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HEALTH Talking Is tobacco ? sugar t h e n e w By Professor Kiran Bhagat




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HEALTH Talking Is tobacco ? sugar t h e n e w By Professor Kiran Bhagat

By Professor Kiran Bhagat,

Heart Foundation of Botswana

Diabetes – a developing-world epidemic

After heart disease, diabetes is the most rapidly developing disease on our planet. 382 million adults are living with diabetes and it is estimated that the number will increase by another 200 million by the year 2035. Unfortunately, like heart disease, diabetes is increasing fastest in the developing world; in Africa, Asia and South America. The main causes are rapid urbanisation, economic growth and changes in dietary habits, largely because we are eating more calories and our overall quality of diet has declined.

60% of South Africans are overweight or obese

The consumption and quality of dietary fats and carbohydrates have been critical in causing the phenomenal rise in obesity, which is the commonest reason for the increase in diabetes. At the same time,

diets rich in whole grains, fruits, legumes (e.g. peas, beans, lentils) and nuts have reduced.Take for example South Africa. A recent, shocking study has revealed that seven out of ten women are overweight, and so are four out of ten men. 60% of the SA population is overweight or obese.This is almost double the global rate according

to a study published in the Lancet (2011), a leading

medical journal.

Understanding Type 1 and Type II diabetes

Type 1 (previously known as juvenile onset) is principally a result of the lack of insulin in the body. Various causes for the destruction of the organ that produces insulin (the pancreas) have been postulated and several breakthrough research studies are near completion.These herald possible vaccines and other exciting treatment developments. However the escalation in diabetes is not Type 1 but

what is now termed adult onset (Type II) diabetes.This is

a result of an ‘obesogenic’ diet, weight gain and lack of

exercise. Insulin is the ‘key’ that ‘unlocks’ the cells in the body, permitting glucose (the energy molecule) to enter and provide the energy required for all living cells. If insulin is lacking (Type 1) or insulin ‘resistance’ occurs (Type II) the



cells, tissues, organs and ultimately the body suffer.The irony is that large amounts of sugar are circulating in the blood but cannot enter the cellular structures because of insulin resistance. So death of tissues occurs amidst plenty!

The management of Type 1 diabetes is always insulin based. Tablets do not work

The management of Type II however is principally

a radical change in diet, weight loss and exercise. It’s

important to change the food you eat, leaning more heavily on whole grains, fruits, vegetables, legumes and nuts. A reduction in alcohol, refined grains (processed starch), red or processed meat and sugar-sweetened drinks has been shown to remarkably reduce the complications of diabetes and improve blood glucose

in some situations. Lifestyle changes need to be

co-managed with the use of oral medication and occasionally with insulin injections.

How to address the diabetes problem?

This serious epidemic requires global public health policies that create healthy food environments and promote corporate social responsibility. Potential strategies include nutrition and agricultural policies that favour the production and distribution of healthy food. The accessibility and affordability of fruits, vegetables, whole grains, legumes and nuts need to be increased. Higher taxes on sugar-sweetened drinks and other unhealthy products may also reduce consumption of

these toxic foods and improve overall diet quality. Finally, the standardisation of packaging nutrition

labels and nutrition facts in conjunction


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with public health campaigns and sound

agricultural and food policies could

reshape this escalating epidemic. We

must not remain idle!

sound e

e Heart Foundation of Botswana is committed to Educating, Enabling, Engaging and Empowering Botswana on lifestyle management in the prevention of lifestyle diseases.

H&D magazine

H&D magazine