Why is the rate of incidence of diabetes increasing?
The increasing rate of diabetes, often attributed to overweight associated with hypercaloric diets, has led to numerous dietary and lifestyle intervention trials. In these, the dietary components have focused particularly on controlling caloric intake through reduced fat or sugars 1, 2, 3, 4. No firm conclusions have emerged.
What appears to be overlooked is the role of high glycemic load combined with a hypercaloric diet. This dietary pattern is exacerbated by focus on reducing saturated fat consumption, and drives metabolism towards android obesity and subsequent diabetes.
Significant caloric restriction reverses biochemical markers of insulin resistance 5. Diets favoring calories from carbohydrate rather than fat lead towards markers, especially dislipidemia, typical of pre-diabetes in an iso- or hypercaloric state 6, 7, 8. The mechanism probably involves de novo lipogenesis from glucose in the liver and pancreatic β-cells.
Restricted caloric intake, especially via very low fat consumption, can delay or reverse the onset of diabetes, but has not proven a sustainable long-term diet. Focusing instead on hypo- or isocaloric diets with very low glycemic load (low carbohydrate), is both feasible in the long-term 9, and addresses factors leading to obesity and overt diabetes.