Can we really blame diabetes on diet choices?

Many chronic diseases are attributable, at least in part, to diet, among them are type 2 diabetes, heart disease and several forms of cancer. 

Type 2 diabetes is an enormous burden on human health and longevity worldwide, It’s has wide consequences for the people suffering from it, and on healthcare systems, as type 2 diabetes affects most organ systems including the heart, kidney, eye, brain, and liver, it increases the chances of cancers, infections, and dementia. 

Type 2 diabetes may run in families, but its rapid rise makes it clear that there’s much more than genetics at play. In the last 40 years type 2 diabetes incidence has risen 5 fold, 1 in 10 adults live with the disease and this is occurring worldwide. It’s clear that diet plays a big role, whether through weight gain and obesity or directly: by affecting sugar metabolism, inflammation, and changes in the gut. 

To what extent does your diet drive the incidence of diabetes, and which foods are most to blame?

To assess that researchers from Tufts University looked at data from 184 countries from 1990-2018. They looked at diet components, as well as age, sex, education, and where people lived. Their model relies on information from the Global Dietary Database, population demographics, global type 2 diabetes incidence estimations, and published research on how food choices impact type 2 diabetes. The findings appeared recently in Nature Medicine.

And the conclusions: about 70 percent of new cases of type 2 diabetes are attributable to a suboptimal diet and could have been avoided with a better diet. Eating too much of the wrong foods – such as refined rice and wheat, sugary drinks, processed and unprocessed meats – can explain 60 percent of the harm. Not eating enough of the protective foods – such as fruits, vegetables, nuts, seeds and whole grains – explains the 40 percent rest of the risk.

Poor diet drives type 2 diabetes in men more than in women, according to the study, in younger people more than in older ones, and in city dwellers more than in rural ones. And although men and city-dwellers with higher education tended to have a greater burden of type 2 diabetes caused by their diet, the opposite was seen in wealthier countries where living in urban areas and a higher education was predictive of a healthier diet. Interestingly, the link between a country's economic development and its diet-attributable type 2 diabetes burden has become weaker over the years – which suggests that as highly processed foods spread worldwide and expand so does type 2 diabetes.

The assessment that 70 percent of type 2 diabetes is diet related is astounding. It’s higher than previously assessed: Another study estimates 40 percent of cases are due to a suboptimal diet. This study, however, looks at 11 dietary factors instead of just six in other studies. Either way, many people could change the trajectory of their health by making healthier food choices and the biggest culprit is refined/highly processed foods – and especially refined carbs.

The diet to prevent diabetes

To lower your risk of type 2 diabetes it's important to control weight gain, which is a major risk factor for the disease. Other important lifestyle risk factors include inactivity and smoking.

Pay special attention to these diet principles to lower your risk:

Skip the sugary drinks: Excess added sugar is an established risk for diabetes, sugary drinks are the leading source of added sugar in our diet, and many studies show a clear link between soda consumption and the development of type 2 diabetes. These include randomized controlled studies that showed that sugary drinks aren’t just associated with diabetes – they cause obesity, insulin resistance and chronic inflammation, which are the harbingers of type 2 diabetes. 

Choose whole, unprocessed foods: Select whole grain over refined grains, eat nuts, beans, legumes, make sure you eat plenty of fruits and veggies (non-starchy vegetables, a potato isn’t in this category).Limit meat, especially processed meat.

Dr. Ayala