What are we going to do about the diabetes ‘timebomb’?

It’s been hard to miss the dire warning we’ve had about the burgeoning rates of diabetes we’re seeing in the World. Another came this week came out of Cape Town in South Africa during the World Diabetes Congress. It was announced at a news conference that by the year 2025, 380 million people will be diagnosed with diabetes. Compare this with the situation just two decades ago, when a mere (in comparison) 30 million people had been diagnosed with this condition. Experts are telling us that diabetes represents one of the major public health challenges for the 21st century. I’ll say!

So what is there to be done about diabetes? Well, not surprisingly, some of the major solutions to this problem are to be found in the lifestyle factors of diet and exercise. Here in the UK, statistics have just been released which suggest that half of people don’t take any exercise at all. And only one in five are getting moving at least three times a week. There seems little doubt that this state of affairs, as mirrored in other developed countries, is not a recipe for good health or protection from diabetes. As I’ve said before, I recommend walking as a core exercise. Why? Because it’s low-impact, doesn’t require any special skills and most of us can do it. And it’s free.

What about diet? Well, conventional dietary advice for the prevention of diabetes is to eat a low fat, carbohydrate-rich diet. The rationale here seems to be that by doing so we’re more likely to attain or maintain a healthy weight and protect ourselves from excesses of weight that are linked with diabetes. Well, this basic rationale falls down on two main counts:

Firstly, low fat diets have been shown to be thoroughly ineffective for the purposes of weight loss. And secondly, and perhaps even more importantly, let’s not forget that diabetes is a condition which is principally characterised by raised levels of sugar in the bloodstream. In type 2 diabetes (which accounts for about 95 per cent of cases of diabetes) the body is typically unable to regular blood sugar levels normally as a result of some ineffectiveness in the hormone insulin (the chief hormone responsible for tempering blood sugar levels). This state of affairs is usually the result of the body having to secrete copious quantities of insulin over time.

Now, let’s remind ourselves of the main reason why insulin is secreted in the first place ” to reduce blood sugar levels. Which comes from what sorts of foods? That’s right, CARBOHYDRATES (sugars and starches) ” NOT FAT. It is a plain nutritional fact that many of the starchy carbohydrates we are encouraged to base our diet on including bread, potatoes, rice, pasta and breakfast cereals have the capacity to cause considerable surges in our blood sugar levels. In light of this, does it really make sense for individuals wanting to prevent diabetes to eat a diet based on these foods?

What is perhaps even more incredible is that individuals already suffering from diabetes are generally advised, again, to base their diet on these foods. In fact, they are often told to incorporate these foods at each meal. Does it not defy logic and common sense to recommend to people that have problems stabilising blood sugar levels to eat plenty of food KNOWN to causes considerable surges in sugar? The prevailing ‘wisdom’ may be good for drug companies wanting to sell diabetes medications, but in no way is it good for individuals actually suffering from this condition.

I was lecturing last week and in the audience was a lady with type 1 diabetes. This is the form of diabetes that usually develops relatively early in life and is caused by a failure of the pancreas to secrete enough insulin. After the lecture, I was chatting to this lady about her diabetic control, and it turns out that compared to other type 1 diabetics, she takes a very low dose of insulin. What is more, her level of something known as HbA1C (also known as ‘glycosylated haemoglobin’) which gives a good guide to blood sugar control over the preceding 2 ” 3 months is NORMAL. Basically, this lady has got good, tight blood sugar control on minimal medication. How has she done it? Not by taking standard anti-diabetic advice, that’s for sure. In reality, this woman eats a diet that is essentially devoid of the very food diabetics are traditionally encouraged to base their diet on.

In answer to the question about what we’re going to do about diabetes, I suggest we move more and dispense with conventional dietary advice with regard to this condition. Below, I’ve added a piece which explores this dietary angle in more depth.

What should diabetics really eat? – posted 27th January 2002

Diabetes is not the most sexy of conditions, but it’s an important one. Characterised by raised levels of sugar in the blood stream, it can ultimately lead to diverse problems including blindness, gangrene, kidney disease, nerve damage and impotence, and is the third leading cause of death after cardiovascular disease and cancer. What is more, diabetes is turning into a bit of an epidemic in the UK, with the number of sufferers set to double over the next decade. But it’s not all doom and gloom. The good news is there is plenty of evidence that making informed dietary choices offers real potential in the treatment of diabetes.

The chief substance in the body responsible for keeping blood sugar levels in check is the hormone insulin. In diabetes, insulin simply doesn’t do its job. About one in 10 diabetics have what is known as type 1 diabetes, where the body fails to make sufficient quantities of insulin. In the more common form of diabetes, termed type 2 diabetes, there is usually plenty of insulin around; the problem is that the body has become resistant to its effects.

Whatever the precise nature of the diabetes, eating a diet that helps to keep blood sugar levels on an even keel is of obvious importance. Until recently, the traditional view has been that sugar, because it tends to cause surges in blood sugar levels, should be limited in the diet. On the other hand, starches such as bread, potato, rice and pasta are generally recommended by doctors and dieticians because of the long-held belief that they give slow, sustained releases of sugar into the blood stream.

However a growing number of nutritionists and nutritionally-oriented doctors are beginning to question the conventional wisdom behind the standard diabetic diet. Over the last two decades scientists have been busily testing carbohydrate foods (those containing sugar and/or starch) for the speed and extent that they release sugar into the blood stream. The sugar-releasing potential of a food is represented by a number known as it glycaemic index (GI). As expected, foodstuffs packed full of refined sugar such as soft drinks, biscuits and confectionery have been found to have high GIs. What comes as more of a surprise, however, is that many of the supposedly slow-releasing starches that pervade our diet turn out, in reality, to be fast sugar releasing. Potatoes and most refined starches such as breakfast cereals, breads, crackers, corn chips, white rice and pasta are now known to have high GIs. In contrast, foods that are truly slow sugar-releasing include oats, beans, pulses, vegetables other than the potato, wholewheat pasta, pumpernickel bread, apples, pears and citrus fruits.

Because low GI foods give less pronounced releases of sugar into the blood stream, common sense dictates that these foods should form the basis of the diabetic diet. Despite this logic, many doctors and dieticians have generally been resistant to embracing the GI concept. In fact, a recent article in the British Medical Journal announced that the influential American Diabetes Association (ADA) has dismissed the concept of the low GI diet. More than that, it has also recommended a relaxation of restrictions on sugary foods for diabetics. The ADA’s stance is based on its belief that there is little evidence for benefit from the low GI approach. But is this really the case?

There have been more than a dozen studies that have compared the effects of low and high-glycaemic diets in diabetics. Most treatment periods were between two and six weeks. One wonders how realistic it is to expect significant changes so quickly in individuals who may have had impaired blood sugar control for many years or even decades. Also, many of the studies involved relatively minor dietary changes, and study participants were often still permitted to eat plenty of destabilising foods.
Yet, despite these and other shortcomings, all but one of these studies showed improvements in some measure of blood sugar control and/or the levels of the unhealthy blood fats cholesterol or triglyceride in the blood stream (these tend to be raised in diabetes). Study after study concluded that eating a low glycaemic diet appears to serve diabetics well, and that the approach has merit.

While is may fly in the face of orthodoxy, there is a good case for the role of the low GI diet in combating diabetes. The ADA’s recent dismissal of the low GI approach to diabetes and it laissez-faire attitude to sugar is not only counter-intuitive, but appears to me to go against the grain of the current scientific evidence. My belief is this latest offering from the diabetes establishment is likely only to worsen the plight of diabetics and those at risk of this condition. Smack bang next to the British Medical Journal’s report trumpeting the ADA’s recommendations was another article entitled ‘Diabetic care must improve’. I couldn’t have put it better myself.

6 Responses to What are we going to do about the diabetes ‘timebomb’?

  1. Neil 19 December 2006 at 11:03 pm #

    as a UK District Nurse, it is chastening to see colleagues (GPs and Practice Nurses) following the low fat party line. These are good people, yet they seem to have no desire to question or challenge the validity of the Diabetes establishment dogma. It is ironic that the lady you mention achieves good control IN SPITE of the official advice rather than because of it.
    When the professionals cease to think for themselves, its no wonder than neither do the general public.
    By the by, exactly the same situation occurs in the field of ‘high’ blood cholesterol and the push to medicate the majority of the population.
    Cui bono?

  2. Neil 20 December 2006 at 7:43 pm #

    Apologies John,
    having read more of your articles, I see I’ve merely repeated what you’ve already wrtten

  3. abi 30 January 2007 at 8:24 pm #

    I have type 1 diabetes and am a GP. The standard dietary advice given to diabetics leaves a lot to be desired and the recipes in a certain diabetes publication leave me speechless. Slavish devotion to low fat without even considering that mono unsaturated fat is beneficial- essentially meals that are high in sugar. As an insulin user I won’t wear the “take more insulin! to eat more carbs ” advice- higher doses lead to erratic absorption and both hypo and hyperglycaemia. Yet again the food industry has complicated issues by labelling many foods “low GI” that certainly do not behave in a low GI fashion for an insulin dependant diabetic. I am convinced that moderate portions of truly low GI carbs, and liberal intake of monunsaturated fats is a good diet to follow
    I there is a reluctance to use the GI more as some low GI foods are high in fat- which is automatically perceived to be a problem

  4. Wendy Clare 13 March 2007 at 12:39 am #

    I usually eat low carb and my blood sugar levels are stable between 5-7. However, when my diabetic sister piles my plate with her ‘recommended’ whole grain bread and boiled potatoes, my blood sugar spikes to an astonishing 9 or more and hers is often 13+. I notice that 2 days eating her choice of foods, results in my keto urine testing stick showing as negative for fat burning, even if I have been doing well prior to visiting her. She is convinced that I am harming myself by eating low carb. I am losing weight (from a BMI of 39 (very obese) to 26.7 (overweight) and still going down), feel much better, and hope to avoid the diabetes illness that several in my family have. The ‘eat high carbs’ advice given to diabetics for decades has actually been worsening their health and the ‘experts’ are reluctant to admit they were wrong.

  5. Janet Alton MNIMH 28 April 2007 at 1:25 am #

    And let’s not forget, as Dr. John often rightly points out, that high carbohydrate foods such as wheat-based items (which are among the most common high-GI culprits) are not even foods which human beings evolved to eat. No wonder they cause so many problems.

  6. margaret grima 10 August 2007 at 11:57 am #

    I fully agree with low G1 food eliminating as much as possible white flour, rice and pasta. Including alkaline food veggies and fruithoping this will lead to an improved reading. Your articles are most appreciated

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