The Diabetes Epidemic + Research Bites

Hello there, Dr Jedha here and thanks for tuning into episode 43. Over the past couple of months I’ve been gathering together some headlines, highlights, research bites and bits to share so today we’ll be covering a mix mash of topics from global diabetes statistics and world health organization warnings to research bites about metformin timing, high cortisol and high blood sugar, emulsifiers, flavonoids, foods, healthy diets, along with our environment and BPA in plastic bottles and cautions about surfing the wild west web.

First, let’s dig into some sobering statistics. 

Globally we’re facing major major health issues, and in particular, recent headlines across the globe have emphasized the global diabetes epidemic continues to grow out of control. 

The FDA commissioner publicly stated the United States is failing diabetes. In the US there are approximately 34 million living with type 2 diabetes, 98 million living with prediabetes, and 8.7 million people undiagnosed.

The UK noted an 18% rise in cases of prediabetes in just one year, placing people at high risk of type 2 diabetes, 21% increase in type 2 diabetes, at least 1.2 million undiagnosed. In the UK, there are approximately 4 million living with type 2 diabetes, over 3.6 million prediabetes. 

Australia revealed alarming statistics, with rates of type 2 diabetes tripling over the past three decades and at least half a million undiagnosed cases. In Australia there are approximately 1.3 million living with type 2 diabetes, 2 million prediabetes.

In Canada stats are sitting around 3.2 million with type 2 diabetes, 6 million with prediabetes, another million more undiagnosed, with a 26% increase in cases expected in the next decade.

Most disturbing is the increased rates we’re seeing in younger people – and we’re primarily talking about type 2 diabetes, as this is the most common type. 

In the UK, there’s been a 25% increase in the number of people under 40 with prediabetes, and a 40% rise in type 2 diabetes diagnoses in younger people. In Australia, the past decade has seen a 44% increase in people between 21-39 years and 17% rise in those under 21 years!! In the US we’ve seen an increase of half a million diagnosed cases in 18-44 year olds, and an estimated few hundred thousand more undiagnosed. The trends in type 2 diabetes in children and adolescents from 10 to 19 years is increasing. 

To say we have an issue is really an understatement.

What’s interesting about this, and this is where I would like to ask for your help: So the interesting thing is the percentage of people meeting goals for A1c levels under 7%, along with normalizing blood pressure and cholesterol is only sitting at 11.1%. Out of all the millions of people living with diabetes, this is a small percentage. We really need your help in spreading the word about us, about DMP, about the T2Diet Program, about Type 2 Diabetes Talk, because the stuff we do is helping people achieve these goals and we need to help more people do this. I’m proud to say we’re part of the solution and can make a big impact on people’s lives. So please, share a link to our site on social media, recommend our site or our podcast to family, friends or colleagues and if you’re a regular listener of the podcast, please leave a rating on Apple, Spotify or where you listen to the podcast, because this all really helps us reach more people and the more people we can reach, the more lives we can impact and change for the better. And I thank you in advance for doing that. 

As I said, to say we have an issue is really an understatement. This is a global diabetes epidemic and one of the primary issues is our diet and nutrition quality. More importantly though, is two things: 

One, there has been widespread misinformation about diet and nutrition and what the right type of eating plan to change diabetes health. Unfortunately this includes information that has come out of diabetes organizations for decades. This is terrible as we know people turn to places like the American Diabetes Association, Diabetes Canada or Diabetes Australia to get information and they think it’s the best information. Of course, why wouldn’t you think that as these organizations are supposedly the governing bodies of diabetes in the country. In addition, their information is free, which is appealing. But that doesn’t mean it’s accurate or based on the best research. 

The second issue is there just isn’t enough support available. There is not enough workforce capacity to meet the demand. With 34 million people living with type 2 diabetes in the US, there are less than 5000 endocrinologists – who are meant to be specialists in this area. This lack of workforce capacity is widespread, with limited health professionals across all areas, diabetes educators, physicians, dietitians, among others. And it’s an issue that’s global as well. 

That’s where our online nutrition programs and services are helping to close the gap. We can reach people no matter where they are, provide the ongoing education and support people need, and you have the benefit of accessing that support anytime, anywhere. As I said, I’m very proud of the fact that we’ve been supporting people to achieve better health for over a decade and we will obviously continue to do that. 

Moving on with the rest of today’s episode I have some research I’ve been collecting, interesting new research I’ve read that I wanted to share with you. 

The first thing we’re covering is the best time to take metformin. 

Metformin is one of the most commonly prescribed medications for managing both type 2 diabetes and prediabetes. A frequent question I get is, ‘When is the best time to take metformin? Should it be before, with, or after meals?’ Traditionally, to minimize gastrointestinal distress, it’s often recommended to take metformin with meals.

However, new research suggests that the optimal time might actually be 30-60 minutes before meals. The study found that taking metformin before meals led to greater reductions in glucose levels and increased blood levels of GLP-1. Now, you might be thinking, ‘Isn’t GLP-1 the name of a new medication? Actually, GLP-1 stands for glucagon-like peptide-1, which is a hormone naturally produced in the body. It helps regulate blood sugar levels and appetite. Some diabetes medications, like those you might have heard of, Ozempic or Wogovy for example, mimic this hormone to help manage blood sugar more effectively.

So, by taking metformin before meals, you might be enhancing your body’s natural GLP-1 levels, leading to better blood sugar control. 

Speaking of the popular drugs Ozempic or Wogovy. Around the globe there has been surging demand for these and with that comes another major issue – counterfeit drugs! The World Health Organization issued a global critical warning about this counterfeit drug issue, with some drugs found to be falsely claiming to contain semaglutide, the active ingredient in diabetes drug Ozempic and weight-loss treatment Wegovy. According to WHO, counterfeit versions have been found in Brazil, the UK, and the US. The Australian Government also issued warnings about dangerous compounded replicas being distributed to patients. Clearly, this is of high concern and something I wanted to highlight that you be aware of if you do take these medications. 

Another interesting little research bite was a new study about how high levels of cortisol may increase complications or make it difficult to regulate blood sugar. It’s new data so we certainly need more research to truly establish this but essentially if you have been struggling to get your blood sugar levels under control it could be due to high cortisol. Cortisol is our stress hormone and when this is high it elevates blood sugar levels. The researchers screened 1000 people and found 24% of them had high cortisol and even more interesting was that those who were taking multiple medications for high blood pressure had higher rates of high cortisol. They don’t know whether this is stress related or due to alterations in organs, for example, some people had abnormalities in the adrenal gland. This is the gland that produces cortisol. As I said, this is very early data so it will be interesting to see if this evolves as more research is done. 

There was a study highlighting the potentially detrimental effects of common food additives in terms of risk of developing type 2 diabetes. There’s not too much research around specific additives so I always find this research interesting. 

Common emulsifiers with potentially detrimental effects included tripotassium phosphate, guar gum, xanthan gum, sodium citrate, gum arabic, and carrageenans. These might sound familiar as you’ve probably seen them on food labels of common foods like breads, cakes, biscuits, yogurt, ice cream, chocolate bars, margarines, ready-to-eat meals and many other processed foods.  As I said, the research highlighted that additives may contribute to increased risk of developing type 2 diabetes. 

This is why we have such a focus on encouraging nutrient-dense, quality diets. Nutrient-dense diets, rich in vegetables, fiber, protein, and healthy fats, provide vitamins, minerals, and essential nutrients that are foundational for maintaining stable blood sugar levels, reducing cellular inflammation and optimizing metabolism. By focusing on consuming high-quality foods, we can avoid the pitfalls of ultra-processed foods, to help mitigate metabolic disturbances and reduce risk of diabetes. And of course, to treat diabetes more effectively too. Always try to focus on eating whole, unprocessed foods.

Of course it’s logical and makes sense that a healthy eating plan supports better health. It’s certainly been shown in ample research to support improved blood sugar, weight loss, and reduced medications. But just to confirm this, a study looked at almost 1600 men between 51-81 years without diabetes. And of course a healthy eating plan was associated with lower blood glucose and better insulin sensitivity, and this was regardless of whether a person had a genetic risk of type 2 diabetes. The healthy eating part is not really new. It’s just more research to confirm the fact. I guess the interesting thing was that even with a higher genetic risk, you have some control of the outcomes and focusing on a healthy eating plan is important. In the study the unhealthy diets were High in fried potatoes or French fries; hamburgers; pizza; refined pasta or rice; sweet pastries; candy; savory pies and pastries; savory snacks; ice cream or puddings; French roll, baguette, or other white bread; sweet cookies, biscuits; etc. As we can see, we’re talking about lots of refined and processed food that is loaded with added sugar and high in carbohydrates. Nutrient poor food. 

To highlight again the importance of nutrient dense foods having multiple health benefits, a UK Biobank study highlighted that flavonoid-rich foods can help reduce the risk of type 2 diabetes. The population study, involving over 113,000 participants, revealed that a higher intake of flavonoid-rich foods—such as tea, berries, and other foods—was associated with a 26% lower risk of developing T2D.

Key findings included:

• Drinking tea (black and green): with a 21% lower T2D risk with 4 servings/day
• Eating berries: with 15% lower T2D risk with 1 serving/day

So certainly consider including tea and berries in your daily routine. Most natural foods will provide many health benefits due to the compounds they contain – the flavonoids and polyphenols for example, which is why we encourage nutrient dense foods. 

Onto another topic. If you’ve never heard of bisphenol A, or BPA—it’s a chemical found in many plastic water bottles and food containers. For a long time, the evidence linking BPA to health issues has been observational. This means it showed an association but couldn’t prove that BPA was the direct cause of these health problems. However, a groundbreaking new study has provided direct evidence that BPA can reduce insulin sensitivity, potentially increasing the risk of type 2 diabetes. The study found that even levels of BPA currently considered safe by the Environmental Protection Agency can impair insulin response. This suggests that we might need to reconsider our exposure to BPA and opt for alternatives like stainless steel or glass bottles. Certainly with your drinking water you need to be conscious of this and use stainless steel or get BPA free plastic. This concern over BPA is part of a broader awareness about environmental contaminants and their potential long-term health effects. Recent research has also shown that microplastics, which can infiltrate human cells, might pose serious health risks, being found everywhere from our lungs to our reproductive organs. There is ongoing research in these areas but it does highlight the fact that our modern environment plays a role in our overall health as well. 

The last thing I wanted to cover today was the crazy inaccurate stuff I come across when browsing the wild west web. This stuff really frustrates me because it gives people absolutely wrong advice and in doing so is going to keep people from getting better results with their health. For instance, I came across an article titled: ‘Best Diet Plans for People with Diabetes, Reviewed by Experts’. When I see headlines like that I always think: okay, here we go. The article kicks off by promoting the Diabetes Plate Method, which is a method the American Diabetes Association uses, which allows selection of food choices and One-fourth of your plate can be carbohydrate foods like whole grain rice, quinoa, and starchy vegetables such as potatoes and butternut squash, or 3 choices which is around 45 grams of carbs. Now, that’s a lot. Further down the article the nurse/diabetes educator recommends people consume 30-60 grams of carbohydrates per meal. Granted, not all of the article was bad, but the carbohydrate recommendations are out of line. At 60 grams per meal a person with any kind of diabetes will struggle to lower blood sugar and A1c, lose weight and reduce meds, so it’s just not sound advice. Unfortunately I saw this same advice recently on the Australian National Diabetes Service Scheme site. The carbohydrate course they provide and their carbohydrate counting and quick checklist recommends 30-45 grams carbs per meal for women and 45-60 grams of carbs per meal for men. This type of information is outdated and even harmful to people, so as I said, it makes me a bit frustrated. In any case, I wanted to note this for you today, to keep an eye out across the wild west web because it’s more common than not to come across inaccurate information. And when it comes to implementing that advice into your life, it may in fact do you more harm than good. Just keep your sheriff detective hat on as you browse the wild west web, okay. 

Well, that’s all from me today. I hope you’ve enjoyed today’s episode, number 43. As I stressed at the beginning, with the growing rates of diabetes, we really need your help in spreading the word about us, about DMP, about the T2Diet Program, about Type 2 Diabetes Talk, because the stuff we do is helping people achieve these goals and we need to help more people do this. Please share a link to our site on social media, recommend our site or our podcast to family, friends or colleagues and if you’re a regular listener of the podcast, please leave a rating on Apple, Spotify or where you listen to the podcast, because this all really helps us reach more people and the more people we can reach, the more lives we can impact and change for the better. 

Thanks in advance for doing that. 

Take care until next week.

Dr Jedha, over and out.