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Diet and Diabetes

11/14/2003 - In the past, dieticians, public health researchers and the general public had been so focused on fat as the main culprit in the fight against obesity and heart disease that people get the impression that they can load on refined carbohydrates like white bread, bagels, and doughnuts by lowering the fat and that's OK. But according to Frank Hu, assistant professor of nutrition and cardiovascular disease, that's NOT OK at all.

In the past, dieticians, public health researchers and the general public had been so focused on fat as the main culprit in the fight against obesity and heart disease that people get the impression that they can load on refined carbohydrates like white bread, bagels, and doughnuts by lowering the fat and that's OK. But according to Frank Hu, assistant professor of nutrition and cardiovascular disease, that's NOT OK at all.

In collaboration with Fredrick Stare, Meir Stampfer; Eric Rimm; and Rob van Dam (who's from The Netherlands), all Harvard Institute of Public Health researchers, Hu and colleagues had conducted a study published in the Annals of Internal Medicine that is the first to link overall dietary patterns rather than specific foods to the development of type 2 diabetes, which affects 16 million Americans and can cause blindness, kidney failure, and heart disease. In Canada, more than two million Canadians have diabetes and 2.5 million more Canadians are now at risk for type 2 diabetes.

Silent Killer

Hu said finding the causes behind diabetes is particularly important because the incidence of the disease has rapidly increased worldwide over the past two decades, possibly because of the spread of Western diet and lifestyle. The World Health Organization expects the number of diabetics in the world, today between 120 million and 140 million, to double by 2025. In Canada, 41,483 people with diabetes died in 1999-2000 – six times more than previously reported by Statistics Canada.

There are two types of diabetes. Type 1 diabetes mainly occurs in childhood and adolescence and is characterized by the body's complete inability to produce insulin - the hormone that helps the body process sugar for energy. Without insulin, glucose builds up in the blood stream until it damages organs such as the kidneys, eyes, and heart. Untreated, it can eventually lead to blindness, renal failure, heart disease, and death.

Type 2 diabetes, which makes up between 90 percent and 95 percent of cases, usually occurs in adults over age 40 and is caused by a reduction in the body's ability to use insulin. Type 2 diabetes in some cases can be controlled by diet and exercise. Though slower to cause damage than type 1, uncontrolled type 2 diabetes can cause the same complications.

One reason diabetes is dangerous, Hu said, is that people often don't know they have it until high blood sugar levels start to cause complications. ''Diabetes is a silent killer, especially in the beginning (before it is diagnosed),'' Hu said. ''Clearly this has become a worldwide problem.''

Western versus Prudent

The 12-year study tracked the dietary patterns of 42,000 men between the ages of 40 and 75, of which 1,321 developed type 2 diabetes. Subjects filled out detailed dietary questionnaires every four years and provided information about their health status. From their responses, researchers identified two typical dietary patterns. The Western diet consisted of red meat, processed red meat, refined grains, high-fat dairy products, french fries, and desserts. The prudent diet consisted of higher levels of fruits, vegetables, whole grains, fish, and poultry. In analyzing the data, subjects were further divided into five groups for each dietary pattern according to how well they fit the ideal prudent and Western diet. In the group that most closely fit the Western diet, 361 developed diabetes, a 59 percent greater risk than men whose diets were least compatible with Western diet. In the group that most closely fit the prudent pattern, 252 developed the disease, about 16 percent lower than those who did not follow a prudent diet.

The risk is particularly high when Western diet is combined with obesity and physical inactivity. What the study suggest is the need to look at the bigger picture and follow an over-all healthy eating healthy eating pattern and lifestyle, not just focusing on a particular dietary culprit such as fat, to prevent type 2 diabetes.


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