Diabetes not well-controlled in U.S., survey finds

[doreen T]

Diabetes not well-controlled in U.S., survey finds

Wednesday, May 18, 2005

Reuters Health - Two out of three Americans with type-2 diabetes do not have their disease under control and risk early deaths from stroke, heart attack or kidney failure as well as blindness and limb loss, according to a report published on Wednesday.

Doctors and patients alike need to do more to test for diabetes and then to control it with diet, exercise and, if necessary, drugs, the report said.

"Diabetes management actually worsened in the past 10 years," Dr. Jaime Davidson, a diabetes expert at the University of Texas Southwestern Medical School in Dallas, told a news conference.

"We have the tools but we are not doing better."

Unlike juvenile or type-1 diabetes, type-2 diabetes is almost exclusively caused by poor diet and a lack of exercise, although it may involve a genetic susceptibility. As many as 18 million Americans now have it, including a growing number of children and young adults.

Type-2 diabetes can be prevented with improved diet and exercise. It can also be controlled with diet and exercise but many people also need medications to control it and some may eventually need insulin.

The American Association of Clinical Endocrinologists and the American College of Endocrinologists commissioned a survey of 157,000 people with type-2, or so-called adult-onset diabetes.

They looked at a blood sugar reading called A1C, and found 67 percent of the patients did not have an adequate A1C level.

"Two out of every three people analyzed in this study were not in control of their blood sugar," said Dr. Lawrence Blonde of the Ochsner Clinic in New Orleans, a member of the American College of Endocrinologists.

In every state, 50 percent or fewer patients had adequate blood sugar control, they found.

The A1C test indicates average blood sugar levels over the past two months or so by measuring how much glucose is attached to red blood cells.


KEEPING TRACK OF GLUCOSE

The average lean, healthy young American adult has an A1C of about 5.1 percent and the highest desirable level is 6.5 percent. An A1C reading of 6 percent correlates to an average daily blood sugar reading of 135, while 7 percent indicates an average of 170 over the preceding weeks.

Blood sugar should be below 110 before eating and no higher than 140 after eating.

A separate, Harris Interactive survey of 501 adults with diabetes showed that more than 60 percent did not know what A1C was. And 84 percent believed they were doing a good job of controlling their blood sugar.

When glucose levels are too high, they can damage the insides of the blood vessels, leading to heart attacks and stroke. They can damage the tiny capillaries inside the eyes and kidneys, causing blindness and kidney failure.

"Diabetes doesn't necessarily hurt," said singer and actress Della Reese, who has type-2 diabetes. "If you have a backache, the backache will make you take your medication. But this will slip up on you."

She said people need to do more to make sure they are screened for diabetes, and to take care of themselves if they have it. "The doctors mean well but they are not going to be with you 24 hours a day," Reese told the news conference.

Surgeon-General Dr. Richard Carmona said 40 percent of Americans aged 40 to 74 now have pre-diabetes. They still have a chance to prevent diabetes itself if they begin to exercise and eat more healthily. "We must do something about this now," Carmona said.

"Every single year we add 1.2 million Americans with this problem," Davidson said. "It cost us in 2002 about $132 billion."

And drugs can help manage diabetes but cannot cure it. "Once complications have set in, you cannot magically reverse it," said Dr. Paul Jellinger, president of the American College of Endocrinologists.


http://story.news.yahoo.com/news?tmpl=story&cid=594&e=1&u=/nm/20050518/hl_nm/health_diabetes_dc


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[doreen T]

"Diabetes management actually worsened in the past 10 years," Dr. Jaime Davidson, a diabetes expert at the University of Texas Southwestern Medical School in Dallas, told a news conference.

"We have the tools but we are not doing better."
Really? Y'don't suppose it has anything to do with the American Diabetic Association's official position that sugar is just fine to eat (in moderation of course :rolleyes: ), and recommend six servings of starch per day?

:daze:


Doreen

[Kristine]

(Shaking head sadly) Low carb proponents have been screaming about this for years, and they write this article as if it's a perplexing issue. When you've had so much of a substance that your body can't process it anymore, you have to remove that substance, not try to "manage" it!

[wwdimmitt]

Sounds very much like what Dr. Atkins said 35 years ago!!

Go figure.

I think that I would probably have Type II by now if I had not gone on low carb when I did. It will be a battle for the remainder of my life, and the only way I will prevent it is to stay away from sugar, flour and other high glycemic foods.

[ItsTheWooo]

Unlike juvenile or type-1 diabetes, type-2 diabetes is almost exclusively caused by poor diet and a lack of exercise, although it may involve a genetic susceptibility.

You know I have lately grown much more tolerant if not in favor of the theory that most weight problems are primarily mental/emotional/behavioral in origin... but that quote is just waaay excessive and ignorant.

EVERYONE in our country has "poor diet and lack of exercise", but only a certain percentage become insulin resistant to the point where their body is essentially breaking down bit by bit because it can't use sugar anymore. To say there "may involve a genetic susceptibility" in T2 diabetes is A GROSS understatement to say the least.

Furthermore, when it comes to insulin resistance, because of the genetic nature of it, even IF you make an attempt to be more active and eat more healthfully than average, you STILL tend to have problems that "normal people" don't have. Eating badly (high carb & high calorie) and not exercising just like everyone else will only exacerbate the condition and produce more symptoms, but eating "normally" will not "cure" you.
For example, me and my sister have a strong tendency toward PCOS. She historically watched her diet much closer than I did, whereas I historically ate whatever I wanted. As a result, my hunger spiraled out of control resulting in habitual over eating (when you are IR eating poorly will break your satiety mechanism because of what poor quality food does to your sugar) and my ability to burn fat shut down due to hyperinsulinemia (producing chronic hypoglycemic symptoms). These complications of hyperinsulinemia - an inability to effectively burn fat & chronic sugar crashing, and hunger - worked in concert to produce gross obesity. My PCOS symptoms were just awful as well.
On the other hand, my sister has never really eaten everything she wanted and makes a careful effort to control the quantity (and also quality) of food she eats. As a result her PCOS symptoms were and are more mild (she gets periods but once every 3 months or so, she has very mild acne and hair growth etc). She didn't have the hypoglycemic & hunger problems I did either.
She eats salads often, she doesn't eat that much sugar and starch with meals (for example if she will pull out the center of bread and she never drinks juice or soda). However she does eat desserts - real desserts - very frequently, although she does NOT over eat and eats very little total food in fact. Despite this she still is a little pudgy (especially around the belly and neck/shoulders - typical IR fat) and has some PCOS symptoms.

Of course, now that I low carb (and she does not) my symptoms are totally under control and I have a favorable balance of muscle to fat... whereas she still struggles with symptoms and size (despite making an effort to "eat healthfully and not over eat"... she doesn't want to almost totally give up sugar and starches even though she knows she should).

The point is, though, that it's not a simple issue of lifestyle and eating. If you DO NOT have the genes for these diseases, you cannot get them. Furthermore, if you DO have the genes, even a better than average diet and watching how much of what you eat will produce some symptoms, simply because a better than average diet is STILL too great of a glycemic load for the person with a poor sugar metabolism. The amount you need to use "control" and "watch yourself" is also much greater than average simply because when you eat those foods your metabolism goes to pot which is an added burden (and thus, hunger/tendency toward fat gain & muscle loss goes up in response).

The only way to truly control these diseases is by making a concentrated effort to reduce high GI & total carbs. While I do completely support the opinion that obesity and associated diseases are quite often resulting from poor behavior (diet and lifestyle) due to "issues with food" and bad habits... and while I do agree that carbs aren't the only dietary factor that's relevant ... they neglect to realize that the reason "issues with food" exist in the first place is because food has a medicative, sedative, drug-like effect on people with a genetic predisposition to poor sugar metabolism. When it comes to obesity & obesity related diseases, a genetic susceptibility to sugar sensitivity is like the spider weaving a complex web of disease. It's a SUGAR and INSULIN thing primarily, and thats what these people who make their living researching obesity and it's complications just don't get. That must be focused on primarily. Trying to cure obesity without at all focusing on carbohydrate percentage in diet is like trying to get alcoholism under control by telling alcoholics they should switch brands. The advice to focus primarily fat to lose is just absolutely poisonous for most.

[AJCole]

I would only disagree here in one way. I think some people are not predisposed to obesity, but can end up obese due to a proir period of starvation. I was the person who could eat anything and never gained weight. But in 1993 I got sick and could not eat for two weeks. I dropped from 123lbs. to 103 lbs. But I also killed my metabolism and ended up at 185lbs. (on a low fat, calorie restricted diet). I probabley would have only had a little creep in my weight if not for that dramatic event. I really think starvation diets, low fat diets, and binging have damaged people more then if they had never dieted, but still ate alot of carbs. Having said that, I do believe carbs should be restricted by all people desiring optimum health, not just weight loss.

[tie_guy]

My wife had gestational diabetes while having my son. We kept her blood sugar in line by taking the nutrionalist's advise of going on basically a low carb diet. When we went to the hospital (we had to stay there for several days because of a complication) they put here on a standard diabetes diet. The diabetes diet was simply the regular (high carb) diet with fewer calories. So instead of three pancakes she only got one (I am not even sure if she got sugar free syrup.) Result? She was hungry the entire time and here blood sugar went way up. When I mentioned that it would be ok for here to eat more food as long as it was low carb some of the nurses didn't believe me. Most of the nurses though completely agreed with me but said that there was nothing they could do about it. The funny part is that when I first got there no one seemed to know that she had gestational diabetes so no special meals. After my son was born it was hard to convince them that she no longer had diabetes and could get here 3 pancakes instead of 1. She was of course starving at this point since after the complication they didn't let her eat anything for a while. Oh well know it is over and we have a wonderful son.

This is a hospital that doesn't seem to understand what I knew from high school biology -- those on diabetes shouldn't eat sugar (or starch that gets turned into sugar.) No wonder why so many people have diabetes that is out of control.

[mio1996]

I was probably 5 years old when I found out that diabetics shouldn't eat pancakes.

What is wrong with these doctors?

By the way, my mom has always used the term "educated idiot" for people who have much education but know nothing :)

[Angeline]

I was probably 5 years old when I found out that diabetics shouldn't eat pancakes.

What is wrong with these doctors?

By the way, my mom has always used the term "educated idiot" for people who have much education but know nothing :)

I guess that's similar to an "idiot savant" :)

[ItsTheWooo]

I would only disagree here in one way. I think some people are not predisposed to obesity, but can end up obese due to a proir period of starvation. I was the person who could eat anything and never gained weight. But in 1993 I got sick and could not eat for two weeks. I dropped from 123lbs. to 103 lbs. But I also killed my metabolism and ended up at 185lbs. (on a low fat, calorie restricted diet). I probabley would have only had a little creep in my weight if not for that dramatic event. I really think starvation diets, low fat diets, and binging have damaged people more then if they had never dieted, but still ate alot of carbs. Having said that, I do believe carbs should be restricted by all people desiring optimum health, not just weight loss.

While I don't necessarily disagree with your theory (that the physiological trauma of starvation/extreme dieting can wreck metabolism permanently)... I think that another reason starvation and extreme dieting positively correlates with fat gain and wrecked metabolism might be because the type of foods you eat during and after such events. Or, to put it bluntly, when people extreme diet they usually do it on rice cakes and almost no fat or protein (since they make the mistake of thinking "fat will make you fat", or that "a calorie is a calorie and it's best to eliminate energy dense food first". It is the food you eat when you crash diet that permanently causes insulin insensitivity and makes the body more eager to store fat.
Because I know in my experience my metabolism has rebounded quite well from the rapid weight loss... I can practically eat and eat and I only get more energy or build some muscle from it it seems ;). If I were eating mainly high GI carbs though with almost no fat or protein, that would be quite a different story...

[mcsblues]

You know I have lately grown much more tolerant if not in favor of the theory that most weight problems are primarily mental/emotional/behavioral in origin... but that quote is just waaay excessive and ignorant.

EVERYONE in our country has "poor diet and lack of exercise", but only a certain percentage become insulin resistant to the point where their body is essentially breaking down bit by bit because it can't use sugar anymore. To say there "may involve a genetic susceptibility" in T2 diabetes is A GROSS understatement to say the least.

I am struggling to understand your point (again!;)) Although the writer's idea of what constitues a "good" diet probably doesn't mean low carb - if it did then I would agree with that sentence completely. If your idea that only genetically susceptible people get type 2 diabetes, then why are the rates of this disease exploding around the world? The gene pool doesn't change anywhere near that rapidly. What has changed is "our" diet, and to a lesser extent our lack of exercise (the lack of which also influences insulin resistance)

Furthermore, when it comes to insulin resistance, because of the genetic nature of it, even IF you make an attempt to be more active and eat more healthfully than average, you STILL tend to have problems that "normal people" don't have. Eating badly (high carb & high calorie) and not exercising just like everyone else will only exacerbate the condition and produce more symptoms, but eating "normally" will not "cure" you.
I don't want to launch into another diatribe about semantics, but low carb eating takes type 2 diabetes out of the blood glucose range that defines what is type 2 - what you choose to call that is immaterial. More importantly though, if you adopt low carb while your BG is normal or in the so called prediabetic range - you will not get into the diabetic range - so you will never "get" the disease, period. Forget cure (or whatever)- this is prevention, and it will be the same regardless of genetic predisposition. Now perhaps some people will need to adopt a lower carb intake than others because of their genes to achieve this - but regardless, a "good" low carb diet will indeed halt and start to reverse the current 'epidemic' trend in diabetes to which the article refers.
For example, me and my sister have a strong tendency toward PCOS. She historically watched her diet much closer than I did, whereas I historically ate whatever I wanted. As a result, my hunger spiraled out of control resulting in habitual over eating (when you are IR eating poorly will break your satiety mechanism because of what poor quality food does to your sugar) and my ability to burn fat shut down due to hyperinsulinemia (producing chronic hypoglycemic symptoms). These complications of hyperinsulinemia - an inability to effectively burn fat & chronic sugar crashing, and hunger - worked in concert to produce gross obesity. My PCOS symptoms were just awful as well.
On the other hand, my sister has never really eaten everything she wanted and makes a careful effort to control the quantity (and also quality) of food she eats. As a result her PCOS symptoms were and are more mild (she gets periods but once every 3 months or so, she has very mild acne and hair growth etc). She didn't have the hypoglycemic & hunger problems I did either.
She eats salads often, she doesn't eat that much sugar and starch with meals (for example if she will pull out the center of bread and she never drinks juice or soda). However she does eat desserts - real desserts - very frequently, although she does NOT over eat and eats very little total food in fact. Despite this she still is a little pudgy (especially around the belly and neck/shoulders - typical IR fat) and has some PCOS symptoms.
So what is your point? Your sister may have a similar genetic susceptibility to syndrome X realed issues as you (or not) but she ate a slightly better diet than you and so has yet to be badly affected (but eating higher carb may eventually catch up with her anyway). OTOH you started to eat poorly and this caused physical issues such as PCOS and also contributed to emotional eating behaviours which exacerbated the situation. In what way is that inconsistent with the basic thrust of the article? By improving your diet you have managed the physical symtoms and in all probability stopped their progression into type 2 diabetes. Sure the eating disorder needed dealing with as well - but ask yourself would you have ever had to if you had not triggered these factors with a very poor diet in the first place (like your genetically similar sister perhaps?)
Of course, now that I low carb (and she does not) my symptoms are totally under control and I have a favorable balance of muscle to fat... whereas she still struggles with symptoms and size (despite making an effort to "eat healthfully and not over eat"... she doesn't want to almost totally give up sugar and starches even though she knows she should).
Exactly
The point is though, that it's not a simple issue of lifestyle and eating. If you DO NOT have the genes for these diseases, you cannot get them.
Like I said before the simple statitistics suggest that this is not the case. Type 2 diabetes has doubled (at least) and looks like doubling again - this is not just genetics.
Furthermore, if you DO have the genes, even a better than average diet and watching how much of what you eat will produce some symptoms, simply because a better than average diet is STILL too great of a glycemic load for the person with a poor sugar metabolism. The amount you need to use "control" and "watch yourself" is also much greater than average simply because when you eat those foods your metabolism goes to pot which is an added burden (and thus, hunger/tendency toward fat gain & muscle loss goes up in response).
A poor (high carb) diet will eventually cause sugar metabolism problems for a lot of people - regardless of genes. A good (low carb) diet will prevent such metabolic issues ever arising. Are some people more susceptible and therefore need to be more careful? Sure, and if any of us go beyond whatever our threshold is, to a point where blood glucose instability triggers even worse eating behaviour then the problems are multiplied. But a low carb diet will still prevent you getting on that rollercoaster.

The only way to truly control these diseases is by making a concentrated effort to reduce high GI & total carbs. While I do completely support the opinion that obesity and associated diseases are quite often resulting from poor behavior (diet and lifestyle) due to "issues with food" and bad habits... and while I do agree that carbs aren't the only dietary factor that's relevant ... they neglect to realize that the reason "issues with food" exist in the first place is because food has a medicative, sedative, drug-like effect on people with a genetic predisposition to poor sugar metabolism. When it comes to obesity & obesity related diseases, a genetic susceptibility to sugar sensitivity is like the spider weaving a complex web of disease. It's a SUGAR and INSULIN thing primarily, and thats what these people who make their living researching obesity and it's complications just don't get. That must be focused on primarily. Trying to cure obesity without at all focusing on carbohydrate percentage in diet is like trying to get alcoholism under control by telling alcoholics they should switch brands. The advice to focus primarily fat to lose is just absolutely poisonous for most.
Again there seems to be mixed messages here. I agree that a simple message to lose fat - particularly without any understanding of the metabolic processes which caused it and an appropriate WOE to start to address those issues is pointless (the ADF dietary advice is a BIG part of the problem, not a solution). And I agree that we need to focus on the amount of carbs in the diet (preferably before any symptoms arise) - wern't you just arguing the opposite??:). And weren't you just saying that the big difference between you and your sister is that you, more than her, ignored any attempt to adopt a "good" diet and that this was at least one of the triggers for your subsequent eating disorder??

Perhaps we agree with each other after all.;)

Cheers,

Malcolm

[Turtle2003]

Gee, people with type II diabetes have trouble controlling their blood sugars when they follow the American Diabetes Association Diet? Gosh, what a surprise. ;)

[ItsTheWooo]

I am struggling to understand your point (again!;)) Although the writer's idea of what constitues a "good" diet probably doesn't mean low carb - if it did then I would agree with that sentence completely. If your idea that only genetically susceptible people get type 2 diabetes, then why are the rates of this disease exploding around the world? The gene pool doesn't change anywhere near that rapidly. What has changed is "our" diet, and to a lesser extent our lack of exercise (the lack of which also influences insulin resistance)

mcsblues
I agree that high carbs, especially highly refined carbs, is what is causing these diseases.

My disagreement was with the author's point of view that "badness" of diet and lifestyle is responsible, and that there "may" only be a genetic predisposition.

The author was using the word "bad" in a very different sense as you. You are defining "bad" as eating lots of carbs out of ignorance, triggering genetic predispositions to disease, and winding up in a disease state. To you, bad isn't an emotional thing, it's just a way of describing the unhealthfulness of carbs. I totally agree.

The author was using "bad" in a more moral sense, since the author feels it's more behavior with food, not food quality, that is responsible. That obesity and related diseases are a product exclusively of irresponsible behavior, of gluttony and sloth and choosing to be lazy and gorge yourself on high calorie food and sit on your butt through the mcdonalds drive through window.

While it's true dysfunctional and habitual over eating are often part of extreme obesity (or even minor obesity sometimes) and exacerbate it, what the author is neglecting to realize is:

1) The over eating, disordered eating, dysfunctional eating whatever you want to call it, is a psychological byproduct of sugar sensitivity & metabolic disease. These foods - refined carbs - do things to some people that "triggers" a psychological susceptibility to binge eating, compulsive eating, over eating, or other dysfunctional behaviors with food. It is not a simple CHOICE to be gluttonous and lazy, it is very similar to addiction. Saying obese people are lazy and gluttonous is like saying an alcoholic or a smoker is morally inferior in the same way. There is a powerlessness over normal eating behavior for some when eating a high carb diet.

2) That the constant in ALL obesity related diseases is sugar and insulin. No matter how you change the diet - lower cals, lower fat, space out meals, combine them in a huge sitting with little snacks other times - the best results (physically, emotionally, and psychologically with health and feeling of satiety) will be observed on whichever diet proves to be most effective at reducing glycemic load and normalizing sugar. That is quite often the low carb diet.

Again, it's not about over eating or being sedentary, although they certainly contribute to weight problems. The main catalyst for obesity is refined carbohydrate, and refined carbohydrate is leading the charge that leads people to become dysfunctional eaters (due to psychological sensitivity to the distressful state uncontrolled sugar sensitivity causes) and sedentary (due to complete lack of energy caused by shot metabolism and the obesity).

Or to put it bluntly...
"Bad" is not about behavior "almost exclusively". It's about food & diet quality primarily. We do have a responsibility to make responsible choices, but you can't DO that with the total ignorance about what sound nutrition is being disseminated by people like the author.

Furthermore, there is a MASSIVE genetic predisposition to sugar sensitivity. All people will develop some problem from high refined carbohydrate & grain food diets eventually, but HOW fast and WHAT diseases are primarily controlled by genes. If you have a very weak predisposition you can avoid any problem until old age (like most northern europeans, who are more adapted to a grain based diet). If you have a strong predisposition, you will become ill very quickly (like for example, native americans).

"Badness" of behavior can speed things up beyond your time, but when it comes down to it our genes are really in charge, as they determine how effectively we can process the crap food (both "healthy" and "unhealthy") that saturates our diet.
That's why all the thin wiry northern european and irish girls I went to school with could eat candy and junkfood and not only maintain slimness, but effortlessly control themselves and feel satisfied and show not the slightest sign of problem. When they did pig out on pizza and breadsticks, their body could handle it and compensate. At least, while they were young anyway.

That's why me and my sister could not (both of us genetically strongly take after my north african grandmother who has a familial history of sugar metabolism diseases such as PCOS). My sister was very heavy as a child until she started using excessive "control" to limit her eating, then she thinned out. I never did that. Triggered by the stressful state of carbohydrate sensitivity, I gravitated toward very dysfunctional eating (compulsive over eating) and became very obese and exacerbated my predispositions, instead.


I don't want to launch into another diatribe about semantics, but low carb eating takes type 2 diabetes out of the blood glucose range that defines what is type 2 - what you choose to call that is immaterial. More importantly though, if you adopt low carb while your BG is normal or in the so called prediabetic range - you will not get into the diabetic range - so you will never "get" the disease, period. Forget cure (or whatever)- this is prevention, and it will be the same regardless of genetic predisposition. Now perhaps some people will need to adopt a lower carb intake than others because of their genes to achieve this - but regardless, a "good" low carb diet will indeed halt and start to reverse the current 'epidemic' trend in diabetes to which the article refers.

So what is your point? Your sister may have a similar genetic susceptibility to syndrome X realed issues as you (or not) but she ate a slightly better diet than you and so has yet to be badly affected (but eating higher carb may eventually catch up with her anyway). OTOH you started to eat poorly and this caused physical issues such as PCOS and also contributed to emotional eating behaviours which exacerbated the situation. In what way is that inconsistent with the basic thrust of the article?

I was using me and my sister as an example of:
a) The genetic nature of these diseases - that you cannot get them if you do not have the predisposition, and not everyone has it...

b) That the trigger of these disease predispositions is carbs. Not "badness of diet and lifestyle" (behavior with food vs quality).

c) That eating "well" (as defined by them - lower cal, "good carbs", lower fat, exercise etc aka "good behavior" vs "gluttonous slothful behavior") can only do so much if total carbohydrate & sugar stability remains ignored. I focus on carbohydrate and as a result my symptoms are more or less history (and only come to fore if I slip by eating too many carbs). My sister still struggles because she still eats too many carbs even though her diet is better than the average girl her age.

By improving your diet you have managed the physical symptoms and in all probability stopped their progression into type 2 diabetes. Sure the eating disorder needed dealing with as well - but ask yourself would you have ever had to if you had not triggered these factors with a very poor diet in the first place (like your genetically similar sister perhaps?)

I agree totally.
In fact I would take the additional measure to also say that dysfunctional eating and dysfunctional relationship with food is another form of sugar metabolism disease. I now feel, in retrospect, I would not have become a compulsive eater were it not for sugar sensitivity. While sugar sensitivity was exacerbated by the dysfunctional eating, dysfunctional eating was triggered by sugar sensitivity, too. The food obsession, fixation with eating, and resulting behaviors... this is the product of sugar sensitivity pairing up with a certain psychological and emotional temperament.


Like I said before the simple statitistics suggest that this is not the case. Type 2 diabetes has doubled (at least) and looks like doubling again - this is not just genetics.

It's a combination of genetics and diet/lifestyle.
Genes control how readily you will develop these diseases, if ever. Almost everyone will get it in time (if they live long enough)... but those people who get it at 40, or 30, or 20, or even 10 now... that's genes combined with the trigger of high carb.
It's not just because of "bad behavior with food", thats because people are eating LOADS of refined carbs (which is also triggering the bad behavior BTW). The more carbs and bigger portions of them saturate our diet, the more people who have a genetic predisposition will get sick.
OTOH it's not just carbs, either, because some people can eat carbs forever and stay healthy until old age. It's a combination of both. Carbs are a trigger, but the disease is in the genes.

A poor (high carb) diet will eventually cause sugar metabolism problems for a lot of people - regardless of genes.

Agree, but genes are unavoidably important.
It's not normal to eat a standard diet, and have your hunger and food obsession spiral out of control until you have eaten your way to 280 pounds, hypoglycemic symptoms, and rather extreme PCOS symptoms at 16.

MOST people have a "grace period" at least in youth, where they can gorge themselves on sugar and the only side effect they experience is a rush of energy. I never felt that. All I felt was tired and more tired all the time. Only now do I feel like the energetic little kid I never really was... fidgeting and worming around, running and walking everywhere.

This difference in how readily one gets ill is very strongly genetic, and it is a big difference between those who are "sensitive" (predisposed) and those who are not.

A good (low carb) diet will prevent such metabolic issues ever arising. Are some people more susceptible and therefore need to be more careful? Sure, and if any of us go beyond whatever our threshold is, to a point where blood glucose instability triggers even worse eating behavior then the problems are multiplied. But a low carb diet will still prevent you getting on that rollercoaster.

Again, total agreement.


Again there seems to be mixed messages here. I agree that a simple message to lose fat - particularly without any understanding of the metabolic processes which caused it and an appropriate WOE to start to address those issues is pointless (the ADF dietary advice is a BIG part of the problem, not a solution). And I agree that we need to focus on the amount of carbs in the diet (preferably before any symptoms arise) - wern't you just arguing the opposite??:).

Nope I wasn't :D
I just think you misunderstood my point, because you didn't realize how I was using my understanding of the authors comment of "bad diet" and "good diet". I was defining them the way he was - as predicative of conscious food eating behavior, not food quality.

And weren't you just saying that the big difference between you and your sister is that you, more than her, ignored any attempt to adopt a "good" diet and that this was at least one of the triggers for your subsequent eating disorder??

I was using us as an example to demonstrate that carbs are a crucial factor, that "good behavior" will only go so far and the best results are almost always with low carb.

Perhaps we agree with each other after all.;)

Cheers,

Malcolm
I think we do ;)

[mcsblues]

Wooo, I am glad we agree:) but I really think you are reading a heck of a lot into a simple sentence;
type-2 diabetes is almost exclusively caused by poor diet and a lack of exercise, although it may involve a genetic susceptibility
In the context in which it is written, amongst a lot of quotes from "experts" in diabetes control through nutrition, who appear mystified that their low fat high carb prescription hasn't solved the problem (far from it) I assumed that he/she may have been referring to the establishment's "accepted" good diet as the low fat high carb model. (but there is not enough information to tell).

OTOH you assume that this is part of a moral crusade against those who use food in a "bad' way. I think that is a much bigger jump (to a conclusion) than mine, but who knows? For all we know the author may be well aware of just how 'our' obsession with low fat high carb foods has created this problem and it is just this he or she is describing as a "poor diet" which along with lack of exercise will trigger any genetic susceptibility to insulin resistance which we all, or most of us, share to some degree.

Cheers,

Malcolm

[haycreek]

Crucially missing in all the talk re explosion of type 2 diabetes is how truly physically inactive Americans have become in the last fifty years or so. All the admonitions on diet and "exercise" fail to link the two firmly enough. Very few of us make our living as ax-wielding lumberjacks anymore and cannot consume vast stacks of pancakes without dire consequence.

At 50 years of age, working on my own as a physically active farmer/rancher, I feel much healthier and am totally without the aches, pains and stress I experienced as a 35 year, low-fat/hi-carb eating deskbot.

[Angeline]

When you listens to ads on the TV and to look around, you see a whole culture of lazyness is promoted. All products seem to be designed to minimize bending, reaching, walking....any amount of physical effort. Yet these same people who not think it strange to go to a gym and do streching exercises and the threadmill.

This is not without impact. The rule "use it or loose it" is true. If you limit your movements to just a select few, you will loose the ability to do others.

This culture of lazyness is bound to have an impact, and I believe we are seeing it now.