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Catherine Champagne 2018 Transcript




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Freed: This is Steve Freed here at the American Diabetes Association 78th Scientific Sessions, where they do presentations on new and exciting ideas and technology. You want to know anything about diabetes, you need to be here — and I know most people can’t be here so that’s why we’re doing this interview. We have with us one of the presenters who presented a standing room only conference. The title was “Myth or Science?” Current Fads and Evidence in Diet and Nutrition.” And maybe you can tell us a little bit about yourself. She is Catherine Champagne. And that’s a great name, Champagne. Maybe you can tell us a little bit about yourself and your practice and what you do.

 

Champagne: I have been an assistant professor at the Pennington Biomedical Research Center almost for 29 years right now. I do research primarily in weight loss, nutrition related topics, to weight and nutrition related topics, to chronic disease conditions such as diabetes and cardiovascular disease.

Freed: Before we get into the topic of fad diets I think that just because of your background – involved with diets and diabetes obviously over the years because you’ve been doing it for a while – now, you know you must have picked up some great information, that some readers from our newsletter have only maybe started a year or two or three years ago and they’re going to have to learn all that. All that time to learn what you learned, so maybe you can share with us some things that you’ve picked up that you think that other medical professionals should know, and save 20, 25 years.

Champagne: Well that’s kind of a really tough question but I’ll give it a shot. Over the years, I know that my career has evolved into one where I have been listening more to the patient and looking at what they want and sort of trying to merge that with the changes that I think that are needed to be made in their diet to help their disease conditions. For instance if someone comes into the clinic and they’re not really wanting to lose weight, then I think it’s not a good time to begin. And so I think you need to know where any patient is in terms of their willingness to make change before you can actually enjoy a degree of success.

Freed: That’s great information. Really boils down to what the new information is and that’s personalization. In order to do personalization you have to ask questions.

Champagne: You do have to ask questions and of course you know that the nutrition landscape is constantly changing. So some things that we thought were like absolutely necessary years ago may not be necessarily appropriate depending upon that that patient.

Freed: It’s interesting about nutrition. One of the things that keeps coming up for me even here, there’s people that are for it, people that are against it, there’s not really one statement that says, this is the exact science for people with diabetes. That’s low carb diets. It took years for the American Diabetes Association to say it’s OK for some people; prior to that they were against it, flat out denial.

Champagne: And I would have been against it too. But I have seen a significant amount of literature that suggests that for some people and for people with diabetes it is probably a good way to go. But I guess there’s always some concern about long term use. So I would like to see a lot of long term data on a lot of these diets such as the ketogenic diet.

Freed: Getting back to some facts about your presentation that you did yesterday, on the topic of fad diets. I’m not sure I know what a fad diet is, except if I see it on television – to eat pineapples every day or something. There are so many.

Champagne: And actually the presentation yesterday really did not focus on a number of fad diets. It was more beliefs; for instance we looked at what worked better; was it dietary patterns. Was it the nutrients to focus on. Was it structured nutrients and portion sizes. And you know, what was the best thing. So we didn’t actually go into fad diets. I discussed the DASH diet and the Mediterranean diet, both of which are rated number one by U.S. News and World Report on a yearly basis. DASH has been number one going on eight years now. Dr. Melinda Mariner did talk about the ketogenic diet and just as you previously said, it’s now accepted for use in people with diabetes.

But just looking at the term, fad diets, in general, you know a lot of fad diets are diets that people embark on to lose weight really quick. So the question is, will they be able to sustain that dietary regimen in the long term. And if so, then why would you want to. If you were going to maintain that in the long term and there’s no harm to you then that’s fine. However, my impression of a fad diet is it is something that somebody wants to try to jumpstart their metabolism, lose weight quickly and then return to some other form of eating. Which, if the form of eating that they return to is one that is healthful in nature, and by that meaning not restricting food groups or necessarily foods that may have a beneficial diet effects, then that would be a way to utilize a fad diet for instance

Freed: When you say a fad diet it doesn’t necessarily mean anything bad, right?

Champagne: No, it’s just sort of fashionable at the time.

Freed: So which fad diets are you a proponent of?

Champagne: I’m not a proponent of any fad diet because my research into fad diets has pretty much made me summarize the fact or conclude that by and large fad diets end up being low calorie diets. One example is the HCG diet, a diet that uses some substance to help you lose weight, but then you know along with that the calories are moderated to very very severely reduce calories. The real take home message from that is it’s just a low calorie diet. Lots of the diets are low calorie. The ketogenic diet. Atkins type diet. Those are obviously not low fat diets but I think that there’s a satiating effect such that perhaps the overall caloric intake is not significantly high.

Freed: So a person comes to your office and you want to talk to them about their nutrition and they’re 25 pounds overweight. They have type 2 diabetes and an A1C of eight point seven. What kind of diet would you recommend?

Champagne: Well the first thing I would do is I would actually get the patient’s diet history. I’d like to know more about them so that I could actually look at what may be problematic in their current eating plan and take care of that without recommending any specific diet necessarily. So I think it’s important to implement small changes and make those sustained over the long period because that’s really the key to implementing change. So one thing that we know is that obviously if you have diabetes, then you need to restrict carbohydrates. Maybe look at what types of carbohydrates they’re eating and maybe change those over to be more complex wholegrain carbohydrates which tend to have less of an impact on blood glucose levels. Usually fruits and vegetables are lacking in many diets. I’m sure you’re well aware of that. I think I would encourage more vegetables than fruit but when encouraging fruit I would encourage whole fruit because if they get a little more fiber and health benefits.

Freed: So what is the takeaway message that you wanted the standing room only audience to take away. Because when you do a presentation you prepare for a presentation. You want it to be meaningful. You don’t want to just talk to them. People will forget everything that you said; you know you want them to walk out of the hall with their notes and say I’ve got to make these changes.

Champagne: Well we did not really talk about changes people needed to make. Frankly I was quite surprised at how many people were at the session. Probably close to 600 people. We talked about some faddish issues;  one of them is saturated fat. Because saturated fat increases your risk of cardiovascular disease and there is a currently a big hype about coconut oil but coconut oil in and of itself is a saturated fat. And in fact the data on coconut oil seems to be, typically — compared to medium chain triglyceride oil, and it is different in that medium chain triglyceride oil has higher levels of caproic and caprylic acid as opposed to coconut oil which has lauric acid, which is a very long chain highly saturated fat. So I would like for them to take home that message, because you know although the evidence is in cardiovascular disease one of the key problems that affects the mortality of a person with diabetes is cardiovascular disease, so you know it’s a win win if you don’t consume coconut oil.

We also talked about low calorie sweeteners and I just went to a presentation on low calorie sweeteners so I’m going to have to rethink that one; when I say the nutrition landscape is changing. Sometimes we get data on things like low calorie sweeteners that makes us step back and say well, how much should we be consuming? And I think most of the data suggests that most people with diabetes consume lower than the adequate daily intakes of low calorie sweeteners. And since 2008 there has not been data showing that it’s necessarily bad for someone with diabetes, but probably I would say that they should focus on water.

Freed: Well that’s interesting you bring up low calorie sweeteners.  Like you said there’s always been a debate — causes cancer too much is no good – but it restricts your calories, therefore it’s beneficial especially for people with diabetes. You know you go to Starbucks and they have the yellow and the pink and the white packages. So from your knowledge, number one, is it safe? And number two, should people with diabetes be using more, because you just said they don’t use very much

Champagne: They use some but the evidence doesn’t say that that it’s overused. A lot of the data seems to suggest that people who consume low calorie sweeteners do it, for instance, to maybe embark upon a fast food meal that has maybe a thousand calories, and so in an effort to not add more calories they will choose a diet beverage for instance. I don’t think that there is a significant amount of data to suggest that it causes cancer except maybe in rats when they’re consuming what would equate to 300 packets in a human. And in fact the presentation that I just went to has indicated that the mouse data is using high levels that would not replicate with humans. So I think those are  important things to remember. And I guess if you’re concerned the green packet and the monkfruit are probably the more natural of the artificial sweeteners.

Freed: So what was the last time you had a sugary drink?

Champagne: It has been a while. I can’t remember when I had the last sugary drink and I try not to consume diet beverages but I use artificial or low calorie sweeteners in my coffee on a daily basis. But I don’t drink a lot of soda.

Freed: What about coconut water. We see so many new things in the grocery stores; now they have all these different coconut waters. I keep looking but I’m not sure if it’s healthy.

Champagne: I haven’t seen a lot of data on coconut water. But to me, why would you pay for something that you don’t know whether it has any science behind it to support the fact that is good, it’s any better for your body than just regular water?

Freed: It’s a lot less expensive for regular water.

Champagne: Regular water is pretty cheap. You know it may be, I find that there are some people that that really migrate towards something that’s an imitation. Not really in technical terms, but sort of mimics, you know, water. So there’s a lot of hype about coconut water. There’s also a lot of interest in milk substitutes for regular dairy milk. So a lot of people are lactose intolerant and they may have a reason to go towards either almond milk or other nut milks. But in terms of looking at the comparison between regular milk and these other options like Silk or any of the other brands that are available, I find it more of a challenge to find the amount of protein in those nut milks as opposed to the amount of protein that you get in milk. There are one or two that are higher in protein but you really have to do a lot of searching, whereas you can have some confidence that the dairy milk, if you are not lactose intolerant, is the better choice and cheaper.

Freed: That’s really — all facts are based on science. Sometimes these companies have a patient database of four and they come out and they don’t say it’s four people; they say we did a study and it shows that it reduces our risk by 80 percent. Which really is an invalid study.

Champagne: And actually that brings up a good point. You know that’s anecdotal evidence. That’s not a scientifically rigorously controlled study. So you really have to look for the science.