Diabetes UK has just issued another warning about Type 2 Diabetes (T2D) in a press statement (1).
According to this, there are now almost 3.5 million people in England and Wales who have been diagnosed with T2D, which is an increase of over 60% in the past 10 years. The true value is probably about 4 million if those who were undiagnosed are taken into account. The organisation claims there is a need for urgent action to ensure that all those affected are provided with high quality care as recommended by NICE. It also advocates that there should be more emphasis on prevention. The Chief Executive said that there is huge potential to save money and reduce pressure on NHS hospitals and services by providing better care to prevent people with T2D from developing devastating and costly complications.
The current official approach to the prevention and treatment of T2D is based on a concept of the disease which is fundamentally flawed.
Diabetes UK lists the following factors which increase the risks of developing T2D:
- Being overweight or having a high Body Mass Index (BMI).
- Waist circumference greater than 80 cm in women and 94 cm in men
- African-Caribbean, Black African, Chinese or South Asian background and over 25 years old
- From another ethnic background and over 40
- Have a parent, brother or sister with T2D
- Have had high blood pressure, a heart attack or a stroke
- Have a history of polycystic ovaries, gestational diabetes or have given birth to a baby 4.5kg
- Suffer from schizophrenia, bipolar illness or depression, or you are taking anti-psychotic medication.
There is no suggestion that T2D can be cured. Anyone who is diagnosed with the disease is given information on how to manage it. As a general rule the advice given by Diabetes UK in agreement with the official position of the NHS.
In particular, weight loss is regarded as one of the prime objectives. This can be achieved by a combination of diet and exercise. According to this the fibre content of the diet should be increased by consuming foods such as whole grain bread and cereals, beans and legumes as well as fruit and vegetables. In addition the intake of fat, especially saturated fat (SFA) should be restricted so low fat spreads and vegetable oil are recommended instead of butter as well as low fat versions of other foods.
This approach is a good an example of a failure to see the wood for the trees. T2D is caused by excess glucose in the blood. This in turn stimulates the pancreas to produce insulin which has a variety of different functions. One of these is to direct the glucose to the liver where most of it is converted into fat for storage, thereby leading to body weight gain. Continuous excessive production of insulin results in insulin resistance to many different organs in the body. Effectively this is damage which may eventually cause chronic disease such as atherosclerosis and various cancers.
Ultimately the ability of the pancreas to produce insulin is impaired so that the glucose cannot be effectively controlled. The excess glucose also causes damage. For examples by becoming attached to proteins, which prevents them functioning properly. This is full blown T2D.
It does not take a genius to work out that there is just one single factor which is causing these problems, which is the amount of glucose which is entering the blood stream from the food supply. The obvious answer therefore is to reduce it. The first step must be to reduce the sugar intake. As sugar breaks down to glucose and fructose it is a particularly dangerous combination. This is because fructose can only be metabolised in the liver which means a big reduction in the capacity to deal with the glucose. By contrast the glucose can be metabolised throughout the body. It is important to understand that sugar is present as an ingredient in many different manufactured foods. Rather ironically many “low fat” foods are formulated by removing the fat and replacing it with sugar. Hence those who follow the official advice may well finish up with increasing their sugar intake. In addition the starch, which is present in foods such as bread, flour, potatoes, rice and pasta, is broken down during digestion to release glucose and therefore contributes to the amount present in the blood.
There is now a comprehensive body of evidence which confirms that this strategy of reducing the consumption of sugar and carbohydrate-containing foods is effective and should also be the first approach (2). Furthermore there are numerous personal case histories of individuals who have adopted similar protocols and achieved great success (3). It also follows that increasing incidence of T2D is the direct result of the increasing consumption of sugar and other foods which contain carbohydrates. One of the main reasons for this has been the emphasis on reducing fat that has obviously had an impact as shown by the success of the low fat foods in the market place. When this is combined with the growth in consumption of Sugar Sweetened Beverages (SSBs) there has inevitably been an increase in the consumption of carbohydrates. So it is not in the least surprising that T2D incidence has increased. The only sensible policy that will counter T2D is to introduce measures which will alter the national diet so that there will be a very substantial reduction in the intake of sugar and other carbohydrate-containing foods.
It is difficult to understand how weight loss would be effective. There is no evidence to indicate that overweight/obesity is the cause of T2D. A more rational explanation is that both conditions are caused by a common factor, namely excess blood glucose. In reality the relationship between obesity and T2D may be rather complex. It turns out that several countries with a high incidence of T2D have low rates of obesity and vice versa. In Sri Lanka, the prevalence of T2D increased from 3% in 2000 to 11% in 2011, while the obesity rate remained constant at 0.1%. (4).
It has also been found that up to 20% of people who have a BMI which is “normal” have been diagnosed with T2D. Even more worrying is that the death rate in this group is about double that of those who are overweight or obese when diagnosed with T2D (5).
Another major concern is that the initial damage caused by T2D, such as retinopathy, may not be detectable for several years prior to clinical diagnosis (6).
The present policies for tackling T2D are doomed to failure. First of all, they are far too late and quite considerable damage is likely to have occurred before the disease is actually recognised. Secondly, there is no reliable evidence to demonstrate that weight loss is an effective strategy for coping with T2D. The probability is that it will make things worse since the standard conventional advice is to reduce fat to help with the weight loss but also to reduce the risk of heart disease, which is another rather dubious approach. To compensate for the reduction in fat, an increase in complex carbohydrates is usually recommended. If there is to be a genuine attempt to control T2D, then the only logical strategy is to focus on prevention. Essentially this means there will have to a concerted effort to reduce the consumption of carbohydrates, with the emphasis on eliminating sugar from the diet. However for this to be totally successful, there will have to be some increase in the consumption of SFAs, which is in direct conflict with current government policy in the UK.