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Causes of diabetes CAUSES OF DIABETES
No one knows what causes Type 1 diabetes. Undoubtedly genetic, environmental and immunological factors play a part. It is currently thought that certain genetic abnormalities make particular individuals more susceptible to outside agents that affect the insulin-producing cells in the pancreas.
• Several experimental findings are not easily explained by this hypothesis, though, especially the fact that there are such different incidences of the disease in genetically very similar populations-for example, different generations in Scandinavian countries. If a population is genetically stable yet has very different variations in incidence over the years, it suggests that an environmental factor must be involved.
All of this led a team of doctors in Denmark to look at the link between breastfeeding and childhood diabetes. They found that when breastfeeding rates were low in a population the babies subsequently went on to have more diabetes than when breastfeeding rates were high. So, breastfeeding appears to protect against childhood insulin-dependent diabetes. The peak onset of diabetes was nine years after the low-point in the breastfeeding-popularity graph and this figure coincided with the average age of onset of diabetes in Oslo children (9.3 years).
The authors of this study propose that breast milk (already known to contain many protective factors) contains certain anti-infective agents that prevent viral infections that would otherwise affect the insulin-producing cells in certain people. Another possibility is that cows' milk formula actually changes the pancreatic cells because of the abnormal protein or chemical load it contains. Whatever is the case, it is clear that children from susceptible families would be more vulnerable if bottle-fed.
• It is current practice to give sugar water very early on -often in the nursery of the post-natal ward. I feel that this must be harmful and it is proven that such slugs of sugar (which are of no physiological value) produce surges of insulin production way beyond normal. Perhaps such over-stimulation of the insulin-producing cells of the pancreas also damages them early in life. No one knows if this is so but it seems a reasonable hypothesis.
• Diet has always been seen as a major factor in the control of diabetes of both types. Since the end of the eighteenth century low-carbohydrate diets have been advised on the basis that diabetics, being low in insulin, could not handle the glucose produced by high levels of ingested carbohydrate. A study carried out in 1974 found that the majority of diabetic clinics were recommending a diet providing 40 per cent of daily calories as carbohydrates. In reality such diets usually yield only about 30 per cent of calories in this way and about 50 per cent of all the calories come from fat. There is now substantial evidence that diabetics should be advised to eat a high-fibre diet rich in unrefined, complex carbohydrates. This is an intrinsically slimming diet (if such carbohydrates form 60 per cent or more of total daily energy), which helps middle-aged Type 2 diabetics, whose treatment depends mainly on losing weight. But more excitingly research has found that insulin-dependent diabetics also prosper on the diet and that some can even come off insulin entirely. It seems likely that bulk-forming fibres smooth out the absorption of sugar from the intestine. Such a diet also alters various risk factors for heart disease (namely lipoprotein levels and blood-clotting factors), which is good news because diabetics are especially liable to suffer from heart disease. In fact heart disease is a main cause of death.
• There is no doubt that Type 2 diabetes is caused by obesity, especially in middle age.
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