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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:

Dare to be 100 Avg. Customer Review: 5 out of 5 stars

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We Live Too Short and Die Too Long


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