Sylvia Ley 2018 Transcript

In this Exclusive Interview transcript, Sylvia Ley talks with Diabetes in Control publisher Steve Freed during the ADA 2018 convention in Orlando about why eating red meat and especially processed red meat increases diabetes risk.

To see this interview in full, click here.

Freed: This is Steve Freed. We’re here with Diabetes in Control. We’re at the 78th Scientific Sessions from the American Diabetes Association, and we’ve been interviewing people that have had presentations, that have interesting things to tell people, and to learn from medical professionals. So, today we have a special guest, Sylvia Ley, PhD RD. And she had a presentation on red meats and how that affects people with diabetes. So, we’ve heard about just about everything and how it affects diabetes. So, today I want to thank you for your time and maybe we can start off with a little bit about your presentation on why red meats are bad for people with diabetes. So, maybe you can just kind of go over some of the high points.

Ley: Okay. So, yesterday I was talking to my audience about how red meat intake has increased in the last couple of years, which is rather surprising because in the past 40 years before that red meat intake has been going down in the US population, while the alternative meat choices such as poultry has been increasing, but it really flipped in 2016 and we’re seeing more of people consuming red meat now. So, we’re asking this question again, is red meat good for us? And of course, the cancer population are saying red meat and especially processed red meat is  a carcinogen. So, that sort of brings us back to, what about diabetes? And in population-based studies, it shows that especially the processed red meat is associated with higher risk of developing type 2 diabetes and to some degree total red meat is also associated with a higher risk.

Freed: So, you mentioned processed red meat or processed meat and red meat, what is processed compared to red meat? I mean, what’s the difference?

Ley: So, unprocessed red meat would be fresh meat, beef, other types of animal meat from four-legged animals. Whereas, processed red meat, it would be sausages, bacons. And basically it’s processed to add to the taste, to improve the taste as well as to improve the preservation but in the process there are other products that’re being introduced. So, for example, salt and nitrate, and so on is introduced to make the meat more tasteful or make it last longer and so on, so that has potential implications.

Freed: We talked about red meat and processed red meat a little bit. But now, we’re learning that when you cook the meat, depending on how you cook it, it’s actually going to increase your risk for diabetes and also cancer. And so, what kind of science — I mean, you’re telling people they can’t barbecue anymore. So, that hurts most people whether they have diabetes or not because it’s not just diabetes, it’s cancer. So, what kind of science is behind that fact?

Ley: Yeah. So, it’s been shown. It’s pretty well known that when you barbecue red meat it produces carcinogens. And of course, that is a concern for cancer but also has implication on those products, the chemicals that have been produced can have impact on the insulin sensitivity as well as the inflammatory pathways which we know are associated with the progression to type 2 diabetes and it’s within its pathogenesis. So, for that context it’s important to choose slower cooking, lower temperature cooking methods if you are to have red meat. But of course, the science, the more population-based, prevention for diabetes, science is based on comparing people who have been consuming barbecued meat less than once a week, compared to those who are cooking high temperature meat — cooking meat at high temperature almost every other day or more often, and the risk is increased by almost 40%. So, by saying that, if you are using barbecue choices less often it may not have as much of an implication. So, if you’re having a special party and have a guest over or it’s July 4th and you want to have some barbecue and if you don’t participate in those activities you may get depressed and that may increase your risk of developing type 2 diabetes anyway. So, those are the choices you will have to consider.

Freed: Does it makes a difference what you eat with that?

Ley: Of course. So, it’s not just about red meat. The science says if you increased your red meat intake as an adult, it increases your risk of developing type 2 diabetes. But there really hasn’t been much evidence supporting that if you actually reduced your total red meat intake as an adult it improves your risk of developing diabetes. And more evidence is supporting towards if you change your overall diet quality, so we’re talking about eating whole grains, more vegetables, fruits, and eating less sugar-sweetened beverages and the whole dietary patterns, if you improve the total dietary patterns that really helps your risk of developing diabetes and it reduces it.

Freed: What about poultry or fish? A lot of people strobe fresh vegetables on the grill and burn them, does that affect your risk?

Ley: So even poultry — if you use poultry on a grill, it also increases risk of developing type 2 diabetes. And its data on vegetable is not as clear, but it’s something we need to think more about. But in terms of animal poultry products, if you grill it doesn’t seem to be beneficial.

Freed: Is that same for fish, in the same class as poultry?

Ley: I have not seen the data on fish being as strong, so it’s mostly on poultry and red meat.

Freed: Can you say the same thing about, let’s say, McDonald’s or Burger King, they cook it on the grill with high heat and obviously they want it on as high as possible so they can make it faster?

Ley: So, those are processed meat choices when you choose those at a fast-food restaurant, so that would increase your chance much more so. And cooking it in a high flame, it would increase it even more.

Freed: So, the fast-food aspect, it’s all processed food. Actually it increases your risk more than pure red meats and there’s science to show that. So, I saw a presentation on what makes a good presenter.

Ley: Okay.

Freed: And a good presenter, for their presentation, people learn something but they use it in their practice when they walk out the door.

Ley: Yeah.

Freed: The next day they see a patient, they use that concept, that idea, with that patient and that’s a good presenter.

Ley: Yeah.

Freed: We’ve all been to presentations, hundreds of them. And sometimes you go to a presentation, you walk out, and you don’t even remember what the person said, that’s the difference between a good presenter and one that isn’t. So, what in your presentation did you want people to walk away with?

Ley: I mean, I think different presenters are targeting different audiences when they come to places like ADA where you have science by people who are doing research as well as clinicians. And there are people who are interesting just the audience, the public, and so on. So, you need to know who your target is. But I come from background of being a dietitian and having seen the patients myself, but then now I’m a researcher and I do population based studies and I’m much closer to meeting people who are looking at changing public health policies and so on. So, I think you just have to think about different audiences and who you’re targeting. But when I give a talk and especially in this context I need to think about the MDs and RDs who are in the audience and how to interpret the data that’s currently available out there and what do you want to tell your patients. And then, of course you want to bring it back to the current guidelines because red meat we know that it may not be as beneficial for type 2 diabetes prevention and especially not the processed red meat, but we really need to bring it back to the ADA guidelines which currently states, “Recommend patients about the overall healthy eating patterns, not single food items when we’re talking to people with diabetes for prevention for further progression for other complications.” And not only that, when we are talking about prevention of type 2 diabetes, we go to tighter guidelines for Americans and those guidelines are so focused on the overall dietary patterns not just single food items, having variety of different protein sources not just, think about red meat but think about poultry, think about fish, think about legumes, think about soy products, and so on. So, those are the messages you want to bring it back to, not just focus on red meat alone.

Freed: Well, it would be better if you told us what we could eat —

Ley: Yeah.

Freed: — rather than what we can’t eat.

Ley: Right.

Freed: Because with diabetics we’d say, “You can’t eat potatoes. You can’t eat white breads and rice and pasta.

Ley: Yeah.

Freed: And now, you’re saying we shouldn’t be eating too much red processed meat or even red meat.

Ley: So, in my research when I do substitution models, when I substituted total red meat or processed red meat intake with the same serving size of alternative protein choices such as poultry, fish, nuts, and legumes, it improves the inflammatory biomarkers such as CRP. It also improves the insulin markers. It improves the A1C. So, it’s just that we need to think about just not taking something out, but putting something back in to replace it. And there are healthier choices you can make.