Reading a review of British writer Bee Wilson’s “First Bite: How We Learn to Eat” in the London Review of Books, I stumbled on an astonishing figure: 4 million people in the U.K. have diabetes. An unhealthy diet and increasingly sedentary lifestyle have taken their toll, causing a 65 percent surge in cases in the past decade alone. Treating this epidemic is costing the National Health Service an estimated £1 million (roughly ¥155 million) an hour.
Obesity is the main culprit, and one major dietary factor is the high-sugar content in many processed foods. It was astounding to learn that tomato ketchup (22.8 percent) has a higher sugar content than Coca-Cola (10.6 percent), and that we consume far more glucose-fructose syrup and other sugary ingredients than most people are probably aware of.
Globalization in eating habits has spread a craving for what dieticians call “SFS”: sugar, fat, salt. Sweet-salty food with an undercurrent of fat is a global crowd-pleaser and the mainstay at fast-food restaurants, but is not good for our health. Coffee itself isn’t bad for you, but all those flavored lattes are oozing sugar and calories.
Given the longevity enjoyed by Japanese, often attributed to their healthy diet, I never really thought about the incidence of diabetes here. America, after all, is the homeland of spandex for a good reason, but obesity in Japan seems relatively rare.
Yet as of 2015, Japan has 7.2 million people diagnosed with diabetes. The average cost per patient is more than ¥400,000 a year, mostly covered by national health insurance. About 7.6 percent of adults between the ages of 20 and 79 are diabetic and it is estimated that Japan may have more than 3 million undiagnosed cases.
Part of the reason for the sharp increase of diabetes in Japan is the increasing proportion of the population that is over 60, an age when Type 2 diabetes becomes more prevalent.
According to the International Diabetes Federation, Asia is on track to become the global epicenter for diabetes as dietary habits change and people become less active. Currently there are about 138 million diabetics in Asia, and this is projected to rise to 215 million by 2040, with the number of related deaths surging by 46 percent. The disorder affects 8.6 percent of all adults in regional areas.
China leads the Asian diabetes spike with nearly 100 million cases (9.6 percent of adults) and almost 1.3 million diabetes-related deaths in 2015, compared to just under 65,000 in Japan. India has about 65 million cases, with a prevalence of 8.56 percent among adults, and more than 1 million die annually from diabetes-related causes. Both China and India have not invested enough in prevention and treatment.
Japan and Australia are regional leaders in terms of diabetes public health policies. Both nations promote public awareness and embrace preventive policies that focus on lifestyle and dietary adjustments that can lessen the likelihood of adult-onset diabetes.
Trawling through the grim statistics is educational but no substitute for gathering personal perspectives about the effects of diabetes and how people cope with it. Friends who suffer from diabetes tell me that the carbohydrate-rich diet in Japan is a major problem when it comes to controlling insulin levels. Polished white rice is the main culprit, but noodles and breads, along with tempting sweets, are the bane of diabetics.
The good news is that food-processing companies are responding by introducing products with reduced carbohydrate and sugar content, but that certainly doesn’t solve the problem. Veterans tell me that being on a permanent diet means a degree of strategic backsliding is required when wanting to have a so-called cheat day rather than total denial — it’s about going for quality over quantity in the realm of “forbidden fruits.”
Monique Truong, acclaimed author of “The Book of Salt” and “Bitter in the Mouth,” is now writing a novel about Lafcadio Hearn titled “The Sweetest Fruits.” Running out of flavors, she jokes that next she will use “sour, or rather, tart, for the title of my memoir.”
She is also a food writer, gourmand and has been diabetic for more than two decades — not the easiest of combos. In 2015 she spent a few months in Japan researching her new book and discovered that being a diabetic in Japan was not as hard as she had anticipated. The basic problem is that a traditional carb-heavy diet suited to a traditional lifestyle of physical exertion can significantly worsen a diabetic’s condition.
“As a diabetic, I actually found it much easier than I thought it would be to eat delicious, healthy, low-carb meals during my months in Tokyo,” she says. “The biggest obstacle, of course, is that the Japanese diet is centered on rice and noodles.”
Nevertheless, she adds, “I don’t hesitate to eat a portion of rice, noodles and even desserts. I’ve never felt as fulfilled by a small bowl of rice as when dining out in Kyoto, for instance: kernels like glossy freshwater pearls, steamed with a delicate piece of tai (sea bream), a wisp of sanshō (Japanese pepper) leaves perched on top and served in a bowl that in itself was also a feast for the eyes. In all honesty, when I think of that bowl of rice now, I’m full and satisfied all over again.”
“The important thing is to eat with all of your senses, which is something that I understood deeply after my sojourn in Japan.”
When cooking at home, she chooses ingredients like shirataki (devil’s tongue yam noodles), which have very little carbs, or 100 percent buckwheat flour soba (as opposed to a mix of wheat flour and buckwheat flour, which are cheaper and higher in carbs) as diabetic-friendly alternatives.
“I don’t like to use the word ‘substitute’ because, let’s face it, there’s no true substitute for the texture and flavor of rice, ramen, udon or sōmen (thin, white wheat noodles),” she says.
And like many excellent chefs, Truong finds inspiration in a glass or two, confiding, “I’m very fond of sake. Though, in general, sake has almost twice the carbs as white wine, I rarely say no to it. Again, quality over quantity is my rule.”
Famous last words!
One of my now-deceased elderly neighbors, who was also a diabetic, drank a green-labeled lager beer that he explained was developed especially for diabetics, and I chose to believe him.
Diabetes in this region stems from Asian “affluenza” and the growing consumption of Western fast food and soft drinks.
“This is analogous to what happened to Native Americans and the Pacific Islanders earlier in history,” Truong points out, “when their diets began incorporating white flour and processed sugar because they began trading with white folks or receiving food from the U.S. military as in the case of the islanders.”
Spam has a lot to answer for.
“The irony is that the Asian diets with their rice and noodles have not been a problem for earlier generations, clearly due to food shortages and also to a life that involved physical labor and exertion,” she says. “But once diabetes is triggered, then rice and noodles exacerbate the disease.”
As I was researching this column just before my annual health checkup, I could not resist the optional diabetes test for ¥1,080, and was relieved to learn I am not yet diabetic. Must be that new low-carb sake!
Jeff Kingston is the director of Asian Studies, Temple University Japan.