Diabetes: An American
Epidemic?
By Dr. Walter M. Bortz II
Q: My grandfather passed away recently of a diabetes-related
heart
attack. Since then, my family has been concerned with who is
susceptible for getting the disease. Who is at risk for diabetes? Could I get
it? I have noticed a few “signs” that he had that I am starting to develop, such
as frequent urination, a constant thirst and the feeling of “something” lacking
in my normal diet. Should I be tested?
A: Thanks for your interesting and important
question. Talk about an epidemic! Diabetes incidence is soaring. The New York
Times ran a recent article under the title “The Diabetes Explosion,” and
“skyrocketing” was the verb they used. In 1935, there were 1.5 million people
with diabetes in America. In 1965 there were 2 million. Today there are 16
million, and the number is projected to increase to 22 million by 2025.
This soaring incidence is a huge concern because the
diagnosis of diabetes carries with it tremendous costs in disease complications.
Common co-conspirators include greatly increased tendency toward heart
disease and circulatory problems, high blood
pressure, blindness and kidney
failure. Almost every American family has been touched, as has yours,
in one way or another by the dreadful collection of health problems that
diabetes directly causes.
But what is the cause of this explosion? The
explanation goes way beyond merely a larger population overall. To search for
the cause demands, initially, an examination of the nature of
diabetes.
It is now well-established that there are two separate and
absolutely distinct forms, which predictably go by the labels type I and type
II. Type I also goes by the tag "juvenile diabetes," which is generally, but not
universally, accurate. Type I is usually seen in young people, but not
exclusively. This form of diabetes is severe and is due to an autoimmune
destruction of the insulin-producing cells of the pancreas, possibly induced by
an as-yet-unidentified viral agent. People with type I are often termed
"brittle" because it's difficult to control their blood sugar levels with injections. These people are absolutely
dependent on insulin for their survival.
I ran across an interesting
speculation the other day by Professor G.F. Bottazzo at the London Hospital,
published in the journal Diabetes in 1993. Judging both by the
universally fatal nature of this type of diabetes, and the relatively recent
emergence of other types of autoimmune diseases, he concludes that type I is a
relatively new disease.
There is much excitement these days about the
development of an artificial pancreas, or islet-cell transplantation, which
would result in a cure for type I diabetes. I recently looked in on the care of
a close family friend with an awful case of type I diabetes, complete with all
the complications. He received a pancreas-kidney transplant and is now,
miraculously, cured of his diabetes.
But type I is not the disease that
is expanding; it is type II. Type II, often called "adult onset diabetes," also
is generally age-correlated. But there is growing concern about the number of
children who are starting to show up with the adult onset type. Type II is
different from type I in that the basic problem is not lack of insulin, but is
instead a resistance to the insulin that is being produced. A portion of the
disease is genetic, but that explanation cannot be held responsible for the jump
in cases because our genes haven't changed one bit — something else
has.
| Perhaps I am being overly simplistic
in laying the epidemic at the feet of our progressively rising, national levels
of physical inactivity and obesity. To me, the facts that 55 percent of Americans
are overweight, few of us exercise enough and diabetes is rampant are all
tightly correlated. |
My wife and I had an interesting encounter
in Alice Springs, Australia, last summer, where I visited a local county health
officer. He was lamenting the tremendous increase in health costs generated by
huge numbers of the aboriginal population after abandonment of their
time-honored nomadic ways. Through various inducements, the government had
coaxed the Aborigines into town, where their diets and exercise patterns changed
dramatically. Obesity, diabetes and kidney failure — and huge dialysis bills —
followed directly.
This story is exactly reminiscent of the Pima
Indians of our own Southwest. The Pimas are known to display the highest
incidence of diabetes of any group in the world. The natural habitat of the
Pimas is the rugged mountains of northern Mexico where they lived very robust
lives, traveling up and down the mountains, eating grains and Spartan diets.
Then the Pimas saw the bright lights of Phoenix, resettled there, adopted a
"civilized" American way of life, and the same sequence as the Australian
Aborigine played out — to everyone's dismay. It is obvious that the problem is
not genes; those haven't changed at all. Rather, the Pimas' lifestyle was
altered dramatically in a brief time interval, to disastrous
consequences.
What is the answer to this situation? More dialysis
machines or more insulin or more transplants? Or something simpler, like
lifestyle re-adjustment?
So my long answer to your straightforward
question is: It depends. If you are slim, physically active and otherwise fit in
your lifestyle, I feel the chance of your developing diabetes is slight, even
with your family history. If, on the other hand, you are in the huge number of
unfit, overweight Americans, you are literally leading with your chin, and the
prospect of you becoming part of the epidemic of diabetes is
substantial.
| I would certainly encourage
you to be checked for diabetes, which is easily and cheaply done by a blood
test. |
Perhaps 30 percent of people with diabetes are as yet undetected,
and early diagnosis and treatment are very important.
Cure would be
nice, but prevention, now, is a more realistic and practical goal. Look into
your mirror. You will be able to tell if you are at risk.
For further
information, I encourage you to contact the
Diabetes Research and Wellness Foundation with which I
am involved. Its address is 1206 Potomac St. NW, Suite 300, Washington, D.C.
20007. This group produces much useful information and is the source of a new
book, of which I am a co-author, titled "The Diabetes Weight Loss System."
Other books by Doctor Bortz II:
