Tag Archive for: type 2 diabetes

Body Fat: Location Matters

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Last week, I mentioned in passing that a hippopotamus has less body fat than most humans. Since then, I’ve wondered exactly how little body fat they had. By several estimations, it’s around 5%—about the same as elite soccer players. That’s not enough fat to cause the hippo health problems as we see in humans; they have a thick skin and a bad disposition to boot. What they also have is a lot of muscle.

I was reminded about the differences between visceral and subcutaneous fat. Subcutaneous fat is found underneath the skin and seems to be more a storage facility for fat. Visceral fat is the worst type because it’s packed in and around our organs like the liver, kidneys, and intestines. It’s also metabolically active and not in a good way. It causes the release of inflammatory hormones which contribute to all sorts of diseases such as cardiovascular disease, type 2 diabetes, and cancer. But is it hazardous for every person who is obese, even morbidly obese? I’ll let you know on Saturday.

Tomorrow is the Insider Conference Call. Without realizing it, I picked a day where many readers have another important teleconference that they want to attend. The Guest Pass is still a great option because you can watch the replay at your leisure, and if you send your questions before the meeting begins at 9 p.m. Eastern Time, I’ll answer them as well. It’s an opportunity to double your education investment that can help your business and your health. I hope you’ll join me.

What are you prepared to do today?

        Dr. Chet

Obesity: A Man-Made Disease

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In order to determine whether obesity is an untreatable disease without pharmaceuticals, I took a look at BMI data since 1960. In comparing the BMI of people in the lowest income brackets with the highest income from 1960 through 2024, the lowest income group is always about one BMI unit above the highest income group. The adjusted mean is roughly a BMI of 27 for the poor people versus 26 for the richest people. That continues until the mid-1980s. After that point, the mean BMI continues to rise for the next 40 years—a mirror image with the same one BMI-unit difference.

Mid-1980s

What happened in the mid 1980s that caused the surge in obesity? After checking various sources, there appear to be three factors, not ranked in any particular order.

  • The mid-1980s saw increases in two-income families. There are plenty of economic reasons for that, but the net effect was less time spent preparing food in the home and a reliance on convenience food purchases.
  • There was an increase in fast-food drive-thrus and take-out foods. Since COVID, there is more reliance on food delivery.
  • The mid-1980s saw an increase in ultra-processed foods. Using inexpensive ingredients, particularly carbohydrates and fats, and filled with flavor enhancers that accented the salty and umami, the amount of ultra-processed food has risen to over 50% of the typical American’s diet.

She was asked, “If people stop using GLP-1, will they gain back the weight?” She said yes because there’s no other way to maintain weight loss because of the fat setpoint. I just can’t accept that premise.

The Bottom Line

Overweight and obesity appear to be man-made diseases because of the environment we live in today with so much easily available food. However, I cannot accept that the fat setpoint is permanent. Yes, there are many factors in the brain, the pancreas, and the digestive system that control the feelings of hunger and the anticipation of food, but that doesn’t mean you really need nutrition. You and I just have to learn to ignore those signals that say, “what will my snack be?” when we’re still stuffed from dinner. We must take command. I’m not suggesting it will be easy, but it’s not impossible. In my mind, it’s a lot easier than taking a medication every day for the rest of my life.

What are you prepared to do today?

        Dr. Chet

References:
1. Int. J. Environ. Res. Public Health 2024, 21, 73.
2. Stat Pearls. 2025. Obesity and Type 2 Diabetes

Is Obesity a Disease?

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In a podcast about GLP-1 receptor agonists and several new medications that are under development, the expert was a researcher on the cutting edge of what these peptides can do for weight loss. A couple of things she said didn’t sit right.

One was that obesity is a disease of genetic tendencies to store fat more effectively and create a body-fat setpoint. The implication is that in a land of food abundance, specifically ultra-processed food, the setpoint could be raised but never lowered without medical intervention. The second was that these medications are the best solution for obesity, and thus people will have to take the medications for life or they’ll gain back weight.

According to the World Health Organization and just about every other medical society in the world, overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. But is it as simple as that? Based on a recent paper, the risk of getting type 2 diabetes is 7% to 12% in men and women at a BMI of 30; as BMI increases to over 40, the risk goes up to 74% for both men and women. It’s not an excuse to stay obese, but does it mean someone who is obese will get the diseases associated with obesity?  I have more questions, and I’ll cover them on Saturday.

Insider Conference Call is tomorrow night. The topics of the evening are reviewing the top five foods that prevent cancer as well as answering Insider questions. Interested? Become an Insider by 8 p.m. Wednesday and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. Int. J. Environ. Res. Public Health 2024, 21, 73.
2. Stat Pearls. 2025. Obesity and Type 2 Diabetes

The Bottom Line on Full-Fat Dairy

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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 Diabetes?

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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

Why Scientific Research Must Never Stop

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The current U.S. administration has tried to stop or delay basic and clinical research related to human conditions and diseases, and in the next few Memos, I’m going to illustrate why that’s a serious mistake. When I’ve laid it out, you can decide for yourself whether clinical research is a waste of money or critical for human health and well-being.

Example One: Glucagon-like Peptides

Sometime during the last century, chemicals were found in the intestines that seemed to increase the release of insulin in response to glucose. It wasn’t until the early 1980s that a gene was identified that resulted in the manufacture of proglucagon. Continued research found that when the protein was unfolded, it was responsible for the production of six different hormones. While all are important, one in particular has become popular 40 years later: GLP-1 (glucagon-like peptide-1). Depending on where it’s produced, its major function is to increase satiety by delaying digestion in the stomach. The net effect is to reduce food intake; that impacts glucose levels in people with pre-diabetes and type 2 diabetes, which can lead to weight loss and the possible prevention of every other condition downstream from diabetes such as cardiovascular disease or diabetic neuropathy.

You may recognize GLP-1 agonists, chemicals which will turn the production on, by their brand names such as Ozempic and Trulicity. They are helping millions of people control their type 2 diabetes with a side benefit of weight loss. From the time that the chemical was discovered, through identifying the gene that produces it, and the development of a chemical that could stimulate the gene to produce GLP-1, the process took over 50 years. The scientists began with basic research and ended with clinical trials to prove the efficacy of the medication. And the research is still not done—if research is able to continue to find something that stimulates only GLP-1 receptors in specific locations in the body instead of systemically, side effects could be controlled more effectively.

Another illustration on Saturday. Tomorrow is the March Insider Conference Call. The primary topic will be more detail on how drugs like Ozempic work as well as answering your questions. Maybe it’s time you become an Insider and join the call.

What are you prepared to do today?

        Dr. Chet

Reference: J Clin Invest. 2017 Dec 1;127(12):4217–4227. doi: 10.1172/JCI97233

The FFQ: Still Too Vague

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I spent a long time examining validation and reliability studies on the Food Frequency Questionnaires (FFQ). It was interesting to compare the original validation studies with a new FFQ that was published in early 2024; researchers asked subjects in those studies that began decades ago to participate in this recent validation study.

The Stats

I learned more about a variety of statistics that I don’t typically encounter: coefficient of correlation, and then attenuated and deattenuated coefficient of correlations, and more. The researchers concluded that the “study showed that the FFQ used in prior studies has reasonably high reproducibility and validity in measuring food and food groups intakes among both women and men.” I disagree.

The coefficient of correlation is important (COC) because it gives an indication of the association of the variable with a standard, in this case a 7 Day Dietary Recall. The best COC is 1.0 or -1.0, which means it’s perfectly correlated or not correlated with the standard. A COC greater than 0.8 is considered a strong relationship, but a relationship of 0.6 – 0.79 is considered moderate.

The COC for most categories of food was well below 0.6. How can that in any way be valid? It may be reproduceable, but you’re reproducing the same mistake over and over again.

How Dangerous Is Meat?

High level analytics like this aren’t my area of expertise, but logic dictates that you can’t get precision even with large numbers of subjects. This is especially true when using FFQ data to correlate nutrition with disease. Remember the study on red meat intake and type 2 diabetes? The Hazard Ratio was only 10% per 100-gram serving of red meat. If the meat intake is moderately correlated, how much does any error of intake impact the HR?

Whether researchers are trying to estimate how much of each type of meat a person eats or trying to calculate the heme-iron content of that meat, the FFQ doesn’t have enough precision to be used in determining those values. Remember, the increase in HR was 10% per 100 grams—that’s 3.3 ounces—of unprocessed red meat per day. If a patty were 100 grams, a reasonable size, and you ate six patties every day, that would be 600 grams or over 1.5 pounds of hamburger patties per day. Would that raise the HR to 60% based on that single answer? What about a vegan who gets no heme iron? Would they never get type 2 diabetes? We know that’s not true either.

One more thing: People under-report what they eat. It can be 100 to 200 calories per day, or even up to 500 calories per day. No after-the-fact adjustment of the food intake can make up for that kind of imprecision.

The Bottom Line

What we’re left with is this: There may be a relationship between red meat, and subsequently, heme iron intake, and the risk of type 2 diabetes, but we don’t know how much. That’s about it. We’re going to need much better studies to nail that down before we make a pronouncement. For now, you’re probably safe eating red meat, especially if you keep this in mind: eat better, eat less, and move more.

What are you prepared to do today?

        Dr. Chet

References:
1. Am J Epidemiol. 1985;122(1):51–65.
2. Am J Epidemiol. 2024;193(1):170–179

Ice Cream, the Health Food

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Paula gave me an article to read from The Atlantic written last summer, in which author David Merritt Johns tackled the issue of outlandish results in nutrition-science studies. In this case, the issue was research demonstrating that eating ice cream regularly reduced the risk of developing type 2 diabetes and cardiovascular disease. He interviewed the chairman of acclaimed nutrition research schools and departments. He interviewed the scientists who published the results of the studies—or not, in one case, because they wouldn’t talk about it. No one could explain it, it didn’t fit their model, so the results got buried.

I reviewed the studies in question, including the dissertation of the researchers who wouldn’t talk about the study. Any way you look at it, two servings per week of a half cup of high-fat ice cream reduced the risk of the aforementioned conditions between 12–54%. The researchers didn’t want to talk about it or acknowledge it, but the data is the data.

Five Reasons the Data Should Be Accepted

  • The assumption is that the Dietary Guidelines are correct for everyone. Maybe they aren’t.
  • The studies used a food frequency questionnaire. They’ve been used forever and are still no better than they were when developed, like trying to paint the Mona Lisa with a 6-inch brush. For example, how many servings of carrots did you have in July? Few people could answer with any accuracy, so why are we still depending on these tools?
  • They could have assessed the data differently. Divide the subjects by caloric intake first, then by foods or macronutrients. They used the same approach as I’ve talked about before and statistically added a percentage of calories to see how it would impact the results.
  • Maybe the results are just the results. It really confirmed prior studies. Why would you ignore data just because it doesn’t agree with your view of how things should be?
  • Maybe it’s time to stop parsing the imparsible. When the data tell a different story, quit trying to make it fit your theory of nutrition.

Maybe what they should have done is find out what is found in full-fat ice cream but not in high-fat milk or cream, which do contribute to CVD and T2D. Maybe it’s a microbiome issue. Stop saying it’s an outlier and find out why it appears to work.

The Bottom Line

Nobody asked me, but I think it’s portion control. Two half-cup servings per week is very different from two pints a day. That may be the real reason behind the positive results. If you want to have a couple of half-cup servings of ice cream a week, I don’t think it will harm you and just may help. Just pay attention to the portion size.

What are you prepared to do today?

        Dr. Chet

References:
1. http://nrs.harvard.edu/urn-3:HUL.InstRepos:37925665
2. Arch Intern Med. 2005;165:997-1003
3. JAMA. 2002;287(16):2081-2089. doi:10.1001/jama.287.16.2081
4. https://www.theatlantic.com/magazine/archive/2023/05/ice-cream-bad-for-you-health-study/673487/

Free Men’s Health Webinar

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June is National Men’s Health month. My first thought was to do a series of Memos on the key points of men’s health, but because I can talk faster than I can type (and you may not want to read that much), I decided to do a Men’s Health webinar next Wednesday night, June 26 at 8 p.m. Eastern Time. All you have to do is reply to this email and say something like “I’m in” and I’ll add you to the email list. I’ll send out the login information the day before, with a reminder in Tuesday’s Memo.

While cardiovascular disease and type 2 diabetes can cause the most serious negative outcomes if untreated, men don’t completely understand prostate issues, especially prostate cancer. Most men’s way of dealing with it is to ignore it. I’m a prostate cancer survivor, so I’ll talk about my experience. I’ll provide the top five things you can do to decrease your risk of all the major diseases and conditions that afflict men and what you can do when you’re diagnosed. You’re never too young or too old to take your health into your own hands; there’s always something you can do to be healthier.

Men—you don’t want to miss this webinar. Women are welcome as well.

The live webinar is free next Wednesday, and then I’ll consider having it as a product for a nominal fee. Hearing it live is better, and I know it’s short notice, but so is the warning for a stroke, and none of us need that. Join me next week.

What are you prepared to do today?

        Dr. Chet

What Is Secondary Prevention?

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Secondary prevention encompasses a wide range of health-related conditions. It includes people with risk factors such as high cholesterol and blood pressure, cigarette smoking, elevated HbA1c, atrial fibrillation, and more. It also includes people who may have had a heart attack, stroke, cancer, or were treated and now are trying to prevent a recurrence of another incident. This all falls under the umbrella of secondary prevention.

The problem, as I see it, is that we don’t take the risk factors seriously enough to prevent the occurrence of serious health events. For example, let’s say a person gets a reading of 5.9% in an HbA1c reading. That’s considered pre-diabetic and is definitely on the path to type 2 diabetes. The solution is pretty straightforward: reduce refined carbohydrate intake and total caloric intake if the person has weight to lose. Then start an exercise program and stick to it.

Did you know that within three days of beginning a walking or exercise bike program, your body will begin to utilize insulin better? That’s how quickly your body reduces insulin resistance and starts the path back to a lower HbA1c and thus reducing the risk of type 2 diabetes.

Aging with a vengeance is all about prevention—primary prevention to prevent serious diseases and conditions from occurring in the first place and secondary prevention to deal with them if they do occur. Aging is a risk factor in and of itself but not because of a calendar; it’s the changes that naturally occur as we age. What we do to resist or delay those changes is at least partly in our hands. That’s why I said aging with a vengeance begins in your 30s and maybe even younger.

It all begins with six simple words: Eat less. Eat better. Move more. I’ll continue to comb the research to find strategies to deal with other issues. Next week, I’ll review a research study that reveals the secret to getting results.

What are you prepared to do today?

        Dr. Chet