Barely Better Than Nothing

Diabetes Australia just published their position statement on type 2 diabetes remission. Recognising that a lifestyle disease can be improved or even reversed with lifestyle interventions seems self-evident but has, in fact, been anything but blindingly obvious except to a few fringe dwelling lunatics who believe mainstream medical advice to eat a "healthy diet high in wholemeal grains" and "all foods can fit" is complete tripe.

If you take the time to read through the position statement you will conclude, at least fringe dwelling lunatics will conclude, that the position statement is better than nothing, but not by much. Firstly, this phrase "Healthy eating (with attention to portion size and kilojoule intake)" sounds suspiciously like "eat less, move more" to lose weight. While that strategy may involve weight loss, how does one actually eat less and move more? If the equation were so simple we would not have a diabesity problem that is currently far worse than any infectious pandemic.

But, back to "healthy eating." What is healthy eating? Who knows, there is glaringly no definition. Similarly, "portion control and kilojoule intake" is a failed strategy. We now have literally decades of advice from conventional medical practitioners to pay "attention to portion size and kilojoule intake" and the result is a population that is sicker, fatter and weaker at every age group. There is a point at which even the "experts" have to come around to the idea that "insanity is doing the same thing over and over, and expecting different results."

What is surprising - or maybe it isn't - about this position statement is that the real drivers of type 2 diabetes remain completely ignored. Sure there is the standard "genetics, age, lifestyle factors including food intake and physical activity, weight, use of some medicines, and other medical conditions" (which came first the insulin resistance and diabetes or the other medical conditions?) to explain type 2 diabetes but none of these explain the rapid and disastrous increase of type 2 diabetes over the last several decades. Our genetics have not changed, our physical and social environment has.

Here is a short list of the things that really lead to type 2 diabetes:

• An over abundance of cheap, readily available addictive processed and highly processed food.

• "All foods can fit," aka "moderation", "portion control" and other such platitudes.

• Protein dilution in the modern diet.

• Poor dietary guidelines which, if followed, minimise protein intake.

• Ignoring the protein leverage hypothesis and maximum foraging strategy as evolutionary drivers of food intake.

• A societal trend towards rewarding every event with food.

• Eating as recreation.

• An environment which favours little movement and maximal calorie intake.

• The addition of industrial seed oils and sugar (in various forms) into every packaged food in the supermarkets and all cafe, restaurant, and take out meals.

• Lack of social support for people who want to eat a real food diet.

Overall, the tone of the position statement is negative and realistically, I think, represents the reality of achieving diabetes remission in our current environment. Giving up processed and ultra-processed food is, in fact, very hard and goes against both evolutionary drivers that control our behaviour and social norms. I know this personally, yet I consider myself lucky to have a partner who is both supportive and who shares my lunatic, fringe dwelling beliefs. People with less conviction, less grit, less social support, even less understanding of how our brains actually work, are literally standing against Big Food, Big Pharma and Big Medicine like David battling Goliath.

There are three words missing from this position statement that doom it to failure by the time the sun sets this evening and those are "whole food diet."