Dispelling nutrition myths, ranting, and occasionally, raving

The real cause of Type 2 Diabetes

5 Comments

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The other day someone I follow on Twitter shared a tweet from an MD/PhD student that said that, “excess calories causes diabetes” and that this results from ready availability of palatable food, sedentary lifestyles, and genetics. Apparently anyone who disagrees with this assertion is either trying to sell you something or wants you to think they’re smart. I scrolled back and forth a few times before deciding I really didn’t want to get into a “thing” on twitter but it really got under my skin and I just can’t let it go. I decided that blogging about it would be more productive than arguing with someone who’s already made up their mind about the motives for my disagreement without hearing why I take issue with his sweeping statement. Just to be clear: I have nothing to sell you and I’m not trying to make you think that I’m smart. I just don’t like this simplification of a complicated disease.

To begin, I am assuming that the tweeter was referring to Type 2 Diabetes, not Type 1. A little bit of a pet peeve of mine when people don’t distinguish between the two because despite leading to similar consequences they really are separate diseases with different causes and treatments.

Okay, so my problem with this doctor’s statement is really the implications that it has for people with T2D and the lack of acknowledgement of health inequities that contribute to the development of T2D. Yes, he mentions that it’s the food environment and the inactive lifestyle that is common in our society that’s the problem. This, I will admit, is a step above simply blaming people for eating too much and not exercising enough. However, the implied solution is the same for both messages: don’t eat too many calories and get off your lazy butts and you won’t get T2D. Unfortunately, it’s not that simple. For many, poverty and health inequities are at the root of many chronic diseases, including T2D.

Recent research has highlighted the relationship between the social determinants of health and chronic diseases, such as T2D. This research has shown that, “social determinants (such as income, education, housing, and access to nutritious food) are central to the development and progression of Type 2 diabetes” and, “individuals with lower income and less education are 2 to 4 times more likely to develop diabetes than more advantaged individuals”. That’s right, privilege provides greater protection against developing Type 2 Diabetes than does lifestyle “choices” while poverty greatly increases risk. Not to mention that certain racialized and ethnic groups are often touted as having greater risk for T2D even though much (if not all) of this increased risk can be attributed to inequities and racism experienced by these groups.

We need to stop thinking about T2D as the result of lifestyle choices and start thinking about it as the result of societal structures. If you have the level of privilege where you can choose to eat healthfully and be physically active that’s great and you should absolutely do so. But we need to stop pretending that it’s lifestyle “choices” that are causing this disease when many people do not have that choice.

Author: Diana

I'm a registered dietitian from Nova Scotia, living and working in Ontario, Canada. My goal is to help people relearn how to have a healthy relationship with food.

5 thoughts on “The real cause of Type 2 Diabetes

  1. well said

    Liked by 1 person

  2. Diana – Thanks for this. The best data I am aware of regarding the progression of T2DM to date comes from a large randomly controlled study of more than 3000 individuals deemed at “high risk” called the Diabetes Prevention Project (DPP, 1994-2001), and a subsequent follow up study called the Diabetes Prevention Project Outcome Study (DPPOS, 2002-2015). Perhaps you are already familiar with them. The latest findings of the DPPOS were published in 2017. This showed that even with “lifestyle modification” and/or metformin fully half of all participants went on to develop T2DM. Those who did nothing (control group) had a 60% rate of illness. In other words the current “diet and exercise” treatment regimen is not very effective for *anyone*. This is why T2DM is so prevalent; we don’t actually treat pre diabetes (aka metabolic syndrome) effectively until it becomes full blown T2DM. Instead we just tell people that it’s their own fault for not eating properly and getting exercise. It’s one of the worst failures of modern medicine (and the medical establishment), and for an illness that has already become one of the most significant public health problems of our time (and could help to overwhelm an already wholly inadequate public health “system” in the US).

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    • Thank you so much for adding to the discussion! Very important points that are also relevant in Canada. Particularly as our Ontario premier has just announced huge cuts to our public health system :(

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  3. The usually recommended daily energy intake for the non-obese diabetic patient is between 1500 and 2500 calories per day, the average allowance being 2000 k calories per day. The recommendation for the overweight diabetic patient is between 800 and 1500 k calories per day, while the underweight (including growing children and adolescents) should be allowed at least 2500 k calories/day. accordingly plan the dietary chart with the diabetes controlling foods and follow dietary guide lines to control diabetes. This is latest research link for the dm management..hope this is useful

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