Is Obesity The Only Causal Factor for Diabetes?

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DavidGeorge Posted: Fri, Dec 12 2008 6:54 AM

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There's a letter to the editor in today's New York Times from Alan R. Morse, President and Chief Executive of The Jewish Guild for the Blind which repeats the lament that "America’s widespread disregard for healthy nutrition and a more physically active lifestyle is causing a wave of obesity ... and this is leading to more and more cases of diabetes." You can read the letter at: http://www.nytimes.com/2008/12/12/opinion/lweb12diabetes.html?_r=1&emc=tnt&tntemail1=y

For the past year or so now, in its articles, the Times has been promoting the idea that the patient is to blame for his or her diabetes because of being over weight.  And they have only been publishing letters which support this point of view.  I've written to them suggesting that it's just possible that things other than obesity can be responsible for diabetes.  I've been diabetic for over 40 years, am 5'11" tall and have never weighed more than 144 lbs, but they haven't responded to any of my letters.

I suppose it's easier, less expensive and more acceptable to the taxpayers to blame the patient and avoid funding research into solutions for the problem.  Perhaps it would help if more of us wrote to them suggesting that all diabetes can't be blamed on obesity...

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nomorecarbs replied on Fri, Dec 12 2008 6:56 PM

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To me the evidence is clear.  Obesity is not the cause of diabetes but a coincident result of the unnatural consumption of refined carbohydrates.  No people anywhere in the world, contract diabetes that don't eat levels of refined carbohydrates that were never eaten before the modern era.

So, I don't blame the victims, rather, the authorities that turn a blind eye to the obvious cause, because of economic inducements.  I blame the food manufacturers who continue to produce appetite enhancing foods despite their obvious economic harm.  The evidence is starkly clear.  Look at refined carbohydrate consumption in 1800, 1900, 1950 and 2000.  How can there be any doubt what the cause of the current diabetes, obesity, heart disease epidemic actually is?  If the executives of the FDA, ADA, Joslin Institute had any conscience at all, I'd have to think they would have at least, listened to these words by Harvard's Walter Willett,

"Put more plainly, the low-fat, high-carbohydrate diet recommended by the National Cholesterol Education Program and the USDA Food Guide Pyramid may be among the worst eating strategies for someone who is overweight and not physically acitve. "

Well, I agree with Dr., Willett, except that I think it's the worst eating strategy not just for the overweight, but anyone vulnerable to diabetes.  I'm physically active and do just fine without carbohydrates as a fuel.  All in my humble opinion, of course.

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Spirit replied on Fri, Dec 12 2008 7:03 PM

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Well, David George, I think this is a pretty murky area.  I know some obese people who are not diabetic (but they are probably prone to it plus a plethora of other health problems as they age...and the aging factor may be the big variable here since some diseases kick in later naturally and are magnified by aging issues, such as less physically active and set in the ways of poor nutrition...Big Macs may not affect 20 year olds until those 20 year olds turn 50 and are still downing mega quanitites of carbs and saturated fats and their clogged arteies can't take it anymore).  When I was diagnosed I weighed 12 pounds more than I do now and I was still within normal weight limits for my height, although bumping against the top of the chart.  So, actual weight wasn't the causal issue.  At the same time, those 12 pounds were gained very rapidly and were an unusual happening for me.  Up until a year before diagnosis my weight was never a concern for me.  It always stayed about the same.  The reason I went to the doctor in the first place was this unusual weight issue, albeit a small one from most perspectives (12 pounds probably won't send most people racing to their doctors!)  The diagnosis was diabetes, so I caught this thing very early. 

Genetics play a part in diabetes.  I wasn't unduly surprised to hear the diagnosis since the disease is prevalent in my family.  Obestiy wasn't a causative factor in my case; genetics probably played a larger role.  But until you get the diagnosis, you can't tell which is goinmg to be the most important spin of the roulette wheel.  So, why take a chance?

I do think that obesity is a major societal problem.  It tips the scales in favor of diabetes (yep, I  really think it does) and cardiac problems and bone replacement problems (how many knee and hip replacements are done in people who are carrying around was too many excess pounds, putting stress on those joints) and respiratory problems.  There really is no justification for being overweight.  Please understand, I don't mean to discriminate against those who are battling a weight problem.  But we do need to recognize it as that... a problem. 

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nance replied on Fri, Dec 12 2008 9:22 PM

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I think the New York Times has it backwards.  Wouldn't be the first time they've been wrong.  LOL

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Ron AKA replied on Fri, Dec 12 2008 10:34 PM

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There is little doubt that obesity is a contributing factor in most, but not all cases of type 2 diabetes. Weight loss in these cases can result in significant reversal of the condition. There are other flavours of type 2 where insulin resistance is less of an issue and lack of insulin more prominant. Suspect in these cases weight is unrelated to the cause. 

If there was a simple reason for obesity, our society would not be dealing with the issue. My suspicion is that portion sizes and low cost of high fat/calorie fast foods is a major reason, along with a reduction in level of physical activity.

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nomorecarbs replied on Fri, Dec 12 2008 11:49 PM

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" there was a simple reason for obesity, our society would not be dealing with the issue. My suspicion is that portion sizes and low cost of high fat/calorie fast foods is a major reason, along with a reduction in level of physical activity."         

Well, Ron, there is a simple answer- refined carbohydrates.  You can't possibly argue that refined carbohydrate consumption has not gone up significantly as diabetes has become more prevalent, whether you agree with me, that it is the primary cause.  On the other hand, high fat foods tend to be more expensive than high carbohydrate foods, not less.  Trust me, as I am on a tight budget, and have to spend more money on my low carb diet, than I would have if I could eat your high carb diet.  We have reduced saturated fat consumption in the U.S. and Canada, lard has disappeared, relatively few eat butter and egg consumption is down.  It isn't fat consumption that is fueling the diabetes growth.  Well the experts say we are eating more calories.  That's true, but check the facts, Ron, those extra calories are not fat, they are not protein, they are carbohydrates, and usually, they are refined carbohydrates.  No other people in history ate anything like the fritos, potato chips, cookies, doughnuts, sweetened cereals, or drank sugary sodas, like modern day people.  It's really that simple.                              

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Ron AKA replied on Sat, Dec 13 2008 12:15 AM

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Lets take a Double Whopper with Cheese, King sized fries, and a diet coke for an example of a cheap typical North American fast food quick meal. This is based on Burger King "Nutrition" Info:

Calories; 990 + 600 + 0 = 1560 total

Fat; 64+43= 107 total grams which represents 107*9= 963 Calories

Carbohydrates; 52+69= 121 total grams or 121*4= 484 Calories

% of Calories from Fat = 963/1560= 62%

% of Calories from Carbs = 484/1560= 31%

And then consider for a moment that the total calories no matter how you got them in this one quick meal is more than what many need for the whole day given the sedentary life style.

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nomorecarbs replied on Sat, Dec 13 2008 12:34 AM

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Ron,

Let's be real, what are Americans eating?

http://www.usda.gov/news/pubs/fbook98/ch1a.htm

They are not eating more red meat.  They are eating more salty snacks, eating more pasta and grains, drinking more sodas.  When I talk about cheap eating, I'm talking about bread, and pasta versus beef.  And let's not forget caloric sweeteners that are in almost every product sold in a supermarket today.  Never in history have people eaten more than a small fraction of the refined carbohydrates being consumed in any industrialized nation today.  That is the problem in a nutshell.  It is not fast food per se, or people being gluttonous, or people being too sedentary, it is a totally inappropriate diet that has been encouraged by governments, medical authorities, and commercial food producers.

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Ron AKA replied on Sat, Dec 13 2008 2:33 AM

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That study is 12 years out of date. However, just in case it has some significance lets talk about it:

The largest increase is in cheese, which is nearly 1/2 saturated fat. All Carbonated drinks does not distinguish between those with sugar and those without. My guess is that 1/2 are calorie free. Poultry is fat and protein. Fish is up and is protein and fat. Those Caloric sweeteners represent the foods like carbonated beverages that have no calories. Fats and oils are up, and I wonder if that figure includes all the hidden stuff like that in potato chips, cookies, and nearly any dessert style bakery.

While flour is not a great food for diabetics in particular, not all cereal is bad. Many have a low glycemic index and are high in fiber.

Sorry I'm unconvinced, as weight issues always come back to calorie intake and calories burned. There is no other food with as many calories per gram as fat. Serving size, fat, and the low cost of calories is the biggest evil facing NA.

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nomorecarbs replied on Sat, Dec 13 2008 2:20 PM

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Ron,

It's hard to determine exactly what it is that you are contesting.  But you seem to disagree with me that the cause of the epidemic increase in obesity and diabetes is the growing consumption of refined carbohydrates.  You might want to refer to this study.  In multivariate analysis, they found no correlation between diabetes and protein and fat consumption.  They found an inverse correlation with fiber.  They found a positive correlation with refined carbohydrate consumption.  Why are so many refined carbohydrates being consumed?  Certainly, in part, it is due to the inane campaign against saturated fat, which has led people to eat harmful trans fats and refined carbohydrates to fill the void.  For many of us, refined carbohydrates are the ultimate 'you can't just eat one' food.  It has made my job as consumer more difficult, I eat a high fat diet, and local supermarkets are quite uncooperative, seeming to only be willing to stock 'low fat' foods.

http://www.ajcn.org/cgi/content/full/79/5/774

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Simi_Papa replied on Sat, Dec 13 2008 3:04 PM

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Here is a better view of that graph you showed Ron, and more up-to-date:

Average daily calorie intake grew by 523 calories   Per capita consumption Commodity group 1970 2003 Increase in pounds, 1970-2003 Increase in daily calories, 1970-2003   Pounds Percent Number Fats and oils 53 86 63 216 Grains 136 194 43 188 Sugar and sweeteners 119 142 19 76 Meat, eggs, and nuts 226 242 7 24 Vegetables 337 418 24 16 Fruits 242 275 12 14 Dairy 564 594 5 -11 Total 1,675 1,950 16 523 The ERS per capita data represent the amount of food and calories available for consumption after adjusting for spoilage, plate waste, and other losses in the home or marketing system.

The dairy increase (including cheese) is fairly insignificant in the overall caloric intake.  The big increases are in fats and oil and in grains.  The other thing is, I posted statistics a couple of years ago that show only about 30% of obese people become diabetics which implies that obesity is not the only cause for the increase in diabetics.

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Ron AKA replied on Sat, Dec 13 2008 6:13 PM

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Simi_Papa:

Here is a better view of that graph you showed Ron, and more up-to-date

Yes, that is a more useful way to display the data. Fat and oils represent the largest gain both % wise and calorie wise. Grains are up too, which could be good and bad. Obviously the flour is not a great product due to the high glycemic index, but I would assume some are eating heathly stuff like rolled oats, and whole barley. The sugar represents a significantly lower calorie increase.

NMC my only point was that weight gain is due to increased calories and fats are a large contributor to the issue due to the fact that many love the taste and it is so dense in calories. This increase of 523 calories per day will result in a 1 lb gain per week, assuming calories were balanced with exercise in 1970. Of that gain, fat is responsible for 41%.

Off topic but I did discover a handy trick in this new forum. If you want to quote only a section of a previous post when replying, just highlight it and then click on the quote hot text. Nice feature! Now how did you put data in a table format? I have been stumped in all forums on how that is done.

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Simi_Papa replied on Sat, Dec 13 2008 7:38 PM

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I just did a copy/paste and the formating came through.  Probably because of the new software.

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DavidGeorge replied on Sat, Dec 13 2008 9:03 PM

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It's amazing to me how our conversations evolve...  My first post was an agit-prop piece where I was trying to get everybody to write a letter to the editor of the NY Times.  It changed into our usual discussion of fats vs carbs and then became an exploration of how to handle column/table format on the new bulletin board.  Nothing wrong with that.  Just surprising....

Murph

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Simi_Papa replied on Sun, Dec 14 2008 2:18 PM

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Hi Murph,

I got your email and you are right, our conversations/posts to go wide afield quite often.  It is one of the things I like most about this board.