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Diabesity: A Modern Plague
What’s in a name? Insulin resistance, metabolic syndrome, syndrome X, obesity, pre-diabetes, adult-onset diabetes, type 2 diabetes — these are all essentially one problem. Some vary by severity, but all can have deadly consequences.
“Diabesity” is a more comprehensive term coined to describe the continuum from optimal blood sugar balance toward insulin resistance and full-blown diabetes. Nearly all people who are overweight (more than 70 percent of adult Americans) already have pre-diabetes and significant risks of disease and death. They just don’t know it.
Even worse, though the word “diabesity” is made up of the concepts of “obesity” and “diabetes,” even those who aren’t overweight can have this problem. These are the “skinny-fat” people. They are underlean (not enough muscle) instead of overweight and may have a little extra weight — belly fat — around the middle.
Currently there are no national screening recommendations, no treatment guidelines, no approved medications and no reimbursement to health care providers for diagnosing and treating anything other than full-blown diabetes. Think about that: Doctors are not expected, trained or paid to diagnose and treat the single biggest chronic disease in America, which, along with smoking, causes nearly all the major health care burdens of the twenty-first century, including heart disease, stroke, dementia and even cancer.
Our current medical practice has not caught up with our knowledge. In 2008, the American College of Endocrinology and the American Association of Clinical Endocrinologists gathered twenty-two experts and reviewed all the scientific data on pre-diabetes and diabetes. Their conclusions were as follows:
- The diagnosis of pre-diabetes and diabetes is arbitrary. A fasting blood sugar over 100 mg/dl is considered pre-diabetes, and a blood sugar over 126 mg/dl is considered diabetes. However, they found that these cutoffs don’t reflect the whole spectrum of risk — including heart disease, cancer, dementia, stroke and even kidney and nerve damage — which starts at much lower numbers. Numbers most people consider normal.
- The DECODE study of 22,000 people examined the continuum of risk measured not by fasting blood sugar, but by blood sugar after a big sugar drink (the best way to diagnose the problem). The study found that even starting at blood sugar levels that were perfectly normal (95 mg/dl), there was a steady and significant risk of heart disease and complications well below the accepted abnormal of less than 140 mg/dl for pre-diabetes and long before people reached the diabetic cutoff of 200 mg/dl.
Bottom line: Even if you have perfectly normal blood sugar, you may be sitting on a hidden time bomb of disease called diabesity, which could prevent you from losing weight and living a long healthy life. Insulin resistance is the major cause of aging and death in the developed and most of the developing world.
Diabesity: The major cause of chronic disease and decreased life expectancy
Diabesity is one of the leading causes of chronic disease in the twenty-first century, including heart disease, stroke, dementia and cancer. Consider the following:
- One-third of all diabetics have documented heart disease.
- People with diabetes are four times more likely to die from heart disease, and the rate of stroke is three to four times higher in this population.
- Those with pre-diabetes are also four times more likely to die of heart disease. So having pre-diabetes isn’t really “pre” anything in terms of risk.
- The link between obesity and cancer is well documented and is driven by insulin resistance.
- Diabesity is the leading cause of high blood pressure in our society. Seventy-five percent of those with diabetes have high blood pressure.
- Diabesity is an important cause of depression and mood disorders. Women with diabetes are 29 percent more likely to develop depression, and women who take insulin are 53 percent more likely to develop depression.
- Nervous system damage affects 60–70 percent of people with diabetes, leading to a loss of sensation in the hands and feet, slow digestion, carpal tunnel syndrome, sexual dysfunction and other problems. Almost 30 percent of people age forty or older with diabetes have impaired sensation in their feet, and this frequently leads to amputations.
- Diabesity is also the leading cause of blindness among people ages twenty to seventy-four.
- Diabesity is the leading cause of kidney failure — accounting for 44 percent of new cases each year.
A recent remarkable study published in the New England Journal of Medicine examining 123,205 deaths in 820,900 people found that diabetics died an average of six years earlier than non-diabetics and 40 percent of those did not die from heart disease or the usual diabetes-related causes. They died from other complications not obviously related to diabetes, complications most wouldn’t necessarily correlate with the disease. Yet it makes perfect sense, given that diabesity is the underlying cause that drives most chronic illnesses.
A hidden epidemic: The United States of Diabetes
Diabesity is almost entirely caused by environmental and lifestyle factors. This also means that it is almost 100 percent preventable and curable.
Diabesity affects more than 1.7 billion people worldwide. Scientists conservatively estimate it will affect 1 in 2 Americans by 2020, 90 percent of whom will not be diagnosed. I believe it already affects more than 1 in 2 Americans and up to 70–80 percent of some populations.
Obesity (almost always related to diabesity) is the leading cause of preventable death in the United States and around the world. Gaining just 11–16 pounds doubles the risk of type 2 diabetes, while gaining 17–24 pounds triples the risk. Despite this, there are no national recommendations from government or key organizations advising screening or treatment for pre-diabetes. We are becoming the United States of Diabetes.
The prevalence of type 2 diabetes in America has tripled since the 1980s. There are now 27 million Americans with diabetes (25 percent of whom are not diagnosed) and 67 million with pre-diabetes (90 percent of whom are not diagnosed). And African-Americans, Latin Americans and Asians have dramatically higher rates of diabesity than Caucasians do.
By 2015, 2.3 billion people worldwide will be overweight and 700 million will be obese. The number of diabetics will increase from 1 in 10 Americans today to 1 in 3 by the middle of this century.
A childhood problem
Perhaps most disturbing, our children are increasingly affected by this epidemic. We are raising the first generation of Americans to live sicker and die younger than their parents. Life expectancy is actually declining for the first time in human history. Here are some startling statistics:
- One in three children is overweight in America.
- Childhood obesity has tripled from 1980 to 2010.
- There are now more than 2 million morbidly obese children above the 99th percentile in weight.
- In New York City, 40 percent of children are overweight or obese.
- One in three children born today will have diabetes in their lifetime.
- Childhood obesity will have more impact on the life expectancy of children than all childhood cancers combined.
Preventing and reversing diabesity
Want to know what you can do to prevent or reverse diabesity? Find out here.
This is an excerpt from The Blood Sugar Solution by Mark Hyman, M.D. Copyright © 2012 by Mark Hyman, M.D. Reprinted by permission of Little, Brown and Company, New York, NY. All rights reserved.