History of Diabetes, and Modern Trends

[bulkbiker]

Genetic risk factors may play a crucial role in this uncontrolled raise in the prevalence of T2DM in the Middle Eastern region

Do they really believe this.. nothing to do with dietary changes.. does the Middle East permit HFCS perchance?
Why have these genetic risk factors lain dormant for centuries and are now suddenly rearing their head..?

 

[Grateful]

Do they really believe this.. nothing to do with dietary changes.. does the Middle East permit HFCS perchance?
Why have these genetic risk factors lain dormant for centuries and are now suddenly rearing their head..?

That portion of the paper is weak. In the body of the article they say that (unspecifed, as far as I can tell) genetic factors "cannot be ruled out" and then go on to list other culprits for the dramatic increase in T2D, especially in the past two decades.

Some of these are: A sedentary lifestyle. Obesity including in children. Political instability in some countries, leading to poor care. A culture of women not taking physical activity. The focus of the "uncontrolled rise" in the rate of T2D is the Gulf countries (members of the Gulf Cooperation Council, i.e. basically Arabian Peninsula nations). It points to data showing that the prevalence of T2D in Saudi Arabia is 25.4 percent as of 2014 (!).

They don't talk much, or at all, about diet. From my experience living in, and traveling to, countries in the area, the diet in many of these countries has been high in refined sugar for a long time. Also, since the middle of the last century, soda-type drinks (often originally implanted by Coke or Pepsi franchises) have become ubiquitous. Those drinks, and highly sweetened coffee and tea, are a common social ice-breaker (replacing alcohol, in the Gulf countries that ban or restrict booze). Sweet drinks are, in some countries, also part of the desert Bedouin heritage. Syrupy dessert pastries are common, for instance in the Levant countries. There is a widespread culture of hospitality and it is just "not done" to refuse food when profferred. This is lovely, of course, but it may be having unintended consequences. (All of this paragraph is just my own first-hand observation.)

The paper says that T2D is now the fifth-leading cause of death in the Arab world. The countries of the region are trying to do something about it, in the form of the "Riyadh Declaration" promoting a healthy lifestyle. (But to my mind it would be a huge challenge to get effective regional action on the issue.)

It also says that a lot of information is simply unavailable at this point and urges that the issue be studied further.

It would be interesting to get @hichamgsm's perspective on the matter, albeit from the extreme western end of the Arab world. ("Maghreb" means "west" in Arabic.)

 

[Guzzler]

That portion of the paper is weak. In the body of the article they say that (unspecifed, as far as I can tell) genetic factors "cannot be ruled out" and then go on to list other culprits for the dramatic increase in T2D, especially in the past two decades.

Some of these are: A sedentary lifestyle. Obesity including in children. Political instability in some countries, leading to poor care. A culture of women not taking physical activity. The focus of the "uncontrolled rise" in the rate of T2D is the Gulf countries (members of the Gulf Cooperation Council, i.e. basically Arabian Peninsula nations). It points to data showing that the prevalence of T2D in Saudi Arabia is 25.4 percent as of 2014 (!).

They don't talk much, or at all, about diet. From my experience living in, and traveling to, countries in the area, the diet in many of these countries has been high in refined sugar for a long time. Since the middle of the last century, soda-type drinks (often originally implanted by Coke or Pepsi franchises) have become ubiquitous. Those drinks, and highly sweetened coffee and tea, are a common social ice-breaker (replacing alcohol, in the Gulf countries that ban or restrict booze). Sweet drinks are, in some countries, also part of the desert Bedouin heritage. Health-care ranges from pretty good in some countries to primitive in others. There is a widespread culture of hospitality and it is just "not done" to refuse food when profferred. This is lovely, of course. (All of this paragraph is just my own first-hand observation.)

The paper says that T2D is now the fifth-leading cause of death in the Arab world. The countries of the region are trying to do something about it, in the form of the "Riyadh Declaration" promoting a healthy lifestyle. (But to my mind it would be a huge challenge to get effective regional action on the issue.)

It also says that a lot of information is simply unavailable at this point and urges that the issue be studied further.

It would be interesting to get @hichamgsm's perspective on the matter, albeit from the extreme western end of the Arab world. ("Maghreb" means "west" in Arabic.)

Doctor Robert Lustig has a fine lecture on youtube which is about an hour and a half long but does cover a little bit about this. Hecsays that in some countries in ME the fact that they partake of no alcohol, have dubious water supplies and because it is so hot that the preferred beverage is a soft drink and yes, they have HFCS in all of them. Apart from the sub continent the ME has the fastest rate of diagnoses of T2.

Edited to add. The lecture is titled 'Sugar. The Bitter Truth.' Quite enlightening.

 

[HICHAM_T2]

That portion of the paper is weak. In the body of the article they say that (unspecifed, as far as I can tell) genetic factors "cannot be ruled out" and then go on to list other culprits for the dramatic increase in T2D, especially in the past two decades.

Some of these are: A sedentary lifestyle. Obesity including in children. Political instability in some countries, leading to poor care. A culture of women not taking physical activity. The focus of the "uncontrolled rise" in the rate of T2D is the Gulf countries (members of the Gulf Cooperation Council, i.e. basically Arabian Peninsula nations). It points to data showing that the prevalence of T2D in Saudi Arabia is 25.4 percent as of 2014 (!).



It would be interesting to get @hichamgsm's perspective on the matter, albeit from the extreme western end of the Arab world. ("Maghreb" means "west" in Arabic.)

I agree with you completely

Moreover, there is a lack of food culture in some Arab countries

Welfare has also become a problem

 

[Grateful]

Hecsays that in some countries in ME the fact that they partake of no alcohol, have dubious water supplies and because it is so hot that the preferred beverage is a soft drink and yes, they have HFCS in all of them.

Very interesting, I must watch that video. Good to have some backing for my otherwise anecdotal observations. That's another acronym I had not seen before, High Fructose Corn Syrup of course.

Another thing I did not mention is the prevalence of certain high-carb staple foods in addition to just refined sugars in drinks. I don't want to go on a high-carb "witch hunt" necessarily but some of those beloved staples would include:

• Arabic-style flat bread, used in all sorts of ways, for instance as the wrapping for the delicious "foul" beans in Egypt or to scoop up hummus or other parts of your meal. (In Egypt bread was, when I lived there, very highly subsidized by the government and so relatively cheap that it made up a huge part of the diet.)
• Couscous, in the Maghreb nations.
• Rice, in Iran (it is not an Arab country but the alimentary habits are similar).

Edited to add: When I lived in Cairo, white sugar was rationed. I think each family had a coupon book, or something, for a monthly quota. But supplies were inadequate, so there was a thriving black market. The doorman of our building kept a big stash of it under his bed in his little room just off the front door, and did a thriving traffic!

 

[Guzzler]

Very interesting, I must watch that video. Good to have some backing for my otherwise anecdotal observations. That's another acronym I had not seen before, High Fructose Corn Syrup of course.

Another thing I did not mention is the prevalence of certain high-carb staple foods in addition to just refined sugars in drinks. I don't want to go on a high-carb "witch hunt" necessarily but some of those beloved staples would include:

• Arabic-style flat bread, used in all sorts of ways, for instance as the wrapping for the delicious "foul" beans in Egypt or to scoop up hummus or other parts of your meal. (In Egypt bread was, when I lived there, very highly subsidized by the government and so relatively cheap that it made up a huge part of the diet.)
• Couscous, in the Maghreb nations.
• Rice, in Iran (it is not an Arab country but the alimentary habits are similar).

And yet the epidemic gathers pace? Look at the statistics and you will see startling graphs showing that the spread of the western diet over the last fifty years has seen an almost vertical rise in metabolic disease. It is not just down to genetics, imo homosapiens do not evolve (or 'de evolve' if that is even a word) over a period of half a century.
Some cite the slower progress of T2 in Japan as evidence against HFCS being one of the baddies little knowing that it was the Japanese who actually developed it but only for export. HFCS has now filtered back into the Japanese diet with the result of...

 

[HICHAM_T2]

Very interesting, I must watch that video. Good to have some backing for my otherwise anecdotal observations. That's another acronym I had not seen before, High Fructose Corn Syrup of course.

Another thing I did not mention is the prevalence of certain high-carb staple foods in addition to just refined sugars in drinks. I don't want to go on a high-carb "witch hunt" necessarily but some of those beloved staples would include:

• Arabic-style flat bread, used in all sorts of ways, for instance as the wrapping for the delicious "foul" beans in Egypt or to scoop up hummus or other parts of your meal. (In Egypt bread was, when I lived there, very highly subsidized by the government and so relatively cheap that it made up a huge part of the diet.)
• Couscous, in the Maghreb nations.
• Rice, in Iran (it is not an Arab country but the alimentary habits are similar).

Edited to add: When I lived in Cairo, white sugar was rationed. I think each family had a coupon book, or something, for a monthly quota. But supplies were inadequate, so there was a thriving black market. The doorman of our building kept a big stash of it under his bed in his little room just off the front door, and did a thriving traffic!

Did you know here in my country sugar is added in all beverages and coffee tea desserts everything

 

[Grateful]

And yet the epidemic gathers pace? Look at the statistics and you will see startling graphs showing that the spread of the western diet over the last fifty years has seen an almost vertical rise in metabolic disease. It is not just down to genetics, imo homosapiens do not evolve (or 'de evolve' if that is even a word) over a period of half a century.

I see two issues.

The first is the one you mention, the rise of the Western diet although that does need to be tempered in some regions (such as the Arab world) by the existence of cultural food habits some of which date back longer than colonial, or neo-colonial, days. Of course back then, people were probably more physically active. The invention of air conditioning, and the automobile, have a lot to answer for too. Another factor of course is increasing life expectancy, since T2D is a disease that comes on in middle-age, for many. In the "old days" something else would kill us first.

A second factor is just really speculation on my part, and I have mentioned it in another thread here. That is the idea that because human evolution is slow, homo sapiens may never have adapted properly to carbs. "Processed" high-carb foods (from wheat, dairy, sugar cane, whatever) have their genesis in our switch from hunter-gathering to agriculture about 10,000 years ago. Ten thousand years is the blink of an eyelid in evolutionary terms. So my theory, but I don't know whether there is any scholarly backing for it, is that our poor old pancreas has not yet learned to cope, and that our entire body is still inadequate to cope, hence insulin resistance. Diabetes is an ancient disease, known to the ancient Egyptians, who were also of course one of the earliest settled agricultural civilisations.

 

[Grateful]

Did you know here in my country sugar is added in all beverages and coffee tea desserts everything

Believe me I know! I lived in the Middle East for 13 years and paid no attention to sugar or carb intake myself (why would I?). So you and I have a dozen years of a very similar shared diet.

I love Moroccan green tea, with the leaves sticking out of the top of the glass! But from what I remember, everyone adds several spoonfuls of sugar. Multiplied by several glasses of tea per day. Similar in Turkey, but the glasses are smaller, the tea is brown, and the taste is that of boiling-hot pure sugar!

 

[Bluetit1802]

Edited to add: When I lived in Cairo, white sugar was rationed. I think each family had a coupon book, or something, for a monthly quota. But supplies were inadequate, so there was a thriving black market. The doorman of our building kept a big stash of it under his bed in his little room just off the front door, and did a thriving traffic!

My mother did exactly the same with sugar, presumably due to rationing during WW2. She continued doing this. After I married and left home, I was staying with my parents in my old bedroom. I opened the wardrobe door and dozens of bags of sugar fell out! This was in Lancashire in the 1970's!!

Just to add my penny's worth to the sugar in Egypt. As a tourist there in the Nile regions we were given raw sugar cane straight from the field to chew on. The locals chewed it all day. I thought it tasted awful but felt obliged to join in so as not to appear rude.

 

[Guzzler]

I see two issues.

The first is the one you mention, the rise of the Western diet although that does need to be tempered in some regions (such as the Arab world) by the existence of cultural food habits some of which date back longer than colonial, or neo-colonial, days. Of course back then, people were probably more physically active. The invention of air conditioning, and the automobile, have a lot to answer for too. Another factor of course is increasing life expectancy, since T2D is a disease that comes on in middle-age, for many. In the "old days" something else would kill us first.

A second factor is just really speculation on my part, and I have mentioned it in another thread here. That is the idea that because human evolution is slow, homo sapiens may never have adapted properly to carbs. "Processed" high-carb foods (from wheat, dairy, sugar cane, whatever) have their genesis in our switch from hunter-gathering to agriculture about 10,000 years ago. Ten thousand years is the blink of an eyelid in evolutionary terms. So my theory, but I don't know whether there is any scholarly backing for it, is that our poor old pancreas has not yet learned to cope, and that our entire body is still inadequate to cope, hence insulin resistance. Diabetes is an ancient disease, known to the ancient Egyptians, who were also of course one of the earliest settled agricultural civilisations.

I have viewed and read of the theory of Ancestral/Paleo diet in man. The bioanthropological evidence is there to support the theory. Yes, 10,000 years is a blip on human evolution and I agree that that Diabetes was known by ancient peoples, my point is that the fifty years of (and let's be blunt) the SAD has only been around for fifty odd years. The use of the chemical sludge they call cooking oil, HFCS, sedentary lifestyle and the rise of technology since the industrial revolution plus our inability to process such higher carb levels has led to what is now termed pandemic. Genetics plus triggers have brought us to this pass.

 

[Grateful]

My mother did exactly the same with sugar, presumably due to rationing during WW2. She continued doing this. After I married and left home, I was staying with my parents in my old bedroom. I opened the wardrobe door and dozens of bags of sugar fell out! This was in Lancashire in the 1970's!!

In Cairo our doorman's name was Abdu. He was a rotund, canny peasant from Upper Egypt (he came from the region around Aswan). He ran various rackets from his tiny room in the building's foyer, a room that resembled a sort of bric-a-brac shop as he was always buying and selling electronic goods and furniture when tenants moved in or out. He sent all the money back to his huge family in Upper Egypt. I learned much of my Arabic from him, but have now forgotten almost all of it unfortunately.

 

[Grateful]

I have viewed and read of the theory of Ancestral/Paleo diet in man. The bioanthropological evidence is there to support the theory. Yes, 10,000 years is a blip on human evolution and I agree that that Diabetes was known by ancient peoples, my point is that the fifty years of (and let's be blunt) the SAD has only been around for fifty odd years. The use of the chemical sludge they call cooking oil, HFCS, sedentary lifestyle and the rise of technology since the industrial revolution plus our inability to process such higher carb levels has led to what is now termed pandemic. Genetics plus triggers have brought us to this pass.

Yes it appears to be a double-whammy and I think you are right that the recent era is where the damage is concentrated.

Thank you for mentioning the ancestral/paleo thing. I had never heard of that stuff until recently, when I started hearing about something called the "paleo diet" (it is hard to keep track of all these diets!). Must look into that.

 

[Guzzler]

Yes it appears to be a double-whammy and I think you are right that the recent era is where the damage is concentrated.

Thank you for mentioning the ancestral/paleo thing. I had never heard of that stuff until recently, when I started hearing about something called the "paleo diet" (it is hard to keep track of all these diets!). Must look into that.

Be wary of those who say that they are on a (honest) Paleo diet. Back then the animals were different in that although of the same species would be disimilar to todays. The plant foods of today are to put it mildly, wholly different to what was eaten then with the advent of selective breeding. But interesting nonetheless.

 

[Grateful]

Be wary of those who say that they are on a (honest) Paleo diet. Back then the animals were different in that although of the same species would be disimilar to todays. The plant foods of today are to put it mildly, wholly different to what was eaten then with the advent of selective breeding. But interesting nonetheless.

Yes. I remember reading somewhere (perhaps on dietdoctor.com) that today's cultivated fruits bear almost no resemblance to their wild forebears. So although our distant hunter-gathering ancestors could pluck fruit from the trees, the carb load would have been considerably more modest.

I have seen this happen even within my lifetime. The strawberries are gigantic nowadays! So are tomatos and all sorts of other common staples.

 

[Chook]

Very interesting thread... maybe we need a daily discussion thread

 

[Chook]

Yes. I remember reading somewhere (perhaps on dietdoctor.com) that today's cultivated fruits bear almost no resemblance to their wild forebears. So although our distant hunter-gathering ancestors could pluck fruit from the trees, the carb load would have been considerably more modest.

I have seen this happen even within my lifetime. The strawberries are gigantic nowadays! So are tomatos and all sorts of other common staples.

In the area where I live we have some 'wild' fruit trees - and the apples and pears are small, hard and very sour - you wouldn't want to eat them normally - then for about two weeks in September, they turn sweet - then fall off the trees and rot.

 

[Guzzler]

Yes. I remember reading somewhere (perhaps on dietdoctor.com) that today's cultivated fruits bear almost no resemblance to their wild forebears. So although our distant hunter-gathering ancestors could pluck fruit from the trees, the carb load would have been considerably more modest.

I have seen this happen even within my lifetime. The strawberries are gigantic nowadays! So are tomatos and all sorts of other common staples.

And the animals differ now due to a change in habitat brought on by mans intervention as well as selective breeding. The evidence builds.

 

[Grateful]

Very interesting thread... maybe we need a daily discussion thread

I am impressed by the deep knowledge of forum members.

Diabetes is a bit of a bummer, but its history (and what is happening today in front of our eyes) is really interesting.

Partly because it is a complex interplay of straight medical stuff, and strong cultural and lifestyle issues. Plus the fact that as people with diabetes, we have an unusual amount of agency in our own care, compared to many other diseases.

 

[Guzzler]

In the area where I live we have some 'wild' fruit trees - and the apples and pears are small, hard and very sour - you wouldn't want to eat them normally - then for about two weeks in September, they turn sweet - then fall off the trees and rot.

Alpine strawberries are, I think, closer to the original and are inedible until fully ripe.