Categories
Uncategorized

What did you have for dinner?

Important Points:

  • Healthy diet
  • Type 2 diabetes
  • Nutrition
  • Carbohydrates
  • Protein

What did you have for dinner?

If type 2 diabetes were an infectious disease, it is said we would be in the midst of an epidemic. This problematic disease is striking an ever-growing number of adults, and with the rising rates of childhood obesity, it has become more common in youth especially among certain ethnic groups. The good news is that prediabetes and Type 2 Diabetes are largely preventable. About 9 in 10 cases in the U.S. can be avoided by making lifestyle changes. These same changes can also lower the chances of developing heart disease and some cancers. In this article, we will look at diet as a means to prevent and regulate type 2 diabetes.

How What You Eat Affects You

According to the Centers for Disease Control and Prevention, one out of every three American adults has prediabetes; that is 86 million people. Without intervention, up to one third of them will go on to develop type 2 diabetes within five years.

Is all lost? Not at all! Lifestyle changes can help. While excess body fat is a recognized risk factor for diabetes (and weight loss is an important way to lower risk), specific diet patterns and foods seem to decrease or increase risk, independent of weight. The latest research suggests that diabetes risk (as well as risk of heart disease and stroke) is largely influenced not by single nutrients but by specific foods and overall diet patterns.

Poor diet quality may influence weight and metabolic risk independent of calories; different types of foods have different effects on satiety, glucose-insulin responses, liver fat synthesis, fat-cell function, craving and reward responses in the brain, and the creation of visceral fat.

Foods that Lower the Risk of Getting Type 2 Diabetes

We will discuss in some detail every day food that might either aid in the prevention of diabetes or accelerate your progression towards it. When you are making the decision of what to eat, choose wisely.

  1. Choose high-fiber, slow-release carbs

Carbohydrates have a big impact on your blood sugar levels—more so than fats and proteins—so you need to be smart about what types of carbs you eat. Limit refined carbohydrates like white bread, pasta, and rice, as well as soda, candy, packaged meals, and snack foods. Focus on high-fiber complex carbohydrates, also known as slow-release carbs because they are digested more slowly, thus preventing your body from producing too much insulin.

2. Eat more plant foods
Minimally processed plant foods such as fruits, non-starchy vegetables, legumes, and nuts/seeds are consistently linked to better cardio-metabolic outcomes, including decreased diabetes risk.

3. Choose protein wisely
While they have been studied to different extents, meat, poultry, eggs, fish, and dairy protein sources appear to impact diabetes risk differently.

In their 2011 meta-analysis, Pan and colleagues determined that red meat consumption, particularly processed red meat, is associated with an increased risk of type 2 diabetes and suggested that substituting one serving of nuts, low-fat dairy, and whole grains per day for one serving of red meat would lower diabetes risk by 16% to 35%.

4. Use quality fats instead of quantity
Most research on fats typically looks at their impact on cardiovascular, not diabetes risk, and fats’ association with diabetes risk is in need of clarification. Recent evidence suggests that the quality of fats consumed in the diet is more important than the total quantity of dietary fat.  In other words, the exact fats consumed are more relevant than just the quantity of consumption, and some fats may be proinflammatory (omega 6 fats from industrial seed oil, vegetable oil) and others may be anti-inflammatory (omega 3 fats from natural products or saturated fats found in real food). Some researchers point out that source of fat is important. In studies looking at total fat intake and health effects, results showed:

  • A Mediterranean dietary pattern which is relatively high in monounsaturated fats may help prevent type 2 diabetes.
    • Intake of high-fat dairy products is associated with a decrease in type 2 diabetes risk.
    • Omega-3 fatty acid ALA (alpha-linolenic acid) may be associated with modestly lower risk.

5. Drink unsweetened beverages and water
What to drink is a choice we make every day, and it is just important to get into healthy drinking habits.

• Both coffee (caffeinated and decaffeinated) and tea are associated with lower risk of diabetes.  The problem arises because many people add sweeteners and artificial creamers to coffee, which may contain significant carbohydrates and defeats the purpose of not consuming refined carbohydrates.

•Fruit juices have historically been considered safe, but the reality is that most fruit juices contain about the same amount of carbohydrate as does soda.  We urge our patient’s to avoid both soda and fruit juices altogether.

• There’s strong evidence that moderate alcohol use is associated with lower diabetes risk across diverse populations, but people who don’t currently drink alcohol shouldn’t be encouraged to do so, and drinkers should limit themselves to up to two drinks per day for men and one to 1.5 for women.

In Summary

Eat more:

  • Healthy fats from nuts, olive oil, fish oils, flax seeds, or avocados
  • Fruits and vegetables—ideally fresh, the more colorful the better; whole fruit rather than juices
  • High-fiber cereals and breads made from whole grains
  • Fish and shellfish, organic chicken or turkey
  • High-quality protein such as eggs, beans, low-fat dairy, and unsweetened yogurt

Eat less:

  • Trans fats from partially hydrogenated or deep-fried foods
  • Packaged and fast foods especially those high in sugar, baked goods, sweets, chips, desserts
  • White bread, sugary cereals, refined pastas or rice
  • Processed meat and red meat
  • Low-fat products that have replaced fat with added sugar, such as fat-free yogurt

A Healthy Lifestyle

It is easier to adapt a healthy eating lifestyle than to go on a diet. Working with dietary patterns instead of focusing on individual nutrients or “superfoods” (or vilifying particular food groups) allows greater flexibility for you and lets you choose foods you like at times that are convenient to you.

Given the health advantages of plant foods like leafy greens and whole grains and their association with reduced diabetes risk, you should ensure your diet pattern includes a healthy serving of them at all times.

References:

  1. Today’s dietician (2017):Diabetes Management & Nutrition Guide: Foods and Eating Patterns for Diabetes Prevention. Retrieved from

https://www.todaysdietitian.com/newarchives/0717p40.shtml

  • Harvard School of Public Health (2019): Simple Steps to Preventing Diabetes. Retrieved from
https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/
  • Health Guide (2018): The Diabetic Diet. Retrieved from
https://www.helpguide.org/articles/diets/the-diabetes-diet.htm
Categories
Uncategorized

Does chronic overnutrition play a role in metabolic inflammation?

Important Points:

  • Inflammation
  • overnutrition
  • obesity
  • carbohydrates
  • fatty acids

Does chronic overnutrition play a role in metabolic inflammation?

We have been looking at metabolic inflammation and its role in the development of obesity, diabetes, and other chronic diseases. Does overnutrition contribute to metabolic inflammation? How?

Background on Overnutrition

It is estimated that by 2020[b1] , two-thirds of the global burden of disease will be due to chronic non-communicable diseases, most of which are associated with an unhealthy diet. While hunger is a tremendous global health concern that cannot be minimized, overnutrition should similarly be given concentrated attention. Malnutrition affects up to 1 billion people and doesn’t just affect those who are thin due to food shortages; people who are overweight could also be malnourished.

The “double burden of malnutrition” is a term coined by the World Health Organization (WHO) to describe a situation which is characterized by “the coexistence of undernutrition along with overweight and obesity, or diet-related non-communicable diseases, within individuals, households, and populations, and across the life course. Globally, the problem is not the availability of food resources but the allocation and consumption of food.

1. What  is overnutrition?

Overnutrition is defined as the overconsumption of nutrients and food to the point at which health is adversely affected. Overnutrition can develop into obesity which increases the risk of serious health conditions including cardiovascular disease, hypertension, cancer, and type-2 diabetes.

Until recently, overnutrition had been viewed as a problem that only affected developed nations. However, this has been reviewed to affect most populations. The prevalence of obesity is increasing in developing countries with the introduction of fast food and refined sugars.

While once considered the disease of the rich, low-income groups in richer countries are also being affected by this condition.

2. What is overnutrition-induced inflammation?

Inflammation is a biological response launched by the immune system against dangerous assaults which threaten the integrity and normal physiology of an organism. Chronic nutrient overload causes an increase in fat tissue (adipose) irregularities in that, if adipose tissue expandability is low, there will be an increased presence of thickened tissue. This would lead to a proinflammatory state that can trigger insulin resistance, release of macrophage chemoattractant proteins, and in chronic inflammation, even the death of the thickened adipose tissue itself. This creates cyclic action that extends the insulin resistance to all adipose tissue.

An important characteristic of overnutrition-induced diseases is chronic low-grade inflammation caused by nutritional excess. Overnutrition-induced inflammation is thought to occur in the brain and thus plays an extensive and steering role in overnutrition-induced diseases.

3. Overnutrition and the Metabolic Syndrome

The metabolic syndrome is a constellation of metabolic risk factors including high cholesterol, elevated blood pressure, insulin resistance and elevated serum glucose, a pro-inflammatory state, and a prothrombotic state.

Most persons with metabolic syndrome are obese and usually have abdominal obesity. Generally, obesity is a reflection of overnutrition. A current view is that when adipose tissue fails to store all excess nutrients as triglycerides, lipids (fats) begin to accumulate in various tissues (e.g., muscle, liver, pancreas, and heart). The foundation of the metabolic syndrome thus appears to be overnutrition – more nutrient intake than can be safely disposed by lipid oxidation.

When obesity is present, adipose tissue becomes inflamed. This inflammation may result in a pro-inflammatory state which could contribute to both cardiovascular disease and diabetes.

4. What is Carbohydrate Overnutrition?

Most evidence supports the concept that fatty acids represent the final common pathway to tissue nutrient overload. Less attention has been given to the possible negative effects of excessive intake of carbohydrates.

Chronic overstimulation of insulin secretion induced by dietary carbohydrates could have the following adverse effects:

  • β-cell function may be impaired by chronic glucotoxicity
  • carbohydrate-induced hyperinsulinemia may suppress muscle insulin sensitivity.

Furthermore, high-carbohydrate intakes can prompt the formation of fatty acids in the liver by way of lipogenesis; fatty acids produced in this way can feed into the final common pathway of ectopic lipid accumulation. There is thus need to look further into the role of carbohydrate overnutrition in the development of the metabolic syndrome.

5. What Factors Contribute to Overnutrition?

Obesity in the United States has reached startling heights. The National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) estimated that in 2015-2016, the prevalence of obesity in the United States was 39.8% in adults and 18.5% in youth. 

While obvious factors including genetics, drugs, and other medical conditions may contribute to obesity, behavior is perhaps the most common contributor. Healthy weight on an individual level is associated with a healthy diet and regular physical activity. Restaurants serve incredibly caloric meals, with some meals containing as much as 2,000 calories. The sedentary lifestyle practiced by most adds to the epidemic.

Unfortunately, this obesity trend has spread to other nations, including many developing countries. China, for example, now has more than 5,000 Kentucky Fried Chicken (KFC) restaurants in 1,100 cities. Similarly, McDonald’s expects to have 4,500 restaurants in China by 2022, up from 2,500 in 2017. A growing number of Chinese households also own television sets, personal vehicles, and other technologies that reduce physical activity and facilitate weight gain.

It is of note that economic inequality in developing nations is a primary cause of both overnutrition and undernutrition. Studies conducted in India show that income inequality had the same effect on the risk of being overweight as it did on the risk of being underweight; specifically, for each standard deviation increase in income inequality, the odds of being underweight increased by 19% and the odds of being obese increased by 21%. 

While some people have the resources to purchase amounts of food beyond their daily caloric requirements, others cannot meet their recommended caloric intake. However, increasing numbers of poor people are becoming overweight in more nations, as these individuals consume affordable, yet highly caloric meals, such as fast food and processed foods.

6. What Should Be Done to Avoid Overnutrition?

An approach to understanding the effects of overnutrition on the metabolic profile is through overfeeding studies. These indicate that overnutrition produces a deterioration of metabolic status. Variability in individual response is however to be expected. Such investigations are potentially useful for identifying those who are particularly susceptible to the development of metabolic risk factors.

The host of genetic factors likely act at tissue levels to influence the response to nutrient excess. Different people may react differently to accumulation of fat, but overnutrition is generally considered to trigger metabolic disorders and predispose one to chronic conditions like Type 2 Diabetes. When choosing what to eat, one should be careful to ensure they choose balanced meals rich in fiber and nutrients and avoid the modern day fast food craze, as the cost of bad eating is too high.

References

  1. Unite for sight (2018): Module 4: Overnutrition. Retrieved from http://www.uniteforsight.org/hunger/module4
  2. NCBI (2009): From chronic overnutrition to insulin resistance: the role of fat-storing capacity and inflammation. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19171470
  3. NCBI(2013): Neuroinflammation in Overnutrition-induced Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389772/
  4. American Federation for Medical Research (2016): Overnutrition, ectopic lipid and the metabolic syndrome. Retrieved from https://jim.bmj.com/content/jim/64/6/1082.full.pdf
  5. NCBI (2009): From chronic overnutrition to insulin resistance: the role of fat-storing capacity and inflammation. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19171470