{"id":9790,"date":"2023-11-13T11:30:18","date_gmt":"2023-11-13T11:30:18","guid":{"rendered":"https:\/\/www.zoeharcombe.com\/?p=9790"},"modified":"2023-11-13T10:52:14","modified_gmt":"2023-11-13T10:52:14","slug":"world-diabetes-day-2023","status":"publish","type":"post","link":"https:\/\/www.zoeharcombe.com\/2023\/11\/world-diabetes-day-2023\/","title":{"rendered":"World Diabetes Day 2023"},"content":{"rendered":"
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Executive summary<\/strong>\n <\/p>\n * Each year, November 14th is World Diabetes Day.\n<\/p>\n * This World Diabetes Day we look back at progress over the past 10 years.\n <\/p>\n * The International Diabetes Federation (IDF) definition of diabetes has barely changed. The definition mentions the word “glucose<\/em>” five times and acknowledges that all carbohydrate foods are broken down into glucose.\n <\/p>\n * The latest definition of diabetes has added gestational diabetes as a third type alongside Type 1 diabetes (T1D) and Type 2 diabetes (T2D).\n <\/p>\n * The IDF estimated that 371 million people had diabetes in 2013. Ten years later, they estimate 537 million people have diabetes. Forecasts for the next 10 years predict this rising to over 700 million. This is not a condition being improved globally.\n <\/p>\n * Progress has been made in research over the past 10 years. Trial evidence now exists to show that very low calorie or very low carbohydrate diets can put T2D into remission. \n <\/p>\n * The IDF and American Diabetes Association advice does not reflect this evidence. Dietary advice to avoid fat and consume carbohydrates prevails.\n <\/p>\n * This diet advice emanates from the long held fear of fat. This fear is without evidence base, but it is obstructing progress \u2013 particularly in the field of diabetes, although for other health conditions too.\n <\/p>\n <\/p>\n Introduction<\/strong>\n <\/p>\n Each year, the 14th of November is World Diabetes Day. I have done something to mark this day on six previous Monday notes (Ref 1). The first was in 2013 (Ref 2). Let’s see if any progress has been made in the past 10 years.\n <\/p>\n The definition of diabetes<\/strong>\n <\/p>\n In the 2013 note, I opened with the definition of diabetes according to The International Diabetes Federation (IDF):\n <\/p>\n “Diabetes mellitus, or simply diabetes, is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.<\/em>\n <\/p>\n Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.<\/em> \n <\/p>\n Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues.”<\/em> \n <\/p>\n The 2023 definition has shortened a couple of sentences, but it has not changed otherwise (Ref 3):\n <\/p>\n “Diabetes is a chronic condition that occurs when the pancreas can no longer make insulin, or the body cannot effectively use insulin.<\/em>\n <\/p>\n Insulin is a hormone made by the pancreas that acts like a key to let glucose from the food we eat pass from the bloodstream into the cells in the body to produce energy. The body breaks down all carbohydrate foods into glucose in the blood, and insulin helps glucose move into the cells.<\/em>\n <\/p>\n When the body cannot produce or use insulin effectively, this leads to high blood glucose levels, called hyperglycaemia. Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues<\/em>.”\n <\/p>\n Note the mention of the word “glucose” five times and the acknowledgment that all carbohydrate foods are broken down into glucose.\n <\/p>\n The different types<\/strong>\n <\/p>\n In 2013, two types of diabetes were defined by the IDF (Type 1 and Type 2). In 2023, there were three types defined: Type 1, Type 2 and gestational. \n <\/p>\n – Type 1 diabetes (T1D) is the type where the body is no longer able to make insulin (or makes so little as to be ineffective). The IDF estimates that, in 2022, there were approximately 9 million people with T1D; 1.5 million of these under the age of 20. That’s interesting because T1D used to be called “juvenile diabetes”, since it tended to appear in childhood. It is now occurring in older people more frequently. People with T1D must take insulin regularly or they will die. T1D is an auto-immune condition. We still don’t know exactly what causes it.\n <\/p>\n – Type 2 diabetes (T2D) is the type where the body cannot make good use of the insulin it produces. The 2023 definition of T2D included the phrase “insulin resistance<\/em>.” This was presented as “the primary indicator of T2D<\/em>.” The definition continued \u2013 “because<\/em> insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. Unfortunately, for some people with type 2 diabetes, this can eventually exhaust the pancreas. As a result, the body produces less and less insulin, causing even higher blood glucose levels (hyperglycaemia).”<\/em> \n <\/p>\n<\/p>\n <\/a><\/p>\n \n T2D is by far the most common form \u2013 accounting for over 90% of all diabetes. This used to be called “maturity onset<\/em>” diabetes, as it tended to arise only in older people. It is now being diagnosed in younger adults and even children and adolescents, which is deeply troubling.\n <\/p>\n – The new definition of Gestational diabetes mellitus (GDM) is high blood sugar that develops during pregnancy and usually disappears after birth. “During pregnancy, the placenta produces hormones that can interfere with the body’s ability to use insulin effectively. This is known as insulin resistance, a normal part of pregnancy. However, in some women, insulin resistance becomes too high, leading to gestational diabetes.”<\/em>\n <\/p>\n The IDF estimated that, in 2021, approximately 21 million live births (16.7% of births) involved some form of high glucose (hyperglycaemia) during pregnancy. This is serious for both mother and baby. It can lead to pregnancy-related, and possible long-term, complications. During pregnancy, complications can include high blood pressure, large birth weight babies and obstructed labour. Longer term, babies exposed to high blood sugar levels during pregnancy may be at higher risk of becoming overweight or obese and developing T2D. The IDF reported that women who experience GDM have an increased risk of developing T2D within 5 to 10 years of delivery.\n <\/p>\n All three types of diabetes can be improved\/better managed with lifestyle interventions. Richard K. Bernstein’s brilliant book “Diabetes Solution” explains how T1D can be optimally managed with a very low carb diet, and with careful meal and exercise timing (Ref 4). Dr Bernstein was diagnosed with T1D in 1946 at the age of 12. In 1969, after following ADA guidelines for more than 20 years, Dr Bernstein had many of the debilitating complications of T1D. As an engineer, he decided to examine the condition. He obtained one of the early blood glucose meters and became the first diabetic to monitor his own blood sugars. After considerable trial and error, not to mention research, he discovered that he could normalise his blood glucose through diet, exercise and medication \u2013 and that he could help others do the same. He was ignored by the medical community, of course. In his mid-forties, he decided to leave his successful career in business and go to medical school.\n <\/p>\n T2D can be put into remission with diet and exercise (predominantly diet). GDM can largely be avoided by managing blood glucose levels during pregnancy. Reaching a healthy weight before pregnancy would also help to avoid GDM.\n <\/p>\n The incidence of diabetes<\/strong>\n <\/p>\n The 2013 World Diabetes Day post noted “The IDF also informs us that more than 371million people have diabetes<\/em>.” The same web site today reports that there are 537 million people with diabetes (Ref 5). There were an estimated 6.7 million deaths from diabetes in 2021. The IDF forecasts that there will be 643 million people with diabetes in 2030. Worse, “By 2045, IDF projections show that 1 in 8 adults, approximately 783 million, will be living with diabetes, an increase of 46%<\/em>” (Ref 6). That’s a shocking indictment of our ability to improve this condition. \n <\/p>\n Because the vast majority of diabetes is T2D, the IDF reported that the key contributors to the rise in T2D include urbanisation; an ageing population; decreasing levels of physical activity and increasing overweight and obesity prevalence. \n <\/p>\n I disagree with this. Given the definition of diabetes in the opening \u2013 when insulin can no longer manage glucose blood levels \u2013 it makes sense to see diabetes as a condition of glucose handling. If the issue is handling glucose, then glucose must be a key contributor to the condition. Consequently restricting the body’s requirement to handle glucose becomes a solution. The definition told us where glucose comes from “The body breaks down all carbohydrate foods into glucose in the blood.” <\/em>Hence to manage, reverse (T2D) or avoid diabetes (T2D & GDM) carbohydrates should be restricted. \n <\/p>\n I cannot understand why people who work in the field of diabetes cannot see that glucose\/carbohydrates are the crux of the problem and hence glucose\/carbohydrates are the crux of the solution. (Overweight and obesity may just be markers of carbohydrate intake.)\n <\/p>\n The recommendations \u2013 IDF<\/strong>\n <\/p>\n Much research has been done in the field of T2D especially since 2013 (Ref 7). This has culminated in there being two proposed dietary routes to manage T2D. One is a very low calorie plan; the other is a very low carbohydrate plan. \n <\/p>\n The IDF recommendation for a healthier diet is as follows (Ref 8): (I’ve put my comments along side in brackets, starting with ZH).\n <\/p>\n – Choose water, coffee or tea instead of fruit juice, soda, or other sugar-sweetened beverages. (ZH \u2013 I agree, but coffee and tea should be specified as without sugar. They should also be without milk, if being consumed between meals. Otherwise, this is grazing).\n <\/p>\n – Eat at least three servings of vegetables every day, including green leafy vegetables. (ZH \u2013 there is no benefit to T2D from eating vegetables. There’s not too much harm either \u2013 but minimums are not needed. Recommendations for vegetables should clarify “non-starchy”).\n <\/p>\n – Eat up to three servings of fresh fruit every day. (ZH \u2013 good to see an upper limit of three, but fruit is essentially sugar with a few nutrients. Fruit is best avoided for T2D, other than a few berries).\n <\/p>\n – Choose nuts, a piece of fresh fruit, or unsweetened yoghurt for a snack. (ZH \u2013 don’t snack! If you’re hungry between meals, improve your meal choices).\n <\/p>\n – Limit alcohol intake to a maximum of two standard drinks per day. (ZH \u2013 alcohol impairs the functioning of glucagon \u2013 the hormone working in partnership with insulin. Alcohol is best severely limited or avoided by anyone with diabetes) (Ref 9).\n <\/p>\n – Choose lean cuts of white meat, poultry or seafood instead of red or processed meat. (ZH \u2013 this emanates from two beliefs: i) meat is full of saturated fat; and ii) saturated fat causes heart disease. Both are false (Ref 10). Red meat contains more nutrients than white meat. Oily fish contains more nutrients than white fish, so choose red meat and oily fish).\n <\/p>\n – Choose peanut butter instead of chocolate spread or jam. (ZH \u2013 you shouldn’t need any of these because they go on bread, and you should avoid bread).\n <\/p>\n – Choose whole-grain bread, rice, or pasta instead of white bread, rice, or pasta. (ZH avoid all of these \u2013 white or whole-grain. They all break down into glucose, which people with diabetes can’t handle).\n <\/p>\n – Choose unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil or palm oil). (ZH \u2013 this is too ignorant to know where to start. All foods that contain fat contain all three fats. Olive oil contains more saturated fat than most meat, for example. Fat is the one macronutrient that has no impact on glucose or insulin. Any pure fat is not an issue for diabetes, therefore. People would be advised to avoid seed oils for other health reasons) (Ref 11).\n <\/p>\n<\/p>\n