Re: The dietary advice on added sugar needs emergency surgery
The cardiologist Aseem Malhotra (1) describes with great insight the problems associated with sugar consumption and the obesity and type 2 diabetes (T2DM) epidemics and requests urgent action. Dr Malhotra highlights some of the conflicts of interest involved in the sugar industry. Conflicts of interest were also highlighted by Dr Des Spence in his recent article ‘Bad medicine: the way we manage diabetes’ (2) http://www.bmj.com/content/346/bmj.f2695
Sugar, however, is not the only confounding issue concerning healthy living. Hidden Sugars seem to have provided a replacement ‘filler’ for the low fat fad which has wreaked havoc on human health. Unlike sugar, the correct proportions of fats within the diet are irrefutably essential. Cardiovascular health, renal function, eyesight, healthy brain function and healthy reproduction (Male and female) fundamentally rely on good quality fats in the diet for normal function. Fats are also important for satiety of appetite. Yet the majority of those with T2DM are put on slimming diets as a priority. This may be due to the lack of knowledge on what constitutes a diabetic diet.
The Look AHEAD (Action for Health in Diabetes) study tested whether a lifestyle intervention resulting in weight loss would reduce rates of heart disease, stroke, and cardiovascular-related deaths in overweight and obese people with type 2 diabetes, a group at increased risk for these events.
In 2012, after eight to eleven years of participant follow-up, the Look AHEAD intervention arm was stopped by the study sponsor when it was determined that intensive lifestyle interventions did not decrease the occurrence of cardiovascular events, the primary trial outcome.(3) It therefore might be concluded that diet and lifestyle approaches are ineffective in type 2 diabetes management. However looking at the sponsorship received in the LOOK-AHEAD trial it is not surprising to see why. (4) http://www.lookaheadtrial.org/public/la%20donor%20list%20website%2007.pdf
Medical research is too reliant on financial support from those with commercially vested interest. What a disappointing result for all the undeniably hard work by the researchers and participants in this extensive study. If only they had used real food instead of slimming aids such as meal replacement shakes and Orlistat! Hardly a sustainable option for T2DM which affects many countries with very limited health and financial resources.
A healthy balanced diet appropriate to the individual, not a slimming diet, is fundamentally a key factor in disease .prevention. Commercial interests have played a key part in pushing the high carbohydrate/low fat diet which has undoubtedly contributed to the T2DM epidemic. The food and drug industry are inextricably linked. They are therefore in a win-win situation. The diet currently recommended for T2DM is not a balanced one. When blood glucose results are consistently too high (which you would expect when consuming a high refined carbohydrate diet) Combined with consuming fats which are in an unhealthy balance contributing to the disease process. The person, having failed to control their condition by lifestyle measures, is then a target for polypharmacy.
Type 2 diabetes is fundamentally a self-managed condition. As a priority it is essential for people to be given meaningful and appropriate advice on managing their life with diabetes. Prevention at the grass roots level of this problem has to be a priority. Children are being diagnosed with T2DM are we really to believe this disorder cannot be reversed? Dr Malhotra is absolutely right to be concerned about the adverse effects of sugar in children’s diets. Sugary foods used to be an occasional treat, but is now an everyday diet staple for many children. This is a ticking health time bomb which needs diffusing. Unfortunately there are still members of the public and health professionals who believe diabetes (both types 1 and 2) is caused by the consumption of too much sugar, this myth should be dispelled.
The food and drug industries are commercial organisations and are therefore driven by profits. They enjoy close relationships with various world health organisations, whether through sponsorship of clinical trials, patient information leafleting, or providing refreshments at the local diabetes association meetings. How can any headway be made in improving outcomes for those with diabetes. Whilst overcoming such conflicts of interest and potential research bias? Certainly the BMJ Open Data Campaign would be of great benefit within diabetes research.
Dr Malhotra states that ‘It’s time for the UK’s Scientific Advisory Committee on Nutrition and the Department of Health to act swiftly as the dietary advice on added sugar is in desperate need of emergency surgery’ Unfortunately, one of the biggest problems would be to convince the public to listen to and follow such advice.
In 1990 the eminent diabetologist Professor Robert Tattersall (now retired). Wrote in an article about perceived benefits of high fibre diet and diabetes:
‘Since medicine began doctors have been liberal dispensers of conflicting nutritional advice and this phenomenon is currently at a peak. Many of the proffered recommendations are scientifically dubious or premature, confusing patients and reducing the credibility of the adviser’. (5)
Over twenty years on this statement is still pertinent, although the dispensers of advice seem to belong to commercial industry. There is an urgent need to clarify the diet and lifestyle measures as a guide for healthy living. The aim should be to prevent obesity and allied diseases in the first place. There is also an urgent need to provide unbiased common sense advice on living a normal life with diabetes.
(1) The dietary advice on added sugar needs emergency surgery
Aseem Malhotra BMJ 2013;346:f3199
(3) Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes Edward W. Gregg, PhD; Haiying Chen, PhD; Lynne E. Wagenknecht, DrPH; Jeanne M. Clark, MD, MPH; Linda M. Delahanty, MS, RD; John Bantle, MD; Henry J. Pownall, PhD; Karen C. Johnson, MD, MPH; Monika M. Safford, MD; Abbas E. Kitabchi, MD, PhD; F. Xavier Pi-Sunyer, MD; Rena R. Wing, PhD; Alain G. Bertoni, MD, MPH; for the Look AHEAD Research Group JAMA. 2012;308(23):2489-2496. doi:10.1001/jama.2012.67929.
Rapid Response:
Re: The dietary advice on added sugar needs emergency surgery
The cardiologist Aseem Malhotra (1) describes with great insight the problems associated with sugar consumption and the obesity and type 2 diabetes (T2DM) epidemics and requests urgent action. Dr Malhotra highlights some of the conflicts of interest involved in the sugar industry. Conflicts of interest were also highlighted by Dr Des Spence in his recent article ‘Bad medicine: the way we manage diabetes’ (2) http://www.bmj.com/content/346/bmj.f2695
Sugar, however, is not the only confounding issue concerning healthy living. Hidden Sugars seem to have provided a replacement ‘filler’ for the low fat fad which has wreaked havoc on human health. Unlike sugar, the correct proportions of fats within the diet are irrefutably essential. Cardiovascular health, renal function, eyesight, healthy brain function and healthy reproduction (Male and female) fundamentally rely on good quality fats in the diet for normal function. Fats are also important for satiety of appetite. Yet the majority of those with T2DM are put on slimming diets as a priority. This may be due to the lack of knowledge on what constitutes a diabetic diet.
The Look AHEAD (Action for Health in Diabetes) study tested whether a lifestyle intervention resulting in weight loss would reduce rates of heart disease, stroke, and cardiovascular-related deaths in overweight and obese people with type 2 diabetes, a group at increased risk for these events.
In 2012, after eight to eleven years of participant follow-up, the Look AHEAD intervention arm was stopped by the study sponsor when it was determined that intensive lifestyle interventions did not decrease the occurrence of cardiovascular events, the primary trial outcome.(3) It therefore might be concluded that diet and lifestyle approaches are ineffective in type 2 diabetes management. However looking at the sponsorship received in the LOOK-AHEAD trial it is not surprising to see why. (4) http://www.lookaheadtrial.org/public/la%20donor%20list%20website%2007.pdf
Medical research is too reliant on financial support from those with commercially vested interest. What a disappointing result for all the undeniably hard work by the researchers and participants in this extensive study. If only they had used real food instead of slimming aids such as meal replacement shakes and Orlistat! Hardly a sustainable option for T2DM which affects many countries with very limited health and financial resources.
A healthy balanced diet appropriate to the individual, not a slimming diet, is fundamentally a key factor in disease .prevention. Commercial interests have played a key part in pushing the high carbohydrate/low fat diet which has undoubtedly contributed to the T2DM epidemic. The food and drug industry are inextricably linked. They are therefore in a win-win situation. The diet currently recommended for T2DM is not a balanced one. When blood glucose results are consistently too high (which you would expect when consuming a high refined carbohydrate diet) Combined with consuming fats which are in an unhealthy balance contributing to the disease process. The person, having failed to control their condition by lifestyle measures, is then a target for polypharmacy.
Type 2 diabetes is fundamentally a self-managed condition. As a priority it is essential for people to be given meaningful and appropriate advice on managing their life with diabetes. Prevention at the grass roots level of this problem has to be a priority. Children are being diagnosed with T2DM are we really to believe this disorder cannot be reversed? Dr Malhotra is absolutely right to be concerned about the adverse effects of sugar in children’s diets. Sugary foods used to be an occasional treat, but is now an everyday diet staple for many children. This is a ticking health time bomb which needs diffusing. Unfortunately there are still members of the public and health professionals who believe diabetes (both types 1 and 2) is caused by the consumption of too much sugar, this myth should be dispelled.
The food and drug industries are commercial organisations and are therefore driven by profits. They enjoy close relationships with various world health organisations, whether through sponsorship of clinical trials, patient information leafleting, or providing refreshments at the local diabetes association meetings. How can any headway be made in improving outcomes for those with diabetes. Whilst overcoming such conflicts of interest and potential research bias? Certainly the BMJ Open Data Campaign would be of great benefit within diabetes research.
Dr Malhotra states that ‘It’s time for the UK’s Scientific Advisory Committee on Nutrition and the Department of Health to act swiftly as the dietary advice on added sugar is in desperate need of emergency surgery’ Unfortunately, one of the biggest problems would be to convince the public to listen to and follow such advice.
In 1990 the eminent diabetologist Professor Robert Tattersall (now retired). Wrote in an article about perceived benefits of high fibre diet and diabetes:
‘Since medicine began doctors have been liberal dispensers of conflicting nutritional advice and this phenomenon is currently at a peak. Many of the proffered recommendations are scientifically dubious or premature, confusing patients and reducing the credibility of the adviser’. (5)
Over twenty years on this statement is still pertinent, although the dispensers of advice seem to belong to commercial industry. There is an urgent need to clarify the diet and lifestyle measures as a guide for healthy living. The aim should be to prevent obesity and allied diseases in the first place. There is also an urgent need to provide unbiased common sense advice on living a normal life with diabetes.
(1) The dietary advice on added sugar needs emergency surgery
Aseem Malhotra BMJ 2013;346:f3199
(2) Bad medicine: the way we manage diabetes. Des Spence BMJ 2013;346:f2695 http://www.bmj.com/content/346/bmj.f2695
(3) Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes Edward W. Gregg, PhD; Haiying Chen, PhD; Lynne E. Wagenknecht, DrPH; Jeanne M. Clark, MD, MPH; Linda M. Delahanty, MS, RD; John Bantle, MD; Henry J. Pownall, PhD; Karen C. Johnson, MD, MPH; Monika M. Safford, MD; Abbas E. Kitabchi, MD, PhD; F. Xavier Pi-Sunyer, MD; Rena R. Wing, PhD; Alain G. Bertoni, MD, MPH; for the Look AHEAD Research Group JAMA. 2012;308(23):2489-2496. doi:10.1001/jama.2012.67929.
(4) Lookaheadtrial.org public donors.
http://www.lookaheadtrial.org/public/la%20donor%20list%20website%2007.pdf
(Accessed 31 May 2013)
(5) Benefits of fibre itself are uncertain Robert Tattersall, Peter Mansell 'BMJ VOLUME 300 19 MAY 1990
Competing interests: No competing interests