Tag Archive for: diabetes

The Bottom Line on Full-Fat Dairy

/in /by

If you’re a long-time reader, you know that science by headlines really annoys me because they often distort the findings of the research papers to make them seem more important than they are—gotta get that next click! It doesn’t help that research institutions send out press releases that contribute to the hype of their research findings. Such is the case with the two papers I reviewed this week.

In the first paper, researchers claimed blood values of fatty acids found in high-fat dairy products potentially decreased the risk of developing type 2 diabetes in two large cohorts. Of the 3,333 subjects who were free of diabetes when the study began, 277 developed diabetes after 15 years of follow-up. That seems like a low number compared to the general population, although these were studies on healthcare professionals who might have a better lifestyle than the rest of the population.

The problem is that they tested the blood only for dairy fats at the beginning of the study. While they did administer the food-frequency questionnaire every four years, there’s no way of knowing how the dairy fats changed over the years. At best, this is a large study that shows some form of correlation between dairy intake and type 2 diabetes but tells us nothing to help us decide whether we should change the type of dairy we eat.

In the second paper, they also used a similar food-frequency questionnaire to identify what types of dairy products the subjects used. As I’ve said many times, these are fraught with potential errors. On top of that, the difference in body weight gain between those who used the most low- and no-fat dairy products and those who used the most high-fat dairy products was about a tenth of a pound. If you account for the initial BMI and body weight, the results are about two tenths of a pound. That’s not exactly exciting over 11 years, is it?

The Bottom Line

They didn’t state the obvious, but I will. It could be that full-fat dairy keeps women (and probably men) feeling satisfied longer so they don’t eat as much. That’s what fat can do. But we can’t really know because researchers didn’t measure diet carefully enough in either study to be able to analyze it. In these cases, they didn’t collect the right type of data that could really answer the questions; thus results were not very significant.

It always comes down to six words: Eat less. Eat better. Move more. If you choose to eat dairy, you can’t overeat any type because while it may take more of the low-fat foods to reach the number of calories in high-fat dairy, eating too much is just what it says: eat too much and you’ll gain weight.

What are you prepared to do today?

Reminder: Taking Back Your Muscle, Part 2: Protein is tomorrow at 1 p.m. Eastern Time. If you want clarity on creatine, amino acid, peptides, and protein and how to use them for your health, buy the webinar by 11 a.m. ET to watch live, or you can watch the replay at your convenience.

        Dr. Chet

References:
1. circ.ahajournals.org/content/early/2016/03/22/CIRCULATIONAHA.115.018410
2. Am J Clin Nutr 2016;103:979–88.

Does Whole Milk Reduce Obesity?

/in /by

The second research paper that was included in many news articles that talked about the potential benefits of full-fat dairy products was a study from the Women’s Health Study (1); researchers collected dietary data and self-reported weight and height from over 39,000 women. The analysis included only about 18,000 middle-aged and older women who had a normal BMI when the study began. They analyzed the change in body weight over 11 years of follow-up.

All women gained weight over time. Contrary to expectations, those who consumed the highest number of high-fat dairy products gained less weight than those who used low- or no-fat dairy products. Of the 18,000 women with normal BMI in the beginning of the study, just over 8,000 became overweight or obese over the duration of the study.

Is it time to switch back to whole milk and cheese? I’ll give you the bottom line on Saturday.

The next webinar, Taking Back Your Muscle, Part 2: Protein, is on Sunday at 1 p.m. ET. If you’ve ever had any questions about protein, amino acids, or creatine, this webinar is for you. I added one more topic that fits with protein and that’s the role of peptides, short chains of amino acids that are a hot topic today. Find out what they are, what do they do, and how much need by joining me Sunday at 1.p.m. Purchase your access to the webinar and/or replay today for $17.95; Insiders and Members get their usual discounts.

What are you prepared to do today?

        Dr. Chet

Reference: Am J Clin Nutr 2016;103:979–88.

Does Whole Milk Reduce Diabetes?

/in /by

Full-fat foods are back in the headlines in light of the recent proclamations by the USDA. I don’t know about you, but it’s been decades since I drank whole milk or ate whole fat yogurt or cheese. It’s not just about the calories; it just doesn’t seem to taste as good. Have I been missing something? Headlines tend to exaggerate, especially when they are based on press releases. Let’s take a look behind the headlines at the research behind the proclamation.

In the first paper, researchers examined the data from both the Nurses Health Study and the Healthcare Professionals Follow-up Study. I’ve talked about these large studies many times before. They examined blood samples taken in the 1990s for fatty acids that would typically come from eating and drinking milk products. In a sub-sample of subjects, those who had higher fatty acids from milk products in their plasma and blood cells had a 45% reduced rate of developing type 2 diabetes an average of 15 years later.

We’ll take a look at the second study on Thursday. (We’ve still been having computer problems—that’s why you’re getting the Memo today instead of last Saturday and why we’re sending a second Memo on Thursday.)

The next webinar, Taking Back Your Muscle, Part 2: Protein, is available for purchase now. If you’ve ever had any questions about protein, amino acids, or creatine, this webinar is for you. I added one more topic that fits with protein and that’s the role of peptides, short chains of amino acids that are a hot topic today. Find out what they are, what do they do, and how much you need by joining me Sunday at 1.p.m.

What are you prepared to do today?

        Dr. Chet

Reference: circ.ahajournals.org/content/early/2016/03/22/CIRCULATIONAHA.115.018410

Artificial Sweeteners—Still Your Choice

/in /by

The use of artificial sweeteners is always a contentious topic in the health field. Some people hate them, other people love them. I use them occasionally, but when it comes to benefits versus harms, I stick to the research. In this case, it’s what wasn’t stated in the headlines about the study that is important, but we can make a decision based only on what we read. This was an abstract of a presentation at a conference, so some details may have been left out that were included in the study.

The Rest of the Story

The authors established an increased risk of diabetes with artificially sweetened drinks and saccharin in any form, but there were no statistically significant diabetes symptoms linked with total intake of artificial sweeteners, sucralose, or aspartame in all foods. That means that artificial sweeteners used in other foods didn’t raise the risk of diabetes, such as added to coffee, used in ice cream or other dairy products, or used in baking. You have to wonder why it had no apparent impact.

It may be that the specific food delivery system has some impact on why it does or does not have an effect. One possibility is that if the sweetener reaches the gut bacteria, it’s modified in some way so that it doesn’t impact blood sugar or blood sugar release.

It seems odd that they used markers of diabetes as their criteria rather than physician diagnosis. They looked for fasting glucose of 126 mg/dl or more; oral glucose tolerance test 2-hour glucose of 200 mg/dl or more; hemoglobin A1C of 6.5% or more; or use of diabetes medications. The last one makes sense, because you don’t get the meds unless you have a diagnosis, but still, odd language.

FFQ—Again!

Even though the food frequency questionnaire is still a good assessment tool when used with interviews, I checked the validation studies. The correlations with food diaries and interviews for the food frequency questionnaire developed specifically for the CARDIA study were no better than 0.5, indicating a moderate positive relationship—maybe it did, maybe it didn’t. That’s much worse than other correlations used in large studies. Also, the first two nutritional assessments couldn’t have assessed sucralose because it wasn’t available until after they took place; I don’t know why sucralose was included when it wasn’t available for almost half the follow-up period.

The Bottom Line

The debate on artificial sweeteners will go on, because people love them or hate them. Based on the results of this observational study, nothing of worth has really been added to the knowledge base. The researchers called for more research to examine how artificial sweeteners impact glucose metabolism. We don’t know that it does from anything done in this study, but that doesn’t mean well-designed studies shouldn’t be done in the future. Until then, it’s up to you whether to use artificially sweetened drinks or not. Maybe a better idea is to give up the mega-burger and fries instead.

What are you prepared to do today?

        Dr. Chet

Reference:  Cur Devel in Nutr  https://doi.org/10.1016/j.cdnut.2025.107034

Artificial Sweeteners—Again

/in /by

“I’ll have the jumbo mega-burger with extra cheese, a large order of fries, and a diet cola.” Have you ever heard that when you’re standing in line? Have you maybe ordered that yourself? That’s what I thought of when I read the health headlines about the dangers of artificial sweeteners contributing to the development of diabetes.

The Coronary Artery Risk Development in Young Adults (CARDIA) study began in the early 1980s by recruiting and tracking young adults to determine which factors are associated with the development of heart disease. Nutrition was one of the primary factors that was tracked using a food frequency questionnaire with dietician interview. They tested the subjects at the beginning of the study, at year 7 of follow-up, and year 20 of follow-up.

After tracking the subjects for almost 25 years, they found that 14.8% of subjects developed metabolic changes that indicated diabetes. Comparing the highest quintile of artificially sweetened drink use with the lowest quintile, there was a 129% increased risk for developing diabetic symptoms in the highest quintile. The use of saccharin was also associated with 120% increased risk of developing diabetes.

Is there more to this study that wasn’t highlighted in the headlines? I’ll cover that in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Reference:  Cur Devel in Nutr  https://doi.org/10.1016/j.cdnut.2025.107034

Childhood Obesity: A Family Thing

/in /by

I hope you took some time to scan the Executive Summary of American Association of Pediatrics Guidelines for Physicians. If you couldn’t, here are the three things that stood out to me.

Screening by Pediatricians and Primary Care Physicians

The focus of the guidelines was to assess risk factors for degenerative disease such as heart disease and diabetes in children who exceed the 85th percentile of the normal growth charts, indicating overweight, and 95th percentile, indicating obesity. The guidelines recommend beginning at 2 years of age and continuing through 18.

Were there recommendations for the use of medications and bariatric surgery in children over 12 and 14 respectively? Yes, but they were referrals to specialists for evaluations, not a blank invitation to write prescriptions.

It Must Be a Family Thing

Without exception, the guidelines recommend intensive health behavior and lifestyle treatment. “Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a three- to twelve-month period.”

That’s not the same as giving Mom and Dad a diet for the child and sending them on their way. Family-based programs have demonstrated great success, but it has to be a family thing.

It’s All About the Money

The summary also talked about obstacles to the family-based treatment approach. The major obstacle is money:

  • Money for training pediatricians and family practice physicians on how to assess childhood obesity.
  • Money for training more people to teach and work with families—it’s labor intensive.
  • Money for public health and community programs that can support the family-based approach.

It’s a situation we’ve seen many times: Everyone knows how important preventive healthcare and early treatment is, but no one wants to pay for it. But maybe we shouldn’t always look to government to foot the bill; maybe schools, community organizations, and churches could offer programs for their members. If what we’ve always done isn’t working, let’s try something different.

The Bottom Line

The guidelines introduce a couple of new approaches for those with the most severe weight problems, but the focus is on intensive nutrition and behavior-change training for the entire family. That’s not just “Here’s a diet and exercise program, and I’ll see you next year.” The guidelines give a reasonable approach to help the future health of the nation. The approach is simple: Eat less. Eat better. Move more. What they’re saying is that healthcare professionals need training to be able to do that effectively as a team in a reasonable family-based approach. That’s the right approach as I see it.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-060641

Is It Worth It?

/in /by

At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Happy New Year!

/in /by

It’s good to be back talking to all of you again. The New Year is a time of optimism, everything seems possible, and there’s an enthusiasm for achieving health goals. One thing many people want to do is to lose some weight. It seems appropriate to cover a couple of drugs that were recently approved by the FDA to treat obesity. They’re a pharmaceutical approach to weight loss, and they’ve gotten so much press I have to cover them.

You’ve probably seen the commercials for a pre-diabetes and diabetes medication called Ozempic. It also has a sister drug called Wegovy that was approved for use in teens. In at least two clinical trials, subjects who had weekly injections of the drug lost at least 15% or more of their body weight in 68 weeks. Those who were switched to placebo injections started to gain back the weight they lost. All subjects were supported with monthly consultations with dieticians to induce a 500-calorie reduction in food intake and to increase exercise levels. Markers for type 2 diabetes improved such as HbA1c and blood glucose.

Is this the be-all and end-all to the obesity epidemic? And exactly how does this drug work? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

What Not to Do When You Want to Lose Weight

/in /by

How did my mother-in-law lose 30 pounds when she was completely sedentary? I’ll tell you, but let me tell you first what not to do. Why begin there? Permanently changing your weight (or any other significant health goal) takes a lifetime commitment. You don’t know what life will bring, so the best way to attack the problem is by doing the best you can every day until you really have changed your habits permanently.

What You Don’t Have to Do

When you’re ready to make a change in your lifestyle, especially to lose weight, you don’t have to announce it on social media. If you want to keep track of your progress and do something with that information later, fine. But not everyone responds the same way to social scrutiny and it can be brutal. The only person you ever have to be accountable to is yourself.

You don’t have to throw out everything that’s in your refrigerator or freezer or clean out your pantry. It’s a good idea to get rid of the food that’s two years or more past its “best by” date, but that’s it.

You don’t have to follow any specific diet or exercise program when you start. Eat a little bit less and move a little bit more.

Understanding How to Start

Whether you want to lose weight, lower your cholesterol, reduce your risk of type 2 diabetes, you start slow and you add a little bit to it each day.

Think about this related to weight loss. You can’t fast (by the most common definition of fasting—abstaining from food) long enough to lose all the weight that you want to lose. It wouldn’t be healthy not to eat. Your body’s going to continue to produce waste products and you need nutrients, fresh nutrients, to help it do that.

What you can do is improve the quality of your diet a servings of grapes per day or a small salad before your meal to help suppress your appetite. Every small step is an important one. The catch is that you have to maintain it. So whether it’s a serving of grapes one day and strawberries the next and blueberries after that, add that serving of fruit every day. Or vegetables. Or nuts and seeds. You have to change your eating style permanently.

Turns out, losing weight that way takes some time. But let me ask you this question: did you sit down at a table one day and decide that you were going to overeat and overeat and overeat every second of every day so that you could put on 25, 50, or 100 pounds? Of course you didn’t. What makes you think you can take it off all at once? You have to do it one bite at a time, one meal at a time, one day at a time, just like you put it on.

The Bottom Line

I’m sure you’ve figured out why my mother-in-law was able to lose weight even though conventional exercise wasn’t an option: she consistently ate less than her body needed to maintain her weight. She stopped eating desserts and snacks and didn’t go back for seconds. Even though her body wasn’t as strong as it had been, she still had the mental toughness to stick to her plan, and it worked.

Consistency—what a concept! No fad diet, no keto or paleo, just consistently eating more of the healthier food and avoiding empty calories. I’ll say it again: it was, it is, and it will always be about the calories. It all comes down to a single question:

What are you prepared to do today?

        Dr. Chet

P.S. There’s a new Straight Talk on Health for Members and Insiders, and I’ve done something a little different. I took the Memos from the week and expanded on what I wrote. More about how my mother-in-law was able to lose weight while being sedentary and tips for other goals such as decreasing pre-diabetes and high blood pressure. If you don’t have a membership, this would be a good time to start.

Weight Loss Is Always Possible

/in /by

After last week’s Memos, you may think that you have to do something radical to address your body weight or some other health situation, but that’s not the case. You can lose weight under the most extreme conditions, even if you’re completely sedentary. Let me tell you about my mother-in-law, Ruth Jones.

My mother-in-law struggled with her weight for decades. I don’t know what her peak weight was, but I would estimate around 240 pounds. She maintained around 200 pounds for most of the time I knew her. She had severe arthritis in her knees and because she wouldn’t have been able to do the rehab, the decision was made to replace them both at once. She did great at lifestyle and occupational therapy, but she never quite got the complete mobility she thought she would get because the physical therapy was more of a challenge than she could handle. She was able to get around the house but used a wheelchair or scooter in public.

A few years later, she had a very bad reaction to a new statin that damaged a great deal of muscle mass, and she remained in long-term care until she died several years later. But here’s the thing. Even though wheelchair bound, she was able to lose 30 or so pounds; that’s discounting the last few months before she died when she lost interest in eating.

How? How was she able to do it?

How about you—are you ready to make a change in your weight? Blood pressure? Prediabetes? Then you really don’t want to miss Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet