*Paul Olusegun Adepoju
Lecturer, Department of Medical Laboratory Science, Babcock University, Ogun state, Nigeria *Correspondence to firstname.lastname@example.org
“Paul, that sugar you are adding to your tea is too much,” said my mother as I added the fourth cube to my teacup. She would say the same thing when anyone around her used more than two cubes of sugar, because as she told everyone, intake of sugar increases an individual’s risk of suffering from diabetes. She was not the only one with this mindset on diabetes.
Nigerian mothers are not comfortable with excessive sugar intake, even though the science of diabetes is very clear. It is funny to note that the mothers who loath refined sugar are also the ones that give their children food with high carbohydrate content. Look at the Yoruba people of western Nigeria for instance, their popular breakfast would be yam, rice, or bread, while in the afternoon, large bowls of amala, eba, fufu, or any other starchy food made from cassava are served with different kinds of soup. For dinner, foods rich in carbohydrates are also highly preferred.
Yet they ask their children to stay away from sugar. Hypocritical huh?
Even with the avalanche of new therapies and management protocols for individuals living with diabetes, Nigerian parents still do not agree that sugar is not as deadly as they think it is. But has this worked for them?
A few weeks ago, I took my mom for a routine medical checkup and she had her sugar level tested. It was perfectly normal, even with a family history of diabetes! There and then I began to think of her advice differently.
At first I wanted to start analysing the latest and landmark research in the field of diabetes. I spoke with Tosin, a medical researcher and good friend, about the update on diabetes and potential new therapies: gene therapy, the CRISPR/Cas9 system, and several others. None of them really explained why my mother stayed diabetes-free, even though we live on a carbohydrate-rich diet thrice daily in addition to a significant genetic risk.
Then a thought began to form in my mind. The earliest definition of diabetes that I heard while in primary school was one that defined the condition as a disease that is characterised by the presence of sugar in urine. Even though it could best be described as glycosuria, the way they explained it was that sugar-loving insects would mobilise to where a patient with diabetes had urinated. Those with this understanding of diabetes would believe that the presence of sugar in urine is due to its abundance in the circulatory system, and as insects are attracted to sugar, the ultimate way to prevent the condition is presumed to be by reducing sugar intake.
Do not get me wrong, this is inaccurate since there is no mention of insulin or insulin resistance; nor is there mention of the various types of diabetes. People of that generation are living a life based on a fear of sugar and a poor understanding of diabetes. Surprisingly, those living around me are mostly diabetes-free. Is there anything we can learn from them?
First of all, diabetes researchers, be it mellitus or insipidus, need to find a way to simplify their research findings in ways that everyone can understand. Research concerning diabetes is understandably getting highly complicated, even though the patients that are expected to benefit from the research do not hold a doctorate in endocrinology.
Another lesson we can learn is to ensure that researchers do not digress too much. I know this is also difficult and not always possible to do at this stage, but it would be practical to pinpoint the answers to questions raised about diabetes before moving onto more in-depth research.
I believe that more funds are spent yearly on research that does not directly attempt to solve the primary problem of diabetes than those that do. Even though current diabetes research is necessary, it would really be helpful for researchers in the field to fully commit their expertise, time, and resources towards efforts to develop solutions that overcome insulin resistance once and for all.
If, for a year, all diabetes researchers took a break from looking at the disease from a multitude of perspectives and fully focussed on pinpointing the primary issues at hand, we might finally have a chance at solving the puzzle of diabetes.
For one last moment I decided to look at mum’s anti-diabetes strategy from a closer perspective. I realised that her logic was actually somewhat scientific! Researchers have been able to connect sugar cubes with dyslipidaemia, and with diabetes.
I came across a study1 which showed that individuals who ate the largest amounts of added sugar had the highest blood triglyceride levels and the lowest high-density lipoprotein (HDL) (good) cholesterol levels. The study also showed that eating a lot of sugar more than tripled the odds of having low HDL cholesterol levels, which is a strong risk factor for heart disease. Another study2 showed that too much fructose, produced with the ingestion of sugar, has a negative effect on hepatic de novo lipogenesis and insulin sensitivity (the latter is the hallmark of diabetes).
As if that wasn’t scientific enough, I also came across a study3 encompassing 175 countries that drew clear association between sugar and diabetes.3 They found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1%.
Yet another study4 concluded that intake of refined carbohydrate (corn syrup) concomitant with decreasing intake of fiber, paralleled the upward trend in the prevalence of Type 2 diabetes, observed in the USA during the 20th century.
I guess African mothers were right all this time, it has always been about sugar (in different forms) and we can end the scourge by fully focussing on the underlying cause and primary symptoms, instead of contending with the cofounding factors.
When I finally informed mum about my little critique of her diabetes theory, she looked at me, smiled and said the four words many African children hate to hear: “Mum knows it all.”
- Welsh JA et al. Caloric Sweetener Consumption and Dyslipidemia Among US Adults. 2010;303(15):1490-7.
- Faeh D et al. Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin Sensitivity in Healthy Men. Diabetes. 2005;54:1907-13.
- Basu S et al. The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE. 2013;8(2):e57873.
- Gross LS et al. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004; 79(5):774-7.