Diet & Diabetes

Eating to Keep Diabetes in Check

By PETER JARET

Tony Cenicola/The New York Times, Daniel Acker/Bloomberg News

In Brief:

One in four people born today are expected to develop Type 2 diabetes during their lifetimes.

Shedding excess weight and exercising more can cut Type 2 diabetes risk by 58 percent.

Favoring foods in their unrefined state -- brown rice and whole grains, for instance -- can help keep blood sugar levels from spiking.

Exercise improves blood sugar control by increasing insulin sensitivity.

As rates of Type 2 diabetes continue to rise around the world, experts say we mostly have ourselves to blame. Genes certainly play a role in determining risk. But the surge of new cases of this debilitating disease is caused mostly by poor diets and lack of physical activity.

By all rights, the prescription should be simple: lose weight if you are overweight, and get more exercise.

Easy? Of course not. Experts have yet to come up with anything close to a surefire approach to help people shed pounds. And dietary recommendations to prevent or slow diabetes have often been contradictory and confusing. Nearly 30 years after the American Diabetes Association recommended a low-fat, high-carbohydrate diet to control diabetes, overturning the high-fat, low-carbohydrate approach of earlier decades, controversy still swirls around the amount and types of carbohydrates to eat.

Much of the debate focuses on the glycemic index, a measure of how carbohydrate-rich foods affect blood sugar, and whether these effects play a significant role in the progression of Type 2 diabetes. Foods high on the glycemic index, like sugared beverages, cake and white rice, are known to send blood sugar levels up sharply after a meal. Foods low on the index, like broccoli, lettuce, brown rice and whole grains, on the other hand, take longer to digest and hence keep blood sugar levels on a more even keel.

The American Diabetes Association has decided that patients should not be counseled to take the glycemic index into account when choosing foods. “Although it is clear that carbohydrates do have differing glycemic responses,” its policy statement declares, “the data reveal no clear trend in outcome benefits.”

That’s a mistake, says Dr. David Ludwig, an endocrinologist at Children’s Hospital in Boston and an associate professor at Harvard Medical School. “High-glycemic foods like refined grains raise blood sugar levels two to three times higher than unprocessed foods with a low glycemic index,” he said. When blood sugar levels spike, the body must churn out insulin to move glucose out of the bloodstream and into cells, where it is used for energy.

“If you’re eating high-glycemic foods meal after meal, snack after snack, day after day, that’s going to put a lot of stress on the system that produces insulin,” Dr. Ludwig said. “If the system is already compromised due to a family history of diabetes, those rapid swings of blood sugar could make a difference between remaining healthy or decompensating into Type 2 diabetes.”

Dr. Ludwig cites a study he conducted in which rats fed foods high on the glycemic index lost lean muscle mass, gained body fat and began to lose their ability to control blood sugar.

“A high percentage of insulin-producing cells in the high-glycemic rats were undergoing a process of destruction, disruptions in their architecture and scarring,” Dr. Ludwig said. The same thing, he suspects, happens in people.

But so far, evidence from human studies has been sketchy. In one recent Canadian study, there were no differences in blood sugar control among 162 volunteers assigned to one of three very different diets for a year: a low-carbohydrate regimen; a high-carbohydrate, low-glycemic-index diet; or foods high on the glycemic scale. Fasting glucose, a test widely used to monitor diabetes risk, actually rose in the group eating the low-glycemic foods.

A second study of 1,898 people found that risk of Type 2 diabetes was the same whether people reported eating foods high or low on the glycemic index.

“The notion that glycemic index matters makes intuitive sense,” said Dr. John M. Miles, a diabetes expert at the Mayo Clinic. “A lot of people have strong feelings on the subject. But the evidence just isn’t there.”

Dr. Xavier Pi-Sunyer, an endocrinologist and diabetes expert at St Luke’s-Roosevelt Hospital in New York, agreed. Given the new findings, “It seems unwise at this point to burden Type 2 diabetes patients with trying to pick and choose among different high- and low-glycemic-index foods,” he wrote in a recent review of the evidence.

But Dr. Thomas Wolever, a University of Toronto researcher who led the Canadian trial, noted that those who ate low-glycemic-index foods showed improvements in blood sugar control after meals, which may be a more important measure of glucose control than the fasting glucose test. They also had reductions in levels of C-reactive protein, a marker for inflammation that also appears to be linked to diabetes risk.

Low-glycemic diets may have another crucial advantage, Dr. Wolever suggested: they help some people shed pounds. “I’ve had people tell me it’s the only way they’ve been able to lose weight,” he said.

While no single diet works for everyone, losing weight may be the single most effective way to lower Type 2 diabetes risk. Evidence for that comes from a major trial sponsored by the National Institutes of Health, in which a randomly assigned group of overweight volunteers with early signs of diabetes were encouraged to lose about 7 percent of their body weight and engage in 150 minutes of moderate exercise weekly.

Over the next three years, only 5 percent of the lifestyle intervention group went on to develop diabetes each year, compared with 11 percent of volunteers in a control group. Weight loss and exercise proved more effective than a leading diabetes medication in preventing Type 2 diabetes.

“There’s no question that if we can get people to lose 5 or 10 pounds, we’ll be doing them a world of good,” Dr. Wolever said. The confounding question remains how.

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Publisher Tested the Waters Online, Then Dove In

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By STEVE LOHR

Published: May 5, 2008

It may be a niche publisher, but the International Data Group has been working out the answers to some big mainstream questions. The biggest one: Can print media survive the transition to the Internet?

The question has taken on new urgency lately. A faltering economy is heightening the pressure on newspapers and magazines to find a sustaining future online, as the flight of readers and advertisers to the Web accelerates.

Just last week, The Capital Times, a 90-year-old daily newspaper in Madison, Wis., ended its print version and began publishing only online.

The journey beyond print is uncertain and perilous, but the experience of I.D.G., the world’s largest publisher of technology newspapers and magazines, suggests that it can be done. A privately held company, whose magazines include Computerworld, InfoWorld, PC World, Macworld and CIO, it appears to have made a profitable migration to the Internet, with revenue from online ads now surpassing print revenue.

Advertisers and readers of high-tech publications have moved online more swiftly than other audiences, so I.D.G. may offer a glimpse of the future of publishing. Yet the transition at I.D.G. came only after years of investment, upheaval and changes in its practice of journalism.

“The excellent thing, and good news, for publishers is that there is life after print — in fact, a better life after print,” said Patrick J. McGovern, the founder and chairman of I.D.G.

The biggest single step in the company’s online shift came on April 2, 2007, when the last print edition of InfoWorld appeared and it became a Web-only publication. InfoWorld, a weekly, started out as Intelligent Machines Journal in 1978; I.D.G. bought it a year later, and it has long been one of the company’s flagship magazines.

There were nervous months after the switch as the company awaited the reaction from advertisers and readers, but before long InfoWorld’s Web audience was growing and its business improved. Today, I.D.G. says, the InfoWorld Web site is generating ad revenue of $1.6 million a month with operating profit margins of 37 percent. A year earlier, when it had both print and online versions, InfoWorld had a slight operating loss on monthly revenue of $1.5 million.

Across the company, the remaining print publications still typically play a vital role, but a lesser one — physically smaller and financially diminished. In 2002, 86 percent of the revenue from I.D.G.’s publications came from print and 14 percent online. These days, 52 percent of the revenue is from online ads, while 48 percent is from the print side.

Last year, print and online publications accounted for 70 percent of I.D.G.’s $3 billion in revenue, with the rest coming from its conference business and its technology research firm, I.D.C.

The giant technology publisher has not just stabilized its business, Mr. McGovern said, but is also now growing at about 10 percent a year — though a severe recession would surely dim its growth prospects this year.

Throughout its far-flung network of 300 print publications and 450 Web sites in 85 countries, I.D.G. has converted smaller magazines to online only, but InfoWorld was the big one. More will come, company executives say, as print magazines slip into the red and are left behind. But they emphasize that the print versions of some publications like CIO, a glossy twice-monthly magazine, are likely to be around for many years.

CIO (for chief information officer) is distributed free to senior technology managers. It is solidly profitable and runs long articles that detail the use of technology in corporations and government institutions. A recent issue included a nine-page article on the effort to use computerized records to improve health care in California’s prison system, under a court-ordered program.

Yet even CIO has adopted what its managers call an “online first” business model. Three years ago, the editorial staff was divided into three people who worked on the Web site only and the rest only on print. Today, there are no print and Web barriers. The total staff size, at 23, is one fewer than in 2005, but now most of them spend 80 percent of their time on the Web, while a handful of writers spend 80 percent of their time on the long centerpiece articles in the print magazine.

But everyone writes for the Web these days. “It’s only fair to people for their career development,” said Michael Friedenberg, the president of CIO. “How can you say to anyone, in this environment, that they can only write in print and not online?”

The most striking change, though, has occurred at more news-oriented publications like InfoWorld, the former weekly, given the Internet’s ability to deliver news instantly to readers and deliver narrowly defined audiences to advertisers.

When Robert Carrigan, the executive in charge of I.D.G. media properties, met with the senior business managers of InfoWorld in February last year, the only thing left to decide was the death date for the print edition. With a controlled circulation of 180,000 copies, the print edition was losing money, while investment and resources had shifted to the InfoWorld Web site. “We were eager to evolve the business and prove what we felt deep down, that we could move beyond print,” Mr. Carrigan said.

There was little surprise in the editorial ranks either. By then, the editorial staff was down to its current level of 17 people, about half the number in 2002, and way below the peak of nearly 100 during the technology spending boom of the late 1990s. The separation of the print and online staffs had ended long before.

Steve Fox, the editor in chief of InfoWorld at the time, said that the most fundamental difference between print and online was the ability to measure precisely how many readers view a particular article on the Web — and how those results influence editorial decisions on what to write about.

The link to the business is direct. When a person views a Web page, ads are automatically presented on the page and the publisher collects a payment.

“It’s wonderful to have the feedback that you get online, but you need enlightened ownership so that you are not a slave to page views,” said Mr. Fox, who left amicably last October to join a social networking start-up.

At InfoWorld, page views are important, said Eric Knorr, the current editor in chief, but as a guide rather than a substitute for editorial judgment. Predictably, he added, certain topics that stir strong opinions among technology readers produce spikes in traffic. “If we were chasing page views, all we’d ever write about is H1-B visas for tech workers, Macs and how bad Microsoft is,” Mr. Knorr said.

Yet as a Web-only publication, InfoWorld is very different from the bygone print edition. Gone, Mr. Knorr says, are the long pieces of more than 3,000 words, with anecdotes and narrative, examining how technology had transformed some company or industry. Instead, he said, the key online is packaging information into “digestible chunks,” typically of no more than a page of text or so, sometimes in lists of “10 things to do” to solve some technology problem in companies.

The Web, Mr. Knorr said, also opens the door to offerings that are impossible in print. He pointed to short animations that explain complex technologies, and an online petition urging Microsoft to keep selling the aging Windows XP operating system beyond its June cutoff date, which has collected 160,000 names.

Without the physical limitations of print, Mr. Knorr said, it becomes easier to explore topics more deeply. InfoWorld presents a stable of bloggers, including 19 freelance writers, who are authorities in niches including data protection, green technology, open source software and cloud computing.

The goal, with reporting and blogging, Mr. Knorr said, is to create “thought leadership and depth” in several subject areas online, and also set up InfoWorld conferences around those topics.

The approach, it seems, resonates with the advertising industry. “Print brands are going to continue to live, but the distribution channels are certainly changing and so is the content,” said Latha Sundaram, a senior vice president at Starcom Worldwide, an advertising buyer. “InfoWorld has focused on the depth of information in technology that is best presented in an online format.”

Stewart Alsop, a journalist turned venture capitalist, was the editor in chief of InfoWorld in the 1990s, when it was thick with ads and its editorial staff was at its peak. “Technology publishing just happens to be at the point of this whole transformation of media,” Mr. Alsop said. “What’s happening at I.D.G. is a fairly accurate map for every other publishing organization. Get over it, it’s going to happen.”

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