The Diabesity Epidemic

Article courtesy of The Diabetes Plan by Dr Peter Brukner, Auckland University Press, RRP $39.99

The ‘Diabesity’ epidemic (obesity and type 2 diabetes) is likely to be the biggest epidemic in human history. – Professor Paul Zimmet AO, 2007

We have heard a lot about pandemics and epidemics recently, but the words above from eminent Australian diabetes expert Professor Paul Zimmet ring true.

Let’s look at the numbers.

Diabetes

In 2021 the International Diabetes Federation (IDF) released the 10th edition of their IDF Global Atlas with updated figures on the incidence and cost of diabetes. It makes for grim reading.

Since the first edition in 2000, the estimated world-wide prevalence of diabetes in adults aged 20–79 years has more than tripled, from an estimated 151 million (4.6 per cent of the global population at the time) to 537 million (10.5 per cent) today. Without sufficient action to address the situation, they are predicting 643 million people will have diabetes by 2030 (11.3 per cent of the population), and if trends continue, the number will jump to a staggering 783 million (12.2 per cent) by 2045.

Globally, more than one in ten adults are now living with diabetes. Moreover, there is a growing list of countries where one in five or even more of the adult population has diabetes. Almost one in two adults with diabetes is unaware they have the condition. An estimated 240 million people are living with undiagnosed diabetes.

Approximately 6.7 million adults aged between 20–79 are estimated to have died as a result of diabetes or its complications in 2021. This corresponds to 12.2 per cent of global deaths from all causes in this age group. Approximately one-third (32.6 per cent) of all deaths from diabetes occur in people of working age (under the age of 60). This corresponds to 11.8 per cent of total global deaths in people under 60.

The overall direct cost of diabetes worldwide is A$1.344 trillion (or A$1,344 billion), a 316 per cent increase in cost over the last 15 years.

The Australian picture is no better.

One-and-a-half million Australians aged between 20–79 have diabetes, which equates to a prevalence of 8.2 per cent of the population, and 280 Australians are diagnosed with diabetes every day; that’s over 100,000 annually. Another approximately 400,000 are thought to be undiagnosed. The annual number of diabetes-related deaths is over 20,000. The annual cost of diabetes in Australia, including direct health costs and government subsidies, is estimated to be A$19 billion.

Obesity

Obesity is associated with a higher mortality rate and increases the likelihood of many chronic diseases including type 2 diabetes, and Australia has one of the highest rates of obesity in the world. Two-thirds of all adult Australians are overweight (36 per cent) or obese (31 per cent). The obesity rate has increased from 19 per cent in 1995. It is slightly more prevalent in males than females and is more common in older age groups.

A quarter of all Australian children and adolescents aged five to 17 are overweight, with 8.1 per cent obese, almost double the figure from a generation ago.

Where have we gone wrong?

A generation or two ago, seeing an obese person in the street or at the beach was a rarity. Likewise, it was unusual to see a patient in clinic with type 2 diabetes. In fact, the condition was originally known as adult-onset or mature-onset diabetes, until they had to change the name because so many younger people were developing it. The rate of incidence of both diabetes and obesity has increased dramatically in the past 40 years.

Why?

Some people blame lack of exercise; however, the amount of exercise we do now is not dissimilar to a generation or two ago, except that then it was more occupation-related and now it is more leisure-related. Certainly not enough difference to explain the increase in obesity and diabetes.

What has changed dramatically is what we eat and drink. Our grandparents’ generation ate a diet consisting of meat, poultry, eggs, dairy, fruit and vegetables. They cooked with butter, beef tallow, duck fat or lard and they drank water, beer and copious amounts of tea.

Then we were told – wrongly, as it has turned out – that cholesterol and saturated fat were the cause of the increasing rates of heart disease. We were advised by government-appointed committees producing dietary guidelines that we needed to reduce the cholesterol and saturated fat (all that butter, fat and lard) in our diet and replace them with carbohydrates and polyunsaturated fats (vegetable oils).

The food industry saw this as an opportunity, and produced a vast array of ‘low-fat’ foods. However, when they removed the fat from foods, they discovered that much of the flavour also disappeared, so they came up with a brilliant (for their pro ts) solution – replace the fat with sugar. So the recommended low-fat foods were actually low-fat/high-sugar foods.

The result has been a disaster: we have just got fatter and sicker.

Processed, take-away or junk foods and ready-to-eat meals now fill our shopping baskets. Over 80 per cent of processed foods contain added sugar, often disguised by using one of the 50-odd names the industry uses for sugar.

Foods such as ‘low-fat’ fruit yoghurts, cereals, muesli bars, sauces, mayonnaise, bread and most packaged ready-to-heat meals are full of added sugar. Take-away foods are cooked with re-used vegetable oil and are full of sugar. The food industry has succeeded in getting us all addicted to sweetness – sweet is the new normal.

Calories out, nutrient-density in

Calories in, calories out. Calories, calories, calories. That’s all some people ever focus on. But we don’t eat calories; we eat food.

Many foods are nutrient-hollow – lacking any nutrients such as vitamins and minerals. It is important to focus on eating nutrient-dense foods rather than foods with little to no nutritional value.

Common nutrient-hollow and nutrient-dense foods

Nutrient-hollow foods

• Sugar
• Foods with added sugars, including many foods labelled ‘low-fat’
• White flour
• Cakes
• Biscuits, cookies, crisps
• Confectionery
• Ice cream
• Margarine
• Vegetable (seed) oils
• Soft drinks
• Fruit-flavoured drinks
• Beer

Nutrient-dense foods

• Eggs
• Full-fat dairy, including butter, milk, cheese
• Meat – beef, lamb, pork, chicken
• Oily fish – salmon, sardines, mackerel
• Shellfish – oysters, prawns, mussels
• Liver and other organ meats
• Nuts – particularly almonds, macadamias
• Olive oil, lard, ghee
• Mushrooms
• Seaweed
• Avocado
• Green vegetables, especially broccoli, spinach
• Cacao – 70+ per cent dark chocolate

Nutrient-hollow food is fine in small amounts, but most of what you eat should be nutrient-dense.

‘The diabetes diet’

Given that type 2 diabetes is a disease where one does not tolerate carbohydrates, what do you think the recommended diet (based on fraudulent research and a corrupt industry) for those with type 2 diabetes has been for the past 50 years?

A high-carbohydrate, low-fat diet.

Let me say that again–a high-carbohydrate, low-fat diet.

Such has been our obsession with reducing fat intake that we have got diabetes management totally the wrong way around. A high-carbohydrate diet is the worst thing you can do for your diabetes. It perpetuates high blood glucose levels, which is exactly what we want to avoid in order to minimise any long-term damage to our eyes, heart, kidneys, nerves and legs.

Fortunately, people are starting to realise the error of our ways – some would say the biggest mistake in medical history – and are using a low-carbohydrate diet in type 2 diabetes management with remarkable results.

Inflammation

We now understand that chronic low-grade inflammation is a major cause of most of the chronic diseases that are so prevalent in the modern world. These include atherosclerosis, type 2 diabetes, heart disease, stroke, asthma and other respiratory diseases. Even mental illnesses such as anxiety and depression are now thought to be closely associated with inflammation.

In diseases associated with acute inflammation, the standard treatment involves the use of anti- inflammatory medications, but the most successful management has involved modifying lifestyle factors, particularly diet.

Dietary factors that promote inflammation include sugar, processed carbohydrates, vegetable (seed) oils, alcohol and processed meats. It seems that some but not all individuals find specific foods, such as gluten or dairy, inflammatory as well.

The management of these chronic diseases associated with chronic low-grade inflammation is now focusing on removing sugars, processed carbohydrates and vegetable oils from the diets of those suffering, with encouraging results. In diseases such as Parkinson’s disease, Alzheimer’s disease, inflammatory bowel disease and mental illness, to name just a few, research has shown dietary measures to be at least, if not more, effective than the traditional use of medications, with many additional positive effects to overall health, and reduced adverse effects when compared to drugs.