Correlations and Causations
When I reversed my type—2 diabetes I did several things:
Cut out free sugars
Shifted to a low-carb diet focused on low-GI carbs (later, I refined this to think about low-GL carbs rather than low-GI.)
Ate smaller (child-sized) portions
Practiced a form of intermittent fasting
Avoided processed foods
Cooked from fresh as often as possible
Increased my exercise levels
The end result was remission of my T2D, improvement in average blood pressure, loss of significant weight and improvements in my triglyceride and cholesterol levels. What I did worked for me, but I’m reluctant to attach a causal explanation to any single one of those things. This is because I think it was the cumulative impact of all of those things that had the effects, that this is all about the interaction of a number of elements in the metabolic system.
My personal experience, naturally enough, informs how I react to news items and comment pieces. I like to think that I’m conscious of my priors and am open to re-examining them when faced with contrary opinions, but I’m only human. The systems-thinking approach conditions, for example, my response to the hard-core reductionist approaches touted on the internet that assume single-factor causality and, in essence, promote the idea that if only you do x then y will necessarily be the outcome.
With that in mind, I read an article in this morning’s Guardian with interest. The article, written by health editor Andrew Gregory, reports on studies published in The Lancet and is here: More than 1.3bn adults will have diabetes by 2050, study predicts.
The Lancet material is here: Global inequity in diabetes.
The Lancet studies look at the role of structural racism and geographical inequity in diabetes outcomes, international progress on interventions to address global inequity in diabetes, and disparities in diabetes prevalence and management by race and ethnicity in the USA. There is also an accompanying editorial piece identifying diabetes (overwhelmingly T2D) as a ‘defining disease of the 21st century.
I should be clear at the outset that I do not for one moment have a problem with any of the issues raised in the papers. Nor, as I hope I’ve made clear in previous posts here, do I think that there is any single ‘cause’ of T2D – people are different and the condition arises from several factors. Demographic and social elements in the prevalence and impact of T2D are obviously important, and I’ve written here previously about the relative costs of good fresh food as against processed/ultra-processed food and thus the impact of income inequality. I thought that the Lancet study on T2D disparities by race and ethnicity in the US was particularly good on identifying the multiple factors involved including a ‘non-linear’ relationship between weight and T2D in at least some ethnicities.
The Lancet editorial piece rightly draws attention to increasing pharmaceutical spend at the expense of other factors in T2D prevention and treatment, but none of the papers have their focus on other systemic issues or, except in passing, on other rising health problems – eg non-alcoholic fatty liver disease and heart disease – and none (as far as I could see) think about the global rise in obesity, T2D, non-alcoholic fatty liver disease, etc. as symptomatic of linked metabolic systemic issues.
The obvious absence from the discussions, except by inference, is diet.
I’m neither a doctor nor an expert, just a bloke on the internet whose priors are based on personal experience as a white British man in his sixties. I may very well be barking up the wrong tree. But the work by, amongst many others, Drs David and Jen Unwin and Dr Chris van Tulleken, suggests to me that there is a lot more going on here. As a layman, it seems to me that the global rise in a number of metabolic conditions correlates to large-scale urbanisation and the spread of a ‘western*’ diet – for example in the US, Mexico, India and China. Correlations can be, and often are, spurious, but they also suggest avenues for critical analysis and I reckon this is one such occasion.
*By ‘western’ diet I mean in general terms one rich in highly-processed foods and sugary drinks and snacks.
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I had an interesting interaction with a couple of people on the internet recently. I have been looking at questions of nutrition for distance running after remission of T2D and thus aiming to avoid carbs. I contacted two people, who will remain nameless. One was a respected senior clinician in the field of the metabolic system and diabetes (who is also a runner) and the second was someone in the US who blogs about running and diet.
The senior clinician replied wrote back quickly offering a few friendly tips as to what they have found works for them - exactly what I was looking for. The American blogger declined to say anything at all to avoid liability issues – unless I paid them up to $200 for a personalised consultation and plan.