, Volume 18, Issue 10, pp 1211-1214
Date: 30 Aug 2008

Surgery for Diabetes at Lower BMI: Some Caution

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Many thousands of years ago, our ancestors were hunter–gatherers and performed arduous labor. They hunted animals and also ate some fibrous roots, berries, and nuts—a diet high in protein with some complex carbohydrates [13]. This coincides with a diet with a low glycemic index [4, 5]. These meals were irregular and sometimes infrequent, and when there was a “kill”, the entire clan would share the meal. Through natural selection, early man developed “thrifty” genes for times of famine [6].

However, in the past 8,000 years, farming of indigenous wild grains commenced. Frequent high carbohydrate meals with a higher glycemic index became available, with frequent stimulation of insulin secretion from the pancreas. High plasma insulin levels and insulin resistance developed, with impaired glucose tolerance. This progressed to the modern era where fast foods (containing particularly high levels of simple sugars), affluence, and a sedentary lifestyle have led to an “obesity pandemic”. The so- ...