Setting the scene
In April 2016, the World Health Organisation (WHO) released its “Global Report on Diabetes” (1). It spells out the awful truth about the extent and impact of these diseases. Here are some of the key facts:
- It has been estimated that in 2014 there were 422 million adults with diabetes, which compares with 108 million in 1980.
- There were 1.5 million deaths attributed to diabetes in 2012. In addition there were a further 2.2 million deaths from other causes such as cardiovascular disease.
- Of these, 43% occurred before the age of 70 years.
Those with diabetes may suffer other complications such as heart attack, stroke, kidney failure, leg amputation, vision loss and nerve damage. In pregnancy, poorly controlled diabetes increases the risk of foetal death and other complications.
It has been estimated that the direct annual cost of diabetes to the world is more than US$ 827 billion. Because of the increased number of people with diabetes and the increased spend per capita, the International Diabetes Federation (IDF) has estimated that total global health-care spending on diabetes more than tripled over the period 2003 to 2013.
Although the costs of hospital care are significant, another important contributor to rising costs is increased expenditure on patented, branded medicines used to treat people with diabetes, including both new oral treatments for type 2 diabetes (T2D).
The increase in total global diabetes health expenditure is expected to continue. Low- and middle- income countries will carry a larger proportion of this future global health-care expenditure burden than high-income countries.
Diabetes can be catastrophic for families affected. This is because the high costs of treatment may be accompanied by loss of income associated with disability and premature loss of life, especially in countries with low incomes.
The impact on national economies is just as bad. One study has estimated that losses in GDP worldwide from 2011 to 2030, including both the direct and indirect costs of diabetes, will total US$ 1.7 trillion, comprising US$ 900 billion for high-income countries and US$ 800 billion for low- and middle-income countries.
So clearly the picture is extremely bleak.
Tackling the issues
The root of the modern day concerns is T2D, which is the main factor responsible for the rapid increase in the incidence. So that will be my focus in this blog.
Despite the dire consequences, it particularly regrettable that the WHO report continues to re-iterate the same old policies that have failed so miserably in the past and have contributed to the current state of play. WHO is still recommending that the intake of saturated fat (SFA) should be restricted less than 10% of total energy intake. For high risk groups, it is even lower at 7%. It also recommends that there should be regular consumption of wholegrain cereals. However WHO recommends the intake of free sugars should be less than 10% of total energy and ideally should be limited to 5%.
There is a total failure to appreciate the crucial role played by excess insulin production in the body in the development of T2D. This in turn is driven by the excessive amount of glucose in the blood.
According to WHO, T2D is caused by the “body’s ineffective use of insulin”. While this is true, it is certainly not the whole story. Let me explain the events leading up to the diagnosis of T2D. If a person consumes a diet, which has an excessive content of sugar and starchy foods there will be a high load of glucose in the blood. The starch present in foods such as bread, potatoes, rice and pasta is broken down to glucose. With high quantities of glucose, there are increased demands on the pancreas to produce insulin. However, the organs of the body have to protect themselves from this high insulin concentration and so they develop resistance to insulin, which means that they become less sensitive to the insulin. As a consequence, even more insulin has to be produced in order to deal with the blood glucose. This can continue for about ten years. Eventually there is catastrophic failure as the pancreas cannot cope with the demand. It has been damaged and is unable to produce sufficient insulin so the glucose is now out of control. It is only at this point that T2D would be diagnosed because the blood glucose has exceeded specified limits.
Symptom is not a cause
So the “ineffective use of insulin” that the WHO report says is the cause of T2D is really just a symptom of the disease. The fundamental cause is pretty obvious and is of course the excessive consumption of sugar and other carbohydrates. Although there is now widespread agreement that the sugar should be restricted, the presence of starch in the foods consumed has a similar effect, which is a contribution to the glucose load in the blood.
Implications for dietary recommendations
WHO and so many professional bodies get things so badly wrong by advising a reduction in fat, especially the SFA. There is now overwhelming evidence that there is no justification for this advice, which is totally dependent on the now discredited diet/heart theory based on the role of cholesterol (2). As there is no justification for raising the intake of protein, the default position is to increase carbohydrates. This is where were are now. Not only was there no justification for this advice, we can be virtually certain that the emphasis on fat reduction has had a measurable impact on dietary patterns. It is therefore rather ironic that the increase in the incidence of obesity and diabetes coincided with the initial advice to lower the fat intake.
The way ahead
There is plenty of evidence that T2D can be treated successfully by a diet which has a low carbohydrate content and is high in fat (LCHF). The research has been done and there are thousands of individuals who have discovered for themselves that this approach to diet works very well indeed. The scandal is that so many are complying with the official advice to do the very opposite by reducing fat and increasing carbs. As a result their condition deteriorates: many suffer and die prematurely.