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Omega-3 index – do you know yours?

January 29 2015

by Emily Ryan

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There is a large volume of research regarding the importance of long chain omega 3 fatty acid levels in our bodies, with reference to cardiovascular risk reduction as well as neurologic health and joint health. EPA and DHA are the specific long chain omega 3 fatty acids that are often at inadequate levels. The measurement of levels in your blood is a relatively inexpensive test that can help you to determine if your intake is adequate or not. Omnivores usually consume fish or fish oil, while vegans (and vegetarians) can supplement with EPA and DHA from marine algae. Here are a couple of recent studies:

 

Higher omega-3 index is associated with increased insulin sensitivity and more favourable metabolic profile in middle-aged overweight men.

Albert BB1, Derraik JG1, Brennan CM1, Biggs JB1, Smith GC2, Garg ML3, Cameron-Smith D1, Hofman PL4, Cutfield WS4.
Sci Rep. 2014 Oct 21;4:6697. doi: 10.1038/srep06697.

Abstract

We assessed whether omega-3 index (red blood cell concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) was associated with insulin sensitivity and other metabolic outcomes in 47 overweight men aged 46.5 ± 5.1 years. Participants were assessed twice, 16 weeks apart. Insulin sensitivity was assessed by the Matsuda method from an oral glucose tolerance test. Linear associations were examined; stratified analyses were carried out with participants separated according to the omega-3 index: lower tertiles (LOI; n = 31) and highest tertile (HOI; n = 16). Increasing omega-3 index was correlated with higher insulin sensitivity (r = 0.23; p = 0.025), higher disposition index (r = 0.20; p = 0.054), and lower CRP concentrations (r = -0.39; p < 0.0001). Insulin sensitivity was 43% higher in HOI than in LOI men (Matsuda index 6.83 vs 4.78; p = 0.009). Similarly, HOI men had disposition index that was 70% higher (p = 0.013) and fasting insulin concentrations 25% lower (p = 0.038). HOI men displayed lower nocturnal systolic blood pressure (-6.0 mmHg; p = 0.025) and greater systolic blood pressure dip (14.7 vs 10.8%; p = 0.039). Men in the HOI group also had lower concentrations of CRP (41% lower; p = 0.033) and free fatty acids (21% lower, p = 0.024). In conclusion, higher omega-3 index is associated with increased insulin sensitivity and a more favourable metabolic profile in middle-aged overweight men.

PMID: 25331725
Full text 
Intrinsic heart rate recovery after dynamic exercise is improved with an increased omega-3 index in healthy males

Macartney MJ1, Hingley L1, Brown MA1, Peoples GE1, McLennan PL2.
Br J Nutr. 2014 Dec;112(12):1984-92. doi: 10.1017/S0007114514003146. Epub 2014 Oct 30.

Abstract

Dietary fish consumption contributes to a reduced risk of cardiac mortality. In the present study, the effect of low-dose fish oil (FO) supplementation on heart rate (HR) response to intense exercise and recovery was investigated in physically fit males. The subjects (n 26) were supplemented (double-blind, parallel design) with (2 × 1 g/d) soya bean oil (control) or tuna FO providing the long-chain n-3 PUFA DHA (560 mg) and EPA (140 mg). Erythrocyte omega-3 index (%EPA+DHA), HR, HR variability and HR recovery were analysed during rest, intense exercise and recovery at baseline and after 8 weeks of supplementation. The mean erythrocyte omega-3 index, which did not differ between the groups at baseline (control 4.2 (sem 0.2), n 13; FO 4.7 (sem 0.2), n 13), remained unchanged in the control group (3.9 (sem 0.2)), but increased in the FO group (6.3 (sem 0.3); P< 0.01). The mean HR during supine resting conditions (control 56 (sem 10); FO 59 (sem 9)) was not affected by FO supplementation. Poincaré analysis of HR variability at rest exhibited a decreasing trend in parasympathetic activity in the FO group (SD1 (standard deviation of points perpendicular to the axis of line of identity)/SD2 (standard deviation of points along the axis of line of identity): control 0.02 (sem 0.01); FO – 0.05 (sem 0.02); P= 0.18). Peak HR was not affected by supplementation. However, during submaximal exercise over 5 min, fewer total heart beats were recorded in the FO group (-22 (sem 6) ( = -4.5 beats/min)), but not in the control group (+1 (sem 4)) (P< 0.05). Supine HR recovery (half-time) after cycling was significantly faster after FO supplementation (control – 0.4 (sem 1.2) s; FO – 8.0 (sem 1.7) s; P< 0.05). A low intake of FO increased the omega-3 index and reduced the mean exercise HR and improved HR recovery without compromising the peak HR. A direct influence of DHA via reductions in the cardiac intrinsic beat rate was balanced by a reciprocal decrease in vagal tone.

PMID: 25355484

Is too much sitting killing you?

January 29 2015

by Emily Ryan

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sitting

This meta-analysis found that the more we sit, the higher our risk for cardiovascular disease, diabetes, cancer and death. No question that we need to move more.

Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis

Aviroop Biswas, BSc; Paul I. Oh, MD, MSc; Guy E. Faulkner, PhD; Ravi R. Bajaj, MD; Michael A. Silver, BSc; Marc S. Mitchell, MSc; and David A. Alter, MD, PhD

Ann Intern Med. 2015;162(2):123-132. doi:10.7326/M14-1651

Abstract

Background: The magnitude, consistency, and manner of association between sedentary time and outcomes independent of physical activity remain unclear.

Purpose: To quantify the association between sedentary time and hospitalizations, all-cause mortality, cardiovascular disease, diabetes, and cancer in adults independent of physical activity.

Data Sources: English-language studies in MEDLINE, PubMed, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and Google Scholar databases were searched through August 2014 with hand-searching of in-text citations and no publication date limitations.

Study Selection: Studies assessing sedentary behavior in adults, adjusted for physical activity and correlated to at least 1 outcome.

Data Extraction: Two independent reviewers performed data abstraction and quality assessment, and a third reviewer resolved inconsistencies.

Data Synthesis: Forty-seven articles met our eligibility criteria. Meta-analyses were performed on outcomes for cardiovascular disease and diabetes (14 studies), cancer (14 studies), and all-cause mortality (13 studies). Prospective cohort designs were used in all but 3 studies; sedentary times were quantified using self-report in all but 1 study. Significant hazard ratio (HR) associations were found with all-cause mortality (HR, 1.240 [95% CI, 1.090 to 1.410]), cardiovascular disease mortality (HR, 1.179 [CI, 1.106 to 1.257]), cardiovascular disease incidence (HR, 1.143 [CI, 1.002 to 1.729]), cancer mortality (HR, 1.173 [CI, 1.108 to 1.242]), cancer incidence (HR, 1.130 [CI, 1.053 to 1.213]), and type 2 diabetes incidence (HR, 1.910 [CI, 1.642 to 2.222]). Hazard ratios associated with sedentary time and outcomes were generally more pronounced at lower levels of physical activity than at higher levels.

Limitation: There was marked heterogeneity in research designs and the assessment of sedentary time and physical activity.

Conclusion: Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.

Ten Things Doctors Should Know About Celiac

December 5 2014

by Emily Ryan

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Many physicians, gastroenterologists included, would benefit from a review of this list.
Celiac disease remains under-diagnosed despite being far from rare at 1% of the population.

Celiac Disease: Ten Things That Every Gastroenterologist Should Know

Oxentenko AS, Murray JA.

Clin Gastroenterol Hepatol. 2014 Jul 19.

There are 10 things that all gastroenterologists should know about celiac disease (CD).

(1) The immunoglobulin A tissue transglutaminase is the single best serologic test to use for the detection of CD.

(2) CD can be recognized endoscopically, and water immersion enhances villi detection, although a normal endoscopic appearance does not preclude the diagnosis.

(3) It is recommended that 4 biopsies be taken from the second part of the duodenum and 2 bulb biopsies be taken at the 9 o’clock and 12 o’clock positions to maximize the sensitivity for histologic confirmation of CD.

(4) Consider serologic testing of first-degree relatives, patients with type 1 diabetes mellitus, Down’s, Turner’s, and Williams’ syndromes, as well as those with premature osteoporosis, iron deficiency, abnormal liver biochemistries, and other manifestations of CD.

(5) Patients already on a prolonged gluten-free diet (GFD) should be tested for the presence of HLA DQ2 or DQ8, thereby avoiding the need for further evaluation of CD in non-allelic carriers.

(6) The basic treatment of CD is a strict, lifelong GFD, enabled by an expert dietitian.

(7) Newly diagnosed adults with CD should be assessed for micronutrient deficiencies (iron, B12, folate, zinc, copper), fat soluble vitamin deficiencies (vitamin D), and bone densitometry.

(8) All patients diagnosed with CD should have clinical follow-up to ensure response and adherence to a GFD.

(9) In those with persistent or relapsing symptoms, the robustness of the original diagnosis should be reviewed, gluten exposure sought, and a systematic evaluation for alternative and associated diseases performed.

(10) Evaluate those with refractory disease for malignant transformation.

PMID: 25051511

CoQ10 improves outcomes in heart failure patients

November 28 2014

by Emily Ryan

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This randomized controlled trial looked at the use of CoenzymeQ10 as an add-on therapy in patients with chronic heart failure. They found that Long-term CoQ10 treatment of patients with chronic heart failure is safe, improves symptoms, and reduces major adverse cardiovascular events. This adds to a previous body of evidence showing benefit.

This study should change the standard of care for heart failure patients in that Coenzyme Q10 should be used as an add-on therapy. This study used the ubiquinone rather than ubiquinol form of CoQ10.

The Effect of Coenzyme Q10 on Morbidity and Mortality in Chronic Heart Failure: Results From Q-SYMBIO: A Randomized Double-Blind Trial

Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP; Q-SYMBIO Study Investigators.

JACC Heart Fail. 2014 Sep 25. pii: S2213-1779(14)00336-9. doi: 10.1016/j.jchf.2014.06.008. [Epub ahead of print]

Abstract

OBJECTIVES:
This randomized controlled multicenter trial evaluated coenzyme Q10 (CoQ10) as adjunctive treatment in chronic heart failure (HF).

BACKGROUND:
CoQ10 is an essential cofactor for energy production and is also a powerful antioxidant. A low level of myocardial CoQ10 is related to the severity of HF. Previous randomized controlled trials of CoQ10 in HF were underpowered to address major clinical endpoints.

METHODS:
Patients with moderate to severe HF were randomly assigned in a 2-year prospective trial to either CoQ10 100 mg 3 times daily or placebo, in addition to standard therapy. The primary short-term endpoints at 16 weeks were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro-B type natriuretic peptide. The primary long-term endpoint at 2 years was composite major adverse cardiovascular events as determined by a time to first event analysis.

RESULTS:
A total of 420 patients were enrolled. There were no significant changes in short-term endpoints. The primary long-term endpoint was reached by 15% of the patients in the CoQ10 group versus 26% in the placebo group (hazard ratio: 0.50; 95% confidence interval: 0.32 to 0.80; p = 0.003) by intention-to-treat analysis. The following secondary endpoints were significantly lower in the CoQ10 group compared with the placebo group: cardiovascular mortality (9 % vs. 16%, p = 0.026), all-cause mortality (10 % vs. 18%, p = 0.018), and incidence of hospital stays for HF (p = 0.033). In addition, a significant improvement of NYHA class was found in the CoQ10 group after 2 years (p = 0.028).

CONCLUSIONS:
Long-term CoQ10 treatment of patients with chronic HF is safe, improves symptoms, and reduces major adverse cardiovascular events.
(Coenzyme Q10 as adjunctive treatment of chronic heart failure: a randomized, double-blind, multi-center trial with focus on SYMptoms, BIomarker status [Brain-Natriuretic Peptide (BNP)], and long-term Outcome [hospitalisations/mortality]; ISRCTN94506234).

PMID: 25282031

Reversal of cognitive decline: A novel therapeutic program

November 18 2014

by Emily Ryan

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This is a small case series of individualized and multimodal approach to dementia with results than appear to be quite remarkable. This should offer more hope than we have seen from simpler drug regimens. More study is underway.

Dale E. Bredesen

AGING, Vol 6, No 9 , pp 707-717

Abstract

This report describes a novel, comprehensive, and personalized therapeutic program that is based on the underlying pathogenesis of Alzheimer’s disease, and which involves multiple modalities designed to achieve metabolic enhancement for neurodegeneration (MEND). The first 10 patients who have utilized this program include patients with memory loss associated with Alzheimer’s disease (AD), amnestic mild cognitive impairment (aMCI), or subjective cognitive impairment (SCI). Nine of the 10 displayed subjective or objective improvement in cognition beginning within 3-6 months, with the one failure being a patient with very late stage AD. Six of the patients had had to discontinue working or were struggling with their jobs at the time of presentation, and all were able to return to work or continue working with improved performance. Improvements have been sustained, and at this time the longest patient follow-up is two and one-half years from initial treatment, with sustained and marked improvement. These results suggest that a larger, more extensive trial of this therapeutic program is warranted. The results also suggest that, at least early in the course, cognitive decline may be driven in large part by metabolic processes. Furthermore, given the failure of monotherapeutics in AD to date, the results raise the possibility that such a therapeutic system may be useful as a platform on which drugs that would fail as monotherapeutics may succeed as key components of a therapeutic system.

Full text link: here

Healthy diet and lifestyle and risk of stroke in a prospective cohort of women

November 7 2014

by Emily Ryan

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Here is another study looking at diet and lifestyle that reveals a very large risk reduction for stroke in women.
We have long under-estimated the sheer magnitude of the impact of a healthier lifestyle on not only cardiovascular disease but on a very wide range of diseases.

Larsson SC, Akesson A, Wolk A.

Neurology. 2014 Oct 8. pii: 10.1212/WNL.0000000000000954. [Epub ahead of print]

Abstract

OBJECTIVE:

To investigate the association between a low-risk lifestyle and risk of stroke.

METHODS:

The study population comprised 31,696 women, in the population-based Swedish Mammography Cohort who at baseline had completed a questionnaire about diet and lifestyle and were free from cardiovascular disease and cancer. We defined a low-risk lifestyle as a healthy diet (top 50% of a Recommended Food Score), moderate alcohol consumption (5-15 g/d), never smoking, physically active (walking/bicycling ≥40 min/d and exercise ≥1 h/wk), and body mass index below 25 kg/m2. Stroke cases were identified from the Swedish National Patient Register and the Swedish Cause of Death Register.

RESULTS:

We ascertained 1,554 incident stroke cases, including 1,155 cerebral infarctions, 246 hemorrhagic strokes, and 153 unspecified strokes during 10.4 years of follow-up. The risk of stroke, in particular cerebral infarction, decreased steadily with increasing number of low-risk lifestyle factors. Compared with no low-risk factors, the multivariable relative risks (95% confidence interval) of cerebral infarction across increasing number of low-risk factors (1-5) were 0.72 (0.56-0.93), 0.67 (0.52-0.85), 0.57 (0.44-0.74), 0.54 (0.40-0.73), and 0.38 (0.20-0.73).

CONCLUSIONS:

These findings indicate that a low-risk lifestyle can substantially reduce the risk of stroke, especially cerebral infarction.

PMID: 25298305

Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men – A Population-Based Prospective Cohort Study

October 31 2014

by Emily Ryan

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We have known for decades that lifestyle matters when it comes to the risk of cardiovascular disease. This is yet another study to show us that the magnitude of the risk reduction is HUGE!
Agneta Åkesson, PhD; Susanna C. Larsson, PhD; Andrea Discacciati, MSc; Alicja Wolk, DMScJ Am Coll Cardiol. 2014;64(13):1299-1306. doi:10.1016/j.jacc.2014.06.1190

Abstract

Background: Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI).

Objectives: The aim of this study was to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men.

Methods: The population-based, prospective cohort of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week), and having no abdominal adiposity (waist circumference <95 cm).

Results: During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population.

Conclusions: Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

 

Higher produce intake correlates with better mental health

October 22 2014

by Emily Ryan

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This health survey of almost 14 000 adults looked at measures of lifestyle and mental well-being. Not surprisingly, higher vegetable and fruit intake was strongly associated with better mental health. Imagine that — the brain prefers to be well nourished!

Major health-related behaviours and mental well-being in the general population: the Health Survey for England.

Stranges S, Samaraweera PC, Taggart F, Kandala NB, Stewart-Brown S.
BMJ Open. 2014 Sep 19;4(9):e005878. doi: 10.1136/bmjopen-2014-005878.

Abstract

BACKGROUND:
Major behavioural risk factors are known to adversely affect health outcomes and be strongly associated with mental illness. However, little is known about the association of these risk factors with mental well-being in the general population. We sought to examine behavioural correlates of high and low mental well-being in the Health Survey for England.

METHODS:
Participants were 13 983 adults, aged 16 years and older (56% females), with valid responses for the combined 2010 and 2011 surveys. Mental well-being was assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). ORs of low and high mental well-being, compared to the middle-range category, were estimated for body mass index (BMI), smoking, drinking habits, and fruit and vegetable intake.

RESULTS:
ORs for low mental well-being were increased in obese individuals (up to 1.72, 95% CI 1.26 to 2.36 in BMI 40+ kg/m(2)). They increased in a linear fashion with increasing smoking (up to 1.98, 95% CI 1.55 to 2.53, >20 cigarettes/day) and with decreasing fruit and vegetable intake (up to 1.53, 95% CI 1.24 to 1.90, <1 portion/day); whereas ORs were reduced for sensible alcohol intake (0.78, 95% CI 0.66 to 0.91, ≤4 units/day in men, ≤3 units/day in women). ORs for high mental well-being were not correlated with categories of BMI or alcohol intake. ORs were reduced among ex-smokers (0.81, 95% CI 0.71 to 0.92), as well as with lower fruit and vegetable intake (up to 0.79, 95% CI 0.68 to 0.92, 1 to <3 portions/day).

CONCLUSIONS:
Along with smoking, fruit and vegetable consumption was the health-related behaviour most consistently associated with mental well-being in both sexes. Alcohol intake and obesity were associated with low, but not high mental well-being.

PMID: 25239293
PMCID: PMC4170205

Lifestyle Study Finds Impressive Heart Risk Reduction

October 5 2014

by Emily Ryan

No Comments

This well-designed population-based, prospective cohort study of Swedish men followed them for 11 years. They found a dramatic risk reduction in heart attacks when comparing those with no risk factors with those with 5 risk factors. While a risk reduction is not surprising the magnitude of the risk reduction is huge.

Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men
A Population-Based Prospective Cohort Study

Agneta Åkesson, PhD; Susanna C. Larsson, PhD; Andrea Discacciati, MSc; Alicja Wolk, DMSc

J Am Coll Cardiol. 2014;64(13):1299-1306. doi:10.1016/j.jacc.2014.06.1190

Abstract

Background: Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI).

Objectives: The aim of this study was to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men.

Methods: The population-based, prospective cohort of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week), and having no abdominal adiposity (waist circumference <95 cm).

Results: During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population.

Conclusions: Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

Link to abstract: content.onlinejacc.org/article.aspx?articleid=1909605

Dairy products could cut risk of type 2 diabetes

September 26 2014

by Emily Ryan

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Consumption of high-fat dairy products could lower the risk for type 2 diabetes, according to researchers from the Lund University Diabetes Center in Malmö, Sweden.

The research team, led by Dr. Ulrika Ericson, concluded that people with the highest intake of high fat dairy products reduced their chances of developing type 2 diabetes by 23 percent.

Here, researchers say it’s a question of where the fat comes from, citing the benefits of unsaturated fat found in dairy products. On the flip side, researchers note, the saturated fat content of red meat is known to increase risk of the disease.

The large-scale study was conducted over a 14-year span and involved 26 930 individuals of which 60 percent were women, aged 45 to 74 years.

After adjusting their data for factors like BMI, physical activity level and smoking which could affect participants’ risk factor, researchers analyzed participants’ diets and arrived at some conclusions.

For example, 30 ml or more a day of cream was associated with a 15 percent reduced risk for the disease, while high-fat fermented milk consumption at 180 ml per day was associated with a 20 percent risk reduction.

These findings build on the case for untreated milk after Harvard scientist David Ludwig published a study last year alerting the public to the added sugar in low-fat milk intended to enhance the reduced taste.

The Swedish research team presented their findings Monday at the annual meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria.

A concurrent study also suggested that sufficient proportions of dairy intake per day can reduce risk for type 2 diabetes: researchers from CHU de Québec Research Center and Laval University in Canada noted that sufficient proportions of dairy intake per day can be beneficial to metabolic health.

 

Read more: http://www.ctvnews.ca/health/dairy-products-could-cut-risk-of-type-2-diabetes-study-1.2010930#ixzz3E4B4WdRb