Saturday, November 9, 2013

The Nutrition Debate #159: While ‘Rome Burns,’ the GACD fiddles and the EASD naps


Please excuse me if once in a while I tear into a rant. I get frustrated and then very cynical with some of the things I read. I also know that, individually, I have so little power to influence outcomes beyond my own…and if I’m lucky, a few others. But I still have to get some things off my chest. I could throw the print copy out, but the content would still be swirling around in my head. So, the only thing for me to do is to write about it. What set me off this time was a piece that appeared in The Lancet last month, “Funding: Global Alliance for Chronic Diseases tackles diabetes.”

Here’s what the BBSRC science writer Arran Frood said: “To meet the challenge in emerging economies, the Global Alliance for Chronic Diseases (GACD) has launched a call for research proposals to prevent and treat type 2 diabetes. The GACD is an alliance of some of the world’s biggest publicly funded research organizations, ranging from the UK’s Medical Research Council to China’s Ministr­­y of Health and the European Commission.” Okay, that’s benign enough; it’s an employment program for government scientists, a kind of job security. Here’s what set me off:

“Refreshingly, GACD members have realized that the science of type 2 diabetes is well understood; this is no high-spending, high-tech genomics initiative but a strict focus on implementation of existing policies, present knowledge, and proven interventions.” It is reading arrogant bull$#%& like this, I think, that gave me high blood pressure. Of course, it could also be related to my weight, hehe, (because when I lost 140 pounds, my BP went from 130/90 to 110/70 on the same meds).

So, these government bureaucrats, who know all about type 2 diabetes, are going to disseminate their message to “low-income and middle-income countries, such as China, India, and South Africa where the biggest emerging problems are to be found, but where success might pay the highest dividends.” That’s just great!!! The “developed” world, where this type 2 diabetes problem arose as a result of “developments” in the growing, processing, manufacture and marketing of the very foods that have made us sick, is going to spread the word about fixing the problem, which is our Western Diet. Sell the problem and then sell the solution!

Boy, that’s irony for you, but obviously Mr. Frood doesn’t see it that way. He’s refreshed. The GACD is going to “strict(ly) focus on (the) implementation of existing policies, present knowledge, and proven interventions.” It doesn’t occur to him that existing policies and present knowledge have not led to proven interventions. They have produced the growing and out-of-control epidemic of not only type 2 diabetes, but obesity (an outcome, not a cause of T2DM), dyslipidemia (characterized by low HDL, high triglycerides, and Pattern ‘B’ LDL particles), and hypertension, collectively known as the Metabolic Syndrome.

Okay, Ivory Tower Dictocrats live in a special world – a world in which a primary duty is to “call for research proposals” from other “publically funded research organizations.” They are isolated from the real people-populated world in which we mere mortals spread the word about the most effective intervention “to prevent and treat type 2 diabetes” - Eat Real Food.” Now that would be “refreshing.” ­­­­­But where’s the money? No drugs to market. No processed foods to manufacture and sell. Simply small scale farming – just like they do now in low-income and middle-income countries like China, India and South Africa!

So, the best thing we “developed” countries can do is stay the hell out of the management of type 2 diabetes in the underdeveloped and developing world until we get the message right. I’m not hopeful, though. This is not likely to happen so long as the Agribusiness lobby remains so thoroughly insinuated in the interstitial tissue of our nation’s and the world’s advisory and regulatory bodies. I do not see an end to this pernicious and insidious influence soon.

Meanwhile, diabetes experts from all over the world met in Barcelona last month for the annual meeting of the European Association for the Study of Diabetes (EASD). They listened, I’m sure, to riveting presentations, and maybe got in a round of golf. Among the reports, chronicled in Diabetes in Control here, was a research paper titled, “Big breakfast rich in protein improved glycaemic control and satiety feeling in adults with type 2 diabetes mellitus.” I wonder how much the taxpayer of some nation paid for that earth shattering news. I really shouldn’t knock it, though. It’s the right message, and yet so many clinicians and dietitians still don’t know this. For diet-controlled diabetics like me, this is Nutrition 101, 1st day of class stuff.

My favorite news flash, though, came from another Diabetes in Control item, here: “Afternoon Napping Tied to Increased Risk for Diabetes.” It begins, “Since afternoon napping is very common in China, Fang et. al. conducted a study to determine if the duration of a person’s nap affected their risk for developing diabetes or an impaired fasting blood glucose (IFG).” Their conclusion: “Napping duration was associated in a dose-dependent manner with IFG and DM” (emphasis mine). And “This finding suggests that longer nap duration may represent a novel risk factor for DM and higher blood glucose levels.”
Okay, but association is not causation. Perhaps the Chinese scientists will now apply for a grant to undertake a randomized controlled trial (RCT) to determine if the outcome observed by Fang et. al. can be attributed causally to the blood glucose crash of some of the 27,009 participants a few hours after eating a bowl of overcooked white rice. Maybe they’ll “discover” insulin resistance (IR). It will certainly keep the scientists busy interpreting and reporting the results for publication. Whew!

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