Just imagine there was a medical condition that:
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- Affected 1.5 million Australians between the ages 20 and 79
- Was the leading cause of blindness, kidney disease and amputations
- Was thought to be closely associated with cardiovascular disease and dementia/Alzheimers
- Was the direct cause of death of more than 23,000 Australians annually
- Cost the country $12.36 billion per year
And what if medical research showed there was a treatment that significantly reduced the impact of the disease and resulted in approximately half those diagnosed with the disease putting the condition into remission?
Wouldn't that be amazing? If that were the case, you would expect it to be the medical discovery of the century, on the front page of every newspaper, Nobel prizes for those who discovered it, advocated by every health practitioner, supported by governments who loved the idea of all those reduced medical costs.
If only.
The medical condition is type 2 diabetes which, according to the latest global update from the International Diabetes Federation, affects more than 8 per cent of Australian adults.
Hear more from Dr Brukner on the Voice of Real Australia podcast
Worldwide, since 2000, the estimated prevalence of diabetes in adults has more than tripled, from an estimated 151 million (4.6 per cent of the global population at the time) to 537 million (10.5 per cent) today.
If this trend continues, the number will jump to a staggering 783 million (12.2 per cent) by 2045.
The treatment referred to above is a restricted carbohydrate eating program. By reducing the carbohydrate intake for those with type 2 diabetes, blood glucose control improves.
It is thought that persistently elevated blood glucose levels cause many of the complications of type 2 diabetes, such as blindness, kidney disease, amputations, cardiovascular disease and dementia.
So what are carbohydrates? There are two types of carbohydrates: sugars and starches. The obvious sources of sugar are soft drinks, confectionary and the sugar you add to your tea or coffee. But sugar is everywhere.
Most processed foods contain added sugar and many foods and drinks that we have always considered "healthy", such as breakfast cereals, fruit yoghurts, fruit juice, energy drinks, flavoured milk, barbecue sauces, to name a few, are full of sugar.
Starches are just bunches of glucose molecules stuck together. When you eat starchy food such as rice, pasta, potatoes or white bread, the body's digestive system breaks the starch down into glucose and is absorbed by the bloodstream.
The only difference between the glucose from sugars and the glucose from starches is that the glucose from starch is absorbed more slowly into the blood.
Type 2 diabetes is a disease of carbohydrate intolerance. Common sense would suggest that the simple solution is to restrict carbohydrate intake.
Just look at the condition of gluten intolerance. Those who cannot tolerate the gluten contained in foods simply avoid gluten in their diet and usually control their disease very well.
So the official recommended diet for those with type 2 diabetes would be one that restricts the intake of carbohydrates.
Wrong.
Unfortunately, because of our belief (now largely disproven) that we need to reduce cholesterol and saturated fat in our diet, we have ignored the carbohydrate issue and recommended a low fat, high carbohydrate diet for everyone, including those with carbohydrate intolerance (diabetes).
We were told 50 years ago, on the basis of some very dubious research, that fat was the cause of heart disease, the so-called "diet-heart hypothesis".
The food industry responded by producing a wide range of low-fat, highly processed and ultra-processed foods. Unfortunately, when manufacturers removed the fat from food, it affected the taste, so sugar was substituted for fat.
We have been on a low-fat, high-sugar diet for the past 50 years and the results have been disastrous. We have been getting fatter and sicker ever since.
The 10th edition of the International Diabetes Federation Diabetes Atlas, which gathers information on the burden of diabetes from countries across the world, reports that 6.7 million adults worldwide are estimated to have died due to diabetes or its complications in 2021 - just over 12 per cent of deaths from all causes. Approximately one-third of those deaths occurred in people under the age of 60.
The overall direct cost of diabetes worldwide is A$1.344 trillion, a 316 per cent increase in cost over the last 15 years.
These figures demonstrate why, more than ever, we urgently need to revise our dietary advice: to stop demonising cholesterol and fat; reduce the intake of processed and ultra-processed foods; and get back to eating the way our grandparents used to eat before the era of ultra-processed junk food.
We have been on a low-fat, high-sugar diet for the past 50 years and the results have been disastrous. We have been getting fatter and sicker ever since.
We need to focus on meat and fish, non-starchy vegetables and low sugar fruits such as berries, eggs, full fat dairy and nuts.
Results from low-carb programs in the UK and US have shown high remission rates of type 2 diabetes, and preliminary results from our Australian Defeat Diabetes program show similar encouraging results.
Low calorie meal replacements and bariatric surgery have also been shown to be effective in reducing the impact of type 2 diabetes.
However the former is difficult to sustain due to constant hunger, while the latter is associated with significant side effects and is very much a last resort.
The fats and proteins in a low-carb eating program prevent hunger, making the low-carb option sustainable for the longer term.
Fortunately, there are now increasing numbers of people with type 2 diabetes who have benefited from a low-carb lifestyle and are influencing their doctors and dietitians to re-examine how they manage those with type 2 diabetes.
Type 2 diabetes is, I believe, the biggest single health challenge we face in this country. Fortunately, there is now hope for the thousands of Australians with this condition.
- Professor Peter Brukner is the founder of Defeat Diabetes and the author of A Fat Lot of Good.