Excess Carbohydrates Can Result in Diabetes

Research has shown that excess carbohydrates and other foods that raise the body’s dietary inflammatory index (DII) can lead to severe diabetes.

Dietary Inflammatory index is a measure of the potential of a particular diet to raise the concentrations of inflammatory markers in the blood plasma. This measurement standard was developed recently and is used in the assessment of high-risk medical cases. Some of these inflammatory biomarkers include Interleukins IL-1B, IL-4, IL-6, IL-10, Tumor Necrosis Factor-alpha (TNF-a), and the C-reactive protein (CRP). A study done by King et al. (2003) about “C-reactive Protein and Glycemic Control in Adults with Diabetes” showed a keen relationship between diabetes and HbA1c, results which have been confirmed and supported by this study.

The study was a retrospective cross-sectional study, and data used was derived from another external study conducted by another group: The National Health and Nutrition Examination Survey (NHANES), which is a survey that comes in stages from the National Center for Health Sciences (NCHS). All the participants voluntarily issued their informed consent, per bioethics regulations. The NHANES survey also fulfilled all the legal parameters required by the NCHS Review Council. The research was done using 4,434 subjects who were adult participants. The study only analyzed participants age 20 and above.

The dietary inflammatory index of these participants was measured. The calculations were performed from 24 hours of dietary data, as recalled by each of the participants. The analysis of this data was done using SAS, and the results were used to establish the relationship between DII and diabetes. A chi-square (X2) test was done on all the participants to check for any difference between the severity of diabetes. Of the 4,434 subjects, 46.5 were males, and 53.5% were women. 59% of them had no diabetes, 26.5% had pre-diabetes and 14.1% of them had diabetes. The results of the study showed that participants who had diabetes and pre-diabetes had a significantly higher DII (P = 0.01) and (P = 0.03) respectively, compared to subjects who had no diabetes. The average age of the participants was 49.4 years with an average Body Mass Index of 29.3kg/m2. The DII scores of the participants were determined using a regression analysis which showed the contrast of the severity of diabetes condition the participants had. The study accounted for the differences in gender, race, BMI scores and their social and economic statuses. The study showed a positive correlation between DII and Hemoglobin A1c (HgbA1c). For every 1-point increase in DII, HbA1c increased by a factor of 0.03. DII score negatively correlated with fiber in the diet. The more fiber a diet has the lesser the DII score.

Another recent study published in the International Journal of Food Science and Nutrition (2015) showed a negative correlation between non-inflammatory diet and diabetes severity. Taking up a diet that is low on inflammation-inducing foods will lower the risk of developing diabetes or reduce the severity of the condition for people who already have the disease.

The study found that after factoring in race, sex, BMI, age, and other factors that might affect the results, there was still a significant correlation between DII and Diabetes severity. HbA1c is a molecule that reveals the average concentration of blood sugar over a given period. An elevated HgbA1c (HbA1c > 9% or 75mmol/mol) is an indication of raised blood sugar levels and, consequently, the risk of diabetes. These findings show that inflammation induced by diet can, indeed, be related to diabetes.

The study provides findings that are in tandem with previous research done on inflammatory inducing diet and diabetes severity. However, further research into this topic is needed to establish the usefulness and effectiveness of DII in reducing the advancement of diabetes. Developing a system to measure DII at home can help control diabetes for patients. People with diabetes can monitor their diet by ensuring they take non-inflammatory inducing foods, reducing their trips to the hospital and ultimately reducing the cost of medicating and treatment.

Practice Pearls:

• The relationship between diabetes and DII has not been studied extensively. Establishing this relationship could provide further insights into the condition of diabetes.
•  HbA1c is a molecule that reveals the average concentration of blood sugar over a given period.
• The higher the dietary inflammation, the higher the DII, and consequently, the higher the risk of diabetes severity, concerning HbA1c levels in the blood.

Reference for “Excess Carbohydrates Can Result in Diabetes”:
King D. E & Xiang J. (2019). “Dietary Inflammatory Index and Diabetes Severity.” J Am Board Fam Med 2019; 32:801– 806). doi: 10.3122/jabfm.2019.06.190092

Sandra Zaki, PharmD Candidate, Florida A&M University

See more about how excess carbohydrates and other factors contribute to diabetes in our Diet & Nutrition center.