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Published on Leave a comment on Eating Meals Prepared At Home Linked To Lower Incidence of Type 2 Diabetes

Of course eating meals prepared at home is healthier! The study results - that people who often consume meals prepared at home are less likely to suffer from type 2 diabetes than those who consume such meals less frequently shouldn't be surprising. The researchers attributed the higher incidence of type 2 diabetes to weight gain in those eating fewer meals prepared at home, but there are other things going on also.

Restaurant and fast food meals tend to have very large portions, frequently with rich sauces, and the meal choices tend to be heavy on fat and salt. The meals can be high in calories, contain many artificial ingredients, and may be low in nutritional quality (and so also not nourishing the beneficial gut microbes that are linked to health). At home you can limit portions, control the food ingredients, and eat only healthy foods (see earlier post on this). From Science Daily:

Enjoying meals prepared at home: Short-cut to avoiding diabetes?

People who often consume meals prepared at home are less likely to suffer from type 2 diabetes than those who consume such meals less frequently, according to  new epidemiological research reported by Qi Sun, of the Harvard T.H. Chan School of Public Heath, Boston, USA and colleagues as part of PLOS Medicine's special issue on Preventing Diabetes.

Internationally, there is an increasing tendency for people to eat out, and this could involve consumption of fast food, for example. Concerns have been raised that such people have a diet that is rich in energy but relatively poor in nutrients -- this could lead to weight gain which is, in turn, associated with an increased risk of type 2 diabetes.

Sun and colleagues employed large prospective data sets in which US health professionals -- both men and women--were followed-up for long periods, with rigorous collection of data on health indicators, including self-reported information on eating habits and occurrence of diabetes. The results were corrected for various known factors that could affect dining habits, including marital status. All in all, the study analyzed 2.1 million years of follow-up data.

The findings indicate that people who reported consuming 5-7 evening meals prepared at home during a week had a 15% lower risk of type 2 diabetes than those who consumed 2 such meals or fewer in a week. A smaller, but still statistically significant, reduction was apparent for those who reported consuming more midday meals prepared at home. Other analyses suggest that less weight gain could partially explain the reported reduction in occurrence of type 2 diabetes in those often eating meals prepared at home.

Published on Leave a comment on Eating Whole Grains Linked To Living Longer

A second study was just published about the benefits of eating whole grains daily - again a significantly lower risk of premature death, and again the effects were dose-related. That is, the more whole grains eaten daily, the lower the risk of early death. Like the first study, this also was a review study. This study (published in BMJ) found that whole grain consumption was associated with a reduction in the risk for death from cancer, coronary heart disease (heart attack and stroke), respiratory disease, infectious disease, and diabetes.

A slice of 100 percent whole grain bread contains about 16 grams of whole grains, and current U.S. dietary guidelines recommend 48 grams or more of whole grains daily, but this study suggests that eating even more whole grains daily is best (eating 90 grams of whole grains a day reduced the risk for mortality from all causes by 17 percent).

Grains are divided into two subgroups: whole grains and refined grains. Whole grains or foods made from them contain all the essential parts and naturally-occurring nutrients of the entire grain seed in their original proportions. This definition means that 100% of the original kernel – all of the bran, germ, and endosperm – must be present to qualify as a whole grain. Some whole grains are: whole wheat. barley. buckwheat, corn (including whole cornmeal and popcorn), millet, oats (including oatmeal), quinoa, brown rice, rye, sorghum, spelt, bulgur, and wild rice. From Eurekalert:

Seven servings of whole grains a day keep the doctor away

Eating three more portions of dietary fiber a day--say, two pieces of whole grain bread and a bowl of whole grain breakfast cereal--is associated with a lower risk for all cardiovascular diseases and for dying of cancer, diabetes, and respiratory and infectious diseases, a study just published in the BMJ has shown. The study is strong proof that consuming lots of whole grains is good for our health, says first author Dagfinn Aune, a PhD candidate at the Norwegian University of Science and Technology who is currently working at Imperial College, London.

....In general, the study showed that the higher the consumption, the better protected you are. "We saw the lowest risk among people who ate between seven and seven and a half servings of whole grain products a day, which was the highest intake across all the studies. This corresponds to 210-225 grams of whole grain products in fresh weight and about 70-75 grams of whole grains in dry weight, and is about the same as the health authorities in Norway and other Nordic countries recommend as the minimum daily allowance," says Aune.

The researchers' analyses showed fewer risk factors for people who consumed more bread and cereal with whole grains, as well as foods with added bran. On the other hand, people who ate a lot of white bread, rice or cereals with refined grains did not show reduced risk.

Nine studies with a total of more than 700,000 participants examined the risk for all types of cardiovascular disease and correlated cardiovascular deaths....The risk of dying prematurely from all causes was 18% lower for individuals who consumed a lot of whole grains compared to those who consumed lesser amounts, while three additional servings each day were associated with a 17% reduction in mortality. The risk for deaths associated with cancer (15%), respiratory diseases (22%), diabetes (51%) and infectious diseases (26%) was also lower the more whole grains individuals consumed.

Published on Leave a comment on Should a Healthy Plant-based Diet Include Lots of Sweets?

A plant-based diet (eating lots of plant foods - fruits, vegetables, whole grains, legumes, seeds and nuts) once again shows health benefits in a new study - here a lower incidence of type 2 diabetes. But what kind of plant-based foods one eats is important: consumption of a plant-based diet that emphasized healthy plant foods was associated with a larger decrease (34%) in diabetes risk, while consumption of a plant-based diet high in less healthy plant foods (soda, fruit juices, sweets/desserts, refined grains) was associated with a 16% increased diabetes risk. From Medical Xpress:

Healthy plant-based diet linked with substantially lower type 2 diabetes risk

Consuming a plant-based diet—especially one rich in high-quality plant foods such as whole grains, fruits, vegetables, nuts, and legumes—is linked with substantially lower risk of developing type 2 diabetes, according to a new study from Harvard T.H. Chan School of Public Health.

While previous studies have found links between vegetarian diets and improved health outcomes, including reduced risk of type 2 diabetes, this new study is the first to make distinctions between healthy plant-based diets and less healthy ones that include things like sweetened foods and beverages, which may be detrimental for health. The study also considered the effect of including some animal foods in the diet.

The researchers followed more than 200,000 male and female health professionals across the U.S. for more than 20 years who had regularly filled out questionnaires on their diet, lifestyle, medical history, and new disease diagnoses as part of three large long-term studies. The researchers evaluated participants' diets using a plant-based diet index in which they assigned plant-derived foods higher scores and animal-derived foods lower scores.

The study found that high adherence to a plant-based diet that was low in animal foods was associated with a 20% reduced risk of type 2 diabetes compared with low adherence to such a diet. Eating a healthy version of a plant-based diet was linked with a 34% lower diabetes risk, while a less healthy version—including foods such as refined grains, potatoes, and sugar-sweetened beverages—was linked with a 16% increased risk. Even modestly lowering animal food consumption—for example, from 5-6 servings per day to about 4 servings per day—was linked with lower diabetes incidence, the study found.

The researchers suggested that healthful plant-based diets could be lowering type 2 diabetes risk because such diets are high in fiber, antioxidants, unsaturated fatty acids, and micronutrients such as magnesium, and are low in saturated fat. Healthy plant foods may also be contributing to a healthy gut microbiome, the authors said.

Published on Leave a comment on Regular Physical Activity Is A Magic Bullet In Preventing Health Problems

A recent editorial in the journal Cardiology calls exercise the "magic bullet" in preventing all sorts of diseases, including cardiovascular disease and diabetes.

From Science Daily: Regular physical activity is 'magic bullet' for pandemics of obesity, cardiovascular disease

In an editorial published in the current issue of Cardiology, professors from the Charles E. Schmidt College of Medicine at Florida Atlantic University have evaluated the totality of evidence and conclude that regular physical activity bears the closest resemblance to a "magic bullet" to combat the worldwide epidemic of obesity and cardiovascular disease.

The statistics on regular physical activity in the United States are bleak; only about 20 percent of Americans (23 percent of men and 18 percent of women) engage in recommended levels of regular physical activity and about 64 percent never do any physical activity. In Europe, the statistics are not much better with only 33 percent who engage in physical activity with some regularity, while 42 percent never do any physical activity.

The authors also point out that physical activity confers important beneficial effects beyond body weight and include blood pressure, cholesterol, triglyceride, diabetes, heart attacks, strokes, colon cancer and possibly even breast and prostate cancers as well as arthritis, mood, energy, sleep and sex life.

Starting in their 30s, Americans and many Europeans tend to gain between 1 and 3 pounds of body weight per year, and by 55, many are between 30 and 50 pounds overweight....The authors note that brisk walking for only 20 minutes a day burns about 700 calories a week, results in a 30 to 40 percent reduced risk of coronary heart disease, and can be performed even by the elderly. They stress that regular physical activity also should include resistance exercise such as lifting weights, which can even be safely performed in the elderly and in patients with heart failure.

Published on Leave a comment on Reduce Chronic Inflammation With Food

As we know, chronic inflammation is linked to cancer and other diseases. It is long-term persistent low-grade inflammation, and it has a "wear and tear" effect on the body. What causes chronic inflammation? Being overweight or obese, sedentary lifestyle, Western (low fiber, high processed foods and meat) diet, chronic illnesses, viruses or bacteria (e.g., gum disease), smoking, air pollution, stress, excessive alcohol intake. It often does not have symptoms, but doctors can test for C-reactive protein levels (CRP), which increase when the body is inflamed. So you absolutely want to lower chronic inflammation if you can.

High dietary intake of fruits and vegetables, which are rich in polyphenols, has been linked through many studies with reduced risk for diseases that are associated with chronic inflammation, such as cardiovascular disease, type II diabetes, cancers, Alzheimer’s disease, and Parkinson’s disease. Polyphenols are a class of chemicals or micronutrients found in many foods, especially fruits and vegetables.

New research looked at 31 polyphenols (alone and in some mixtures) to see which lowered inflammation the most. They found that some mixtures of polyphenols actually had more than an additive effect - that it's more than a sum of the individual polyphenols. They found that the polyphenols resveratrol, isorhamnetin, and curcumin were the most anti-inflammatory. Isorhamnetin is a flavonol that occurs in apples, onions and green tea; curcumin is from the Indian spice turmeric; and resveratrol is present in the skin of red, purple and black grapes, and in especially high concentrations in Itadori tea (from Japanese knotweed). Another important anti-inflammatory polyphenol is vanillic acid, which is found in vanilla, wine, whole wheat, and berries.

Just remember that it is better to eat a variety of fruits and vegetables rather than taking supplements. Foods are more than just one or 2 isolated ingredients, but consist of many micronutrients, microbes, etc , and when eating a varied diet, a person typically has mixtures of many polyphenols in their system at once. The research finds that these polyphenol mixtures interact with one another. Studies  typically find real foods to be superior to supplements in beneficial health effects. From Science Daily:

What foods can help fight the risk of chronic inflammation?

A new study by the University of Liverpool's Institute of Ageing and Chronic Disease has identified food stuffs that can help prevent chronic inflammation that contributes to many leading causes of death. Inflammation occurs naturally in the body but when it goes wrong or goes on too long, it can trigger disease processes. Uncontrolled inflammation plays a role in many major diseases, including cancer, heart disease, diabetes and Alzheimer's disease.

Diets rich in fruits and vegetables, which contain polyphenols, protect against age-related inflammation and chronic diseases. Polyphenols are abundant micronutrients in our diet, and evidence for their role in the prevention of degenerative diseases such as cancer and cardiovascular diseases is already emerging. The health effects of polyphenols depend on the amount consumed and on their bioavailability.

T-cells, or T-lymphocytes, are a type of white blood cell that circulate around our bodies, scanning for cellular abnormalities and infections. They contribute to cell signalling molecules (cytokines) that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokines are modulated by fruit and vegetable intake.

The study, conducted by Sian Richardson and Dr Chris Ford from the University's Institute of Ageing and Chronic Disease, examined the different potencies of the polyphenols. Sian Richardson, said: "The results of our study suggest that (poly)phenols derived from onions, turmeric, red grapes, green tea and açai berries may help reduce the release of pro-inflammatory mediators in people at risk of chronic inflammation. "Older people are more susceptible to chronic inflammation and as such they may benefit from supplementing their diets with isorhamnetin, resveratrol, curcumin and vanillic acid or with food sources that yield these bioactive molecules."

Published on Leave a comment on Eat A Chocolate Bar Daily For Health?

Image result for dark chocolate  Another yes to daily chocolate consumption -  a 3.5 oz. chocolate bar a day! This study looked at 1,153 people aged 18-69 years old and found an inverse relationship between daily chocolate consumption and levels of insulin and liver enzymes. This suggests that chocolate consumption may improve liver enzymes and protect against insulin resistance (risk factors for cardiometabolic disorders such as diabetes, heart disease, or stroke). From Science Daily:

Eating chocolate each day could reduce heart disease, diabetes risk

A new study published in the British Journal of Nutrition appears to back up the adage that a little of what you fancy does you good. Including a small amount of chocolate each day could help prevent diabetes and insulin resistance. That's one of the research findings from the Luxembourg Institute of Health (LIH), the University of Warwick Medical School, the University of South Australia and the University of Maine.

Data of 1,153 people aged 18-69 years old who were part of the Observation of Cardiovascular Risk in Luxembourg (ORISCAV-LUX) study were analysed. It was found that those who ate 100 g of chocolate a day -- equivalent to a bar -- had reduced insulin resistance and improved liver enzymes. Insulin sensitivity is a well-established risk factor to cardiovascular disease.

The academics hypothesised that chocolate consumption may have a beneficial effect on insulin sensitivity and liver enzymes and therefore decided to analyse a national sample of adults, taking into account lifestyle and dietary factors, including the simultaneous consumption of tea and coffee. This is because both drinks can be high in polyphenol, the substance which may provide chocolate with its beneficial cardiometabolic effects.

More than 80% of participants claimed to eat an average of 24.8 g of chocolate a day. The study also found that those who claimed to eat chocolate were younger, more physically active and had higher levels of education than those who claimed not to eat chocolate on a daily basis. Dr Ala'a Alkerwi, the Principal Investigator of the study at LIH said: "It is also possible that chocolate consumption may represent an overall marker for a cluster of favourable socio-demographic profiles, healthier lifestyle behaviours and better health status. This could explain, at least in part, the observed inverse associations with insulin and liver biomarkers."

Published on Leave a comment on Many Health Benefits of Nuts and Seeds

Nice summary article about the known benefits of nuts and seeds, and the nutrients they contain. Bottom line: all nuts and seeds are beneficial to health. It's best to eat a variety of nuts, and eat some nuts daily or at least a few times a week. A typical serving is 1/4 cup or small handful of nuts. Go to the article for the complete nut and seed list and a nut and seed nutrient chart. From Today's Dietician:

The Wonders of Nuts and Seeds

Nuts and seeds have been part of the human diet since Paleolithic times. A few nuts, such as almonds and walnuts, and seeds, namely flax and chia, get most of the glory, but the fact is each nut and seed brings something beneficial to the table. While exact nutrient compositions vary, nuts and seeds are rich sources of heart-healthy fats, fiber, plant protein, essential vitamins and minerals, and other bioactive compounds, including an array of phytochemicals that appear to have antioxidant and anti-inflammatory properties.

A wealth of data from prospective observational studies and clinical trials suggest that tree nut consumption reduces the risk of several chronic diseases, including cardiovascular disease (CVD), type 2 diabetes, and some forms of cancer. Moreover, there may be benefits for cognitive health. Adding support to these findings is research suggesting that incorporating tree nuts in the diet lowers the risk of conditions that contribute to disease, such as hypertension, high cholesterol, insulin resistance, abdominal obesity, endothelial dysfunction, oxidative stress, and inflammation. Various components of nuts, such as heart-healthy monounsaturated and polyunsaturated fats, plant-based protein, fiber, vitamins, minerals, and phytochemicals may work together to offer protection against oxidation, inflammation, cancer, and CVD.

Recent findings from the PREDIMED trial suggest that a Mediterranean diet that includes one serving of nuts per day protects against heart attack, stroke, or death from other cardiovascular causes in people at high risk due to type 2 diabetes or metabolic syndrome. PREDIMED data also suggest that eating more than three servings of nuts per week reduces risk of death from all causes, especially if also following a Mediterranean diet. Subjects who frequently consumed both total nuts and walnuts had a lower rate of death from cancer....While the number of nuts per serving varies by type, a typical serving is 1 oz or about 1/4 cup or a small handful (palm of the hand only)....

• Almonds are high in monounsaturated fats, which may explain their association with lower LDL cholesterol levels and reduced heart disease risk. The antioxidant function of the vitamin E (37% DV in 1 oz) in almonds along with their magnesium and potassium also may play a role in cardiovascular health. One study found that almonds may reduce LDL as much as statins.

• Brazil and cashew nuts: Technically a seed, 1 oz of Brazil nuts contains a whopping 767% DV for selenium. That's over the Tolerable Upper Intake Level of 400 mcg. But eating two Brazil nuts per day has been shown to be an effective way to increase blood levels of this antioxidant mineral healthfully. Cashews are lower in fat than most nuts and contain anacardic acid, which may improve insulin sensitivity and help prevent chronic inflammation.

• Pecans contain multiple forms of vitamin E and are especially rich in gamma-tocopherol, which has been shown to inhibit oxidation of LDL cholesterol. Oxidized LDL contributes to inflammation in the arteries and is a risk factor for CVD. Pecans also have the highest polyphenol and flavonoid content of the tree nuts.

• Pistachios: Two studies have shown that eating in-shell pistachios enhances feelings of fullness and satisfaction while reducing caloric intake. When eating in-shell pistachios, study subjects consumed about 40% fewer calories compared with pistachio kernels. Pistachios have the second highest polyphenol and flavonoid content of the tree nuts. 

• Walnuts are another excellent source of plant-based omega-3 fatty acids. Walnuts also boast the highest antioxidant content of the tree nuts, followed by pecans and cashew nuts. This makes walnuts one of the best nuts for anti-inflammatory benefits. Like pecans, walnuts are unusually rich in the gamma-tocopherol form of vitamin E. ... Walnut consumption among NHANES subjects is positively associated with cognitive function in both younger and older adults. They're a natural source of melatonin, which is critical in the regulation of sleep, circadian (daily) rhythms, and may play a role in walnuts' anticancer benefits.

Published on Leave a comment on Male Infertility Linked to Other Chronic Medical Conditions

A recent study found that men with infertility have a much higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, renal disease, alcohol abuse, and drug abuse. Thus, it appears that male infertility may be a symptom or a clue that there may be other health problems. One example is that male infertility is linked to an 81% greater risk of diabetes, and the greatest risk for renal disease occurred among men with azoospermia (zero sperm counts, the most severe form of male infertility). From Medscape:

Infertility in Men Tied to Heart Disease, Chronic Conditions

Men with infertility have a higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, alcohol abuse, and drug abuse, according to a retrospective cohort study published online December 7 in Fertility and Sterility."The results suggest that male factor infertility has more than just reproductive implications," write Michael Eisenberg, MD, assistant professor of urology and director of male reproductive medicine and surgery at Stanford University School of Medicine in California, and colleagues.

The researchers used insurance claims data from 2001 to 2008 from the Truven Health MarketScan to identify more than 115,000 patients for the study population. They compared outcomes among 13,027 men diagnosed with male factor infertility (average age, 33 years), with outcomes among 23,860 men (average age, 33 years) who received semen or infertility testing and with outcomes among 79,099 men who had received vasectomies.

The authors looked for 16 conditions: hypertension, diabetes, hyperlipidemia, renal disease, chronic pulmonary disease, liver disease, depression, peripheral vascular disease, cerebrovascular disease, ischemic heart disease, other heart disease, injury, alcohol abuse, drug abuse, anxiety disorders, and bipolar disorder.

The men with infertility had higher rates of obesity and smoking, but even after adjustment for these covariates and for age, follow-up time, and healthcare use, men with infertility had a higher risk for multiple conditions compared with vasectomized men or those receiving only fertility testing. Specifically, compared with the men who received fertility testing, men with infertility had a 30% increased risk for diabetes (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.10 - 1.53), a 48% increased risk for ischemic heart disease (HR, 1.48; 95% CI, 1.19 - 1.84) and for alcohol abuse (95% CI, 1.07 - 2.05), a 67% increased risk for drug abuse (HR, 1.67; 95% CI, 1.06 - 2.63), and a 19% increased risk for depression (HR, 1.19; 95% CI, 1.04 - 1.36).

Compared with men who received vasectomies, those with infertility had a 9% higher risk for hypertension (HR, 1.09; 95% CI, 1.02 - 1.17), a 14% greater risk for hyperlipidemia (HR, 1.14; 95% CI, 1.07 - 1.22), a 41% greater risk for ischemic heart disease (HR, 1.41; 95% CI, 1.19-1.67), and a 16% greater risk for other heart disease (HR, 1.16; 95% CI, 1.04 - 1.29). Further, men with infertility, compared with vasectomized men, had an 81% greater risk for diabetes (HR, 1.81; 95% CI, 1.57 - 2.08), a 60% greater risk for renal disease (HR, 1.60; 95% CI, 1.14 - 2.24), a 53% greater risk for liver disease (HR, 1.53; 95% CI, 1.31 - 1.80), and a 52% greater risk for peripheral vascular disorders (HR, 1.52; 95% CI, 1.12 - 2.07).

Published on Leave a comment on Drink Coffee and Live Longer?

 Drink coffee daily -  3 to 5 cups of either regular or decaffeinated - and live longer by lowering your risk of premature death from cardiovascular disease, neurological disease, type 2 diabetes, and suicide. Yes, it was an observational study, but the results are similar to what other studies are finding. From Medical Xpress:

Moderate coffee drinking may lower risk of premature death

People who drink about three to five cups of coffee a day may be less likely to die prematurely from some illnesses than those who don't drink or drink less coffee, according to a new study by Harvard T.H. Chan School of Public Health researchers and colleagues. Drinkers of both caffeinated and decaffeinated coffee saw benefits, including a lower risk of death from cardiovascular disease, neurological diseases, type 2 diabetes, and suicide.

"Bioactive compounds in coffee reduce insulin resistance and systematic inflammation," said first author Ming Ding, a doctoral student in the Department of Nutrition. "That could explain some of our findings. However, more studies are needed to investigate the biological mechanisms producing these effects."

Researchers analyzed health data gathered from participants in three large ongoing studies: 74,890 women in the Nurses' Health Study; 93,054 women in the Nurses' Health Study 2; and 40,557 men in the Health Professionals Follow-up Study. Coffee drinking was assessed using validated food questionnaires every four years over about 30 years. During the study period, 19,524 women and 12,432 men died from a range of causes.

In the whole study population, moderate coffee consumption was associated with reduced risk of death from cardiovascular disease, diabetes, neurological diseases such as Parkinson's disease, and suicide. Coffee consumption was not associated with cancer deaths. The analyses took into consideration potential confounding factors such as smoking, body mass index, physical activity, alcohol consumption, and other dietary factors.

Published on Leave a comment on Reducing Sugar Improves Health

This study showed that children reducing sugar consumption (but not fruits), and without reducing calories, after 10 days improved all sorts of metabolic health markers: blood pressure, LDL cholesterol, triglycerides, liver function, fasting blood glucose, and insulin levels. As one of the researchers said: "I have never seen results as striking or significant in our human studies; after only nine days of fructose (sugar) restriction, the results are dramatic and consistent from subject to subject." Once again, not all calories are the same.

On average, the obese children in this study had been getting about 27 percent of their daily calories from sugar, and during the study period it was lowered to about 10 percent of daily calories. By comparison, the average American takes in about 15 percent, though children typically consume much more than this in part because they have the highest intake of sugar-sweetened beverages. In February of this year, the federal government’s Dietary Guidelines Advisory Committee recommended that Americans limit their intake of added sugars to no more than 10 percent of daily calories. From Medical Xpress:

Obese children's health rapidly improves with sugar reduction unrelated to calories

Reducing consumption of added sugar, even without reducing calories or losing weight, has the power to reverse a cluster of chronic metabolic diseases, including high cholesterol and blood pressure, in children in as little as 10 days, according to a study by researchers at UC San Francisco and Touro University California.

"This study definitively shows that sugar is metabolically harmful not because of its calories or its effects on weight; rather sugar is metabolically harmful because it's sugar," said lead author Robert Lustig, MD, MSL, pediatric endocrinologist at UCSF Benioff Children's Hospital San Francisco. "This internally controlled intervention study is a solid indication that sugar contributes to metabolic syndrome, and is the strongest evidence to date that the negative effects of sugar are not because of calories or obesity."

Metabolic syndrome is a cluster of conditions—increased blood pressure, high blood glucose level, excess body fat around the waist, and abnormal cholesterol levels—that occur together and increase risk of heart disease, stroke, and diabetes. Other diseases associated with metabolic syndrome, such as non-alcoholic fatty liver disease and type 2 diabetes, now occur in children—disorders previously unknown in the pediatric population.

In the study, 43 children between the ages of 9 and 18 who were obese and had at least one other chronic metabolic disorder, such as hypertension, high triglyceride levels or a marker of fatty liver, were given nine days of food, including all snacks and beverages, that restricted sugar but substituted starch to maintain the same fat, protein, carbohydrate, and calorie levels as their previously reported home diets.....The study menu restricted added sugar (while allowing fruit), but substituted it by adding other carbohydrates such as bagels, cereal and pasta so that the children still consumed the same number of calories from carbohydrate as before, but total dietary sugar was reduced from 28 to 10 percent, and fructose from 12 to 4 percent of total calories, respectively. The food choices were designed to be "kid food" - turkey hot dogs, potato chips, and pizza all purchased at local supermarkets, instead of high sugar cereals, pastries, and sweetened yogurt.

Children were given a scale and told to weigh themselves everyday, with the goal of weight stability, not weight loss. When weight loss did occur (a decrease of an average of 1 percent over the 10-day period but without change in body fat), they were given more of the low-sugar foods."When we took the sugar out, the kids started responding to their satiety cues," said Schwarz. "They told us it felt like so much more food, even though they were consuming the same number of calories as before, just with significantly less sugar. Some said we were overwhelming them with food."

After just 9 days on the sugar-restricted diet, virtually every aspect of the participants' metabolic health improved, without change in weight. Diastolic blood pressure decreased by 5mm, triglycerides by 33 points, LDL-cholesterol (known as the "bad" cholesterol) by 10 points, and liver function tests improved. Fasting blood glucose went down by 5 points, and insulin levels were cut by one-third. "All of the surrogate measures of metabolic health got better, just by substituting starch for sugar in their processed food—all without changing calories or weight or exercise," said Lustig. "This study demonstrates that 'a calorie is not a calorie.' Where those calories come from determines where in the body they go. Sugar calories are the worst, because they turn to fat in the liver, driving insulin resistance, and driving risk for diabetes, heart, and liver disease."