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Fighting diabetes: Why the target is white rice

As a staple, more of it is eaten; but more brown rice will boost health

News that the Health Promotion Board (HPB) is targeting white rice in its fight against diabetes has created a storm of protest from rice lovers. Could the staple food of Asians for centuries truly be bad for health, they asked.

Many of those outraged by the report on the targeting ("Diabetes: the rice you eat is worse than sugary drinks", May 6) were more than happy to make sweet drinks and junk food the real villains that cause diabetes, which, while enjoyable, are not part of Singapore's heritage. But they were vehement that it could not be the traditional, steaming bowls of white rice that they consider essential.

Yes, sweet drinks and junk food are bad, and no one, least of all the HPB, is denying this. What it is saying, though, is that white rice is also a major culprit - largely because it is a staple, so more of it is eaten.

 

Starchy white rice, it has been found, can overload Asian bodies with blood sugar and heighten their risk of diabetes. Then add to that, this in terms of consumption: The 2010 National Nutrition Survey found a typical serving of rice here was 250g, and that a third of Singaporeans' daily intake of calories comes from rice - compared to 3.5 per cent from sugary drinks.

Then there is this: A Harvard School of Public Health study found that each serving of white rice a day raises the risk of diabetes by 11 per cent. A study of rice and noodle consumption by 2,728 Chinese here by the National University Health System found it resulted in greater insulin resistance.


ST ILLUSTRATION: CHNG CHOON HIONG

For those who argue that rice has been eaten for centuries with no ill effects, the counter-arguments are:

  • In the pre-industrialisation era, there was a lot more physical exertion. Even in everyday life, people walked a lot more than today. Exercise is known to offset some of the ill-effects of unhealthy food.
  • 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.

HOW BROWN RICE IS BETTER

For decades, nutritionists have condemned processed food as unhealthy. Traditionalists raising their eyebrows at brown rice might consider this: What is white rice but processed brown or red rice?

And consider this: White rice, which is a simple carbohydrate and tastes more starchy, is likely to turn into sugar more quickly than unpolished rice.

White rice has a glycaemic index (GI) of 78-98, while the GI for brown rice is 65-76. The higher the index, the more blood sugar is produced.

So while having a lot of white rice in the diet is certainly not the only contributory factor, it is difficult to deny that it does contribute significantly to the high level of diabetes here.

Having said that, changing people's taste is not an easy task.

This is why HPB's chief executive officer, Mr Zee Yoong Kang, has been quick to say that he is not asking people to stop eating white rice. What he would like to see is more people adding some brown rice to their diet - a modest 20 per cent of it mixed with 80 per cent white rice.

This is because another Harvard study, which followed 197,000 people over 20 years, found that replacing a fifth of white rice with brown cut the risk of diabetes by 16 per cent.

Soaking brown rice in water before adding it to the pot to be cooked with white rice makes it softer. With only one in five grains of rice being brown, the taste is pretty much like normal white rice.

Aside from having a lower glycaemic index - indicating a lower surge in blood sugar - brown rice also has vital nutrients, such as zinc and iron, that white rice lacks. These nutrients are taken off when the husk of bran and germ are removed. But getting people to adopt this 20 per cent brown-mixed-into-white-rice is going to be a big challenge.

The Government can take the lead by insisting that caterers serve such rice for all functions. Or at the very least, to offer this as a choice.

Foodcourts and restaurants should also be encouraged to sell this mixture. Many readers have complained that it is difficult to get brown rice when they eat out - which most workers do for weekday lunch.

Schools should also tell their canteen operators to offer this version instead of plain white rice, since habits picked up when young tend to remain as people age.

NSMEN CAN HELP IN THE BATTLE

And, of course, a brown-white rice mix should be the default option served to full-time national servicemen. While they do a lot of physical activity - so white rice should do them less harm than the population at large - the combination is better for them.

Hopefully, after two years of eating this mix, they will continue with it after leaving NS. It would be even better if they were to urge their parents to serve this at home.

Today, brown rice costs more than white rice - which, when you think about it, doesn't make sense as there is less processing needed.

So the higher cost is probably due to low demand - only 5 per cent of rice sold here is unpolished. It then follows that if demand rises, the price should come down, so price would no longer be a major reason for choosing white rice.

While it is difficult to change people's tastes, it is not impossible.

The HPB has shown this with its campaign for wholemeal bread in 2009/10. At that time, only 18 per cent of bread sold here was wholemeal or wholegrain. This has gone up to 30 per cent today.

Part of this is due to the superfine wholemeal flour that is available today, that makes bread taste like soft white bread. With this flour, there are now also wholemeal noodles that are more nutritious and have a lower GI than noodles made from white flour.

People are generally reluctant to give up what they enjoy eating - which is why the focus is on adding some brown rice, rather than replacing white with brown.

So this battle will be a long one. In the meantime, the HPB should not let up on discouraging the consumption of junk food, including sweetened soda drinks.

One complaint that was a constant in comments from supporters of brown rice is the difficulty in getting this when eating out.

Several also said that at foodcourts and restaurants, water can be as expensive, and sometimes even more expensive, than buying drinks. Ensuring that all food outlets offer free water to diners would be a good way to reduce the unnecessary calories many are now consuming - sometimes unwillingly.

There is no one single formula for beating the rising rates of diabetes here. But action needs to be taken, and fast.

According to a study by the Saw Swee Hock School of Public Health, diabetes already costs Singapore $1 billion a year, and is expected to soar to $2.5 billion by 2050.

If we can reduce the rate of diabetes by just 10 per cent, it would cut $250 million off the bill in 2050. That's a lot of money.

More importantly, it would also cut down on much suffering, since diabetes is a leading cause of kidney failure, blindness and amputations.

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A version of this article appeared in the print edition of The Straits Times on May 12, 2016, with the headline 'Fighting diabetes: Why the target is white rice'. Print Edition | Subscribe