April 16, 2008

Should You be Eating the DASH Diet?

This week the medical news has been highlighting the findings of the Nurses Health Study that women eating the so-called DASH diet over a period of 24 years had fewer heart attacks and strokes.

As described by press coverage the DASH diet is one that "included plenty of fruits, vegetables, nuts, legumes, and whole grains and consumption of low-fat dairy products in quantities close to the recommended dietary guidelines." The DASH diet discourages the consumption of processed and red meats, sodium, and sweetened beverages.

The limitations on this study finding, are, of course, that a) diet is self-reported. People are notoriously bad at remembering or reporting what they really ate. b) The DASH diet is more expensive than the junk food diet and c) The DASH diet is really a "low fast food", "low boxed crap" diet. There are strong socioeconomic issues involved in who eats this diet, and many of the factors that make for eating the diet--like higher education, less polluted home neighborhoods, higher status in the workplace etc, also protect against heart disease and stroke. So it is, as usual, difficult to know whether the diet causes the improvement in heart disease or if eating it is a marker of the wealth, education, and status which protect against heart disease.

My guess is that it is a combination of both.

The next question is this: assuming this diet was protective against heart disease, what does it mean for people with diabetes?

Obviously, it does not mean that they should rush out and start eating a lot of whole grains. We know for certain that exposure to high post-meal blood sugars over time raises the incidence of both heart attack and stroke. (Read the details HERE)

But there are some good takeaway messages:

1. Eat lots of low carb fruits and vegetables. These low carb fruits and vegetables should be the basis of the diet of every person with diabetes. Any "low carb" diet that does not tell you to eat as much fresh low carb vegetables as possible is not a good diet. Even those of us who have very little insulin production find that leafy greens, fibrous vegetables, and berries are very kind to our blood sugar.

There is only ONE major caveat with fruits and vegetables, which is that, sadly, while eating them may protect against heart disease, the pesticides and herbicides sprayed all over crops, especially those from the Third World countries that provide winter produce, probably cause cancer. It would have been interesting to see whether those nurses who did not get heart disease in this study had a higher incidence of cancer.

Solution? Shop your local farmers market in the spring and summer and freeze stuff for winter. "Organic" produce sold in the United States, alas, may still have pesticides in them thanks to the Republican regulators' weakening of the labeling laws.

2. Cook from scratch. Processed foods are filled with corn syrup, soy, and a long list of mystery chemicals none of which occur in food you cook from scratch.

Many of you are from the generation whose mom's did not cook, and as a result you have fallen for the myth that cooking is a complex art pursued by celebrity specialists. This is utter nonsense. Cooking is not hard. It fact, it's easy.

Ignore the cooking shows where celebrity chefs make cooking look complicated. Buy yourself a basic cook book that explains cooking techniques like The Joy of Cooking, and learn how to make any of the hundreds of meals you can cook in 15 minutes, start to finish. If you have a friend who can cook, have them show you how to make a basic sauce or thicken stew. Cooking your own low carb desserts will make it possible to eat low carb without ingesting all the frankenfood chemicals found in boxed stuff. It's also cheaper, and by the way, what you end up with actually IS low carb, which is not true of much of the boxed stuff.

3. Stay away from preserved meats. This is probably the toughest for me, because I am addicted to various forms of salami. The biggest problem with processed meat probably is the very high salt content (which is part of what makes them so addictive.)

4. Avoid being an uber control freak. Because we know that high blood sugars DO cause massive amounts of harm to the body, it is easy to think that if we just ate the "right foods" we could eliminate all the other diseases known to man. It ain't true.

If you eliminate heart disease, you get to die from either cancer, emphysema, neurological deterioration, or a long list of other metabolic breakdowns many of which are very unpleasant.

Personally, when my time comes, I'd prefer a swift and fatal heart attack. But because I'd prefer to have that heart attack while still able to walk on both legs, see with both eyes, and pee without the help of complex electronic machines, I am obsessive about blood sugar control. It isn't the stuff that kills us that worries me so much as the stuff that destroys our quality of life while we are alive.

But hey folks, the simple truth is this: none of us gets out of here alive.


Scott S said...

One has to admire all of the carefully-constructed acronyms given to various studies, and apparently, diets (as in the DASH diet). Some friends of mine suggested that we should sponsor a study called "FART", but so far, we have yet to assign words to go with each letter that sounds clever like so many of these studies do; I suspect they hire agencies to do the acronym development piece for them -- otherwise, they would spend more time on that than they would on good study design (maybe that explains something?).

Anyway, while I think there are nuggets of knowledge to be derived from this diet, as you so eloquently note, its unclear whether these are causal or merely coincidence. The combination theory is probably correct! Still, as always, thanks for covering this stuff -- now if only we could get doctors to do the same thing!

Unknown said...

The crunchy pepperoni chips are my downfall.

Boz said...

Love your blog, which I stumbled across after doing a google search for a cortisone shot's effect on blood sugar. It effected mien a lot, especially in the morning. It rose 130 between 9:00 pm and 6:00 am this morning.

Also, this whole grain thing is a good idea, I've eaten this way even before I was diagnosed w/ type 2, But moderation is the key. The ADA guide lines just push too many carbs, no matter what form, IMHO.

Anonymous said...

Could you help me interpret this passage from that link on blood sugar and heart disease?

"In nondiabetic adults, HbA1c level was not related to CHD risk below a level of 4.6% but was significantly related to risk above that level (P<.001). In diabetic adults, the risk of CHD increased throughout the range of HbA1c levels. In the adjusted model, the Risk Ratio of CHD for a 1 percentage point increase in HbA1c level was 2.36 (95% CI, 1.43-3.90) in persons without diabetes but with an HbA1c level greater than 4.6%. In diabetic adults, the Risk Ratio was 1.14 (95% CI, 1.07-1.21) per 1 percentage point increase in HbA1c across the full range of HbA1c values."

I'm guessing that "Risk Ratio" of 2.36 here means a non-diabetic's risk of CHD goes up 2.36 percent for every 1 percent in A1c. In other words, a rise 4.6 to 4.646 = 2.36 rise in CHD, and a rise from 4.6 to 6.0 equals a 71.8 percent rise in CHD.

That's a pretty striking figure, if I've read it right.

For diabetics, the Risk Ratio is lower: 1.14. So (by my interpretation) a diabetic with an A1c of 6.0 has a 35 percent higher risk that one at 4.6.

That seems counterintuitive to me - I'd have thought diabetics would be more at risk from higher A1c. Of course, way more diabetics *have* high A1c.

Another thing that puzzles me is that the article doesn't say diabetics have normal, minimal, or any particular CHD risk at 4.6 or any other level, it just says the risk increases with rises in A1c.

Can you clarify any of this, or point me to a good source?

Chris B.

Jenny said...

Here's an article on the relative risk ratio used in these studies:


Unknown said...

A one percent rise in an A1c=4.6% would give you an A1c=5.6%

Anonymous said...

nonegiven: You're right. Puzzling out the data I came to the same conclusion. So a diabetic with an A1c of 5.6 has a 14 percent higher risk (within the time period they studied - 5 years?). An A1c of 6.6 = 30 percent higher (note the compound-interest effect), A1c 6.7 = 48 percent.

The question is, does a diabetic with an A1c of 4.6 run the same risk of CHD as a non-diabetic. That would suggest you'd need a A1c of around 10 before you'd actually double your risk over a normal person. That sounds excessively optimistic (I like optimism, but it needs to be well-grounded.)

My apologies if this is excessively off-topic or annoying elemental to more-expert readers.

Chris B.

Anonymous said...

i haven't attempted to try out the dash diet yet, i'm still somewhat curious about it .. there are some other ways in addition to this that can assist with diabetes: my father recommended taking multivitamin supplements. according to the dietary supplement information bureau page on type 1 diabetes, taking supplements rich in fiber and magnesium can help better regulate symptoms of diabetes.

Jenny said...

If you do a version of the DASH diet, be sure it is one that limits carbs. All those whole grains they recommend will raise your blood sugar and a diet that raises blood sugar is NOT healthy for a person with diabetes.

I've written up what peer-reviewed studies have found about the effectiveness most supplements HERE

Jim said...

Who should be eating DASH diet? Those with hypertension and who want to lose weight.