Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
18 Nov

Dear Mark: Acid Load and Type 2 Diabetes, and the Safety of Homemade Baby Food

babyfoodFor today’s edition of Dear Mark, we’ve got a question about dietary acid load and type 2 diabetes. A new study’s just come out suggesting that the acid load of the diet does indeed have a significantly negative impact on our health and may actually cause type 2 diabetes. The reader is understandably worried, so I dig into the research and try to see what’s going on. Then, for Dear Carrie, my lovely wife answers a reader’s question about the safety of homemade baby food.

Mark,

I was under the impression that this was rubbished a long time ago provided you ate plenty vegetables? Unfortunately I can’t get hold of the full “The Times” article without subscribing but it was in the UK print edition. I thought you would be able to work your magic with journals to uncover what is really at work here.

Acidic Foods like Meat, Cheese and Soft Drinks Increase Diabetes Risk

Acids from meat and cheese are linked to higher diabetes risk

Regards,

Euan

Hey Euan, thanks for bringing this to my attention. I was able to find the full text of the study (PDF). It’s called “Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study” and tracks the type 2 diabetes incidence across 14 years among 66,000 French women.

So yeah, you could look at the results and claim that a high dietary acid load is associated with type 2 diabetes. That would be true. There is an association. The data is clear. But let’s look a little closer and see if there’s another way to consider the issue.

If you scroll on down to Table 1 in the study text, you’ll see the average intake of various macronutrients and food groups broken down by low, low-medium, medium-high, and high acid load quartiles. Intakes were very different across quartiles, particularly comparing the lowest and highest quartiles. Let’s look at some of them and consider how they might relate to the risk of diabetes:

The high-acid quartile ate the least magnesium. Magnesium intake has been strongly, consistently, and inversely linked to type 2 diabetes. A 2011 meta-analysis spanning 13 studies and over half a million subjects found a significant inverse association between magnesium intake and type 2 diabetes risk (in a dose response relationship, so the more they ate the less diabetes they got); an earlier meta-analysis had similar results. Just recently, a study found that higher magnesium intakes were associated with lower fasting glucose and insulin resistance, prompting the authors to posit that magnesium intake can protect against progression from pre-diabetes into full-blown type 2 diabetes. Another recent study confirmed these associations, finding that a high magnesium intake predicted reduced insulin resistance.

The high-acid quartile ate the least potassium. Potassium intake may be linked to type 2 diabetes as well, but it’s not clear. A recent review of the inconsistent evidence makes some interesting observations, however: induced hypokalemia (potassium deficiency) causes glucose intolerance in humans and repleting potassium reverses it.

The high-acid quartile ate the fewest vegetables. Although the evidence is somewhat unclear, vegetable intake is usually associated with a reduced risk of type 2 diabetes, particularly root vegetables and leafy greens. One study found that a great quantity and variety of vegetable intake led to a lower risk of type 2 diabetes. And once you have type 2 diabetes, green vegetable intake is associated with improved HbA1c scores and lower triglycerides. Plus, vegetables are the best source of protective nutrients like magnesium.

The high-acid quartile ate the fewest fruits. Certain fruits, particularly ones with antioxidant-rich skins like blueberries, plums, apples, and grapes, are associated with a reduced risk of type 2 diabetes despite the sugar content.

The high-acid quartile drank the least coffee – about half as much as the lowest quartile. Coffee is one of those consumables that everyone knows is bad for you but which is actually linked to a number of health benefits, most prominently a reduced risk of type 2 diabetes. Across study after study, habitual coffee consumption is consistently associated with less type 2 diabetes. They’ve even run randomized controlled trials where coffee consumption protected against glucose intolerance, one of the first signs of pre-diabetes. This is almost certainly a factor.

The high-acid quartile ate the most calories, and high calorie intake (or, put another way, energy excess) may increase the risk of type 2 diabetes (if it’s not accounted for by activity or basal metabolism) by inducing insulin resistance at the cellular level. They were also the least active of all quartiles, which would contribute to the energy excess.

Although this wasn’t listed in the nutrient intake table, the high-acid load quartile would have also consumed the fewest plant polyphenols and antioxidants due to lower fruit, vegetable, and coffee intake. Plant polyphenols have been shown to improve glucose tolerance and homeostasis, which may help prevent type 2 diabetes and partially explain the protective effect of fruits, vegetables, and coffee on metabolic health. Grape polyphenols, for example, prevent fructose-induced oxidative stress and insulin resistance.

So, is it the acid load causing (or preventing) the diabetes? Or is the acid load merely a representation of the diet which in turn causes (or prevents) the diabetes? Heck, it may even be that the diabetes is causing kidney disease, which in turn leads to acidosis. We don’t know for sure from this study. As the authors write in the discussion section, “this is the first prospective study to evaluate the risk of type 2 diabetes associated with scores reflecting the acid load of the diet.” What we do know is that many aspects of the overall dietary pattern of the high-acid quartile, like low magnesium, potassium, coffee, and produce intake, are consistently linked to type 2 diabetes across multiple studies. For now, that seems to be where the strongest evidence lies.

Eat your vegetables and fruits. Get your micronutrients and plant polyphenols. Drink your coffee. Try not to eat so much food that you gain weight and overload your cells’ ability to handle the energy. Exercise consistently and intelligently.

Dear Carrie: Is Homemade Baby Food Safe?

I actually do not have any children of my own… but as someone who is part of a local farm’s veggie & protein CSA, and is very passionate about “knowing where my food comes from”… this subject really disturbs me.

I’ve recently been warned via mass Facebook update about the risk of making baby food at home: “In 2005, the American Academy of Pediatric released their advisory for homemade baby food. They stated, ‘Infants fed commercially prepared infant foods generally are not at risk of nitrate poisoning. However, home-prepared infant foods from vegetables (eg, spinach, beets, green beans, squash, carrots) should be avoided…'”

Can you please provide your input? This seems like a marketing ploy… I can’t see how commercially prepared is better?

Thanks!!

Bethany

The worry with too much dietary nitrate in baby food is that it can lead to something called methemoglobinemia, or excess methemoglobin levels. Methemoglobin binds oxygen and prevents it from getting to the tissues in our body. In normal conditions, methemoglobin levels are extremely low and cause no problems. With too much nitrate in the baby’s diet, however, rapid conversion to nitrite in the immature intestines causes methemoglobin levels to jump 1000-fold, leading to tissue hypoxia (lack of oxygen). This is bad, particularly for a cute little helpless baby.

So, watch out for nitrates, right?

I found the Facebook post to be extremely misleading. I went ahead and took a look at what the AAP actually recommends. Nitrate only poses a problem for kids of a certain age. At six months, intestinal conversion from nitrate to nitrite is greatly reduced, making dietary nitrates much safer. It’s right there in what the AAP actually wrote back in 2005: “the intake of naturally occurring nitrates from foods such as green beans, carrots, squash, spinach, and beets can be as high as or higher than that from well water, these foods should be avoided before 3 months of age.” They go on to say that this shouldn’t be an issue anyway since “there is no nutritional indication to add complementary foods to the diet of the healthy term infant before 4 to 6 months of age.” Since you shouldn’t even be feeding complementary foods before 3 months, this isn’t a problem. In fact, I breastfed Devyn for two years and Kyle for a year. They were given only breast milk for the first six months of their lives.

Total non-issue, unless you know people who are pureeing these foods for their newborns under six months. That can be an issue. In a recent study looking at a group of homemade food-associated infant methemoglobinemia cases, the biggest risk factor was homemade food that was made too far in advance. Food made 24-48 hours before the kids ate it had an odds ratio of 17.4 and food made more than 48 hours before consumption had an OR of 24.9, most likely because the nitrate was converting to nitrite in storage (which, remember, is what does the damage). Other risk factors included breastfeeding (!), chard, and borage.

When I was introducing solid food to Devyn and Kyle, I usually made my own at home, (and vegetables were probably the last things I introduced). Even though I eat a ton of vegetables now, I do find many children tend to dislike vegetables, and you shouldn’t try to override their natural revulsion because it may be in place to keep them away from plant toxins they haven’t developed a defense for. It’s probably not a great idea to introduce chard, borage leaves, and spinach too early. Try meat, lightly cooked egg yolks, ripe fruit. My children enjoyed, peas, carrots and sweet potatoes. Those are way more digestible (and enjoyable). Besides, if you are feeding complementary foods, ones made at home are way more nutrient-dense than store-bought purees.

That’s it for today, folks. Let us know what you think in the comment board!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. You know, living is bad for you, because it WILL cause your death!

    I’ve made a lot of changes in my diet over the years, based on studies touting the latest findings, only to have later findings contradict the earlier findings. Just seriously listen to your body, although I think in today’s world most people have lost that ability. I know I did for the longest time.

    Cody wrote on November 18th, 2013
    • LOL….that’s a great point. I think a lot of people can overdo it by trying to look at EVERY single detail only to not have a profound effect on the longevity of their life compared with those who “slip” a little every now and again for some indulgence. Life is made to enjoy from time to time.

      Matt wrote on November 19th, 2013
  2. Does the danger of making homemade baby food still apply if you freeze it, or only if it’s sitting in the fridge for more than 2 days? What if you cook a bunch over the weekend, freeze individual containers, and defrost as needed?

    Tasha wrote on November 18th, 2013
    • That is what I do with I do with my left over soup after 2 days in the fridge. I also freeze things in individual serving size containers. That is fine for children as well.

      Carrie wrote on November 18th, 2013
    • The conversion from nitrate to nitrite is a chemical reaction. As a rule, chemical reactions go faster at higher temperatures. At a chemistry course we were taught a rule of tumb: adding 10 degrees doubles the reaction speed (so in this case, speeds up the accumulation of toxic components). It also means lowering the temp slows the process down a lot. Fridge is better than room temp, freezer is better than fridge.
      So cook the veg (to kill bacteria and make the food easy to digest) and either serve soon or cool it down fast. You can use a bowl of water to cool down a jar with hot food (put the jar in the bowl, not the water in the jar with food) or putting the pot in a sink with a layer of water (very effective for large batches of soup or stew, too). If you want to freeze portions, don’t let them sit in the fridge for days first, just freeze them.

      I grew up on homemade (baby)food (storebought was available in the late eighties, but generally only used as a convenience item on long days away from home, and those were not a weekly occurance) and I didn’t get poisoned ;)
      Why buy overpriced jars if you can boil some veg and mix in a hard boiled egg in no time? Serve an avocado in even less? I know, working moms, busy lives, but it’s easy to get so used to something you forget the other options, even if they were common practice just one generation ago.

      Feather wrote on November 21st, 2013
  3. Hi Carrie and Mark!

    Are there any plans on releasing a PDF-file or a book about suitable primal food for babies/small children and possibly dogs/cats and other pet animals?

    Mike wrote on November 18th, 2013
  4. Homemade baby food is something that I’ve always wondered about; I do feel like the homemade baby food is a MUCH safer alternative to the processed foods that are manufactured and put into jars and shipped out across the country. What is the “shelf life” of homemade baby food? I might have missed it if you mentioned it earlier.

    John Jarvis wrote on November 18th, 2013
    • When my daughter was a baby we made a bunch of baby food and froze it. We tended not to keep it in the fridge more than 2 days after we thawed it out. Great response to baby food safety question Mark, thanks.

      Captain Competition wrote on November 19th, 2013
  5. Take a look at baby led weaning – there’s really no need to ‘make baby food’ at all, just offer your baby appropriate foods from the family table around 6 months of age and they’ll do the rest. I have four children between the ages of 7 and 1 and I’ve never puréed a thing :)

    Katie wrote on November 18th, 2013
    • I was about to make the same comment. We fed our son lightly cooked egg yolks from about 6 months to wean him (he was breast fed until about a year). After he was weaned off of breast milk we just put bits of what we were eating in front of him. It’s pretty clear that when he sees us eat something he’s much more likely to eat it himself without issue.

      The other thing we do is just put the stuff in front of him and let him choose what he eats and so far he’s been a really good eater. If you push them to eat things they’ll push back for control by not eating anything and then it just escalates.

      Rob wrote on November 18th, 2013
    • Also take a look at pre-mastication and kiss feeding. Turns out adult saliva has some of the same antibodies as breastmilk, plus enzymes to start pre-digesting the food. Also infants in pre-masticating cultures are at much lower risk of the iron deficiency that plagues pretty much the rest of the world.

      Gross, but fascinating. Especially when babies are more clued in than you and try to eat the food right out of your mouth.

      em wrote on November 18th, 2013
      • but I have heard it passes on took decay?

        wendy wrote on November 19th, 2013
        • Tooth decay. Darn spell check!

          wendy wrote on November 19th, 2013
        • The bacteria that can cause tooth decay, yes. Also any other bacteria and viruses that can survive in saliva (or traces of blood). Except in the case of serious infection, like HIV, the consensus seems to be that the kids will get inoculated with bacteria and viruses eventually, and for many babies the benefits are worth the risk. That’s mostly research on developing countries; in industrial nations we have iron supplements. ::shrug::

          I’m not like a premastication activist or anything. I just think it’s very interesting, especially since both my children seemed to want to do it. When I was a kid, I used to suck food between the gaps in my teeth until it was a puree. And before I had heard of premastication, my first son looked up at me one afternoon while i was eating a banana with his mouth open like a baby bird, and I just instantly knew the easiest, safest way to give him some would be to puree itbthrough my teeth first, but then I thought “Ew” and mashed it up with a fork. And my second son literally would come at your mouth with his mouth wide open. That’s all gross TMI, and I’m sorry, but my point is, I wonder if we actually have some kind of instinct for this that we’re socialized out of.

          em wrote on November 19th, 2013
        • What Em said. I would’t promote it as a rule, but I don’t see problems with it either.

          Those bacteria are passed on from parent to child anyway, by kisses and such. What do you do with a dropped pacifier if there’s no water at hand? Wiping it clean, then putting it in your own mouth before returning it to the kiddo is a commonly used safe option. Again, those bacteria are passed on.

          There is one catch: there are about 500 different types of bacteria found in human mouths, and an individual has about 50 of them. You don’t want your kid to get all 500, so limit these salivaswapping behaviours to parents/active caregivers only. Close family and regular/daily babysitters, fine. All your neighbours, colleages and that girl at the local store? Better not.

          Feather wrote on November 21st, 2013
  6. People had no commercial baby food before the industrial revolution.

    Diane wrote on November 18th, 2013
  7. I totally agree with Katie. I have an 8-month-old baby and he just gets what we eat in little cut-up bits on his high chair tray. He is perfectly capable of stuffing it in his mouth, he controls how much he eats and, for things that he can’t feed himself (like yogurt) we pay attention to his cues as to when he’s done and don’t force it on him. He’s my second kid – my first never got any “baby food” either and she is now 8 years old, disgustingly healthy and the least picky eater of any kids I know. Baby food just sets kids up for pickiness and the introduces the idea that they can and should have special different food than the rest of the family. That just doesn’t fly in our house :-)

    Sarah wrote on November 18th, 2013
    • Nothing can compare to good old fashioned mothers milk, nurse them to a year, 18 months, build up their resistance, and they should be able to eat anything (except maybe a two finger steak)

      Fred Timm wrote on November 18th, 2013
  8. I made most my own baby food using this
    http://www.happybabyproducts.com/kidcofoodmill1.html

    I rarely froze or refrigerated stuff…with the food mill I just pureed what we adults were eating (peas, spinach, meat, etc.)…easy to use, take apart and clean. I had two, as one always was drying from previous meal it seemed, and good to have a spare to throw in the diaper bag.

    mims wrote on November 18th, 2013
  9. Hey guys, just wondering, is whipped cream primal???

    Ripken Holt wrote on November 18th, 2013
    • Grass Fed Grass Finished whipped cream is excellent…if you are not lactose intolerant.

      Nocona wrote on November 18th, 2013
  10. Thanks for the beautiful alert and breakdown Mark. After I looked at the study I noticed this

    “Dietary acid load and food consumption With respect to specific food groups, a high-PRAL diet included significantly more meat, fish, cheese, bread and soft drinks, particularly artificially sweetened beverages, whereas a diet with a low- PRAL score included more dairy products, fruit, vegetables and coffee (Table 1).”

    Doesn’t this tell me that the high acid group a lot more bread and drink sodas and diet sodas? Plus a high-protein diet is a high sugar and acidic diet.

    Dr. Ron Rosedale always says the biggest failing of a low-carb diet is to make it into a high-protein diet

    As a type one diabetic I need a high beneficial fat. adequate protein, LowCarb diet.

    The minute I go above 4 ounces of protein per meal my blood sugars will double 4 to 6 hours later.

    I eat to beat Diabetes and Fat is where it’s at!

    Andre Chomene wrote on November 18th, 2013
    • Hey Andre, as a fellow t1 I agree that’s the case too – if I have high protein my blood sugars go higher too. I’m not sure what 4oz equates too (I’m in the UK so a grams kinda gal ;) but I know I have to stick to high fat, low carb, medium protein to keep my blood sugars stable.

      Its really interesting you’ve noticed the spike at 4 / 6 hrs later – do you notice that with protein only? I always thought the “optimum” time to test what a meal has done to blood sugars was between 1 and 3hrs after eating… Is the 6hrs cos of the liver converting the protein to glucose at that point do you think…?

      Nadia wrote on November 19th, 2013
  11. I agree there is something to be said for not giving babies too many greens early on… we do have an aversion to the bitterness for a reason! Peas and avocados seem to be tolerated well + most fruits + sweet potatoes, carrots, squash, etc. Also, egg yolks, meat, even liver are often palatable to babies.

    And offering them chunks of soft-cooked food that they can select & feed themselves (versus spoon-feeding them a puree of stuff) works better IMO.

    Sara wrote on November 18th, 2013
  12. Like Mark says, “Eat your vegetables and fruits. Get your micronutrients and plant polyphenols. Drink your coffee. Try not to eat so much food that you gain weight and overload your cells’ ability to handle the energy. Exercise consistently and intelligently.”

    Translation: don’t over-think it :)

    Karl Nilsson wrote on November 18th, 2013
  13. I was skimming and missed both mentions of Dear Carrie. So I did a pretty good doubletake when I read “In fact, I breastfed Devyn for two years…”

    em wrote on November 18th, 2013
    • Nominated for Comment of the Week.

      Piper A R wrote on November 19th, 2013
  14. Both Canadian, American and WHO Paediatric guidelines strongly advise that babies should not be fed anything except breastmilk or infant formula (if you are unable to provide breastmilk) up to 6 months of age. After that, the new Canadian guidelines recommend starting with proteins and fats such as egg yolks, avocado, soft meats ect. Carb sources, like from veggies, should be added in slowly after 8 months and it’s best to start with things like yams. This is due to the fact that babies don’t really start producing salivary amylase until that this time. A pretty Primal recommendation I’d say!

    Meghanne wrote on November 19th, 2013
  15. you heard it folks

    enjoy plenty of fruits of veggies

    steffo wrote on November 19th, 2013
  16. Is it the caffeine in coffee that is associated with a lower risk of Type 2 Diabetes, or some other antioxidant power of coffee. How about green tea or black tea?

    Jennifer L. wrote on November 19th, 2013
  17. Where I live (Greece) store bought baby food in jars is seriously frowned upon by pediatricians and family alike. It’s considered pure laziness on behalf of the mother/parents and people only use it rarely for example when they have to travel. Most doctors advise introduction of solids at 6 months and the vast majority of families cook for the babies daily and Greece’s infant rate mortality is very low, I believe lower that the U.S. despite the more advanced medical care in the U.S. I personally cooked double the amount needed and kept individual servings in the freezer, so that my babies would eat a freshly made meal one day and a frozen one the next and I consider it a lot healthier than bought food. Actually, having raised 3 kids not once did they taste food from a jar.

    Katerina wrote on November 21st, 2013
  18. I like the valuable info you provide in your articles.
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    คอกกั้นเด็ก wrote on January 8th, 2014
  19. I’m a type 2 and I can say that vegetables are helps me a lot. My blood sugar levels are much lower since I’ve introduced much vegetables into my diet. Still, my blood sugar levels are way above normal (). I mostly eat raw vegetables as boiling them will remove many vitamins and minerals. I always add vegetables or fruit to each of my meals. I didn’t like vegetables before but now I quite like them. These two articles might be helpful to you:
    http://healthiack.com/diets/diet-for-people-with-diabetes
    http://healthiack.com/health/what-is-normal-blood-sugar-level#how-to-lower-blood-sugar-level
    Hope this helps.
    Best regards, Tom

    Tom wrote on January 8th, 2014

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