White rice increasing the risk of diabetes

From ‘Diabetes: The rice you eat is worse than sugary drinks’, 6 May 2016, article by Salma Khalik, ST

The health authorities have identified one of their top concerns as they wage war on diabetes: white rice. It is even more potent than sweet soda drinks in causing the disease. Sharing his battle plan to reduce the risk of diabetes, Health Promotion Board chief executive Zee Yoong Kang said that obesity and sugary drinks are the major causes of the condition in the West.

But Asians are more predisposed to diabetes than Caucasians, so people do not have to be obese to be at risk. Starchy white rice can overload their bodies with blood sugar and heighten their risk of diabetes. Mr Zee is armed with data. A meta- analysis of four major studies, involving more than 350,000 people followed for four to 20 years, by the Harvard School of Public Health – published in the British Medical Journal – threw up some sobering findings.

One, it showed each plate of white rice eaten in a day – on a regular basis – raises the risk of diabetes by 11 per cent in the overall population. Two, it showed that while Asians, like the Chinese, had four servings a day of cooked rice, Americans and Australians ate just five a week.

This is what the ST didn’t tell you about the meta-analysis published in the BMJ.

  1. This study isn’t new. It was published 4 years ago. No authority raised alarm bells about white rice then. We were probably still preoccupied with eggs, butter and fruit juice. And we’ve been wrong about these before. Butter is not worse than margarine. Eggs and their cholesterol do not instantly clog your arteries. Fruit juice is actually bad for kids. The GI theory may turn out to be as misleading as our obsession with saturated fats.
  2.  Clinical trials were excluded from the analyses. In other words, the authors did not consider double-blind controlled studies, the supposedly ‘gold standard’ of trial design. The analysis doesn’t answer the question of whether Asians who consumed the alternative brown rice had a lower risk of diabetes compared to the white rice eaters. So hold your horses and don’t toss your rice to the stray cats just yet.
  3.  Of the 4 studies, there were TWO that were done in China and Japan. The other two were US and Australia. So it’s a foregone conclusion that the Asians were eating more white rice anyway. Also, note China and Japan. Not Singapore. We have options: Bread. Pasta. Potatoes. Carrot Cake.
  4.  In the Discussion section of the paper, the authors acknowledge that ‘socioeconomical status’ between Asians and Westerners may be a confounding factor is these studies. So it’s possible that they were comparing uneducated folk who don’t know much about preventing the disease, vs a typical Westerner who owns a gym membership and goes for regular health checks to ward off diabetes.
  5. Glycaemic load aside, another possible factor accepted by the authors was the relative lack of nutrients in white rice, in particular insoluble fibre and magnesium, which have been associated with lower diabetes risk in other studies. Stuff which can be supplemented by other parts of a NORMAL diet. In short, a glycaemic surge doesn’t explain everything, yet ST is sensationalising the index using the soft drink comparison like how blood pressure serves as marker for hypertension.
  6. The study doesn’t control for influential food trends. How many KFCs, Starbucks and Bubble Tea shacks have opened in China and Japan during the study period? Is it possible that the Asians were falling sick because of culinary invasions? Could the same thing happen to Singaporeans and their salted-egged everything?

Something else remains unexplained. In Singapore, it is mainly the ethnic Indians who are most affected by diabetes, followed by the Malays and then the Chinese. Every one of us consumes white rice in some form, fried, glutinous, nasi-padanged or porridged, but it’s not so much how often or the quantity of rice being eaten, it’s what it’s being eaten WITH. Even a doctor in the 1940s would agree that diet composition is key, contrary to the (racist) notion that white rice was the cause of the ‘physical degeneracy’ in Asiatics compared to the mighty wheat-munching ang mohs.

You can’t demonise white rice in isolation from the other things we put into our stomachs. Curries, meats, gravies, vegetables and fruits all affect how carbohydrates are broken down and absorbed. If you’re gorging on rice ALONE every day and science tells you that you’re dumping a daily can of soda’s worth of sugar in your bloodstream, then this scaremongering seems slightly justifiable. Singaporeans don’t eat like the Chinese or Japanese study subjects, not to mention white rice on its own. Sure we have one of the highest rates of diabetes in the world today, but to blame it an iconic, culture-defining food that some people offer ritualistically to their ancestors seems not just simplistic, but downright blasphemous. White rice is literally our ‘food of the gods’. In Chinese custom, to say ‘have you eaten (rice)’ is to say ‘how are you’. With this recent advisory, the answer to this question would be ‘Still not diabetic yet, thank you!’.

Show me that a daily diet of white rice, fish and vegetables will still do my pancreas in compared to someone who eats brown rice and chicken wings, before I decide to point fingers. Then there’s the matter of genetics. We all know of people who eat like there’s no tomorrow and don’t exercise but remain perfectly healthy. No meta-analysis can explain these GI-defying freaks of nature.

Meanwhile, brown rice makers rejoice. You can now refer to the HPB’s knee-jerk public health advisory when promoting your wares. For those of us who’ve been fed white rice since we were babies, switching to a less palatable brown rice may mean that we’ll eat more of everything else just to sate our appetites i.e overcompensating with more CALORIES/SALT/FAT, like how low-fat yogurts seduce you into consuming more than those with normal fat content. Post-dinner ice cream? It’s OK cos I just had BROWN RICE! Turns out that magnesium isn’t the only element that’s found at higher concentrations in brown rice. ARSENIC, too. Mmm. Arsenic.

Cost is also an issue. How much more are you willing to spend on brown rice to ward of a 11% increased risk of diabetes?  For poorer income families, the reluctance to switch to brown rice but a government-endorsed phobia of white rice may mean more cheap bread and pastries, which all have high levels of hidden SALT.

HPB shouldn’t jump the gun and come to a hasty conclusion based on a 4-study analysis with its own set of limitations, with the intent of ‘ingraining’ in us that white rice is evil. This isn’t what ‘eating wisely’ is about. By focusing its ammunition on a convenient target, and ignoring all the other social/economic/emotional factors that come into play when tackling a complex disease like diabetes, they risk shooting down a red herring, only for others to rise up whilst the dust and smoke are settling. Given our unique diet and lifestyle, HPB should venture into a state-sponsored local study before declaring war on a staple food.

 

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