America’s losing battle against diabetes

Type 1 diabetes really is the type that hits out the blue seemingly without explanation. It is not caused by obesity, poor diet, or lack of exercise. Type 1 is caused by the body's immune system turning round and destroying the pancreatic beta cells that produce insulin. There has been a lot of suggestion that this may be triggered by a viral infection that the immune system is trying to fight, but we're not 100% sure. It can hit at any age, although most commonly it tends to be in the teens and early twenties. Regardless, if your sister truly has type 1 diabetes (and it can often be misdiagnosed) then she has few to no working beta cells left, and it is entirely not her fault.

Interestingly, there is a stronger genetic component to type 1 diabetes than there is to type 2 diabetes. We can analyse a set of 30 or so locations in the genome and give you a score, which is how likely you are to trigger type 1 diabetes. Most of the score is based on just one region in the genome, the HLA region which controls the way your immune system distinguishes between self and enemy. A person with a low score can still get type 1 diabetes, but it is much less likely.

We know that to get type 1 diabetes, you need to be susceptible (that we can measure with the genetic test) but also there needs to be some kind of trigger. I don't think having a second child was the trigger, but something was.

> Well, then I disagree. There's people getting no diabetes even though eating a lot of sugar and I bet there's also a lot of people getting or having diabetes without eating any sugar.

The only people getting diabetes without eating sugar are the ones that are genetically predisposed to it. (i.e. Type 1 Diabetes) We are not talking about those people. We are talking about the people who get diabetes because of insulin resistance due to being obese (Type 2 Diabetes). Sure there are lots of foods that don't contain sugar like chicken breasts, vegetables, legumes, etc; however, these are not the foods people are eating that is causing them to become obese. It's really hard to overeat those kinds of foods only, because you will become full and stop eating before you have consumed way too many calories.

> I don't think that's how it works.

I mean you can think anything you want, but you thinking something is not going to change the basic science. People can only gain weight by consuming more calories than they use. The majority of people are losing most of their calories by just breathing every day. Even if they introduce regular exercise they won't significantly change the calories out number, so the only choice left is to shrink the calories in number and the easiest way to do that is remove foods from your diet that contain a lot less added sugar.

> If anything, it is a surplus of calories in general, but that can happen without sugar and it also doesn't explain how it even comes to this surplus.

> To me it honestly feels as if you are just trying to make your life easy by finding an "easy" solution.

Sure, in principle obesity can happen with any food or additive, but in practice the leading contributor is sugar. You don't need to believe me you can DYOR on this subject. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959843/) There are other foods that should be limited besides sugar, but the way you start tackling a problem like obesity/diabetes is eliminate the biggest contributors first and then work your way down.

> Replace sugar with fat and the same is true, no? So tax added fat as well? How about protein then?

In fact, the food industry did the opposite. They replaced all the added fat with sugar and that is why there is so much sugar in everything now. The other thing though we haven't talked about is the fact that foods with sugar tend to have a high glycemic index. A high GI value causes blood sugar levels and insulin to increase quickly, which in turn causes insulin to be overproduced and more fat to be stored. In effect, the sugar that replaced fat turned out to be worse, because of biochemical processes within the human body. Perhaps if the industry starts adding lots of fat back into food if sugar was eliminated, then there would need to be a fat tax. You'd get no argument from me there, but it is not such a big problem currently. As for protein, try and consume your daily caloric intake just eating chicken breasts some time. You'll probably throw up before you get there.

> Maybe you meant "doesn't make you feel as full as other things"? Well then I might agree, but here it becomes complicated - if you are actually consequent, you would not tax sugar, but things that "make you not feel as full", don't you agree?

No, it's not about taxing something that doesn't make you feel full. It's about taxing the biggest contributor that is adding lots of excess calories into your diet and effecting the chemical processes in your body to store more fat.

> You just said something very important: "too much". But what is too much? That question can't even be answered in general, because, for example, it is different for someone lying on their couch the whole day and someone doing extreme sports.

While the threshold for how much sugar can be consumed safely may vary from person to person, it is quite obvious that on the aggregate the majority of people in the world are consuming way more than they should. The AHA recommends an added sugar limit of no more than 36 grams per day for men. (https://www.hsph.harvard.edu/nutritionsource/carbohydrates/a...) That means if you consume one can of regular coke you have already exceeded your limit for the day. You set public policy and pass laws based on the population at large and most people are not doing extreme sports. Also, for those that are doing extreme sports sugar consumption is best targeted pre-workout or during the workout for a quick boost of energy. They will still though get a lot of their glucose intake from natural sources of sugar and so even athletes should limit the amount of added sugar they consume.

How will you enforce a climate tax on China?

> But you seem to assume that insulin or frequent high insulin levels cause insulin resistance.

In another comment You stated obesity causes T2D. As I previously stated there are obese people that do not get T2D, but more importantly there are skinny people who get T2D.

In response you replied to another comment claiming there are medical cases where people who do not eat carbs get T2D in attempt to disprove my position. Again I ask you to link a single case of T2D where the patient did not consume carbs/sugars. It would be the same as trying to find a case of non alcoholic fatty liver disease where the patient does not consume carbs/sugars, another chronic condition that is linked to obesity but not cause by obesity, it is cause by chronic damage to the liver by way of processing sugar, like T2D it just doesn’t happen without carbs/sugars.

Consider that in many - not all - cases of pre-diabetes and even full T2D, patients can make dietary/lifestyle changes to reverse their insulin resistance and even get off medication entirely. Reversing T2D is successfully done by reduction of sugar/carb consumption, it can be but doesn’t need to be a ketogenic diet. But I have never heard of any case where a patient successfully reversed T2D with weight loss alone without reduction of carb/sugar intake.

> Actually, quite the opposite. People who don't consume foods with lots of added sugar are already healthier and wouldn't end up paying a lot more for their food.

Not "the opposite". Exactly as I said: a lot of people would end up paying more, for no health benefit.

> Increasing physical activity and micro-nutrients are great goals, but do not play a large part in the obesity epidemic.

That is merely your own opinion, but you seem to think that this is a fact. If you are so sure, I'm sure you have some good sources for that? I mean, the first study you linked actually doesn't speak in your favor.

> Sure, it does. As you yourself stated "added sugar has zero good micro-nutrients", by definition these are excess calories that you don't need.

Wait what? That's not how "excess" is commonly defined. Here's how this term is usually used:

> When you eat more calories than you need, your body stores the extra calories as body fat. Even a fat-free food can have a lot of calories. Excess calories in any form can be stored as body fat. (https://my.clevelandclinic.org/health/articles/4182-fat-and-...)

or

> “Excess calories per day” is simply an arbitrary measure over an arbitrary unit of time to better calculate and plan your diet and calorie deficit/surplus (depending on your goals). (https://www.forbes.com/sites/quora/2017/07/27/how-long-does-...)

So this term is used simply for surplus calories. Sure, sugars can be surplus calories, but if I eat 2500kcal of protein in a day and my body only burns 2000kcal, then 500 of these are excess calories. But I could have left out 500 of any of these 2500kcal to avoid excess calories. So my point still stands.