Diabetes prevention is not working because initiatives to reform food labeling, the dish of good eating and other actions are not considering that it is not the same to eat peanuts than papitas.
In Mexico there are more than 10 million people living with diabetes.One in three Mexican people between 60 and 69 years (30%) lives with diabetes. [1]And the epidemic reflects the inequalities of our country: people with less income have more diabetes complications. [2]The challenge just begins.
There are more and more Mexican babies born from moms who developed diabetes during pregnancy. [3]This multiplies the chances that those babies and moms develop diabetes later.In addition, diabetes is more fatal in Mexico than in other countries. [4]Last year 105 thousand people died because of diabetes;Cause number one death in the country.Although in the last decade several prevention strategies have been implemented, [5] the problem is not being solved.Between 2000 and 2016 the prevalence increased 65%. [6]
Diabetes prevention strategies are not working because we are not defining the problem well.Here is a national definition: “Diabetes: It includes a heterogeneous group of diseases […] of unknown cause, with varying degrees of hereditary predisposition and the participation of various environmental factors […].” [7] This is the perfect definition forA public policy disaster: unknown and heterogeneous causes.If we want to solve a problem, whatever, we must define its causes and prioritize them.
Yes, in effect, there are many types of diabetes. [8]But the public health problem we have in Mexico is type 2 diabetes. Type 1 diabetes, Autoimmune, [9] is not a public health epidemic.The different ‘diabetes’ have very different causes and very different prevalences. [10]We must separate problems forcefully and give them different names.Making them equivalent has led us to think that diabetes 2 is chronic and progressive. [11]Fake.Most cases of diabetes 2 do not have to be progressive. [12]Diabetes 2 is preventable. [13]And if high sugar levels are detected before it is full diabetes - in a state called prediabetes - it can be made reversible. [14]
Diabetes 2 does have many causes.It is a disease that interacts with genetics, (des) Physical activation, stress, lack of sleep, but on everything - with what we eat. [15]This diabetes - which is a ‘food diabetes’ - is caused, in susceptible people, for 20, 30, 40 years of rapid digestion food (high glycemic index) that causes the body to release a lot of insulin.The insulin of more, when circulating in the blood, makes us accumulate fat and that we become resistant to the insulin itself.A lot of insulin circulating in the blood causes obesity (and, in the long run, diabetes appears).If it is insulin resistance: not all meals or all calories are the same.For example, 100 calories of peanuts do not produce the same insulin secretion as 100 calories of papitas, [16] and therefore do not interact the same with diabetes.
Diabetes prevention is not working because initiatives to reform food labeling, the dish of good eating and other actions are not considering that it is not the same to eat peanuts than papitas.Obesity is a complex disease [17] and is not automatically prevented by lowering total calorie consumption or exercising when one eats more.He who sins and says does not tied.Biology does not work like this. [18]
Diabetes prevention is not working because actions are isolated in a single sector.Diabetes will hardly be resolved if doctors, nurses, nutritionists, medicines and tests oflaboratory continue to be the axis of the solution."Prevalence", "incidence", "risk factor" and "chronic non -transmissible disease" are words that say nothing to anyone (that is not personal of the health sector).This is a leading doctor in the subject: doctors will promote medical solutions;Nutriologists Dietary solutions.The technical specialty is crucial, but we should not stop seeing the complete system. [19]
The medical approach has made us categorize all diabetes under the same name.This approach is useful in the office, because the approach to treatment is similar: Control blood sugar levels.But this classification (useful for complications control) has not worked for prevention.
In addition, the medical approach has put too much emphasis on individual responsibility.Many doctors are convinced that patients are not taken care of because they don't want to take care of themselves.This emphasis on the individual has led us to design prevention strategies with a narrative that directs efforts, for example, towards media campaigns with panzas full of cakes and pizza beer, where responsibility is put in the individual and not in the food environment.The medical approach has led us to focus the discussion on what we should not eat or take.Neither obesity nor the complications of diabetes are prevented with more willpower.The medical prevention approach has given little attention to what we should consume;And no attention on how to make it produce and consume more nuts, seeds, beans, slow digestion meals.
How to prevent diabetes: Road to a Food System for Health
The health system in Mexico is doing what it can, using the public policy instruments at its disposal.The health sector must continue with its prevention efforts in health centers and promoting actions for early detection and control of people's sugar levels.But it is time to radically change the prevention paradigm.It has been said experts from the World Health Organization: “In the last 20 years, we have seen the explosion of chronic diseases in the world helpless.Without a dramatic strategy change, the resounding collective failure will continue. ”[20]
We have to redefine the problem with a strategic approach to public policy (not under a medical definition).Recently, a call to change the name of non -transmissible diseases was published in Lancet magazine: “calling it 'non -transmissible' to the number one cause of death in the world has proposed confusion, subtracted urgency and removed attention to systemic interventions”. [21]Changing our epidemic name can be the first step to imagine new systemic strategies that prevent ‘food diabetes’.
We have to mobilize new sectors to imagine other types of solutions.Diabetes should be considered an ‘food’ epidemic ’so that prevention actions are aimed at improving the food system.A new food system must be redesigned by doctors, nutritionists and public health experts, together with urban planners, agronomists, activists, environmentalists, exporters, economists, innovative and the food industry.If we stay in the vocabulary of "chronic non -transmissible diseases", it will be difficult to build bridges between sectors and disciplines;It will be difficult to imagine different solutions.
Today, the public policy questions we ask are how to press the industry to lower fat, sodium or sugar of its products;on how to change the label so that people are better informed, or on how to strengthen the ability of health centers.This is going to fall short of the magnitude of theepidemic we face.As long as we continue to point to the individual and underline what we cannot eat, our prevention strategies will not focus on how to produce more broccoli;Yes produce, distribute, process, market and want to consume more beans.In the last 30 years, per capita bean consumption has fallen by half.No one says this.We only hear that our soda consumption is increasing.We need a new prevention paradigm.We must move from focus on individual responsibility towards an approach to the food environment.We must focus on food as a strategic prevention axis, in order to raise other questions and imagine other types of solutions.
How do we make people access and consume a more varied, healthy food, slow digestion?It is time to ask more questions about the feeding system.How do we make the industry to produce and market healthier products?How do we increase biotechnology research?How do we do so that people consume more fruits and vegetables, that they want to eat them, who want and know how to prepare them, that they are available, that they do not spoil?How do we encourage innovation to find new marketing channels for healthy local products?How do we do to redefine the basic basket, including more slow digestion foods?
Diabetes prevention will work when we recover attention in the food system.Fortunately, there are more and more voices promoting understanding prevention approaches.In 2012, the document “Obesity in Mexico: recommendations for a State Policy” of the Institute of Public Health and the National Academy of Medicine proposed an integral vision, where for example, agricultural policies were included as part of prevention policies.Now in 2018, the manifesto for a nutritional, fair and sustainable food system has emerged as a proposal that puts food as the guiding axis of the nation project.International platforms such as Eat Forum are emphasizing collaboration between government, science and industry to find solutions to food system problems. [22]
Malaria was largely resolved with paving and drainage, not only with medicines and pesticides rose in puddles.If we stay with an old prevention paradigm, the health system that is already exceeded, will explode.It is seriously: there is no fiscal policy in 2050 that agrees and the prevalence of diabetes of Mexicans.We need a fresh look at the problem.We have to make the easy option - a chance, tasty - is also the healthy option.For that, the food industry must be part of the solution.We must design strategies that stimulate a vision where diabetes is preventable and reversible prediabetes;and where prevention is staying in the food to which the population has access.Diabetes prevention will arise from the design of health food systems.
* Braulio Torres Beltrán is a research director at Idea Foundation and Research Fellow in the Massachusetts Institute of Technology (MIT) department.
References:
[1] National Survey of Health and Nutrition (Ensenut) 2016.
[2] Gutiérrez, J., et al (2016).Inequality in chronic disease indicators and their attention in adults in Mexico: analysis of three health surveys.Public Health of Mexico.
[3] Serrano, M. (2013).Incidence of gestational diabetes at the Adolfo López Mateos Regional Hospital through the O’Sullivan test.Rev Esp Méd Quir.See also: Medina-Pérez E., Sánchez-Reyes A., et al (2017).Gestational diabetes.Diagnosis and treatmentIn the first level of attention.Med int mex.
[4] Alegre -Díaz, J., Herrington, W., López -Cervantes, M., et al (2016).Diabetes and Cause-Specific Mortality in Mexico City.The New England Journal of Medicine.
[5] A complete summary in: Pérez, V. (2016).Construction of public policies and decision making in nutrition and food in Mexico.FUNSALUD.
[6] Simple calculation from the data in: Rojas-Martínez, R. et al (2017).Prevalence of diabetes by previous medical diagnosis in Mexico.Public Health of Mexico.
[7] Official Mexican Standard NOM-043-SSA2-2012, Basic Health Services.Promotion and education for food in food.Criteria for providing guidance.Official Gazette of the Federation.
[8] Type 1 diabetes, type 2 and a broad continuum of types.See: Flannick, J., Johansson, S., Njølstad, P. (2016).COMMON AND RARE FORMS OF DIABETES MELLITUS: TOWARDS Next of diabetes subtypes.Nature Reviews Endrocrinology.See also in: AHLQVIST, E. et al (2018).Novel Subgroups of Adult-Nset Diabetes and Their Association with Outcomes: A Data-Driven Cluster Analysis of Six variables.The Lancet Diabetes & AMP;Endocrinology.
[9] Autoimmune diabetes, which destroys the ability of the pancreas and requires external insulin, is presented in children, adolescents and adults.Autoimmune diabetes in adults has led to confusion in diagnoses and prevention and control strategies.On autoimmune diabetes in adults also see: Leslie, R., Williams, R., & AMP;Pozzilli, P. (2006).Clinical Review: Type 1 Diabetes and Latent Autoimmune Diabetes in Adults: One End Of The Rainbow.The Journal of Clinical Endocrinology & AMP;Metabolism.
[10] A clear analysis in: Brahmkshatriya, P., Mehta, A., Saboo, B. & AMP;Goyal, R. (2012).CHARACTERISTICS AND PREVALENCE OF LATENT AUTOIMMUNE DIABETES IN ADULS (LADA).ISRN Pharmacology.
[11] There are types of diabetes that are progressive and that do require insulin, but it is a minority.In Mexico, 11% of the people living with diabetes receive insulin and perhaps there is an additional percentage that requires insulin.In the US, the use of insulin is higher.A study would be useful that determines how many patients are incorrectly using insulin as a treatment.It is likely that between 15-20% of patients living with some type of diabetes eventually require medicines and/or external insulin because their pancreas loses the ability to produce insulin (own).But at least 80% of patients living with diabetes would not need insulin or medicines;They need to have access and consume a diet with healthy foods of slow digestion, which do not raise insulin secretion.There are different estimates with respect to people with some type of diabetes that have a dysfunctional pancreas;The following classifications and considerations are used: Autoimmune diabetes, insulin deficiency, presence of antibodies, likely ketoacidosis.See Bibliography on Page Number 8.
[12] Lim, E., Hollingsworth, K. et al (2011). Reversal of Type 2 Diabetes: Normalisation of Beta Cell Function in Association with DeciestEd Pancreas and Liver Triacyllycerol.Diabetology
[13] See: Uusitupa, M. (2018).REMISSION OF TYPE 2 DIABETES: MISSION NOT IMPOSIBLE.LancetAnd here a very good explanation.There are also promising results on the reversibility of diabetes, see in: Cheng, C., Villani, V., Longo, V. et al (2017).Fasting-Mimicking Diet Promotes NGN3-Driven B-Cell Regeneration to reverse diabetes.Cell
[14] Perreault, L., Kahn, S. et al (2009).Normal Glucose Regulation in the Diabetes Prevention Program.Care diabetes.
[15] Food is the main risk factor in the global disease load.See in: Haddad, L., Hawkes, C. et al(2016).A New Global Research Agenda for Food.Nature Comment.And see in: GBD 2013 Risk Factors Collabrators.Lancet
[16] Here a clear illustration of the glycemic index.
[17] See the book "Always Hungry?"And here bibliography on adipose tissue as an endocrine organ.Additionally see in: Gesta, S., TSEng, Y. & AMP;Kahn, R. (2007) .Developmental Origin of Fat: Tracking Obesity to its Source.CellAlso see this analysis "Thinking in Circles About Obesity" about the complexity of obesity.
[18] See: Salomon, T. et al (2010).A Low-Glycemic Index Diet combined with exercise reduces insulin resistance, postprandial hyperinsulinemia, and glucose-dependent insulinotropic polypeptide responsibility in obese, prediabetic humans.Am J Clin Nutr.And see also: Barazzoni, R., Deutz, N. et al (2017).Carbohydrates and Insulin Resistance in Clinical Nutrition: Recommendations From The Espen Expert Group.Clinical Nutrition.
[19] Rutter, H. (2011).WHERE NEXT FOR OBESITY?Lancet
[20] Nishtar, S. (2017).The NCDS Cooperative: A Call To Action.Lancet
[21] Allen, l.& AMP;Feigl, A. (2017).What’s in a name?A Call to Reframe Non-Communicable Diseases.Lancet
[22] Also, the informas coalition has developed an index of food environments where wide considerations such as sale and food prices are included.Different international agencies is collaborating to promote comprehensive strategies around food systems.
