GP referral to Weight Watchers avoided type 2 diabetes in third of patients (UK)

More than a third of patients at risk of developing type 2 diabetes who reside in the UK avoided developing the condition after they were referred by their family doctor (GP) to a diabetes prevention program delivered by the commercial weight management provider, Weight Watchers, finds research published in BMJ Open Diabetes Research & Care.

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The initiative also helped more than half of those referred either to reduce their risk of developing diabetes or to get their blood sugar levels back to normal. The number of people diagnosed with type 2 diabetes in the UK has increased from 1.4 to 2.9 million since 1996. An even more substantial increase can be seen in the United States (U.S.) with a rise from 7.6 to 23.4 million. A new diagnosis is made every 2 minutes, and by 2025, an estimated 5 million people in the UK and 53 million in the U.S. will have the condition. Horrifying statistics! Risk of developing type 2 diabetes is strongly influenced by lifestyle factors but can be significantly reduced by weight loss, achieved by eating less and exercising more.

The UK’s national health and social care guidance organization, the National Institute for Health and Care Excellence (NICE) says that certain commercial weight management providers, such as Weight Watchers, can help obese people shed pounds. A U.S. study showed that participation in a commercial weight management program succeeded in reversing progression to type 2 diabetes. However, the effectiveness of this approach in UK primary care has not been thoroughly evaluated. Therefore, the researchers identified 166 patients from 14 general practice surgeries at high risk of developing type 2 diabetes: Those with impaired glucose regulation known as pre-diabetes or non-diabetic hyperglycemia and with a body mass index (BMI) above 30 kg/m2.

These patients were then invited to contact Weight Watchers to book a place on their diabetes prevention program, which included a 90-minute induction session followed by 48 weekly group meetings. From among the 166 primary care referrals, 149 patients were eligible. Some 117 attended the induction, and 115 started the weekly sessions, representing a take-up rate of 70%, which is high for a lifestyle intervention, according to the researchers. The program focused on improving diet quality, reducing portion size, increasing physical activity levels, as well as boosting confidence in the ability to change and a commitment to the process.

Blood tests were repeated at 6 and 12 months to check risk factors, and any changes in weight were recorded by trained Weight Watcher staff. Analysis of the results showed that the initiative led to an average fall in HbA1c (a measure of average blood glucose levels over several weeks) of 2.84 mmol/mol after 12 months to levels regarded as standard. Blood glucose levels also returned to normal in more than a third (38%) of the patients and only 3% developed type 2 diabetes after 12 months. The average weight loss amounted to 10 kg (22lb) at the 12 month time point (a reduction in BMI of 3.2kg/m2).

The researchers acknowledge that not all patients at high risk go on to develop type 2 diabetes, added to which the referral numbers were low, based on the funding available, with few black or minority ethnic participants, men, or those on low incomes. Nevertheless, they conclude that the initiative has the potential to have considerable impact. “A UK primary care referral route partnered with this commercial weight management provider can deliver an effective diabetes prevention programme,” they write. “The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact.”

Adapted from: Carolyn Piper, Agnes Marossy, Zoe Griffiths, Amanda Adegboye. Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for non-diabetic hyperglycemic patients referred by primary care in the UKBMJ Open Diabetes Research & Care, 2017; 5 (1): e000418 DOI: 10.1136/bmjdrc-2017-000418

*If you are looking to knock $30.00 off of your next wine purchase, check out Bright Cellars! You can also find the link posted on the right side of the blog. Happy sippen! 

Daily Nutrition Nugget

Add Protein To Your Breakfast! A protein-packed breakfast will reduce hunger later in the day. This doesn’t mean load up on three kinds of breakfast meats, instead add a hard-boiled egg or some Greek yogurt to your first meal of the day. Try a cup of plain Greek yogurt with some sliced almonds, mixed berries, honey and chia seeds mixed together.

Daily Inspiration Nugget 

People change for two main reasons: either their minds have been opened, or their hearts have been broken.

 

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

B6-dependent protein, potentially opening avenues for new antibiotics and drugs to battle diseases such as drug-resistant tuberculosis, malaria, and diabetes.

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Specifically, the team used neutron crystallography to study the location of hydrogen atoms in aspartate aminotransferase, or AAT, an enzyme vital to the metabolism of certain amino acids. “We visualized the first neutron structure of a vitamin B6 enzyme that belongs to a large protein family with hundreds of members that exist in nature,” said Oak Ridge National Laboratory’s (ORNL) Andrey Kovalevsky, a senior co-author of the study, which was published in Nature Communications. Vitamin B6-dependent proteins are part of a diverse group of enzymes that conduct over a hundred different chemical reactions in cells. The enzymes are of interest to biomedical, as well as bioenergy, researchers because of their role in metabolizing amino acids and other cell nutrients.

“These enzymes are unique in that each one performs a specific chemical reaction with exquisite accuracy while suppressing other viable chemical transformations,” Kovalevsky said. “How they accomplish this is not well understood, but it is of great significance for drug design.” The team’s previous research predicted that hydrogen atoms move in and around the enzyme’s active site, where the chemical reaction takes place, indicating that the hydrogen atoms’ positioning controls the reaction type. Knowing the precise location of hydrogen atoms can explain why the behavior of these enzymes is so specific, but hydrogen is hard to detect with standard methods such as X-ray crystallography.

To directly determine the positions of hydrogen atoms within AAT, the ORNL-led team turned to neutron diffraction techniques. The researchers exposed fine protein crystals to neutrons using the IMAGINE beamline at ORNL’s High Flux Isotope Reactor and the LADI-III beamline at the Institut Laue-Langevin in Grenoble, France. Surprisingly, the team observed a reaction within one AAT protein biomolecule while another AAT biomolecule was unchanged, providing a before-and-after perspective of the enzyme-catalyzed chemical reaction. “The data revealed that in one of the enzyme’s biomolecular structures the covalent bonds reorganized after a chemical reaction occurred in the active site and, in another, the reaction had not taken place,” Kovalevsky said. “Essentially, we were able to obtain two structures in one crystal, which has never been done before for any protein using neutrons.”

With this knowledge, the team will run molecular simulations to determine the hydrogen atoms’ specific behavior when interacting with the enzyme. The results could be useful in guiding the future design of novel medicines against multidrug-resistant tuberculosis, malaria, diabetes and antibiotic-resistant bacteria. “This study highlights how neutrons are an unrivaled probe for identifying the location of hydrogen atoms in biological systems, providing us with an unprecedented level of structural detail for this important enzyme,” LADI-III beamline scientist Matthew Blakeley said.

Adapted from: Steven Dajnowicz, Ryne C. Johnston, Jerry M. Parks, Matthew P. Blakeley, David A. Keen, Kevin L. Weiss, Oksana Gerlits, Andrey Kovalevsky, Timothy C. Mueser. Direct visualization of critical hydrogen atoms in a pyridoxal 5′-phosphate enzymeNature Communications, 2017; 8 (1) DOI: 10.1038/s41467-017-01060-y

Nutrition Daily Nugget

Eat the rainbow! A fun and tasty way to make sure your family is eating a good variety of fruits and vegetables is to eat as many different colors as you can each day.

Daily Inspiration Nugget

Why do we close our eyes when we pray, cry, kiss, dream? Because the most beautiful things in life are not seen but felt only by the heart.

 

 

World will have more obese children and adolescents than underweight by 2022

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The number of obese children and adolescents (aged 5 to 19 years) worldwide has risen tenfold in the past four decades, according to a new study led by Imperial College London and the World Health Organization (WHO). If current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022. The study is published in The Lancet. It analyzed weight and height measurements from nearly 130 million people aged over five (31.5 million people aged 5 to 19, and 97.4 million aged 20 and older), the largest number of participants ever involved in an epidemiological study. More than 1000 researchers contributed to the study, which looked at body mass index (BMI) and how obesity has changed worldwide from 1975 to 2016.

During this period, obesity rates in the world’s children and adolescents increased from less than 1% (equivalent to five million girls and six million boys) in 1975 to nearly 6% in girls (50 million) and nearly 8% in boys (74 million) in 2016. Combined, the number of obese 5 to 19-year-olds rose more than tenfold globally, from 11 million in 1975 to 124 million in 2016. An additional 213 million were overweight in 2016 but fell below the threshold for obesity. Lead author Professor Majid Ezzati, of Imperial’s School of Public Health, said: “Over the past four decades, obesity rates in children and adolescents have soared globally, and continue to do so in low-and-middle-income countries. More recently, they have plateaued in higher income countries, although obesity levels remain unacceptably high.”

Professor Ezzati adds: “These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities. The trend predicts a generation of children and adolescents growing up obese and also malnourished. We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods.”

More obese than underweight 5 to 19-year-olds by 2022

The authors say that if post-2000 trends continue, global levels of child and adolescent obesity will surpass those for moderately and severely underweight for the same age group by 2022. Nevertheless, the large number of moderately or severely underweight children and adolescents in 2016 (75 million girls and 117 boys) still represents a major public health challenge, especially in the poorest parts of the world. This reflects the threat posed by malnutrition in all its forms, with there being underweight and overweight young people living in the same communities. Children and adolescents have rapidly transitioned from mostly underweight to mostly overweight in many middle-income countries, including in East Asia, Latin America, and the Caribbean. The authors say this could reflect an increase in the consumption of energy-dense foods, especially highly processed carbohydrates, which lead to weight gain and poor lifelong health outcomes.

Dr. Fiona Bull, the programme coordinator for surveillance and population-based prevention of noncommunicable diseases (NCDs) at WHO, said: “These data highlights, remind and reinforce that overweight and obesity is a global health crisis today, and threatens to worsen in coming years unless we start taking drastic action.”

Global data for obesity and underweight

In 2016, there were 50 million obese girls and 74 million obese boys in the world, while the global number of moderately or severely underweight girls and boys was 75 million and 117 million respectively. The number of obese adults increased from 100 million in 1975 (69 million women, 31 million men) to 671 million in 2016 (390 million women, 281 million men). Another 1.3 billion adults were overweight but fell below the threshold for obesity.

Regional/Country data for obesity, BMI and underweight

Obesity:

The rise in childhood and adolescent obesity in low- and middle-income countries, especially in Asia, has accelerated since 1975. Conversely, the rise in high-income countries has slowed and plateaued. The largest increase in the number of obese children and adolescents was seen in East Asia, the high-income English-speaking region (USA, Canada, Australia, New Zealand, Ireland and the UK), and the Middle East and North Africa. In 2016, obesity rates were highest overall in Polynesia and Micronesia, at 25.4% in girls and 22.4% in boys, followed by the high-income English-speaking region. Nauru had the highest prevalence of obesity for girls (33.4%), and the Cook Islands had the highest for boys (33.3%).

In Europe, girls in Malta and boys in Greece had the highest obesity rates, at 11.3% and 16.7% of the population respectively. Girls and boys in Moldova had the lowest obesity rates, at 3.2% and 5% of the population respectively. Girls in the UK had the 73rd highest obesity rate in the world (6th in Europe), and boys in the UK had the 84th highest obesity in the world (18th in Europe). Girls in the USA had the 15th highest obesity rate in the world, and boys had the 12th highest obesity in the world. Among high-income countries, the USA had the highest obesity rates for girls and boys.

BMI:

The largest rise in BMI of children and adolescents since 1975 was in Polynesia and Micronesia for both sexes, and in central Latin America for girls. The smallest rise in the BMI of children and adolescents during the four decades covered by the study was seen in Eastern Europe. The country with the biggest rise in BMI for girls was Samoa, which rose by 5.6 kg/m2, and for boys was the Cook Islands, which rose by 4.4 kg/m2.

Underweight:

India had the highest prevalence of moderately and severely underweight (BMI <19) throughout these four decades (24.4% of girls and 39.3% of boys were moderately or severely underweight in 1975, and 22.7% and 30.7% in 2016). 97 million of the world’s moderately or severely underweight children and adolescents lived in India in 2016.

Solutions exist to reduce child and adolescent obesity

In conjunction with the release of the new obesity estimates, WHO is publishing a summary of the Ending Childhood Obesity (ECHO) Implementation Plan. The plan gives countries clear guidance on effective actions to curb childhood and adolescent obesity. WHO has also released guidelines calling on frontline healthcare workers to actively identify and manage children who are overweight or obese. Dr. Bull added: “WHO encourages countries to implement efforts to address the environments that today are increasing our children’s chance of obesity. Countries should aim particularly to reduce consumption of cheap, ultra-processed, calorie dense, nutrient poor foods. They should also reduce the time children spend on screen-based and sedentary leisure activities by promoting greater participation in physical activity through active recreation and sports.”

Dr. Sophie Hawkesworth, from the Population Health team at Wellcome Trust, which co-funded the study, said: “Global population studies on this scale are hugely important in understanding and addressing modern health challenges. This study harnessed the power of big data to highlight worrying trends of both continuing high numbers of underweight children and teenagers and a concurrent stark rise in childhood obesity. Together with global health partners and the international research community, Wellcome is working to help identify new research opportunities that could help better understand all aspects of malnutrition and the long-term health consequences.”

My thoughts: The unfortunate and sad reality is that I was not surprised when I read the research. 😔 However, this is just more proof that we have to work together as a world, not a country, to fight this epidemic…..and not only obesity but eating disorders as a whole. We can win!

Adapted from: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128*9 million children, adolescents, and adults. The Lancet, 2017 DOI: 10.1016/ S0140-6736(17)32129-3

Nutrition Tip of the Day

Schedule time each week to plan healthy meals! Keep your recipes, grocery list, and coupons in the same place to make planning and budgeting easier.

 

Daily Inspiration 

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Is an Anti-Inflammatory Diet the Best for You?

Fans of anti-inflammatory diets say they can transform you inside and out. Is this another  “health” fad…or do we all really need to go AI?

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An anti-inflammatory diet=less pain, happy gut, more energy, and more! This diet may be buzzy, but the tenets of an AI diet; more plants, less sugar, no refined stuff, is far from a passing fad. “Who needs to eat a more anti-inflammatory diet? Everyone,” says Barry Sears, PhD, creator of The Zone diet, who has spent decades studying chronic inflammation. Here’s the lowdown on inflammation, and how to fight it with food.

What the heck is inflammation, anyway?

Believe it or not, inflammation starts as a good thing. It happens when your immune system sends out white blood cells and “warrior” compounds, such as eicosanoids to attack invading viruses, bacteria, or toxins. A classic example of normal inflammation: Pain, heat, redness, and swelling around a wound or injury (think of a tender sprained ankle). “There’s a separate response called ‘resolution’ that brings the dogs of war back to their barracks and heals your tissues,” says Sears. “The first phase of inflammation causes cellular destruction, and the second phase, resolution, begins cellular rejuvenation. As long as those phases are balanced, you stay well.”

However, for most of us, the balance never happens. That’s because sugar, refined grains, and saturated fat can also trigger an inflammatory immune response, notes Sears, and the typical Western diet is packed with them, meaning we’re inflaming our bodies over and over, every time we eat. Meanwhile, guess what the average American gets way too little of? Fruits, non-starchy veggies, and fatty fish. Fruits and vegetables are packed with antioxidants that help cool things down and reduce the intensity of the initial inflammatory response and fatty fish, a great source of omega-3 fatty acids, can help your body move into the resolution phase.

Air pollution and environmental toxins also trigger your immune system in the same way, but “most of the chronic, extra inflammation in our bodies is diet-related,” says Sears. In arteries, chronic inflammation can lead to heart disease. In the brain, it’s linked to anxiety and depression. In your joints, it causes swelling and pain. In the gut, inflammation throws off the balance of helpful bacteria and causes direct damage to the lining of the intestines, says Mark Hyman, MD, director of the Center for Functional Medicine at the Cleveland Clinic and author of The Blood Sugar Solution: 10-Day Detox Diet. This may contribute to IBS, food sensitivities, autoimmune diseases, and even obesity, research suggests.

In contrast, research shows that following a more anti-inflammatory style of eating may reduce the risk of heart disease, obesity, and some cancers and may even extend your life, says Frank Hu, MD, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. Other claims about anti-inflammatory diets, such as reversing autoimmune disease (the goal of the Autoimmune Protocol, an extremely restrictive AI diet) or improve mental health, have less solid proof, he says.

How to spot an anti-inflammatory diet

There isn’t just one specific “AI Diet,” unlike Atkins or South Beach. Sears’s Zone diet and Dr. Hyman’s Detox are both highly anti-inflammatory, as is the soy-heavy plan from integrative medicine guru Andrew Weil, MD. Paleo and Whole30 diets are both AI, as well. However, the plan with the most research-backed anti-inflammatory credibility is the traditional Mediterranean diet, emphasizing fruits, vegetables, whole grains, legumes, fish, and olive oil. Several very large studies, including the famed Nurses’ Health Study, have found that people who follow a Mediterranean pattern of eating have lower levels of the inflammatory markers C-reactive protein and interleukin-6 in their blood compared with those who do not. This may be one reason the Mediterranean diet is linked to so many health benefits, from keeping weight down to slashing heart and stroke risk, notes Dr. Hu.

The goals of an AI plan are simple: Cut back on foods that trigger an inflammatory response and eat more of the foods that heal damage. While there are some variations in what’s allowed and what isn’t, most AI plans share an emphasis on eating whole, minimally processed foods, non-starchy vegetables, monounsaturated fats, such as olive and avocado oil, colorful berries and other fruits, omega-3s from fatty fish (or supplements), and avoiding added sugar and refined grains. That said, your plate may look a little different from your friend’s or coworker’s, and that’s the way it should be, says Dr. Hyman. Some people thrive on a grain-free Paleo plan, while others would rather die than give up bread. Food sensitivities also play a role: “People react to foods differently, and if someone has a sensitivity to a particular food, it will lead to cytokine production and an increase in other inflammatory chemicals,” says Dr. Hyman. If you suspect you have a sensitivity, talk to your doctor or a dietitian, who can design an elimination diet to help ID the culprit.

What’s off the menu?

While all AI plans give a thumbs-up to veggies, fatty fish, and olive oil, the foods you can’t eat vary. Women with a history of eating disorders take note: “Restricting whole food groups can be triggering,” says Sonya Angelone, RDN. Here is what’s not allowed in four different diets:

Autoimmune protocol: Nightshade vegetables (tomatoes, eggplants,peppers), nuts, seeds, eggs.

Paleo: All grains, dairy, legumes, (chickpeas, lentils, beans, peanuts).

The Zone Diet: All refined grains, white potatoes.

Mediterranean Diet: Added sugar, refined sugar.

So what exactly do you eat?

You don’t have to follow any AI diet perfectly to make a big impact. A healthy body is built to handle the occasional onslaught of inflammation (like having a cupcake at a party); it’s the regular, consistent consumption (and overconsumption) of inflammatory foods, such as sugar and saturated fat that’s linked to serious disease, says Sonya Angelone, RDN, a spokesperson for the Academy of Nutrition and Dietetics. A 2012 study of nearly 2,000 people, for example, found that those who ate the most sweets over two years had significantly higher levels of interleukin-6 than people who ate more veggies, fruits, and whole grains. That’s why it’s more important to eat an overall “super” diet rather than focus on individual superfoods, says Angelone. “If you’re regularly eating a bunch of doughnuts along with a bunch of anti-inflammatory veggies, you’re still harming your body,” adds Dr. Hyman. Follow these AI guidelines on most days:

1. Aim for half to two-thirds of your plate to be nonstarchy vegetables. Greens of all kinds, mushrooms, summer squash, beets, cauliflower…the list goes on and on, as well as at breakfast, too, says Dr. Hyman. They’re packed with gut-balancing fiber and powerful antioxidants.

2. Limit added sugar and sweet drinks. That includes fruit juices and natural sweeteners, such as honey, says Dr. Hyman. In a small 2005 study, people who were fed a high-sugar diet for 10 weeks had significantly elevated blood levels of haptoglobin, an inflammatory marker that in high concentrations is associated with diabetes, heart attack, stroke, and obesity, compared with controls.

3. Eat fish. Especially fatty kinds, such as salmon, mackerel, herring, and anchovies, or take omega-3 supplements, at least 1,000 milligrams daily, says Dr. Hyman.

4. Nix white flour and limit other flour-based foods. Focus on whole, intact grains, such as quinoa, brown rice, and bulgur wheat instead of loading up on whole-grain crackers, breads, and tortillas. Even 100% whole-grain flour will cause a spike in blood sugar that exacerbates inflammation, especially for people with insulin resistance, metabolic syndrome (i.e., prediabetes), or diabetes, so use them moderately, says Sears.

5. Choose fats carefully. The most abundant saturated fats in our diet contain the same fatty acids as do fragments of the cell walls of many bacteria. No wonder our immune system sees a bacon cheeseburger as a threat! Limit saturated fats and skip vegetable oils that are high in omega-6 fats, such as safflower and corn oils. Opt instead for olive, avocado, or walnut oil. “It might sound tough, but if you think about it, it’s exactly how your grandmother probably told you to eat!” says Sears, and a diet endorsed by your nana? Now that sounds like a plan.

Yes, you might lose some weight

Going AI doesn’t automatically mean you’ll drop pounds, says Angelone, especially if your weight is in a healthy range to begin with. However, research does suggest that an AI diet packed with veggies and low in sugar and refined carbs can help with weight loss goals. “You feel fuller on fewer calories because the high-fiber foods have so much more volume,” she says. The healthy fats in an AI plan may also play a role: A large, five-year study published in 2016 found that people who ate a veggie-and fat-rich Mediterranean diet lost more weight than those who went on a low-fat plan.

The 10 best foods for fighting inflammation

These are foods that research has shown to have exceptionally strong effects on inflammation:

• Berries

• Dark green Leafy vegetables (like kale, spinach, Swiss chard)

• Fatty fish

• Garlic and onions

• Green tea

• Ginger

• Turmeric

• Nuts

• Oranges

• Tart cherries

What are your thoughts on an AI diet? Can it transform you from the inside out?

Nutrition Tip of the Day

Cook vegetables in healthy ways that will help bring out their natural flavors, including roasting, grilling, steaming and baking. You’ll need less salt (if any) and may even turn the most anti-veggie kid into a fan!

Daily Inspiration 

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Too much sugar? Even ‘healthy people’ are at risk of developing heart disease

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Healthy people who consume high levels of sugar are at an increased risk of developing cardiovascular disease. A ground-breaking study from the University of Surrey found that a subject group of otherwise healthy men had increased levels of fat in their blood and fat stored in their livers after they had consumed a high sugar diet. The study, which has been published in Clinical Science, looked at two groups of men with either high or low levels of liver fat, and fed them a high or low sugar diet to find out if the amount of liver fat influences the impact of sugar on their cardiovascular health. The low sugar diet contained no more than 140 calories a day worth of sugar, an amount close to the recommended intake, while the high sugar diet contained 650 calories worth.

After 12 weeks on the high sugar diet, the men with a high level of liver fat, a condition known as non-alcoholic fatty liver disease (NAFLD), showed changes in their fat metabolism that are associated with an increased risk of cardiovascular disease, heart attacks and strokes. Fat metabolism is the biochemical process by which fats are transported and broken down in the blood, and used by the cells of the body. The results also revealed that when the group of healthy men with a low level of liver fat consumed a high amount of sugar, their liver fat increased and their fat metabolism became similar to that of the men with NAFLD.

Professor of Nutritional Metabolism, Bruce Griffin, said: “Our findings provide new evidence that consuming high amounts of sugar can alter your fat metabolism in ways that could increase your risk of cardiovascular disease. “While most adults don’t consume the high levels of sugar we used in this study, some children and teenagers may reach these levels of sugar intake by over-consuming fizzy drinks and sweets. This raises concern for the future health of the younger population, especially in view of the alarmingly high prevalence of NAFLD in children and teenagers, and exponential rise of fatal liver disease in adults.”

Adapted from: A. Margot Umpleby, Fariba Shojaee-Moradie, Barbara Fielding, Xuefei Li, Andrea Marino, Najlaa Alsini, Cheryl Isherwood, Nicola Jackson, Aryati Ahmad, Michael Stolinski, Julie Anne Lovegrove, Sigurd Johnsen, Jeewaka Mendis, John Wright, Malgorzata E Wilinska, Roman Hovorka, Jimmy Bell, Louise E Thomas, Gary Frost, Bruce Arthur Griffin. Impact of liver fat on the differential partitioning of hepatic triacylglycerol into VLDL subclasses on high and low sugar diets. Clinical Science, 2017; CS20171208 DOI: 10.1042/CS20171208

Nutrition Tip of the Day

Use fresh or dried herbs and spices or a salt-free seasoning blend in place of salt when cooking. Add a squeeze of fresh lemon or lime to add flavor to cooked foods.

Daily Inspiration 

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Good Carbs, Bad Carbs — How to Make the Right Choices

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Carbs are highly controversial these days. The dietary guidelines suggest that we get about half of our calories from carbohydrates. On the other hand, some claim that carbs cause obesity and type 2 diabetes, and that most people should be avoiding them. There are good arguments on both sides, and it appears that carbohydrate requirements depend largely on the individual. Some people do better with a lower carb intake, while others do just fine eating plenty of carbs. So lets take a detailed look at carbs, their health effects and how you can make the right choices.

What Are Carbs?

Carbs, or carbohydrates, are molecules that have carbon, hydrogen and oxygen atoms. In nutrition, “carbs” refers to one of the three macronutrients. The other two are protein and fat. Dietary carbohydrates can be split into three main categories:

  • Sugars: Sweet, short-chain carbohydrates found in foods. Examples are glucose, fructose, galactose and sucrose.
  • Starches: Long chains of glucose molecules, which eventually get broken down into glucose in the digestive system.
  • Fiber: Humans can not digest fiber, although the bacteria in the digestive system can make use of some of them.

The main purpose of carbohydrates in the diet is to provide energy. Most carbs get broken down or transformed into glucose, which can be used as energy. Carbs can also be turned into fat (stored energy) for later use. Fiber is an exception. It does not provide energy directly, but it does feed the friendly bacteria in the digestive system. These bacteria can use the fiber to produce fatty acids that some of our cells can use as energy. Sugar alcohols are also classified as carbohydrates. They taste sweet, but usually don’t provide many calories.

Whole” vs “Refined” Carbs

Not all carbs are created equal. There are many different types of carbohydrate-containing foods, and they vary greatly in their health effects. Although carbs are often referred to as “simple” vs “complex,” some find the terms “whole” vs “refined” to make more sense. Whole carbs are unprocessed and contain the fiber found naturally in the food, while refined carbs have been processed and have had the natural fiber stripped out.

Examples of whole carbs include vegetables, whole fruit, legumes, potatoes and whole grains. These foods are generally healthy. On the other hand, refined carbs include sugar-sweetened beverages, fruit juices, pastries, white bread, white pasta, white rice and others. Numerous studies show that refined carbohydrate consumption is associated with health problems, such as obesity and type 2 diabetes.

They tend to cause major spikes in blood sugar levels, which leads to a subsequent crash that can trigger hunger and cravings for more high-carb foods. This is the “blood sugar roller coaster” that many people are familiar with. Refined carbohydrate foods are usually also lacking in essential nutrients. In other words, they are “empty” calories. The added sugars are another story altogether, they are the absolute worst carbohydrates and linked to all sorts of chronic diseases.

However, it makes no sense to demonize all carbohydrate-containing foods because of the health effects of their processed counterparts. Whole food sources of carbohydrates are loaded with nutrients and fiber, and do not cause the same spikes and dips in blood sugar levels. Hundreds of studies on high-fiber carbohydrates, including vegetables, fruits, legumes and whole grains show that eating them is linked to improved metabolic health and a lower risk of disease.

Low-Carb Diets Are Great For Some People

No discussion about carbs is complete without mentioning low-carb diets. These types of diets restrict carbohydrates, while allowing plenty of protein and fat. Over 23 studies have now shown that low-carb diets are much more effective than the standard “low-fat” diet that has been recommended for the past few decades. These studies show that low-carb diets cause more weight loss and lead to greater improvement in various health markers, including HDL (the “good”) cholesterol, blood triglycerides, blood sugar, blood pressure and others.

For people who are obese, or have metabolic syndrome and/or type 2 diabetes, low-carb diets can have life-saving benefits. This should not be taken lightly, because these are currently the biggest health problems in the world, responsible for millions of deaths per year. However, just because low-carb diets are useful for weight loss and people with certain metabolic problems, they are definitely not the answer for everyone.

“Carbs” Are Not The Cause of Obesity

Restricting carbs can often (at least partly) reverse obesity. However, this does not mean that the carbs were what caused the obesity in the first place. This is actually a myth, and there is a ton of evidence against it. While it is true that added sugars and refined carbs are linked to increased obesity, the same is not true of fiber-rich, whole-food sources of carbohydrates.

Humans have been eating carbs for thousands of years, in some form or another. The obesity epidemic started around 1980, and the type 2 diabetes epidemic followed soon after. Blaming new health problems on something that we’ve been eating for a very long time simply doesn’t make sense. Keep in mind that many populations have remained in excellent health while eating a high-carb diet, such as the Okinawans, Kitavans and Asian rice eaters.

What they all had in common was that they ate real, unprocessed foods. However, populations that eat a lot of refined carbohydrates and processed foods tend to be sick and unhealthy.

Carbs Are Not “Essential,” But Many Carb-Containing Foods Are Incredibly Healthy

Many low-carbers claim that carbs are not an essential nutrient. This is technically true. The body can function without a single gram of carbohydrate in the diet. It is a myth that the brain needs 130 grams of carbohydrate per day.
When we don’t eat carbs, part of the brain can use ketones for energy, which are made out of fats.  Additionally, the body can produce the little glucose the brain needs via a process called gluconeogenesis. However, just because carbs are not “essential,” that does not mean they cannot be beneficial. Many carb-containing foods are healthy and nutritious, such as vegetables and fruits.
These foods have all sorts of beneficial compounds and provide a variety of health benefits. Although it is possible to survive even on a zero-carb diet, it is probably not an optimal choice because you’re missing out on plant foods that science has shown to be beneficial.

How to Make the Right Choices

As a general rule, carbohydrates that are in their natural, fiber-rich form are healthy, while those that have been stripped of their fiber are not. If it’s a whole, single ingredient food, then it’s probably a healthy food for most people, no matter what the carbohydrate content is. With this in mind, it is possible to categorize most carbs as either “good” or “bad,” but keep in mind that these are just general guidelines. Things are rarely ever black and white in nutrition.

“Good” Carbs:

  • Vegetables: All of them. It is best to eat a variety of vegetables every day.
  • Whole fruits: Apples, bananas, strawberries, etc.
  • Legumes: Lentils, kidney beans, peas, etc.
  • Nuts: Almonds, walnuts, hazelnuts, macadamia nuts, peanuts, etc.
  • Seeds: Chia seeds, pumpkin seeds.
  • Whole grains: Choose grains that are truly whole, as in pure oats, quinoa, brown rice, etc.
  • Tubers: Potatoes, sweet potatoes, etc.

People who are trying to restrict carbohydrates need to be careful with the whole grains, legumes, tubers and high-sugar fruit.

“Bad” Carbs:

  • Sugary drinks: Coca cola, Pepsi, Vitaminwater, etc. Sugary drinks are some of the unhealthiest things you can put into your body.
  • Fruit juices: Unfortunately, fruit juices may have similar metabolic effects as sugar-sweetened beverages.
  • White bread: These are refined carbohydrates that are low in essential nutrients and bad for metabolic health. This applies to most commercially available breads.
  • Pastries, cookies and cakes: These tend to be very high in sugar and refined wheat.
  • Ice cream: Most types of ice cream are very high in sugar, although there are exceptions.
  • Candies and chocolates: If you’re going to eat chocolate, choose quality dark chocolate.
  • French fries and potato chips: Whole potatoes are healthy, but french fries and potato chips are not.

These foods may be fine in moderation for some people, but many will do best by avoiding them as much as possible.

Low-Carb Is Great For Some, But Others Function Best With Plenty of Carbs

There is no one-size-fits-all solution in nutrition. The “optimal” carbohydrate intake depends on numerous factors, such as age, gender, metabolic health, physical activity, food culture and personal preference. If you have a lot of weight to lose, or have health problems, such as metabolic syndrome and/or type 2 diabetes, then you are probably carbohydrate sensitive. In this case, reducing carbohydrate intake can have clear, life-saving benefits.

On the other hand, if you’re just a healthy person trying to stay healthy, then there is probably no reason for you to avoid “carbs.” Just stick to whole, single ingredient foods as much as possible. If you are naturally lean and/or highly physically active, then you may even function much better with plenty of carbs in your diet. Different strokes for different folks.

Adapted from: Kris Gunnars, BSc

Nutrition Tip of the Day

Cook someone a meal! There’s no better way to show you care than to make the effort to cook for somebody you care about.

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2 Ways to Slash Your Blood Sugar

The usual advice is to cut back on foods that are rich in carbohydrates. However, there may be a way to keep blood sugar down without eliminating carbohydrate-rich foods.

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It’s perfectly normal for your blood sugar to rise after a meal, as your body converts the food you eat into energy. This is known as your post-prandial glucose response, but you don’t want your blood sugar to rise too high or take too long to come back down.

This is particularly important if you’re diabetic. However, all of us can benefit from avoiding excessively high blood sugar levels after eating. Read on to find out about a simple hack that can help you minimize your post-prandial glucose levels.

What Happens When You Eat

Your blood glucose (or sugar) levels begin to rise within about ten minutes of beginning a meal, reach a peak after 1 to 2 hours and should return back to baseline within 2 to 3 hours. How high that peak is and how long it takes for your blood sugar to return to normal depends on many factors, including what and how much you eat, whether you’ve exercised recently, and how well your body responds to the insulin produced by your pancreas. High post-prandial glucose levels can be a warning sign that your body is becoming less responsive to insulin, which means you may be heading towards full-blown Type 2 diabetes. If you’ve already been diagnosed with Type 2 diabetes, it suggests that your diabetes is not being well managed.

If you use a blood sugar monitor, you can test your blood sugar 2 hours after eating to see how you’re doing. The American Diabetes Association recommends that your post prandial glucose should be 180 or lower if you have diabetes and 140 or lower if you don’t.

How to lower post-prandial glucose

If your post-prandial glucose is high, the usual advice is to cut back on your portion sizes–in particular of any breads, grains, potatoes, fruit, baked goods, sweetened beverages and other foods that are rich in carbohydrates. Certainly, eating these foods in excessive quantities is not a good nutrition prescription for anyone. However, assuming that the portions are reasonable, there may be a way to keep those post-meal blood sugar levels under control without having to further reduce or eliminate carbohydrate-rich foods.

Slash #1 Eat your carbs last

Researchers from Weill Cornell Medical College found that the order in which we consume foods may have a substantial impact on our blood sugar response to the entire meal. In the study, subjects were given the same meal–consisting of chicken, vegetables, salad, bread, and orange juice on two different occasions. The first time, they ate the high carbohydrate foods (the bread and orange juice) first, followed by the chicken and veggies.  The second time, they reversed the order and ate the chicken and veggies first, followed by bread and orange juice. In the usual nutritional analysis, these two meals would be considered identical. However, it appears that even small differences in timing make a big difference.

Eating the carbs second had a major impact on blood sugar and insulin levels after the meal. Peak blood sugar levels were about one third lower and the total rise in blood sugar was about 75% less when the subjects ate the protein and vegetables first. Now there were some limitations to this study. First, it was small, involving only about a dozen subjects. Hopefully, a larger trial to confirm these findings is in the works. Secondly, these subjects were all overweight and diabetic, so we can’t say for sure whether healthy or prediabetic subjects would respond the same way. My educated guess? That the trend would be similar but the difference perhaps not as dramatic.

So what would this mean in terms of meal planning? Perhaps instead of starting breakfast with fruit or juice and following with eggs, it might be smarter to start with the eggs and finish with the fruit. Maybe you’d be better off trading that pre-dinner bread basket for a piece of cake afterward. Another potential benefit to this strategy is that you might get full before you get to the carbs!

Slash #2: Choose olive oil instead of butter

This is one more hack that may help avoid post-meal blood sugar spikes, especially if your meal contains high glycemic foods, such as white bread. Researchers from the University of Naples, Italy, found that when subjects ate a meal containing high-glycemic carbohydrates, their post prandial glucose levels were about 50% lower when they ate those foods with extra virgin olive oil than when they ate those foods with either butter or no fat at all. This was also a small study but this time involving Type 1 diabetics but it’s consistent with previous studies in both Type 1 and Type 2 diabetics. Although we tend to focus on carbohydrates when thinking about post-prandial glucose, it appears that the type and amount of fat may play a significant role in how those carbs affect our blood sugar. Monounsaturated fats seem to blunt post meal blood glucose while saturated fats do not. In fact, the saturated fat appeared to delay the speed at which blood sugar returned to normal after the meal.

So, if you’re going to have that white bread with your meal, save it for the end and then dip it in a nice olive oil instead of spreading it with butter! For a special occasion, you might want to skip the bread and have a piece of olive oil cake for dessert.

Adapted from: Monica Reinagel, MS, LD/N, CNS

Nutrition Tip of the Day

Plan, Prepare and Store Healthy Meals for the Week! We are all CRAZY busy!! Work, school, extracurricular activities and house work are realities for many families; however, they should never be at the expense of your health. Take 3 to 4 hours on a day that you have some extra time (and you do!!) to cook 4-5 healthy meals for the week. Store those meals in the refrigerator so that you and your family can just reheat, eat and go. Preparing meals in advance takes the stress away from healthy eating, even when practice runs late or the unexpected happens.

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