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Risky business

I was recently reading about a new initiative from the World Health Organisation (WHO). The WHO are bringing out guidance on the whole subject of sugar in our diets and how we all need to reduce the daily quantity we consume.

Apparently in 2002, their recommendation was that sugars make up less than 10% of our total energy intake per day. The new draft guideline goes even further, suggesting that not only should our total energy intake be less than 10% sugars each day, but if we are able to reduce our intake to below 5% we will get additional benefits. In simple terms that equates to eating no more than six teaspoons of sugar, or 25g of sugar in some shape or form.

All around us we can see the evidence of the fact that we all have been eating too much sugar by the levels of obesity we witness. We do need to take some action now, to stop further increases in obesity and diabetes, because it is going to become even more difficult to manage in the not too distant future.

Do we need to make changes to the foods that we cook and eat; do you think we need government legislation to help us to improve our diets? Something does need change, and even little changes can make a difference.

Some years back measures were taken to try and reduce the fat we were eating and ensure we were eating fats that were less harmful to us. Despite those endeavours, we find that deaths due to heart attacks and coronary heart disease (CHD) have reduced, but there has been an obesity explosion, and the consequent growth of type 2 diabetes has been staggering.

I am undertaking a module on Diabetes and Obesity as part of an online diabetes diploma and this week we've been looking at the metabolic syndrome (MS). Looking at MS is a stark warning that when we see someone in practice who is obese, or has raised blood pressure or impaired fasting glycaemia or raised cholesterol, we need to look at them as holistically and ensure we are treating them for all the other risk factors for MS.

We cannot ignore the facts when we know these metabolic risk factors may all appear in the same person, and if left untreated may mean the person develops type 2 diabetes, CHD or some complication caused by them.

How many of us use the term metabolic syndrome? There again, how many are aware of what it is referring to? MS, for those who don't know, is the group name for certain metabolic risk factors, including central obesity or increased waist circumference, raised BP>130/85 mmHg, raised fasting blood glucose > 5.6mmol/l, elevated triglycerides and reduced HDL cholesterol.

As you may also be aware, the threshold for waist size in Asian men and women is somewhat reduced compared to white Caucasians, as they appear to develop these metabolic changes earlier then those who are of Caucasian origin.

I'm sure that those of us working with those of South Asian origin will have seen the much higher prevalence of type 2 diabetes in this race, and it would be so good if we could pick up the elements of MS and help the person to reduce the development of any one or more of these factors, to prevent the development of type 2 diabetes, gallstones, cardiovascular disease, non-alcoholic fatty liver disease or polycystic ovarian syndrome.

There is always a way to modify at least one risk factor!