In taking up the task of reversing your Type 2
Diabetes, trying to figure what foods to eat and which ones to avoid makes it a
very confusing situation for many who wrestle daily with this disease. The
so-called experts in the medical field are telling us one thing while a small
group of doctors are exploring alternative routes and are finding that there
are choices that we can make along with the traditional medicines that we treat
ourselves with. Let me give you one example.
Dr. Neal Barnard has done research into the
effects of a low fat vegan diet on people who have Type 2 diabetes. When
compared to studies done by the American Diabetes Association, the low fat
vegan diet was superior in results and was found extremely effective in
reversing Type 2 diabetes. Dr. Barnard seems to think that it may be the
abundance of bad dietary fat in the diet that corrupts the cell wall and makes
it ineffective in allowing insulin to bring blood sugar into the cell.
This very in-depth and informative article is
an attempt by the author (Zoe) to inform of the misleading information put out
by the media to sabotage our attempts to control or reverse the type 2 diabetes
problem. It is very long but full of a lot of serious content. I also placed a
link to the original article to show that not one letter or word was changed.
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Low-fat dairy foods & diabetes risk
I woke up on the morning of Thursday
6th February 2014 to a number of tweets informing me that headlines were
claiming “yoghurt is key to beating diabetes.” The on-line version of the Express moderated the headline
to “How low-fat dairy food can help to
cut your diabetes risk” but the
story was all over the news from Australia to India.
This study in the journal Diabetologia
was the source article. It is available for free download (as of the time of
writing), which is helpful.
The study
There is a study going on across
Europe called the European Investigation into Cancer Study (EPIC). It started
in 1991 and I just happen to be one of the UK members. I get questionnaires
every few years asking me to share health details and asking me what I ate over
the previous year. This blog post has a link to the
questionnaire.
The Norfolk part of the EPIC study
(this is called a cohort) has 25,639 men and women. They were aged 40-79, when
they were recruited into the study between the years 1993-1997. The numbers in
the Diabetologia paper are confusing at times. It appears that this
diabetes/dairy study has randomly selected 4,127 participants – 753 with known
cases of type 2 diabetes from the full cohort and 3,502 as a subcohort. This
3,502 group also contains cases of type 2 diabetes (as a valid random selection
will reflect the original group). There are 128 cases of type 2 diabetes in the
subcohort of 3,502. (Incidents of type 2 diabetes were recorded up to 31 July
2006. There were 892 in the whole study – 25,639 people – giving an incident
rate of 3.5%.)
Don’t worry about any of this. It
will soon become irrelevant.
I then tried to work out when the
dietary questionnaire was undertaken. Is this diabetes/dairy study relying upon
the initial food diary questionnaire completed on entry? Or one undertaken
during the study? The paper says “Baseline dietary intake data were collected
using a 7 day food diary [Reference 15].” Reference 15 is dated 2001 and
describes the general method for the Norfolk EPIC study. Does this mean the
study is relying upon a food diary from between 1993 and 1997 – baseline entry
to the study?
I read on a bit and realised that
this too is irrelevant. And this is why…
The characteristics of the subjects
Table 2 is the important one on the
study. It puts the 3,502 subcohort people into three groups – those with total
dairy intake under 183 grams per day; those with total dairy intake between
184-312 grams per day and those with total dairy intake over 313 grams per day.
These may seem strange groups – but they’ve just split the 3,502 into equal
numbers of people and seen where the lowest, middle and highest thirds of dairy
intake fall.
Table 2 tells us that we ended up
with no age differences between the three groups (all had an average age of
59). However that’s where the similarities ended.
|
TABLE 2 in the paper
|
Tertile 1
|
Tertile 2
|
Tertile 3
|
|
g/day
|
≦ 183
|
184-312
|
≧ 313
|
|
People in group
|
1,168
|
1,167
|
1,167
|
|
Mean (average) age
|
59
|
59
|
59
|
|
Total dairy intake – mean g/day
|
116
|
245
|
447
|
|
Men (% of group)
|
40.5%
|
41.1%
|
48.5%
|
|
Related factors lifestyle:
|
|||
|
Alcohol (units/week)
|
8.5
|
6.6
|
5.4
|
|
Smoking (% current smokers)
|
14.1%
|
10.7%
|
9.6%
|
|
Physical activity (% active)
|
15.6%
|
19.9%
|
21.8%
|
|
BMI (mean)
|
26.8
|
26.2
|
25.8
|
|
Waist circumference (men) – mean
in cm
|
97.5
|
95.7
|
93.9
|
|
Waist circumference (women) – mean
in cm
|
82.4
|
81.4
|
81.3
|
|
Dietary factors:
|
|||
|
Saturated fat (% total energy)
|
12.9%
|
12.9%
|
13.1%
|
|
Mononunsaturated fat (% total
energy)
|
12.3%
|
11.9%
|
11.6%
|
|
Polyunsaturated fat (% total
energy)
|
6.7%
|
6.6%
|
6.2%
|
|
Calcium intake (mg/day)
|
624
|
807
|
1,077
|
|
Magnesium intake (mg/day)
|
256
|
289
|
330
|
|
Vitamin D intake (mcg/day)
|
2.38
|
2.85
|
2.98
|
The claim
The Abstract of the paper (the
summary) states:
“Results: Total dairy, high-fat
dairy, milk, cheese and high-fat fermented dairy product intakes were not
associated with the development of incident diabetes. Low-fat dairy intake was
inversely associated with diabetes in age- and sex-adjusted analyses (tertile
[T] 3 vs T1, HR 0.81 [95% CI 0.66, 0.98]), but further adjustment for
anthropometric, dietary and diabetes risk factors attenuated this association.”
In simple terms this is saying:
- We found NO association (positive
or negative – no association at all) between the incidence of type 2 diabetes
and total dairy OR high-fat dairy OR milk OR cheese OR high-fat fermented dairy
products. NO ASSOCIATION AT ALL.
- The claim is then that low-fat
dairy intake was inversely associated with diabetes when we only adjusted for
age and men/women i.e. a higher intake of low-fat dairy was associated with a
lower incidence of diabetes with virtually no data adjustment. This still says
nothing about causation. It merely says we observed two things together when we
didn’t adjust for things that we need to adjust for.
- The final part says that – when we
did properly adjust for all the things that were different, the observation was
“attenuated”. This is so disingenuous it’s scandalous. It should have said from
the outset, when we adjust for all the differences between the groups there is
no association whatsoever between low-fat dairy and diabetes. There is nothing
to observe. We have found nothing and there need be no newspaper headlines.
There are 3 models in the paper:
Model 1 adjusts for age and sex and
nothing else – that’s the one they use to claim an inverse association between
low-fat dairy and incidence of diabetes. Table 2 tells us that there is no
difference in age – all groups have an average age of 59. There are more men in
the higher dairy group, but so what?
Model 2 adjusts for BMI, family
history of diabetes (which is not in table 2 for some unknown reason), smoking,
alcohol, physical activity and other lifestyle attributes. We can see from
Table 2 that the lower dairy group have 1.6 times the alcohol unit intake of
the higher dairy group. The lower dairy group has one and a half times the
percentage of current smokers. The lower dairy group has 70% of the physically
active people in the higher dairy group. The lower dairy group have higher BMIs
and larger waistlines. All of these favour the higher dairy intake having less
incidence of diabetes and this having nothing to do with dairy, but lots to do
with alcohol, smoking, activity, weight and waist size. And sure enough – when
the data is adjusted to compensate for these stark differences, the association
disappears.
Model 3 then further adjusts for
dietary differences – energy intake, vegetables (higher in the higher
dairy/lower diabetes group), processed meat (lower in the higher dairy/lower
diabetes group)etc and this also eliminates, sorry, attenuates, any
associations.
I was amused by the fact that group
3 – with the higher dairy intake and lower incidence of diabetes also had the
highest saturated fat intake, lowest monounsaturated fat and lowest
polyunsaturated fat intake, but that didn’t make the headlines. Less amusing is
the difference in calcium, magnesium and vitamin D intake between the three
groups. What impact did that have on health?
If you like stats, table 3 in the paper
shows you all of this. This table takes the lower dairy tertile as being the
baseline of 1 and then looks at the middle intake of dairy and the higher
intake of dairy relative to this – for models 1, 2 and 3.
Each row gives a mean (average) and
then the standard deviation in this kind of format: 0.93 (0.74-1.18). This
means that the average was 0.93 but that the standard spread around this
average lies between 0.74 and 1.18. a) That’s quite wide and b) the number 1
falls within this range so this is not seen as significant – because the
comparator of 1 falls within both groups.
You can use this principle to see at
a glance – as the paper reported – that nothing is significant for total dairy,
high-fat dairy, milk, cheese or high-fat fermented dairy. Low fat dairy is only
significant for model 1 – with none of the adjustments that need to be made.
There is no association when the lifestyle factors are properly taken into
account. Ditto – the association with fermented dairy disappears as soon as
lifestyle factors are properly taken into account.
Only one factor nudges out of the
significant range. Look at the last line in table 3. The upper limit of the
standard deviation is 0.99 – just a notch away from touching the line of no
significance and this is for low-fat fermented dairy. And it’s association, not
causation. And it’s about relative, not absolute risk. Do you think that was
worth today’s headlines?!
***********************************
I hope all the
information wasn’t too much to handle. I think the bottom line to this subject
is that we need to cut WAY BACK on our consumption of dairy products and that
even if it is low fat, you may be better off without. I personally prefer to
not drink or eat anything made of cow’s milk. I am not a baby cow and just can’t
see why I would put such a thing in my body. Beat Type 2 diabetes with a pH balanced
diet
Randy Powell, Eating-Veggies.com
