10 votes

Medical care alone won’t halt the spread of diabetes, scientists say

9 comments

  1. [7]
    hungariantoast
    Link

    Researchers who study Type 2 diabetes have reached a stark conclusion: There is no device, no drug powerful enough to counter the effects of poverty, pollution, stress, a broken food system, cities that are hard to navigate on foot and inequitable access to health care, particularly in minority communities.

    7 votes
    1. [3]
      EgoEimi
      (edited )
      Link Parent
      I think that diabetes tie in most closely with food culture than anything else. It'd be interesting to look at a small slice of America. According to the American Diabetes Association, among Asian...

      I think that diabetes tie in most closely with food culture than anything else. It'd be interesting to look at a small slice of America.

      According to the American Diabetes Association, among Asian Americans, 5.6% of Chinese and 12.6% of Indians have diabetes.

      Both ethnic groups have similarly very high socioeconomic metrics: very high income, very high educational attainment. Both groups also have similar urban settlement patterns: many educated Chinese and Indian Americans are settling in affluent suburbs. Following this, it's safe to say that both groups have access to the same food systems and do not experience food deserts at different rates, and that both groups have similar mobility habits.

      So why are Indian Americans experiencing diabetes at a rate 2.25x that of Chinese Americans? That's big! What's going on?

      Off hand and anecdotally, Indian cuisine is significantly sweeter than Chinese cuisine. Many immigrants retain cultural eating habits. We can look at per capita sugar consumption data from OECD-FAO in India and China to get a rough sketch of those cultural eating habits.

      China is at 11.1 kg/pp, while India is at 18.7 kg/pp — despite China being significantly wealthier and more developed**, twice as urbanized, and having more western-like food systems, like grocery stores and convenience stores selling to-go foods.


      **sugar consumption tends to be depressed in low-income countries, and then hits a spike in middle-income countries because at that point the population significantly urbanizes are are introduced to the aforementioned food systems that provide sugary drinks and processed foods the newly urbanized population.

      Though India's per capita sugar consumption is a little below the world average, it's already extremely high for a semi-poor, largely rural country. It's expected to massively spike as it develops from a lower-middle-income country to a solidly-middle-middle-income country and urbanization rates trend from its current 34% toward the world average of 57% and as newly urban Indians consume more and more processed foods.


      Adding more:

      It's possible that Indians are genetically predisposed toward diabetes. But looking at obesity by Asian American subgroup, 22.4% of Indian Americans and 13.6% of Chinese Americans have BMIs greater than 27.5, which tracks along at 1.64x rate.

      I think that poverty, broken food systems, inequitable access to healthcare, mobility, etc. do not sufficiently explain how two communities super similar on almost every socioeconomic level are experiencing two extremely different health outcomes.

      3 votes
      1. [2]
        skybrian
        Link Parent
        I probably have a distorted, westernized idea of Indian versus Chinese food but it doesn’t surprise me. On the other hand, a problem with doing this sort of comparison is that we’re talking about...

        I probably have a distorted, westernized idea of Indian versus Chinese food but it doesn’t surprise me.

        On the other hand, a problem with doing this sort of comparison is that we’re talking about culture where there are a lot of small differences between ethnic groups, all correlated, and they correlate with other things like genetics. Good luck figuring out what causes what in a “natural experiment” like this.

        2 votes
        1. EgoEimi
          Link Parent
          Yeah, it's difficult to figure out a lot of the small differences. My personal anecdote: I'm Taiwanese/Chinese (American) and raised by a single mom, and my family was poor when I was 0 to 8,...

          Yeah, it's difficult to figure out a lot of the small differences.

          My personal anecdote: I'm Taiwanese/Chinese (American) and raised by a single mom, and my family was poor when I was 0 to 8, unstable 8 to 12, and ok 12 to 18.

          This blog post depicts a fairly normal weeknight dinner for a Chinese family. It's basically what I grew up eating for every single night: bowl of rice, some steamed/stir-fried vegetable, and some stir-fried protein (often tofu or chicken). It was cheap, quick, and easy for my mom to whip up after a long workday.

          There was absolutely zero soda at home: my mom refused to allow soda into the house. There was tea, water, and milk.

          I remember going to my non-Asian friends' homes to play video games, and they'd have 12-packs of soda chilling in their garages that they could grab anytime. Young me was always gobsmacked.

          Admittedly, it was very bland, and young me yearned for more exciting flavors. When other kids were doing weed in high school, my secret indulgence was buying a bottle of soda from the school vending machine as an end-of-week treat, knowing my mom wouldn't approve. :) When I left for college, I gained several pounds because I saw the wonders of a nice American college cafeteria that offered 4 different kinds of pies/cakes every night, soft serve ice cream, and one of those Coca-Cola touchscreen soda machines that dispense like 100 soda flavor permutations.

          3 votes
    2. [3]
      Thrabalen
      Link Parent
      Our nutritional system (in the US) is fundamentally broken. Food is cheap, easy, and plentiful... if you don't mind it having the minor side effect of basically poisoning you. My eating habits...

      Our nutritional system (in the US) is fundamentally broken. Food is cheap, easy, and plentiful... if you don't mind it having the minor side effect of basically poisoning you. My eating habits gave me a stroke by the time I was 40, and I only recently found out that my attempts at a healthy breakfast will lead to kidney failure if I don't eat differently. I half-seriously think that food is the reason humans will never achieve immortality.

      1 vote
      1. [2]
        cmccabe
        Link Parent
        I like this article's emphasis on the broader social determinants of health, because there are so many elements that lead people into really unhealthy life patterns. The paragraph about "food...

        Our nutritional system (in the US) is fundamentally broken.

        I like this article's emphasis on the broader social determinants of health, because there are so many elements that lead people into really unhealthy life patterns. The paragraph about "food prescriptions" really emphasized to me how bad the situation is and how deeply entrenched it is. The solution should be about as simple as "eat healthy food and live an active lifestyle". But society actually makes that simple goal difficult for some people.

        4 votes
        1. Loire
          Link Parent
          Alternatively eating healthy and living an active life may not save you. Anecdotal of course however I have lived an extremely active and healthy life and I still developed diabetes at the age of...

          Alternatively eating healthy and living an active life may not save you. Anecdotal of course however I have lived an extremely active and healthy life and I still developed diabetes at the age of 32 (still up on the air if its Type 2 or will develop into Type 1).

          I started playing hockey at the age of six, was moderately talented and played at the highest possible levels until 18. As I got older this involved 2 games a week and 3-4 practices. I joined a hockey based highschool program and added an additional daily icetime and/or gym session five days a week. It was very rare for me to have a day without physical activity outside of holidays. Diet was moderately healthy for North America, low carb, although probably balanced too much in favour of meat. Sugar consumption was largely incidental or unavoidable.

          Quit hockey as I went to university and transferred my habits to a 5-7 day a week gym habit. Food habits deteriorated in quantity (student poverty), but not quality (chicken and vegetables base, low carb).

          As my career started quantity increased I transitioned to a Mediterranean diet with slightly higher chicken content. Gym activity continued 5-7 days a week however cardio deteriorated in favour of pure weight lifting. All in all my lifestyle was likely 99 percentile for healthiness on North America with the exception of alcohol consumption, although that would still be classified as moderate.

          Since developing diabetes I have been introduced to a number of people in a similar boat as me, having inexplicably developed diabetes at a unusual age, despite living healthy lifestyles. These people are also exhibiting atypical presentations of the disease where their symptoms appear to be unlike typical versions of Type 1 including incomplete pancreatic failure.

          There is something on top of diet and exercise exacerbating this epidemic, whether these are environmental factors caused by modern society or perhaps viral triggers (increasingly research suggest enterovirus can trigger Type 1 in otherwise healthy individuals, perhaps strains of COVID could do the same?)

          5 votes
  2. [2]
    pocketry
    Link
    I would like to make small improvements to eat healthier. Does anyone have any trustworthy sources or references?

    I would like to make small improvements to eat healthier. Does anyone have any trustworthy sources or references?

    5 votes
    1. NoblePath
      (edited )
      Link Parent
      Go see a nutritionist. Edit: because tildes deserves a little more. My pcp referred me to a nutritionist, and i found it very beneficial. My goal was to shrink my waistline, which persists...

      Go see a nutritionist.

      Edit: because tildes deserves a little more. My pcp referred me to a nutritionist, and i found it very beneficial. My goal was to shrink my waistline, which persists regardless of my activity level (which includes endurance cycling). She helped.

      1 vote