‘Diabetes surge tied to overeating, and not staple foods’
The study, conducted in eastern Uganda, warned that long-standing dietary habits shaped by regional and cultural norms may be driving the country’s growing diabetes burden.
Any carbohydrate-rich food eaten in excess without physical activity can cause insulin resistance and increase the likelihood of developing diabetes. (File photos)
By Agnes Kyotalengerire and John Masaba
Journalists @New Vision
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Health experts have weighed in on new findings linking Uganda’s rising diabetes cases to traditional food practices, emphasising that staples like matooke and millet bread (kalo) are not inherently harmful.
However, they caution that overconsumption — even of traditional foods — combined with poor preparation methods and sedentary lifestyles significantly increases the risk of developing type 2 diabetes.
They agreed that food plays a crucial role in the prevention and management of type 2 diabetes, adding that when people consume carbohydrate-rich foods such as matooke and kalo, these are converted into glucose and other simple sugars. The body then uses the hormone insulin, produced by the pancreas, to move glucose from the blood into tissues for energy.
They were responding to a Makerere University study linking Uganda’s sharp rise in type 2 diabetes (T2D) to traditional food culture. The study, conducted in eastern Uganda, warned that long-standing dietary habits shaped by regional and cultural norms may be driving the country’s growing diabetes burden.
The findings reveal that deeply rooted cultural and social norms — where people consistently consume a single type of staple unique to their region, such as matooke in Buganda — may promote unhealthy dietary habits that increase the risk of type 2 diabetes across various populations.
The study, titled “Social norms as influencers of type 2 diabetes risk-taking behaviours: a qualitative deep-dive diagnosis in two high-burden districts in Uganda”, was led by Dr Juliet Kiguli from Makerere University’s School of Public Health and published recently in the British Medical Journal (BMJ).
Currently, 3.3% (or 1.5 million) of Ugandans aged 40 and above are struggling with diabetes. This was an increase from 1.4% (about 600,000 Ugandans) in 2014 according to statistics from the health ministry.
The prevalence of type 2 diabetes in Kenya is estimated to be around 2.4% to 3.3%. This translates to roughly 2.4% of adults being diagnosed with diabetes, with a significant portion of cases remaining undiagnosed.
Type 2 diabetes occurs when the body becomes resistant to insulin or doesn’t produce enough, leading to elevated blood glucose levels. If unchecked, this can result in serious health complications.
The overall prevalence of diabetes in Tanzania is around 10.1%, according to a study published in Taylor & Francis Online.
Carbohydrate-rich foods
Nutrition specialist Dr Paul Kasenene noted: “If people consume a very high-carbohydrate diet, blood sugar levels rise. Consequently, insulin rises as the body tries to lower blood sugar. Eventually, cells become resistant to insulin and stop absorbing sugar efficiently. This causes blood sugar to remain high, leading to diabetes.”
He further explained that carbohydrate-rich foods low in fibre tend to be problematic.
“The biggest culprits are refined carbohydrates such as white rice, wheat products in various forms of bread, chapati, cakes, mandazi, samosas, pasta, pizza and sweets. Table sugar is also a major problem, as are processed and packaged drinks like soda and juices,” he said.
According to Kasenene, these cause blood sugar spikes much faster compared to fibre-rich foods like matooke, millet, sweet potato, yams, and pumpkin. Notably, pumpkin, matooke, sweet potato and kalo are nutrient-rich foods offering several health benefits. Other healthy carbohydrates include whole grains such as whole maize flour and brown rice.
Type 2 diabetes occurs when the body becomes resistant to insulin or doesn’t produce enough, leading to elevated blood glucose levels. If unchecked, this can result in serious health complications.
Kasenene said physically active people are more likely to use the nutrients and glucose from the carbohydrates they consume efficiently.
“However, if someone is not physically active, even healthy foods like kalo or matooke eaten in large quantities can become problematic. This is less of an issue for most Ugandans living in rural or remote areas, where people tend to be more active, unlike in urban areas,” he said.
Healthy lifestyle is key
“If someone has a physically active job, they will burn the sugar or glucose from fruits like pineapple, mango, and banana,” he said, cautioning people who consume large amounts of fruit but remain sedentary, as this increases the chance of blood sugar rising due to lack of utilisation.
He emphasised that natural foods such as matooke, sweet potato, pumpkin or yams do not cause diabetes by themselves. The problem arises when individuals do not burn calories through physical activity or regular exercise.
“Any carbohydrate-rich food eaten in excess without physical activity can cause insulin resistance and increase the likelihood of developing diabetes,” he noted.
Nicholas Kamara, the Kabale Municipality MP and chairperson of the Parliamentary Forum on Non-Communicable Diseases (NCDs), revealed that an estimated three million Ugandans are currently living with either diabetes or pre-diabetes.
Bahendeka, a senior consultant diabetologist at Doctors Plaza, attributed the rise in type 2 diabetes prevalence to excessive weight gain, lack of exercise and poor dietary habits, including high consumption of processed, packaged and junk foods.
Kamara attributed the apparent rise in diabetes cases partly to improved data collection and diagnosis.
“As our record-keeping improves, we are starting to see the true extent of the problem, which previously went unrecognised,” he noted.
However, he warned that the data likely underrepresents the true scale of the issue due to low health-seeking behaviour among the population.
“In sub-Saharan Africa, many people with diabetes are never diagnosed. For every person we identify, there are likely many more in the community who remain undetected,” Kamara said.
Kamara says lifestyle changes among Ugandans are to blame for the rising trend.
“People are urbanising at a fast rate — moving from rural areas to towns — where they adopt more sedentary lifestyles,” he explained.
“Diabetes and other NCDs thrive when there is little physical activity.”
Kamara emphasised that physical activity doesn’t necessarily mean going to the gym. “It could be walking to work, gardening, climbing stairs, washing your car. These day-to-day activities used to keep us healthy, but urban life has stripped many of these away,” he said.
He noted that if Ugandans could shift their eating habits — especially cutting back on sugar and processed foods — the diabetes crisis could be significantly curbed.
He pointed to the current trend at social gatherings, where meals are heavy on carbohydrates and fats but lack fruits and vegetables.
However, Kamara reiterated that type 2 diabetes — which accounts for the majority of the cases — is primarily driven by lifestyle. “Type 1 diabetes is mostly genetic and has not increased as sharply. It is type 2 that is being fuelled by inactivity and poor diet,” he said.
Simplistic narratives
He dismissed simplistic narratives blaming specific foods like matooke and kalo, clarifying that the issue is not the food itself, but overconsumption without moderation.
“Sugar is not just what you spoon into your tea. It comes from foods like matooke, kalo, rice, sweet potatoes and Irish potatoes. Eating large quantities of these starchy foods without balance causes blood sugar spikes,” Kamara explained.
The risk, he added, increases with age.
“As people grow older, their bodies lose the ability to regulate sugar effectively because of reduced insulin sensitivity. So, when you continue eating these high-starch foods without moderation, complications arise — either pre-diabetes or full-blown diabetes,” he warned.
Prevention starts with you
Despite the need for more institutional investment, Kamara stressed that individual responsibility is equally crucial in the fight against NCDs like diabetes.
“Once you are over 40, you need to think about prevention and screening as part of your routine,” he advised.
By detecting conditions early, he said, individuals can improve their chances of managing them effectively or avoiding them altogether.
Dr Joseph Ogavu Gyagenda urged the public to differentiate between “foods that cause diabetes” and “foods that should be avoided or reduced once someone has diabetes.”
“This distinction is key to effective prevention and management,” he said.
Diet a double-edged sword
Dr Robert Kalyesubula, a kidney and diabetes specialist, says the growing burden of type 2 diabetes in Uganda is closely linked to changing lifestyles, especially poor dietary habits, lack of exercise and increased stress.
He warns that many people are unknowingly pushing themselves into the disease due to preventable behaviours.
He explains that understanding whether one is trying to prevent or manage diabetes is critical in choosing the right diet. For those aiming to prevent the disease, Kalyesubula recommends a balanced plate: at least half should consist of fruits and vegetables, with modest portions of carbohydrates, proteins, healthy fats and minerals.
“Carbohydrates are the most dangerous food group when it comes to diabetes,” he said, adding that not all carbohydrates are created equal. For instance, matooke (green bananas), though a carbohydrate source, is safer than many other starches because of its low to moderate glycemic index — it raises blood sugar slowly, giving the body time to adjust. However, problems arise with how it is prepared.
“Frying matooke or pairing it with other carbohydrate-heavy dishes, as well as large portion sizes, can negate its health benefits,” he said.
“A plate full of matooke and little protein is still a dietary risk,” he emphasised.
Like Kamara, Kalyesubula underscored the importance of physical activity as essential in preventing diabetes.
Citing the World Health Organisation recommendations, he said every person should carry out at least 150 minutes of moderate exercise per week — roughly 30 minutes a day, five days a week.
Cost of managing diabetes
According to Kalyesubula, diabetes progresses in stages. If caught in the pre-diabetic phase — a state where sugar levels are high but not yet harmful — one can reverse the condition through lifestyle adjustments without medication.
“If diagnosed early, all a person may need is diet and exercise. That costs nothing,” he noted.
For diagnosed diabetics, especially those caught early, treatment is affordable. Most begin with a drug called metformin, which costs around sh10,000 per month and is widely available in government health facilities.
However, complications raise the stakes.
“The real cost of diabetes comes with the complications,” he warned.
These include kidney failure, blindness, heart disease, nerve damage and amputations — often requiring costly specialist care and life-long medication.
Take-home message
Kalyesubula urges Ugandans to shift from curative to preventive healthcare.
“You do not need to wait for symptoms. A simple sugar test — a quick finger prick — can detect diabetes or pre-diabetes early.”
Kalyesubula also points to other habits worsening the diabetes crisis, naming some of these as limited sleep, late-night eating, stress, alcohol and smoking as well as drug abuse. For example, he said while ideally every human should have at least six to eight hours of sleep, some sleep less.
“Inadequate sleep hampers organ function and overall metabolism,” he said.
He says chronic stress increases cortisol, a hormone that interferes with insulin’s ability to regulate blood sugar. “Stress contributes significantly to insulin resistance,” he said.
Foods to avoid
Kalyesubula advises the public to avoid table sugar, soda, and all artificially processed packaged drinks. Refined grains such as white rice, wheat products like cornflakes, mandazi, chapati, samosas, cakes, biscuits, doughnuts, muffins, spaghetti and pizza should also be avoided.
Alcohol is harmful due to its high-calorie content and its potential to worsen or contribute to diabetes. Beer and spirits are the worst offenders, followed by wine.
Fruit juice is not recommended because it often contains high sugar concentrations.
Processed meats like sausages, bacon, salami, frankfurters and burgers cause inflammation that can worsen diabetes.
Kasenene cautioned against carbohydrate foods, saying they tend to be white foods such as Irish potatoes and cassava.
“We must encourage staple carbohydrate foods because people need energy for their daily activities. However, those who are not physically active should avoid excessive consumption,” Kasenene advised.
Regarding fruits, Kasenene clarified that fruits do not cause diabetes, except when made into juice.
“Juices made from sweet fruits are more likely to raise blood sugar quickly. It is even worse if you are inactive because the cells stop responding properly to insulin, increasing diabetes risk,” he said.
He recommends eating whole fruits instead of juices with added sugar. Some fruits that raise blood sugar faster include pineapple, mango and banana, compared to apples, pears, guavas and passion fruit.
Healthy foods
Kasenene recommends eating non-starchy vegetables such as broccoli, cauliflower, cabbage and sukuma-wiki. Green leafy vegetables like spinach, lettuce, and local varieties such as dodo, buga and nakati should be included.
Other healthy options include carrots, eggplants, legumes (beans, peas and groundnuts), nuts and seeds like almonds, cashews, pumpkin seeds, simsim and chia seeds.
Healthy fats such as avocado and olives are beneficial, as are lean animal proteins from local chicken, fish and eggs.
Hydration is also critical since cells require water for metabolism. To estimate daily water intake, divide your weight in kilogrammes by 30. At least 60% of fluid intake should be water, with the remaining 40% being healthy vegetable juices, teas, and high-water fruits like watermelon.