Friday, May 26, 2006

Type II Diabetes: Food for Thought

This morning as I mulled over the news that 2.8-million adolescents are at risk for diabetes, I wondered if the messages we communicate about the disease were part of the problem. I clicked over to the American Diabetes Association (ADA) website, as I often do when seeking some information, and started to poke around.

Within a minute I had what I was looking for - "Type 2 diabetes is serious, but people with diabetes can live long, healthy, happy lives."

Clearly the message is that even if you have diabetes, you can be healthy and lead a long and normal life. The last time I looked, the definition of health was "the condition of being sound in body, mind, or spirit; especially : freedom from physical disease or pain."

So if type II diabetes is "not good health" why do we communicate the opposite to those at risk or newly diagnoised?

Secondly, why does the ADA misrepresent the fact that physical degradation, progressive physical disability and premature death goes hand-in-hand with type II diabetes when current treatment protocols are followed? To paint a rosy picture of health and happiness living with type II diabetes may relieve some of the anxiety one will have if diagnoised, but isn't doing anyone any favors in the long-term if the double-speak "health=disease" corrupts the reality that someone with type II diabetes must make radical changes in their lifestyle to even start to make progress toward regaining their lost health!

Interestingly, on the same page was a brief explanation about what causes the disease to manifest:

"In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:
  • Right away, your cells may be starved for energy.
  • Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart."

Basically the message is the problem is insulin.

Let's turn that around for a moment and consider the parallel not stated - the body has trouble keeping insulin production at levels to meet the demands of excessive glucose.

Think about how we might consider our diet differently if the message included the damaging effect of a diet that produced high levels of blood glucose. Levels so high that over time the body simply cannot keep up with demand to lower blood sugar repeatedly, day in, day out. If we were to modify the message that when we eat too many foods that make high levels of blood glucose, maybe people might look at the foods they eat differently?

To accomplish this, they'd need a better way to understand which foods elevate their blood sugars and those that don't. Basically they'd have to understand how carbohydrates, protein and fats affect their metabolism, specifically blood sugar.

These days many are encouraged by the concept of using the glycemic index (GI) and glycemic load (GL) as a way to communicate how various foods stimulate insulin and/or elevate blood sugar. While such an approach works in laboratory and study settings, in real-life it's more difficult to translate what to eat with the GI/GL approach.

Personally, I think there may just be a much easier and effective way to help the public understand how the food they eat affects their blood sugar and insulin.

By nature, most of us are very visually oriented - when we see things presented simply we understand them quickly. When things are presented in a complicated manner, we tend to just ignore the minutia in favor of the less complicated.

Case in point - food labels today are highly detailed with specifics that we're encouraged to read, interpret and make educated decisions from. All the details, however, mean food labels are complicated to pick apart and understand. One only has to do a search for "understanding food labels" to find there are tens-of-thousands of articles attempting to educate consumers about how to read and process the information on a package label.

Consumers today are actually more likely to be confused by food labels and packaging than at any time in the past! This in light of the fact that in the last two decades policy makers have attempted to simplify labeling for consumers!

Is there a better way?

How about defining the ingredient most likely to elevate blood sugars simply?

Currently carbohydrates - the macronutrient that is directly converted to blood glucose - is listed by grams per serving. Can anyone tell me how many Americans actually stand in the grocery aisle and do the math to figure out that the 40-grams of carbohydrate in the serving means they're eating the equivalent of 10-teaspoons of sugar?

Can you imagine the effect of labeling the carbohydrate content in terms of teaspoons of sugar?

Suddenly a can of soda might not seem so thirst-quenching if one visually saw they were consuming the equivalent of 11-teaspoons of sugar in one can; a bowl of raisin bran and cup of skim milk might look less appetizing to start the day if a consumer realized it was the equivalent to 12-teaspoons of sugar; and parents may skip taking junior to the fast food restaurant altogether - the Hamburger Happy Meal at McDonald's ( plain hamburger with apple juice and apple slices with low-fat carmel dipping sauce) is the equivalent of 20-teaspoons of sugar! Forget the Cheeseburger Happy Meal - it's even more!

How many parents do you know that would sit and willingly spoon-feed their child 20-or-more-teaspoons of sugar? But that's exactly what they do each and every time they feed their child something as popular as the Hamburger Happy Meal!

Now imagine the toll on the child's body trying to lower blood glucose levels with insulin after consuming such a meal!

See what happens when the message is clear and the visual is simple?

Just some food for thought!


  1. This is great, and serendipity. I have notes for an article exactly along these lines. People really have to understand that (non-fiber) carbohydrate IS sugar.

  2. I love your idea of listing the equivalent in tsp of sugar on the labels! You are right. People would notice.

    Unfortunately I am not holding my breath on that happening until there is some kind of consensus about sugar being unhealthy. Imagine how much the manufacturer would resist such a move? So it would take a pretty powerful push from governement official to ram that through.

    However they have managed to change labeling laws for transfat, so there is hope yet.

  3. I am continually amazed at how many people think that the only thing to worry about is the "sugar" grams, not the carbohydrate grams!!!!

    Even articles on WebMD (NOT one of my favorite sites!) you'll see articles raving about something that only has 2 or 3 grams of "sugar"....but when you read the actual label, it's got a total carb count of 40+!!!!! One of the articles there prasied the "100 calorie snacks" (oreo thins, etc...?nabisco?). They rave about how they only have 2-7g sugar per serving! What, carbs aren't sugar? I guess not.

    Of course they also rave about how they're "trans-fat free" even tho the ingredients clearly list partially hydrogenated oil!

  4. Refer to Diabetes for
    useful information

  5. Anonymous8:02 PM

    There is alot of diabetics that don't understand what't good and what's bad. So why not lable the food that diabetic can eat as,Safe for diabetics

  6. From what I understand, its not just the amount of non-fiber carbs (a.k.a "sugars") that is important. More important is the Glycemic Load of these "sugars". 100g of a very low GL food is much safer than 10g of simple carb. The labels should reflect GL of the entire food.