Choosing Words Wisely

I specialize in the fields of two chronic diseases: obesity and diabetes. In each of these areas, stigma is a huge concern. There are dangerous and inaccurate stereotypes about people with obesity or diabetes, such as people being lazy, uninterested in their healthcare, or deserving of their disease because they brought it upon themselves. The truth is that genetic factors play a significant role in these diseases. Most people will need a lifetime of many types of therapies to manage their obesity or diabetes. With this in mind, we need to be thoughtful about the words we use whether talking about ourselves, our family members, our friends, or our patients with obesity & diabetes. I blogged about this for Cecelia Health. Choose your words wisely!

Beyond Type I and Type II Diabetes

When I became a dietitian about 10 years ago, we learned about type 1 and type 2 diabetes, as well as gestational diabetes. Since then, not only has the prevalence of diabetes greatly increased, we’ve also discovered that diabetes is more complex than just these few categories. Do you know about MODY and LADA? I recently blogged about this for Cecelia Health.

Happy (& Healthy) Holidays

While the holidays are typically full of fun and excitement, they also bring challenges related to physical, mental, and emotional health. I provided some tips for healthy holidays for people with diabetes on the Fit4D blog. You can read my blog post by clicking on this link. Wishing everyone the best for the holidays and a wonderful 2019!

Is a Ketogenic Diet a Treatment for Type 2 Diabetes?

I receive questions about the ketogenic diet almost every day that I’m in clinic with patients. While this diet has been around since the 1920s to treat epilepsy in children, it is relatively new in the fields of weight management and diabetes. I recently had the opportunity to speak about a ketogenic diet in the context of bariatric surgery at the ObesityHelp conference. While it works for some people in the short-term, it’s not a sustainable lifestyle for most people to follow for the rest of their life. It also requires the support of trained nutrition professional (like a Registered Dietitian!) to follow it correctly and manage negative side effects. It doesn’t mean that you can’t experiment with it! Just be sure to work with an RD so you can try it safely and effectively.

So what about diabetes? I wrote a blog post about ketogenic diets for people with type 2 diabetes for Fit4D. Click on this link to check it out.

Metabolic Surgery as a Treatment for Type 2 Diabetes

I've been a bit too busy this year to contribute to my blog; however, I did write a post on metabolic surgery as a treatment for type 2 diabetes for Fit4D. I'm incredibly passionate about this topic as it combines my fields of obesity and diabetes management. Unfortunately, despite the number of people who greatly benefit from it, metabolic surgery remains an underused treatment. Through education and advocacy, I'm hoping we can change this trend. Visit the Fit4D blog to read the post.

Exploring the Science: “Fat but Fit” & Metabolic Health

Have you heard of the phrase “fat but fit”? It’s the idea that you can be healthy even with large amounts of extra weight. It is somewhat controversial in medical and public health communities because we don’t want to stigmatize people for having extra weight but we also know that extra weight can carry health risks. In August, a study was published in the European Heart Journal which has added to the controversy. Let’s go through the details.

Who did the research? The research was primarily funded by the European Union Framework, the European Research Council, the UK Medical Research Council, the British Heart Foundation, and the UK National Institute of Health Research. There were nearly 50 researchers from many institutions across Europe including Imperial College London, University of Ioannina, University Medical Center Utrecht, German Cancer Research Center, and University of Cambridge.

Who did they study? The participants were part of the European Prospective Investigation into Cancer and Nutrition cardiovascular disease (EPIC-CVD) case-cohort. A case-cohort is a study where a group of people are identified and followed over a period of time but are not given any intervention. The researchers look at the different things they are exposed to, such as diet choices, work environments, smoking, and alcohol use, to see how it affects their risk of diseases or negative health outcomes.

The EPIC-CVD group included 366,521 women and 153,457 men, mostly aged 35 to 70 years old when they were recruited between 1991 and 1999. They were recruited at 23 centers across 10 European countries: Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK.

The participants that were used for this particular study were a sub-group of 17,640 people who were randomly selected from the full EPIC-CVD group and who did not have any history of stroke or heart disease.

What did they study? The researchers followed the sub-group for an average of 12.2 years to see how many people developed heart disease. They wondered what the connection was between body fat, metabolic health, and the development of heart disease.

How did they try to answer their question? The participants completed questionnaires and gave blood samples to have their cholesterol and blood sugar measured. They also had their blood pressure, weight, height, and waist circumference measured.

The researchers used this information to determine how many of the participants were “metabolically unhealthy”. A participant was considered metabolic unhealthy if they had 3 or more of the following criteria at the start of the study:

  • high blood pressure, use of blood pressure medications, or self-reported history
  • high triglycerides or use of lipid-lowering medication like statins
  • low HDL (good) cholesterol
  • high blood sugar, use of diabetes medications, or self-reported history
  • high waist circumference

Obesity was defined as BMI > 30 and normal weight was BMI < 25.

When they looked at results, they used statistical models to make sure that other lifestyle factors weren’t affecting the risk of heart disease. They adjusted for these types of factors: country, gender, age, education, smoking status, alcohol intake, diet and physical activity.

What did they find? They found increased risk of heart disease for two groups of people: people with obesity who were metabolically healthy and people with normal weight who were metabolically unhealthy.

We can think of people who were metabolically healthy and normal weight as our lowest risk group. Compared to this group, people who were metabolically healthy with obesity had a 28% increased risk of heart disease. People who were metabolically unhealthy with normal weight had double the risk of heart disease compared to the lowest risk group.

What does this mean?  Having obesity, even if you are healthy now, means that you are at an increased risk for heart disease compared to someone at a normal weight. There are many people with obesity who will not develop heart disease but it is a risk factor that we must take into account. However, just being at a normal weight doesn’t make you healthy. If you are at a normal weight, you still need to think about the metabolic health criteria: blood pressure, triglycerides, cholesterol, blood sugar, and waist circumference.

When I work with people who are thinking about losing weight, we always talk about what a healthy weight means to them. It’s not realistic or healthy for everyone to be at a normal weight and we can’t pretend that just being at a normal weight will solve everyone’s health and life problems. This study shows us that having poor metabolic health (regardless of weight) is actually more risky than having obesity. On the other hand, we also can’t ignore the impacts on the body from carrying too much extra weight. It’s why I individualize goals to find a healthy and realistic weight range for each person.

Everyday Inspirations: The Serenity Prayer

I had the pleasure of meeting psychologist Dr. Beverly Adler (aka Dr. Bev) at a diabetes educator conference this month. She gave a presentation on incorporating spirituality into counseling sessions with an example of the Serenity Prayer. Now if you’re starting to get nervous with the words ‘spirituality’ and ‘prayer’, hear me out for a few more paragraphs. You don’t need to be religious to appreciate this post.

You’re probably familiar with the Serenity Prayer. It was written in the early 1900s and has been adopted by Alcoholics Anonymous (AA) and other 12-step programs. The first three lines are:

Grant me the serenity to accept the things I cannot change,
Courage to change the things I can,

And wisdom to know the difference.

As I mentioned, you don’t have to be religious to apply these words to your life. You can call it a mantra instead of a prayer. It was originally written as an appeal to God but you can substitute any higher power in which you believe. And your higher power doesn’t need to be a deity. Maybe it is the healthiest and happiest version of you or a role model in your life. It’s someone you look to for strength when times are tough.

How does this apply to your health journey? Imagine this scenario: You had a long day of work and are on your way home when you hit a massive delay. Traffic is backed up for miles or the train was cancelled due to a mechanical issue. What a pain! By the time you get home, you are starving. You raid the cupboards or refrigerator and fill up on food that does not align with your health goals. Can you relate to this story? There are many variations. You had a rough day at work and took it out on your partner or children at home. The weather was crummy so you didn’t exercise. Someone brought treats to the break room and you overindulged. 

Let’s line it up with the Serenity Prayer:

Grant me the serenity to accept the things I cannot change
(traffic, people’s behavior, weather, genetic predisposition to disease)

Courage to change the things I can
(emotional responses such as outbursts, eating, or avoiding healthy habits)

And wisdom to know the difference
(Instead of stressing about what you can’t change, focus your energy on modifying your response to align with your health goals)

In stressful situations, it’s easy to get swept up in emotions and to forget about the things you can change. Your emotional response becomes a habit. It might be such a strong habit that you don’t feel you have control, but you do! It takes patience and compassion to change an emotional response but with time, you’ll be able to respond to stressors in a way that will help you move towards your health goals. Sometimes you’ll need extra support from a healthcare provider or group. And you might need a lasting reminder that you can look to in tough moments.

I find these words so valuable that I choose to carry them with me everywhere I go; I keep a handwritten copy of the prayer in my wallet. Dr. Bev feels the same way. She wears a bracelet with the lyrics and has pillows and other inscribed objects in her office. Whether you carry it in your mind or as a physical memento, I hope you can use this concept to move towards a healthier and happier life.

Everyday Inspirations: My Crummy Teeth

“You can’t relate to me because you don’t have a weight problem.” If you are a dietitian working in weight management, you have probably heard this before. If you are a person working with a dietitian, you have probably said this before (at least in your head). I always struggle with the best response to this statement. What am I supposed to say?

  • “No, I can’t relate to you which makes me a terrible dietitian.”
  • “Well, you don’t know anything about my weight history.”
  • “Actually, I also work hard to maintain my weight.”

Don’t worry. I’ve never said any of these things. I just acknowledge the statement and try to move forward in a more productive way.

And then it came to me recently while walking home from a dentist appointment reflecting on my crummy teeth. Let me give you some history. As I child, I had yellow tooth stains from penicillin, buck teeth, and abnormally large gums making for a smile that led to lots of teasing. After bleaching and gum removal, my smile was somewhat improved. Unfortunately, after 2+ years of braces, the stains reemerged accompanied by bright white calcification. In my early 20’s, a mysterious dark stain appeared on my gums above my front teeth. It has never disappeared. And then the cavities…. I have had so many fillings that my teeth weakened leading to my first root canal at age 25. By age 28, I had 3 crowns, one of which has cracked twice in 3 years. Did I mention I grind my teeth?

Every time I visit the dentist, I am complimented on my amazing hygiene. “We can tell you do a great job with brushing and flossing! But… unfortunately there’s another cavity.” It turns out that some people have genetically bad teeth and are prone to these types of issues. Lucky me. For how hard I work at maintaining my teeth (prescription-strength fluoride toothpaste, daily flossing, anti-cavity mouth wash, etc.) and the amount of money I’ve spent on procedures (can we get dental insurance reform?), I deserve a celebrity smile. But it’s not in the genes. Do you see where I’m going with this?

Obesity is a multifactorial disease and one of the factors is genetic. Many people who struggle with their weight have a genetic disposition that makes it easier for them to gain weight and harder to lose weight. How frustrating! It means you can bust you butt exercising and have a near-perfect diet but you still might not reach the weight of a person without this genetic factor. If you want to become a multi-millionaire, join a research lab discovering these genetic components and create a drug or therapy targeting them.

Walking home from that dentist appointment, after learning that my crown had cracked again, I was so discouraged. But then I thought about the state my teeth would be in if I didn’t try so hard. I probably would have had a full set of dentures at age 30. I know I will struggle with my awful mouth for the rest of my life but giving up on hygiene will only make the problems worse.

It’s not fair that you might be prone to obesity. It’s not fair that you will have to work hard the rest of your life to maintain a weight that isn’t your ideal. But what if you gave up? Where would your weight be now? What kinds of health problems would you have? You can’t control your genes (until you develop that drug!) but you can control your response.

And not just the behavioral response such as exercising regularly and eating healthfully, but also your mental response. Maybe you are stuck with some crummy genes in terms of weight but what genes are you grateful for? Is it your eye color, hair texture, skin complexion, or shape of your nose? Is it your ability to sing, play instruments, think analytically, or crunch numbers in your head? Is it your senses of sight, smell, hearing, taste, and touch? Refocus those negative thoughts into something positive before they start impacting your behaviors.

It’s frustrating to have a genetic factor impacting your health but nearly everyone is dealing with one of these challenges in some form. Accept it for what it is, continue your hard work to manage it the best you can, and when you are feeling down, count your blessings. There are always more of those than challenges.

Everyday Inspirations: Empuja la Vaquita

I recently came across a story in Spanish class called ‘Empuja la Vaquita’. Its author is unknown and it is translated into many languages. You might have heard it in English as ‘Pushing the Cow’.

Here is a summary: A professor and a student are walking through the countryside when they come across a small ramshackle home near the edge of a cliff. They meet the inhabitants, a man and woman with three children. All are dressed in rags and don’t appear to have been bathed recently. The professor asks the father of the family how they make a living in this small village with few opportunities. The father replies that they have a cow that provides milk every day. What they don’t consume, they trade for other goods.

The professor and student leave the home and, as the title suggests, the professor orders the student to push the cow off the cliff. The student is in disbelief but eventually gives in to the professor and pushes the cow. A few years later, still racked with guilt, the student returns to the village to find the family and apologize. However, upon searching the same location, the student finds a well-furnished home with a well-dressed and clean family of five. He asks about the people that used to live in that home and learns, surprisingly, that it is the same family. The father explains that they used to have a cow that fell off a cliff and died. Without the cow, they had to support themselves through other abilities that they didn’t realize they had and they were wildly successful.

The moral of the story? It’s a long-winded (and extreme) reminder that it’s important to get out of our comfort zone. Without the cow, the family discovered abilities they never knew existed.

When it comes to achieving your healthiest life, what types of cows are keeping you in your comfort zone? Maybe it’s the same exercise class you do every week and it’s time to challenge your body in a different way. Maybe you rotate through the same meals each week and are taking the flavors for granted. It might be a challenging habit, like reaching for a snack, a drink, or a cigarette in times of stress. Or it might be spending time with friends who don’t support you to be your best self. Routine is natural and comfortable. Without it, your life would be unnecessarily difficult. However, sometimes routine leaves you in a rut of repeated decisions that give you the same not-so-great results.

It’s hard to recognize when you are relying on these cows. The family was content and never dreamed that they had potential to live a better quality of life. If you are open to the feedback, you can ask a trusted family member or friend if they’ve noticed any cows in your yard. Or you can wait for someone else to make a decision that pushes you out of your comfort zone but you might be waiting a long time.

Maybe you have recognized that these cows exist but you’re not comfortable pushing them off the cliff yourself. Of course it’s scary! Thankfully, it doesn’t have to be as extreme as the metaphor. When it comes to exercise, there are low-risk, low-cost ways of exploring new ways to move your body. Go to a gym open house and try a new class. Buy a discount voucher (Groupon, Living Social, etc.) for a rock climbing, yoga, or circus class. Ask your friends about their favorite types of exercise and whether you can tag along with them to try it out.

As for a cooking rut, make a goal to try one new recipe each month. Search sites like Skinny Taste or Cooking Light for healthy spins on your favorite dishes. Have a recipe exchange with your friends. Splurge on a cooking class at a food store or community adult education program. Sign up for a trial of a home-order meal prep plan like Blue Apron or just get recipes without the ingredients from a program like Fresh 20.

Routine and stability play important roles in your life but don’t let them keep you from achieving your health potential. ¡Empuje la vaquita!

Disclaimer: No cows were injured in the writing of this post.

Everyday Inspirations: Responding with Curiosity and Compassion

While I was visiting my family in Minnesota last month, I went to a yoga class and was inspired by a phrase. We spent a few minutes meditating at the beginning of class and our teacher was offering suggestions for mindfulness during our practice. She encouraged us to be present while moving through poses and to respond to our bodies “with curiosity and compassion”. This phrase stayed with me after class and got me thinking about how it applies to the weight loss journey. So here we go:

Have you ever kept a food log? It’s a common recommendation for people who are working towards weight loss goals. Food logging promotes awareness and accountability which typically helps people to stay on track. If you keep a food log, you are encouraged to review it regularly, such as at the end of each day, to see what can be learned. Sometimes you might not be proud of the choices that you made that day but reviewing a food log shouldn’t be a reason to judge yourself or feel guilty. That’s not productive. Instead, I encourage you to look at your food log with a mindset of ‘curiosity and compassion’.

Be curious. Why did I make that choice today? Would things have been differently if I packed my lunch at home or if I took a few breaths to relieve stress before eating that brownie in the break room? What is triggering me to make these choices? How can I prevent it in the future?

Have compassion. These choices don’t make me a bad person. I am faced with a lot of choices every day and I might not always make the best ones. But I am motivated to reach my health goals and I know I can continue to improve.

While I’m using the example of a food log, this can be applied to other situations too. You can reflect on any past behaviors with curiosity and compassion. Instead of getting trapped in an unproductive cycle of self-blame, this mindset allows you to respond more productively to behaviors that you would like to change. Curiosity helps you to think about choices from a neutral and unbiased perspective while having compassion encourages self-kindness and a no judgment zone. Are there areas of your life that could use more curiosity and compassion? 

Everyday Inspirations: Make sure your mask is secure...

I have been on quite a few airplane flights recently which means that I have heard the safety speech enough times that I practically have it memorized. While the information is specific to air travel, there’s one line that has stuck out to me as a great reminder for people in the weight loss journey: Make sure your mask is secure before helping others. What happens if you don’t secure your own oxygen mask in an airplane emergency? You may pass out before you are able to help those around you.

And what does this have to do with weight loss?

The majority of my patients are women; they are daughters, wives, and/or mothers and they are givers. (Side note: Of course, men can be givers too! I just happen to see this more often in women). They give of themselves in their families on a daily basis. Additionally, several of them have giving professions such as personal care attendants, health care providers, and teachers. Over the years, they have always put other people’s priorities before their own. They worry about taking care of the needs of others and they neglect their own health needs, such as sleep, nutritious food, exercise, and relaxation. For example, I worked with a patient who took time to make lunches for her three children and her spouse every night but never made her own lunch. Instead, she relied on fast food during the day for herself which was contributing to her weight problem. If you are a giver, I’m sure you can think of similar examples.

It’s wonderful to be a giver but you can’t neglect giving to yourself. To achieve your health goals and live your happiest life, you need to prioritize yourself. If you don’t keep yourself healthy, it is going to impact your ability to give to those around you. Maybe you will be less patient or have less energy due to lack of sleep, or you maybe you won’t physically be able to help someone due to mobility or strength problems, or maybe your life will be shortened due to health problems you have neglected. You need to take care of yourself so you can be the best you, whether it’s as a spouse, parent, child, sibling, coworker, or friend.

In the case of the patient I mentioned earlier, I encouraged her to take a few extra minutes each night to make her own lunch. She did this and started losing weight since she was eating less fast food. Losing the weight gave her more energy and made her feel better about her body, and this made her a happier person and a happier wife and mother. Taking care of herself helped her to better take care of her family.

If you are a giver, tune into whether you might be giving to others at the expense of your own health needs. Remember to make sure your health is secure before helping others. 

Exploring the Science: Long-term Outcomes after "The Biggest Loser"

I’m sure you’ve seen these headlines:

  • “The Biggest Loser”: Their bodies fought to regain weight
  • “The Biggest Loser” contestants gain again: Why weight keeps coming back
  • ‘Biggest Loser’ contestants have slower metabolisms

They certainly caught my attention and I was excited for another opportunity to explore the science. Where are these headlines coming from? On May 2nd, an article titled “Persistent metabolic adaptation 6 years after 'The Biggest Loser' competition” was published on the website of the journal Obesity.

Who did the research? The research was supported by the National Institutes of Health (NIH). Most of the researchers were affiliated with NIH, one was affiliated with the Washington DC Veterans Affairs Medical Center and one with Towson University in Baltimore.

Who did they study? The participants were all competitors on “The Biggest Loser” television show. They had agreed to participate in a study 6 years ago when they were doing a 30-week weight loss challenge on the TV show. Of the original 16 participants, 14 agreed to be in this current study: 8 women and 6 men. When the participants started "The Biggest Loser" competition, they all had obesity. Their average starting weight was 328 pounds and they lost an average of 128 pounds. In this study, 6 years had passed since they finished "The Biggest Loser".

What did they study? The researchers were testing the resting metabolic rate (RMR) of the participants. RMR is the amount of calories that your body needs every day to maintain your current weight without adding any extra calories for exercising. Usually, the higher your body weight is, the higher your RMR is because there is more of you that requires calories or fuel. After losing weight, it is normal for RMR to decrease because there is less of you. But sometimes the RMR goes even lower than we would expect based on your body weight. This is called ‘metabolic adaptation’ and it is believed to be one of the reasons that people regain weight. The researchers were wondering if “The Biggest Loser” participants would continue to have metabolic adaptation 6 years after the competition and if the metabolic adaptation was related to weight regain

How did they try to answer their question? The researchers looked at the weight and the RMR of the participants at the end of the competition and 6 years later.

What did they find? "The Biggest Loser" participants all had lower RMRs after losing weight in the competition. Six years later, 13 of the 14 participants had regained weight; 5 of them had regained almost all of the weight they had lost. The surprising part was that the RMR of 9 of the participants did not increase even though they gained weight. The researchers also found that the subjects who had lost more weight at 6 years after the competition continued to have lower RMRs but this wasn’t surprising. Unfortunately this is one of the challenges faced by people who lose weight. One positive outcome was that 8 of the 14 patients maintained a 10% weight loss over the 6 years. While this is much less than the amount of weight they originally lost in the competition, it is a better success then we would see in most weight loss studies.

What does this mean? We already knew that metabolic adaptation happens after losing weight and it makes it hard for people to maintain their weight loss. Since they need fewer calories to maintain their new weight, they have to be very strict forever and that’s not realistic. We didn’t know that RMR would stay low even for the patients that had regained weight.  This was concerning because it would be even more difficult for those people to lose weight again. This tells us that once we have been carrying large amounts of extra weight, our body wants to settle at that weight and it makes it difficult to maintain lower weights.

There is some research that suggests that people who have bariatric surgery, such as Roux-en-Y gastric bypass, do not have the same level of metabolic adaptation. Their RMR gets lower after losing weight but it doesn’t keep getting lower over time as they continue to lose weight. This might be an advantage of bariatric surgery that helps people to maintain a greater weight loss for longer than we see in non-surgical weight loss. But we’ll save that for another post on ‘Exploring the Science’. 

Everyday Inspirations: Acknowledge Your Practice Without Judgement or Praise

Acknowledge your practice without judgment or praise. One of my first yoga teachers used to say this at the end of every practice. It didn’t really make sense to me. At the time, I was new to yoga and I was so excited to learn new poses at each class. It was a fun challenge and at the end of class, I did want to praise myself for doing those poses. And yes, maybe I was a little frustrated with myself for not being able to do other poses but I never felt like I was judging myself.

It took a few months of practicing yoga before this phrase made sense. Making cool shapes with your body is not the main point of yoga. Yes, it’s fun to learn a new pose but if that is all you get out of yoga, you are missing the bigger journey. It’s not about whether you were ‘good’ or ‘bad’ at yoga. It’s that you took time to nurture your body and to practice self-awareness.

How does this apply to the bariatric surgery journey?

Let’s change one word in this phrase. Acknowledge your weight without judgment or praise. Easier said than done, right? So often, people’s bariatric surgery journeys get distilled to one thing: weight. How much weight did you lose? How quickly are you losing weight? Have you regained any weight? I’m not saying that we should completely ignore weight. We are still acknowledging that number but we need to put it into context instead of making it the only measure that matters.

The bariatric surgery journey is not just about weight loss. I would argue that people who are focusing only on weight are in a less healthy place mentally, and sometimes physically too. When you focus only on weight, you don’t give yourself credit for all of the quality of life successes that happen after surgery. Greater energy levels, ability to walk further without getting winded, taking your kids on rides at the amusement park without worrying about weight limits, feeling comfortable in an airplane seat, bending over to tie your shoes… these are all huge quality of life successes!

When we acknowledge our weight with judgment or praise, we are turning our weight into a ‘good’ or ‘bad’ number and that can be toxic for our mental health. We shouldn’t think of weight as being a ‘good’ or ‘bad’ number. But ‘good’ and ‘bad’ can apply to quality of life. If you are not able to do the things you enjoy, you are not having the best quality of life that you deserve. For example, if you can’t play with your children or grandchildren, does it really matter what your weight is? If your weight is so low that you don’t have energy or strength to go for walks on the beach, is that still a ‘good’ weight? If your weight is higher than your “ideal body weight” according to a chart but you are able to wear the clothing you love and dance the night away at a party, is that a ‘bad’ weight? Your mental and physical health is most important for your quality of life and that isn’t always reflected in a number on the scale.

So next time you get on the scale, don’t let your weight become a ‘good’ or ‘bad’ number. Don’t judge yourself or praise yourself. Just acknowledge that number for what it is (a number) and focus on the quality of life milestones that really matter.

Exploring the Science: Dairy Fat and Risk of Diabetes

On March 22, 2016 a study was posted online, or “ahead-of-print”, on the website of the scientific journal Circulation. The title of the study is Circulating Biomarkers of Dairy Fat and Risk of Incident Diabetes Mellitus Among US Men and Women in Two Large Prospective Cohorts and it has generated a lot of buzz over the past few weeks. Here are just a few of the headlines I saw:

  • Skim Milk Could Increase Your Risk of Diabetes, Study Suggests
  • The Case Against Low-Fat Milk is Stronger than Ever
  • Are Full-Fat Dairy Foods Better for You After All?

As I mentioned in my introduction post, I plan to use this blog to explore the science behind the headlines so this seemed like a perfect study for this series.

Let’s start with the “publish-ahead-of-print” category. It means that this study has been accepted to be published in the journal Circulation but it hasn’t been published yet. Right now, it is being prepared for publishing which means copyediting, typesetting, proofreading, and author review. Since this process hasn’t been completed yet, the final article that gets published could be different than the article that is currently online in the “publish-ahead-of-print” category. We’ll look forward to seeing the final article once it is published.

Who did the research? It is a group of Boston researchers from well-respected institutions. Most are affiliated with Harvard Medical School, Harvard School of Public Health, and Brigham and Women’s Hospital, and one researcher is affiliated with Tufts University.

Who did they study? Their participants were two large groups of people who have been studied for many years: 1864 women in the Nurses’ Health Study and 1469 men in the Health Professionals Follow-Up Study. These study participants agreed to be studied back in the 1970’s and 80’s. They agreed to answer questions about their health, eating habits, and lifestyle habits over the years so the researchers could learn about how their choices linked with their health.

What did they study? They looked at biomarkers in blood samples that had been taken from the participants in the 1980’s and 1990’s. Biomarker, short for biological marker, is a body factor that can be measured and is linked to a specific body process or disease. In this situation, they looked at biomarkers that would be created in the blood from eating dairy fat. Their research question was: Are people who have higher levels of dairy fat biomarkers less likely to get diabetes?

How did they try to answer their question? They only studied the blood of participants that did not have diabetes when their blood was drawn. Since the participants had agreed to answer questions about their health regularly, they used the participants' reports to see how many of them had diabetes by the end of 2010.

What did they find? They found that participants with higher levels of dairy fat biomarkers in the 1980’s and 1990’s were less likely to get diabetes by the end of 2010. Depending on which one of the three biomarkers they looked at, participants with higher levels had 43-52% lower risk for diabetes than participants with lower levels. Some participants with higher levels of dairy fat biomarkers still got diabetes but it was less likely to happen compared to the participants with lower levels of dairy fat biomarkers.

What does this mean? There is a link between dairy fat biomarkers and the risk of diabetes but this study is showing correlation and not causation. A correlation means that two things are linked but it doesn’t mean that one thing causes the other thing. We can't say that eating dairy fat prevents diabetes because some patients with higher levels of dairy fat still got diabetes. We also can't say that avoiding dairy fat causes diabetes because not all of the patients with lower levels of dairy fat biomarkers got diabetes. We just know that people with higher levels of dairy fat biomarkers have a lower risk of diabetes compared to people with lower levels of dairy fat biomarkers.

For us in the nutrition world, we hope that this study will lead to more research so we can better understand how dairy fat impacts our health. We have been recommending low-fat and fat-free dairy products for many years because they are lower in calories and have less saturated fat than full-fat dairy products. However, some other studies are also suggesting that the saturated fat from dairy products might not be bad for our health. A study like this makes health professionals think critically about what we are recommending and why we recommend it. It's one of the exciting parts of being in the world of nutrition science. We still have so much to learn about nutrition and our bodies and the ever-emerging research keeps us on our toes.

Welcome to my blog!

If you read my bio, you already know that I started planning to become a dietitian at age 16. But long before that (as in age 5 thanks to a wonderful 1st grade teacher), I thought I’d become a writer. As it turns out, it’s not too hard to combine the two. I’ve written articles for the public and articles for research journals, lots of newsletter articles for patients, and occasional guest blog posts for the hospital. However, this will be my first independent adventure into the blogosphere.

So what am I going to blog about? Well, I enjoy breaking down research studies to help people understand the takeaways. There are some crazy headlines in the media and it’s important to understand what really happened in the study and whether the research was interpreted correctly. I plan to use this blog to spotlight interesting research in the bariatric world to see what we can learn from it.

I also want to pull from everyday experiences to provide tips for healthy and happy lives before and after bariatric surgery. For example, I might be taking a yoga class or attending a conference or reading the church bulletin and I hear or read something that connects to a person’s bariatric surgery journey. I often share these thoughts with my patients and I hope to reach many more people with this blog.

Hope you enjoy!