August 2, 2011, TIME, Meredith Melnick

Lose weight. That’s often the first advice from doctors to their pre-diabetic patients. But while losing excess fat can help reverse Type 2 diabetes risk factors like insulin resistance and high blood-sugar levels, a new study finds that increasing muscle mass may also help lower risk of the metabolic disease.

According to lead researcher, Dr. Preethi Srikanthan, this may be good news for many people with pre-diabetes — a condition that results in higher-than-normal blood sugar, but does not qualify as diabetes — who have difficulty slimming down.

“Our findings suggest that beyond focusing on losing weight to improve metabolic health, there may be a role for maintaining fitness and building muscle mass,” Srikanthan, an assistant professor of medicine at the University of California, Los Angeles, David Geffen School of Medicine, said in a statement. “This is a welcome message for many overweight patients who experience difficulty in achieving weight loss, as any effort to get moving and keep fit should be seen as laudable and contributing to metabolic change.”

Srikanthan and colleagues based their study on data on 13,644 adults who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) III between 1988 and 1994. Looking at the participants’ skeletal muscle index (SMI), a ratio of muscle mass to total body weight, researchers found an association between increasing SMI and a reduction in certain diabetes risk factors: for each 10% increase in SMI, there was an 11% decrease in insulin resistance and a 12% decrease in pre-diabetes.

The findings are in line with what is already known about the metabolic effects of muscle and fat. “Extra fat has bad effects, but more muscle has good effects. These data are also consistent with data we see on exercise, that it helps decrease diabetes risk, and that a lack of exercise and weight gain increase risk,” Daniel Rubin an assistant professor of medicine at Temple University School of Medicine, told USA Today.

The research was an extension of a 2009 study by the same UCLA team that found that people with high waist-to-hip ratios were at greater risk for diabetes. The team then began examining a subset of patients who had “sarcopenic obesity,” a condition marked by unusually high body fat and unusually low muscle mass.
The following year, using data from NHANES, the team was able to show that sarcopenic obesity was associated with pre-diabetes and diabetes risk. But in this latest study, the team found that the association between muscle mass and pre-diabetes held, even among those who did not suffer from sarcopenic obesity.

The study will be published in the September issue of the Journal of Clinical Endocrinology and Metabolism.

Read more: http://healthland.time.com/2011/08/02/gains-in-muscle-mass-not-just-weight-loss-may-help-lower-diabetes-risk/#ixzz1TxIWRVSy
Gains in Muscle Mass, Not Just Weight Loss, May Help Lower Diabetes Risk – TIME Healthland.

By Takkk (Own work), via Wikimedia Commons

June 14, 2011, Harvard School of Public Health

Watching television is the most common daily activity apart from work and sleep in many parts of the world, but it is time for people to change their viewing habits. According to a new study from Harvard School of Public Health (HSPH) researchers, prolonged TV viewing was associated with increased risk of type 2 diabetes, cardiovascular disease, and premature death.

The study appears in the June 15, 2011, edition of theJournal of the American Medical Association.

“The message is simple. Cutting back on TV watching can significantly reduce risk of type 2 diabetes, heart disease, and premature mortality,” said senior author Frank Hu, professor of nutrition and epidemiology at HSPH. “We should not only promote increasing physical activity levels but also reduce sedentary behaviors, especially prolonged TV watching,” said Hu.

Many people around the world divide their days largely between working, sleeping, and watching television, according to the researchers. Europeans spend an average of 40 percent of their daily free time in front of the television set; Australians, 50 percent. This corresponds to three to four hours of daily viewing — still less than a reported average of five hours in the U.S. The negative health effects of TV viewing have been documented in prior studies, including associations with reduced physical activity levels and unhealthy diets.

Hu and first author Anders Grøntved, a doctoral student and visiting researcher in the HSPH Department of Nutrition, conducted a meta-analysis, a systematic assessment of all published studies from 1970 to 2011 that linked TV viewing with increased risk of type 2 diabetes, cardiovascular disease, and premature death. Eight large prospective cohort studies from the United States, Europe, and Australia met the researchers’ criteria and were included in the meta-analysis.

The results showed that more than two hours of TV viewing per day increased risk of type 2 diabetes and cardiovascular disease, and more than three hours of daily viewing increased risk of premature death. For each additional two hours of TV viewing per day, the risk of type 2 diabetes, cardiovascular disease, and premature mortality increased by 20, 15, and 13 percent respectively. Based on disease incidence in the United States, Hu and Grøntved estimated that among 100,000 individuals per year, each 2-hour increment in TV viewing per day was associated with 176 new cases of type 2 diabetes, 38 new cases of fatal cardiovascular disease, and 104 new cases of all-cause mortality.

Hu and Grøntved found that the effect of prolonged television viewing on type 2 diabetes, which usually occurs in adults, was to some extent explained by the unfavorable influence of TV viewing on obesity, which is related to unhealthy eating habits and low activity levels, major risk factors for both type 2 diabetes and cardiovascular disease.

Limitations to the meta-analysis included the relatively small number of studies and that the assessment of TV viewing was self-reported by participants. In addition, the majority of the studies did not assess the role of diet and physical activity in explaining the adverse effects of TV watching on chronic disease risk.

“Sedentary lifestyle, especially prolonged TV watching, is clearly an important and modifiable risk factor for type 2 diabetes and cardiovascular disease,” said Grøntved. “Future research should also look into the effects of extensive use of new media devices on energy balance and chronic disease risk.”

“Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality: A Meta-Analysis,” Anders Grøntved, Frank B. Hu, Journal of the American Medical Association, June 15, 2011.

via Prolonged Television Viewing Linked to Increased Risk of Type 2 Diabetes, Cardiovascular Disease, and Premature Death – June 14, 2011 -2011 Releases – Press Releases – Harvard School of Public Health.

Reuters, Bill Berkrot, Novemner 23, 2010

More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated, according to analysis of a new report released on Tuesday by health insurer UnitedHealth Group Inc.

Diabetes and prediabetes will account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion — up from an estimated $194 billion this year, according to the report titled “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead.”

The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for the non-diabetic public, according to new data in the report drawn from 10 million UnitedHealthcare members.

The average annual cost nearly doubles to $20,700 for a person with complications related to diabetes, the report said. Complications related to diabetes can include heart and kidney disease, nerve damage, blindness and circulatory problems that can lead to wounds that will not heal and limb amputations.

Diabetes, which is reaching epidemic proportions and is one of the fastest-growing diseases in the United States, currently affects about 26 million Americans.

Another 67 million Americans are estimated to have prediabetes, which may not have any obvious symptoms. More than 60 million Americans are unaware that they have the condition, according to UnitedHealth.

People with prediabetes have higher than normal blood sugar levels, but not yet high enough to be diagnosed as diabetes. Prediabetics often have other risk factors, such as overweight, high blood pressure and high cholesterol.

The 52-page UnitedHealth report also focuses on the growing obesity epidemic as that condition is a leading cause of diabetes.

The authors of the report contend the skyrocketing cost forecasts are not inevitable, however, if the crisis is tackled aggressively, including early intervention to prevent prediabetes from becoming diabetes.

“Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early on and prevent this devastating disease before it’s too late,” Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform & Modernization, said in a statement.

“What is now needed is concerted, national, multi-stakeholder action,” Simon Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in a statement.

“Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models.” Stevens added.

If solutions for tackling the epidemic offered in the report were adopted broadly and scaled nationally it could lead to cost savings of up to $250 billion over the next 10 years, according to the UnitedHealth analysis.

via Half of Americans facing diabetes by 2020: report | Reuters.

Time Magazine, Erin Skarda, November 24, 2010

Two common conditions — depression and diabetes — frequently appear together, and a new study by researchers from the Harvard School of Public Health suggests that each illness may be both a consequence and a contributor to the other.

The 10-year study followed 65,381 women, ages 50 to 75, who were participating in the Nurses’ Health Study. Over the course of the research, depression and new cases of Type 2 diabetes were monitored: 2,844 women from the group were diagnosed with diabetes and 7,415 women developed depression — unsurprising numbers based on the prevalence of both illnesses.

Researchers also found a correlation between the conditions: women who suffered from depression were 17% more likely to develop Type 2 diabetes during the study period than women who weren’t depressed; women with diabetes were 29% more likely to develop depression than women without diabetes, even after adjusting for other mood disorders and risk factors, such as weight and lack of frequent exercise.

Additionally, the more severe the depression or diabetes was, the more likely that women would develop the other disease. Women whose diabetes was serious enough to require insulin, for instance, were 53% more likely to develop depression during the 10-year time frame, compared with women without diabetes. And women who took antidepressants to manage their depression were 25% more likely than undepressed women to develop diabetes.

Lead researcher Dr. Frank Hu, professor of nutrition and epidemiology, told WebMD that factors such as physical activity and body mass index (BMI) might partially explain the connection between the two illnesses, but that the more likely common denominator is stress.

High levels of stress hormones, which are often found in people who are depressed, can lead to problems with glucose and blood sugar metabolism, increased insulin resistance and an accumulation of stomach fat — all risk factors for diabetes. Depression also tends to lead to unhealthy lifestyle behaviors, such as eating a poor diet and not exercising, which may further up the risk of diabetes.

Conversely, people with diabetes must deal with managing a chronic disease, which requires changing diet and lifestyle and adjusting to various prescription medications, so it’s easy to see how the disease could increase stress levels and risk of depression.

The study’s authors say, therefore, that doctors should take care to address the psychological aspects of disease management with diabetes patients, and pay attention to blood sugar levels and other signs of diabetes in patients diagnosed with clinical depression.

The new study was published this week in the Archives of Internal Medicine.

via Study: The Link Between Diabetes and Depression Goes Both Ways – TIME Healthland.

Food and Health News, November 13, 2010

In the second paper in The Lancet Series on Chronic Disease and Development, experts show that in the UK everyone eating a healthy diet would deliver big health effects with minimal knock-on effects to domestic agriculture and trade. But in a middle-income country like Brazil, it’s a different story. There, healthier eating (both in Brazil or the UK) could have a major impact on agriculture, trade, and, by definition, jobs. The second paper is by Professor Richard Smith, London School of Hygiene and Tropical Medicine, UK, and colleagues. The paper is the first to examine the health and economic knock-on effects of healthy eating together in this manner.

Transition to diets that are high in saturated fat and sugar has caused a global public health concern, as the pattern of food consumption is a major modifiable risk factor for chronic non-communicable diseases. For example, cardiovascular disease is the world’s leading cause of death, and although the number of deaths from such disease is highest in high-income

countries, it is rapidly becoming a major health burden in middle-income countries. But unlike many risk factors for other diseases, changing dietary habits to target chronic disease can have a major impact on the wider economy of the country concerned, and other countries who produce and export diet-related products, thus causing disruption to vested interests, while also having variable impacts on health. Yet although agri-food systems are intimately associated with this transition towards western diets, agriculture and health sectors are largely disconnected in their priorities, policy, and analysis, with neither side considering the complex inter-relation between agri-trade, patterns of food consumption, health, and development.

Improvements to diets will necessitate changes in agricultural production and trade worldwide, resulting in various winners and losers between sectors of the economy, rural and urban communities, and regions and countries.

Adherence to WHO dietary recommendations in Organisation for Economic Co-operation and Development (OECD) countries would mean a substantial decrease in the consumption of vegetable oils (by 30%), dairy products (by 28%), animal fats (by 30%), meat (eg, pork by 13•5% or mutton and goat by 14•5%), and sugar (by 24%), and a substantial increase in the consumption of cereals (by 31%), fruits (by 25%), and vegetables (by 21%). The UK government has estimated that, if diets matched nutritional guidelines, 70 000 premature deaths could be prevented each year, with a saving to the health service of £20 billion every year.

The authors estimated that, to meet WHO healthy eating guidelines of no more than 10% of dietary energy as saturated fat, adults in the UK would need to reduce dietary saturated fat consumption by 22%, and adults in São Paulo by 7%. These figures equate to reductions of 7% in disability-adjusted life years and 3270 (3%) premature deaths averted in 1 year in the UK, and reductions of 3% of disability-adjusted life years and 2800 (2%) premature deaths averted in 1 year in Brazil.

But reductions similar to those required above by the UK, if translated across the EU, could have a massive impact on major meat exporters such as Brazil and China, damaging their economies and causing widespread job losses. The world economy would have to adjust to less meat and dairy produce. However, the authors point out that the jobs lost in the meat industry could be at least partly replaced by jobs elsewhere in agriculture, as other sectors such as cereal and fruit production increase to make up the calories lost from the diet through meat.

The authors say: “The benefits of such a healthy diet policy will vary between populations, not only because of population dietary intake but also because of agricultural production, trade, and economic factors… Knowledge of the effects of dietary change on both national health and wealth, and of winners and losers from policy change, are essential to secure a sustainable food policy to maximise health benefits and minimise potential risks.”

They add: “Our analysis suggests that the UK would acrue substantial health benefits and associated low costs from adoption of a diet low in saturated fat from animal sources. Conversely, Brazil would experience little health benefit but far more striking economic costs from such a policy.”

They conclude: “Public health policy makers need to judge whether present agriculture and trade are contributing to—or detracting from— efforts to attain dietary goals, and how agricultural policy interventions could help achieve dietary goals.”

Food and Health News, November 6, 2010

Older Americans are less healthy than their English counterparts, but they live as long or even longer than their English peers, according to a new study by researchers from the RAND Corporation and the Institute for Fiscal Studies in London.

Researchers found that while Americans aged 55 to 64 have higher rates of chronic diseases than their peers in England, they died at about the same rate. And Americans age 65 and older — while still sicker than their English peers — had a lower death rate than similar people in England, according to findings published in the journal Demography.

The paper was co-authored by James Banks and Alastair Muriel of the Institute for Fiscal Studies and James P. Smith, distinguished chair in labor markets and demographic studies at RAND.

“If you get sick at older ages, you will die sooner in England than in the United States,” Smith said. “It appears that at least in terms of survival at older ages with chronic disease, the medical system in the United States may be better than the system in England.”

The study expands upon an earlier analysis by Banks and Smith that found that Americans aged 55 to 64 suffered from diseases such as diabetes at rates up to twice those seen among similarly aged people in England. The trend was observed across all socioeconomic groups.

Researchers analyzed information from two comparable surveys of people age 50 and over in the United States and England — the Health and Retirement Survey and the English Longitudinal Survey of Ageing — funded by the National Institute on Aging in the United States.

In the new study, researchers examined the prevalence of illness among those 55 to 64 and 70 to 80. They also looked for the first time at the onset of new illnesses in those age groups in the United States and England during the years spanning 2002 to 2006. Finally, researchers examined trends in death rates in each country.

The findings showed that both disease prevalence and the onset of new disease were higher among Americans for the illnesses studied — diabetes, high-blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Researchers found that the higher prevalence of illness among Americans compared to the English that they previously found for those aged 55 to 64 was also apparent for those in their 70s. Diabetes rates were almost twice as high in the United States as in England (17.2 percent versus 10.4 percent) and cancer prevalence was more than twice as high in the United States (17.9 percent compared to 7.8 percent) for people in their 70s.

In spite of both higher prevalence and incidence of disease in America, death rates among Americans were about the same in the younger ages in this period of life and actually lower at older ages compared to the English.

Researchers say there are two possible explanations why death rates are higher for English after age 65 as compared to Americans. One is that the illnesses studied result in higher mortality in England than in the United States. The second is that the English are diagnosed at a later stage in the disease process than Americans.

“Both of these explanations imply that there is higher-quality medical care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States,” Smith said.

“The United States’ health problem is not fundamentally a health care or insurance problem, at least at older ages,” Banks said. “It is a problem of excess illness and the solution to that problem may lie outside the health care delivery system. The solution may be to alter lifestyles or other behaviors.”

The study also investigated the relationship between the financial resources of individuals in both countries and how soon they would they would die in the future.

While poorer people are more likely to die sooner than their more well-off counterparts, researchers say their finding supports the view that the primary pathway between health and wealth is that poor health leads to a depletion of household wealth, rather than being poor causes one’s health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death.

Cleveland.com, Evelyn Theiss, October 24, 2010

Move over, trans fat. There’s a new nutritional pariah.

It’s high-fructose corn syrup, a moniker that has become so unappealing that the industry trade group behind it — the Corn Refiners Association — made a bid to the Food and Drug Administration in September to change the name to “corn sugar.”

The group says that “corn sugar” is more accurate, because “high-fructose corn syrup” incorrectly implies that the product, which is used in foods as a sweetener, is high in fructose when actually its proportion of fructose to glucose — approximately 55 percent fructose and 42 percent glucose — is about the same as table sugar.

When package fronts of crackers and breads tout, as they have in recent months, “Contains no high-fructose corn syrup,” you know there’s an image problem.

David Katz, director of Yale University’s Prevention Research Center, wrote in a recent blog post that he used to think the name “high-fructose corn syrup” was chosen years ago because it didn’tsound like sugar.

Times sure have changed when a substance called a “sugar” is considered a good thing.

The rap against high-fructose corn syrup? Those who oppose it — from dietitians to doctors to health-conscious consumers — connect it with health problems that range from obesity and diabetes to kidney disease, fatty liver disease, and, in a study this past summer, pancreatic cancer.

But a number of the best-known dietitians, nutritional experts and doctors — well-respected names such as Marion Nestle, a blogger, author and professor of nutrition at New York University, andWalter Willett, chairman of the Department of Nutrition at Harvard University — say there is no hard science, or studies that they deem credible, to back up those claims.

They say high-fructose corn syrup, or HFCS — a syrup made from corn that undergoes enzymatic processing to convert some of its glucose into fructose to produce a desired sweetness — is only as bad as sugar, which they agree Americans eat too much of in general.

No less than food cop Michael Jacobson, the executive director of the Center for Science in the Public Interest, famed for “outing” unhealthy foods (remember fettuccine Alfredo, aka “heart attack on a plate”?) refuses to condemn HFCS.

“There’s no nutritional difference between it and table sugar,” he says. “If all food manufacturers switched from high-fructose corn syrup to sugar, it wouldn’t make any difference in the levels of obesity.

“People are looking too hard for a problem, when the fact is Americans are consuming too much of all kinds of sugars.”

Search for HFCS online and the Corn Refiners site pops to the top of the list. The name of its web site is sweetsurprise.com. The group also has enlisted dietitians around the country to monitor blogs and other “reports” that connect HFCS to health woes. The dietitians then try to balance the commentary with what they say is a grounded-in-science view.But consumer opposition to HFCS has turned into a runaway train. The Corn Refiners Association is pushing back. Besides proposing the name change for their product, they’ve created a number of homey commercials in which one mom admits to another that she doesn’t know why high-fructose corn syrup is supposed to be bad and is shortly persuaded by her friend that it isn’t, that it is as “natural” as sugar.

Lisa Cimperman, a clinical dietitian at University Hospitals Case Medical Center, says she recently became a spokeswoman for the Corn Refiners Association.

“Obviously, it’s a hot-button topic now that’s polarizing. My concern as a dietitian is that we have this substance and all our dietary ills are blamed on it, so it’s become another scapegoat,” she says.

“I chose to work with the Corn Refiners because we are pointing out to people that sugar and high-fructose corn syrup are nutritionally equivalent,” she adds. “And there’s no benefit to taking it out of food. We should all limit added sugars, period.”

From sugar to corn

If you are over 50 years old, the pop you drank when you were a child was sweetened with sugar. By the time you were 25, the sugar had been swapped for high-fructose corn syrup.

Here’s how that shift came about.

In 1957, two researchers at the Oklahoma Agricultural Experiment Station, Richard O. Marshall and Earl R. Kooi, developed the basics of a process to produce what would become HFCS. (See “Refining Sweetness.”)

But it took five years of additional work, from 1965 to 1970, for a food scientist in Japan, Yoshiyuki Takasaki, to further refine the process for industrial production.

By 1972, Takasaki had a patent for his process, and within a few years, high-fructose corn syrup was making its way into the U.S. marketplace — in soft drinks and in products ranging from salad dressing to cereals.

What was happening in the marketplace at the same time was that corn subsidies, which began in the 1970s, increased the supply of corn, while lowering its price. Tariffs and quotas imposed on sugar in the late 1970s drove up the cost of that product. Food manufacturers began switching from the higher-priced sugar to lower-cost HFCS.

HFCS had other advantages that manufacturers appreciated. In liquid form, it was easily piped through factories for use in foods and beverages. It has a lower freezing point than table sugar, which meant foods could be frozen at a lower temperature without freezer burn or water crystallization. Using HFCS in vending machine products with a long shelf life was helpful, too: The taste remained fresh. (You don’t often encounter a stale Twinkie — instead, you see its moist sheen.)

Manufacturers found that using HFCS in rolls and biscuits that hadn’t previously contained sugar made the products look as if they had been browned and, thus, appear more appetizing.

By 1984, soft drink companies in the United States had replaced sugar with HFCS in their drinks and the cheaper cost eventually allowed them to sell far bigger bottles at fractionally higher cost to the customer. This led to a huge increase in overall soda consumption: rising more than 60 percent from 1977 to 1997 and doubling in children over that same period.

It was Michael Pollan and his groundbreaking and best-selling book “The Omnivore’s Dilemma,” that generated a lot of the attention about HFCS. The makers of the documentary “King Corn,” Ian Cheney and Curt Ellis, which takes a hard look at corn growing and processing, cited Pollan as their inspiration. (See a trailer for “King Corn” here.)

Pollan and the filmmakers point out two memorable things: that HFCS is cheap, and that its use is hugely prevalent, in many, if not most, of the processed foods that Americans eat.

Pollan wrote: “Today [HFCS] is the most valuable food product refined from corn, accounting for 530 million bushels [of corn] every year . . . The pipe marked HFCS leads to the fattest spigot at the far end of a corn refinery’s bewildering tangle of pipes and valves.”

Like other registered dietitians who work with the Corn Refiners, Atlanta-based Carolyn O’Neil says, “All added sugars should be consumed in moderation — corn sugar, table sugar, honey and fruit juice concentrates.” Other dietitians point out that it’s hard to consume high-fructose corn syrup in moderation, when it’s used in so many products that aren’t even sweet.

Those include ketchup, salad dressings, soups, canned vegetables, crackers and bread, in addition to the more obvious “sweet” foods such as yogurt, ice creams and puddings.

Its low cost also made it easy and economically smart for snack and soda pop producers to “upsize” their products, one of the issues that many experts blame for the growth of obesity in the U.S. population.

Why does it make us fat?

Many doctors and dietitians believe HFCS might be detrimental to people’s efforts to maintain their weight.

Dr. Michael Roizen, the Cleveland Clinic’s chief wellness officer, explains how HFCS can lead to weight gain, as he did in the most recent edition of “You: On a Diet,” the book he wrote with Dr. Mehmet Oz.

When you eat calories from healthy sources — for example, whole foods (fruits and vegetables with their fiber or protein) — they soon turn off your urge to eat more by inhibiting the production of neuropeptide Y, also referred to as NPY, or by producing a protein called cocaine-amphetamine-regulatory transcript, or CART. So you slow down your eating, then stop.

But the fructose in HFCS, used to sweeten processed foods, is not discerned by your brain in the way that a regular whole food is. (After all, HFCS has existed in our diets for only around 30 years, and human beings have been around for about 200,000 years.)

As several studies have shown, because your brain doesn’t recognize the fructose in processed foods as excess calories, it tells you to keep eating.

This creates what Roizen calls the “perfect storm.” Foods with HFCS can make you both hungry (many sugary foods can trigger what feels like hunger) and unable to diminish your appetite, because HFCS doesn’t spur your body to make leptin, a hormone that tamps down appetite.

Because foods that have HFCS are a rich and dense source of calories, we can consume them quickly, so it’s easy to eat too much.

There’s another issue, too.

If you ate a piece of fruit every hour, doctors say, your liver could easily process that source of fructose, surrounded as it is by fiber. Eating fruit requires more chewing, then digesting, which slows down your intake, and the absorption of the food by the body.

But large amounts of fructose — which can be quickly ingested in processed foods and beverages high in HFCS — overwhelm this organ. That is, the body absorbs the fructose so fast that it can inhibit the liver’s ability to process it. The excess fructose causes the release of toxins, and inflammation caused by toxins can damage arteries and the immune system.

But not everyone agrees that’s a valid conclusion. Dr. James Rippe, an author, well-known cardiologist and founder of the Rippe Lifestyle Institute in Orlando, Fla., is one of many doctors who say that such conclusions are simplistic — even flawed.

“The studies that theory is based on were based on the ingestion of fructose only,” he says. “And high-fructose corn syrup is made up of both glucose and fructose, just as table sugar is.”

Those who counter him say the fact is that Americans do ingest a lot of fructose, because of the prevalence of HFCS in our diet.

Dr. James Cameron, a gastroenterologist at University Hospitals, notes that because he is not a nutrition expert or registered dietitian, he doesn’t speak in big-picture terms about HFCS. But he has encountered a number of people who have trouble digesting fructose, which is also found in fruit juices and honey.

“For people who have trouble digesting it, it gets into the colon, where it causes fermentation, and that causes gas and bloating,” he says. “So I tell them to try to particularly avoid foods with high-fructose corn syrup and see how they feel.

“For many patients, it comes down to the amount of fructose they take in. And most Americans take in a lot, in foods they aren’t aware contain a lot of fructose, especially processed foods,” he adds. “Many of those patients have had a dramatic improvement in their symptoms.”

Whom do we trust?

Proving that any substance causes a disease isn’t easy. It took decades, for example, for tobacco and asbestos to be widely accepted as carcinogens, even by doctors. And both of those conclusions met with longtime opposition from their respective industries. As recently as the early 1960s, doctors were still making commercials for the tobacco industry, saying that cigarette smoking was not harmful.

So skepticism by consumers toward the corn refiners might be understandable. Nutrition blogs and comments on them and on online articles about HFCS show a vociferous crowd vehement in its belief that HFCS is bad for humans. They profess their suspicion of industry efforts to say that it isn’t.

Reader comments on news articles and blogs also show that many people have an inherent suspicion on another level, one that Pollan mentions in his book “In Defense of Food.”

“Our bodies have a long-standing and sustainable relationship to corn that they do not have to high-fructose corn syrup. . . . for now the relationship leads to ill health because our bodies don’t know how to handle these biological novelties.”

Consumption of HFCS in the United States is actually down slightly because consumers have cut back on soft drinks in particular, says Jacobson of the Center for Science in the Public Interest. But, he says, part of the loss in pop sales is being picked up by sweetened sports drinks and juices, both of which often also are sweetened with HFCS.

What isn’t in dispute is that the rise in obesity and Type II diabetes levels correlates to a rise in the consumption of HFCS. That was most famously pointed out in a 2004 article by Barry Popkin, a research scientist at the University of North Carolina at Chapel Hill, which was published in a nutrition journal.

That article further fueled public concern about HFCS. But doctors like Rippe and food researchers like Marion Nestle pointed out that correlation is not the same as causation.

Now even Popkin has pulled back. In an e-mail he said, “We speculated, based on science, that the pathway [between HFCS and obesity] might be important and we challenged scholars to study the topic. We now realize that it is any type of caloric sweetener in a beverage that is strongly associated with obesity and diabetes in the U.S.

“What happened was that the bloggers took over and made HFCS a horror product.”

To prove the connection to obesity, many point to Europe, where HFCS is used sparingly, and obesity is less prevalent. However, that may be drawing a correlation without statistical evidence.

Many believe HFCS is actually banned in Europe. But it’s not. HFCS, known as isoglucose there, has been subject to strict production quotas since 1977. Limiting the supply of competitive sweeteners, which includes isoglucose, protects the European Union’s own domestic sugar producers.

The EU quota for sugar and isoglucose is 14 million tons annually, of which 13.3 million tons is for sugar.

There’s also the European stance against foods that come from genetically modified plants, and HFCS produced in this country is usually made from genetically modified corn. In the United States, more than 80 percent of the crop of field corn, which HFCS is made from, has been genetically modified.

Even in the United States, there are registered dietitians and other nutritional experts who share such concerns and advise against eating processed foods with HFCS — whether or not studies clearly point to it as a cause of obesity or illness.

Susan Levin, director of nutrition education at the Physicians Committee for Responsible Medicine, says this: “I avoid it, and I recommend people avoid it. I’m a big ingredients reader. Yes, when you look at nutrition facts, the numbers are important — that means looking at added sugar grams, for example.

“But ingredients are equally important, and I explain it this way: I think it is an unnatural food product. And I recommend avoiding chemical additives in food.”

Still, she and other nutrition experts caution that there is no silver bullet, like avoiding HFCS or no longer eating trans fats.

“There’s a bigger picture about what we eat in this country,” Levin says. “The standard American diet is bad: It’s fatty, low in fiber and high in sugar, with too much processed food loaded with sodium. We need to completely change our approach to food.

“You’ll never hear the truth from industry and, as long as there are lobbyists, you won’t hear it from government,” she says.

“You have to seek it out, to inform yourself and take care of yourself.”

Nutritional maze grows more complicated with high-fructose corn syrup debate | cleveland.com.

The study appears online October 27, 2010, in the journal Diabetes Care and will appear in the November print edition.

“Many previous studies have examined the relationship between sugar-sweetened beverages and risk of diabetes, and most have found positive associations but our study, which is a pooled analysis of the available studies, provides an overall picture of the magnitude of risk and the consistency of the evidence,” said lead author Vasanti Malik, a research fellow in the HSPH Department of Nutrition.

Consumption of sugary drinks, the majority of which are sodas, has increased substantially in the U.S. and across the globe and previous scientific studies have shown consistent associations with weight gain and risk of obesity. However, this study is the first meta-analysis to quantitatively review the evidence linking sugar-sweetened beverages with type 2 diabetes and metabolic syndrome. (Metabolic syndrome is a group of risk factors, such as high blood pressure and excess body fat around the waist, that increase the risk of coronary artery disease, stroke and diabetes.)

The researchers, led by Malik and senior author Frank Hu, professor of nutrition and epidemiology at HSPH, did a meta-analysis that pooled 11 studies that examined the association between sugar-sweetened beverages and those conditions. The studies included more than 300,000 participants and 15,043 cases of type 2 diabetes and 19,431 participants and 5,803 cases of metabolic syndrome.

The findings showed that drinking one to two sugary drinks per day increased the risk of type 2 diabetes by 26% and the risk of metabolic syndrome by 20% compared with those who consumed less than one sugary drink per month. Drinking one 12-ounce serving per day increased the risk of type 2 diabetes by about 15%.

“The association that we observed between soda consumption and risk of diabetes is likely a cause-and-effect relationship because other studies have documented that sugary beverages cause weight gain, and weight gain is closely linked to the development of type 2 diabetes,” said Hu.

While a number of factors are at work in the development of type 2 diabetes and metabolic syndrome, sugar-sweetened beverages represent one easily modifiable risk factor that if reduced will likely make an important impact, say the researchers. “People should limit how much sugar-sweetened beverages they drink and replace them with healthy alternatives, such as water, to reduce risk of diabetes as well as obesity, gout, tooth decay, and cardiovascular disease,” said Malik.

Other HSPH authors include Walter Willett, chair of the Department of Nutrition and Frederick John Stare professor of nutrition and epidemiology.