If you reduce carb consumption, what do you replace it with? Dr. Hallberg favors fat.
“Asian Indian” as opposed to American Indian, aka Native Americans.
Since I have a number of blog visitors from India, I decided I need to know more about Indian diabetes. I started by reading “The current sate of diabetes mellitus in India.” I looked at a few other things, too, thanks to the Internet. Here are a few facts and issues:
- India has at least 32 million diabetics (most of whom have type 2 diabetes); it’s the country with the most diabetics (data from 2000)
- The population of India is 1.28 billion
- By 2030, diabetics in India may number 79 million
- The prevalence of diabetes in urban centers is perhaps 9% of the population; higher in southern locales, lower in the north
- Indians tend to see type 2 diabetes at much lower BMIs compared to Western populations
- India is rife with diversity: genetic, cultural, linguistic, socio-economic, among others
- Poverty—or at least lack of affluence—is a major stumbling block to diagnosis, treatment, epidemiologic study, clinical research, and intervention
- Vegetarianism is more common than in the West
- I need to learn more about Indian cuisine and foods such as jowar, chappathis, and chana dal (aka Bengal gram dhal), to name just a few
It’s clear to me that I cannot assume that Indian type 2 diabetes is the same type 2 disease I treat here in Scottsdale, Arizona, an overwhelmingly non-Indian population. If it’s not the same disease, the optimal treatment may be different. I hope to learn more about Indian diabetes over the next year.
I’m not sure why, but lately I’m getting lots of blog visitors from India. Even more than from Canada and Australia. If you guys are looking for something in particular that you’re not finding here, let me know.
Steve Parker, M.D.
Let me be clear. Exercise is not important because it burns calories! Exercise without calorie restriction is a remarkably ineffective weight loss intervention, because it usually makes us hungry enough to replace the calories we burn. Exercise is important because it restores your ability to oxidize fat—both when fasting and after meals. And we can tie this in with mitochondrial dysfunction by noting that exercise is proven to increase mitochondrial volume.
Medical student Kris Gunnars has an article at Business Insider, of all places, that shows graphically many of the major U.S. dietary changes of the last hundred years. In this case, transmogrification may be a better term than mere “changes.” Much of the Western world has evolved in similar fashion.
You need to read the article and ponder the graphs if you question why we have so much obesity, type 2 diabetes, heart disease, hypertension, and perhaps cancer. You’ll see dramatic increases in consumption of added sugars, industrial seed oils (esp. soybean), soda pop and fruit juice (added sugar!), total calories, and fast food. You’ll see how much we’ve increased dining away from home. Butter consumption is down drastically, but doesn’t seem to have done us much good, if any.
There’s fairly good evidence that coronary artery disease (CAD) the cause of most heart attacks) was very prominent between 1960 to 2000 or so, but it’s been tapering off in recent years and didn’t seem to be very common 100 years ago. Understand that you can have it for 20 years or more before you ever have symptoms (angina) or a heart attack from it. In fact, the disease probably starts in childhood. I’ve always wondered about the cause of the CAD prevalence trends, and wondered specifically how much of the long-term trend was related to trans-fat consumption. But I’ve never been able to find good data on trans-fat consumption. Kris came up with a chart of margarine consumption, which may be a good proxy for trans-fats. Another of his charts includes shortening, a rich source of trans-fats and probably also a good proxy. I remember growing up in the 1960s that we always had a 1/2 gallon tin can of Crisco hydrogenated fat in the cupboard. Shortening consumption increased dramatically from 1955 until dropping like a rock around 2000.
The timeline curves for trans-fat consumption (by proxy) and prevalence of coronary heart disease seem to match up fairly well, considering a 20 year lag. In the early 1990s, we started cutting back on trans-fats, and here we are now with lower mortality and morbidity from coronary artery disease. (CAD is very complex; lower rates of smoking surely explain some of the recent trend.)
Read the whole enchilada. Very impressive. Highly recommended.
The largest benefits were seen in people who ate seven or more servings of fruits and vegetables a day compared with those who ate less than one serving, with the higher level of consumption associated with significantly lower all-cause mortality (hazard ratio 0.67; 95% CI 0.58-0.78), lead researcher Oyinlola Oyebode of University College London, and colleagues, reported online in the Journal of Epidemiology and Community Health.
The population under study was English. In addition to lower risk of death, the heavy fruit and vegetable consumers had lower rates of cancer and cardiovascular disease. Click for the actual research report.
If seven servings a day seems like a lot, note that a typical serving is only half a cup. You’ll get those with the Low-Carb Mediterranean Diet.
Steve Parker, M.D.
An article at Diabetes Care suggests that insulin-treated T2 diabetics getting bariatric surgery were almost twice as likely to get off insulin if they had roux-en-Y gastric bypass rather than laparoscopic adjustable gastric banding. The former procedure is also generally more effective for weight loss.
If you think bariatric surgery is a sure-fire cure for type 2 diabetes, it’s not.
Steve Parker, M.D.