of who will gain weight is who says they plan to lose some. Last year, 108 million Americans went on diets. Long-term studies of dieters find that they’re more likely to end up gaining weight in the next two to fifteen years than people who don’t diet.” Sandra Aamodt, Ph.D. Why Diets Make Us Fat. 2016.
Rebound’ Weight Gain: A Disconnect Between Brain and Gut May Be a Factor
Healthline. By Christopher Curley, September 15, 2022
Fact Checked: Jennifer Chesak
“Experts say weight gain after weight loss is common among adults and children.
Researchers say a new study indicates that a disconnect between the brain and the gut may be a reason that people tend to gain weight after initially losing weight.
They say in many people who have lost weight their gut will tell them they’re full after eating a meal, but their brain will try to tell them they’re still hungry.
Experts say the disconnect may be due to the body’s attempt to store fat during weight loss.
Nearly halfTrusted Source of adults in the United States try to lose weight each year, but many will not keep that weight off long-term.
While there are many competing theories about why that is, ranging from psychological to biological, a new study of children with obesity suggests the answer might lie in a disconnect between gut hormones and brain signals.
Researchers at Seattle Children’s Hospital in Washington put children with obesity on a 24-week weight loss program, monitoring their brain activity and gut hormone responses before and after the trial.
At the end of the weight loss program, the researchers reported that after eating a meal the children’s gut showed normal levels of regulatory hormones indicating that they were full and satisfied.
Their brains, however, showed levels of activity signaling that they were still hungry.
The researchers also found that the more weight a child lost, the more likely they were to react to food cues after completing a meal —their brain essentially telling them they were still hungry while their gut was telling them the reverse.
“Our results imply that during weight loss intervention, your body acts to conserve fat through maintaining hunger responses in the brain and that this needs to be addressed,” Dr. Christian Roth, a lead study author and professor at Seattle Children’s Hospital, said in a press release.
Roth said larger, more extensive studies would be required to confirm these findings.
“It would also be useful to investigate how long the disconnect between central and local appetite regulation persists after maintained weight loss, to guide intervention plans,” he added.
“This is a very interesting study and I think that a lot of these findings are applicable to adults as well,” said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.
“I see in my patients that they feel the need to eat, even if their stomach feels full,” Ali told Healthline. “There is certainly a strong psychological component to eating behavior that surgery and medications cannot always address completely.”
“I feel this research is on the right track and we need to find a way to satisfy the brain as well as the gut,” he added. “This will require extensive research in both children and adults to find the right solution.”
One of the more notable aspects of the study is how it complicates our understanding of how hormones affect appetite and rebound weight gain.
Previous studies have shown that an increase in appetite hormones after weight loss might be a key driver of these rebound gains.
The results of this study paint a more nuanced picture where even if gut hormones are normal, the brain is out of sync.
“The study underscores our understanding of obesity and weight homeostasis as a chronic disease of the brain,” said Dr. Mert Erogul, an attending physician at Maimonides Medical Center in New York.
“The regulation of appetite is enormously complex and layered,” he told Healthline. “From the digestive tract, there are hormones that signal fullness, such as leptin, CCK, and peptide YY. There are also hormones that signal hunger, such as ghrelin. These are in constant interplay with seemingly subjective feelings that come from the brain such as food preference and liking as well as motivation to eat.”
Ultimately, experts say this may require a holistic approach to weight loss and maintaining a healthy weight.
“Rebound weight gain is very common and happens for many physiological, behavioral, and psychological reasons,” said Dr, Steve Patching, a medical director of bariatric surgery at Sutter Hospital in Sacramento, California.
“Believe it or not, weight loss actually sets up your body for weight gain,” he told Healthline. “This is because the body always strives for symbiosis. This is why we often still feel hungry or even starving after we eat a ‘normally satiating’ meal. It is also why correct weight loss should be done slower than we often want.”
Weight loss needs to occur in the context of a durable commitment to changes in diet and lifestyle,” he said. “Even then, obesity medicine specialists recognize that people who are overweight often need lifelong therapy with medications to maintain weight loss.”
The aging process usually does not cause malnutrition in healthy, active adults, but nutritional health can be complicated by physical changes that occur with age, the presence of disease(chronic and acute), economic, psychological and social circumstances. Malnutrition then exacerbates some of these factors, contributing to a downward health spiral from which it is difficult to recover.
“Poor diets in the US are a national security threat” – CNN
By Gisela Crespo, CNN ! Updated 2:43 PM ET, Mon July 20, 2020 (CNN) — America’s poor diet isn’t just bad for us. It’s now considered a threat to national security. Diet-related illnesses are a growing burden on the United States economy, worsening health disparities and impacting national security, according to a white paper published Monday in the American Journal of Clinical Nutrition. Poor nutrition is the leading cause of illnesses in the US, with unhealthy diets killing more than half a million people each year, a group of experts who have formed the Federal Nutrition Research Advisory Group wrote in the paper. About 46% of adults in the country have an overall poor-quality diet, and this number goes up to 56% for children, according to the paper. Related Article: Add fruit, veggies and grains to diet to reduce type 2 diabetes risk by 25%, studies say for the most vulnerable Americans.” Meanwhile, US healthcare spending has nearly tripled from 1979 to 2018, from 6.9% to 17.7% of the gross domestic product. These increases in health spending, the advisory group said, affect government budgets, the competitiveness of the US private sector and workers’ wages. Diet-related health disparities affect minority, rural and low- income communities. “While social and economic factors such as lower education, poverty, bias, and reduced opportunities are major contributors to population disparities, they are likewise major barriers to healthy food access and proper nutrition,” the paper reads. “Poor diets lead to a harsh cycle of lower academic achievement in school, lost productivity at work, increased chronic disease risk, increased out-of-pocket health costs,
The paper’s authors called for the expansion of federal investment in nutrition science by creating a new Office of the National Director of Food and Nutrition or a new US Task Force on Federal Nutrition Research, with the goal of improving coordination within the agencies that budget for research in this topic.
The paper also called for “accelerating and strengthening” nutrition research within the National Institutes of Health by creating a new National Institute of Nutrition.
“Every day, our country suffers massive health, social, and economic costs of poor diets,” said Dr. Dariush MozaWarian, co-author of the paper and dean and Jean Mayer Professor of Nutrition at the Friedman School of Nutrition Science and Policy at Tufts University.
“With its prefix from the Greek word epi, which means “in addition to,” this word relates to factors in addition to DNA base sequence that influence the function of genes”
Epigenetic tags are chemical tags, e.g. methyl groups, added to DNA that record the effects of experience, changing the gene expression.
“DNA sequencing is the order in which the four nucleotides (A, C. T, or G) are strung together on the DNA molecule.”
Epigenetics is a hot topic right now and appears more in news articles as science makes further associations. It is becoming more obvious that our lifestyle and experiences can affect our genes and can be passed down to our children and grandchildren through genetic pathways.
DNA is the blueprint for the instructions for the entire body, but chemical tags called methyl groups make up what is called the epigenome to decide which genes are active – this is called methylation or gene expression. It is often referred to as an “on and off switch” that turns on or off certain genes. It is what makes identical twins different over time. Although our DNA code does not change, the epigenome is flexible and reacts to our environment. Our experiences help shape how genes are expressed.
DNA methylation works by adding a chemical group to specific places on the DNA as “tags” where it blocks the proteins that attach to the DNA to “read the gene”. This chemical group can be removed through a process called demethylation. Typically, methylations turn genes “off” and demethylation turns genes “on”.
Women are not solely responsible for the health of their future children. Science is finding that the health of a man’s unborn children can be affected by things like the man’s diet, life experiences and trauma, exposure to toxins and how old he is at conception.
Why Should I Care About Epigenetics? Utah Valley Pediatrics, September 30, 2013