Billions of tax dollars are spent on government and private nutrition-related programs, said to prevent the chronic diseases of aging that are main causes of death, and reduce obesity. But conflicting information about what makes healthy eating abound. So in 1992, the National Institutes of Health and U.S. Department of Health and Human Services launched the largest preventive health study in our history, the Women's Health Initiative. One part was the WHI Dietary Modification Trial - one of the largest, longest and most expensive randomized, controlled clinical dietary intervention trials in the history of our country. It was specifically designed to provide the strongest, most indisputable evidence in support of its ‘healthy eating' guidelines for the primary prevention of chronic diseases and for weight control.
According to the NIH, it was "one of the largest studies of its kind ever undertaken in the United States and is considered a model for future studies of women's health." It was a major undertaking, costing $415 million and conducted at 40 medical centers across the country. It was a well-designed and carefully conducted study. A total of 48,835 postmenopausal women (the age most associated with risks for developing heart disease and cancers) were enrolled and received extensive physical work-ups, labwork, and dietary assessments at baseline, year one, and every three years. They had clinical follow-ups every 6 months and their medications were monitored in a pharmacy database. At the start of the trial they were randomly assigned (with each group exceedingly well matched in every index and risk factor) to either their regular unrestricted diet or to a "healthy" diet and lifestyle program.
The more than 19,000 women in the diet intervention group followed the diet and an intense behavioral modification program for a healthy lifestyle. To keep them on their diet, these women received rigorous follow-up by specially trained and certified professionals:
The WHI dietary intervention group received intensive nutritional and behavioral modification training consisting of 18 group sessions in the first year followed by quarterly sessions throughout the trial. Each participant received an individualized dietary fat gram goal estimating 20% of energy from fat during the intervention and a common dietary goal of 5 or more servings daily of combined vegetables and fruits and 6 or more servings daily of grains. Self-monitoring techniques and group session attendance were emphasized.
While the intervention group backslide a little, they did surprisingly well in sticking to the diet - as good as dietary prescripts will ever get and money can buy - at a cost of $8,498 spent per person. The women in the healthy eating intervention group cut their total fat intakes down to 24% of their calories and 8% saturated fat the first year - well below the control group eating about 38% total fat and nearly 40% more saturated fats. By the end of the study, the healthy eaters were still averaging 29% fat, compared to 37% in the control group. The ‘healthy dieters also ate about 25% more fruits and vegetables, grains and dietary fiber than the typical American diet of the control group. Throughout the trial, the dieters continued watching what they ate and consumed fewer calories, about 361 kcal/day less than they had been eating at the start of the study.
Right up to the end of the 8 years of follow-up, researchers remained confident that their trial design and the dietary changes these participants made, while not perfect, were significant enough to prove that following a healthy lifestyle and healthy diet leads to weight control and lower rates of chronic diseases. They confidently projected a 14% decrease in breast cancer, for example.
After eight years, there were no significant differences in the incidences of more than 30 clinically-documented cancers, heart attacks or strokes, or all-cause mortality. The dieters initially lost some weight but rebounded and their body weights, despite 8 years of watching what they ate, were no statistically different from the women who'd been eating whatever they wanted. Both groups ended up at nearly the identical weights they started with, differing a mere 0.7kg, about one pound.
No one was happy with the null result of this major clinical trial. No one. The healthy eating interests didn't like it. The low-fat advocates didn't like it. The low-carb advocates didn't like it. The weight management programs didn't like it. Everyone diligently set out to spin it, downplay its results, or not call any attention to it, no doubt hoping it would quietly go away.
(from the blog junkfoodscience.blogspot.com)
Thanks David for this honest post. It is a tuff enough adjustment to realize you have a chronic condition with potential damage if uncontrolled. To not be able to eat anything tasty drags a person down to depression. It has been about a year since I've had to begin to deal with this blood glucose issue seriously. Sometimes I eat things that do make me feel bad, usually its not worth it so those times are less frequent. Allowing some treats, changing the definition of treat and experimenting with testing to clarify has enabled a more balanced approach to living. I may not make it to 100 undamaged but I will live and laugh and share positive options and keep perspective. C
David, Your post is right on the money. I keep up with all the latest on Diabetes and Health Issues, but I find it very frustrating that one minute we are doing/eating things that are supposed to be healthy, and the next minute a small study says the same things may cause illness, disease, or predispose us to it. The bombardment of different expert opinions can cause a person to become confused, anxious, and even rebellious. Eat low fat, no -- eat some fat ---, etc... Drink a bit of alcohol like red wine -- it has health benefits, no don't - your risk of breast cancer increases. Drink or eat chocolate/cocoa -- no don't - too much caffeine Use Splenda -- oh no -- it's artificial.... sugar alcohols make you gassy ( how sweet) -- and Stevia is not tested thoroughly -- but it is natural...Eat peanuts -- low glycemic -- no - don't they are a legume, and are inflammatory... The list goes on and on.... eat some agave -- Oh, no -- don't - it has fructose in it !!! Eat dairy -- it protects against colon cancer, helps bones, and helps the glycemic load -- Oh no -- it is mucous producing and constipating.... LOLOLOL !!! Eat whole grains for diabetes and fiber, oh no -- some of them are inflammatory and still raise BGS. Eat red meat for protein and nutrients-- Oh no -- you can't it's inflammatory and increases cancers.... Eat chicken -- it's OK -- oh no -- it has traces of arsenic !! Drink soy --- Oh no, An actor claims he drank too much and now has MAN BOOBS !! What I love about you David is that you do such an awesome job of presenting us the latest research and studies.... and I know how perfectionist you are with your diet. I am so happy, you have let loose, and are having some Grass fed meat/bison/dairy. We have to ask ourselves, what did our ancestors do ??? How did one grandfather live until 97 years of age, and both grandmothers until age 86 and age 92 respectively ? How did my father who was an ABSOLUTE metabolic mess even make it to age 78 with heart disease, obesity, high blood pressure, and full blown with sugars of 250 ??? My point is the more I read about the reasons why we should or shouldn't eat , drink, do something, one minute I
feel empowered,and the next I feel so anxious, that I could go eat three cheese danishes, or an entire pizza..... which brings me back to your suggestions -- keeping BGS in check, weight down, and listening to your body !!! I have come to the realization that though I too follow a reasonably low carb diet, and try to choose low glycemic, I am not perfect. I also do not eat much red meat, avoid real eggs, and lessen my dairy. When I get a craving whether it is physical or emotional (comfort), for a high carb or high glycemic food, I battle it out in my mind, until I can either overcome it, or sheepishly give in with profound guilt and EXTRA ANXIETY !!!! We all have specific genetics, and other factors that affect our health, other than just what we eat or don't eat/drink. I feel that people have to do the best they can.... If my compliance to my diet is 80 to 85 %, and I sneak a bit of chocolate, or ice cream, or red wine, or pizza, I am ONLY HUMAN !!!!! On Halloween, a friend bought me many drinks... and I also decided to go to Denny's and eat what I wanted (fried appetizer,) and then I had a chocolate donut , and four munchkins !!
My BGS the next day on awakening: 101 !! Since I gave in to my Food Envy/temptation that day, I have been on a healthy roll ever since, eating well. It was like a FIX, lol. One of the 22 year olds at the gym is consuming 4,000 to 8,000 calories a day to gain muscle weight. I said OH PLEASE, PLEASE take my metabolism..... I will always be the one that works out quite hard, and still ends up looking that they don't, while my sisters who it seems - have my mothers genes -do not battle this insulin resistance. We have to do what we can in our diets and fitness.... however we can't let every study and every article SCARE us -- but they do.... especially when they are contradictory-- because it is beyond frustrating. In fact sometimes, they may be doing us more harm than good, by increasing our anxiety level. Listen to your body.... and watch the markers that are important... and once in a while, if you have to --- have a treat or some meat, or some cheese, or a glass of wine. Health is synergistic ---- and everything including a good attitude and positive outlook filters in. I admittedly have gone bonkers while reading some articles... and trying to make decisions even about sweeteners... or dairy.. or light consumption of red wine. My grandfather drank a Schlitz beer or two daily, and ate red meat almost every day, and nearly made it to 100. He laughed, worked until 83, and watched the news every day -- in a time where they did not analyze and overanalyze everything. So, we need to laugh, and stay active and stimulated, and even when there is "Nothing to Eat," we can find our moderate happy medium that is not as extreme as being a fruitarian or a vegan, or eating all meat. We have to feel well, and we have to make peace with our day to day choices --- Oh, btw, I am not giving up bottled water, LOL ! Just like my doctor
is not giving up his M & Ms. We are only human...... and food and drink feeds our "soul"as well as our bodies.
David - this was all well put. I decided some time ago not only to have a continuing campaign to reduce medicines and supplements to the minimum I could justify. Still take some I may drop. But I also 'reduced' the number of dietary rules I would follow. If it doesn't affect my blood sugars, and there are not strong non controversial studies saying I should not eat, I devour!
Supplements I will keep - Fishoil and Vitimin D-3.
Ones I am questioning - Niacin, CoQ10 (I have recovered from statin poisoning, and no longer take them), a 'one a day sr. vitamin', antioxidents (Macular Degeneration?)
RobLL
Great article David.
And great reminder RobLL - what we eat is not JUST the foods but all the supplements. Each sounds so helpful when we consider them but when it adds up to a good sized handful daily red flags start going off. what is the combo doing and why can't I get enough needed nutrients from a 'healthy diet' - whatever that may be! Could be that when we remove items or categories of food from our diets we remove necessary nutrients and then scramble to replace them with supplements.
David, you can buy selzer bottles to make your own. You add CO2 cartridges and the water of your choice.
I think it's as important to enjoy life as to follow the "perfect" diet, and no one knows what that is anyway. I don't mean going out and eating entire pizzas, but if you crave something like red meat or eggs, I think you should eat them in moderation.
My sentiments exactly. I am a type II who follows a carb restricted diet and for the most part I don't talk about it to people. Even my personal physician looks at me like I'm crazy. I love your rules and they are right on. My wife and I also love sparkling water. We make our own with equipment from Soda Club (sodaclub.com) It's pennies and it's sodium free. We love it. MIght want to take a look. Take care of those legs!
Roger M. Moery
Mount Dora, FL.
I needed this today. You have been such a help to me in teasing out the best from the mind-numbingly complex results of nutrition research. I admire your tough-minded ability to research and experiment, without becoming an accolyte of any particular theory that does not have practical, evidentiary proof in your own experience. The tenacity to continue the quest without becoming a "know-it-all" is a rare quailty, and I appreciate your humility in the face of complexity without giving up entirely. So, thanks again!
David, I have been reading you for years, but this is the first time I've commented. This Feb. it will be eight years since i was diagnosed with type 2 at 47. At 6' 1" and 200lbs i was hardly obese, nor was I sedentary by todays standards. But I was scared and read everything I could get my hands on, started eating a carb restricted diet and exercising in ernest. Without the junk carbs my weight fell to 160lbs within six months. My "diabetic educators" ( who pushed the ADA diet) at the hospital were convinced I was starving myself obsessively. But my blood sugars normalized, and my wife, god bless her, said I never looked better without my clothes on. As the years have passed I have pared even more carbs from my diet, kept the weight off, never taken a diabetes drug, and my last A1C at Mayos 5.2. But I do enjoy red wine in moderation, a little very dark chocolate, whole eggs, some red meat, most fruits (a little at a time), all veggies, greek yogurt, cheese, coffee, tea, and the occasional going off the reservation treat. By blood pressure, lipids, C-RP, etc. are all great. I'm convinced that it is the vigorous exercise that allows for the more varied diet. Both aerobic and anaerobic exercise are essential to controlling BS and better health in general. Heck, if I push the weights around long enough I can even enjoy a slice of pizza without a BS penalty or the guilt that goes with it. I am well aware that there are those who would say that my 5.2 is too high and we should all strive for A1C's in the 4's, but I believe life is all about balance, and I know just how hard it is to stay on a very restricted diet. I mean, if we all stopped eating all together we'd have great blood sugars, for a while. So don't forget to factor exercise into the equation, it may help some folks broaden their choices.
Dear Patrick,
Thanks for writing -- finally!
Your weight and your A1C are fine. Both are well within the normal level.
Your diet makes a lot of sense. Very few people are perfectionists in their diet -- certainly not me either!
I also agree on the importance of exercise and have written many articles about it. I try to walk or hike a couple of hours at least every other day and just came back from a 3 mile hike near my apartment.
Keep up the good work!
David
I loved that last comment! For years I was vegan, tracking on protein grams, basing my diet on soy and vegetables. Much to my frustration, I learned that soy was bad for you if you had thyroid problems like I did. The most influential idea after that has been how I feel after eating something. That seems to be a reliable guide, and I notice that foods that make me feel good are also the ones nearly everyone agrees are healthy -- fish, vegetables, nuts, and some few low glycemic fruits. Gosh, it's all so complicated, and at the same time so simple. Will we get this figured out? Thank you, David, for keeping this conversation going! Diana
I think the experts try TOO hard and make it sound like we can`t have anything. But in reality everyone just needs to eat a little of everything instead of piling your plates sky high. I think they mean well, the experts, and they get exasperated because people keep their bad habits and to them(experts) we don`t try hard enough.Am I making any sense to anyone? I don`t know. I drink Nestles` Pure Life, and I like really well.
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Imagine if they made people food like pet food. They could dial up all the nutrients that we need based on some baseline measurements and poof! Back to earth, I think your criteria are more pertinent than all of the pet theories. I think the exact chemistry for our bodies needs to be analyzed so what we eat can be customized.
For me it comes down to this: Guess, eat, test, review, focus, eat, test, review until the food I eat: lowers or maintains my blood glucose to an appropriate level of self-management and lowers or maintains my weight where it's supposed to be. I'd add one more thing though: What do my blood test/blood pressure numbers look like (HDL, LDL, Triglycerides etc.). If what I'm eating lines up all of those numbers, I think I'm fairly close to where I need to be. And that can be proven by those tests and how I'm actually feeling!
Dear Robert,
You are so right! I love your approach starting with "guess." That recognizes the problem.
Best regards,
David
I sure as hell wouldn't eat people chow, it would be based on the food pyramid which succeeded in making me fat and diabetic. Our cats and dogs are also getting fat and diabetic on kitty chow and doggy chow. Put them on a low carb, high protein & fat, no grain diet and they improve, too.
Dear Robert,
After mulling it over, I agree that we have more principles to follow than I wrote originally. Thanks to you, here is my revised list:
Each of us has five guiding principles available for us to follow:
1. Does what we eat help us to control our blood glucose level?
2. Does it help us to control our weight?
3. Does our diet help us control our blood pressure?
4. Do our lipid, vitamin D, and other blood tests look good?
5. How do we feel when we eat the foods we do?
Best regards,
David
Too many tests.