The first survey of Maltese diabetes prevalence was conducted by Professor J.V. Zammit Maempel in the 1960s, and the results were published in a leading British medical journal. A further WHO-assisted diabetes prevalence survey was conducted by Antoine Schranz in the late 1980s (Times of Malta, October 20) and also published in an international medical journal.

In spite of these studies, the prevalence of Maltese diabetes type 2 is thought to have continued to rise and, furthermore, there is the intelligent guess that a substantial proportion of the population has the pre-diabetic state without their knowledge.

The moral of the story is that, as useful as they are, surveys of prevalence do not prevent the emerging epidemic of diabetes type 2, because the fundamental causes of the epidemic are diet and lifestyle – if these are not tackled, the problem of diabetes type 2 will continue to grow.

For decades we were under the impression that dietary animal fats were unhealthy and health authorities around the world advised low-fat and high-grain diets. Apparently consequent to this advice, the prevalence of diabetes type 2 in America (and many other parts of the world) has not only shot up (doubled), but has also surfaced in youngsters.

The high dietary content of sugars and grains (particularly refined high glycaemic ones) are now being blamed for the rising prevalence of diabetes and its serious complications – an increased risk of heart attack and stroke, kidney failure, blindness, leg amputations and of some cancers.

It is perhaps not sufficiently appreciated that foods based on grains, such as bread, pasta, pizza, biscuits and pastries, and also rice and potato, all produce blood sugar, and so the culprit foods are not just desserts. Too much blood sugar sustained for a long time is a poison which harms blood vessels all over the body.

Diabetes type 2 has two phases in its evolution, a pre-diabetic state when the pancreas is struggling to produce ever increasing amounts of insulin (hyperinsulinaemia) to control blood sugar from a high glycaemic carbohydrate diet, and the full-blown diabetic state when the pancreas gets worn out and its ability to produce insulin deteriorates, control on blood sugar levels is gradually lost and excess blood sugar appears in the urine. Transition from the pre-diabetic to the diabetic stage means the management of the condition has not been successful.

The ideal pharmaceutical drug for the pre-diabetic phase of high blood insulin and insulin-resistance in the tissues (a vicious cycle) is metformin. This is derived from a natural product and increases insulin sensitivity in the tissues, lessen­ing the need for insulin and lessening the strain on the pancreas.

Other drugs which increase insulin production do more harm at this stage as they increase the strain on the pancreas.

For decades we were under the impression that dietary animal fats were unhealthy

It needs to be understood that the crux of managing diabetes is not any complicated rocket science but simply the diet – that is, the amount and type of food consumed. Exercise is very important but food in­take and food type are fundamental considerations. This has been unequivocally proven by stomach surgery for obesity – this drastically decreases stomach capacity, food intake is severely reduced and diabetic patients observe a reversal of their clinical and laboratory signs of diabetes, permitting discontinuation of medication.

Even without this type of stomach surgery, diabetes type 2, particularly in its early stages, can be reversed by dietary modification and exercise.

Furthermore, there are various vitamins, minerals and botanical food supplements which are helpful for the diabetic state.

The spice cinnamon, for example, lowers blood sugar and can be used as a sweetener. Nuts, beans and lentils are ideal for diabetics, as are berries and cherries. Smoothies can be made at home by crushing berries and apples with walnuts, yoghurt and coconut cream (healthy non-sugar sweet fat) to produce a nutritious meal which also satisfies a sweet tooth.

Very recent animal experiments indicate that grapefruit juice lowers blood sugar and increases insulin sensitivity like the drug metformin. All other fruit juices should be avoided because they all contain very quickly absorbed sugar.

There is increasing suspicion that adulterated oils (full of unhealthy trans-fatty acids) are particularly harmful when combined with too many sugars and refined carbo­hydrates. Adulterated oils are found in deep-fried foods and margarine, which should be avoided.

This is only an extremely brief outline of how diabetes needs to be managed (inheritance cannot be changed), that is, primarily by nutritional means.

Even the most sophisticated surveys of prevalence will not tackle the increasing diabetic epidemic. Measuring prevalence increase is really re-discovering the wheel and not a management breakthrough.

Unfortunately, conventional medical schools around the world do not teach nutritional medicine. In America there are institutions offering five-year courses in nutritional medicine culminating in a Doctor of Nutritional Medicine degree (ND).

Conventional doctors tend to know only about pharmaceutical drugs and surgery, and their “default” nutritional advice is usually a “balanced” diet – whatever that means.

For diabetics (and the obese) to seriously cut down on food portion sizes, sugars and high glycaemic carbohydrates, they not only need strong motivation to help themselves, but also regular help and encouragement at nutritional clinics staffed by people with the right knowledge about the dietary cause of obesity and diabetes type 2.

Prof. Cilia-Vincenti, a pathologist, is a scientific delegate to the European Medicines Agency and chairman of the Academy of Nutritional Medicine (London).