Diet and Chronic Disease: Type 2 Diabetes and Heart Disease

Written by Dr. Steve Chaney on . Posted in Chronic Disease, Diabetes, Diets, Heart Disease

Can You Cut Your Risk Of Heart Disease And Diabetes In Half?

Author: Dr. Stephen Chaney

 

diet and chronic disease heart attackIt is no secret that heart disease and diabetes are among the top two causes of death in this country. They are killers. Even worse, they can affect your quality of life for years before they kill you. Finally, they are bankrupting our health care system. Anything we can do to reduce the toll of these diseases would be of great benefit.

Is there a connection between diet and chronic disease, specifically type 2 diabetes, stroke, and heart disease?

That is why recent headlines suggesting that deaths due to heart disease, stroke, and diabetes could be cut almost in half simply by changing our diet caught my attention. Of course, those headlines came as no surprise. It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes.

 

How Was The Study Done?

diet and chronic disease heart diseaseThis was a major study (R. Micha et al, JAMA, 317: 912-924, 2017 ). They started by using something called the National Health and Nutrition Examination Survey (NHANES). NHANES is a major survey conducted approximately every 10 years by the US government to collect data on demographics, disease, and diet from a cross section of the US population. They used this database to determine how frequently Americans consumed various heart-healthy and heart-unhealthy foods. They collected data from two surveys conducted in 1999-2002 and 2009-2012 to determine how consumption of those foods had changed over that 10-year period.

  • The heart-healthy foods they included in their study were fruits, vegetables, nuts & seeds, whole grains, and seafood omega-3s (long chain omega-3s).
  • The heart-unhealthy foods they included in their study were red meats, processed meats, sugar-sweetened beverages, and sodium.

They then did a meta-analysis of high quality clinical studies measuring the effects of those foods on deaths due to heart disease, stroke, and diabetes. They combined the data from all these studies to calculate the deaths due to all three causes combined, something they called deaths due to cardiometabolic disease.

Diet and Chronic Disease, Preventing Type 2 Diabetes and Heart Disease

diet and chronic disease lifestyleWhen the investigators combined all the data, they estimated that changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes) by 45.4%. That is an almost 50% reduction just by eating a healthier diet.

  • This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sweets, and refined carbohydrates on cardiometabolic deaths.
  • The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
  • The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
  • Decreasing sodium intake gives a 9.5% reduction in deaths.
  • Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
  • Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
  • Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
  • Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
  • Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
  • Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
  • Decreasing red meat consumption gives a 4.2% decease in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

diet and chronic disease heartHolistic changes are best: It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show a relationship between diet and chronic disease:

  • A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
  • Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The good news is that Americans have made some positive changes in their diet between the first and second NHANES survey, and, as a result, cardiometabolic deaths declined by 26.5%. The biggest contributors to this improvement were:

  • Increased polyunsaturated fat consumption (-20.8%).
  • Increased nut and seed consumption (-18%).
  • Decreased sugar sweetened beverage consumption (-14.5%).
  • This was partially offset by increased processed meat consumption (+14.4%)

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”  Below is a summary of the relationship between diet and chronic disease (specifically type 2 diabetes, stroke, and heart disease).

 

The Bottom Line

It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes. A recent study looked at the effect of a healthier diet on what they called cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes). They concluded:

  • changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths by 45.4%. That is an almost 50% reduction just by eating a healthier diet.
  • This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sugary foods, and refined carbohydrates on cardiometabolic deaths.
  • The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
  • The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
    • Decreasing sodium intake gives a 9.5% reduction in deaths.
    • Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
    • Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
    • Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
    • Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
    • Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
    • Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
    • Decreasing red meat consumption gives a 4.2% reduction in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show:

  • A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
  • Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Trackback from your site.

Leave a comment

Recent Videos From Dr. Steve Chaney

READ THE ARTICLE
READ THE ARTICLE

Latest Article

Does Protein Supplement Timing Matter?

Posted May 15, 2018 by Dr. Steve Chaney

How Do You Gain Muscle Mass & Lose Fat Mass?

Author: Dr. Stephen Chaney

 

protein supplement timingMost of what you read about protein supplements on the internet is wrong. That is because most published studies on protein supplements:

  • Are very small
  • Are not double blinded.
    • Both the subjects and the investigators knew who got the protein supplement.
  • Are done by individual companies with their product.
    • You have no idea which ingredients are in their product are responsible for the effects they report.
    • You have no idea how their product compares with other protein products.
    • There is no standardization with respect to the amount or type of protein or the addition of non-protein ingredients.

Because of these limitations there is a lot of misleading information on the benefits of protein supplements timing and maximal benefit. Let’s start by looking at why people use protein supplements. Let’s also look at what is generally accepted as true with respect to the best supplement timing.

There are 4 major reasons people consume protein supplements:

  • Enhance the muscle gain associated with resistance training: In this case, protein supplements are customarily consumed concurrently with the workout.
  • Preserve muscle and accelerate fat loss while on a weight loss diet: In this case, protein supplements are customarily consumed with meals or as meal replacements.
  • Provide a healthier protein source. In this case, protein supplements are customarily consumed with meals in place of meat protein.
  • Prevent muscle loss associated with aging or illness. There is no customary pattern associated with this use of protein supplements.

How good are the data supporting the customary timing of protein supplementation? The answer is: Not very good. The timing is based on a collection of weak studies which do not always agree with each other.

The current study  (J.L. Hudson et al, Nutrition Reviews, 76: 461-468, 2018 ) was designed to fill this void in our knowledge. It is a meta-analysis that compares all reasonably good studies that have looked at the effect of protein supplement timing on weight gain or loss, lean muscle mass gain, fat loss, and the ratio of lean muscle mass to fat mass.

How Was The Study Done?

The authors started by doing a literature search of all studies that met the following criteria:

  • The study was a randomized control trial with parallel design. This means that study contained a control group. It does not mean that the investigators or subjects were blinded with respect to which subjects used a protein supplement and which did not.
  • The subjects were engaged in resistance training.
  • The study lasted 6 weeks or longer.
  • Reliable methods were used to measure body composition (lean muscle mass and fat mass).
  • The subjects were healthy and at least 19 years old.
  • There was no restriction on the food the subjects consumed.

The authors started with 2074 published studies and ended up with 34 that met all their criteria. They then separated the studies into two groups – those in which the protein supplements were used with meals and those in which the protein supplements were used between meals.

Both groups were diverse.

  • Group 1 included subjects who consumed their protein supplement with their meal and those who consumed their protein supplement as a meal replacement.
  • Group 2 included subjects who consumed their protein supplement concurrent with exercise (usually immediately after exercise) and those who consumed their protein supplement at a fixed time of day not associated with exercise.

Does Protein Supplement Timing Matter?

 

protein supplement timing workoutsBecause the individual studies were very diverse in the way they were designed, the authors could not calculate a reliable estimate of how much lean muscle mass was increased or fat mass was decreased. Instead, they calculated the percentage of studies showing an increase in lean muscle mass or a decrease in fat mass.

When the authors compared protein supplements consumed with meals versus protein supplements consumed between meals:

  • Weight gain was observed in 56% of the studies of protein supplementation with meals compared to 72% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • An increase in lean muscle mass was observed in 94% of the studies of protein supplementation with meals compared to 90% of the studies of protein supplementation between meals. In other words, timing of protein supplementation did not matter with respect to increase in muscle mass.
  • A loss of fat mass was observed in 87% of the studies of protein supplementation with meals compared to 59% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • An increase in the ratio of lean muscle mass to fat mass was observed in 100% of the studies of protein supplementation with meals compared to 87% of the studies of protein supplementation between meals. In short, protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean muscle mass to fat mass.

The following seem to suggest protein supplement timing matters:

The authors pointed out that their findings were consistent with previous studies showing that when protein supplements are consumed with a meal they displace some of the calories that otherwise would have been consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors stated that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

The others concluded: “Concurrently with resistance training, consuming protein supplements with meals, rather than between meals, may more effectively promote weight control and reduce fat mass without influencing improvements in lean [muscle] mass.”

What Are The Limitations Of The Study?

Meta-analyses such as this one, are only as good as the studies included in the meta-analysis. Unfortunately, most sports nutrition studies are very weak studies. Thus, this meta-analysis is a perfect example of the “Garbage In: Garbage Out (GI:GO)” phenomenon.

For example, let’s start by looking at what the term “protein supplement” meant.

  • Because the studies were done by individual companies with their product, the protein supplements in this meta-analysis:
    • Included whey, casein, soy, bovine colostrum, rice or combinations of protein sources.
    • Were isolates, concentrates, or hydrolysates.
    • Contained various additions like creatine, amino acids, and carbohydrate.
  • As I discuss in my book, Slaying the Food Myths, previous studies have shown that optimal protein and leucine levels are needed to maximize the increase in muscle mass and decrease in fat mass associated with resistance exercise. However, neither protein nor leucine levels were standardized in the protein supplements included in this meta-analysis.
  • Previous studies have shown that protein supplements that have little effect on blood sugar levels (have a low glycemic index) are more likely to curb appetite. However, glycemic index was not standardized for the protein supplements included in this meta-analysis.

protein supplement timing workout peopleIn short, the conclusions of this study might be true for some protein supplements, but not for others. We have no way of knowing.

We also need to consider the composition of the two groups.

  • Protein supplements used as meal replacements are more likely to decrease weight and fat mass than protein supplements consumed with meals. Yet, both were included in group 1.
  • Some studies suggest that protein supplements consumed concurrent with resistance exercise are more likely to increase muscle mass than protein supplements consumed another time of day. Yet, both are included in group 2. We also have no idea whether the meals with protein supplements in group 1 were consumed shortly after exercise or at an entirely different time of day.

This was the most glaring weakness of the study because it was completely avoidable. The authors could have grouped the studies into categories that made more sense.

In other words, there are multiple weaknesses that limit the predictive power of this study.

What Can We Learn From This Study?

Despite its many limitations, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, most of us are using protein supplements to lose weight or to increase our lean mass to fat mass ratio. Simply put, we are either trying to lean out (shape up) or lose weight. And, we want to lose that weight primarily by getting rid of excess fat. For us, calories do matter. With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

 

The Bottom Line:

 

A recent study looked at the optimal timing of protein supplements consumed by subjects who were engaged in resistance exercise. Specifically, the study compared protein supplements consumed with meals versus protein supplements consumed between meals on weight, lean muscle mass, fat mass, and the ratio of lean muscle mass to fat mass. The study reported:

  • Protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • Timing of protein supplementation did not matter with respect to increase in muscle mass.
  • Protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • Protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean mass to fat mass.

The authors pointed out that their findings were consistent with previous studies showing that when a protein supplement was consumed with a meal it displaces some of the calories that would have been otherwise consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors said that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

As discussed in the article above, the study has major weaknesses. However, despite its many weaknesses, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, for those of us who are using protein supplements to lose weight or to increase our lean mass to fat mass ratio, calories do matter.  With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

For more details, read the article above:

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

UA-43257393-1