Putting Nutrition in the Gutter (Literally)
The last IMS Magazine issue highlighted research on the metabolic mechanisms and treatment of diabetes. However, a discussion about Type 2 diabetes is not complete without consideration for lifestyle and diet. While physicians often recommend dietary changes as part of the treatment plan for diabetic patients, the central role of nutrition and lifestyle in this disease has not been represented fully in mainstream medicine, medical school teachings, and medical research.1
Our busy lives, hidden ingredients and obscure labelling of food items, and the powerful marketing of the food industry make it difficult to make healthy dietary choices. Unsustainable fads and dietary myths, including calorie counting for weight loss2 and the notion that all fat is bad,3 are popular despite being unsubstantiated. Can scientific research untangle the complex link between nutrition and diabetes?
Controversially, it is common for food industries to fund, and therefore introduce the possibility of bias in nutrition research. For example, shortly after the correlation between sucrose consumption and coronary heart disease (CHD) was published in the 1950’s, the Sugar Research Foundation (founded by Kellogg’s) sponsored its first CHD project that published data identifying fat and cholesterol as the dietary culprits of CHD while downplaying sucrose consumption as a risk factor.4 What is more, the authors of the CHD project did not disclose the conflict of interest (COI) arising from Kellogg’s funding, a large manufacturer of breakfast cereal. Similarly, the National Dairy Council funded research that led to an article that showed that those who consumed a high dairy or high fat meat diet had higher levels of HDLs (the “good” cholesterol) compared to those consuming low-fat diets, such as diets containing mostly high carbohydrate diets,3 hinting that high fat animal-based diets are superior to other diet types. However, given this COI, the study design and specific contents of each diet may have been tailored to produce the results they obtained.
Studies without COIs have found a direct link between processed meats and Type 2 diabetes,5 as well as cancer.6,7,8 Further, scientific evidence suggests that plant-based diets or a diet that minimizes processed food consumption reduces the risk of cardiovascular disease,9 dementia,10 and diabetes,11 to name a few. Anecdotally, many individuals have successfully weaned off their long-list of medications to control diabetes and other diseases by adopting a plant-based diet. Nevertheless, the close relationship between pharmaceutical companies and medical organizations, including pharmaceutical company funding toward research and targeted education on drugs,12 highly encourages the medical field to emphasize drug treatments rather than preventative medicine.
Documentaries like What the Health, recently featured on Netflix, delve into detail regarding some of the overarching themes discussed here.13 However, one of the critiques of the film is downplaying the role of sugar in optimal heath. Chronic overconsumption of simple carbohydrates leads to chronic insulin spiking, and therefore, insulin resistance–which progresses to Type 2 diabetes. In addition to being mindful of diet, reducing feeding frequency will give the body a rest from insulin and prevent insulin resistance. Perhaps we should remind ourselves every day, “Let food be thy medicine, and medicine be thy food (Hippocrates).”
- Schoettler CL, Lee JN, Ireland KA, et al. A Novel Method of Increasing Medical Student Nutrition Areness and Education. J Biomed Edu. 2015; 2015, Article ID 784042, 8 pages.
- Thomas DM, Martin CK, Lettieri S, et al. Can a weight loss of one pound a week be achieved with a 3500-kcal deficit? Commentary on a commonly accepted rule. Int J Obes (Lond). 2013;37(12):1611– 161.
- Thorning TK, Raziani F, Bendsen, NT et al. Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. AJCN. 2015;102(3):573–581.
- Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685.
- Pan A, Sun Q, Bernstein AM, Manson JE, Willett WC, Hu FB. Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women. JAMA internal medicine. 2013 Jul 22;173(14):1328-35.
- Stefani E, Boffetta P, Ronco AL, et al. Processed meat consumption and risk of cancer: a multisite case–control study in Uruguay. Br J Cancer. 2015;107(9):1584–1588.
- Pearson H. Red meat strongly linked to cancer. Nature [Internet]. 2005 Jan 11 [Cited 2018 April 28]; Available from: https://www. nature.com/news/2005/050110/full/news050110-7.html.
- Gilsing AM, Schouten LJ, Goldbohm RA, et al. Vegetarianism, low meat consumption and the risk of colorectal cancer in a population based cohort study. Sci Rep. 2015;5:13484. doi:10.1038/srep13484.
- Hu FB. Plant-based foods and prevention of cardiovascular disease: an overview. AJCN. 2013;78(3):544S–551.
- Zheng F, Yan L, Yang Z, et al. HbA 1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing. Diabetologia. 2018 Apr 1;61(4):839-48.
- McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of geriatric cardiology: JGC. 2017 May;14(5):342
- Wendy Glauser. Pharma influence widespread at medical schools: study. CMAJ 2013;185: 1121–1122.
What the health. (2017). (film) Directed by K. Anderson and K. Kuhn. United States: A.U.M. Films and Media.