In The News: Concerning Diabetes

At ADW Diabetes we always want to keep you informed about trending news and studies with the primary focus on diabetes. It is important for you to stay up to date with the latest information so you can ask questions and know which new information may be available to you.

1. New diabetes risk factors emerge: Phthalates and Nitrites

Phthalates:

A new study has found that, “women had a significantly higher incidence of type 2 diabetes if they have had greater exposure to phthalates which are considered endocrine disruptors.” The incidence increased by 30-63%, especially in white women, over a 6-year exposure period.

Women tend to have higher levels since they tend to use more personal products. The incidence was not found in Black or Asian women, but more investigation needs to be done.

What are phthalates?

Phthalates are a group of chemicals which make plastics more durable. It gives plastic the ability to be flexible, softer, transparent and strong. You can’t see, taste or smell phthalates. Levels are especially high in those who work in painting, printing, or the field of plastics.

Phthalates are found in many products including items like personal care products, shampoos, fragrances, soaps, deodorant, make-up, nail polish, hair spray. They are also found in plastic shower curtains, detergents, air fresheners, plastic food containers and cups, adhesives, insecticides, medical tubing, IV fluid bags, vinyl toys and diapers.

Even BPA or phthalate-free plastic may leak harmful chemicals when heated. Phthalates are found in the air, dust, and water supply. Babies and children have even higher exposure since they practice “hand to mouth behavior” and are always licking and chewing objects.

Phthalates are found in high-fat dairy, fatty meats and poultry skin as well as fast foods, restaurant foods and cooking oils. Some of this is due to packaging of the food in plastic and Styrofoam containers as well as animal exposure to plastics. Cows are milked with plastic tubing.

We have known that when they are absorbed into the body “phthalates mimic or block female hormones or suppress the hormones involved in male sexual development.” They can also cause allergies, skin rashes, asthma, some types of cancer and possible learning/behavioral disabilities. They leave the body through your urine and perspiration.

What can you do to reduce your exposure to phthalates?

Use fragrance-free products.
Read labels for product ingredients.
Avoid fast food especially when served in to-go containers.
Microwave on regular dishes not in plastic containers.
Do not put plastic containers in the dish washer.
Always use glass containers over plastic ones.
Drink fluids in a stainless steel, glass or silicone cup.
Avoid plug-ins, air fresheners and scented candles.
Eat more fruits and vegetables such as beans, tempeh, wheat germ, mangos and drink coffee.
Eat more seeds and nuts. People who ate more of these had less phthalates in their blood.
Use grass-fed products.
Find meats and cheeses wrapped in paper wrap not plastic.
Eat low-fat dairy over full fat dairy. “Foods with full fat are particularly prone to chemical leaching.”
Invest in a good home water filtration system.

Nitrites:

A study published in PLOS Medicine found ” When higher amounts of nitrites were consumed in food, the diabetes risk increased by 27%.”This did not occur with nitrates. Nitrites are found in certain foods, soil and water. They are found in the soil and water due to nitrogen based fertilizer and water run-off.

Nitrite additives are added to processed meats to preserve the color and shelf life. This was the first study with over 100,000 participants (80% were females) followed for over 7 years “showing nitrites, especially sodium nitrites , as a risk factor for type 2 diabetes.”

There were some limits to the study and more research needs to be done but it is still a wise idea to lower the amount of nitrites you consume.

What can you do?

Eat less or no processed or cured meats.
Check labels to look for added sodium (nitrites).
Consider eating only organic produce.
Eat 4-5 vegetables or fruits per day. Wash in soap or fruit/veggie rinse and water.
Check home water supply especially if you use well water. Consider drinking bottled water.
Get enough vitamin C.

2. Latest Diabetes numbers and expenditures

Over 38% of the US population has type 2 diabetes.
29.7 million in the US are diagnosed while 8.6 million in US are not yet diagnosed.
1.75 million adults are diagnosed yearly, it grows 3% annually.
Over 50% of people aged 65 or older have pre-diabetes. It accounts for 67% of all health care expenses used by adults over 65.
It remains the 7th leading cause of death.
Obesity and poor lifestyle choices contribute heavily.
Type 2 diabetes accounts for 90-95% of cases.
Continuous Glucose Monitors, insulin pumps and insulin pens dominate the field of diabetes technology.
Diabetes care expenditures totaled $412.9 billion dollars in the US in 2022.
Diabetes care in the US accounts for 25% of the total health care expenditures.
All facets of diabetes care costs are growing including in-patient care, out-patient care, diabetes medications, diabetes supplies, productivity losses, inability to work and premature death.
“1 in 4 health care dollars” in the US went towards diabetes treatment and care.
Every country and region in the world will continue to be affected but the growth rates which will be hit the hardest are Northern Africa, The Middle East and Latin America.
All health care systems throughout the globe will find challenges related to diabetes in the future.

These statistics were taken from government data bases. The good news is there is a concerted effort to both diagnose diabetes and treat diabetes earlier, so we can prevent long- term complications and premature death in those with diabetes.

3. Intermittent fasting or 16/8 hour time restricted eating may help with weight loss

Giving people with diabetes different options and strategies for weight loss is always important. Consult your health care provider before starting any change in your eating habits or diet plan. They may need to lower your diabetes medications.

“Intermittent fasting works by prolonging the period when your body has burned through the calories consumed during your last meal and begins burning fat.” Different time frames are 7AM-3PM, 9AM-5PM, and 12PM-8PM. These periods each allow for 3 meals. Experiment to see which time frame works best for you.

“Those who ate from noon-8PM lost more weight than those who cut their calories by 25%.” It’s possible that watching the clock may be easier to follow than calorie restriction. By losing weight these participants dropped their blood sugars, their A1Cs and their blood pressure.

Improved blood sugars by lifestyle changes will also decrease the need for diabetes medications. You can drink calorie-free beverages at any point of the day or night. There usually is an adjustment period where you may find yourself cranky or hungry, but this dissipates when you get used to intermittent eating. It’s more flexible than other diet plans.

Remember to eat nutritious food when you are eating:

Lean protein
Healthy fats
Whole grains in moderation
Fruits and vegetables
Seeds, nuts, legumes
Calorie-free beverages

4. Obesity updated information

There are 60 comorbidities (causes of death) tied to obesity with diabetes being one of them. There are over 100 million Americans with obesity. Put in other terms, 3/4 of Americans are currently dealing with obesity or being overweight.

It is considered a significant, real medical diagnosis with multiple health complications. The numbers are obtained from your BMI (body mass index). BMI “figures out if you are a healthy weight for your height.”

Normal BMI: 18.5-<25
Overweight BMI: 25-<30
Obese: 30 or higher

Always check with your own health care provider before starting any new diet program. According to research, “Change to a low-fat, plant-based diet plus exercise could lead to weight loss without obesity drugs or bariatric surgery.” Health care providers could and should recommend and offer programs.

“Physician’s Committee for Responsible Medicine offers a 12-week plant-based weight loss program.” It consists of weekly 75-minute online sessions with input from an MD and RD (registered dietician) and includes cooking demos, education and practical eating tips.

There is also a 12-week binge and emotional eating program with an MD, clinical psychologist and RD. The concept is that this eating plan is filled with fiber which fills you up without adding extra calories or sugar. It aims to incorporate 40 grams of fiber a day which “feeds good gut bacteria.”

Fat intake is low since the plan is plant based. Beans, peas and lentils are filling, satisfying and a healthy source of protein. Weight loss is the best way to take control of your type 2 diabetes. It also helps reduce your blood pressure, cholesterol levels and risk of future heart disease.

5. Zepbound

Another new injectable drug called Zepbound was approved by the FDA specifically for weight loss. The last 10 years have been exceptional for discovering effective weight loss medications. Like Mounjaro, also made by Eli Lilly, it’s active ingredient is tirzepatide.

Besides boosting weight loss, it lowers the risk of heart disease, stroke and diabetes by 20%. Zepbound helped lower body weight by 18% compared to a placebo. Wegovy, another injectable for weight loss has the same ingredient as Ozempic which is semaglutide.

“7 out of 10 Americans are overweight or obese and tend to have hypertension, diabetes and high cholesterol.” Weight loss medications activate the hormones that we naturally produce to regulate weight. These medications “impact cravings, thoughts of food and binge eating.” Every 5-10% weight loss can make a big difference.

These medications are not covered by Medicare or Medicaid and are extremely expensive. They can cost somewhere between $900-$1400 a month, out of pocket. They are started at a low dose and slowly increased to prevent side-effects such as nausea, overfullness, gastric reflux, diarrhea or constipation.

They may soon be available in “pill form.” Find out if there is a way to get coverage by checking with your physician.

6. Diabetes and Depression

A large portion of Americans with diabetes also suffer with depression, anxiety and poor mental health. A chronic disease like diabetes weighs heavily on daily coping skills. A recent study looked at 15,000 people and “overall participants with diabetes were 1.7 times more likely to die prematurely than those without diabetes.”

The risk quadrupled for those who had existing depression and diabetes. The study suggests it could be tied to “lower income, lower education, racial minorities, unhealthy lifestyles and having other chronic diseases besides diabetes. Many people with diabetes get the medical care they need for their diabetes but not the proper mental health care.

Stress, anxiety and depression can certainly raise blood sugars and keep them out of control. The study suggests your family practitioner, GP, or internist should question you and look to integrate your mental health issues to “improve your well-being and life expectancy”. Speak up when you have concerns about your mental health.

7. Salt intake and Diabetes

A new study published in The Mayo Clinic Proceedings “links frequent salt consumption to increasing your risk of type 2 diabetes.” Tulane University conducted the research. Over 400,000 adults registered in the UK discussing and documenting their salt intake.

Over 12 years the research team saw more than 13,000 cases of type 2 diabetes develop in those who kept “adding salt to their food.” Salt does not affect blood sugar, but it does affect blood pressure. The thought is there is a connection between nutrition and developing diabetes which is greater than “just eating carbohydrates and sugar.”

Also, “adults with type 2 diabetes who consumed the highest intake of sodium had an increased risk of cardiovascular disease by more than 200% compared to those who ate the lowest.” The reasons could be:

Eating larger portions due to the richer flavor from salt.
Inflammation appeared from the salt, possibly causing diabetes.
Added salt from all processed foods without salting your food.

What can you do?

Eliminate adding salt to your foods.
Watch dissolvable vitamins and effervescent tablets that contain added salt.
Read labels. -5% or less of sodium per serving is considered low sodium food.
Rinse canned foods or stick to fresh or frozen foods.
The type of salt used was not differentiated but fancy, flavored salts are considered no better, all are sodium chloride. Rock salt, pink Himalayan salt, purple salt and flavored salt all had an effect.
Reduce eating condiments and prepared sauces.
Chicken, packaged instant oatmeal, bread are all high in salt. Moderate your intake.

8. Red Meat Intake Study

A new study, done by The Harvard TH Chan School of Public Health and published in The Journal of Nutrition, finds “2 weekly servings of red meat could increase your risk of type 2 diabetes by 51%.” The more red meat eaten, both processed and unprocessed, the higher the level of diagnosed diabetes.

When replaced with plant-based proteins, they found a reduction in type 2 diabetes. This has been seen before but never studied on so many individuals. You should monitor red meat intake which may increase insulin resistance. “Saturated fat from red meat can reduce beta cell function and reduce insulin sensitivity.”

Iron, found in red meat, increases oxidative stress and increases insulin resistance. Iron also impairs beta cell function. Over 217,000 adults were analyzed and over 22,000 developed diabetes. They were followed up to 36 years. As they increased their fish, beans, legumes, tofu, tempeh, edamame, quinoa and amaranth intake, the rate of diabetes diagnosis went down.

9. Sugar Cravings

It comes as no surprise that sugar and carbohydrate intake makes it more difficult for someone with diabetes to regulate their blood sugars. Sugar has been around for centuries, but sugar sales really rocketed after WWII. Remember processed and bagged foods are cheaper than fresh fruits and vegetables and contain more sugar.

A craving is “an intense desire for a specific food.” Sugar stimulates dopamine or “The Feel Good Hormone” also known as the pleasure chemical. Eating sugar also releases serotonin, another feel good hormone. Our bodies associate eating sugar with being happy. Sugar is even eaten during tough times and relationship break ups.

“The 2020-2025 US Dietary Guidelines for Americans recommend limiting added sugar intake to a maximum of 10% of your daily calories.” Obviously, this amount is still too much if you already have diabetes.

Why do we crave sugar?

Poor quality of diet.
Eating a high amount of refined carbohydrates such as white bread, white rice, white pasta or processed and bagged foods can make you crave even more.
Eating a high amount of saturated fats or poor quality of fats will have a detrimental effect on your gut microbes lowering the good gut bacteria and driving up sugar cravings.
Yeast overgrowth in your system from eating refined and processed carbohydrates can cause sugar cravings.
Dehydration. Sometimes, being thirsty can mimic hunger. Being hungry can mimic a food craving and send you down a dangerous path. “Up to 62% of the time, people think they are hungry even though they are actually thirsty.
Hormones. Sugar cravings can be related to women’s hormones including progesterone, estrogen and estradiol. Estradiol is especially related to sugar cravings which make women overeat carbohydrates, sugary snacks and chocolate during certain phases of their menstrual cycle.
Stress/depression/boredom. Chronic stress does many things to your brain and body and one specific thing is it drives up sugar cravings. Stress creates cortisol which raises blood sugar and then makes you crave more sugar creating a vicious cycle. Depression and boredom can present the same sugar cravings.
Poor or lack of sleep. Lack of sleep can set you up for sugar cravings. The fatigue makes you crave sugar to fight off the exhaustion.
Eating disorders. Binge eating can cause cycle sugar cravings as well as anorexia since your brain craves sugar for energy.
Medications. Amphetamines can cause sugar cravings.
Memories. Sugar cravings can be driven by thoughts and memories of holidays, parties and family dinners. Even smells, like baking cookies or pies can increase sugar cravings.
Deficiencies of certain nutrients. Mineral deficiencies can lead to sugar cravings. Iron, chromium, zinc, calcium and magnesium can cause you to crave sugar. For example, with low magnesium you get fatigued and think you need an energy boost by eating more sugar.

Remedies to fight sugar cravings:

Eat a well-balanced Mediterranean type of diet including lean protein, olives, olive oil, grains, fruits and vegetables, oats, beans, lentils, eggs and cheese.
Drink calorie-free beverages, do not wait until you are thirsty to drink.
Practice stress management techniques, get mental health help, when needed.
“Give in” occasionally and consider it a treat. Do not over-do it.
Eat seeds and nuts in moderation. They will give you protein and fiber.
Have fruit and dark chocolate for a snack in small amounts. Add some nuts.
Eat nuts, low-fat cheese, Greek yogurt and leafy greens for added minerals.

Keep up with what is trending in the health and diabetes news so you can stay informed. Happy learning!

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844911/
https://www.medicalnewstoday.com/articles/type-2-diabetes-nitrites-may-increase-disease-risk
https://www.webmd.com/a-to-z-guides/features/what-are-phthalates
https://www.healio.com/news/endocrinology/20231101/providers-should-make-plantbased-nutrition-a-central-part-of-obesity-treatment
https://www.washingtonpost.com/wellness/2023/11/07/dietary-guidelines-ultraprocessed-foods/
https://organic.org/phthalates-in-food-7-ways-to-reduce-your-exposure/
https://www.healthline.com/nutrition/16-8-intermittent-fasting
https://www.pcrm.org/health-topics/weight-loss
https://www.medpagetoday.com/endocrinology/diabetes/107112
https://www.healio.com/news/endocrinology/20231109/cost-of-diabetes-care-in-us-rises-to-4129-billion-in-2022
https://www.medicinenet.com/depression_can_be_killer_for_people_with_diabetes/news.htm
https://www.everydayhealth.com/diet-nutrition/foods-that-can-help-fight-sugar-cravings/
https://www.healio.com/news/endocrinology/20231107/timerestricted-eating-reduces-weight-hba1c-for-adults-with-type-2-diabetes
https://www.medicinenet.com/fda_approves_new_diet_drug_zepbound_mounjaro/news.htm
https://www.health.com/red-meat-diabetes-risk-8365083
https://www.medicalnewstoday.com/articles/insulin-resistance-high-sugar-diet-links-obesity-with-dementia