Every now and then someone will inform TheFatNurse that over indulging on carbohydrates is “no big deal because Asians [and Asian Americans] eat carbs all the time and they are thin!” First, TheFatNurse thinks that is quite a general blanket statement to put on a whole race of peoples, but TheFatNurse is guessing this assumption is from the cultural importance of rice in those cultures. The following fact is usually a shocker to a lot of people:
Despite having lower body weight, Asian Americans are more likely than Caucasians to have diabetes
Sayyy whhhhat? That’s taken straight off the Joslin Diabetes Center of Asian American Diabetes Initiative which also says:
Because Asian descents develop diabetes at a body weight considered “normal” by mainstream western standard, some have concluded that obesity is not an important cause for diabetes in Asian descents.
This rise in diabetes occurs not only to Asian-Americans but extends to Asians as well. Last week in businessweek a story covered the dramatic rise of diabetes in China:
Prevalence of Type 2 diabetes, a disease linked to inactivity and excess calories, has more than tripled in China over the past decade, fueling 20 percent-a-year growth in drug sales and straining health services. It’s also stoking need for newer, costlier medications from Merck & Co. (MRK), Novo Nordisk A/S (NOVOB) and Sanofi that help avoid blood-sugar spikes and complications such as heart attack and stroke.
As few as two in five diabetics in China have their blood- sugar under control…That compares with the U.S., where blood-sugar is controlled in 70 percent…
…China’s health spending is forecast to almost triple to $1 trillion over the next eight years, surging rates of diabetes mean China is struggling to detect cases and provide basic care…
China has almost four times as many people with diabetes than the U.S., where there are 23.7 million sufferers, according to the IDF. By 2030, 40 million more will have the condition in China…
China has overtaken Japan to become Novo Nordisk’s biggest market after the U.S…
If you want to make some $$$ sounds like investments in pharmaceuticals for diseases related to high blood sugar will get you far in the future! The more important, but less financially rewarding message, is that these populations are becoming diabetic with lower weight gain compared to other populations. This can be troublesome since treatment and prevention is often focused on weight loss. For example, a new study that made the headlines a few weeks ago in the NIH newsletter showed:
An intensive diet and exercise program resulting in weight loss does not reduce cardiovascular events such as heart attack and stroke in people with longstanding type 2 diabetes, according to a study supported by the National Institutes of Health.
Few, if any, studies of this size and duration have had comparable success in achieving and maintaining weight loss. Participants in the intervention group lost an average of more than 8 percent of their initial body weight after one year of intervention. They maintained an average weight loss of nearly 5 percent at four years, an amount of weight loss that experts recommend to improve health. Participants in the diabetes support and education group lost about 1 percent of their initial weight after one and four years.
What kind of intensive diet was this? A low fat calorie restricted one. From their protocols page:
the calorie goals are 1200-1500 kcal/day for individuals weighing 250 lbs (114 kg) or less at baseline and 1500-1800 kcal/day for individuals who weigh more than 250 lbs. These goals can be reduced to 1000-1200 kcal/day and 1200-1500 kcal/day, respectively, if participants do not lose weight satisfactorily. These calorie levels should promote a weight loss of approximately one to two lbs/week.
The composition of the diet is structured to enhance glycemic control and to minimize cardiovascular risk factors. The recommended diet is based on guidelines of the ADA and National Cholesterol Education program and includes a maximum of 30% of total calories from total fat, a maximum of 10% of total calories from saturated fat, and a minimum of 15% of total calories from protein.
Interesting stuff…TheFatNurse will definitely have to wait until the final report is released to go over the details! TheFatNurse isn’t trying to say that exercise and weight loss isn’t important in diabetics because there are other benefits such as reducing sleep apnea, increased energy and etc. TheFatNurse is merely trying to suggest that weight loss is not everything! A new meta analysis form the American Journal of Epidemiology on clinical controlled trials recently showed something similar.
In comparing low fat to low carb diets, they found no statistical significance between the two on weight loss or abdominal obesity; subjects lost weight on either diet. However, there was statistical differences between the two on reducing Cholesterol, reducing LDL cholesterol, increasing HDL cholesterol and reducing triglycerides; this was the low carb. However, its important to note the low fat diet yielded good changes to these markers as well, the low carb diet just did it better.
Summary;TL;DR: TheFatNurse hopes this gives pause to the use of Asians and Asian Americans in the debate of high amounts of carbs being healthy. It’s an assumption that asians and asian americans have a high carbohydrate diet but even if we assume that is true, we can see that whatever diet they are eating is not exactly yielding good health due to the staggering amount of diabetes they are having in North America and Asia. This increase of diabetes is occurring even at lower levels of weight which also suggests there might be more to the story than the usual “obesity is a risk factor for diabetes.” Even when weight loss is the same between different diets, some studies have shown low carbohydrate diets yielding better results on metabolic markers vs low fat diets.
Ultimately, the problems of diabetes and diet in Asian/Asian American populations is a lot more complex than just the amounts of carbs eaten. With the introduction of western foods, marketing, and increased economic gain in China, there are ultimately other psychologic, social and financial factors that make the issue more complex…but well worth future study.
Hu et al (2012). Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials. Am. J. Epidemiol. (2012) 176(suppl 7): S44-S54