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Dangers of ignoring the complexity of diabetes

14th Feb 2012
Lynnette Hoffman   all articles by this author
Dangers of ignoring the complexity of diabetes

A one-size-fits-all approach to diabetes may not be appropriate.

You’ve heard it before: people in industrialised countries live sedentary lives and eat too much high-fat, high-sugar food. They then become obese and develop insulin resistance – and eventually diabetes.

However, Professor David James, head of the Diabetes and Obesity Program at Sydney’s Garvan Institute of Medical Research, believes that some of the common assumptions about diabetes are being oversimplified. 

He wrote about some of the complexities in an essay published in Diabetes Management Journal late last year.

“When we look at the worldwide obesity epidemic, and the number of people developing diabetes, we tend to make sweeping generalisations, try to make one size fit all,” Professor James says.

Not only is that not the case, “but our approach might end up compromising, or even endangering, people’s health.

“One obvious example is the notion that all obesity is bad. While in most cases it’s true that obesity is very bad for health, there is a considerable sub-group of obese people – around 20% – who are metabolically healthy,” he points out.

“A recent study showed that when you force these ‘healthy obese’ people to lose weight by putting them on calorie restricted diets, their metabolism gets worse. 

“So arguably those people are living in an equilibrium that for them is perfectly fine.

“Then, we have the French. They eat lots of fat in their diets and their daily calorie intake is as high as any of ours. 

Yet they remain thinner and succumb less to diabetes.”

Professor James takes pains to make it clear that he is not arguing that nutrition and obesity aren’t significant factors, but he adds it’s “impossible to stop people from eating food”.

“If you can’t stop people eating food, you have to find a solution elsewhere. That’s when the open road turns into a myriad of back alleys and dead ends – or unanticipated traffic jams.”

Simplistic views of the causes of diabetes – or more to the point, oversimplified solutions – will have unintended consequences and side effects, he writes. 

“To give an example, one arm of diabetes research focuses on allowing the pancreas to keep producing ever-increasing amounts of insulin to compensate for insulin resistance… 

“The problem is that insulin has many functions in the body. 

“Flooding the system may solve the problem of insulin resistance, but it exacerbates fat synthesis, so people would end up with hypertriglyceridaemia, which causes severe cardiovascular problems.”

That’s why it’s so important to take a holistic approach, he concludes.

“We must remember that the body is a finely tuned mechanism, so tampering with parts of it before you can see the big picture could have many unpleasant and unforeseen effects.”

Diabetes Management Journal, Volume 37, published and distributed in November 2011.

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