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The Diabetes Epidemic

It is the biggest global health threat to the world today. A lot of runners I talk to have little understanding of the condition or its cause and in particular the need to eat a controlled diet. So here is a quick question answer type guide.

What is diabetes?
It is the prevalence of high blood sugar levels due to the inability of the body to reduce sugar levels by means of insulin released by the pancreas.

What are the long term effects?
Fungus can grow in the body, feeding on the high blood sugar levels. This can cause the rotting of a limb which then has to be amputated. Today in Vietnam limbs are being amputated at a greater rate due to diabetes than the rate of amputations during the war with America 40 – 50 years ago.

What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes is a condition whereby the pancreas ceases to function and hence no insulin is produced to neutralise high blood sugar levels. It is more common in young people and is believed to be the result of a virus. There is no cure other than having a pancreas transplant. This treatment is very rare as the condition can be controlled with insulin injections. My daughter has Type 1 diabetes.

Type 2 diabetes is the gradual resistance over time of the body to insulin. To bring down sugar levels ever greater amounts of insulin are needed. A point is reached where the pancreas is no longer able to keep pace with the demand for more insulin and high blood sugar levels prevail. In advanced cases insulin injections are needed.

What is the cause of Type 2 diabetes?
Until recently it was explained as an aging condition. Insulin resistance appeared to be a progressive condition which got worse as people got older. It is not clear as to whether the body becomes immune to the effects of insulin due to frequent exposure or if accumulation of body fat inhibits the insulin release.

However, Type 2 diabetes is now becoming common in young people and it is generally agreed that the current epidemic is down to poor diet control. Over the last 30 years the rate of Type 2 diabetes in the west has increased from 6 / 1000 population to 60 / 1000. The increase is credited to change in diet.
There is a strong correlation between Type 2 diabetes, abdominal fat, high cholesterol and high blood pressure.

What changed to cause the epidemic of Type 2 diabetes?
To understand this we have to go back 60 years. In 1957 the American nutritionist Ancel Keys released a paper known as the 7 countries study. He believed that high fat in the diet caused high cholesterol in the body and high cholesterol gave greater risk of heart disease. The study showed a correlation between the amount of fat in the diet in the countries and the level of heart disease.

The study was flawed. Ancel Keys actually collected data from around 20 countries but omitted from his study the results which didn’t fit his theory. One notable omission was Holland. The Dutch love of cheese places them among the highest consumers of fat in the world, but the level of cardiovascular disease in Holland is one of the lowest in Europe.

It took around 20 years for governments to react to the report, but in 1977 the US food and drugs administration changed its guide lines to recommend a reduced fat diet. The consequence was a move to so called “healthy” low fat products filling the supermarket shelves.

Since 1977 the average daily intake of calories in the US has increased by 25%. During the same period the consumption of full fat food has fallen. Hence the intake in carbohydrates in the diet has increased dramatically, a lot of it in fast foods and processed foods. Many “reduced fat” products have sugar added to give taste. The increase in the rate of type 2 diabetes has closely matched the change in diet.

Today in the US two thirds of the population exceed the maximum recommended BMI (Body Mass index). One third of Americans are obese, body weight exceeds maximum recommended by more than 20%.

Is type 2 diabetes a generic condition?
Whilst it is possible that certain people may be more susceptible to developing Type 2 diabetes than others, no gene has been found which is associated with Type 2 diabetes.

Some studies have suggested a genetic link because type 2 diabetes is more prevalent in African Americans than in those of European descent. However if this was the case then why is rate of diabetes in African Americans 10 times higher than in West Africa, their ancestral home? Eating habits is the main link connecting those sections of the community which have a high incidence of type 2 diabetes.

Is lack of exercise a contributing factor?
There is common, almost universal, agreement that control of diet is 80% of the way to get rid of body fat and exercise contributes only around 20%. In particular, the high intensity “carb” burning exercises a lot of people follow in the gym have no effect in reducing body weight. This is because they don’t burn body fat.

Isn’t it a question of just reducing calorie intake?
No it’s not that simple. High carbohydrate diets are addictive. Shortly after eating them you feel hungry again and want more. Even worse, some carbohydrates have a high Glycogen Index meaning that the sugar is released to the blood stream in a short period of time causing a “sugar spike”. The sugar spike triggers a spike in the release of insulin. Other carbohydrates have a low glycogen index. It takes time for your body to break down the food to get at the sugar. Blood sugar levels rise more slowly over a longer period. There is a lower release of insulin. A carbohydrate controlled diet is necessary.

High GI carbohydrates to be avoided include:
Anything which has added sugar including soda drinks and processed food.

Good sources of carbohydrates are:
Green vegetables

What about high fat and high cholesterol?
Around 80% of cholesterol in the blood stream is created in the liver. Only 20% comes from diet intake. High cholesterol levels are generally a hereditary condition. There is no evidence to link high cholesterol in food with high levels of cardiovascular disease. Some foods rich in cholesterol, such as egg yolk have very important diet nutrients.

Fat in your diet is very important for good health. It helps with balancing hormones and fat rich in calcium such as butter, cheese and milk is needed to strengthen bones. A high fat diet encourages a high fat burning metabolism which results in weight reduction.

Good fats include:
Full fat cheese, milk and butter.
Fat contained in meat.
Oily fish such as salmon.

Bad fats:
Anything processed such as margarine, easy spread butter, reduced fat products.

Cooking oils
Processed oils such as sun flower oil are not good for the diet.
The following are recommended for cooking purposes:
Extra Virgin olive oil.
Avocado oil
Coconut oil

Is type 2 diabetes reversible?
Yes it is. Where type 2 diabetes has a strong association with poor diet it has been found that in just a few weeks blood sugar levels can be returned to normal with diet control. In one dramatic case an obese person who was hours away from having a limb amputated, cancelled the operation and with diet control achieved a completely normal blood sugar level.

What can I expect if I change from a high carb diet to a high fat diet?
The first couple of weeks will be difficult. Because your body has been reliant on “carb burning” it takes a few days for the fat burning metabolism to pick up. During this period you may well feel lethargic and have head aches. The low “carb” intake will cause glycogen levels to reduce. Since glycogen require 3 parts water to bind it to the liver and muscles there will be a short term loss of body fluid and hence loss of weight.

Once established, a high fat diet satisfies the appetite for longer meaning that you have less desire to “snack” between meals.

Returning to the good old days.
If you are my age and were brought up in the UK then you will be familiar with the following advertising slogans.

“Drinka pinta milka day”
“Go to work on an egg”
“An apple a day keeps the doctor away”

In fact much of this article is about returning to the good old days of 50 years ago when most food consumed was fresh and unprocessed.

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