ADA released the blacklist: these beverages must not be drinked!

ADA released the blacklist: these beverages must not be drinked!  On June 9th, the ADA annual meeting reached the third day. Compared with the previous “food-oriented”, the “drinking” part of the “diabetes-related dietary structure intervention” has announced multiple results this year.

What drink is prone to diabetes? What can you drink to prevent diabetes? What should diabetic patients drink? Two experts from Harvard University’s School of Public Sustainability, Jean-Philippe Drouin-Chartier and Derrick Johnston Alperet, gave us the answer.

01   Stay away from all sweet drinks

In order to solve the problem of sugar-sweetened beverages, major manufacturers have introduced seemingly healthy “zero”, “diet” and “sugar-free (but sweet)” drinks with artificial sweeteners, and because they have solved the problem of “sugar” The problem is declared “healthy”.

In fact, more and more studies have proved that the harm of artificial sweeteners is not small. In terms of the risk of type 2 diabetes, it is almost the same.

As shown in the figure above, the Drouin-Chartier report shows that through the analysis of several large cohort studies, the results are as follows: The left column shows that daily sugary drinks can increase the risk of type 2 diabetes by 28%, while the right It is a beverage containing no sugar but artificial sweeteners, which increases the risk of diabetes by 29%…

In the middle is 100% juice with the same label of “health”, which increases the risk of diabetes by 10%.

This is the evaluation data released by BMJ in 2016. In order to verify whether this data is effective in dynamic changes (in other words, what he wants to verify is: if you increase or decrease the consumption of the above-mentioned beverages, the risk of type 2 diabetes will not change), Drouin-Chartier selected several American medical services Personnel database to investigate.

The above picture shows the data and information extracted from the experiment, which come from the American Nurses’ Health Study, Medical Staff Follow-up Study, and NHS II. The data of the enrolled persons are more than 120,000, more than 50,000, and more than 110,000, and the time span is from 1978 to 2018.

The result trend is basically the same as BMJ’s risk assessment.

This is the case of sugary drinks-

The definition in the figure is to drink more than 8oz a day (about 226mL, a typical cola is 330mL a can), and drink less than 8oz a week (that is, you can’t drink a can of sugary drinks a week).

The risk of always drinking less is set to 1. After analyzing the data for 4 years before and after, he found that from drinking less to drinking more, the risk of diabetes was 1.15 (that is, 15% higher than people who basically did not drink); from drinking more to drinking less, The risk of diabetes is 1.09; if you keep drinking too much, the risk of diabetes is high, 1.23.

It can be seen that if you have not started to drink sugary drinks, do not start, because the risk of diabetes will rise by 15% in 4 years; if you are used to drinking, stop quickly, it can be saved, 1.09 is still a very significant drop from 1.23.

If the results of sugary drinks are in line with everyone’s expectations, then the results of fruit juice and sugar-free drinks with artificial sweeteners will be more cruel.

It is still consistent with the assessment direction of BMJ, even if it is 100% pure fruit juice, increasing the consumption will still increase the risk of type 2 diabetes.

On the right is the juice data. Drinking more than 30mL a day can effectively increase the risk of diabetes. So 100% pure fruit juice (the kind without additional sugar, many on the market called “pure juice” do not meet this standard, should be classified as sugary drinks), even if it is called “healthy”, if you don’t drink too much now (Drink less than 100mL a week), don’t increase it later…

So what about artificial sweetener beverages whose harm does not lose to sugary beverages in the BMJ assessment?

Similarly, if you change from basically not drinking to drinking more than 100 mL a day, the risk of type 2 diabetes will increase by 20% in 4 years.

02   How should we drink drinks?

Regarding the drink strategy, Drouin-Chartier gave a very simple and clear picture. The green square in the picture represents the correct operation to reduce the risk of type 2 diabetes——

To put it simply, “white water”, “coffee (no sweetness)” and “tea (no sweetness, iced tea on the market, etc.) are used instead of sugary drinks), which are completely sugar-free and unsweetened. Sugar or sugar-free beverages with sweeteners.

To put it bluntly, stay away from sweetness.

As for what to do with 100% juice, let’s talk about it later.

03  Why are sugar-free sweet drinks so terrible?

Alperet, also from the Harvard School of Public Health, is also conducting research in this direction. His research sample is adolescents (high school students) in Singapore. In terms of living habits and ethnicity, it can be said that the characteristics of our Chinese population are closer.

(Alperet’s research poster presentation)

In his research results, adolescents who choose to drink more sugar-free soda drinks with artificial sweeteners have a 58% higher risk of developing type 2 diabetes, even higher than those who use sugary drinks incrementally. And if pregnant women drink more sweetener soda during pregnancy, it will also increase the risk of overweight or obesity in their offspring during childhood.

In response to this result, “Medical Circle” interviewed Alperet.

“Medical Circle”: Your research shows that sugar-free soda with artificial sweeteners will increase the risk of diabetes and is more dangerous than ordinary sugar-containing soda. Why is this?
Alperet:
There are several reasons for this.

First, sweeteners have no calories. After you drink it, your body will not get energy, and you will continue to be hungry, so you have to eat to supplement it.

Second, the psychological and behavioral impact, because it tells you “no calories” and “0 calories”. After you drink it, if you are not as guilty as drinking a high-calorie sugary beverage, of course it will be more guilty than feeling guilt. The situation eats more.

Third, the sweetness of sweeteners is much higher than that of real sugar, which is rarely noticed by consumers. This may cause our brain to receive a strong stimulus signal and order the body to secrete the corresponding hormones when there is no sugar, causing our hormones, especially those related to diabetes, to become disordered and increase the risk of T2D. In addition, research on CELL pointed out that artificial sweeteners can disturb the intestinal flora and also cause disorders of the digestive glands. This may be the physiological mechanism that leads to increased diabetes risk.

However, this is not to say that we should choose sugary drinks-a harmful diet with less harm is still a harmful diet!

Interestingly, we found that in Alperet’s research, juveniles are beneficial to drinking juice, which can reduce their risk of developing diabetes in adulthood. The trend of this result is contrary to the results of Drouin-Chartier’s research on adults. On this point, we interviewed them separately.

“Medical Circle”: Your colleague Derrick Johnston Alperet also did research on beverages. In his research, fruit juice is good for preventing adult diabetes in adolescents. What do you think about this?
Drouin-Chartier: I think the key issue in this matter is the difference between teenagers and adults. The hormone secretion and body metabolism of adolescents are very different from those of adults, especially middle-aged and elderly people. This may be a reason. But another more important reason is that teenagers themselves eat fruits better than adults. Many adults directly drink fruit juice instead of eating fruit. The sugar intake in the fruit has not decreased, but the food in it is not consumed. Fiber, and if you use fruit juice instead of fruit, you will eat more sugar. I think this is the reason for the difference.

“Medical Circle”: Why does fruit juice increase the risk of diabetes among adults, but it is beneficial among teenagers?

Alperet: This may be related to the composition of the juice. Among the juice sources I sampled for teenagers, the main source is distributed by the school. I think this may be due to the fact that the juiced fruit selected by the school has a lower sugar content, or that the juice of the school also retains more fiber content. Adults buy fruit juice from the market. In order to make the juice drink better and sell better, they will choose fruit with more sugar to increase the taste. But this is just my guess. We need to further study this difference, such as analyzing the composition of the juice obtained by the sample population.

This answer also reminds us of a truth: all fruits are equal, but some fruits are more equal… well, healthier.

04   You can have more low-fat dairy products!

After reading the above, what else can I drink? You can drink yogurt (low-fat, sugar-free and sweetener-free)! You can also have a glass of milk (low-fat, sugar-free and sweetener-free)!

In general, eating more dairy products will help reduce the risk of diabetes, while insufficient intake of dairy products will increase the risk of diabetes…

(Taking 226g of dairy products a week has a diabetes risk of 1. If you reduce the intake of dairy products to almost no consumption, the risk of diabetes will increase significantly)

However, not all dairy products have the same harm caused by the reduction of intake. For example, reducing the intake of low-fat dairy products will increase the risk of diabetes, but high-fat dairy products do not matter, and may also reduce the incidence of diabetes to a certain extent. risk.

(On the left is low-fat dairy products. If you reduce your intake to basically not eaten, you can increase the risk of diabetes by 10%. On the right is high-fat dairy products, without this risk)

The difference between low-fat milk and whole milk is the same as the trend above.

In addition, there are differences between different dairy products, such as yogurt (without sugar), increasing from about 60g per week to more than 60g per day can significantly reduce the risk of diabetes. But if it is cheese, increasing intake will not reduce the risk of diabetes, eating more will only increase the risk…

(Cheese on the left and yogurt on the right. You can see that the risk of disease goes down after the yogurt increases, while the cheese goes up)

Having said that, how should dairy products be consumed? Drouin-Chartier also told us the tips for ingesting dairy products:

• Eat more low-fat dairy products and less high-fat dairy products;
• Eat more yogurt (no sugar and no sweeteners) and less cheese;
• Choose low-fat milk.

In short, do not drink sweet (artificial sweeteners are not good either), do not drink fruit juice instead of eating fruit, try to choose healthier fruit. Low-fat milk and yogurt are helpful to reduce the occurrence of diabetes, and you can develop a habit of taking it every day.

(source:internet, reference only)

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