Saturday, March 9, 2013

Banting and Best, What is the Cause Again?

Banting and Best where are you when we really need you? I am always amazed by authors such as Basu et al who come out with a new discovery regarding sugar and Diabetes. It is as if they have just gotten some clear insight into the obvious. Obesity drives the suppression of the islet cells which drives down the insulin production which drives up the glucose level. Get the BMI below 22.5 and you drive out the main initiator of Type 2 Diabetes, the inflammatory effects of weight.

Now the authors state[1]:

While experimental and observational studies suggest that sugar intake is associated with the development of type 2 diabetes, independent of its role in obesity, it is unclear whether alterations in sugar intake can account for differences in diabetes prevalence among overall populations.

Using econometric models of repeated cross-sectional data on diabetes and nutritional components of food from 175 countries, we found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p ,0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income.

No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other confounders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight.

Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. …

In summary, population-level variations in diabetes prevalence that are unexplained by other common variables appear to be statistically explained by sugar. This finding lends credence to the notion that further investigations into sugar availability and/or consumption are warranted to further elucidate the pathogenesis of diabetes at an individual level and the drivers of diabetes at a population level.

Well one would think that to be the case. Sugar, sucrose, is a powerful carbohydrate and Diabetes is a carbohydrate disorder, and Type II Diabetes is exacerbated by obesity and sugar has excess calories thus causing obesity. It is logical causality. We have seen genes, billboards, environment, sugar, and endless excuses for the fact that people eat too much.

Most physicians treating Type II Diabetes sees the patient as obese, having a high carb diet, more than likely smoking and with no exercise. Further if they examine the diet, they find tremendous amounts of carbs, and if they look deeper they are dominated by various sugars. Thus this conclusion is not only obvious but it faces physicians on a day by day basis.

The prototypical Type II Diabetic is a candy eating obese person. Instead of a small candy bar, they get bags of them, cakes, cookies, and the list continues. So what is new?