The Road to Diabetes

Examination of the Impaired Fasting Glucose data from the 1999–2000 National Health and Nutrition Examination Survey (NHANES) suggests that 27 million United States adolescents alone are at risk for developing diabetes and cardiovascular disease (Williams, 2005). The prevalence of diabetes in the U.S. in 2005 exceeds 20 million, or about 7% of the total population, with estimated annual health-care costs of approximately $132 billion.

Whether we are discussing type 1 diabetes, previously known as insulin-dependent diabetes mellitus, or type 2 diabetes, formerly called non-insulin-dependent diabetes mellitus, it is safe to assert that lifestyle changes are important disease-modifying variables.

Type 1 diabetes has been regarded as an autoimmune attack on the insulin-producing cells of the pancreas. This pathology, which accounts for 5–10% of all diagnosed cases of diabetes, does not have any known roads of prevention. Type 2 diabetes, which accounts for 90–95% of all diagnosed cases of diabetes, is driven by a resistance or insensitivity to adequate insulin. Type 2 diabetes is strongly associated with diet and exercise patterns, thereby providing a non-medical means of managing a potentially devastating and multifactorial illness.

Other provocative evidence from the Nurses’ Health Studies suggest that increased duration of lactation is associated with a decreased risk of type 2 diabetes among young and middle-aged women (Stuebe, 2005).

Meanwhile, the impact that dairy food consumption may have on type 2 diabetes continues to stir considerable discussion within nutrition and medical communities. Recent statistical assessment of the prospective epidemiological Health Professionals Follow-up Study suggested that higher consumption of low-fat dairy products may lower the risk of type 2 diabetes among males 45–75 years old (Choi, 2005). Several mechanisms have been proposed to explain this observation, and several studies have been cited to counter these explanations.

Dairy products contain an array of components that may support the inverse relationship between dairy consumption and type 2 diabetes. (King, 2005). Notably, bioactive peptides with insulinotropic properties may augment insulin secretion and stimulate glucagon-like peptides that potentiate insulin activity. Magnesium may function as a mild calcium antagonist intracellularly and thus participate in the modulation of lipolysis and insulin sensitivity. Dairy consumption is also associated with a lower risk for hypertension and cardiovascular disease, which may be co-morbidities associated with type 2 diabetes. Independently, the increased intake of potassium and supplemental vitamin D intake associated with dairy foods have been linked with a lower incidence of type 2 diabetes and related health complications.

We are reminded that the 2005 Dietary Guidelines for Americans include a recommendation that Americans “consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.” The strength of clinical evidence regarding the inverse relationship of dairy product consumption and chronic disease is interesting, yet the mechanisms to explain the importance and complexity of this evidence still falls under the tentative umbrella of “emerging science.”

Nonetheless, there is sufficient evidence to suggest that reducing the risk of type 2 diabetes and preventing the complications associated with this disease represent significant opportunities for the food industry to build a strong relationship with nutrition and health-care professionals. There is clinical evidence of foods that improve glycemic control, reduce blood pressure, lower risks of cardiovascular disease, and develop favorable serum lipid profiles in conjunction with appropriate physical activity.

It is interesting to note that among the 37 government-sponsored clinical trials on type 1 and type 2 diabetes, none has an objective to examine opportunities for dietary intervention per se. The value of continued research that integrates food science, nutrition, and health should not be underestimated.

by Roger Clemens, Dr.P.H.,
Contributing Editor 
Director, Analytical Research, Professor,
Molecular Pharmacology & Toxicology,
USC School of Pharmacy, LosAngeles, Calif.
[email protected]

by Peter Pressman, M.D.,
Contributing Editor
Attending Staff, Internal Medicine,
Cedars-Sinai Medical Center, Los Angeles, Calif.
[email protected]

References