Small healthy changes could prevent nine out of ten new cases of Type 2 diabetes

We've always known that Type 2 diabetes was in large part a "lifestyle" disease.  Now, a new study pins some staggering numbers to this.  Healthy lifestyle choices can reduce your risk of being diagnosed with diabetes by up to 90%.

Here's what you need to do:

1. Get a little bit of regular exercise. No marathons required. Even a small amount of physical activity makes a big difference.

2. LImit your alcohol consumption to two drinks a day or less.

3. Quit smoking (or don't start).

4. Keep your weight and your waist size from expanding.  You don't need to be rail thin. Just keep your your waist size under 35 inches and your BMI under 25 (calculate your BMI using our Daily Needs Calculator).

5. Eat a bit more fiber and a little bit less sugar and refined carbohydrates. Again, your diet doesn't need to be perfect.  If you can eat just a little better than the average American (now there's a bar that's set pretty low!), you'll lower your risk.

That may seem like a lot to keep track of. But keep in mind that any if you can manage any ONE of these healthy habits, you can reduce your risk of diabetes by 35%.  For every additional one you implement, your risk goes down that much further.

Reference: Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older AdultsDariush Mozaffarian, MD, DrPH; Aruna Kamineni, MPH; Mercedes Carnethon, PhD; Luc Djoussé, MD, ScD; Kenneth J. Mukamal, MD; David Siscovick, MD, MPH Arch Intern Med. 2009;169(8):798-807.

Nuts and fish both improve blood fats, but differently

My recent post on the effects of low-carb and low-fat diets touched off a heated debate among ND readers on which heart risk factors are most significant.  Various commenters argued that triglycerides were more important than cholesterol, or that HDL was more significant than LDL, or that various ratios were the key to assessing heart health risk. 

Well, there's something for everyone in this latest study, which found that eating both walnuts and fish reduces a variety of heart health risk factors.  Eating four ounces of salmon twice a week lowered triglycerides about 12% and increased HDL levels by about 3%. Eating an ounce an a half of walnuts every day, on the other hand, lowered total cholesterol about 5% and LDL cholesterol by about 9%, thereby improving the ratio of total to HDL cholesterol.

Interestingly, there was very little overlap in the benefits of these two foods.  Walnuts had no effect on triglycerides, for example, while salmon did not change LDL cholesterol.  So, it appears that a heart healthy diet should include both. And the amounts used in the study are perfectly reasonable: A small handful of walnuts per day and a small portion of fish twice a week. 

Update (5/1/09): For a heart healthy spring meal that features both salmon and walnuts, see Megan Steintrager's post on our sister site Epicurious.com

"Sugar-free" foods don't make a diet healthier, just lower in sugar

Q. When my daugher was diagnosed with Type 2 diabetes a year ago, I bought every sugar-free thing that I could for her. Now her liver enzyme levels are elevated.  I'm wondering whether the sugar-alcohols in diabetic foods may have something to do with it. 

A. Because your daughter has at least one diet-related medical concern, I hope you are working with a dietician or nutritionist. No-one can (or should) diagnose your daughter's medical issues over the internet. 

Diabetics often have elevated liver enzymes.  And to my knowledge, sugar alcohols are not generally linked to liver problems. But your letter brings up an interesting issue. You don't say how much sugar alcohol your daughter is consuming but you write, "I bought every sugar-free thing that I could."

The fact that your daughter was diagnosed with insulin resistant (Type 2) diabetes at a young age suggests that her diet may have been out of balance, containing too much refined sugar and/or carbohydrates.  If your daughter was eating a lot of sugary foods, replacing all of these with sugar-free foods could leave you with a diet that's lower in sugar but still out of balance. 

Does your daughter's diet contain fresh fruits and vegetables? Lean protein? Whole grains? Healthy fats? Or is she eating a diet of artificially-sweetened diabetic junk food? One positive step would be to replace most nutrient-poor, "sugar-free" foods with nutritious, whole foods.

Sugar-free foods have a place: they allow allowing diabetics and others who need to avoid sugar to enjoy an occasional sweet treat. But just because something is sugar-free doesn't make it good for you!  If foods processed with sugar alcohols and artificial sweeteners make up a significant portion of your (her) diet, chances are that they are displacing other healthier foods. For that reason, I recommend that sugar-free and artificially-sweetened foods and beverages be consumed in very limited quantities--just like foods containing sugar.

Surprising news about how cooking affects antioxidants

Solid information about how various cooking methods affect antioxidant content of vegetables is scarce...and much of it seriously out-dated.  Here are new findings, just published in the Journal of Food Science.

Microwave cooking redeemed

There's a persistent urban legend that microwaving destroys nutrients. People often cite a certain, badly-designed study, in which broccoli was cooked (submerged in water) in a microwave for a ridiculously long period of time. Not surprisingly, the nutrient content was decimated. 

However, this latest study shows that microwaving vegetables without water and only until tender appears to minimize nutrient loss. In general, dry cooking methods, like baking, grilling, or microwaving, protect nutrients better than boiling or pressure cooking. 

In terms of nutrient losses, water is your worst enemy. Losses during pressure cooking were only about half of losses from boiling, however. And, unfortunately, they did not include steaming in their trial. (Why do researchers keep overlooking this common cooking method?!?)

Some vegetables hang onto their nutrients better than others

Regardless of cooking methods, certain vegetables seem to hang on to their nutrients better than others.  Beets, artichokes, green beans, and garlic seem to keep more of the antioxidant powers, regardless of how they are cooked.

Cooking actually increases antioxidant capacity in some vegetables!

Carrots, celery, and green beans actually were more potent in scavenging free radicals after they were cooked.  Researchers aren't sure why but speculate that additional antioxidants might be "liberated" due to cell wall destruction during cooking, or that new antioxidant compounds might be formed by "thermal/chemical reactions."

If you'd like to read the whole study, you'll find it here.  But don't get too hung up on the details.  Although how you cook vegetables does affect nutrient content, the most important thing, by far, is to eat a variety of vegetables, and plenty of them. Eat some of them raw and cook the rest however you enjoy them most!

Watch out! The reduced-fat version may be higher in sodium

If you are trying to cut back on fat, you are probably on the look out for lower-fat versions of your favorite processed foods. However, if you're also watching your sodium, then you've no doubt noticed that it's hard to find reduced-fat versions of processed foods that are also reduced-sodium. In fact, the low-fat versions are often even higher in sodium than their regular counterparts.

Food scientists have found that reducing the salt affects the flavor of low-fat foods more than it affects regular fat foods.  It seems that the absence of fat makes us more sensitive to the absence of salt.  That's why it's practically impossible to produce decent-tasting products like cheese or deli meats that are both low-fat and low-sodium.

Why bother with these highly-processed foods, anyway? Whole foods are naturally low in sodium--even when you salt them to taste. Most (about 70 to 80%) of the sodium in our diet comes from prepared and processed foods. The salt we add during cooking or at the table is minor by comparison.   

So, if you're trying to reduce fat and sodium, skip the deli counter and cured meats altogether and head for the salad bar, instead.

Kids who are able to delay gratification are less likely to be overweight

I was struck by the common-sense wisdom of this recent study, showing that 4-year-olds who aren't able (willing?) to delay gratification are about 30% more likely to be overweight by the time they are 11. 

What the authors of the study don't tackle is how (or whether) the ability to delay gratification can be taught. Is it a personality trait or a learn skill?  Studies show that, at least among college students, the ability or willingness is directly related to how important the pay-off seems. 

In other words, being willing to delay gratification isn't just about learning to wait for a reward. It requires that we are convinced that the delayed reward is BETTER than the instant reward. I can spend this $10 today, or I can sock it away in my IRA and, thanks to the miracle of compounding interest, have $100 to spend 20 years from now.  (Recent events have temporarily undermined the effectiveness of this argument but I think over the long haul it still holds true...)

I think we're all invested in getting our kids off this obesity ride we all seem to be on.  Unfortunately, a four-year-old clamoring for a candy bar is unlikely to appreciate the pay-off of not being overweight when she's in fifth grade.  Maybe even small kids can begin to learn this skill by having to choose between a small treat now or a slightly bigger treat later.

Think of all the ways in which learning to delay gratification or reward can improve our lives: if kids can learn to wait until after dinner to have a sweet, are they more likely to grow up to be people who will get their homework done before playing video games...put aside money for retirement before going on a shopping spree...go to the gym on the way home from work before flopping down in front of the TV set?

Parents, any thoughts?

Agave nectar: A healthier option?

Q. I have seen lots of hype about "agave nectar" being low in calories and having a low-glycemic-index. But in comparing the data, I found that it contains almost exactly as many calories as something like honey which is definitely not low-calorie. Are there any other factors that would affect the body's glycemic response besides caloric density?

A. I'm really glad you asked this question!  Many people, who have seen agave touted as a healthier sweetener, mistakenly believe that it's lower in calories. But you're absolutely right: Agave syrup or nectar contains virtually the same amount of calories as other liquid sweeteners like honey and maple syrup.

However, caloric density is not the only thing that determines glycemic impact, or how a food is likely to affect your blood sugar levels.  Although it has roughly the same number of calories as honey--and, therefore, is just as likely to contribute to weight gain--agave has a lower glycemic impact. It won't cause as great a rise in blood sugar. That's because a high percentage of the sugars in agave nectar are in the form of fructose, which is not absorbed into the bloodstream but processed in the liver. 

Fructose: friend or foe?

As you might have noticed, there's been a lot of hoopla over fructose lately.  Researchers have found that large amounts of fructose may raise triglycerides and cause damage to the liver.  A lot of these studies are in rats, not humans, and involve feeding them giant amounts of 100% fructose--which is not how it is generally consumed.

Still, many people are now trying to avoid concentrated sources of fructose and agave syrup is quite high in it. In fact, it often contains more fructose than the much-reviled high fructose corn syrup! 

As an aside, I think the hysteria about fructose (and HFCS) is slightly misplaced. The real problem, in my opinion, is that we tend to over-consume sugar, IN ALL ITS FORMS.  It's not really our fault. Our sweet tooth is hard-wired into our DNA and we have a catastrophic abundance of refined sugar available.

Intellectually, we know that too much sugar isn't good for us. But our bodies and brains cry, "More! More! More!"  I think that's we're so quick to latch onto (and over-consume) any new product that's promoted as a "healthier" sweetener. 

Bottom line: Small amounts of agave syrup are unlikely to cause problems and may offer some advantage (vs. honey, etc.) in terms of blood sugar control. But, in my opinion, it should be consumed in limited quantities, just like ALL concentrated sweeteners!

For another take on this, see this recent story from the LA Times.

With four weeks to go in our challenge, Vanessa's got her eye on the prize

We've reached the half-way point of our eight-week Heart Health Champion event!  Over the last four weeks Vanessa Bush has been diligently tracking her diet and transforming her nutritional profile, one habit at a time!

A busy working mom, Vanessa is up against the sort of challenges and habits that keep many people from attaining their health goals: no time to exercise, lots of meals on the run, and a weakness for comfort foods. Nonetheless, having confronted the nutritional realities, and bolstered by the tips and support from the NutritionData community, Vanessa is "more determined than ever" to improve her diet and reduce her heart disease risk factors.

Despite the speed-bumps thrown into her path by a bad cold, a family vacation, and holiday festivities, she's made steady progress toward her nutritional goals. She's trimmed fat, sodium, and calories by cutting down on soft drinks and fried foods. She (and her kids!) are eating more fruit and vegetables, and making more meals at home. 

Over the next four weeks, we'll be fine-tuning the process...bringing a few last nutritional details into line and starting to strategize about how to translate the efforts of the last month into life-long habits.  And, as we wrap up the challenge in mid-May, we'll evaluate how Vanessa's efforts have impacted her heart disease risk factors.

Please join us! You can follow Vanessa's progress on the Heart Health Champions page and Vanessa's blog.

What growing your own food can do for you

As global economic woes persist, many families are reviving the tradition of the family vegetable garden.  What a great upside to a tough time!  Not only is the back-to-garden movement saving folks money on their grocery bills, but it's putting healthier food on the table.

Need a few more reasons?

1. Fresh vegetables are more nutritious, and it doesn't get any fresher than straight from the garden to the table. Vegetables start to lose valuable nutrients (and flavor) the moment they're picked. When they're harvested just moments before you serve them, you're getting the absolute maximum nutritional benefit.

2. You can grow organic a lot cheaper than you can buy it.  If you're struggling to make ends meet, organic produce may feel like a luxury you can't afford. But you can grow your own organic produce using your own composted kitchen scraps as natural fertilizer. As organic gardening coach Jean Ann van Krevelen says, "Compost is waste turned into plant food."  You can also use inexpensive pest controls like companion planting and soap spray instead of harmful chemical pesticides.

See also this article from the Wall Street Journal: How much can a garden save you?

3. Eating local saves energy and fossil fuels--and it doesn't get any more local than your own back yard.  This translates into lower food costs for you and a lower carbon footprint for your household, as well.

4. Gardening provides free exercise and stress relief.  No money for gym memberships or spa weekends? An hour in the garden will get your heart pumping and your muscles toned.  It also clears the mind and erases the day's stress.

5. Kids will eat what they grow.  (This may be the best benefit of all!).  Want to turn your finicky eaters into vegetable lovers? Let them grow their own. Kids love to garden and are much more willing to eat vegetables that they had a hand in bringing to the table. 

No more excuses!

If you haven't already, why not celebrate Earth Day this year by breaking ground on a small (or large) vegetable plot?  Here are solutions for the most common obstacles:

No idea what you're doing? Look no further than Jean Ann van Krevelen's Growing Food: A Guide for Beginners, available now in electronic format with a print edition available April 15th. Jean Ann's got great advice for new and experienced gardeners and offers garden coaching as well! Check out her Gardener to Farmer blog.

No room for a garden? See how one enterprising gardener got dozens of pounds of produce from one 3X3 foot plot: Growing your own food on one square yard of land

No time to garden? If gardening simply doesn't fit into your life, you can always do the next best thing. Team up with a farmer by buying a share in Community Sponsored Agriculture. CSAs are one of the fastest growing trends in today's evolving food economy.  You support a local farm with money to buy seeds and supplies. In return, you get a share of the harvest.  Find a CSA close to you at LocalHarvest.org.

Related Post:
Five ways to make your diet healthier (for the planet)

Another log on the low-carb fire

The debate rages on:  Since the dawn of low-carb dieting back in the 70s, experts have worried that a low-carb, high-fat diet, such as that promoted by the late Dr. Atkins, would increase your risk of heart disease. Proponents of low-carb dieting insist that carbs, not fats, are the true culprit in heart disease.  Over the years, numerous studies have provided evidence to support both arguments--without leading to any real resolution or consensus.

This week, a new study published in the Journal of the American Dietetic Association adds another log to the fire.  Researchers at the University of Maryland in Baltimore compared the maintenance phases of three popular diets: Ornish (extremely low fat), Atkins (extremely low carb), and South Beach (moderate "smart" carbs,  moderate healthy fats). Among the findings: both Ornish and South Beach reduced LDL cholesterol levels, while the Atkins increased LDL cholesterol.

What happens next is fairly predictable: Those who believe that a diet high in fat (particularly saturated fat) is unhealthy will no doubt seize on this latest evidence as more proof.  Those convinced that low-carb is the way to go will raise questions about the study's design and validity.

The difference between weight loss and weight maintenance

It's interesting that this study focused on the maintenance phase rather than the weight loss phase of these popular diets.  The beneficial effects of a low-carb diet on heart disease risk factors have mostly been observed during weight loss.  It's possible that any negative impact of the diet on heart health risks may be masked by the enormously beneficial impact of losing weight on those same factors. 

There's no doubt that low carb works for weight loss--and for some people it's the only thing that works.  But I've never been entirely comfortable with the extremely low carb diet as a long-term approach.  I'm not a big fan of the extremely low-fat diet over the long haul, either.  Diets that are extremely high or low in one macronutrient seem much more likely to cause problems caused by defiencies and/or excesses. 

Quality versus quantity

I also think that paying attention to the quality of carbohydrates (in terms of their glycemic impact or effect on blood sugar) is at least as important as regulating the quantity.  A low-carb diet restricts all carbohydrates.  Cutting out high-glycemic refined carbs like sweets and baked goods undoubtedly has a positive effect on heart health. But I'm not sure there's much to gain by restricting low-glycemic carbs like fruits and vegetables. In fact, there is much to lose by eliminating these nutrient-dense foods.

By the same token, low-fat diets cut way back on all fats, including healthy fats that have been shown to be beneficial for both heart health and weight loss. Low fat diets are also typically less palatable and less satiating, which makes them poor candidates for long-term success.

I guess I'm revealing my bias: I favor a balanced diet with proteins, (healthy) fats, and (low-glycemic) carbs in roughly equal proportions.  Ultimately, though, I think it's unwise for us to cite ANY single dietary approach as best for EVERY individual.

Your take?