If the Bread Is White, the Markers Rise

At NYU Langone Health and Weill Cornell Medicine a team analysed blood drawn in the FB4 controlled feeding trial. Ezequiel Dantas and colleagues published that ancillary analysis in Cell Press Blue on 10 September 2026. Participants had lost 15% of body weight over 3 to 4 months on a very-low-carbohydrate diet. Serum beta-hydroxybutyrate of 2.7 to 3.1 mM put them in ketosis at randomisation. Mean age was 35, with body mass index from 25 to 31.

After 3 weeks of residential feeding on isocaloric very-low-carbohydrate meals, the investigators randomised participants into 3 arms. A control arm stayed on that diet. The other 2 arms took 57% of energy as carbohydrate and 25% of energy from whole grains. Refined grain supplied the remaining 20% in one arm. Added sugar supplied that 20% in the second arm. Blood analyses covered 40 to 44 participants per assay. After 10 weeks the team drew blood again.

Adipsin, a signalling protein in the complement system, rose most in the starch arm. Activation markers went up on 5 cell types, among them helper T cells, natural killer cells, neutrophils, monocytes and dendritic cells. In circulating white blood cells, genes governing complement signalling and T-cell activation scored higher. Phosphorylated NF-κB rose in helper T cells and in myeloid dendritic cells. The starch arm turned those pathways up, and the sugar arm, down.

Expression of C3AR1, a complement receptor gene, declined in the sugar arm. Genes for interferon-gamma production rose there instead. C-reactive protein fell below 10 mg/L in the 3 groups. The sugar arm did post the largest drop. Adiponectin fell in the 2 high-carbohydrate arms and held steady in the control arm. Only the control arm stayed ketotic. Post-meal glucose climbed higher in the 2 high-carbohydrate arms, their beta-hydroxybutyrate fully suppressed.

To test a mechanism, the team gave mice maltodextrin as a model for starch and sucrose as the comparison. Maltodextrin produced larger rises in insulin and glucose than sucrose. Helper and killer T cells in the maltodextrin mice expressed more CD69 and CD25, 2 activation markers. The likely trigger is a fast glucose rise after refined, high-glycaemic food. Starch intake may switch on complement, a branch of the innate immune system. In their conclusion the authors described starch-rich diets as a source of inflammation after this kind of weight loss.

Although the sugar arm posted lower inflammation readings, the authors warned against treating that result as a benefit of sucrose or fructose. Suppressed complement responses could impair host defence, they wrote. The team only measured circulating immune cells. Functional immune assays and microbiome tests stayed outside the design. The analysis groups were small, their members fresh from months of carbohydrate restriction. A 10-week diet may miss chronic effects, the authors noted.

For 2024 the International Diabetes Federation ranked countries by age-standardised adult prevalence in the 2025 edition of its Diabetes Atlas. Pacific countries and territories took 4 of the world's top 10 places. Behind Pakistan came the Marshall Islands in 2nd, Sāmoa in 4th, Kiribati in 6th and French Polynesia in 8th. Undiagnosed cases made up 83.9% of adults with diabetes in Sāmoa. In Tonga the undiagnosed share approached 75%.

By 2050 the Atlas projects Kiribati at 3rd and Sāmoa at 5th. That would give the Pacific 3 of the world's top 5 places. The projections put adult prevalence at 28.7% in the Marshall Islands and 28.5% in Kiribati. A published protocol for a randomised lifestyle trial in the Marshall Islands attributes the rise there to imported goods such as flour and rice. Population growth has strained supplies of indigenous food, its authors state.

While working in American Sāmoa, Elstad and colleagues convened 7 focus groups in Samoan for a 2008 study. The 64 participants included patients with diabetes and their family caregivers. Samoan speakers call the illness maʻi suka, sugar disease in a literal gloss. Many participants defined it as the sum of its symptoms. They also tied rises in blood glucose to family and environmental stress.

Diabetes Australia administers the National Diabetes Services Scheme. On 17 August 2026 the scheme updated its Tongan resource page. The type 2 fact sheet appears there as Fakamahinoʻi ʻa e mahaki suka kalasi 2. Under the type 2 heading the page gives 2 Tongan forms, suka kalasi 2 and suka kai. The hypoglycaemia sheet takes the title Mapuleʻi e tōlalo ʻo e suka.

The page tells patients to ask a doctor or a tokotaha faleʻi ki he suka about joining the scheme. In the English version a diabetes educator fills that slot. The carbohydrate counting guide goes by Siofi ʻo e kapohaituletí, built on kapohaituleti, the loanword for carbohydrate. Its glycaemic index guide keeps the English term in quotation marks in the Tongan title.

The English guide, which carries a March 2025 version date, defines the index by the speed of that breakdown into glucose. White bread and white rice fall in the higher GI column. Taro and cassava appear under low and medium GI, beside green banana. Choose lower GI varieties of carbohydrate food, the guide advises patients. Chocolate and chips take a lower GI mark, with high energy and saturated fat.

Ronald Gatty's Fijian dictionary, published in Suva in 2009, lists mate ni suka for diabetes beside mate ni uto for heart disease. A 2025 overview of disease in French Polynesia in Médecine Tropicale et Santé Internationale pairs diabète sucré with maʻi ʻōmaha tihota. In April 2020 a Tahitian bulletin from the crisis cell of French Polynesia wrote the phrase as omaha tihota, without the ʻokina or the macron. Its list of chronic conditions left tension and goutte in French.

Huri's team put a diabetes leaflet and a screening reminder into Tongan for a public health client. A first-language reviewer struck the insulin paragraph whole and wrote the replacement out by hand. That replacement separated 2 types of the illness. The body makes no insulin at all in the first type. A patient there takes insulin daily. In the second the patient takes medicine or insulin. Most adult cases fall there. A third margin note asked for a paragraph number, because the highlight had not reached the reviewer's file.

The Tongan Health Society states its aim in Tongan as better care for Pacific people ill with mahaki suka. Its page writes type 2 as kalasi suka hono 2 and puts the English in brackets, an order the reverse of the scheme's. Insulin appears there as the loanword ʻinisulini. Among its patient groups the service lists people with an HbA1c above 64 mmol/mol.