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1 October 2017
GI News - October 2017
FOOD FOR THOUGHT
DON’T CONFUSE CORRELATION WITH CAUSATION
In an entertaining and informative piece in The Conversation,
Jon Borwein and Michael Rose look at the dangers of making a link
between unrelated results. “Here’s an historical tidbit you may not be
aware of,” they write. “Between the years 1860 and 1940, as the number
of Methodist ministers living in New England increased, so too did the
amount of Cuban rum imported into Boston – and they both increased in an
extremely similar way. Thus, Methodist ministers must have bought up
lots of rum in that time period! Actually no, that’s a silly conclusion
to draw. What’s really going on is that both quantities – Methodist
ministers and Cuban rum – were driven upwards by other factors, such as
population growth. In reaching that incorrect conclusion, we’ve made the
far-too-common mistake of confusing correlation with causation.”
As
we are reporting on a number of large prospective studies and their
correlations (otherwise known as associations) in this issue of GI News,
we thought we would kick off with an extract from a post by Prof Arya
Sharma (Even Correlations Based on Billions of Data Points Do Not Prove
Causation, Obesity Notes, August 23, 2017) reminding us of the very
serious limitations of such studies.
Even Correlations Based on Billions of Data Points Do Not Prove Causation
Readers may have already heard about a recent study by Tim Althoff and colleagues from Stanford University, published in Nature,
that analyses physical activity data collected from smart phones
consisting of 68 million days of physical activity for 717,527 people,
in 111 countries (only 46 of which were included in the study). As one
may expect, not only do activity levels vary widely across countries but
also substantially within countries (which in general terms, the
authors refer to as “activity inequality”). It turns out that activity
inequality and not actual levels of activity predict obesity rates
(based on BMI).
The authors discuss [in their paper]
various limitation of their study but fail to mention the biggest
limitation of all, the simple fact that correlations, no matter how
strong or how large the data set, simply cannot prove causality.
Thus,
while the data does prove the point that you can do all sorts of
interesting analyses when you have large data sets, it simply does not
prove that activity levels (or activity inequality for that matter)
actually has much to do with obesity at all. Indeed, one could think of a
number of confounders that would otherwise differentiate countries with
high activity inequality that happen to have high obesity rates from
countries that have low activity inequality and low obesity rates (let’s
not even mention reverse causality).
Thus, as nice as
the figures presented in the paper may be, it is really hard to follow
the authors’ conclusion that, ‘Our findings can help us to understand
the prevalence, spread, and effects of inactivity and obesity within and
across countries and subpopulations and to design communities,
policies, and interventions that promote greater physical activity.’
This
is not to say that designing communities, policies, and interventions
would not be of substantial health benefits – given all of the known
benefits of physical activity. Unfortunately, whether or not, these
policies would do anything to prevent or reverse obesity is another
matter altogether and remains as unclear after this study as before.
- Dr Sharma’s Obesity Notes
- Large-scale physical activity data reveal worldwide activity inequality
- Clearing up confusion between correlation and causation
Dr Sharma is Professor of Medicine and Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program. He has authored and co-authored more than 350 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders and is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.
WHAT’S NEW?
PROTEIN AND THE PROSPECT OF DIABETES
There
have been a couple of prospective studies or what we are now going to
call “Methodist ministers and Cuban rum” studies recently on protein
intake and risk of type 2 diabetes.
- The findings of the University of Eastern Finland study in the British Journal of Nutrition suggest the source of dietary protein may play a role in the risk of developing type 2 diabetes. The researchers found that replacing animal protein with plant protein was associated with a lower risk of type 2 diabetes.
- The findings of a prospective study and meta-analysis of the Melbourne Collaborative Cohort published in the American Journal of Clinical Nutrition showed that higher intakes of total and animal protein were both associated with increased risks of type 2 diabetes, whereas higher plant protein intake tended to be associated with lower risk of type 2 diabetes.
What next? Prospective studies like these are useful for developing hypotheses that can then be put to the test with randomised controlled trials.
The studies
- Intake of different dietary proteins and risk of type 2 diabetes in men: the Kuopio Ischaemic Heart Disease Risk Factor Study.
- Dietary protein intake and risk of type 2 diabetes: results from the Melbourne Collaborative Cohort Study and a meta-analysis of prospective studies.
- An Insulin Index of Foods (full PDF)
SUGAR’S SWOON IS GOING GLOBAL
A new industry analysis by Rabobank suggests sugar’s swoon appears to be passing a tipping point reports ConscienHealth’s Ted Kyle. Food marketers are bowing to consumer pressure and driving sugar out of products, even in developing markets. For more than a decade now, the reputation of sugar as the primary culprit behind obesity trends has been growing. U.S. consumption of added sugars and sugar sweetened beverages peaked at the turn of the millennium. But the market for sugar continued to grow in developing markets. That refuge for marketing sugary foods is fading away.
The Rabobank report describes a cycle of consumer preferences. At its heart, this is a story of steadily rising global obesity rates, finger pointing, and the repercussions of consumers cycling through a love/hate relationship with the three macronutrients – carbohydrate, fat, and protein – and, in the process, demonizing certain foods. Currently, protein is on the rise (certainly in North America and Europe), as sugar, sugar-containing products, and other highly refined carbohydrates are increasingly cast as the main villain in the unremitting rise in obesity and metabolic syndrome rates. A “clean label” with a short ingredient list is the imperative that food companies are chasing. Added sugar will drop out. Artificial sweeteners are scary, so they aren’t coming back, either.
Now that global food makers are bowing to the storm of pressure that started with public health advocates, what are those advocates saying? Tom Farley, Philadelphia’s health commissioner, says it will take many years before any of this has an impact on public health. He says: “Sugar is a problem, but sugar is not the only problem.” In responding to doubts about the impact of Mexico’s sugar sweetened beverage tax, Barry Popkin and colleagues recently wrote: “The obesity epidemic will take decades to slow down, stop, and finally reverse itself, but other benefits might be seen sooner.” In other words, don’t hold your breath for health miracles from declining trends in sugar consumption.
To read more
Ted Kyle is a healthcare professional experienced in collaborating with leading health and obesity experts for sound policy and innovation to address health needs and the obesity epidemic in North America. Through ConscienHealth, he works to advance changes in policy and public opinion that will allow new approaches to be developed and put into use.
NEW GI VALUES 18 EMIRATI FOODS
“I welcome this unique set of data, which provide local populations with a practical and more effective way of controlling their blood glucose levels,” says award-winning Registered Dietitian Azmina Govindji (a media spokesperson for the British Dietetic Association and NHS Choices who was Chief Dietitian to Diabetes UK for 8 years).
“Eating well is about enjoyment, nutritional balance, and also cultural appropriateness. There is a growing incidence of diabetes in UAE and up until now, we’ve only had nutritional and GI information on Western-style foods.
Accurate analysis of the glycaemic impact of locally available produce, as well as dishes cooked using traditional methods, can help people with diabetes make more informed choices about local cuisine. This new research will fill an important gap, enabling healthcare professionals to have a more effective means of providing tailored dietary advice.
The data shows, for example, that foods like khameer bread and beef harees perform well on the GI scale, whereas regag bread and beef thareed are best saved for special occasions.”
Test method: For each test food, at least fifteen healthy participants consumed 25 or 50g available carbohydrate portions of a reference food (glucose), which was tested three times, and a test food after an overnight fast, was tested once, on separate occasions. Capillary blood samples were obtained by finger-prick and blood glucose was measured using clinical chemistry analyser. A fasting blood sample was obtained at baseline and before consumption of test foods. Additional blood samples were obtained at 15, 30, 45, 60, 90 and 120 min after the consumption of each test food. The GI value of each test food was calculated as the percentage of the incremental area under the blood glucose curve (IAUC) for the test food of each participant divided by the average IAUC for the reference food of the same participant.
Study
PERSPECTIVES WITH DR ALAN BARCLAY
PURE BUT NOT SO SIMPLE
Most
nutrition experts have been recommending that we enjoy traditional
healthy eating patterns like the Mediterranean and Okinawan diets for
many years now, rather than focusing on single nutrients, ingredients or
food groups. After all, we eat foods, not nutrients, and the
one-nutrient-at-a-time approach is fraught with unintended consequences
as nutrition scientists such as Dr David Katz have enumerated very
clearly on numerous occasions. However, the old fat versus carbohydrate
debate still seems to attract media attention and the recent publication
of the results of the PURE (Prospective Urban Rural Epidemiology) study
are another example of hype over serious dietary substance.
The
PURE study followed over 135,000 people living in 18 countries (three
high-income (Canada, Sweden, and United Arab Emirates), 11 middle-income
(Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, occupied
Palestinian territory, Poland, South Africa, and Turkey) and four
low-income countries (Bangladesh, India, Pakistan, and Zimbabwe) for
over 7 years and found that death rates were highest in those who
reported having the highest carbohydrate intakes, and conversely were
lower in those with higher fat intakes. “Global dietary guidelines
should be reconsidered in light of these findings,” they proclaim.
While
the PURE study may sound impressive, like all observational studies, it
can only show associations (like the Methodist minister and Cuban rum
story). It also has a number of significant limitations, including the
fact that the associations were only observed in the extreme levels of
consumption (43% and 78% of energy from carbohydrates and 11% and 38% of
energy from fats), and that diabetes diagnosis was self-reported (so we
don’t know how many people really had diabetes). Many people in the
low-income countries may have had diabetes but didn’t know it. This
would significantly confound the results. However, one of the most
significant limitations is how they estimated people’s food and nutrient
intakes.
At the very beginning of the study (seven
years in the past), a food frequency questionnaire was used to assess
people’s food intakes. That was the only time people were asked what
they ate. Food frequency questionnaires ask you to recall all the foods
and drinks you consumed over the previous 12 months – a difficult task
for most of us at the best of times (what did you eat last week?). These
questionnaires also have to be carefully designed to reflect the food
preferences of the people being studied – it’s not wise to use a
questionnaire designed for one country in a different country, as food
preferences and the food supply are usually very different. And finally,
food frequency questionnaires need to be validated to see how well they
measure actual food and nutrient intakes. There are many different ways
of doing this. Overall, it’s highly unlikely that the protein, fat and
carbohydrate estimates used in the PURE study are very accurate, which
of course has profound implications for the results and their
interpretation.
Finally, the study looked at the
different kinds of fat (saturated, mono and polyunsaturated) but for
some reason was not able to look at carbohydrate quality – not even
examining the effect of dietary fibre, let alone refined carbohydrates
(both starches and sugars), glycemic index or load. Like fats, all
carbohydrates are of course not the same, and it is not very useful to
lump them all together.
Despite all these significant
limitations, and taking the study’s results at face value, we must
consider how relevant they are in comparison to what the average person
is eating today. In Australia, for example, our most recent national nutrition survey determined that the average adult consumed 43.5% of energy from total carbohydrate and 30.9% from fat. The nutrient reference values
that underpin Australia’s dietary guidelines recommend that Australians
consume 45-65% of energy from carbohydrates from carbohydrates and
20-35% of energy from fats. These ranges are very similar to what are
recommended in the PURE study – our dietary guidelines therefore do not
need updating based on this. We are already eating the minimum amount of
carbohydrate and close to the upper end of the recommended range for
fat. We therefore need to be eating better quality (minimally refined,
high fibre, low GI) carbohydrates, not less, and similarly we need to be
eating more poly and mono-unsaturated fat, not more saturated fat.
This
is all very academic. We eat foods not nutrients. Most people don’t
know what percent of energy they get from protein, fat or carbohydrate.
Patterns of eating are much more useful, which is what most modern
dietary guidelines focus on: recommending that we eat mostly “good
carbs” like fruits, vegetables, legumes, wholegrains, milk and yoghurt
and save refined carbohydrates like sugar-sweetened beverages,
confectionery, savoury starchy snacks (e.g., chips, crisps), etc for
special occasions. Keep it relevant. Keep it simple.
Study
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).
FOOD UN-PLUGGED
GLUTEN-FREE
In August, the Medical Journal of Australia published an article questioning
the existence of non-coeliac gluten or wheat sensitivity. The article
was hot media fodder, with most stories including a medical expert
suggesting that most people avoiding gluten without being diagnosed with
celiac disease didn’t need to do so. The article also concluded that
gluten-free diets carry risks, are socially restricting and are
costlier. We were glad to see this article published and pleased to see
this issue being raised because we’ve being saying something similar for
years.
While a gluten free diet is the only treatment
for people with coeliac disease, there are many that claim going
gluten-free is the magic bullet to weight loss and optimum health for
everyone. While there is no good evidence to back this up and a growing
number of studies now suggesting it might have adverse effects in the
long run, the marketing horse has already bolted and gluten-free foods
are a large and growing category. We thought we’d take a closer look at
them.
Gluten is a stretchy protein found in grains such
as wheat, rye, oats, barley and triticale. This protein gives bread the
ability to rise and form a light airy loaf. Gluten-free food
alternatives are often made with starches and additives rather than
wholegrain flours. It is perhaps no surprise that one review
found that gluten-free diets are often lower in fibre and higher in
saturated fat. This review also noted that gluten-free diets tend to
have a higher glycemic index (GI). This is not helpful for overall
metabolic health and may leave you feeling hungrier sooner.
We
compared the nutritional value of a muesli bar, mixed grain bread, and a
flaked breakfast cereal compared with their gluten-free variants.
Because
the serve sizes aren’t the same, it’s hard to make direct comparisons
about kilojoules/calories, but there’s not a lot in it. Two significant
differences stand out. When it comes to protein, regular trumps gluten
free by a significant margin. The same goes for dietary fibre (something
most of us need a lot more of).
The down sides of gluten-free
Another
factor to consider is the glycemic index (GI) of food. While the
glycemic index of the bread we refer to above has not been tested,
another similar gluten-free multigrain bread on the market was found to have a high GI (79). Many regular wholegrain breads have a low-medium GI, including this one with a low GI (53). Low GI foods give you more stable blood glucose levels following your meal.
Gluten-free
diets tend to be low on grains that are an important source of B
vitamins. For example, folate is essential prior to and during pregnancy
to help reduce the risk of neural tube defects, and folate is also
important for heart health.
Studies have shown that eating wholegrains regularly protects against type 2 diabetes and coronary heart disease. Avoiding gluten unnecessarily in the pursuit of good health may have the opposite effect.
The un-plugged truth
- The gluten-free diet is essential for people with celiac disease, but unlikely to be of benefit for the rest of us.
- A gluten-free diet should only be undertaken after a confirmed diagnosis and best managed with the help of a qualified dietitian.
- Gluten-free foods can be less healthy: lower in protein and fibre, and higher GI.
Nicole Senior Nicole Senior pulls the plug on hype and marketing spin to provide reliable, practical advice on food for health and enjoyment. She is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.
Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.
KEEP GOOD CARBS AND CARRY ON
CAPSICUMS (SWEET PEPPERS)
Speedy underestimates the rate at which the Old World embraced the New’s zesty chilli. Try these hot peppers (pimiento) said Columbus proudly introducing them in 1493 – after all pepper (pimento or
black pepper) was what he was looking for (well, he possibly said
something like that). Within two hundred years they were widely
cultivated throughout Europe, Asia and Africa as the tongue-tingling
spice we know today.
At the same time a mild, sweet variety of capsicum was also evolving.
And what a veg. Red, orange, yellow, green, purple: capsicum’s crisp,
juicy flesh sets the taste bar high. It’s no wonder they have made
themselves at home in kitchens around the world sliced or diced into
salads, or stuffed, stir fried, roasted, and often peeled which is not
as hard to do as it sounds. Just hold them over a gas flame with metal
tongs or place under a very hot grill or on a lightly oiled tray in a
hot oven until the skin is charred then drop into a plastic bag and
seal. When cool, the skin will slip off easily. If you don’t have time
to do this, you can buy them ready prepared from your favourite deli
counter. There are numerous good brands of jarred “fire-roasted” peeled
strips in olive oil.
What to look for
Red, orange and yellow capsicums are not only sweeter than regular
green ones, but they keep their colour better when cooked. Select well
shaped, firm and glossy capsicums with bright, taut skins and their
stems fresh and green. Watch out for soft spots, wrinkled skin or
blemishes (that means they are starting to dry out). Select capsicums
that are firm and glossy with a uniform colour. Avoid any with dull or
wrinkled skin, spots or blemishes.
Store unwashed capsicums in a plastic bag in the fridge so they keep
their crunch and sweetness. If you have picked up a plastic wrapped tray
for a bargain price, unwrap them when you get home as they need to
breathe a bit.
What’s in them? A medium raw
capsicum (about 90 g or 3 oz) has about 80 kilojoules (19 calories),
1.5g protein, 0g fat, 3g carbs (sugars), 1g fibre, 2mg sodium, 135mg
potassium and a low GI (estimated) as they have no starch. They are one
of the best sources of vitamin C around.
Some like it hot The
hot comes from capsaicin, which is found in its highest concentration
in the chilli’s seeds and fleshy “placenta” material that is joined to
the seeds says Spice and Herb Bible guru Ian Hemphill. It blows your
mind because it releases endorphins which create a sense of wellbeing
and stimulation. In spite of the inordinate preoccupation with heat in
chillies, the tremendous flavour contribution made by dried chillies
should not be overlooked says Ian. And there’s more. Research in recent
years has provided some evidence that capsaicin can raise your metabolic
rate. A meal containing freshly chopped chilli may also help reduce
insulin levels. What’s not to like?
Extract from The Good Carbs Cookbook published by Murdoch Books and available online and in good bookstores.
IN THE GI NEWS KITCHEN
SPICE IS NICE
This
month Kate Hemphill showcases three spice blends – sambar curry powder,
paella spice mix and Creole seasoning – from the Herbies range that
transform simple, relatively inexpensive family meals – a burger, a
one-pot stew and stuffed peppers – into something you could serve for a
more special occasion.
STICKS, SEEDS, PODS and LEAVES
Kate
Hemphill is a trained chef. She contributed the recipes to Ian
Hemphill’s best-selling Spice and Herb Bible. You will find more of her
recipes on the Herbies spices website. Or you can follow her on Instagram (@herbieskitchen). Kate uses Herbies spices and blends, but you can substitute with whatever you have in your pantry.
STUFFED CAPSICUMS LOUISIANA STYLE
The
Louisiana-style seasoning works amazingly with this healthy and
flavoursome dish, giving the rice, beans and corn a huge lift. For meat
lovers, serve alongside beef, lamb or chicken grilled with a sprinkle of
the seasoning. Prep time: 10 mins • Cook time: 1 hour • Makes: 6
1½ cups low or lower GI brown rice (such as Doongara or brown basmati)
6 capsicums, top cut off and seeds removed
1 red onion, finely chopped
2 cloves garlic, finely chopped
2 tbsp Creole seasoning
2 ripe red tomatoes, peeled and diced
½ cup corn kernels
400ml (14oz) can black beans, rinsed and drained
Pre-heat
oven to 170C (340F). • Rinse rice and cook until tender, drain. •
Meanwhile, sweat onions in a little olive oil until soft, then add
garlic and spices. Stir for one minute, then add tomatoes, cooked rice,
corn and black beans. Combine well and taste for seasoning. • Firmly
stuff the capsicums with rice mixture, place lids on top, and bake for
40 minutes, or until capsicum is tender when pierced.
Per serve
1445kJ/345
calories; 14g protein; 2.5g fat (includes 0.5g saturated fat; saturated
: unsaturated fat ratio 0.25); 60g available carbs (includes 14g sugars
and 46g starches); 13g fibre; 455mg sodium; 967mg potassium; sodium :
potassium ratio 0.47
INDIAN LAMB BURGER
These
burgers make great picnic or party food cooked bite-size and served
with raita. You can use any of Herbie’s many Indian spice blends in
these burgers, depending on your mood. The mild sambar powder used here
is perfect for younger children. Prep time: 15 mins • Cook time: 10 mins
• Serves: 6
500g (1lb 2oz) lean lamb mince
1½ tbsp sambar powder
½ tsp salt
1 egg
1 tbsp grated brown onion
1 tsp grated fresh ginger
1 garlic clove, crushed
1 cup Greek yoghurt
1 small cucumber, diced
8 mint leaves, finely chopped
To serve
Turkish bread or burger buns
½ cup mango chutney
2 cups mixed salad leaves
fresh onion and mint for garnish, optional
For
burgers, pulse all ingredients in a food processor, or mix well in a
large bowl with your hands. Shape into 6 burgers and refrigerate until
ready to cook (up to 24 hours). • Combine the yoghurt, cucumber and mint
to make the raita and season to taste. • Heat a grill or barbecue and
cook burgers for 5–6 minutes per side. Allow to rest for 2 minutes
before assembling burger. • Lightly toast bread or bun, if desired, and
top with raita, chutney, salad leaves, burger and garnish fresh onion
rings and mint leaves.
Per serve (with Turkish bread)
1200kJ/290
calories; 23g protein; 9g fat (includes 4g saturated fat; saturated :
unsaturated fat ratio 0.8); 28g available carbs (includes 18g sugars and
10g starches); 3.5g fibre; 450mg sodium; 580mg potassium; sodium :
potassium ratio 0.78
SPANISH CHORIZO and BEAN STEW
One
pot stews are perfect for cooler days, and this dish benefits from a
long, slow cook. This is a great dish to prepare ahead and it reheats
well after storing in the fridge or freezing. Tip: check how hot your
chorizo is, you may like to add some chilli powder if it is mild. Prep
time: 10 mins • Cook time: 2 hours • Serves: 8
1 tbsp olive oil
2 red onions, finely chopped
4 cloves garlic, crushed
2 red bell peppers (or red capsicum) cut into 2cm pieces
¼ cup sherry vinegar
2 tbsp paella spice mix
2 x 400ml (14oz) cans crushed tomatoes
2 x 400ml (14oz) cans cannellini beans, drained
4 small semi-dried chorizo sausages (cooking chorizo), approx 400g (14oz), cut into ¾in (2cm) thick slices
flat leaf parsley
Preheat
oven to 120C (300F). • Sweat onions in olive oil in an ovenproof dish
on the stove top over low heat. Add garlic and capsicum once onions are
soft. Pour in sherry vinegar and stir until evaporated, then add spice
mix, tomatoes, beans and 1½ cups water. • In a large frying pan over
high heat, briefly brown chorizo then add to stew. • Bring stew to a
simmer, stirring, then place in the oven with a lid. Cook for 1½–2 hours
until chorizo is meltingly tender. Check for seasoning and serve with
parsley.
Per serve
1400kJ/335 calories;
20g protein; 15.5g fat (includes 5g saturated fat; saturated :
unsaturated fat ratio 0.48); 22g available carbs (includes 11g sugars
and 11g starches); 12g fibre; 790mg sodium; 840mg potassium; sodium :
potassium ratio 0.94
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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au and http://ndb.nal.usda.gov/ndb/search.
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