It’s Diabetes Awareness Week. But the Australian Diabetes Council continues to advocate a solution that the science shows will make the disease worse rather than better. It is ordinary people who will pay the price.

Type II diabetes (90% of all diabetes is Type II) is a disease of carbohydrate metabolism. Sufferers can no longer properly convert the carbohydrates they consume into energy. The result is that their blood glucose level is permanently too high. A permanently high blood glucose level leads to damage to the fine capillaries of the eyes and kidneys as well as the blood vessels transporting food and oxygen to our lower limbs. Uncontrolled diabetes will eventually lead to blindness, kidney disease and lower limb amputation.

Every day in Australia nine limbs are amputated because of this disease. Worse than that, it affects more than twice as many people today as it did in the nineties. And that number is likely to triple in next 15 years.

You don’t need to be a scientist to figure out that if a person has trouble dealing with carbohydrates they should eat less carbohydrates. After all that is exactly the approach taken with other similar problems. For example people who can’t properly digest fats (because their gall bladder is compromised) are advised to eat a lot less fat.

And if that was your hunch you wouldn’t need to look too far for science to back you up. In 2010 the Harvard School of Public Health published the results of its meta-analysis of the research on the relationship between sugar sweetened drinks and diabetes. They reviewed eight high quality studies which involved 310,819 participants and 15,043 cases of Type II diabetes. Each of the underlying studies was significant in its own right and all had been concluded between 2004 and 2010.

All but one of the studies revealed a strong and significant association between sugar and diabetes. Taken together they showed that consuming one or more soft drinks (or fruit drinks or vitamin waters) per day would increase your chance of contracting Type II diabetes by 26%.

As convincing as this meta-analysis is, it just confirms what a very strong series of studies on the link between soft drinks and diabetes have been saying for the last decade, sugar consumption significantly increases the incidence of Type II diabetes.

Two decades ago (when there were half the number of sufferers there are today) reducing carbohydrates in general and sugar in particular was exactly the advice given. But strangely the Australian Diabetes Council’s advice to Type II diabetes sufferers today amounts to advocacy for increasing the amount of carbohydrate.

Yesterday, their Chief Research Officer Dr Alan Barclay told the Today program that Australians hoping to prevent the onset of this terrible disease should eat less fat, less salt and more fish. He gave no advice about sugar either during that interview or in the similar one he also gave to Alan Jones. Neither does a word about sugar appear in the detailed booklet on preventing diabetes published by the ADC yesterday.

The official position of the ADC on sugar is that it has nothing to do with diabetes. Indeed it “want[s] to end the myth that sugar causes diabetes”. It’s a position which is (strangely) almost identical to the one maintained by CSR Sugar and Nestle Australia. The ADC instead recommends “that people with diabetes choose at least one serve of a low GI food at each meal and snack”.

Sugar is a moderate to low GI food and pure fructose (which is one half of sugar) is the lowest GI carbohydrate available. It shouldn’t therefore come as much of a surprise that foods high in sugar feature heavily in lists of processed food awarded low GI certifications. One type of pure sugar (made by CSR) has even managed to have itself certified as being low GI.

Besides being ADC’s Chief Research Officer (and oft-quoted spokesperson), Alan Barclay has some other strings to his bow. He is also a director and vice-president of the Glycemic Index Foundation. GIF exists to dispense GI symbols.

Prospective supplicants submit their fare for testing, pay the “testing fee” and, if adjudged worthy, receive a little blue G that they can display on their labels. They can leave the proclamation of healthiness on the label for as long as they continue to pay for the privilege with a percentage of their product sales. Some currently certified foods include, Nestle Milo (46% sugar), a range of Nestle muesli bars (around 25% sugar), USANA Meal replacement shakes (around 27% sugar), CSR’s low GI sugar (100% sugar) and of course Danisco pure fructose (100% fructose).

When the ADC exonerates sugar and steers sufferers in the direction of low GI foods, they are driving demand for the services of GIF, and the products certified by them. Barclay’s involvement in both organisations is a clear conflict of interest (which should, at the very least, be disclosed with every appearance he makes on behalf of the ADC).

The studies linking sugar and diabetes are large, well conducted and reliable yet they are ignored on both the ADC website and in Barclay’s most recent public advice to those seeking to avoid diabetes.

People with Type II diabetes will heed the ADC’s advice. They will seek out low fat foods (which are usually high in sugar). They will ignore the sugar content of foods and they will look for foods which bear a low GI certification. This will inevitably increase their sugar intake and the science says they will significantly increase their risks by doing so.

If this was about increasing the risk of your fingernails going green then I would say, so what.  But far more is at stake in this game. Almost 300 Australians will contract an appalling, life destroying disease today. And they will be joined by another 300 tomorrow, and another 300 the next day. They will suffer every remaining day of their (foreshortened) life even though the science on how to avoid it has been clear for at least a decade.

I don’t pretend to know the ADC’s motivations, but telling at-risk people that it is OK to eat sugar seems like an extraordinary abuse of a position of trust. The ADC needs to clean up its act and it needs to do it now. Type II diabetes is not a game.

Peter Fray

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