Two Slices Of Buttered Toast A Day Doubles Diabetes Risk, Study Suggests

[Deleted member 308541]

When young I used to have sugar sandwiches as a treat horrifies me to think of it now.

You were lucky, we had to eat two slices of burnt toast and live in a shoebox near the roundabout.

 

[JohnEGreen]

Some people believe the earth to be flat. There are those who believe that the earth is not flat but also believe that the angles of a triangle add up to 180 degrees not realising that both things are mutually inconsistent

 

[landylara]

You were lucky, we had to eat two slices of burnt toast and live in a shoebox near the roundabout.

oh you live dangerously don't you

 

[Deleted member 308541]

oh you live dangerously don't you

Yes, I can still remember my mother scritch scratching the black burnt stuff off of the toast first up in the morning.

I still eat two slice of toast every morning, not with butter on it but a Canola spread.

 

[landylara]

I used to love burnt toast with butter and thickly spread marmite.

 

[mist]

Scare tactics, nothing more. Considering the amount of junk most people put into their bodies, a bit of toast is hardly going to make much of a difference.

unbelievable.

 

[asparagusp]

Many though put jam or marmalade on toast .....

 

[JohnEGreen]

I used to love burnt toast with butter and thickly spread marmite.

I still do I also used to like toast with beef dripping, basically I just about like toast with any thing except tripe and onions that is.

 

[Bluetit1802]

When young I used to have sugar sandwiches as a treat horrifies me to think of it now. Though sometimes did add lettuce.

Mr. Blue used to put sugar on his lettuce. It was the only way his mother could make him eat it . Lol

 

[Deleted member 308541]

It was the only way his mother could make him eat it .

My mother used to make mint sauce for me every meal, which she put on the cabbage on my plate so ate it.

School dinners have a lot to answer for, for the putrid ***** they called cabbage that was served up for dinner.

 

[Bluetit1802]

Oh yuk. School dinners. Worst ever memory is the disgusting sago puddings with a dollop of jam in the middle

 

[Deleted member 308541]

Worst ever memory is the disgusting sago puddings with a dollop of jam in the middle

I'll drink to that.

 

[Type1Bri]

The Telegraph and The Express, must be true then!!!
The media reporting sensationalist headlines once again. Really does nothing to raise public awareness of the real causes/treatments of diabetes

 

[Type1Bri]

My views on media and sensationalism from last year
https://type1bri.com/diabetes-and-the-media

 

[ME_Valentijn]

The actual study is at http://ajcn.nutrition.org/content/early/2017/02/15/ajcn.116.142034.abstract . Full text is available from Sci-Hub at http://ajcn.nutrition.org.sci-hub.cc/content/early/2017/02/15/ajcn.116.142034.full.pdf+html

Major points:

• The researchers re-used data they already had from an earlier trial of the Mediterranean Diet (PREDIMED) to investigate risk factors for Type 2 diabetes
  
• Only amount and type of fat intake was compared, not other dietary, medical, or lifestyle factors which were also recorded
• 3349 study participants
  
• Participants were initially randomized to one of two types of a Mediterranean diet or control group
• Mediterranean groups and the control group were combined in this analysis
  
• There's nothing published involving toast or bread - that is purely sensationalism from the media
• Study participants were older, all aged 55-80
• Study participants had at least 3 of the following risk factors:
  • Current smoking
  • High blood pressure (based on diagnosis or med use)
    
  • High cholesterol (based on diagnosis or med use)
    
  • Overweight or obese (but BMI not over 40)
  • Family history of premature coronary artery disease
• Participants were excluded if on a very low calorie or very high calorie diet
• Definition used for diagnosing Type 2 Diabetes:
  • 7.0 or higher fasting blood glucose
  • 11.1 or higher blood glucose 2 hours after 75g oral glucose
  • Use of insulin or an oral diabetes medication
  • Elevated result from a trial clinic or other source considered diagnostic if repeated within 3 months
• Frequency of eating types of foods was estimated, not monitored by the patients
• Amounts eaten were not estimated or monitored
  
• Different types of fats were compared: MUFAs, PUFAs, SFAs, trans fat, animal fat, vegetable fat, marine v-3 fatty acids, non-marine v-3 fatty acids, and v-6 linoleic acid
• The researchers created 3 models taking dozens of factors into account

Results:

At baseline, participants with a higher total fat intake had lower blood glucose concentrations, a lower intake of total energy, and a higher intake of all sub-types of fat. Participants with higher SFA and trans fat intake were more likely to smoke, were less physically active, and consumed less dietary fiber (Table 1).

This seems to be suggesting that fat is good, when it comes to blood glucose levels. And the intake of bad fats (at baseline) was correlated with other unhealthy behavior. But it looks like all 3 models adjusted for smoking, hypertension, activity, calories, etc, though the language there isn't very clear, so it might not have been adjusted for in Model 2 and/or Model 3. Model 2 (further?) adjusted for amounts of the other types of fats, and Model 3 further adjusted for cholesterol and fasting blood sugar.

When analyzing yearly updated dietary fats in the total population in the multi-variable model adjusted for cardiovascular disease risk factors, dietary factors, and baseline plasma glucose, a higher risk of T2D was observed for those participants in the highest quartile of updated SFA intake (fourth quartile compared with first quartile—HR: 2.19; 95% CI: 1.28, 3.73; P trend = 0.01) (Table 3). A 5% energy increment from SFA intake was consistently associated with a 2-fold higher risk of T2D (HR: 2.14; 95% CI: 1.30, 3.52; P , 0.05) (Table 4).

They're talking about Model 3 here, but they are not comparing diets, just the amount of saturated fats everyone had versus their diabetes risk. This is a bit dodgy, because they're deviating from comparing diets, and are basically throwing the controlled aspect of the trial out the window. It smells of p-hacking to force a positive outcome.

An HR of 2.19 means that the 5% increase in saturated fats doubled the risk of developing diabetes in this group (55+ with several non-dietary risk factors). In total they had 266 new cases of diabetes per the 3349 participants (13,798.3 people years). So 12.6% of people aged 55-80 with several Type 2 risk factors at the start of the trial ended up with diabetes. There doesn't seem to be a consistent length of duration for anyone's participation in the trial, which is a bit weird. But the average would by 4 years and 1 month. They don't give much data about average intake, which makes it hard to compare the healthy versus unhealthy amount of saturated fats.

Assuming the baseline diet is relevant and consistent (it isn't, they discuss overall fat intake changing later), the participants getting 12.6% of their calories from saturated fats have double the risk of diabetes as the participants getting 7.1% of their calories from saturated fats.

Something I really don't like about this study is that they primarily rely on Model 3 for results, which adjusts for glucose levels as a co-variate. Glucose levels are already the major outcome measurement, as the primary way in which Type 2 Diabetes is diagnosed. It simply doesn't make sense to adjust for glucose levels to determine which risk factors contribute to high glucose levels

Higher SFA intake was associated with T2D in the Mediterranean diet group but not in the control group; however, the interaction between SFAs and intervention group on T2D was not significant (P-interaction = 0.19).

The data actually contradicts their "eat Mediterranean" message in the media, which quotes one of the researchers. Risk of diabetes was also the same in both groups, which they speculate is due to noncompliance with the diet.

Figure 1 shows the risk of T2D by the updated intake of 1 serving of animal food sources rich in SFAs. Increasing the intake of 12 g butter and 30 g cheese was associated with a higher risk of T2D [HR: 2.42 (95% CI: 1.42, 4.13) and P , 0.01 compared with HR: 1.32 (95% CI: 1.15, 1.52) and P , 0.01, respectively], whereas the intake of whole-fat yogurt was associated with a lower risk of T2D (HR: 0.65; 95% CI: 0.45, 0.94; P = 0.02). No significant associations between red meat, processed meat, eggs, or whole-fat milk and diabetes were observed.

I think we might getting into a lot of random noise (false positives) here. Even if assuming a small amount of a pure fat that is mostly saturated (butter and cheese) has more negative impact than a larger amount of a saturated fat mixed with protein or sugars (yogurt, red meat), it's not like people are doing shots of melted butter - they're having it with carbs. These results don't make sense.

However, when we separated the analysis by intervention group, no significant associations between SFAs in relation to T2D were observed in the control group, probably because the Mediterranean diet intervention played an important role in reducing the risk of T2D in the PREDIMED population (13, 14). In addition, we observed a higher risk of T2D for higher intakes of PUFA and linoleic acid only in the Mediterranean diet groups, which could reflect a potential bias from compliance. Those participants who were most compliant (i.e., increasing MUFAs from nuts or olive oil and thereby decreasing other fats) probably had a lower risk of T2D.

None of this makes sense. If being on the Mediterranean diet reduced risk of T2D, we'd expect to see fewer cases in that group. But the prevalence of new cases wasn't significantly different between the groups. And it's quite a stretch to suggest that the poly-unsaturated fats are beneficial when they're showing more cases of T2D associated with higher intake in the Mediterranean group. The underlying assumption requires not just non-compliance with the diet, but inaccurate reporting of what participants were eating. If the participants were lying about that, it would call all of the results in the study into question.

Because we did not differentiate between the type of cheese consumed and the intake of cheese is often combined with refined carbohydrates, this may explain the increased risk of T2D observed in our study; however, clinical trials are needed to confirm these associations.

Finally, something I can agree with They're also pretty up-front about the studies contradicting their results.

MAJOR FLAWS:

• This is not a pre-defined analysis. It was a secondary analysis done post-hoc, after researchers had seen outcome data from the primary PREDIMED trial
• Blinding of researchers was likely long gone by the time this data was analyzed in this manner
• Blinding was further rendered meaningless by dropping comparisons between groups
• There is no apparent statistical correction made for comparing so many dietary variables in several different models, with different combinations of the dietary intervention groups, so it can't be determined if any results are true positives or false positives
• The primary hypothesis of the health benefits from the Mediterranean diet and intake of poly-unsaturated fats was apparently abandoned and is downplayed, after neither were found to be statistically significant
  
• A previously unimportant factor (saturated fat intake) is now being used as the primary variable associated with a positive outcome (less T2D)
  
• Controlling for glucose as a co-variate is senseless when it's also a large part of the primary outcome (T2D)

The combined hype and spin around this study from the researchers and the media is worrying as well. It suggests that maintaining a high profile has been prioritized over good science. Further new research into the role of saturated fats and diabetes might be interesting, if better methodology is used, but there's nothing here that otherwise supports the role of the Mediterranean diet in avoiding Type 2 diabetes.

 

[asparagusp]

Many thanks for finding and posting this!

 

[JRTwalker]

When young I used to have sugar sandwiches as a treat horrifies me to think of it now. Though sometimes did add lettuce.

As a child, my mother used to give me warm sugared water because it was cheaper than the fizzy pop from the Corona Man. (Who remembers the Corona Man?)
I had to have what was left of my milk teeth extracted at the dentist at an age before my adult teeth were ready to replace them. I would say that any sweet-tooth I developed, excusing the pun, was inevitable!

 

[Bluetit1802]

As a child, my mother used to give me warm sugared water because it was cheaper than the fizzy pop from the Corona Man. (Who remembers the Corona Man?)
I had to have what was left of my milk teeth extracted at the dentist at an age before my adult teeth were ready to replace them. I would say that any sweet-tooth I developed, excusing the pun, was inevitable!

Ah! The pop man. Yes, I remember, plus the inevitable large bottle of Lucozade at the bedside when I was poorly!

 

[MikeTurin]

When young I used to have sugar sandwiches as a treat horrifies me to think of it now. Though sometimes did add lettuce.

Me too.
I remember as a child the "old times and sane treat" pane burro e zucchero, that is bread, sugar and butter. Grandma was keen to make this because was a sane treat.

http://www.cookingchanneltv.com/recipes/david-rocco/pane-burro-e-zucchero-bread-butter-and-sugar