Nutrition & Health News This Week
Best diet for IBS, Nestlé sneaks in sugar, Guardian's "Death by Diabetes," and more
What’s the Best Diet for IBS?
A clinical trial in Sweden published this week in The Lancet Gastroenterology and Hepatology, found that a low-carbohydrate diet was just as effective as the “low-FODMAP” approach for reducing symptoms of irritable bowel syndrome (IBS), and both were more effective than drug treatment.
Widely considered the standard of care for IBS, low-FODMAP diets restrict nuts, most dairy products, and several types of “fermentable” carbohydrates such as wheat, legumes and many fruits. The approach is usually combined, as it was in this trial, with general IBS dietary advice: to chew food thoroughly, eat regularly, and avoid excessive fat.
For the Swedish subjects, food was delivered to their homes for a month. The results were impressive for both diet groups: 71–76% of participants reported significant improvements in their gastrointestinal symptoms. Only 58% did in the drug treatment group. Six months later, the diet-group participants still had fewer symptoms than they did at the start of the trial, even though they followed the diet less closely.
The fact that both dietary approaches had similar benefits raises new research questions. FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols,” all short-chain carbohydrates that are absorbed poorly by the small intestine. These are thought to be the cause of IBS, yet people in the low-carb group continued to consume some fermentable carbs while still experiencing significant improvement in gastrointestinal symptoms. Additionally, they increased their fat intake, which is believed to exacerbate IBS.
The trial was funded by the Dietary Science Foundation, a Swedish non-profit whose mission is to fund clinical trials on diet and health. Since our own government has largely abandoned funding meaningful clinical trials on this important topic, grassroots science is now our best bet.
The Guardian Dares to Say Low-Carb Outloud
For years, the American Diabetes Association (ADA) has been a scandal hiding in plain sight: on a mission to end diabetes yet promoting advice that seems to do the exact opposite. Maybe a national conversation will be sparked by two blockbuster articles published this week in the Guardian’s new series, “Death by Diabetes: America’s Preventable Epidemic.”
The author is Neil Barsky, a journalist, former hedge fund manager, and founder of the Marshall Project who himself had type 2 diabetes until he read books by Gary Taubes and adopted a low-carbohydrate diet. A self-avowed innocent in the world of food politics, he couldn’t fathom why this diet was not recommended for all diabetics, a problem he lays out in his first piece: “Low-carb diets work. Why does the American Diabetes Association push insulin instead?”
The main answer, Barsky suggests, lies in the ADA’s ties with the food and pharmaceutical industries, including $134 million in donations from 2017 to 2024. The nature of the apparent grift is described in Barsky’s second article, about a recent lawsuit filed by a nutrition expert who says she was fired by the ADA for resisting pressure to publish recipes laden with Splenda products after the artificial sweetener company gave the ADA more than $1 million in 2022. She found it unethical to recommend pouring 1/3 cup of Splenda into a cucumber-and-onion salad, and so, like seven other ADA nutrition professionals in just three years, was soon out the door.
These pieces in the Guardian (US version) stand out against a dearth of US media coverage on the low-carbohydrate diet and type 2 diabetes, which is an ongoing, open scandal. The existence of a safe, natural solution for a diabetes epidemic affecting 128 million Americans and costing nearly $1 trillion a year has been a bizarrely taboo topic for US news outlets for years. A friend who contributed regularly to the Washington Post told me how her editor responded a few years ago to a low-carb/diabetes story pitch: ‘We aren’t interested in that line of thinking’ was the reply. And the New York Times has barely run an item on the subject since a 2016 op-ed by the late Dr. Sarah Hallberg, then medical director of a weight loss program at Indiana University Health Arnett, and Dr. Osama Hamdy, a medical director at the Joslin Diabetes Center at Harvard Medical School. This piece so incensed the Times’ senior science writer, Gina Kolata, that she retaliated days later in an attack piece, opening with a quote from a retired ADA medical officer: “When you look at the literature, whoa is it weak. It is so weak.”
Why is the media so hostile to low-carb? The explanation could fill a book, but for many years the answer was mainly institutional bias mixed with—perhaps—pressure on publications from food and pharma advertisers. Now, fears of climate change and the animal-rights agenda stand in the way of recommending a diet higher in animal foods, as low-carb tends to be. All the more reason to read and share these Guardian pieces, since clicks will encourage the Guardian editors to keep publishing this good work. (The link to both stories is here.)
Highly recommended nutrition conference in London in May
Our friends at the Public Health Collaboration (PHC) are holding their annual conference on May 18-19, in London, bringing together a superb line-up of metabolic and mental experts. It will address some big questions on nutrition like “How do we reverse the type 2 epidemic?” with Gary Taubes, Dr. Ken Berry and Dr. David Unwin, and “Can we fix mental health with food?” with Dr. Rachel Brown and Dr. Iain Campbell.
The conference will also feature debates on contentious topics, including: “Does cholesterol cause heart disease?” featuring Dave Feldman and Dr. Adrian Soto-Mota (arguing that high LDL-cholesterol may not be a significant indicator of heart-disease risk in lean, healthy people) versus Peter Lansberg, a well-known lipidologist from the Academic Medical Center in Amsterdam and Mike Fisher, a consultant cardiologist from Liverpool. The other debate will ask, “Does red meat shorten lifespan?” for which metabolism expert Ben Bikman and carnivore Dr. Anthony Chaffee will face off against Federica Amati, head of nutrition at the Zoe diet company, which recommends a Mediterranean diet.
These lectures and debates are some of the most interesting nutrition events taking place today. Also, your participation will support this great grassroots charity that is actively working to reverse chronic disease in the UK. (Early bird prices available for another week) Book at http://phcuk.org/conference
This week in Plant Based Foods
The promise of Beyond Burgers and Impossible Meats is that we can have the experience of eating meat without killing animals. One result: the purveyors of these plant-based meat analogs, or PBMAs, are changing the nature of plant-based diets from traditional, minimally processed whole foods – legumes, grains, nuts, fruits, and vegetables – to highly processed meat alternatives. Nutrition science can’t answer whether they’re good for the planet, but it can answer whether they’re good for us.
Many of these products are brand new to the market, so we’re faced with the usual dearth of clinical trials on that question. People who eat these foods thinking they’re a healthier alternative to meat are doing so on faith, not evidence. Now, the first rigorous trial on the topic has been published in the American Journal of Clinical Nutrition. The results: plant-based meat alternatives proved no healthier than the animal products they meant to replace. But also, perhaps, no worse. At least for eight weeks.
The authors, a team of Singapore-based nutritionists led by Christiani Jeyakumar Henry of the Singapore Institute of Food and Biotechnology, say they were motivated to do the trial by the ever-increasing prevalence of diabetes in Asia and the “societal drive to increase the consumption of alternative protein sources in our diet.” While Henry and his co-authors believe that “the cardiometabolic advantages of vegetarian and vegan diets compared to omnivorous diets are well established” based on the association between plant-based eating and health in observational studies (we do not), they had their doubts about plant-based meat analogs.
Not only are these foods typically high in salt – for flavor, among other reasons – they are also highly processed: The “deconstruction and reconstruction of traditional plant-based foods (e.g. soy protein isolates from soya beans, cassava starch from cassava),” the researchers write “introduces potential unintended consequences on various health-promoting constituents inherently present in these plant-based ingredients.”
Henry and his colleagues randomized 89 healthy, omnivorous men and women to get their protein from either chicken, pork and beef or from Impossible Beef, Beyond Burger, the Vegetarian Butcher and other PBMA purveyors. The Singapore researchers get extra credit for delivering free meals regularly to participants’ homes, ensuring greater dietary adherence, and also for assuring that the protein foods were equally processed – chicken nuggets, sausage, patties, mince in both groups -- so any observed effects could not be attributed to the level of processing.
Health markers, including LDL cholesterol, blood pressure and blood sugar, were found to be equal in both groups. Eight weeks, though, was not long enough to establish whether these PBMAs are healthy, let alone a means to prevent the diabetes and obesity epidemics that motivated this research. For that, we’ll have to look forward to future clinical trials. Since the market for these meat alternatives has been tanking, however, the potential healthfulness of these processed products may be a moot point
Nestlé Puts a New Twist on Cocacolonization
The food industry has always recognized that a little sugar goes a long way in getting consumers hooked on a product. The ultimate example is known as cocacolonization, a term coined in the late 1940s to capture how Coca-Cola disseminated its product worldwide during the war years via by the U.S. Government, which saw it as a means of disseminating American culture.
With the emergence of obesity and diabetes epidemics, cocacolonization was invoked to explain how these epidemics spread globally with modern Western foods. Now, the Nestlé Company, which promotes the nutritional quality of its products, has been implicated in a cocacolonization scandal, putting a new twist on an old problem.
According to the Swiss non-profit Public Eye, Nestlé promotes its wildly popular baby and infant foods as helping children “live healthier lives.” After all, they’re fortified with vitamins and micronutrients “tailored to the needs of baby and young children and help to strengthen their growth, immune system and cognitive development.” Yet in Switzerland and other main European markets, Nestlé sells these products with no sugar added, while in low- and middle-income countries of the global south, the same products are sweetened with sugar, as much as five or six grams per serving.
Where added sugar is not allowed, Nestlé touts the benefits, as Public Eye reports;
“It’s ideal to avoid consuming these ingredients in childhood, as the sweet flavour can influence a child’s preference for this type of food in the future,” warns the food giant on the brand’s website in Brazil.
Where no such regulations exist, sugar is added. When Public Eye presented its findings to the World Health Organization, a WHO scientist, Nigel Rollins, said “There is a double standard here that can’t be justified.”
Nestle published a response to the Public Eye investigation that can be summarized as “yes, but…” The company says it applies “the same nutrition, health, and wellness principles everywhere, aligned with international guidelines and regulations” and then proceeds to explain that occasionally, they don’t. In the company’s defense, they do say, “We always declare the total sugars in our products, including those coming from honey, for example.” At least they’re honest about it.
Fake meat is gross and a really stupid idea, and hopefully the industry tanks. If meat ever becomes unavailable, I will eat crickets or grasshoppers but not fake meat.
For several decades I believed avoiding excessive consumption of foods and beverages containing sugar or white flour or vegetable oils would allow me to stay healthy and active for the duration of my lifespan. I didn't realize that the linoleic acid in peanut butter and mayonnaise (gave me varicose veins) and the arachidonic acid in meat in general and in 99% fat-free turkey meat in particular (weight regulation and pain issues) could be so problematic.
Finding out I didn't have all the answers enabled me to keep searching for narratives that explain why humanity is becoming increasingly fat and sick. Clue from a 1998 article.
"Arachidonic acid (AA) in the diet can be efficiently absorbed and incorporated into tissue membranes, resulting in an increased production of thromboxane A2 by platelets and increased ex vivo platelet aggregability. Results from previous studies have shown that AA is concentrated in the membrane phospholipids of lean meats. However, the concentration of AA in the visible fat portion of meats also may be significant despite being ignored in most studies. The aim of this study was to accurately quantitate the AA content of visible fat and the lean portion of beef, lamb, pork, chicken, duck, and turkey. The visible fat of meat contained a significant quantity of AA, ranging from 20 to 180 mg/100 g fat, whereas the AA content of the lean portion of meat was lower, ranging from 30 to 99 mg/100 g lean meat. Beef and lamb meats contained lower levels of AA in both the visible fat and lean portion than that from the other species. The highest level of AA in lean meat was in duck (99 mg/100 g), whereas pork fat had the highest concentration for the visible fats (180 mg/100 g). The lean portions of beef and lamb contained the higher levels of n-3 polyunsaturated fatty acids (PUFA) compared with white meats which were high in AA and low in n-3 PUFA. The present data indicate that the visible meat fat can make a contribution to dietary intake of AA, particularly for consumers with high intakes of fat from pork or poultry meat." https://pubmed.ncbi.nlm.nih.gov/9590632/
In 2023 Perdue University researchers wrote, "Poultry meats, in particular chicken, have high rates of consumption globally. Poultry is the most consumed type of meat in the United States (US), with chicken being the most common type of poultry consumed. The amounts of chicken and total poultry consumed in the US have more than tripled over the last six decades… Limited evidence from randomized controlled trials indicates the consumption of lean unprocessed chicken as a primary dietary protein source has either beneficial or neutral effects on body weight and body composition and risk factors for CVD and T2DM. Apparently, zero randomized controlled feeding trials have specifically assessed the effects of consuming processed chicken/poultry on these health outcomes.” https://pubmed.ncbi.nlm.nih.gov/37630747/
So, in light of the above, does it make sense to suggest that excessive carbohydrate intake causes diabetes and obesity?