Type II Diabetes is not inevitable

One of the primary motivators for Kevin and Nicola’s proposed ‘reform’ of the health system is the explosion in health costs predicted in the Intergenerational Report released in February.

Kevin explains "If we do not change the system, the state and territory budgets will be overwhelmed entirely by health costs over the next 20 or 30 years to the point that their ability to do anything else would be removed," and Nicola backs him up by pointing out that the direct cost of treating diabetes alone is projected to increase 436 percent (!) from $1.6 billion to $8.6 billion by 2032-33.

According to Diabetes Australia, those numbers are likely to be a vast underestimate. They reckon almost 15 percent of the population already suffer from diabetes (or pre-diabetes). Worse still, those numbers are going in only one direction – up, big time – because according to them, “there is no cure for diabetes”.

Diabetes is currently the sixth biggest killer of Australians, but headed for number one with a bullet. And before it kills us (and this is why Kevin and Nicola are worried), we will each probably consume hundreds of thousands of public health dollars (primarily as drugs) being treated (and not being cured).

There are three main types of diabetes (Type I, Type II and Gestational) and they are all on the increase, but the one everyone is worried about (when it comes to health dollars) is Type II Diabetes.

Type II Diabetes is variously called Non-insulin Dependent, Lifestyle or (less and less now) Late Onset, Diabetes and it currently accounts for around 95 percent of all diabetes diagnosed in Australia. It’s been a national health priority since 1996. Since then, the prevalence of the disease has doubled, so whatever we’ve been doing it aint been working too well so far.

Type II Diabetes is the end stage of a disease which starts out as failure of our ability to process carbohydrates (about 60 percent of our food). Our bodies convert most carbohydrates to glucose. In healthy people that glucose is pumped out to the cells that need energy via our bloodstream. Cells that need energy, signal their desires by moving glucose receptors to the cell surface (kinda like hanging out the “this room needs servicing” sign in a hotel).

In people who ultimately become (Type II) diabetic, something goes wrong with the “room needs servicing sign”. The receptors never get to the cell surface (or if they do, it’s in smaller numbers). The result is that the glucose goes sailing by. The maid doesn’t know the room needs her.

Because the glucose doesn’t get used by the cells (or not as many of them), it stays in the bloodstream longer and the result is a longer than normal high blood sugar concentration. People in this early stage fail 2-hour after-meal blood sugar tests but do ok on fasting blood sugar tests. If they’ve been fasting (haven’t eaten) for a while then blood sugar will have returned to normal. These people are often diagnosed as being “pre-diabetic”.

We can be pre-diabetic for decades. Eventually though, we lose the ability to clear the glucose at all and that’s when we officially have Type II Diabetes. It’s the point where we can no longer get our blood sugar levels back to normal even after fasting.

Doctors will tell you that there are all sorts of risk factors associated with Type II Diabetes. If you’ve got a high BMI, thick waist or high total body fat (all different ways of saying you’re fat), you’re in the gun. But one symptom has a much higher correlation than any of those, yet strangely it is never spoken of (probably because it’s a tad bit hard to measure). The one thing that almost always means you are on your way to Type II Diabetes is the amount of fat stored in your muscles (whether you look fat or not).

That accumulated fat in the muscles is an indication of persistent high levels of circulating fat. And it has been shown to directly interfere with the ability of cells (that need energy) to get the receptors to the cell surface. It’s like some fat guy is standing between you and the door when you want to hang out the ‘room needs a service’ sign.

So if you want to do some experiments on diabetic rats and you don’t have any handy, you can give normal rats diabetes by increasing the amount of circulating fat in their bloodstream. And the best way to do that is to feed the rats sugar. The fructose half of sugar (sugar is a 50/50 mix of glucose and fructose) is converted directly to the kinds of fats necessary to create diabetes as soon as it is eaten.

The latest in a line of studies that have tried this on humans got the expected results last year. The researchers at the University of California fed volunteers diets supplemented with fructose (at around twice the level consumed by the average American). The result was a 20 percent decrease in the effectiveness of clearing the glucose out of the bloodstream – step one on the Type II Diabetes treadmill. Other recent studies have shown that when carbohydrates (including sugar) are pulled out of the diet, Type II Diabetes symptoms are reversed.

The Californian study lasted just 10 weeks (and clearly longer term studies are needed) but red flags are waving all over the place. Sugar consumption creates exactly the kind of fat needed to turn us all into Type II Diabetics. It shouldn’t come as much of a surprise then that as our per person sugar consumption soars past 1 kg per week, Type II Diabetics are being minted at the rate of 275 per day (and counting).

But you won’t find any warnings about not eating fructose on the Diabetes Australia website. In the face of a deadly epidemic (accelerating at epic proportions) why are we not being told what the research says about sugar? Why is the government response restricted to rearranging the funding deckchairs on the titanic? And why do our healthy eating guidelines persist in advising that there’s nothing wrong with a diet that’s 20 percent sugar?

Unlike death and taxes, Type II Diabetes is not inevitable. It can be stamped out and it can probably be done easily by eliminating added fructose (sugar) from our diet. But first, those we trust with our health need to stop fighting about who pays for the amputation of our gangrenous limbs and start reading the research on sugar.

How to sell bottled sweat – make it sweet.

In 1965, Dr Robert Cade (a kidney specialist), noticed that if he fed Gators a drink which mimicked human sweat they could play American Football better than before. The Gators in question were not of the large bitey variety. They were his beloved University of Florida football team.

American football in Florida required very fit boys to run around (dressed in a space suit) in a climate similar to North Queensland for three hours at a time. And as you might imagine this took its toll on performance. The players were sweating up to 3 litres of fluid per hour and while they could (and did) drink water, their salt (sodium and potassium) levels were so diluted (by all the water) that nerve and muscle function became impaired.

Coaches routinely handed out salt tablets to combat this problem, but Dr Cade found that if he dissolved the salts in water, it was much more effective. He also theorised that since fatigue was a very real problem for the players, it would be good to slip some instant energy into the drink.

Cade chose to use glucose because that’s the sugar we use for energy (our ‘blood-sugar’ is glucose and most carbohydrates are eventually converted to glucose before we can burn them). He figured pure glucose would provide an instant energy boost. There was just one wee problem with that ‘solution’, it tasted a lot like, well – wee (at least according to the players). The glucose was not sweet enough to overpower the taste of the salts.

The answer was to chuck in an artificial sweetener - and Gatorade was born. Unfortunately Cade chose cyclamates as his sweetener just before the US Food and Drug Administration banned them. An urgent reformulation resulted in the glucose being replaced with sugar.

Sugar was less than ideal because it took the body time to split it into its constituent fructose and glucose. Even worse, the fructose half impaired the uptake of the glucose (because of its lower glycemic index). But hey, now it tasted great! And a great tasting drink that could be legally sold was better than an ordinary drink that contained a banned ingredient.

Gatorade (now owned by PepsiCo) has not looked back. It now controls 77 percent of the $11 billion US Sports drink market. Even Coke’s Powerade is struggling to dent its brand. Apparently no self respecting American athlete would be seen drinking anything else.

Australians are less sensitive to the footballing heritage of Gatorade, so here the sports drink market is a practical duopoly shared by Gatorade and Powerade. We still manage to put away over 300 million bottles of Sports Drink every year (and growing fast), so it’s a market the big boys take very seriously.

Both the major brands (and their minor competitors) are sweetened with sugar and as a result are largely indistinguishable from the carbonated brethren dispensed from the mother ship. Only one brand had (until last week) stuck faithfully to Dr Cade’s original idea (water + salt + glucose + artificial sweetener).

Staminade powder had resisted the pressure of competing with sugar sweetened goliaths. This made it a great option for people trying to avoid the harmful half of sugar (fructose). Glen was one of those people, so he wrote to the makers to protest the change.

In response the makers explained that glucose on its own was not sweet enough, so rather than continue to use an artificial sweetener they switched to sugar. Regarding Glen’s concern about sugar containing fructose, they patiently explained that “Sucrose is a disaccharide containing a molecule of Glucose & a molecule of Fructose. It's like calling Water (H2O) as having hydrogen and Oxygen gases-once bonded to form water . Water becomes totally different to Hydrogen & Oxygen.”

Well, there you go. Chemistry 101. And that would be all well and good except humans are mighty handy at splitting sucrose into glucose and fructose. In fact we can’t use sucrose at all until that little job is done. Water on the other hand is pretty darn useful to us just the way it is. Which is I guess, why we’ve never troubled ourselves to create a home electrolysis unit in our tum-tums.

The really ironic thing about sports drinks is that there is precious little science to suggest they are necessary at all. And any potential positive effects are enormously outweighed by the negative effects of consuming the sugar (such as the $20,000 of dental work former competitive triathlete Jacinta Worland is now facing).

Whenever we exercise we will need to drink water (hydrogen and oxygen to some). If we exercise (and drink water) for two and a half hours at a time, the water should contain some salts or we risk (potentially fatal) water intoxication. If we expect to be able to perform well for more than the first half hour of strenuous exercise, then it would be a good idea to include some glucose in that water.

Since very few of us meet the criteria for elite athletic performance, water will do just fine should we decide to don the lycra. The science says we don’t need to drink sugar and ordinarily we’d need some convincing that it was healthy to down a Coke or Pepsi. But colourful, flat, soft drinks like Gatorade and Powerade are more dangerous than their fizzy cousins because they come wrapped in a health message.

Even if you aren’t sporty, you’ll probably feel sporty with one in your hand. But they still pack a dangerous punch with 9 teaspoons of sugar in the average bottle (about the same as a can of Coke).

The reality is that Staminade had to go the way of its competitors for precisely the reason that they are competitors. We can’t expect them to fight an addictive sweetener like sugar with one hand tied behind their back.

And so, as the last fructose friendly sports drink retreats from our shelves, let us say R.I.P. good health.