We often encounter queries about “viral” news and videos circulated in social media that seem very original and convincing but are often inaccurate scientifically. I shall be discussing some of these, that have stormed the internet in the recent times.
- Eating large quantities of fruits like mango can cure diabetes
A few years ago, a video went viral, which claimed that eating lots of mangoes could cure diabetes. It showed the demonstration of a large spike in glucose levels when glucose was added to a blood sample and a drop in the glucometer readings when fructose was added. In the backdrop of an audience bursting into applause, the presenter concludes that fruits, which are fructose rich, are the magic remedy for diabetes and consuming one kilogram of mango or a dozen of bananas on a daily basis can cure it.
Many were influenced and quite a few of them landed up in clinics and emergencies with extremely high blood glucose levels after attempting this unique “therapy”! So where did the common man get misguided? Cognition of two simple scientific facts can explain this. Firstly, glucose and fructose have different chemical structures and glucometer strips are designed to detect glucose (not fructose). Secondly and more importantly, almost half of the ingested fructose gets converted to glucose in the liver as demonstrated in human and animal experiments. Thus, adding fructose to blood samples will not increase glucometer readings, however consuming large amounts of fructose will cause blood glucose levels to rise in individuals with diabetes. The reality is that, in diabetes, ingestion of fruits is permissible only in moderation.
- Blood glucose level of 250 mg/dL is normal
An internet post stated that doctors in the United States of America believe that HbA1C or glycosylated hemoglobin (a measure of previous 3 months’ average blood glucose) between 7-8% is an acceptable glucose level for all. This post, further goes on to specify that since the blood glucose equivalent of this HbA1c value is 250 mg/dL, a mean value of 250 mg/dL should be considered as normal blood glucose. This post was so convincing, that I have had colleagues from other medical specialties, calling to enquire whether the cut offs for diagnosis of diabetes have been changed.
- Diagnostic criteria for diabetes:
The criteria for diagnosing diabetes are fasting plasma glucose ≥126 mg/dL or 2-hour plasma glucose ≥200 mg/dL during oral glucose tolerance test. Proposed in 1997, these are based on prevalence of retinopathy (diabetic eye disease) in large population-based studies. In 2009, HbA1C of ≥ 6.5% was included as another diagnostic criterion. There is a linear increase in risk of diabetic complications above these thresholds. Thus, by labelling a person as having diabetes mellitus, we essentially hope to prevent the occurrence of diabetes related complications by correcting the high blood glucose levels. These cut-offs have been accepted by most international organizations like World Health Organization (WHO), American Diabetes Association (ADA) and International Diabetes Federation (IDF) and have been in use for more than a decade.
- Target blood glucose once a diagnosis of diabetes is established
Glycemic targets for persons with diabetes mellitus have to be adapted according to their individual characteristics. Most guidelines including the ADA suggest a HbA1c target of less than 6.5 to 7%. The American College of Physicians guideline is the only one to recommend a higher target of 7 to 8%. Even then, a HbA1c target between 7-8% translates to estimated average glucose between 154-183 mg/dL and not 250 mg/dL as asserted in the said post. For all practical purposes, most endocrinologists try to achieve and maintain an HbA1c target of less than 6.5 to 7%, provided this is possible without increasing hypoglycemic (low blood glucose) events. In case of any confusion, glycemic targets need to be decided after discussion with health care providers and not by social media posts.
The term “quinary prevention” was coined by Dr. Sanjay Kalra, a leading endocrinologist and the current president of Endocrine Society of India. It refers to the avoidance of hearsay and misinformation that may interfere with appropriate delivery of healthcare.
Quinary prevention in diabetes is the need of the hour, in today’s world of information overload from social media. There has been a staggering increase in the number of ‘health’ messages created and shared, often by people without adequate expertise or qualification for the same, to spark controversy and trigger dialogue. Some of these have discouraged people from taking their routine pills, or encouraged them to take dubious products like concoction of certain grains, home remedies and dietary supplements in the hope of permanently curing diabetes. There is very little scientific data to support the use of many of these and many of them may be potentially dangerous. The only medically documented cure for diabetes is through weight loss; and healthy lifestyle and dietary habits remain the cornerstones to achieve this. I urge readers to be judicious in believing as well as sharing health related material on social media. An easy way of doing this would be to wait for your next appointment and discuss your doubts with your healthcare provider.