Preventative food before heart disease for diabetics

Food
1

Hey guys, I have a very simple question. Why don’t diabetes docs recommend the following foods in high quantities to diabetics if they have shown great qualities to keep heart disease away?

Pomegranate (shown crazy properties in some studies like getting rid of some plaque in arteries)
Sardines/Salmon
Oranges
Red Wine
Grapes
Garlic
Kale
Olive Oil

etc.

Why would they steer people to just “eat healthy like a normal person” if our chances of heart disease is higher…clearly what works for normal people won’t work for us.

For instance as a type 1 I’ve been eating more and more of these preventative foods alongside a diet of 50% saturated fat intake from the recommended and only 1,500 mg of salt daily, just in case heart disease is in my future.

2

I can only speak for myself, but here has been my experience:

  • my diagnosing doctor answered all questions about diet with “I am not a dietitian.”

  • my CDE at the hospital answered all questions about diet with “here is what the ADA says, but you may want to try looking up a nutritional ketogenic diet, which I can’t recommend due to my licensing requirements.”

  • my diabetes specialist doctor has recommended most of the foods you list, with a few exceptions.

Oranges, grapes, and pomegranates are very high in fructose, which leads to either a large spike in endogenous or exogenous insulin in order to metabolize the sugars. Since hyperinsulinemia is one of the primary reasons that diabetics have high incidences of CV, and high BG is the other, eliminating fruits is probably (in my doctor’s estimation) more beneficial than the antioxidant properties of the same fruits. You have to judge the risk for yourself, since I doubt a controlled study of fruits vs. no fruits in diabetics has been done in a long enough time frame to determine effects on CV risk.

Garlic and Red Wine are staples of the so-called “Mediterranean” diet, and while they certainly have their pluses, the “miracle” qualities associated to them (and resveratrol) ten years ago hasn’t really been borne out by subsequent research. The great medical mystery of why French and Italian men don’t keel over and die from heart attacks after eating cheese, butter, and fatty meat all day is no longer “solved” by red wine: the current thinking is that consumption of plenty of stinky, moldy cheeses has a greater effect on CV risk than consumption of red wine. You can read more about it in this recent article, which sums up nicely what we really know about wine, garlic, cheese, saturated fats, and CV risk: not much, really.

My doctor is super-keen on Sardines, Salmon, Kale, and Olive Oil, on the other hand, and so am I. Why? Because three of the four are full of good fats, and the third is green, tasty, and full of potassium and fiber. But I doubt Kale is, on balance, any more “heart protective” than any other green leafy vegetable (with the exception of iceberg lettuce, which is the dietary equivalent of drinking a glass of water tainted with algae). Omega-3s are short in most “Western” diets, and everyone should be eating plenty of green veggies.

So, to answer your question very succinctly: most doctors don’t know anything about diet, so they don’t give any advice at all; metabolic specialists tend to prescribe food and diet alongside medications for diabetes. So maybe you need a different kind of doctor :slight_smile:

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3

On the point of hyperinsulinemia, has this been proven? I’ve never heard of diabetics avoiding fruits altogether.

4

Yes, the link between hyperinsulinemia, insulin resistance, and cardiovascular disease is one of the few “known” factors in the study of diabetes. And while I don’t think many people suggest “avoiding fruits altogether,” many of us that use diet as one of our primary tools end up avoiding fruits altogether in order to minimize carb consumption (and, thusly, freely available insulin).

It’s not that there is anything wrong with fruits, but fructose is probably the single worst carbohydrate, gram for gram, if you can’t bolus with exogenous insulin to account for it. So, those ways of thinking about diabetes (and a lot of it really is just ways to think about diabetes: certain knowledge can be in short supply) that seek to minimize insulin requirements very frequently suggest eliminating all fruits from the diet that aren’t very low GI berries. Blueberries, raspberries, blackberries, and strawberries have very few sugars (and more fiber) compared to other fruits and many vegetables. But what is frequently suggested is finding the “right” amount of carbs to eat with a meal in order to minimize spikes in BG.

On my doctor’s suggestion, I ate many different things in my first few months post-diagnosis and tested my BG 1 and 2 hours after to find out how they affected my postprandial levels. I found that I can’t, personally, eat even half of a tart apple without exceeding my target blood glucose range. Oranges are out (I do occasionally have a section of my wife’s tangerines), pomegranates are definitely out, and grapes don’t work (very high carb). So it isn’t really about the fruit itself, it’s just about the amount of carbs. If you can bolus appropriately for such fruits, there probably are benefits to eating them. But if, like me, you aren’t on exogenous insulin therapy, they’re pretty much off the list.

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5

I am so sorry David. I am a type 1. I forgot to mention that. I know the concerns with type 2 are different, but not sure how this differs between the two

6

Humm…I worry about cardio health but I’m simply not buying into magic food properties to reduce my risk. For instance antioxidant fruits also result in protoxidant reactions when metabolized - why the focus on half of the process? It would be terrific if we could trust scientific study to remain unbiased and rigorous but too many times I’ve found the sponsors of food related studies influence reports of “beneficial” results. Reduce daily calories and exercise to reduce cardio risk and work with your doctor to obtain relevant testing.

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7

Actually, amusingly enough I’m a Type 1 as well :slight_smile: I’m just in a really deep honeymoon. The doctors think I’m one of those classic cases of a LADA presentation. I wouldn’t have been tested for antibodies except my metabolic specialist realized my insulin production was really, really low for a Type 2 (my initial diagnosis).

So, point taken. I am, as far as treatment goes, a “typical” Type 2, even though I’m a Type 1. By which I mean I can’t control my BG with a basal/bolus regimen, and Metformin doesn’t do much for postprandials. So I have to eat low-carb.

But you bring up something I’ve thought about quite a bit. When my honeymoon is over and I start exogenous insulin therapy, will I continue on a low-carb diet? I know that many Type 1s eat moderate to “normal” amounts of carbs, while many Type 1s also eat low-carb (the Bernstein-type diet). What I do know is that I eat lots of moldy cheese, kale, olive oil, and fatty fish :slight_smile: I don’t care what kind of diabetic you are, those are known to be good for ya!

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8

This seems really pessimistic. There are some studies about the pomegranate stuff from magazines that aren’t in the industry. You seem to be downplaying the role of food here.

9

I am always interested in scientific studies. Do you have an pointers to such studies on pubmed?

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Ummm, actually I meant scientific studies. Here is a list of 5 studies related to Pomegranate and CVD. The best study says that there has been some observations of associations between antioxidant fruits and CVD, however these observations are weak and large intervention studies are needed to understand whether the associations are real and whether eating high antioxidant fruit is beneficial. Sites such as lifeextension or Mercola are really commercial fringe sites, I wouldn’t recommend taking anything they say as credible. And I just don’t know what to say about Ornish. He is not highly thought of in scientific circles, most of his work is clinical, not repeatable of generally hugely distorted by Ornish himself. And Ornish (the no/low fat guru himself) would probably put a hit out on you for eating 50% saturated fat. His paper uses a highly creative scoring mechanism and then fails to show statistical significance and the one little result he had is strangely conflicted. He claims p < 0.05 (which means statistically signficiant), but the variation in his computed score suggests extreme levels of variance making the results somewhat questionable.

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12

lol I don’t eat 50% saturated fat, I eat 50% of the daily allowance of what a “normal” person intakes per day as recommended.

Secondly, you really think that only those studies should be even considered?

The many benefits of fruit, even beyond the polyphenols thing, are known…and maybe for Type 2 there would be some concerns with intake…

13

Ok, let’s look at the lifeextension article. It lists 46 references. I went through a looked at the titles of them. Here is what I found

No intervention studies on humans (or animals) providing evidence that pomegranate decreases CVD or mortality outcomes

No association studies on humans (or again animals) providing evidence pomegranate intake is associated with decreases CVD or mortality outcomes

And the article was written by a nurse whose main experience had been working with children and in an emergency room. Not a particularly credible scientific source. This what is called a “cherry picked” and distorted article.

I would not change my eating habits on such an article. As I mentioned earlier a good source for actual scientific studies is pubmed. And being able to sift through the many unreliable sources of scientific evidence can be difficult. This guide from UCSF is helpful.

I also believe that we also need to take things in “context.” In particular there are compelling studies that find that CVD and mortality in PWD is associated with A1c in a strong and statistically significant manner (independent of things like cholesterol, BP and BMI). This suggests that lowering your A1c may be associated with a big CVD/mortality benefit and this benefit appears to even be present for non-diabetics (A1c < 5.7%). And the effect suggests you might be able to halve your CVD risk by simply lowering your A1c by 1%.

So why do we have all this low fat/high carb argument? It would seem if you really want to reduce CVD eat fat! This was an effect shown strongly by the Look-Ahead study which found that when PWD in a controlled intervention trial that had the intervention arm eat a low fat high carb diet they in fact did not reduce CVD. Not good news for low fat for diabetes.

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14

thanks @Brian_BSC, especially for the UCSF article. It’s very confusing to evaluate whether a claim that something has health benefits is credible. Recently there was a lawsuit against Pom Wonderful’s claim that daily consumption of the company’s products could fight serious health conditions. They could not cite one credible study that used the Gold Standard for scientific research, a randomized and controlled trial. They were ordered to cease and desist from making claims about the health benefits of its products.

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15

So up saturated fat? lol I eat plenty of the good fats.

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I do think that only replicated, scientific studies should be considered, for a pretty solid reason. The reports by folks like Ornish and Mercola, or on pop-sites like lifeextension aren’t conducted with the scientific method. That means there is no way to judge the accuracy of their results, or whether it is even significant or not. They write some stuff, and hope people believe it.

The reason why peer-reviewed science is so important is because of two key features: science is fundamentally skeptical of “positive results,” meaning there is a higher bar set by design for what is considered a significant, positive result; and the peer review process weeds out most of the really biased, crappy results (and even some good, but weak, results). It’s not a perfect process, but it is the best we have.

So I tend to pay the most attention to studies that are actually scientific studies, rather than reports with no basis in science. Turmeric and Cinnamon are great examples of this: according to all the online non-scientific sites, these things should have already cured our diabetes by now if we were eating the right kind in sufficient quantities; according to the actual scientific studies, while such spices aren’t bad there is no evidence of any kind that they can cure diabetes, and only modest evidence for even bringing blood sugar down.

In a world where it can be hard to judge the quality of publicly available information, I’ll go for peer-reviewed science and the experience of people I know and trust before info from sites such as you listed. Not because I think you’re up to anything sinister, but because I don’t trust those sites. At all. I like my information transparent, as honest as I can verify, and absent a profit-motive. So I stick with science.

Which says eat olive oil, moldy cheese, and fatty fish. The science also says that fruits high in antioxidants are probably OK, but have almost as many drawbacks as they do tentative positive effects on CV risk. So it’s a wash, for me.

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17

You know, it is very difficult to judge credibility of information which claims to be fact-based. I wonder if we shouldn’t have a new forum category here in tudiabetes: Local Scientists Please Confirm or Debunk This Claim. In that forum, people could post articles or claims they’ve heard but aren’t sure how to judge to be true or not (or credible or not). We have doctors, research scientists, and even some diabetes researchers that read and comment in these forums. While we most certainly don’t know everything (or even very much) about diabetes, we do know how to judge evidence for and against claims of fact or benefit.

So, for example, we’re seeing that in this thread. The OP has posted a good, solid question about a list of foods, some of which are definitely associated with lower CV risk (in context), and some of which have claims made for them that aren’t entirely credible. It’s fantastic that we have scientists and educated folks here that can help us wade through such claims, since those claims are made to the diabetes online community on a daily basis. Probably because of the profit motive…

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18

I think it’s pretty clear for many reasons that certain kinds of unsaturated fats (as long as they aren’t hydrogenated or “trans” fats) are healthy in comparison to some kinds of saturated fats. But there is a lot of recent evidence that saturated fats have gotten a bad rap. That doesn’t mean one should subsist solely on fatty pork and beef. But there is pretty good evidence that saturated fats have a place in the diet of healthy individuals, whether diabetic or not. For one thing, consumption of saturated fats are directly related to the production of hormones in humans, and for another thing cutting out saturated fats means that we must replace the calories (assuming we are eating at maintenance or deficit) with calories from something else. From the abstract of a recent scientific article:

“Replacement of SFAs with polyunsaturated fatty acids has been associated with reduced CVD risk, although there is heterogeneity in both fatty acid categories. In contrast, replacement of SFAs with carbohydrates, particularly sugar, has been associated with no improvement or even a worsening of CVD risk, at least in part through effects on atherogenic dyslipidemia, a cluster of traits including small, dense low-density lipoprotein particles.”

What this means is that foods are almost never “good” or “bad,” whether that be for your heart, your waistline, or your mental health. All foods, all macros, all fats, can be good or bad depending on context. And the context for healthy eating includes: everything else you eat; what chronic illnesses you have (important for us diabetics); the environment you live in; how much exercise you get; what your lean mass percentage is and where it’s located on the frame; what your body fat percentage is; how much water you retain; …; ad infinitum.

This is one reason it’s hard to make any absolute claims about what is good or not good for people to eat. Some people could clearly benefit from reducing saturated fats in their diets. Others can actually benefit from increasing saturated fat intake (particularly those who workout consistently and at high intensity, in other than ultra-endurance kinds of sports or activities). It really depends on the individual. One of the things that pop-science dietitians (and even the government in the “food pyramid” days) have really screwed up in the last twenty-thirty years is the idea that one diet fits all. It simply enough isn’t true, as any diabetic should know.

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19

Not trying to be pessimistic - realistic? It’s great you are aware and concerned about cardio risk just know the next big food claim is always just around the corner - maybe Ponce De Leon was right about the fountain after all!

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For pomegranates in particular: I tried unsweetened pomegranate juice and found that it naturally contains enough sugar that it seldom needs sweetening. Are you sure you want that much sugar?