Described in 6th century B.C. by celebrated Indian physician Sushruta as madhumeh, diabetes is one of the most troublesome of diseases. It can affect almost all organs of the body, making a person susceptible to heart disease, stroke, kidney failure, limb amputation and blindness, among other things.
Diabetes is a chronic disease. It can be either Type 1 i.e. caused by the inadequate secretion of the hormone insulin via pancreas or Type 2, where efficacy of insulin in controlling blood sugar is impaired due to resistance to its action on tissues.
The consequence is high blood sugar, which can over time lead to damage of nearly all tissues of the body, especially blood vessels and nerves. It also increases the risk of heart attacks and strokes - the leading causes of mortality worldwide. It is the cause behind nearly half of all cases of renal failure and nearly 2/3 of all leg/foot amputations.
Elliott Proctor Joslin, Founder of the Joslin Diabetes Center in Boston, USA - the world’s largest diabetes research center, clinic and provider of education on diabetes, was one of the earliest researchers in the field. He noticed that only 0.3% of all admissions to the Mass General Hospital from 1824-1898 (172 cases out of 48,000 admissions) had diabetes. But, the turn of the century (early 1900s) saw a progressive rise in sugar consumption and the beginning of the diabetes epidemic.
The number of individuals with diabetes has been rising exponentially ever since and extending to the modern era, so much so that its prevalence has increased 4-fold since 1980 (from 108 million to 422 million in 2014), which represents a staggering 8.5% of the adult population.
Needless to mention, diabetes contributes significantly to the total mortality rate as well - 1.6 million deaths in 2016 were directly linked to diabetes.
In past few years, there has been lot of controversy with respect to the criteria for diagnosis. A lot of people have contended that accepted thresholds are made more stringent through pressure from drug companies and other vested interests.
While its true that Big Pharma does have a lot of medical and political clout, these guidelines are generally the much deliberated view of several experienced clinicians and researchers over months and years.
Cut-offs are derived at by studying the values of blood sugar beyond which complications due to a disease begin to rise significantly.
The currently accepted criteria for normal people are as follows:
- Fasting Blood Sugar: < 110 milligrams per deciliter (mg/dL), borderline 111-125 mg/dL
- Two Hours Post Meal or Post Prandial: < 180 mg/dl, borderline 181-200 mg/dl
- Three Monthly Average Sugar or the so-called Hba1c: <5.7%, borderline 5.8-6.4%
This implies that:
- Fasting Blood Sugar > 126 mg/dL
- Two Hours Post Meal >200 mg/dL
- Three Monthly Average Sugar> 6.5%
At random i.e. irrespective of the above, measured Sugar > 200 mg/dL is suggestive of diabetes, while the borderline values are often termed pre-diabetes, which means that they are likely to become diabetic in the future if they don’t bring about a major lifestyle change.
On basis of this criteria, about 12-14% of US adults are diabetic, and about 30% pre-diabetic.
A natural question which follows is WHY? Why has diabetes been multiplying like an infectious disease in the last century, more so in the last 4 decades?
The origin could probably be traced back to the change in dietary patterns in this period, when sugar began to enter the daily diet, at least in the West, and slowly but inexorably, throughout the rest of the world.
The 1960s to 80s witnessed the postulation of the Diet-Heart hypothesis, a theory that proposed that heart disease was mounting due to the high fat content of the Western diet (especially saturated fat, as in meats, dairy products like milk, butter and ghee-clarified butter, and oils like coconut oil).
Dietary guidelines were issued by the US government in 1977 and in the UK in 1983, recommending restriction of fats, especially saturated fats, replacing these with carbohydrates. This signaled the beginning of the low-fat diet and snacks. The obvious choice was refined carbohydrates and sugars. This change was followed by mounting obesity, accompanied by increasing numbers of heart disease, strokes, hypertension, diabetes and dementia.
While attempts were made by the sugar industry to claim that there was no direct connection between sugar intake and diabetes, there is now mounting evidence which suggests that sugars and refined carbs are largely responsible for the obesity epidemic. As obesity has direct correlation with hypertension and diabetes, there is increasing acceptance of the role of sugars and refined carbs in the causation of the lifestyle diseases, especially diabetes. Metabolic syndrome is a condition (upper body obesity, high blood pressure and sugar, abnormal cholesterol levels) directly caused by the modern diets and is a known precursor of the above diseases.
What can be done to reverse, or at least control this trend? More on this, next week.
This is a recurring column published every Sunday. Click here to view my other articles on health, nutrition and exercise.
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