Diabetes: a growing problem
The incidence of type 2 diabetes is on the rise, says Dr Jacques van Staden, a GP at Mediclinic George who specialises in diabetes. It is also striking people earlier on in their lives as they lead sedentary lifestyles and follow diets laden with starch. He explains some of the problems and solutions of this growing epidemic.
Type 2 diabetes has been increasing substantially over the last 20 years. The World Health Organization (WHO) says that about 8.5% of the world’s adult population has diabetes. Its prevalence is a similar percentage in South Africa, although it is higher in certain groups, for example among the Indian population in KwaZulu-Natal, 13.5% of adults have type 2 diabetes.
It is therefore unsurprising that 415 million people are estimated to have diabetes in the world and WHO predicts that these figures will increase to 642 million cases worldwide by 2040. In South Africa, which has the highest incidence of type 2 diabetes on the African continent, about half of diabetic patients remain undiagnosed.
Lifestyle and genetics are major factors
‘Type 2 diabetes is caused by a combination of factors,’ says Dr Van Staden, ‘Not all people who are morbidly obese are diabetic’. Genetics also play a role, along with the following risk factors:
– Family history
– BMI (find out more about how to calculate your BMI here)
– Waist circumference (above 102cm for males and 89cm for females)
Type 2 diabetes: no longer a disease of the old
‘The trend used to be that type 2 diabetes was a disease of people over the age of 60, but now many of the middle and lower income countries have more people under the age of 60 with diabetes compared to the global average,’ says Dr Van Staden.
‘In a developing country like South Africa, where you have younger populations moving into more sedentary work as they complete school and university, as opposed to the manual work of their predecessors, the number of cases of type 2 diabetes is increasing. At the same time, they still follow the same starch-based diet as their parents, not because it is cheaper, but because people continue the habits that have been entrenched at a young age’.
‘In my practice I see a lot of people in their 30s and 40s being diagnosed with diabetes because they were exposed to a lot of starches, such as porridge, sugar, bread and rice as children and their sedentary lifestyles do not aid in metabolising this starch.’
It starts young
Unfortunately, children are taught at school and at home that they should eat porridge for breakfast and are then given sandwiches or unhealthy snacks for lunch, according to Dr Van Staden. He says that a crucial part of the solution comes down to massive nutritional education at all levels as well as healthcare providers having a unified voice around good nutrition.
‘What I teach my patients is to try to eat a low-carb breakfast: for example an omelette and avocado on the side. I also teach my patients to only include one starch in their three daily meals, and not to include this in their evening meal, because it will not be burnt off at night,’ he says.
Cutting down on carbs
‘Glycemic Index of food is an important consideration, but for diabetics I see it as the lesser of two evils, because the question is, if a diabetic can’t tolerate glucose, should you be giving them much starch at all?’ Dr Van Staden poses. He also cautions against consuming too much fat and protein when following a low-carb diet.
‘A general rule for healthy living is to follow a Mediterranean diet which is based around vegetables and lean proteins,’ he advises. But above all he recommends a personalised approach to diets: ‘when diet advice is given to patients it should be individualised because having a blanket approach can be dangerous’. He advises patients to talk to their family doctor about appropriate lifestyle modifications for their individual needs.
It can be done
Type 2 diabetes is reversible if patients adhere to a low carbohydrate diet, exercise and decrease some of their belly fat, according to Dr Van Staden.
‘I often see patients on insulin suddenly realise, like a light bulb going off, that if they lose weight, they can go off their medication. They are then able to change their lifestyle and take very little, if any, medication. Unfortunately, some people are only able to change their ways after a heart attack or stroke which is almost too late.’