At least one in ten persons aged 18 to 69 years has diabetes mellitus in Singapore, according to the 2010 Singapore Burden Of Disease Study (MOH), while prevalence for older adults is one in three persons (“1m diabetes by 2050 as Singaporeans get older, fatter”, Straits Times, 2 Oct 2012). This is relatively higher than the global prevalence which the International Diabetes Federation puts at 8.3% in 2011. Metabolic syndrome, which is closely associated with diabetes, has a relatively high prevalence in Singapore, particularly when body mass indices (BMIs) relevant to Asian body build are applied (read this IDF report).
A local report on diabetes from the Health Promotion Board reveals a relatively high proportion of residents with undiagnosed diabetes. And not surprisingly, a local study of 43,176 adults aged 45 to 74 years revealed that among non-smokers, a greater intake of fruits, vegetables, and soy foods was associated with a lower risk of type II diabetes (Odegaard et al., 2011).
There’s also much hoo-ha at the moment about soda tax and sugar tax. While more fingers are being pointed at sugar as the villain in the landscape of obesity, metabolic syndrome and diabetes, saturated fat isn’t entirely off the hook. True, fructose contributes to insulin resistance while not providing adequate satiation (“Sweet poison: Why sugar is ruining our health”, Telegraph, 12 April 2013; read also “Sugar, not fat, exposed as deadly villain in obesity epidemic”, The Guardian, 20 Mar 2013). But, intake of saturated fat is still associated with higher risks of heart disease (“Fat, Sugar or Carbs: Which Is the Bad Guy?”, Huffington Post, 25 Oct 2013). The good news about soda and sugar taxes is the expectation that obesity would be reduced in the states and cities they’re being applied, even though the debate rages on, and on, and on.
On World Diabetes Day (14 Nov 2013), there’s no time like the present to think about healthy eating. Here’s some thoughts about food:
1. Less is more.
Here’s one diet to aspire to. Studies indicate that the diet structure of Okinawans is responsible for their successful ageing: They eat lots of fruits, vegetables, and soy products (“The Okinawan diet – could it help you live to 100?”, The Guardian, 19 June 2013). But more importantly, it may be their habit of eating until they feel 80% full: It’s their caloric restriction which may be making the big contribution (for details Willcox et al., 2006; 2007). If you’re not convinced, watch this TED talk.
2. Is there something worse than fructose? Yes, artificial sweeteners.
Having a sugar substitute when we desire sugar seems to have the opposite desired effect. As neatly pointed out in a Harvard Health Blog, “Artificial sweeteners: sugar-free, but at what cost?”, there are at least two problems with artificial sweeteners. One is that we are tempted to eat other foods in place of the calories which we didn’t consume. The other is that sugar substitutes don’t provide the endorphins that sugar does and we continue to crave sugar. As a result, we still eat cake after a sugar-free drink. More disturbing facts are easily available at the eloquent Dr Oz website and videos which might help you switch off the “zero-sugar” option.
3. Eat like a caveman. But only if you’re prepared to cook like one?
The paleo diet. It’s the new black. There are apparently benefits to this diet (“5 reasons to follow a caveman diet”, Discovery; “6 health lessons from the paleo diet”, Huffington Post, 13 Sept 2013), and scientific evidence that this diet may have benefits for type 2 diabetes (Klonoff, 2009), possibly because it is more satiating than mediterranean diets (Jonsson et al., 2010). Well, at least it is a proponent of a “whole grains, fruits, and vegetables” diet. And to be a caveman, it would be preferable if one would also grow one’s own herbs, whip up pancakes without electricity, and knead one’s bread too. Not difficult to achieve at all.
4. Breakfast is the most important meal of the day.
The old adage isn’t wrong. A recent report (“Breakfast is the most important meal of the day”, Daily Mail, 23 July 2013) suggested that those who skip breakfast tend to have larger meals during the day, which predisposes them to heart attacks. Another recent study (by Odegaard and colleagues) indicated that eating breakfast frequently lowers the risk of obesity, metabolic syndrome, and diabetes mellitus (“The most important meal?”, press release, UM Minnesota, 16 Sept 2013). More importantly, there’s evidence that a low glycaemic index breakfast (like oats) helps children maintain their attention on cognitive tasks through the morning (Ingwersen et al., 2007; Wesnes et al., 2003).
5. We’re more likely to eat it if we’ve tried it before.
There’s a reason why healthy cooking demonstrations are part of a healthy eating programme at the workplace. One study which asked 205 participants to sample a chicken-and-whole-grain pasta dish and gave them the opportunity to try it at home with a receipe provided to them, found that they were more likely to perceive whole grains positively and to report more confidence about consuming them, compared to controls (Yao et al., 2013). Time for you to try out the recommended roasted brussel sprouts on the Food Network channel and the latest recipes on the Dr Oz show (like sweet potato peanut cookies!).