by Marion Nestle

Currently browsing posts about: Diabetes

Aug 21 2020

Weekend reading: Diabetes, race, and class

Arleen Tuchman.  Diabetes: A History of Race and Disease.  Yale University Press, 2020.Diabetes: A History of Race and Disease: 9780300228991: Medicine & Health Science Books @ Amazon.comI did a blurb for this book:

This is a superb, deeply researched history of the role of racism and class bias in perceptions of type 2 diabetes.  Its root causes?  Poverty and discriminationa new vision for a prevention agenda.

Tuchman does for type 2 diabetes what historians of other diseases have done: explore the central role of race and racism.  Racism, she explains, can

Generate ill health by producing pathological responses to the stress of living in a society in which skin color is endowed with privileges denied to others.  Racism, in other words, can make people sick.  In this way, racism—not race—becomes a fundamental cause of differential disease rates, making it impossible to draw a sharp line between what is biological and what is social.

As she documents, health professionals first viewed diabetes as a disease of the Jews—perhaps because they went to doctors more often.   It took decades for scientists to distinguish type 1 from type 2 diabetes, and more decades to recognize that its higher prevalence among non-white minority groups might be due to the obesity-promoting diets and lifestyles of poverty.

For documentation of the social determinants of health, this book is an instant classic.

Jun 10 2019

Industry-funded study of the week: dairy foods, type 2 diabetes, and cardiovascular disease

Knowing that this review was sponsored by the dairy industry, can you predict its conclusions?

Association between dairy intake and the risk of contracting type 2 diabetes and cardiovascular diseases: a systematic review and meta-analysis with subgroup analysis of men versus women. Moshe Mishali, Shiri Prizant-Passal, Tova Avrech, and Yehuda Shoenfeld . Nutrition Reviews 2019;77(6):417–429.

Conclusions: “In conclusion, these results, indicating that dairy product consumption decreases the risk of T2D and CVD, are in line with the recommendations for the public to consume dairy products. The findings about sex differences and the positive effect of milk on women need further establishment. Future studies should focus on isolating the effect of dairy products for men and women throughout their life span

Funding. This work was financed by the Israel Dairy Board.

Declaration of interests. M.M. is a consultant for the Israel Dairy Board. S.P. was paid for her work by the Israel Dairy Board. T.A. is Chief Health Officer at the Israel Dairy Board. Y.S. is a consultant for the Israel Dairy Board.

Comment: This is a study paid for by the Israeli dairy industry.  As such, it can well be considered an advertisement.  Like other such industry-funded studies (as I discuss in Unsavory Truth), it puts a positive spin on equivocal results (“need further establishment”).

Nov 21 2018

New recommendations for type 2 diabetes in kids

Dr. Robert Lustig notes that the American Diabetes Association (ADA) has just released its newest guidelines for management of type 2 diabetes in children.

He has plenty to say about this organization, its ties to the pharmaceutical industry, and its lack of focus on effective dietary approaches to prevention and treatment—at a time when “insulin prices have soared into the stratosphere.”

The ADA, he says,

is a “bought” organization. Bought by Big Pharma. It’s only about the money. It’s not about lives or health or society. This is extortion. Big Food is Al Capone. And the ADA is Frank Nitti, his henchman.

The ADA recommendations do talk about physical activity and diet, but judge the evidence for them as not particularly strong (grades B and C).

These are standard recommendations, but difficult to follow consistently, not least because they are not nearly forceful or specific enough.

Dr. Lustig would like much greater emphasis on restricting sugars.  That’s a good place to begin.

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Dec 8 2016

Food Politics Alaska style: Supermarket prices

I visited the AC supermarket in Utqiagvik, the town formerly known as Barrow.

It could be anywhere USA, with anything you could possibly want, including fresh blueberries from Argentina.  How’s that for food miles?

Remember: all of this, no exceptions, comes in by cargo plane.

The produce section was lovely, with remarkably fresh foods at equally remarkable prices.

Would you believe the green leaf lettuce is $3.50, the baby carrots $7.29, and the romaine $4.69?  New York prices on steroids.

How about white potatoes at $3.29, red ones at $2.79, and baking potatoes at $18.99 for 10 pounds.

Or the reason I was so concerned about the tossed out school lunch milk cartons: $7.11 on sale.

How about bread on sale for $5.98 a loaf?

Just to make me feel at home, here are the sugary drinks down one entire aisle.  The 12-packs were on sale for $10.98, which must not be enough to discourage sales.

Are soft drinks a problem in Utqiagvik/Barrow?

Yes, they are.

The prevalence of obesity and diabetes is low, but rising steadily, and the Indian Health Service dentists told me that they see plenty of little kids with rotted teeth from drinking sodas and sweet juices in baby bottles.

The nutrition transition is taking place in America too, and for the same reasons that obesity and diabetes are becoming problems in the developing world.

Jul 15 2015

The curious incident of Nick Jonas, Coca-Cola, Crossfit, and Diabetes

Thanks to Melanie Nesheim for sending me a link to Russ Greene’s (The Russells) account of Nick Jonas’s dispute with Crossfit over its posting of this image.

As best as I can tell, here’s what happened.

Nick Jonas of the Jonas Brothers, who has Type 1 diabetes, sent out a tweet objecting to this image as insulting to people with type 1 diabetes.   Note: Sugary beverages are a not a risk factor for type 1 diabetes but they are for type 2 (see, for example thisthis, and this).

Russ Greene entered the fray with a tweet pointing out that Coca-Cola sponsors the Jonas Brothers’ concerts.

Apparently, this caught the attention of Good Morning America.

A spokesman for Nick Jonas denied that he had any kind of deal with Coca-Cola.

Capture

Maybe not, but as Mr. Greene pointed out, Coca-Cola presents or sponsors the concerts and advertises that it does so.

My conclusions from this incident:

  • In taking on CrossFit’s critique of the role of sugary drinks in diabetes, Nick Jonas became a de facto spokesman for Coca-Cola.
  • Coca-Cola’s support of Jonas Brothers’ concerts paid off.
  • Coca-Cola’s sponsorship of musicians and sports figures buys loyalty and deflects attention from the well documented role of sugary drinks in type 2 diabetes and other health conditions.

And, of course, I examine this sort of sponsorship in much greater detail in my forthcoming Soda Politics: Taking on Big Soda (and Winning)which comes out in October.

Nov 19 2013

FoodNavigator-USA.com on “Tackling Diabetes”

FoodNavigator-USA.com has a special edition on “Tackling Diabetes: Formulating for Healthy Blood Sugar.”

We’ve been telling people to lose weight, eat more complex carbs and do more exercise for years to get their blood sugar under control, but the number of Americans with type two diabetes continues to rise at an alarming rate. So how can the food industry help? In this FoodNavigator-USA special edition we explore the growing number of tools in the formulator’s toolbox to help promote healthy blood sugar. We also look at what messages resonate with consumers, from the glycemic index to healthy blood sugar, plus what you can, and can’t, say about diabetes on a food label.

Here are the articles in this series:

It’s always interesting to look at such issues from the food industry’s perspective.  And FoodNavigator reporters do an especially good job of putting the issues in context.

 

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Jun 11 2013

NYC Health Department: one New Yorker dies of diabetes every 90 minutes

The NYC Health Department goes to court at noon today for a hearing on the 16-ounce soda cap (I’ll be there).

Yesterday, it released alarming data on diabetes deaths, now at an all-time high.

The press release notes that although NYC’s overall deaths are going down,  diabetes-related deaths are going up.

The deaths are highest in low-income communities.

In April, the Health Department reported that nearly 650,000 New York adults have diabetes, an increase of 200,000 in a decade.   Most of these are due to type 2 diabetes, the “adult” kind.

Why?  Obesity.

Although a small percentage of overweight people develop type 2 diabetes, most people with type 2 diabetes are overweight.

Losing weight is the first thing to do to prevent or treat type 2 diabetes.

Reducing intake of sugary sodas is the first thing to do to lose weight.

That is why the health department wants to reduce the portion sizes of sugary drinks at food service establishments.

Today’s court hearing should be interesting. Stay tuned.

Mar 1 2013

Does sugar cause diabetes? Is a calorie a calorie?

I spent a lot of time last week talking to reporters about the widely publicized study in PloS One that correlates sugar and diabetes.

The study is based on an econometric model of data food availability and diabetes prevalence in many countries.  Such data are not particularly reliable, but the authors did the best they could with what they had.  They are quite forthcoming about the limitations of their model and the data on which it is based [see addition below].

Their principal conclusion: for every 150 kcal/person/day increase in sugar availability (about one can of soda/day), diabetes prevalence increases by about 1%.

Because no other dietary, weight, or behavioral factor shows this kind of effect in their model, it is tempting to interpret the study as demonstrating that sugar is a risk factor for diabetes independent of calorie intake or body weight.

I’m not so sure.  Take a look at the summary figures and decide for yourself.

Figure 1.  Relationship between obesity and worldwide prevalence of diabetes.

Figure 1 Relationship between obesity and diabetes prevalence rates worldwide.

Despite outliers, this figure shows an obvious and strong correlation between obesity and diabetes.  Compare this to Figure 2.

Figure 2.  Relationship of sugar availability to worldwide diabetes prevalence.

Figure 2 Adjusted association of sugar availability (kcal/person/day) with diabetes prevalence (% adults 20–79 years old).

The correlation here is much less obvious.  Without statistical tests, you could just as easily draw the line straight across the graph.  The statistical significance is much weaker than that in Figure 1.

This means that these data cannot easily distinguish between several possibilities:

(a) Calories –> Obesity –> Diabetes

(b) Sugar –> Diabetes

(c) Sugar –> Calories –> Obesity –> Diabetes

While waiting for science to clarify these distinctions, the bottom line is the same for all of them.

As I explained in yesterday’s post, everyone would be healthier eating less sugar.

Addition: The authors have posted detailed comments about their methods.