Monday, May 23, 2016

The War on Diabetes - Part 1

[I've titled this "Part 1" because any war on anything (drugs, terror, etc) will take time. So I see this declaration of "war" on diabetes already a implied surrender that this war will not be won.

And as in all war the first casualty is truth. 

The comments on the various articles on this War on Diabetes was immediately inundated with "testimonials" (spam) on how the mainstream healthcare with its drugs were ineffective. 

And of course hints of secrets and lies Big Pharma and Big Medicine were keeping from you or telling you or manipulating you.

And of course your true salvation/redemption/healing will come from some obscure (or not so obscure website telling you how you can be free of diabetes.

So if you have diabetes, follow your doctor's advice. Not some quack on the internet. Your doctor studied a long time to be a doctor, and he is supported by a lot of medical knowledge and research. The quack on the internet has years and years of paranoia, suspicion, and a lack of trust in the establishment to back his assertions. 

Of course, it is precisely because of his anti-establishment attitude that draws followers. 

But... if there are a million people (or more) following him, doesn't that make him, an establishment then?

Anyway, whatever you believe or want to believe, here are the news articles.]

Sweet and sour of high-sugar lifestyles
Editorial, May 12 2016

That Singapore needs to fight obesity and diabetes on a war footing is clear from the potentially epidemic nature of those diseases. Of the more than 400,000 diabetics here today, one in three does not even know he has the disease. Alarmingly, of those who do know, one in three has poor control over his blood sugar levels. In waging war on diabetes, which can lead to heart disease, stroke, kidney failure, blindness and amputations, attention has focused on preventive measures related to lifestyle choices and consumption habits.
There are no quick victories in this offensive. One suggestion is to introduce a sugar tax to discourage the excessive consumption of a linked commodity. Attention has been given to a bowl of rice which has more than twice the carbohydrate content of a can of sweetened drink. These messages offer a simpler way of breaking down a complex subject that involves many factors. But to fixate on just one idea, like cutting rice from one's diet, would be self-defeating. The larger picture should be kept in mind. Scientific studies affirm a direct link between the amount of sugar consumed and the occurrence of obesity or diabetes. There are also other causes, like fats, a sedentary lifestyle and genetics.

Still, if even a single contributory factor like sugar can be controlled for starters, that would benefit those at risk. Given that sugary drinks, for example, are a choice and not a necessity, there is a case for taxing them to inhibit excessive consumption. Though not as serious as the use of tobacco or alcohol, the potential harm caused when the young develop a sweet tooth invites preventive intervention. The exercise could draw attention to the excessive use of sugar in a host of other foods as well, in particular desserts. It would be useful to study closely the actual experiences of countries, such as Mexico, which have introduced the tax. And it would be sensible to seek strong evidence that links sugar taxes with reductions in obesity or diabetes rates before embarking on such a policy. It would be important, as well, to study the effects of a regressive health tax on white sugar on the less well-off.

Of course, what would be best is when Singaporeans, of their own volition, settle for a less sugar-dependent lifestyle. Diabetes and its related ailments are not merely personal afflictions but impose costs on the health service directly and on the economy indirectly by affecting work and productivity. As one observer argues persuasively, "the social cost of sugar consumption is greater than the private cost of sugar".

Diabetes is no longer just a disease afflicting the rich but increasingly and disproportionately, one that affects the poor. Hence, the need to persuade food producers to not keep leveraging sugar to push their sales and to encourage consumers to demand healthier alternatives from them.

Fighting diabetes: Why the target is white rice

Salma Khalik
Senior Health Correspondent

May 12, 2016

As a staple, more of it is eaten; but more brown rice will boost health

News that the Health Promotion Board (HPB) is targeting white rice in its fight against diabetes has created a storm of protest from rice lovers. Could the staple food of Asians for centuries truly be bad for health, they asked.

Many of those outraged by the report on the targeting ("Diabetes: the rice you eat is worse than sugary drinks", May 6) were more than happy to make sweet drinks and junk food the real villains that cause diabetes, which, while enjoyable, are not part of Singapore's heritage. But they were vehement that it could not be the traditional, steaming bowls of white rice that they consider essential.

Yes, sweet drinks and junk food are bad, and no one, least of all the HPB, is denying this. What it is saying, though, is that white rice is also a major culprit - largely because it is a staple, so more of it is eaten.

Starchy white rice, it has been found, can overload Asian bodies with blood sugar and heighten their risk of diabetes. Then add to that, this in terms of consumption: The 2010 National Nutrition Survey found a typical serving of rice here was 250g, and that a third of Singaporeans' daily intake of calories comes from rice - compared to 3.5 per cent from sugary drinks.

Then there is this: A Harvard School of Public Health study found that each serving of white rice a day raises the risk of diabetes by 11 per cent. A study of rice and noodle consumption by 2,728 Chinese here by the National University Health System found it resulted in greater insulin resistance.

For those who argue that rice has been eaten for centuries with no ill effects, the counter-arguments are:

In the pre-industrialisation era, there was a lot more physical exertion. Even in everyday life, people walked a lot more than today. Exercise is known to offset some of the ill-effects of unhealthy food.
People did not live as long in the past. In Singapore, for example, life expectancy at Independence in 1965 was only 65 years. Today, Singaporeans are living 20 years longer. This alone provides chronic diseases with a greater opportunity to surface. Among people 65 years and older, one in three is diabetic.


For decades, nutritionists have condemned processed food as unhealthy. Traditionalists raising their eyebrows at brown rice might consider this: What is white rice but processed brown or red rice?

And consider this: White rice, which is a simple carbohydrate and tastes more starchy, is likely to turn into sugar more quickly than unpolished rice.

White rice has a glycaemic index (GI) of 78-98, while the GI for brown rice is 65-76. The higher the index, the more blood sugar is produced.

[That is simplistic. The problem with a high GI food is that the carbo/sugar in it are more quickly released on consumption leading to blood sugar spike. This may overwhelm the body's ability to absorb and deal with the sugar (with the body's own insulin). ]

So while having a lot of white rice in the diet is certainly not the only contributory factor, it is difficult to deny that it does contribute significantly to the high level of diabetes here.

Having said that, changing people's taste is not an easy task.

This is why HPB's chief executive officer, Mr Zee Yoong Kang, has been quick to say that he is not asking people to stop eating white rice. What he would like to see is more people adding some brown rice to their diet - a modest 20 per cent of it mixed with 80 per cent white rice.

This is because another Harvard study, which followed 197,000 people over 20 years, found that replacing a fifth of white rice with brown cut the risk of diabetes by 16 per cent.

Soaking brown rice in water before adding it to the pot to be cooked with white rice makes it softer. With only one in five grains of rice being brown, the taste is pretty much like normal white rice.

Aside from having a lower glycaemic index - indicating a lower surge in blood sugar - brown rice also has vital nutrients, such as zinc and iron, that white rice lacks. These nutrients are taken off when the husk of bran and germ are removed. But getting people to adopt this 20 per cent brown-mixed-into-white-rice is going to be a big challenge.

The Government can take the lead by insisting that caterers serve such rice for all functions. Or at the very least, to offer this as a choice.

Foodcourts and restaurants should also be encouraged to sell this mixture. Many readers have complained that it is difficult to get brown rice when they eat out - which most workers do for weekday lunch.

Schools should also tell their canteen operators to offer this version instead of plain white rice, since habits picked up when young tend to remain as people age.


And, of course, a brown-white rice mix should be the default option served to full-time national servicemen. While they do a lot of physical activity - so white rice should do them less harm than the population at large - the combination is better for them.

Hopefully, after two years of eating this mix, they will continue with it after leaving NS. It would be even better if they were to urge their parents to serve this at home.

Today, brown rice costs more than white rice - which, when you think about it, doesn't make sense as there is less processing needed.

So the higher cost is probably due to low demand - only 5 per cent of rice sold here is unpolished. It then follows that if demand rises, the price should come down, so price would no longer be a major reason for choosing white rice.

While it is difficult to change people's tastes, it is not impossible.

The HPB has shown this with its campaign for wholemeal bread in 2009/10. At that time, only 18 per cent of bread sold here was wholemeal or wholegrain. This has gone up to 30 per cent today.

Part of this is due to the superfine wholemeal flour that is available today, that makes bread taste like soft white bread. With this flour, there are now also wholemeal noodles that are more nutritious and have a lower GI than noodles made from white flour.

People are generally reluctant to give up what they enjoy eating - which is why the focus is on adding some brown rice, rather than replacing white with brown.

So this battle will be a long one. In the meantime, the HPB should not let up on discouraging the consumption of junk food, including sweetened soda drinks.

One complaint that was a constant in comments from supporters of brown rice is the difficulty in getting this when eating out.

Several also said that at foodcourts and restaurants, water can be as expensive, and sometimes even more expensive, than buying drinks. Ensuring that all food outlets offer free water to diners would be a good way to reduce the unnecessary calories many are now consuming - sometimes unwillingly.

There is no one single formula for beating the rising rates of diabetes here. But action needs to be taken, and fast.

According to a study by the Saw Swee Hock School of Public Health, diabetes already costs Singapore $1 billion a year, and is expected to soar to $2.5 billion by 2050.

If we can reduce the rate of diabetes by just 10 per cent, it would cut $250 million off the bill in 2050. That's a lot of money.

More importantly, it would also cut down on much suffering, since diabetes is a leading cause of kidney failure, blindness and amputations.

Diabetes: The rice you eat is worse than sugary drinks

White rice is even more potent than sweet soda drinks in causing diabetes.

 MAY 6, 2016

Salma KhalikSenior Health Correspondent

The health authorities have identified one of their top concerns as they wage war on diabetes: white rice. It is even more potent than sweet soda drinks in causing the disease.

Sharing his battle plan to reduce the risk of diabetes, Health Promotion Board chief executive Zee Yoong Kang said that obesity and sugary drinks are the major causes of the condition in the West.

But Asians are more predisposed to diabetes than Caucasians, so people do not have to be obese to be at risk. Starchy white rice can overload their bodies with blood sugar and heighten their risk of diabetes.

Mr Zee is armed with data. A meta- analysis of four major studies, involving more than 350,000 people followed for four to 20 years, by the Harvard School of Public Health - published in the British Medical Journal - threw up some sobering findings.

One, it showed each plate of white rice eaten in a day - on a regular basis - raises the risk of diabetes by 11 per cent in the overall population.

Two, it showed that while Asians, like the Chinese, had four servings a day of cooked rice, Americans and Australians ate just five a week.

But Mr Zee does not plan to ask Singaporeans to stop eating rice, a popular feature of meals here. What he would like is to see more people turn to healthier varieties.

Long grain white rice is also better than short grain when it comes to how it spikes blood sugar - a rise in sugar levels causes the pancreas to produce more insulin, and frequent spikes can lead to diabetes.

He would also like people to try adding 20 per cent of brown rice to their white rice. This amount is enough to reduce their risk of diabetes by 16 per cent."There is no need to fully replace what they now eat. Just increase the quantity of whole grain and brown rice."

Health Minister Gan Kim Yong said last month that this disease is already costing the country more than $1 billion a year. Diabetes is a major cause of blindness, kidney failure and amputations in Singapore.

Dr Stanley Liew, a diabetes expert at Raffles Hospital, advised people to eat less rice. He added that most junk food and sodas are just as bad and should be discouraged.

The graphic above has been updated for clarity.

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