Diabetes and dairy fat in India.
The epidemics of diabetes, cardiovascular disease and related conditions in India have been called iatrogenic (Raheja B.S. 1994), a product of diets high in linoleic acid as a result of “chasing the phantom of cholesterol” (Raheja et al. 1993). The traditional Indian diet (39% fat) supplied 20.3%E as saturated fats, mainly from ghee, with 5% from linoleic acid. Concerns that this diet is atherogenic have resulted in replacement of ghee with high-linoleate oils; the modern urban diet being 31.9% fat, with 5.6%E as saturated fat, and 16.9% linoleic acid (Raheja, B.S. et al. 1993).
In children and young individuals, a high intake of n-6 PUFA is correlated with fasting hyperinsulinaemia, and dietary supplementation with n-3 PUFA leads to an improved lipid profile but not insulin sensitivity. In adults, high-carbohydrate meal consumption was reported to cause hyperinsulinaemia, postprandial hyperglycaemia and hypertriacylglycerolaemia. (Misra, A. 2009).
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The association of ghee consumption in the Indian diet with a lower rate of diabetes is consistent with the correlation between serum markers of dairy fat consumption and reduced diabetes risk (Mozaffarian et al. 2010, 2013). The NZ Ministry of Health currently recommends a wide range of linoleic acid and alpha-linolenic acid in the diet; the lower recommended intake of LA being 4%, the upper being 10%, and the lower recommended intake of ALA being 0.4%, the upper 1% (the omega 6-3 ratio at median intakes thus being 10:1). Saturated fat intake below 10%E is recommended. (Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 years): A background paper. 2012 MOH).
The message from the Indian researchers into the causes of their diabetes epidemic is that higher consumption of dairy fat protected marginal dietary omega-3 intake from abrogation by excessive intakes of omega-6 fatty acids. Replacing highly saturated dairy fats with diets higher in linoleic acid and refined carbohydrate, which is the same effect that the campaign against saturated fat has had among more disadvantaged New Zealanders, has increased the rate of diabetes, which is consistent with the New Zealand experience, suggesting that the increased incidence of diabetes in New Zealand has been in large part an iatrogenic phenomenon.
"The present epidemic of DM and ACVD in Asian indians and possibly in other communities is iatrogenic resulting from what may be called modern malnutrition due to increased intake of total and n-6 fats and decreased intake of n-3 fat and antioxidants. Such a diet induces oxidative stress and activates the immune system. Imbalance between n-6 and n-3 fats result in inappropriate immune response. It also leads to increased and unbalanced biosynthesis of metabolites of n-6 fats. These are immune suppressive, proinflammatory and thrombogenic. They also contribute to insulin resistance and dyslipidemias. This makes DM and atherosclerosis as malnutrition related oxidative immune inflammatory disorders. Various risk factors are also the result of the same inappropriate response. Our intervention studies give considerable support to this hypothesis. It is suggested that simple correction of diet defects can reverse the disease process and thereby offer a simple, practical therapeutic option not only for the primary prevention of each of these disorders or their complications but also for the so called risk factors for these diseases. It is suggested that the real remedy for DM, ACVD and all the risk factors lies not in drugs or surgery but in the kitchen."
- B. S. Raheja
Misra, A. et al. (2009). South Asian diets and insulin resistance. Br J Nutr. 2009 Feb;101(4):465-73. doi: 10.1017/S0007114508073649
Mozaffarian, D. et al. (2010). Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults. Ann Intern Med. Dec 21, 2010; 153(12): 790–799. doi: 10.1059/0003-4819-153-12-201012210-00005
Mozaffarian D. et al.
(2013). Trans-Palmitoleic acid, other dairy fat biomarkers, and incident
diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr.
2013 Apr;97(4):854-61. doi: 10.3945/ajcn.112.045468.The epidemics of diabetes, cardiovascular disease and related conditions in India have been called iatrogenic (Raheja B.S. 1994), a product of diets high in linoleic acid as a result of “chasing the phantom of cholesterol” (Raheja et al. 1993). The traditional Indian diet (39% fat) supplied 20.3%E as saturated fats, mainly from ghee, with 5% from linoleic acid. Concerns that this diet is atherogenic have resulted in replacement of ghee with high-linoleate oils; the modern urban diet being 31.9% fat, with 5.6%E as saturated fat, and 16.9% linoleic acid (Raheja, B.S. et al. 1993).
In children and young individuals, a high intake of n-6 PUFA is correlated with fasting hyperinsulinaemia, and dietary supplementation with n-3 PUFA leads to an improved lipid profile but not insulin sensitivity. In adults, high-carbohydrate meal consumption was reported to cause hyperinsulinaemia, postprandial hyperglycaemia and hypertriacylglycerolaemia. (Misra, A. 2009).
The association of ghee consumption in the Indian diet with a lower rate of diabetes is consistent with the correlation between serum markers of dairy fat consumption and reduced diabetes risk (Mozaffarian et al. 2010, 2013). The NZ Ministry of Health currently recommends a wide range of linoleic acid and alpha-linolenic acid in the diet; the lower recommended intake of LA being 4%, the upper being 10%, and the lower recommended intake of ALA being 0.4%, the upper 1% (the omega 6-3 ratio at median intakes thus being 10:1). Saturated fat intake below 10%E is recommended. (Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 years): A background paper. 2012 MOH).
The message from the Indian researchers into the causes of their diabetes epidemic is that higher consumption of dairy fat protected marginal dietary omega-3 intake from abrogation by excessive intakes of omega-6 fatty acids. Replacing highly saturated dairy fats with diets higher in linoleic acid and refined carbohydrate, which is the same effect that the campaign against saturated fat has had among more disadvantaged New Zealanders, has increased the rate of diabetes, which is consistent with the New Zealand experience, suggesting that the increased incidence of diabetes in New Zealand has been in large part an iatrogenic phenomenon.
"The present epidemic of DM and ACVD in Asian indians and possibly in other communities is iatrogenic resulting from what may be called modern malnutrition due to increased intake of total and n-6 fats and decreased intake of n-3 fat and antioxidants. Such a diet induces oxidative stress and activates the immune system. Imbalance between n-6 and n-3 fats result in inappropriate immune response. It also leads to increased and unbalanced biosynthesis of metabolites of n-6 fats. These are immune suppressive, proinflammatory and thrombogenic. They also contribute to insulin resistance and dyslipidemias. This makes DM and atherosclerosis as malnutrition related oxidative immune inflammatory disorders. Various risk factors are also the result of the same inappropriate response. Our intervention studies give considerable support to this hypothesis. It is suggested that simple correction of diet defects can reverse the disease process and thereby offer a simple, practical therapeutic option not only for the primary prevention of each of these disorders or their complications but also for the so called risk factors for these diseases. It is suggested that the real remedy for DM, ACVD and all the risk factors lies not in drugs or surgery but in the kitchen."
- B. S. Raheja
Misra, A. et al. (2009). South Asian diets and insulin resistance. Br J Nutr. 2009 Feb;101(4):465-73. doi: 10.1017/S0007114508073649
Mozaffarian, D. et al. (2010). Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults. Ann Intern Med. Dec 21, 2010; 153(12): 790–799. doi: 10.1059/0003-4819-153-12-201012210-00005
Raheja B.S. (1994). Diabetes and atherosclerosis as immune-inflammatory disorders: options for reversal of disease processes. J Assoc Physicians India. 1994 May;42(5):385-90, 395-6. PMID:7829439
Raheja, B.S. et al. (1993). Significance of the N-6/N-3 Ratio for Insulin Action in Diabetes. Annals of the New York Academy of Sciences, 683: 258–271. doi: 10.1111/j.1749-6632.1993.tb35715.x
Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 years): A background paper. (2012) New Zealand Ministry of Health.
http://www.health.govt.nz/system/files/documents/publications/food-and-nutrition-guidelines-for-healthy-children-and-young-people-p4.pdf