dimanche 25 septembre 2011

NAURU AND DIABETES WISH YOU WERE NOT HERE

WISH THEY WERE NOT HERE..


At the recent meeting of the European Association of the Study of Diabetes (September 12-16, 2011) at Lisboa, Portugal, alarm was sounded by the troubadours of Diabetes tragedy how this epidemic is spreading out of control. As one Elder of the Lakota Nation once barked at the officials at one such conference: We are sick and tired of you telling us that we are sick, for God’s sake tell us how to prevent it.
That is something all these echolalic endocrinologists and professor peons have been unable to do while decorating each other with yet another prize or reward for exciting research. I am sure they would be baffled by the following results published in BMC Public Health just one week after the conference.
While diabetes prevalence has decreased in Nauru over the last thirty years, results from this study indicate that the rate of diabetes is still very high. Similar or higher rates of diabetes have been reported in other Micronesian populations in the Pacific region [19, 20]. For example, the prevalence of diabetes (fasting blood glucose ≥ 6.1 mmol/L) in Kiribati individuals aged 22-64 years old was 28.1% in 2006 [20] and in Pohnpei, the prevalence of diabetes (fasting blood glucose ≥ 7.0 mmol/L) among individuals aged 25-64 year olds was 32.1% in 2002 [19]. In other parts of the world, the prevalence of diabetes is notably lower. For instance, the sex standardized prevalence of total diabetes in the United States in 1999-2002 was 6.5% (95% CI: 5.9–7.2) among individuals 20 years and older [21] and 9.7% (95% CI: 9.2–10.1) in China among adults 20 years of age or older [22]
Prevalence and Risk Factors of Diabetes and Impaired Fasting Glucose in Nauru
BMC Public Health 2011, 11:719 doi:10.1186/1471-2458-11-71
Why has Diabetes prevalence dramatically decreased in Nauru? Have they become so health conscious that they started walking around their little island? Have they gone back to the days of yore when they were fisherman, an art form completely lost ever since the Australians and New Zealanders plied them with all the canned goods and hydrogenated food stuff?
Even the authors above had made some suggestion that obesity might have a protective effect against Diabetes? So have the Nauruan, once advertised as the Fattest people on earth, become fatter than before?
I have had the fortune of visiting Nauru twice, once when I was taken aboard as a passenger on their Cenpac Trader boat and upgraded to an officer when I rendered some staff some medical help and another time, had to spend extra days in Nauru when a romantic holiday in Majuro was interrupted by a Tsunami.
At that time, Nauru was flush with money, owned hotels in various parts of the world, a tall building in Melbourne that could accommodate their entire population. I had accidentally ran into KaramChand Ramrakha, a brilliant Indo-Fijian lawyer who explained to me the details of the Phosphate money transfer to the Nauruans. They were getting a pittance per tonne mined and overnight after the case was heard in London, income of each and every Nauruan increased many fold. There were opportunists from Australia and NZ who could build supermarkets, car show rooms and the importation of chemical food. I heard once at the lobby of the only hotel in Nauru: when a car has a flat tyre, the owner rather buy a new car than change the tyre!
The troubadours of tragedy, the epidemiologists from Melbourne arrived on red carpet Air Nauru and pronounced them to have the highest rate of Diabetes and Obesity while the liquor flowed non stop at the Bar at the hotel..
I had tried to keep in touch with what was happening in Nauru but the time and distance made Nauru the smallest island republic a haze in memory. But Nauru resurfaced again, this time again with regard to its Diabetes…
The Economist, in my opinion the best news magazine in the world (despite their slight conservative tendancy and anti Israel leanings) had published articles on Nauru.
Nauru
Paradise well and truly lost
Greed, phosphate and gross incompetence in a tropical setting: the history of Nauru really is stranger than fiction
Dec 20th 2001
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you may wish to read the article in full on line to get to understand the rise and fall of Greed in Nauru.
http://www.economist.com/node/884045?story_id=884045

Recently I had the opportunity to give a talk to Diabetes Professionals working with Native Americans and I stressed the fact that if we look at Diabetes among native people with a very strict scientific viewpoint we would never be able to help them. Because Diabetes is a social illness, brought on my social, environmental factors on a population suppressed and discriminated against, living in poverty in the land of plenty. If such an understanding does not exist, the outcome of adopted treatments would fail. If we understand the true causes then we will institute proper measures.
Give us jobs, said another Elder, then we can conquer this Diabetes..
The cause of the lessening of Diabetes prevalence in Nauru may have to do with Paradise truly being lost. The per capita income went down from approximately 12,000 dollars to 2,000 dollars while the same conditions that existed at the time of Diabetes Storm persisted. 98 per cent are still overweight or obese, on the exercise scale, they are one of the least physically active people on earth, but the diabetes rate is falling, if not dramatically, at least substantially!
This is how the authors explained the decline, you can see their heavy biomedical leanings, but give them credit for including some concession to the social scientists….

The specific reasons for the decline are not certain. Evidence from previous studies support a strong genetic component for diabetes among Micronesians in Nauru [6, 13]. Early data pointed to NIDDM clustering in certain ethnic groups, especially the Pima Indians, Nauruans and Australian Aborigines, lending some support to the thrifty gene hypothesis[14]. The thriftygene hypothesis postulates that metabolically thrifty genes allow more efficient food utilization, fat deposition and rapid weight gain at occasional times of food abundance, for better survival during a subsequent famine [6]. In 1991, Dowse and colleagues reported a decline in the incidence of abnormal glucose tolerance in Nauru, which they attributed to the fall in the population frequency of the thrifty genotype due to higher mortality and lower fertility among diabetic Nauruans [5]. However, work by Barker and colleagues suggested that the size and speed of change was unlikely a eugenic effect of low reproduction among diabetics and more likely a result of improved foetal and infant nutrition in the post-war generation [11]. Counter arguments of the thrifty gene hypothesis warn against using this to explain high rates of chronic disease in post-colonial indigenous societies because it confuses ”genes” with ”race”, and does not give due credit to epidemiological data that shows the effects of social class, education, income, poverty, ethnicity and prior malnutrition on chronic diseases [15]. The 20-fold increase [3] in diabetes prevalence from the 1960s to the 1980s has argely been attributed to lifestyle changes of Nauruans, especially a shift from a healthier and more traditional diet to consuming imported processed foods during a period of extreme wealth.

The prevalence of diabetes in Nauru during the 1970s was alarmingly high and represented one of the highest rates in the world [14, 16]. Over the past decade the economic state of Nauru has changed drastically; the phosphate industry collapsed, leading Nauru to suffer a dramatic decline in its economy, and becoming more dependent on foreign aid [8]. The decline in diabetes prevalence in Nauru may be partly attributed to the rapid change in Nauru from an excessively wealthy state to that of a poor state. However, evidence to support this explanation is lacking. None of the dietary or physical activity measures in this study or in fact, in previous surveys [5, 16], were significantly associated with increased risk of pre-diabetes or diabetes compared to those with normal levels.
As an aside, I can tell you why they thought obesity has a protective effect.
More than once I have seen young American Indians, in their twenties, already diagnosed with Type 2 DM returning to the clinic with loss of weight and normalized blood sugar or A1C. Before you congratulate them on their effort, they tell you that they had run out of their Insulin and other medications and our wise nurse points out that his loss of weight a metabolic one, induced by increased blood sugar and its clearance. May be the Nauruans had less diabetes because they were forced to do the best aspect of Nutritional Therapy for patients and others without Diabetes: Eat Less..
In times of want, mortality and prevalence of diabetes does go down..



Fig. 5. -- England and Wales food consumption and female diabetic deaths. Showing the correlation between food consumption and diabetic mortality rate. The female rate was chosen as less influenced by mobilization, and the curve antedated one year to allow for time lag. (Himsworth.)article published in 1949
here is an image to show sugar and refined carbohydrate consumption and its effect upon diabetes mortality..whatever conclusions the authors may have drawn at that time, one thing is clear: during the time of want, rationing, diabetes mortality does drop and when there is plenty of refined food available, the diabetes mortality climbs.
I suddenly remembered something. When the Mexican dictator Porfirio Diaz was asked about the conditions of his native Mexico, he answered:
Pobre Mexico, tan circa de estados unidos y tan lejos de Dios
Poor Mexico, so close to the United States and so far from God
Poor Nauru, so close to the heart of the Australian Epidemiologists and so far from the truth!