The Diabetes Epidemic

 

According to new research published by the Centers for Disease Control and Prevention (CDC), the burden of diabetes has been growing at a disturbing rate over the past decade.¹ The recent data shows that diabetes rose by 33% between 1990 and 1998 among the US population nationally. The disease incidence rose by 70% among people in their 30s over the same period, by 40% among 40-49 year olds, and by 31% among those age 50-59, and about 13% of those 60-plus had the disease. Add to these figures the fact that about 800,000 new cases crop up each year, and it's fair to say that diabetes is spiraling out of control.

The recent Centers for Disease Control and Prevention figures paint a picture that gives Americans cause for despair. At the same time, the new data gives those with a family history of diabetes, a poor diet, and/or a sedentary lifestyle a strong wake-up call that's as subtle as a blow to the head. The most disconcerting part of the latest information is that diabetes is no longer a disease reserved for an aging population that inherently suffers a slowing down of metabolism and lower glucose tolerance. Diabetes' victims are getting younger, lending much more time for the disease to ripen to the point of presenting complications by the time middle age rolls around.

Nearly 16 million Americans have diabetes, but over 5 million of them don't even know it

 

A recent Newsweek cover story, “An American Epidemic: Diabetes,”² which refers to diabetes (Type II diabetes in particular) as the “next great lifestyle disease epidemic to afflict the United States,” also notes that diabetes is more specifically becoming “a disease of the young.” As Dr. Arthur Rubenstein, a leading endocrinologist and dean of the Mount Sinai School of Medicine in New York, expresses in the feature, the growing number of Type II diabetes cases among teenagers is very disconcerting. He is quoted as saying that, “If people become diabetic at age 10 or 15 or 20, you can predict that when they are 30 or 40, they could have terrible complications.”

 

As it stands, nearly 16 million Americans have diabetes, but over 5 million of them don't even know it—the latter figure represents the number of people that currently go undiagnosed. In fact, it's believed that diabetes is underreported on death certificates, both as a condition and as a cause of death. Future health prospects in America don't look any brighter either, suggests the Centers for Disease Control and Prevention, with the number of diabetics expected to jump from 16 to 22 million by 2025. It's also growing as indiscriminate as cancer, striking out across the ages, assaulting both sexes and every race to boot. Figures from the National Institute of Diabetes and Digestive and Kidney Diseases show that 7.5 million men (8.2%) and 8.1 million women (8.2%) have diabetes. The Centers for Disease Control and Prevention data revealed that Hispanics had a 38% increase in diabetes compared to whites, who had a 29% increase and blacks with a 26% increase.

Future health prospects in America don't look any brighter either, with the number of diabetics expected to jump from 16 to 22 million by 2025.

Defining diabetes

There are four types of diabetes, including Type I, Type II, gestational diabetes and a miscellaneous kind that can stem from genetic syndromes, surgery, drugs, malnutrition, infections and other illnesses. However, gestational diabetes usually is limited to the pregnancy period and affects about 2% to 5% of all pregnancies. Meanwhile, specific “other” types of diabetes only account for a mere 1% to 2% of diagnosed cases. Type I and II are more common, and the latter is the one that is afflicting a disproportionate number of people. Type I diabetes is an autoimmune disease that mainly assaults the body by halting its natural production of the hormone insulin, which the body needs to metabolize and store the glucose it gets from food. As insidious as this form of the disease is, it makes up only about 5% to 10% of diabetes cases, lashing out mostly as adolescence sets in. That's why it's become commonly known as juvenile diabetes, even though the narrow term doesn't allude to the fact that the disease abides by its host for the rest of his/her life.

Type II diabetes, formerly named non-insulin dependent diabetes mellitus or adult-onset diabetes, isn't characterized by the inability to produce any insulin—at least, not at first. Instead, this form of diabetes, which accounts for 90% to 95% of cases, causes one's pancreas to shift into overdrive, churning out copious amounts of insulin in a fear-stricken attempt to try keeping up with ever rising levels of blood glucose. Eventually, though, ambition is overtaken by defeat, and the pancreas may give up trying to keep up with glucose control, and the unfortunate result is dangerously high glucose levels in the face of insulin deficiency. Under normal circumstances, glucose is the fuel that energizes the body's cells. In diabetes, however, glucose hangs around in the blood instead of going to cells, which means that energy is now in short supply. Over time, the blood-glucose overload can lead to complications that can threaten the eyes, heart, kidneys or nerves.

Yet, surprisingly, people persist in their perception of diabetes as simply blood-sugar levels that are a little high or low, rather than recognizing it for the long list of debilitating and deadly complications it heralds. First and foremost, diabetes is a major risk factor for heart disease and stroke. The National Institute of Diabetes and Digestive and Kidney Diseases reports that death rates related to heart disease among adult diabetics are two to four times as high as among non-diabetic adults. The chances of having a stroke also are two to four times higher in diabetics. Uncontrolled diabetes is also associated with horrific complications such as blindness, kidney disease, as well as hypertension, amputations and congenital defects and still births. Further, diabetics are less resistant to infection, such as influenza and pneumonia. The result of this onslaught of related illnesses is a staggering death toll that could simply earn diabetes a new name—the Grim Reaper. According to data from the National Institute of Diabetes and Digestive and Kidney Diseases, diabetes was the cause of some 193,140 deaths in 1996, making it the seventh leading cause of death. Their figures show that death rates are also twice as high among middle-aged diabetics when compared to non-diabetics of the same age group.

Blaming the obesity epidemic

 

Researchers see a causal link between Type II diabetes and the obesity epidemic, and the latter's prevalence is growing at an equally alarming rate. According to the latest national statistics, over 50% of US adults are overweight (body mass index of 25 and up)³ and approximately one fifth of the population is considered obese (body mass index of 30 and up).⁴ Obesity trends have marked an increase from 12% in 1991 to 17.9% in 1998.⁵ The trouble with these growing numbers is that obesity is the strongest environmental risk factor for non-insulin-dependent diabetes mellitus. Obesity threatens with health risks of its own, including the predisposition to diabetes. A 1999 Centers for Disease Control and Prevention report suggests that overweight and inactivity were to blame for 300,000 premature deaths in the US, second only to tobacco-related deaths.⁶ Data collected from the Third National Health and Nutrition Examination Survey demonstrates that people under age 55 with a body mass index of at least 40 are most likely to have Type II diabetes and gall bladder disease, and that the prevalence ratios are higher among younger than older adults.⁷

So what's the connection between fat and blood-glucose levels? Excess weight increases the body's demand on insulin, putting pressure on pancreatic beta cells to produce more of the hormone, until basically the supply can’t meet the demand and the body becomes insensitive to insulin. Studies have also shown that obesity increases levels of free fatty acids in the body, which may impede the body’s insulin metabolic clearance. Obesity has also been related to hormonal abnormalities, namely elevated cortisol and estrogens and waning androgens, both of which act to regulate fat when operating at proper levels.

Practicing prevention

 

The most disheartening part about diabetes is that it isn’t a disease that one can merely blame on chance, or even genetics. By the same token, the fact that diabetes is preventable through a number of modifiable lifestyle lends hope to what otherwise could be depicted as the 21s century plague. Changes to eating and exercise habits, and modest weight loss (under 10 pounds) have all been shown to dramatically reduce the risk of diabetes. Finnish research results were recently presented at the American Diabetes’ Association’s 60th Annual Scientific Session in June 2000, which showed that intensive lifestyle modification reduced the incidence of Type II diabetes by 58% in people at high risk of developing the disease.

The Finnish Diabetes Prevention Study was conducted at five clinics, and tracked 523 adults over a five-year period (1993-1998), whose average age was 55, and on the verge of developing diabetes (measured by impaired glucose tolerance, which is an early warning sign of diabetes). The subjects were divided into two groups: 265 of them received frequent and consistent dietary advice, individual exercise assessment and program plan, and supervised exercise at least three times per week; the control group had a yearly meeting with a nutritionist and physician, and was encouraged to do more exercise of their own volition. Results showed that 22% of the control group developed diabetes after four years in the study, but only 10% of the intervention group got it. The latter also lost an average of 4.2 kilograms (9.24 pounds) within the first study year, while the controls lost only 0.8 kilograms (1.76 pounds).

Another study carried out by investigators at the University of Minnesota in Minneapolis found that postmenopausal women who exercise regularly (moderately to vigorously over four times per week) cut their risk of diabetes in half.⁸ The research involved a questionnaire mailed out to 41,000 women, ages 55-69, to assess their risk of diabetes relative to exercise habits over the next 12 years.

Likewise, research from Yale University illustrated that the benefits of exercise can never come too late. They showed how moderate-intensity aerobic exercise (e.g. walking) improves glucose tolerance in older, healthy adults, even without any weight or fat loss.⁹ Investigators put a group of 16 men and women over 60 on a four-month exercise program. Nine of them were instructed to exercise on a mini-trampoline for 60-minute periods four times per week. The remaining seven participants, who served as controls, were given a less intensive physical program comprising supervised stretching and yoga. Researchers took measurements, before and after the study, of abdominal fat, plasma glucose and fasting concentrations of free fatty acids, as well as administering an oral glucose tolerance test. The cardiovascular training caused a 24% drop in free fatty acid in the nine participants, irrespective of adipose fat measurements remaining unchanged. The control group, however, didn’t show any changes or benefits in terms of improved glucose tolerance. Biological age, coupled with increased body fat, and decreased physical activity, can lead gradually to increased glucose intolerance. Besides the training having a significant effect on free fatty acid levels, the researchers also found that the exercise effects weren’t short-lived, as there was still an evident improvement three days after the training period.

 

The answer seems almost too simple, and it’s the health message conveyed for dodging most chronic diseases: eat less, lose weight and exercise. But that has been a huge challenge for most people and much easier said than done, as any dieter will attest. Dieting is an equivocal act with a backlash effect, in that once you cease a controlled eating and exercising regimen, there is a looming risk of gaining all the weight back again, and then some. The catch about low-calorie diets is that they prompt your body to reserve more of its fat energy for fear of not getting enough through food consumption. It does so by slowing down the basal metabolic rate—which is the rate at which your body burns calories when at rest. A slowed basal metabolic rate is one of the main reasons why some strict dieters seem to plateau in their weight loss efforts and can’t shed any more pounds despite remaining on a fat-restricted diet. The aftermath of this change is that, once the diet is over, and normal calorie consumption resumes, the body continues to burn off energy at the newly established sluggish metabolic rate. And because, as physics would have it, every action has an equal and opposite reaction, now that it’s burning off fewer calories, it means that pounds are regained at a higher rate.

In the following article, we present some natural ways to help prevent and treat adult-onset (Type II) diabetes.

References

1. Diabetes Care 23:1278-1283.
2. Newsweek 2000;9: 40-47.
3. Int J Obesity 1998;22:39-47.
4. JAMA 1999;282:1519-1522.
5. JAMA 1999;282:1519-1522.
6. JAMA 1999;282:1530-1538.
7. JAMA 1999;282:1523-1529.
8. Amer J Pub Hlth 2000;90:134-138.
9. J Am Geriatr Soc 1998 Jul;46(7):875-879.