1 October 2013

We Are What We Ate

The evolution of dietary recommendations for diabetes.   
They knew about diabetes in ancient Egypt. Physician Hesy-Ra of the 3rd Dynasty describes various diseases including a polyuric syndrome, presumably diabetes, in what is now known as the Ebers papyrus (1500BCE). Ancient Ayurvedic texts from India go further describing two types of diabetes-like conditions – congenital and late onset – and noting the relationship of diabetes to heredity, obesity, sedentary life and diet. Talk about the wisdom of the ancients. Today research has completely confirmed that relationship – diabetes risk comes from a combination of diet and lifestyle factors and not from any single nutrient or food (such as sugar or soft drinks) and also tends to run in families. Over the years, people with diabetes have been forced to undergo a number of very challenging dietary regimens. Here we summarise.

Egyptian papyrus.

1797 Scottish physician John Rollo prescribes an ‘animal diet’ for his patients of ‘plain blood puddings’ and ‘fat and rancid meat’ so to manage the disease with foods their bodies could assimilate.
1871 French physician Apollinaire Bouchardat notices the disappearance of glycosuria (sweet urine) in his diabetes patients during food rationing under the Siege of Paris in the Franco-Prussian War, and formulates individualised diets to treat the condition.
1916 Boston pathologist Elliott Joslin compiles 1000 of his own cases and creates the textbook The Treatment of Diabetes Mellitus. In it he reports that ‘the mortality of patients was approximately 20 per cent lower than for the previous year’, due to ‘the introduction of fasting and the emphasis on regular exercise’.
1919 Dr Frederick Allen of the Rockefeller Institute in New York publishes his Total Dietary Regulations in the Treatment of Diabetes that introduces a therapy of strict dieting – dubbed the ‘starvation treatment’ – as a way to manage diabetes.

1921 Insulin was discovered by Canadians Dr Frederick Banting and Charles Best and became commercially available towards the end of 1922 revolutionising the management of diabetes throughout the world. The refusal to patent insulin but to share this miraculous therapy freely with the world will remain an outstanding example of unreserved generosity towards mankind in the history of medical disease. Banting’s colossal contribution has been globally recognised by the declaration, since 2007, of his birthday (14th November) as World Diabetes Day. 

1923 Dr H. Rawle Geyelin demonstrated that a higher carbohydrate diet did not upset blood glucose levels as long as enough insulin was supplied.
1950 The American Diabetic Association and American Dietetic Association developed and published the first set of carbohydrate exchange lists.
1970s Major diabetes organisations review their dietary recommendations due to the increasing number of deaths of people with diabetes from heart and blood vessel diseases. Recommendations for dietary fat dropped to less than 35% calories and carbohydrate recommendations went up to 55–60% of calories. Researchers found that the nutritional status of patients improved with a higher carbohydrate intake, and their insulin sensitivity improved as well.
1981 Dr David Jenkins, Dr Tom Wolever and colleagues develop the concept of the glycemic index (GI) of foods and publish their findings, A physiological basis of carbohydrate exchange, in the American Journal of Clinical Nutrition
1994 The American Diabetes Association completed a major revision of its dietary guidelines for people with diabetes acknowledging that there was no one right diet and dropping specific recommendations to limit the amount of simple sugars.
1997 World Health Organization/Food and Agriculture Organization recommended using the GI as the best guide to the effect of carbohydrate foods on blood glucose levels.
2008 A systematic review Glycemic index, glycemic load, and chronic disease risk–a meta-analysis of observational studies was published reporting that those eating the highest GI diet had a 40% higher risk of type 2 diabetes than those with the lowest GI diet. When it comes to diet and diabetes risk, the researchers found that the overall glycemic load of the diet (i.e. the total amount of carbohydrate x GI) is the biggest potential problem.