Carb counting: The skinny on Thailand’s new war on lifestyle diseases

The Public Health Ministry has launched an ambitious mission to tackle the epidemic of lifestyle diseases among Thais by lowering their carbohydrate intake.

The “Lower Carb, Fewer Health Issues” policy has reached over 31 million people since its launch earlier this year.

By September, that number is expected to grow to 50 million as more people gain access to health-saving information on carbohydrate intake and its effects.

As part of the policy, more than 7,000 NCDs (non-communicable disease) clinics have sprung into action nationwide to treat patients whose illnesses are related to carbohydrate consumption.

So far, 112,661 people have sought help from these clinics, with 16,580 reporting that their health conditions improved after treatment.

Many have recovered well enough to reduce or even stop taking medicines.

Meanwhile, the government estimates the policy has already saved about 414 million baht in health budget.

Reversing the growing NCD trend

According to the Public Health Ministry, nearly half of Thailand’s population – over 33 million people – suffer from NCDs, which cause an average of 400,000 deaths each year.

Overconsumption of carbohydrate is a major contributor, with 350,000 new diabetes cases reported each year and over 100,000 patients currently receiving kidney dialysis.

“Nearly 10% of Thais have diabetes,” Public Health Minister Somsak Thepsuthin stated recently.

Meanwhile, treating NCDs consumes 62.13 billion baht of the universal healthcare scheme’s annual budget.

Add in hidden costs such as patients’ travel expenses and lost work hours, and NCDs cost Thailand an estimated 1.6 trillion baht every year.

Somsak noted that the main causes of NCDs are bad diet, lack of exercise, and obesity.

In line with the World Health Organization’s goal of reducing NCD-related fatalities by 25% by 2030, the Public Health Ministry launched “Lower Carb, Fewer Health Issues” to tackle the root causes of the epidemic.

The ministry’s army of over one million village health volunteers have been trained to calculate carbohydrate units.

While low-carb diets have been popular worldwide for decades, most people are still unsure of their finer details.

“We expect these volunteers to have educated 50 million Thais [on low-carb diets] before the end of this fiscal year [on September 30],” Somsak said.

Under the policy, people are encouraged to calculate their daily carb/calorie intake at www.nubcarb.com – a collaboration between the ministry and the Thai Health Promotion Fund.

The website uses the century-old Harris-Benedict equation to calculate the calorie content of common dishes and drinks.

One unit of carbohydrate is equivalent to a large spoonful of noodles or rice, six slices of watermelon or guava, or a spoonful of sugar or syrup.

Users can enter their height, weight, physical activity level and gender to determine how many calories they actually need to consume each day.

Excess calorie consumption accumulates as body fat and can lead to lifestyle diseases such as obesity, diabetes and heart disease over time.

Carb counting

Dr Wirun Limsawart, a research head at the Office of the Permanent Secretary for Public Health, said that while carb counting is not a cure-all, it can significantly reduce the number of NCD patients.

He described the programme as a form of “social technology” that empowers people to make healthier choices. “The concept is relatively new to Thais,” he said.

However, he cautioned that it would take time for the public to fully understand carb counting, as many doctors are still unable to calculate carb units accurately.

“Many Thais may currently only have a rough understanding, but this issue can be solved with time,” Wirun said.

Before the policy was implemented, doctors tended to simply advise patients to reduce their carb/sugar intake without giving a clear picture of how they should do it.

Carb counting – supported by the ministry’s campaign – fills that information gap and is expected to cut NCD rates significantly.

“There’s plenty of evidence that carb counting helps with preventative healthcare and fosters stronger collaboration between medical workers and patients,” Wirun said.

Tangible guidelines lead to clear benefits

The “Lower Carb, Fewer Health Issues” policy has sparked a nationwide debate and focus on NCD prevention, even in rural communities, according to Public Health Ministry spokesperson Dr Varoth Chotpitayasunondh.

“Thailand’s public health sector has focused on treatment for too long. It’s high time we prioritised disease prevention and health promotion,” he said.

Varoth explained that the Public Health Ministry had shifted its approach after finding that simply advising people to curb their intake of sweet and salty foods had failed to deliver meaningful results.

“We followed this policy for 20 years, but people didn’t understand how much they needed to cut down on,” Varoth said.

Somboon, a 54-year-old village health volunteer in Roi Et, said she had tried for years to cut sugary and sodium-rich foods but had seen no improvement, as she didn’t know how to calculate her calorie intake.

“But after receiving carb-counting training, I’m on the right track. I have better control of my blood sugar levels now,” she said.

Her success has also inspired neighbors in her hometown to embrace carb-counting and follow better dietary habits to maintain or improve their health.

In Nakhon Ratchasima, the "Lower Carb, Fewer Health Issues" policy has benefited from the Diabetes Science Schools' long-standing 12-week programmes that train diabetic patients to monitor their carb intake.

The campaign is up and running at schools in every subdistrict of the province. Buoyed by its success in helping its students to manage or even reverse their diabetes symptoms, authorities plan to expand the programme to other northeastern provinces.

Varoth said that while the “Lower Carb, Fewer Health Issues” policy had helped reduce national healthcare costs significantly, it was not driven by a budget-cutting goal.

“Its main aim is to boost the health of Thais,” he said, adding that patients who stopped taking medications will continue to be monitored to ensure they do not relapse.