If White Rice Is Linked to Diabetes, What About China?

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Protein consumption can exacerbate the insulin spike from high glycemic foods.

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Rice currently feeds almost half the human population making it the single most important staple food in the world, but a meta-analysis of seven cohort studies following 350,000 people for up to 20 years found that higher consumption of white rice was associated with a significantly increased risk of type 2 diabetes, especially in Asian populations. They estimated each serving per day of white rice was associated with an 11% increase in risk of diabetes, which may help explain why the association was even stronger in Asia, where they eat much more rice. This could explain why China has almost the same diabetes rates as we do. They’re at about 10%; we’re at about 11%, despite seven times less obesity in China. Japan has eight times less obesity than we do, yet may have a higher incidence of newly diagnosed diabetes cases than we do– nine per thousand, compared to our eight. They’re skinnier and still may have more diabetes. Maybe because of all the white rice they eat?

Just like eating whole fruit is associated with a lower risk of diabetes, whereas eating fruit processed into juice may not just be neutral but actually increase diabetes risk, eating whole grains–like whole wheat bread or brown rice–is associated with a lower risk of diabetes, whereas eating white rice, a processed grain, may not just be neutral but may actually increase diabetes risk.

White rice consumption does not appear to be associated with increased risk of heart attack or stroke, though, which is a relief after this earlier study in China suggested a connection with stroke. But do we want to eat a food that’s just neutral regarding some of our leading causes of death, when we can eat something associated with a lower risk of diabetes, heart attack, stroke, and weight gain?

For example, if you look at the Cornell-Oxford-China Project, rural plant-based diets centered around rice were associated with relatively low risk of the so-called diseases of affluence, which include diabetes. Maybe Asians just genetically don’t get the same blood sugar spike when they eat white rice? No, if anything, people of Chinese ethnicity get higher blood sugar spikes.

The rise in these diseases of affluence in China over the last half century has been blamed in part on the tripling of the consumption of animal source foods. The upsurge in diabetes has been most dramatic, and it’s mostly just happened over the last decade. That crazy 9.7% diabetes prevalence figure that rivals ours is new—they appeared to have had one of the lowest diabetes rates in the world in the year 2000.

So what happened to their diets in the last 20 years or so? Oil consumption went up about 20%, pork consumption alone went up 40%, and rice consumption dropped about 30%. So diabetes rates were skyrocketing, while rice consumption was going down; so maybe it’s the animal products and junk food that are the problem. Yes, brown rice is better than white rice, but to stop the mounting Asian epidemic, maybe we should focus on removing the cause–the toxic Western diet. That would be consistent with data showing animal protein and fat consumption associated with increased diabetes risk. But that doesn’t explain this.

If the rise in meat consumption is to blame, then why do the biggest recent studies in Japan and China associate white rice intake with diabetes? One possibility is that animal protein is making the rice worse. If you feed people mashed white potatoes, a high glycemic food like white rice, this is how much insulin your pancreas has to pump out to keep your blood sugars in check. But what if you added some tuna fish? Tuna’s got no carbs, no sugar, no starch. Wouldn’t make a difference, right? Or maybe it would even lower the mashed potato spike, by lowering the glycemic load of the whole meal, but instead you get this. Twice the insulin spike. Same with white flour spaghetti, and white flour spaghetti with meat. The addition of animal protein makes the pancreas work twice as hard.

You can do it with straight sugar water if you do a glucose challenge test to test for diabetes, where you drink a certain amount of sugar. This is the kind of spike in insulin you get, but if you take in the exact same amount of sugar, but with some meat added, you get this. And the more meat you add, the worse it gets. Just adding a little meat to carbs doesn’t seem to do much, but once you get up to a third of a chicken breast’s worth, you can elicit a significantly increased surge of insulin. This may help explain why those eating plant-based diets have such low diabetes rates, because animal protein can markedly potentiate the insulin secretion triggered by carbohydrate ingestion.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to IRRI Photos via Flickr.

Rice currently feeds almost half the human population making it the single most important staple food in the world, but a meta-analysis of seven cohort studies following 350,000 people for up to 20 years found that higher consumption of white rice was associated with a significantly increased risk of type 2 diabetes, especially in Asian populations. They estimated each serving per day of white rice was associated with an 11% increase in risk of diabetes, which may help explain why the association was even stronger in Asia, where they eat much more rice. This could explain why China has almost the same diabetes rates as we do. They’re at about 10%; we’re at about 11%, despite seven times less obesity in China. Japan has eight times less obesity than we do, yet may have a higher incidence of newly diagnosed diabetes cases than we do– nine per thousand, compared to our eight. They’re skinnier and still may have more diabetes. Maybe because of all the white rice they eat?

Just like eating whole fruit is associated with a lower risk of diabetes, whereas eating fruit processed into juice may not just be neutral but actually increase diabetes risk, eating whole grains–like whole wheat bread or brown rice–is associated with a lower risk of diabetes, whereas eating white rice, a processed grain, may not just be neutral but may actually increase diabetes risk.

White rice consumption does not appear to be associated with increased risk of heart attack or stroke, though, which is a relief after this earlier study in China suggested a connection with stroke. But do we want to eat a food that’s just neutral regarding some of our leading causes of death, when we can eat something associated with a lower risk of diabetes, heart attack, stroke, and weight gain?

For example, if you look at the Cornell-Oxford-China Project, rural plant-based diets centered around rice were associated with relatively low risk of the so-called diseases of affluence, which include diabetes. Maybe Asians just genetically don’t get the same blood sugar spike when they eat white rice? No, if anything, people of Chinese ethnicity get higher blood sugar spikes.

The rise in these diseases of affluence in China over the last half century has been blamed in part on the tripling of the consumption of animal source foods. The upsurge in diabetes has been most dramatic, and it’s mostly just happened over the last decade. That crazy 9.7% diabetes prevalence figure that rivals ours is new—they appeared to have had one of the lowest diabetes rates in the world in the year 2000.

So what happened to their diets in the last 20 years or so? Oil consumption went up about 20%, pork consumption alone went up 40%, and rice consumption dropped about 30%. So diabetes rates were skyrocketing, while rice consumption was going down; so maybe it’s the animal products and junk food that are the problem. Yes, brown rice is better than white rice, but to stop the mounting Asian epidemic, maybe we should focus on removing the cause–the toxic Western diet. That would be consistent with data showing animal protein and fat consumption associated with increased diabetes risk. But that doesn’t explain this.

If the rise in meat consumption is to blame, then why do the biggest recent studies in Japan and China associate white rice intake with diabetes? One possibility is that animal protein is making the rice worse. If you feed people mashed white potatoes, a high glycemic food like white rice, this is how much insulin your pancreas has to pump out to keep your blood sugars in check. But what if you added some tuna fish? Tuna’s got no carbs, no sugar, no starch. Wouldn’t make a difference, right? Or maybe it would even lower the mashed potato spike, by lowering the glycemic load of the whole meal, but instead you get this. Twice the insulin spike. Same with white flour spaghetti, and white flour spaghetti with meat. The addition of animal protein makes the pancreas work twice as hard.

You can do it with straight sugar water if you do a glucose challenge test to test for diabetes, where you drink a certain amount of sugar. This is the kind of spike in insulin you get, but if you take in the exact same amount of sugar, but with some meat added, you get this. And the more meat you add, the worse it gets. Just adding a little meat to carbs doesn’t seem to do much, but once you get up to a third of a chicken breast’s worth, you can elicit a significantly increased surge of insulin. This may help explain why those eating plant-based diets have such low diabetes rates, because animal protein can markedly potentiate the insulin secretion triggered by carbohydrate ingestion.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to IRRI Photos via Flickr.

Doctor's Note

This one is a little twisty and might require another watch or two. Instead of breaking this into multiple videos, I tried to pack it all into one. Basically, the question is if the modern diabetes epidemic in China and Japan has been linked to white rice consumption, how can we reconcile that with low diabetes rates just a few decades ago when they ate even more rice?

The protein exacerbation of the effect of refined carbs could help explain the remarkable results achieved by Dr. Kempner with a don’t-try-this-at-home diet composed of mostly white rice and sugar. See Kempner Rice Diet: Whipping Us Into Shape.

Refined grains may also not be good for our blood pressure (Whole Grains May Work As Well As Drugs).

 What should we be eating to best decrease our risk of diabetes? See:

Update: I did a deep-dive into the issue of arsenic in rice in summer 2017. Here are the 13 videos in that series:

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