By Max Pemberton
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| Not so sweet: because of our diet, type 2 diabetes is reaching epidemic proportions Photo: Alamy |
By the time you have finished reading this sentence, one person in the world
will have died from type 2 diabetes. Two more will have been newly diagnosed
with it. Yet it is a condition that rarely excites or interests the public. It
has a slow, insidious progression that is interlinked with obesity, and as a
result this disease is considered an abstract, boring and largely self-inflicted
condition. While it’s a killer, it’s not a killer in the dramatic and
attention-grabbing way that other conditions such as cancer and infectious
diseases can be. But given the huge personal and economic impact it has, we
should be taking type 2 diabetes much more seriously.
According to a startling commentary in the journal Nature, by researchers at
the University of California, San Francisco, sugar poses such a health risk –
contributing to around 35 million deaths globally each year – that it should now
be considered a potentially toxic substance like alcohol and tobacco. Its link
with the onset of diabetes is such that punitive regulations, such as a tax on
all foods and drinks that contain ''added’’ sugar, are now warranted, the
researchers say. They also recommend banning sales in or near schools, as well
as placing age limits on the sale of such products.
I have to admit my first response on reading the headlines generated by this
article was to roll my eyes as I tucked into a king-size Twix, and denounce the
suggestion as yet another example of health fascism. Sugar? Toxic? Oh, please,
give me a break (or preferably a KitKat). But the truth is that there is
compelling evidence that sugar is hugely dangerous, because it is a contributing
factor in the twin epidemics of obesity and diabetes faced by developed
countries.
Particularly toxic, argue the researchers, is sucrose – a natural compound
made from glucose and fructose which is refined to produce table sugar and a
processed sugar called ''high-fructose corn syrup’’. Both of these are added to
processed foods – cereals, breakfast bars, some meats, yogurts, soups and
sauces. Rather than increase the fruit content of a drink, manufacturers will
chuck in cheap processed sugar instead to make it taste better. In fact, this
finds its way into all types of food from sweets to soups as a way to boost
flavour.
What makes this added sugar so dangerous, argue the researchers, is that
fructose from refined sugar is primarily broken down in the liver (unlike
glucose which is slowly released from complex carbohydrates during digestion).
The strain that this refined sugar puts on the liver starts a process that can
lead to fatty liver disease and liver failure. But most importantly, its
presence can trigger the development of type 2 diabetes. This is because high
levels of sugar in the blood mean the pancreas has to produce large amounts of
insulin – a hormone that helps control, and keep stable, blood sugar (glucose)
levels by promoting its uptake by cells which need it for energy. Over time, the
pancreas becomes fatigued and starts to fail. At the same time, cells in the
body become increasingly resistant to the effects of insulin, and so blood sugar
levels remain high, with damaging consequences.
It’s important to clarify that this is different to type 1 diabetes, in which
the body’s immune cells attack and destroy the insulin-secreting cells. It can
affect very young people and is not associated with diet. Type 2 diabetes is
predominantly a disease of middle age, affecting the populations of affluent
countries, and fuelled by a diet rich in sugar and processed food. It is
associated with increased morbidity and mortality. Sufferers have a two-fold
increase in risk of stroke in the first five years of diagnosis. It affects all
organs of the body and is linked with heart and kidney disease, peripheral nerve
damage, miscarriage and stillbirth. It affects the blood vessels and circulation
and can lead to amputations and blindness.
Because of our diet, type 2 diabetes is now reaching epidemic proportions. In the UK, there are 2.6 million sufferers, and an estimated further 1 million who have not yet been diagnosed. The cost to the health service is extraordinary – accounting for 10 per cent of the NHS budget. Globally, the economic burden of the disease is estimated at $465 billion a year. To put that in perspective, the economic cost of the Japanese earthquake/tsunami was around $100 billion.
Yet unlike the tobacco/lung cancer link, the refined sugar/diabetes link has yet to grab public attention and cause panic or mobilise any meaningful public health policy. Perhaps those American researchers are right, and it is time that we did view food with added sugar in the same way we now view cigarettes. But what hope is there of doing this when the fast food and confectionery industries are having ever more of an influence on health policy?
According to accounts released by Parliament, until December 2009 the Health Secretary Andrew Lansley had been earning £25,000 a year for 12 days’ work as a non-executive director of Profero, a marketing agency whose major clients include PepsiCo, makers of Pepsi, and the confectioner Mars. This experience clearly gave Mr Lansley a sweet tooth, because last year he decided, as part of plans to relax regulations on salt and sugar in foods, to enlist McDonald’s, Mars, Coca-Cola, Pepsi and other fast-food companies to give the Department of Health advice on healthy eating campaigns and health policy. Critics at the time likened it to placing the tobacco industry in charge of smoke-free spaces.
Given the clear potential for conflict of interest between these companies and the nation’s sugar intake, what hope is there for real change? It would seem sugar’s toxic effects are far-reaching.
We need a 'care plan’ to ease our final days
According to Professor Mayur Lakhani, chairman of the National Council for Palliative Care, the stigma that surrounds death in this country means that more than 100,000 people a year are denied the opportunity to die in the comfort of their own homes. The practising GP and former head of the Royal College of General Practitioners argues that there needs to be a change of philosophy from within the medical profession, so that doctors feel able to talk about death more openly with patients and encourage them to think about what they want when the end comes.
I couldn’t agree more. For some people, dying in hospital offers a degree of security and reassurance. But equally, for many others, they would prefer to face death in their familiar and much-loved surroundings. A study in Scotland showed that ''Anticipatory Care Plans’’ – which enable patients with terminal or chronic conditions to stipulate what kind of care they receive and where – dramatically reduce unplanned hospital admissions for those people about to die.
What a brilliant idea. We already have ''birth plans’’ for pregnant women, and indeed writing one is now a fundamental part of antenatal care. Although they cannot account for every eventuality, they give the woman some sense of control and agency in her treatment, communicating to everyone involved in her care what her wishes are.
If we can make such documents a normal, accepted, widespread part of birth, why not have the same things for death?
Going grey has never seemed so attractive
Alana Stewart, the former Mrs Rod Stewart, has admitted to using human growth hormone in order to stop her hair going grey. After she spotted a few wayward greys she began the injections and they vanished. But it’s not quite the magical solution it might appear. Side-effects include increased risk of colorectal cancer and Hodgkin’s disease, diabetes, carpal tunnel syndrome, facial changes and, for men, breast growth. The prospect of grey hair has never seemed so attractive.
Max Pemberton’s new book, 'The Doctor Will See You Now’ is published by Hodder. To order a copy, call Telegraph Books on 0844 871 1515, or visit books.telegraph.co.uk
Because of our diet, type 2 diabetes is now reaching epidemic proportions. In the UK, there are 2.6 million sufferers, and an estimated further 1 million who have not yet been diagnosed. The cost to the health service is extraordinary – accounting for 10 per cent of the NHS budget. Globally, the economic burden of the disease is estimated at $465 billion a year. To put that in perspective, the economic cost of the Japanese earthquake/tsunami was around $100 billion.
Yet unlike the tobacco/lung cancer link, the refined sugar/diabetes link has yet to grab public attention and cause panic or mobilise any meaningful public health policy. Perhaps those American researchers are right, and it is time that we did view food with added sugar in the same way we now view cigarettes. But what hope is there of doing this when the fast food and confectionery industries are having ever more of an influence on health policy?
According to accounts released by Parliament, until December 2009 the Health Secretary Andrew Lansley had been earning £25,000 a year for 12 days’ work as a non-executive director of Profero, a marketing agency whose major clients include PepsiCo, makers of Pepsi, and the confectioner Mars. This experience clearly gave Mr Lansley a sweet tooth, because last year he decided, as part of plans to relax regulations on salt and sugar in foods, to enlist McDonald’s, Mars, Coca-Cola, Pepsi and other fast-food companies to give the Department of Health advice on healthy eating campaigns and health policy. Critics at the time likened it to placing the tobacco industry in charge of smoke-free spaces.
Given the clear potential for conflict of interest between these companies and the nation’s sugar intake, what hope is there for real change? It would seem sugar’s toxic effects are far-reaching.
We need a 'care plan’ to ease our final days
According to Professor Mayur Lakhani, chairman of the National Council for Palliative Care, the stigma that surrounds death in this country means that more than 100,000 people a year are denied the opportunity to die in the comfort of their own homes. The practising GP and former head of the Royal College of General Practitioners argues that there needs to be a change of philosophy from within the medical profession, so that doctors feel able to talk about death more openly with patients and encourage them to think about what they want when the end comes.
I couldn’t agree more. For some people, dying in hospital offers a degree of security and reassurance. But equally, for many others, they would prefer to face death in their familiar and much-loved surroundings. A study in Scotland showed that ''Anticipatory Care Plans’’ – which enable patients with terminal or chronic conditions to stipulate what kind of care they receive and where – dramatically reduce unplanned hospital admissions for those people about to die.
What a brilliant idea. We already have ''birth plans’’ for pregnant women, and indeed writing one is now a fundamental part of antenatal care. Although they cannot account for every eventuality, they give the woman some sense of control and agency in her treatment, communicating to everyone involved in her care what her wishes are.
If we can make such documents a normal, accepted, widespread part of birth, why not have the same things for death?
Going grey has never seemed so attractive
Alana Stewart, the former Mrs Rod Stewart, has admitted to using human growth hormone in order to stop her hair going grey. After she spotted a few wayward greys she began the injections and they vanished. But it’s not quite the magical solution it might appear. Side-effects include increased risk of colorectal cancer and Hodgkin’s disease, diabetes, carpal tunnel syndrome, facial changes and, for men, breast growth. The prospect of grey hair has never seemed so attractive.
Max Pemberton’s new book, 'The Doctor Will See You Now’ is published by Hodder. To order a copy, call Telegraph Books on 0844 871 1515, or visit books.telegraph.co.uk
