Steve, author of “Adventures of a Funky Heart!” blog and 43 year-old survivor of congenital tricuspid atresia, hosts this week’s Funky Heart edition (volume 6, number 38) of online medical Grand Rounds. Our entry about brown rice vs. white rice and the risk of diabetes was listed as follows:

Warden of On the Wards has been poking around in the cafeteria again and has found a couple of staples that we all eat but should avoid. Personally, I try to avoid Hospital Food. I dislike it so much that I try to avoid the entire hospital! (Hey, they don’t call it mystery meat for nothing!)

I must agree with Steve. With all due respect to the hard-working individuals in Food Services, hospital food leaves a lot to be desired. On the other hand, on really busy work days, I can often find myself chomping down on whatever snacks I can find in the hospital pantry (i.e., Graham crackers and biscuits). I will settle for anything, especially after a long day rounding and doing procedures.

The marketing labels “organic”, “all natural”, and “whole grain” typically bear a positive connotation with broad appeal to health-conscious consumers. Do these foods truly have any health benefits? While “organic” and “all natural” properties of food may have unclear effects, there is mounting evidence that “whole grains” do. Harvard researchers recently compared whole-grain brown rice with refined white rice and evaluated their relative risks for developing type 2 diabetes.

The study analyzed prospective data from 39,765 men and 15,7463 women who participated in 3 separate cohort studies: the Health Professionals Follow-up Study (HPFS) and the Nurses’ Health Study (NHS) I and II. Relevant to this research study, the individual cohort studies had required periodic completion of questionnaires about lifestyle practices and occurrences of chronic diseases.

Individuals who did not complete over 50% of the food items on the food frequency questionnaire (FFQ) were excluded from this study’s analysis. In addition, the researchers excluded those with a pre-existing diagnosis of diabetes, cardiovascular disease, and cancer.

Adjusting for age alone, consumption of >4 servings/week of white rice was associated with a greater risk of developing type 2 diabetes, relative to those who eat <1 serving/month. There was a smaller but similar trend after adjusting for other potential confounders, such as ethnicity, body mass index, smoking status, alcohol intake, multivitamin use, physical activity, and family history of diabetes.

In contrast, consumption of >1 serving/week of brown rice was associated with a lower relative risk of type 2 diabetes, compared to those who eat <1 serving/month. When replacing 50 g/day of white rice with brown rice, there was a 16% decreased risk of diabetes. This risk was 36% lower when white rice was instead substituted with whole grains.

The authors hypothesize that the refinery process that converts brown rice to white rice leads to loss of some protective effects of bran, fiber, vitamins, minerals, lignans, phytoestrogens, and phytic acid.

The findings of this study reinforce that “substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes.” While physicians may counsel their diabetic patients to practice strict carbohydrate control, pre-diabetics should also consider the nutritional impact of their food choices. I will however admit that it is much easier said than done. My acquired taste for white rice is much stronger than for brown rice, and I fear my taste buds may revolt if I were to someday defect to the brown side.

• Source
• Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC, Hu FB. White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med 2010;170:961-9.

The “New & Interesting” series is a biweekly compilation of select research findings, news articles, and random tidbits in bullet-point format. The entries are highly abbreviated, but provide links to the original articles or abstracts if you desire to read further.

General Articles

• Telaprevir leads to 75% cure rate in hepatitis C virus (HCV) infected individuals, as shown in late-stage Phase III drug trial. This is a significant improvement over the 40-50% cure rate of the current HCV therapies: interferon and ribavirin. The side effect profile of telaprevir is also much more tolerable than with interferon and ribavirin. If approved by the FDA, telaprevir may also lead to a multi-billion dollar boon for its developer, Vertex Pharmaceuticals. (Reuters)

• Researchers at Ulm University in Germany discovered that children who ate three or more hamburgers a week had a 40% greater risk of developing asthma than those who ate less hamburgers. The group hypothesizes that saturated fats promote asthma by causing inflammation in the airways. This does not apply to all fats, such as omega-3, which may instead have a protective effect. (WebMD)

Technical Articles

• Bilateral necrosis of earlobes and cheeks may be another complication of cocaine. There has been an increasing percentage of cocaine cut with the antihelmintic agent levimasole. Levimasole is an immunomodulating agent that has neutropenia and vasculitis as adverse effects. Physicians from the University of Rochester report two cases of cocaine abusers who developed these yet unknown consequences of cocaine use. (Ann Intern Med)

• Inactive hepatitis B still carries risk for hepatocellular carcinoma and liver-related death. The REVEAL-HBV (Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer in HBV) Study Group found that the annual incidence rates of hepatocellular carcinoma and liver-related death was higher in inactive HBV carriers when compared to uninfected controls. (Gastroenterology)

The “Memorable Tweets” series is a monthly compilation of notable past tweets from the microblog version of On The Wards. The entries may provide some — albeit small — insight into my world as a clinical physician and scientist.

The comments are invariably true and may reflect real-life experiences. I have nevertheless made every effort to protect patient privacy. Most tweets are sufficiently obfuscated to avoid identification of any particular patient. If you feel a comment resembles your case, it is highly likely a mere coincidence. But if you’re a patient who is absolutely convinced that I was talking about you, and would prefer that I not, then contact me and we can discuss this.

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