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Health Promotion Board changing its tune on rice in its battle cry against diabetes?

By Richard Seah
Is the Health Promotion Board (HPB) changing its tune in its battle cry against diabetes? Or had it been (once again) misquoted and misrepresented by the 154th ranked mainstream media?
Following a storm of protests over HPB’s alarmist message last week that said rice was worse than sugar in causing diabetes, the HPB is now phrasing it somewhat differently. In the latest ST report today, the HPB said that “rice is also a major culprit” in causing diabetes. (Fighting diabetes: Why the target is white rice. ST 12 May) .
Of course, it is. Nobody – whether speaking from the perspective of nutritional knowledge or common sense – would dispute that excessive consumption of rice and other high carbohydrate foods is one of the major factors that contributes to diabetes.
But this was not what the HPB and other members of the government said originally. Consider this slew of earlier messages:
  • Diabetes: The rice you eat is worse than sugary drinks (Headline of ST 6 May).
  • ... white rice. It is even more potent than sweet soda drinks in causing the disease. (Opening paragraph of report, ST 6 May)
  • A bowl of rice has more than twice the carbohydrate content of a can of soft drink (Graphic that shows one bowl of rice with two cans of soda drinks, ST 6 May)
  • Glycemic Index table that shows rice causes a greater surge in blood glucose compared to sugar (ST 6 May)
  • We all need to take note and we need to begin to re-look at our diet and make at least some adjustments. (Facebook post by Manpower Minister Tan Chuan Jin, sharing the ST report).
These messages were loud and clear: Rice is the greater culprit compared with sugar. Yet the HPB now denies having said this. The latest ST report says: “Yes, sweet drinks and junk food are bad, and no one, least of all the HPB, is denying this.”
BROWN RICE
The latest report also emphasises the benefits of unpolished brown rice over white rice, with 12 paragraphs devoted to this topic. Again, if the HPB’s key message was to eat more unpolished brown rice, no one would have taken issue. But no. In the 6 May ST report, brown rice was mentioned in only one small paragraph near the bottom of the article.
But while the HPB (or ST) seems to be modulating its tune, it has not backtracked. No sir. Has any government department ever backtracked?
FOOD VS DRINK
And so the HPB continues to defend its focus on rice. As part of its justification, the HPB informs that rice accounts for 1/3 of total calorie intake by Singaporeans, whereas sugary soft drinks account for a mere 3.5 percent. Thus, rice is of greater concern.
This nonsensical comparison is even more irrelevant that comparing apples with oranges. Rice is a food. It fills the stomach, it provides energy for work. For many people, rice is the main food.
A soft drink is not food. It will not fill you nor satisfy your need for calories. At best, it will quench your thirst temporarily. Some Singlish may better illustrate how meaningless it is to compare the two. Rice eat full. Coke drink shiok.
A more appropriate comparison would be food with food. Rice provides 1/3 of total calories. What about sugar found in soft commercial bread, pastries, cakes, donuts, snacks, sweets, ice-cream, desserts, sauces and a whole lot of other sweetened foods?
Sorry I do not have access to data but I am sure the figure is pretty high. I can also safely say that the figure is much higher in Western societies, especially the United States. People there may not eat much rice but they eat lots of sugared carbohydrates.
And while they may not (yet) have high rates of diabetes, they literally have a bigger problem: obesity. About two thirds of Americans are overweight and half of them (i.e. one third of the population) are obese. Obesity is closely linked to diabetes and many other ailments. It may not be long before obesity rates in Western societies surpass the rates in Asia.
Another appropriate comparison would be drink with drink. In the past, people in Asia drank either plain water or unsweetened beverages like Chinese tea, green tea and “grain teas” brewed from roasted rice or barley. These beverages provided almost zero calories. Today, soft drinks provide 3.5 percent of total calories. It may not seem much, but 3.5 compared to near zero is an infinite increase!
SEDENTARY LIFESTYLE
In insisting that it is not wrong, the HPB said people in the past did not get diabetes from eating plenty of rice because they worked hard and burned up the calories. Today, people lead sedentary lifestyles and this is why rice has become a major problem.
This is not entirely wrong. Too much food is obviously bad for health. But does the HPB CEO, or any of its officers, have any idea how much rice physically active people eat?
Personally, I have seen Indians, presumable manual labourers, eat FOUR MOUNTAINS of rice at those vegetarian restaurants in Little India, where they could get unlimited servings for a fixed price. When I was young, I had an old lady domestic helper at home. She ate rice in a big soup bowl, easily three times as much as what the rest of us normally ate.
We don’t even need to travel back in time. Just visit any of the Southeast countries. Or look at how our foreign guest workers eat. I have seen, for example, Filipino men who are obviously office workers, eat two big heaps of rice. Do they have diabetes? Maybe. Maybe not.
DIABETES ACROSS ASIA
Consider these statistics on diabetes rates across Asia, sourced from the World Bank:
  • Malaysia 17.9
  • Brunei 13.7
  • Singapore 10.5
  • China 9.8
  • India 9.3
  • Bangladesh 8.3
  • Sri Lanka 8.0
  • Hongkong 8.0
  • Korea (South) 7.2
  • Thailand 7.1
  • Philippines 6.9
  • Indonesia 6.5
  • Vietnam 6.0
  • Japan 5.7
  • Korea (North) 4.4
  • Cambodia 3.0
Why does Singapore have higher rates of diabetes than practically all other rice-eating Asian countries? Do we eat more rice than they?
Why is our diabetes rate higher than countries like Japan and Korea where the population eats mainly short grain rice, which is said to be even more likely to cause diabetes (because short grain rice has a higher glycemic index).
Only Malaysia and Brunei have higher diabetes rates than Singapore. Back home, ST reported on 21 Dec 2014: “The Malay population is the unhealthiest in Singapore. Latest statistics from the national disease registry reveal that a disproportionate number of diabetics and patients with kidney failure, heart attacks and strokes come from this group.”
Do the Malays eat a lot more rice than other races? What about the Indonesians? Or is there something in the Malay, but not Indonesian, diet? Again, sorry I do not have access to data. But I suspect the culprit is sugar. Malay, but not Indonesian, food tends to be sweet.
And why does North Korea have a significantly lower rate of diabetes compared to South Korea? Do they eat very different diets? In terms of rice and other traditional foods, not likely. But South Korea is obviously more exposed to modern, processed and sugared foods.
LONGER LIFE?
Finally, the HPB offers another smokescreen – I won’t even call it a reason – as to why people in the past did not have much diabetes despite eating much rice.
“People did not live as long in the past. In Singapore, for example, life expectancy at Independence in 1965 was only 65 years. Today, Singaporeans are living 20 years longer. This alone provides chronic diseases with a greater opportunity to surface. Among people 65 years and older, one in three is diabetic.” (ST 12 May)
Sounds convincing? But when, may I ask, did these people aged 65 and older start to get diabetes? Around age 64 perhaps? Please, HPB, give us the fuller story! RICE VS SUGAR
Meanwhile, all along the HPB talks about rice and sugar as if they are the same. All are carbohydrates.
Sorry. Basic nutrition tells us that not all carbohydrates are equal. Rice gets digested into glucose, which enters the blood immediately – and causes diabetes if the body is somehow unable to deliver this glucose to the cells to be used for energy production.
Sugar gets digested into fructose and glucose. Fructose does not enter the bloodstream. So obviously it will not cause a surge in the blood glucose level. And for a long time, scientists thought fructose was suitable for diabetics.
Now, however, the latest scientific understanding tells us that fructose needs to be processed by the liver in the same way that the liver processes toxins such as alcohol. The liver can only handle small amounts of fructose, such as from eating a bit of fruits.
Huge amounts of fructose in the modern diet, however, causes wide range of problems, including diabetes and obesity. For a fuller discussion, see my earlier note on RICE VS SUGAR.