In April, the American Journal of Clinical Nutrition published a study linking diet soda consumption to an increased risk of diabetes and heart disease. Nobody blinked or cared because this research was just going to be thrown on the pile of allegedly conflicting studies about the safety of artificial sweeteners, particularly aspartame. This pile is referred to as the “aspartame controversy.”
Aspartame is the artificial sweetener sold under the brand names of Equal and NutraSweet. It is used commonly in diet sodas because it tastes the most like sugar, or at least that is what the people selling it say. Despite all the hype about controversy, there is no aspartame controversy. All of the aspartame-industry-sponsored research consistently concludes aspartame is safe, while the independent studies overwhelmingly find side effects and problems. There is no gray area between the two sides. Every study connected to those who sell it says aspartame is safe while the independent studies find concerns. The controversy is really over whether research funded by special interest groups is valid.
Mere mortals, like myself, might be tempted to ignore inconvenient facts if my livelihood or survival were threatened. When I was a teenager, I worked at a family restaurant famous for its generous portions of homemade pies and cheesecake. As a newbie waitress, I was surprised when customers would order dessert while insisting I bring artificial sweetener (saccharine, at that time) with their coffee.
How could any one believe forgoing the 16 calories in a sugar packet (I looked it up) would balance out the 500-plus calories in the coconut cream pie? Since these customers were kindly funding my college education through generous tips and the base salary at the time was $1.15 an hour, I wisely held my tongue. Instead, I asked them if they wanted whipped cream with their Heath bar cheesecake. (“Just a little,” was the usual response.)
At the time, I did not understand why people were counting calories. I grew up in a rural area in the 70s. Everybody I knew guzzled whole milk, and in my family, ice cream was a food group; yet few people were obese. I remember our amazing high school girls’ basketball team. My friend, Nina, was the only one who did not look like she could bench press a Holstein. The girls were tall, fit and strong but there was not a calorie counter among them.
Now, 30-something years later, the average 9-year-old understands calorie-counting, yet a near obsession level with the content of food only seems to be feeding the weight gain epidemic. Despite easy availability of reduced calorie and artificially sweetened food/beverages we are expanding by the minute so that 68 percent of Americans are now overweight.
Caloric sweeteners like sugar and corn syrup certainly deserve some of the blame. Their consumption increased almost 40 percent between the 50s and 1999, when peak consumption levels reached a pancreas-busting 155 pounds per person per year — or 52 teaspoons of sugar a day. Or one of those rain-barrel-sized drinks they sell with your hexane-laced burger at the drive-through. But that is another story. Since 2000, sugar intake has reduced slightly due to a minor decrease in corn-syrup sweetened soda-slurping.
But the diet drink industry is booming.
The primary non-caloric sweetener used in diet sodas and teas is aspartame. Obviously, aspartame (introduced in 1974) and its buddies are not helping people lose weight because as a society, the more diet soda we consume, the heavier we seem to get. The reason for this phenomenon has been consistently found in independent research. That is, the taste for sweets, whether delivered by sugar or artificial sweeteners, enhances appetite. The only people who seem to think diet sodas help with weight loss are the manufacturers and some registered dietitians (RDs).
A majority of RDs recommend artificial sweeteners to their clients. The American Dietetic Association has consistently supported the use of aspartame and in an “evidence-based study” attempted to bust lingering concerns about aspartame. The study reportedly concluded aspartame does not cause side effects, including weight gain. The dietitians claimed to be working independently even though some of the funding for the study came from the aspartame industry. And they want you to know the fact that the aspartame industry has generously supported the ADA through the years has no bearing on their recommendations or research. Pie, anyone?
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Article source: http://www.huffingtonpost.com/kelly-dorfman/aspartame_b_1674707.html
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By Chris Kaiser, Cardiology Editor, MedPage Today
Published: June 12, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
original STAMPEDE trial, reported at the 2012 American College of Cardiology meeting, showed that either of the two surgical techniques plus optimal medical therapy was better than optimal medical therapy alone at controlling type 2 diabetes.
At 12 months, more surgical patients had hemoglobin A1c levels of 6% or less compared with those in the medical therapy arm.
In this substudy, researchers analyzed data from the first 20 patients randomized to each arm (the dropout rate was 10%).
Kashyap noted that patients were in their late 40s with a mean BMI of 36. The average duration of diabetes was from 7 to 10 years. Many were on three or more medications and had metabolic syndrome, and more than half were already taking insulin.
Researchers performed a Mixed Meal Tolerance Test to determine the glucose metabolism. At baseline, both surgical groups started at 150 mg/dL and finished at 250 mg/dL. At two years, however, the bypass patients had normal glucose levels at around 85 to 90 mg/dL.
“This is remarkable. It’s almost like seeing a flatline for the heart and then seeing a normal heart wave. This is really exciting to an endocrinologist,” Kashyap told MedPage Today.
Those in the sleeve gastrectomy arm saw only intermediate glucose effects (150 mg/dL), even though they lost the same amount of weight, she said.
Interestingly, both surgical groups had positive effects for insulin production, but the bypass group had a significant 3.5-fold increase in insulin sensitivity, from 1.5 mg/min at baseline to 5.2 mg/min at 2 years (P0.001). The sleeve group had a less significant improvement in insulin sensitivity (from 3.9 to 5.7 mg/min, P=0.05).
Beta cell function, measured with the oral disposition index, increased 5.3-fold in the bypass group (P0.001) and twofold in the sleeve group, the latter being similar to the medical therapy group.
Researchers also found that the bypass group had better glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) responses. These two hormones are responsible for the secretion of insulin after eating.
Kashyap said that these last two findings are particularly important because insulin production leads to normalization of glycemia.
“But it’s not just the incretin effect because we saw that effect with the sleeve group whose remission rates were not that great,” she said. “We think body composition is the key. The fact that they’re melting away truncal fat helps them be more sensitive to insulin and to produce more of it, which is restoring normal glucose metabolism.”
The original STAMPEDE trial was funded by Ethicon Endo-Surgery, the National Institutes of Health, and LifeScan.
Kashyap reported a relationship with Ethicon Endo-Surgery. Her co-authors reported relationships with Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, sanofi-aventis, Medtronic, Ethicon, Covidien, Orexigen Therapeutics, and Vivus.
Primary source: American Diabetes Association
Source reference:
Kashyap SR, et al “STAMPEDE metabolic substudy: Effects of bariatric surgery vs. intensive medical therapy on glycemic control, ß-cell function and body composition in type 2 diabetes” ADA 2012; Abstract 123-LB.
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Chris Kaiser
Cardiology Editor
Chris has written and edited for medical publications for more than 15 years. As the news editor for a United Business Media journal, he was awarded Best News Section. He has a B.A. from La Salle University and an M.A. from Villanova University. Chris is based outside of Philadelphia and is also involved with the theater as a writer, director, and occasional actor.
Related Article(s):
- ACC: Surgery Bests Drugs for Obese Diabetics
Article source: http://www.medpagetoday.com/MeetingCoverage/ADA/33240
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By Chris Kaiser, Cardiology Editor, MedPage Today
Published: June 12, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial was stopped prematurely in 2008 because of a 22% excess mortality.
Two ACCORD substudies found no cardiovascular benefit for adding fenofibrates to statin therapy or for intensely lowering blood pressure.
The current post hoc study examined the 4,687 participants from the ACCORD Blood Pressure Trial substudy to determine if central obesity had an impact on cardiovascular events.
Researchers had access to waist circumference measurements, but the hip circumference was not measured in ACCORD. So they used the waist-to-height ratio instead, which “has been validated as a marker of cardiovascular disease outcomes related to central obesity,” Barzilay said.
He noted that a waist-to-height ratio of less than 0.50 is associated with less cardiovascular risk than one above that level. In this analysis, the mean waist-to-height ratio was 0.60 and women had higher ratios than men.
Baseline characteristics between the those receiving intensive and conventional blood pressure treatment were similar, with the average age being 62 and two-thirds of the participants being white.
The mean body mass index was 32 kg/m2, waist circumference 41 inches, and height 5 feet 6 inches.
The study is limited by its post hoc nature, the modest number of outcomes (about 7% primary outcomes per year), and the short follow-up, researchers said.
The study received support from the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Eye Institute. The ACCORD study received funding from the Centers for Disease Control and Prevention.
Medications were provided by Abbott Laboratories, Amylin Pharmaceutical, AstraZeneca Pharmaceuticals, Bayer HealthCare, Closer Healthcare, GlaxoSmithKline, King Pharmaceuticals, Merck, Novartis Pharmaceuticals, Novo Nordisk, Omron Healthcare, sanofi-aventis U.S., and Takeda.
No other relevant conflicts of interest were reported.
Primary source: Diabetes Care
Source reference:
Barzilay JI, et al “Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes” Diabetes Care 2012; 35: 1401-1405.
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Chris Kaiser
Cardiology Editor
Chris has written and edited for medical publications for more than 15 years. As the news editor for a United Business Media journal, he was awarded Best News Section. He has a B.A. from La Salle University and an M.A. from Villanova University. Chris is based outside of Philadelphia and is also involved with the theater as a writer, director, and occasional actor.
Related Article(s):
- ADA: ACCORD Diabetes Trial a Complete Bust
- ACC: Close Lipid and BP Control Fail in Diabetes
Article source: http://www.medpagetoday.com/MeetingCoverage/ADA/33218
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