Yogurt consumption has been associated with numerous health benefits, which can be explained by indirect effects – yogurt is associated with a healthier lifestyle – but also by intrinsic characteristics of this fermented food, such as lactic ferments. Dumas et al. reviewed randomized controlled trials (RCTs) that assessed effects of yogurt on metabolic risk markers of chronic diseases in adults.

RCTs, the gold standard

Their work focuses only on “real yogurt”, which contains Lactobacillus bulgaricus and Streptococcus thermophilus (LBST), which were used as a treatment in randomised controlled trials (RCTs), the “gold standard” in evidence based medicine. They have identified seven RCTs, involving 278 participants, which met the inclusion criteria. Among these studies, two reported that LBST yogurt significantly improved several parameters: they showed a reduction of total cholesterol concentrations and the ratio of total cholesterol to HDL-C, and plasma glucose.

More studies are needed

However, the authors pointed out the weakness of the conclusions that can be drown from this analysis, as most selected RCTs presented methodological risks of bias. LBST yogurt shows in this review either favorable or neutral effects on metabolic risk markers, but the effects of yogurt consumption per se on risk markers of chronic diseases need to be confirmed by high-quality RCTs.

To learn more, read the original article.

Source: Dumas et al., European Journal of Nutrition 2016 ; 1-18.

Penny Brooks is a Registered Dietitian, who at the age of 12 was diagnosed with prediabetes, which she reversed within a year. Based on her personal experience and expertise in nutrition, she discusses the health benefits of the full fat dairy option in the context of obesity, diabetes, and cardiovascular disease.

Since the 1940’s the concept of a low-fat diet has been promoted to decrease one’s risk of or improve weight loss and cardiovascular disease. This belief has been reflected in American consumer beverage trends especially among adults 60 years of age and older. It was noted that full-fat dairy was being exchanged for lower fat options such as low-fat and skim milk over the past several years.

Obesity, diabetes, and cardiovascular disease are interrelated conditions through consistently high insulin levels

With nutrition science as a dynamic and constantly evolving discipline, emerging evidence now is debunking fat as being the progenitor of obesity, diabetes, and cardiovascular disease in the diet where the culprit was actually discovered to be sugar and refined carbohydrates. As a result, the theory of low-fat diets for prevention and treatment of these conditions has been the center of much criticism recently. Research conducted using high-fat low-carbohydrate diets demonstrate promise and positive outcomes to assist in preventing and managing these conditions more effectively that align with current and updated nutrition science.

Obesity, diabetes, and cardiovascular disease are interrelated conditions mainly through their common denominator: high and consistently stimulated levels of insulin. So what foods affect insulin the most?

• Fat (from animals or plants): a nutrient that helps to slow digestion (helps you feel full and satisfied), and does not promote a substantial rise in insulin or blood sugar.
• Carbohydrates (starches, sugars, complex carbohydrates, and refined carbohydrates): a class of nutrients that promote an increase in blood sugar and stimulate a rise in insulin. Complex carbohydrates take a longer time to digest so it does not cause as fast of a rise in blood sugar and insulin as the others.

Additionally, high blood sugar levels can interact negatively with body proteins

Insulin is then related to obesity, diabetes, and cardiovascular disease since as a hormone, when it is regularly present at high levels in the blood throughout the day, one of its many roles is that it promotes fat creation and storage. Weight gain and extra fat on your body naturally increases your risk of diabetes and cardiovascular disease. And it makes it more difficult to manage these conditions.

Additionally, high blood sugar levels can interact negatively with body proteins (e.g. blood vessels) and fat (part of our cells and organs). High blood sugar levels compromise these proteins and their optimal function. Blood vessels makeup our entire cardiovascular system and individual organs. So when you take into consideration the potential compounded damage from both high blood sugar and high insulin levels, over time when organs such as the pancreas and blood vessels are sufficiently affected, this deterioration can increase our risk for or worsen current management of cardiovascular disease and diabetes.

Shifting to buying more full-fat dairy over lower fat options demonstrates to be a wise decision based on recent research

With the aforementioned information in mind let’s take a look at the composition of lower-fat dairy vs. full-fat dairy:

• Skim/low-fat dairy: has a higher ratio of milk sugar and carbohydrate with negligible fat since the fat is removed (skimmed out) during processing. Since fat-soluble vitamins are in the fat, and these vitamins need fat in order to be properly absorbed and metabolized, these vitamins are also taken out with this process, so you miss the nutritional benefit of these lost vitamins.
• Full-fat dairy: has a higher ratio of fat to carbohydrate and milk sugar, and contains fat-soluble vitamins.

So if you currently eat and enjoy dairy in your diet and you’re trying to prevent or better manage your diabetes, cardiovascular disease, and weight gain, shifting to buying more full-fat dairy over lower fat dairy options demonstrates to be a wise decision based on recent research.

That’s right: fat is back on the menu! And because fat is naturally flavorful, rich, and satisfying, you may find that your hunger and appetite may be better controlled throughout the day. As a consequence you may not feel as great the temptation or desire to snack on less healthful options. Eating healthy should not feel as though you are starving or depriving yourself of things you love. It’s about finding that balance of eating things that you actually enjoy that also happen to be great for you and help meet your health goals.

As a former prediabetic patient I’m all about win-win situations!

Feel free to try my favorite way of having yogurt using the new information you learned in this article for your next breakfast or snack:

-1 C of your favorite full-fat plain unsweetened yogurt that has “live active cultures” (also known as healthy bacteria) in the ingredient list. Unfortunately, not all yogurt has this gut-promoting bacteria so be sure to look out for it!

-2 Tbsp of walnuts

– ¼ C chopped pieces of 70% or greater cocoa dark chocolate (feel free to get adventurous and try a different type of dark chocolate until you find your favorite.)

– ½ C mixed berries: raspberries, blueberries, blackberries, and strawberries

-Have a sweet tooth? Feel free to sprinkle a weight loss, diabetes, and cardiovascular-friendly sweetener such as Truvia or stevia. Or even fragrant spices like cinnamon* and pumpkin spice.

*Cassia cinnamon in particular has the added benefit in research of helping to reduce blood lipid levels, fasting blood sugar levels, hemoglobin A1c, and postprandial (after meal) insulin levels. To date in clinical studies 6g/day appears to be the highest level that has been tested in humans with safe and beneficial results. Results from these studies demonstrate promise and effectiveness for improving diabetes and cardiovascular outcome measures without reported side effects or negative interactions with medication. So to be on the safe side, don’t use Cassia cinnamon in excess of more than 6g/day since more than 6g/day has yet to be evaluated in research. And because at very high levels, it can be toxic to the liver. This is especially true in patients who currently have liver problems. As a reference 1 teaspoon of cinnamon is equal to about 3g so don’t worry: you should be fine with a couple teaspoons in your yogurt, so enjoy!

---

References

1. Keys A, Grande F. Role of dietary fat in human nutrition III—diet and the epidemiology of coronary heart disease. Am J Public Health Nations Health. 1957; 47(12): 1520-1530.
2. Andrade J, Mohamed A, Frohlich J, Ignaszewski A. Ancel Keys and the lipid hypothesis: from early breakthroughs to current management of dyslipidemia. BCMJ. 2009; 51(2): 66-72.
3. Kromhout D, Bloemberg B, Feskens E, Menotti A, Nissinen A. Saturated fat, vitamin C and smoking predict long-term population all-cause mortality rates in the Seven Countries Study. Int J Epidemiol. 2000; 29(2): 260-265.
4. Ball KP, Hanington E, McAllen PM, et al. Low-fat diet in myocardial infarction: a controlled trial. Lancet. 1965; 286(7411): 501-4.
5. Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav. 2010; 100(1): 4-9.
6. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010; 91(3): 535-546.
7. Ebbeling CB, Swain JF, Feldman HA, et al. Effects of dietary composition during weight loss maintenance: a controlled feeding study. JAMA. 2012; 307(24): 2627-34.
8. Mozaffarian D, Ludwig DS. The 2015 US Dietary Guidelines lifting the ban on total dietary fat. JAMA. 2015; 313(24): 2421-2422.
9. Ludwig DS. Lowering the bar on the low-fat diet. JAMA. 2016; 316(20): 2087-2088.
10. Independent experts find no grounds for retraction of The BMJ article on dietary guidelines. The British Medical Journal Web site. http://www.bmj.com/company/wp-content/uploads/2016/12/the-bmj-US-dietary-correction.pdf Published December 2, 2016. Accessed December 2016.
11. Akilen R, Tsiami A, Devendra D, Robinson N. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diabet Med. 2010; 27(10): 1159-1167.
12. Hlebowicz J, Hlebowicz A, Lindstedt S, Björgell O, Höglund P, Holst JJ, Darwiche G, Almér LO. Effects of 1 and 3 g cinnamon on gastric emptying, satiety, and postprandial blood glucose, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin concentrations in healthy subjects. Am J Clin Nutr. 2009; 89(3): 815-821.
13. Khan A, Safdar M, Khan MMA, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003; 26(12): 3215-3218.
14. Lu T, Sheng H, Wu J, Cheng Y, Zhu J, Chen Y. Cinnamon extract improves fasting blood glucose and glycosylated hemoglobin level in Chinese patients with type 2 diabetes. Nutr Res. 2012; 32: 408-412.
15. Mang B, Wolters M, Schmitt B, Kelb K, Lichtinghagen R, Stichtenoth DO, Hahn A. Effects of a cinnamon extract on plasma glucose, HbA1c, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006; 36: 340-344.
16. Sharma P, Sharma S, Agrawal RP, Agrawal V, Singhal S. A randomised double blind placebo control trial of cinnamon supplementation on glycemic control and lipid profile in type 2 diabetes mellitus. Aust J Herb Med. 2012; 24(1): 4-9.
17. Solomon TP, Blannin AK. Changes in glucose tolerance and insulin sensitivity following 2 weeks of daily cinnamon ingestion in healthy humans. Eur J Appl Physiol. 2009; 105(6): 969-976.
18. Crawford P. Effectiveness of cinnamon for lowering hemoglobin A1C in patients with type 2 diabetes: a randomized, controlled trial. 2009; 22(5): 507-512.
19. Ziegenfuss TN, Hofheins JE, Mendel RW, Landis J, Anderson RA. Effects of a water-soluble cinnamon extract on body composition and features of the metabolic syndrome in pre-diabetic men and women. J Int Soc Sports Nutr. 2006; 3(2): 45-53.

---

Who is Penny Brooks ?

Penny is an emerging expert in researching international functional foods and nutraceuticals. She focuses on those that can be used to treat and prevent diabetes, cardiovascular disease, and obesity. In addition, she also investigates dietary components that promote these conditions. She is a licensed and Registered Dietitian in the State of Florida and a Master of Science Candidate in Nutrition and Dietetics (nutrition biochemistry) at Florida International University.

Having been diagnosed with prediabetes at the age of 12 years old and reversing it one year later, Penny is passionate about finding evidence-based and culturally-tailored dietary solutions in addressing the diabetes epidemic. Having varied clinical and community experience, she has been invited to speak in corporate and hospital sectors but also enjoys giving back through philanthropic community nutrition presentations to low-income and minority communities that are among those at highest risk and prevalence of diabetes, cardiovascular disease, and obesity.

Join the fight and follow her at her Twitter here: https://twitter.com/pbroo003?lang=en

Check-out this review of recent research findings on yogurt consumption and weight management. And discover more about the scientific facts and yogurt mechanisms, related to weight control, in this animated compilation.

Although the relationship between yogurt consumption and metabolic syndrome (MetS) is still inconsistent, several studies have reported an inverse relationship between yogurt consumption and some components of MetS. This study adds some evidence that yogurt, especially low-fat yogurt, is associated with some metabolic benefits.

Less yogurt consumption in metabolic syndrome

The authors assessed, in a cross-sectional study using a randomized-multistage-cluster sampling method, the association between total, low-fat, and whole-fat yogurt consumption and the risk of metabolic syndrome among 973 adults in the west of Iran. The consumption of yogurt was significantly higher among people without MetS (5,8 servings per week) than people with MetS (4,5 serving per week). However, after adjusting for potential confounders, no significant association with MetS appears for low- or high-fat yogurt examined separately.

Less fasting plasma glucose and abdominal adiposity

Other results showed that, after adjustments for confounders, yogurt consumption was inversely associated with high triacylglycerol concentration, which exerts a cardioprotective effect. Furthermore, the authors founded that low-fat yogurt consumption was associated with a lower risk of high fasting plasma glucose, and a lower risk of abdominal adiposity, which suggests a beneficial association between low-fat yogurt consumption and cardiometabolic health.

To learn more, read the original article.

Source: Falahi  et al., International Dairy Journal 2016;61:85-90.

Read the newsletter

Cognitive behavioral factors, such as dietary restriction, disinhibition and the avoidance of fattening foods are involved in food choices and macro- and micronutrient intake. In this study, Cormier et al. aimed at determining whether dietary restriction may moderate the relationship between BMI and the preference for fat-free, low-fat or high-fat yogurts.

Yogurt is linked with less obesity

Yogurt consumption, even high-fat yogurt consumption, has been linked with a lower prevalence of obesity.  In a precedent study, the authors found that lean individuals had more daily servings of high-fat yogurt and less daily servings of fat-free yogurt compared to overweight/obese individuals.

In this study of 664 subjects, the score of dietary restraint was correlated with the score of avoidance for fattening foods and fat-free yogurt consumption, and this regardless of the BMI. Non-restrained eaters choose more high-fat yogurt than low-fat yogurt, and overweight or obese restrainers prefer fat-free yogurt than high-fat yogurt. It’s the same for the avoidance of fattening food. There was no difference in dietary restriction between lean and overweight/obese individuals.

However, when stratified by BMI and restraint behavior, lean unrestrained eaters consumed significantly less fat-free yogurt than lean restrained eaters and overweight/obese individuals. Moreover, overweight/obese restrained eaters also consumed significantly more fat-free yogurt than unrestrained overweight/obese people.

Restriction drives the preference

In the context of obesity, an important driver for choosing calorie reduced dairy products is their fat content. The fat content of yogurt – which goes from 0 % to more than 11% – highlights the low-fat paradigm. The results suggested that restriction may modulate yogurt intake along with the milk fat percentage (% MF) chosen by an individual. Restrained eaters choose preferentially fat-free yogurt, even in lean individuals. However, the total daily fat intake between lean individuals and overweight/obese individuals remains the same.  Only restrained eaters consume less daily fat, independently of their BMI.  These results highlight the low-fat paradigm and the behavior of restrained eaters, which are more likely to avoid some food such as high-fat yogurt, they would like to eat.

To learn more, read the original article.

Source : Cormier et al., Journal of Food Nutrition and Dietetics 2016;1:106.

When we think about microflora and restoring gut bacteria, probiotics are generally the first thing that comes to mind, for a good reason. The relationship between probiotics and gut health is more and more documented. The new handbook from the World Gastroenterology Organization (WGO), developed in the context of the 2016 Word Digestive Health Day (WDHD), focused on diet and the gut, delivers the most important advances in the field.

The WGO handbook summarizes the essentials datas regarding probiotics, prebiotics and their impact on gut health.

What is a probiotic?

Probiotics, defined by the World Health Organization (WHO), are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”

Probiotics are specified by genus, species, and strain. Common probiotic species include Lactobacillus, Bifidobacterium, Saccharomyces (a yeast) and some E.coli and bacillus species. You can find them in yogurt for example, which contains two specific strains Lactobacillus Bulgaricus and Streptococcus thermophiles, but also in other probiotic preparations, such as capsules or drinks.

Effects of probiotics on gut health

A part of the ingested probiotics survive in adequate numbers in order to affect gut microbial metabolism and exert their intended clinical response or even, in case of yogurt’ strains, alleviate digestive symptoms in people, who are lactose maldigesters.

The WGO handbook summarizes the factors, affecting the probiotic life cycle and current challenges in the use of probiotics, like safety concerns, antibiotic interaction, duration of therapy to cater for various indication and population groups or timing and optimal dose definition.

Prebiotics: nurturing of gut microbiota

Probiotics should not be confused with prebiotics, which are “selectively fermented ingredients that allow specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well-being and health.”

Prebiotics include fructooligosaccharides (FOS), galactooligosaccharide (GOS), lactulose and inulin.

Combining probiotics and prebiotics?

Combining probiotic with prebiotics, gives synbiotics, which are an effective way to ensure a maximum benefit from the ingested probiotics. The term refers to the synergy created by getting both probiotics, and prebiotics to feed the human microbiome. Prebiotics are often advised for gut health, for example in the case of acute infectious diarrhea, the prevention of antibiotic-associated diarrhea and nosocomial diarrhea, in irritable bowel syndrome, in ulcerative colitis and even in constipation.

Despite the fact that more research is needed to clarify some aspects on probiotics, much clinical evidence indicates that probiotics and/or prebiotics can be used as a natural intervention to alleviate many of gut disorders.

To learn more, download the WGO handbook and read the original article.

Source : Lee Y., Liong M. and Goh K., Probiotics and Prebiotics for gut health: the essentials; WGO Handbook on Diet and the Gut, World Digestive Health Day WDHD – May 29,2016.

The relationship between what we eat and the subsequent development of gastrointestinal symptoms is of growing interest for healthcare professionals, but also for the public. This new handbook, developed by the World Gastroenterology Organization (WGO), as part of the annual Word Digestive Health Day (WDHD) 2016, represents the State of the Art of the influence of the diet and gut health. It covers some aspects, related to carbohydrate intolerance, such as lactose maldigestion.

What is lactose intolerance?

Carbohydrate intolerance (lactose, sucrose and fructose) has increased over the last few decades, mostly as a consequence of an increase in carbohydrate consumption, especially for added sugar, in the diet. Amongst them, lactose intolerance is the most common subtype. The intolerance of lactose is due to the deficiency of lactase, an enzyme responsible for lactose digestion. This deficiency can be total or relative and can occur because of three disorders:

• Congenital lactase deficiency, which is extremely rare and whereby the production of lactase is inhibited from birth.
• Secondary lactase deficiency, which occurs after a disease affecting the intestine (acute gastroenteritis, coeliac disease, Crohn’s disease, ulcerative colitis…) and is generally reversible. Adult type lactase deficiency, which is the most common case and might concern up to 70% of the world’s population, with great variations, depending on the geographical area. This condition is due to a modification of the DNA sequence that regulates the lactase gene, thus inducing a gradual reduction of the activity of lactase through life.

Symptoms and diagnostic

In response to lactose intolerance, substantial variability of symptoms is to be expected (nausea, cramping, bloating, diarrhea, and flatulence), as the extent and severity of the condition varies among individuals. In patients with the most common adult-type lactase deficiency, the required amount of ingested lactose to produce symptoms varies from 12 to 18 g, or 8 to 12 ounces of milk. The diagnosis of lactose intolerance can be confirmed by lactose hydrogen breath test, lactose tolerance test, and genetic study. Lactose intolerance is distinct from milk allergy, an immune response to cow’s milk proteins.

Treatment and alternatives like yogurt

The mainstay of lactose maldigestion’s treatment is often the avoidance of all lactose-containing milk and other milk-containing products. However, contrary to conventional wisdom, the consumption of dairy products can be maintained, subject to certain hygiene and dietary rules. It is common for health providers to mistakenly tell the patient not to eat any dairy products, which deprives them of a healthy source of protein and the most bioavailable source of calcium. Lactose-free milk and dairy, soy milk but also hard cheeses, yogurts (unless unfermented milk is added back in) and kefir are allowed. Lactase enzyme supplementation can also be used occasionally and when necessary.

Incorporating dairy products, including yogurt, improves the quality of the diet, and reduces nutrient deficiencies. Indeed, thanks to its specific cultures and its thicker-than-milk texture, yogurt is well tolerated by individuals, who have trouble digesting lactose and can help cover daily calcium requirements.

To learn more, read the original article.

Source: Gupta V., Crowe S. and Makharia G., Carbohydrate intolerance (lactose, sucrose, and fructose): identification and treatment; WGO Handbook on Diet and the Gut, World Digestive Health Day WDHD – May 29,2016.