Does substitution with whole grains reduce diabetes risk?

The Buzz:  Whole-grain carbohydrates are recommended in lieu of refined grains to help prevent T2D.
Citation: “White rice, brown rice, and risk of type 2 diabetes (T2D) in US Men and Women” Arch Intern Med. 2010;170(11):961-969

Summary:  Using pooled data from the Health Professionals Follow-up Study and the Nurses’ Health Study I and II, researchers found that substituting brown rice for white rice was consistently associated with a lower risk of developing T2D, and that this effect could be extrapolated to other whole grains.  These associations were independent of lifestyle and dietary risk factors for T2D, as well as ethnicity.  Glycemic index (GI) values differed by variety, but in general they found that white rice consumption generated a relatively stronger postprandial glucose response than the same amount of brown rice.

Commentary:  Recommending whole grains, and whole foods (as nature intended) in general is likely a matter of course for most of us at this point, but for those looking for further substantiation this may prove helpful.  It is also worthy of note as we work with increasing populations of gluten-intolerant patients – we need to ensure we’re not solving a GI related issue, and potentially creating another one in the form of T2D.
By: Karyn Duggan, CNC

What are the most effective lifestyle changes for improvements in lipid profiles?

The Buzz: Various lifestyle modifications can benefit lipid profiles

Citation: "Diet and Exercise in the Management of Hyperlipidemia" AFP, 81;9 May 1, 2010 1097-1101

Summary: This review article is a compilation of various primary studies and meta analysis regarding specific life style modifications and their affect on lipids. Data summarized below:

• Limit saturated fats to < 7% of calories and eliminate trans fats = LDL ↓9-12%
• Increase intake of soluble fiber (3 oz oats per day, psyllium supplement) = LDL  ↓ 5 mg/dL  
• Isocalorically increase consumption of tree nuts ( .5 oz almonds, walnuts, or pecans per day) = LDL ↓ 2-19%
• 1.5 oz soy protein per day - tofu and soy foods to replace meats = ↓ LDL 5mg/dL
  ↑ HDL 0.8 mg/dL 
•  One alcoholic drink for females, two for males = ↓  LDL 7.8 mg/dL
  ↑ HDL 9-13 mg/dL 
• 1 oz Promise, Active, or Benecol spread per day  = ↓ LDL 10% 
• Increase intake of marine omega-3 fatty acids (EPA/DHA) = ↓ Triglycerides in a dose-dependant fashion
• Mediterranian Diet = ↓ total cholesterol:HDL ratio > 12% 
• Portfolio Diet  = ↓ LDL 29-35% 
• Aerobic exercise >120 min/week = ↓ LDL 4mg/dL
  ↑ HDL 1.9 - 2.5 mg/dL

Other pearls include:

• Dietary advice from physicians results in ↓ cholesterol 6.2/ mg/dL and ↓ LDL 7.0 mg/dL.
• Dietary advice from a dietitian results in and additional ↓ cholesterol 9.7 mg/dL.
• The greatest reduction results from avoidance of saturated and trans fats, increase in polyunsaturated and monunsaturated fats, moderate ETOH intake, supplementation with plant sterols or stanols (eg Promise spread), and isocalorically increasing consumption of tree nuts

Commentary: This study helps to quantify the effects of commonly recommended lifestyle modifications on lipid levels. Some of the recommendations, although showing impressive reductions in lipids, require a motivated patient. 

By: Steven Winiarski D.O.