Diabetes in America Part II—Reversing Diabetes with the Vegan Diet

 

INTRODUCTION

 This is Part II of a two part series on Diabetes in America. Part I looked at types of diabetes, my personal experience with the disease, epidemiology of diabetes including its prevalence in various population groups, and the root causes of the disease. In Part II the nature of the Vegan Diet will be explored, how it differs from other types of vegetarian diets, and most importantly—the benefits of a Vegan diet. Changing eating habits can be a difficult job; please keep an open mind to the idea and process of change.

 

THE VEGAN DIET IN A NUTSHELL

The following provides the particulars of the diet:

 

FOODS TO AVOID

Meats

Poultry

Fish

All Dairy Products

     Eggs (Yolks and whites)

     Milk, Yogurt, Cheese, Cream, Sour Cream, and Butter

     Oil, Mayo, Margarine, Cooking Oils

Fried Foods (French Fries, Onion Rings, Potato Chips, Avocadoes, Olives, and  Peanut Butter

All High Glycemic Foods (Rated over 70) i.e., no White Bread or White Potatoes

WHAT TO EAT

Grains

 

One should eat Whole Grain Pasta; Brown Rice; Bran Cereal; Oatmeal; Pumpernickel or Rye Bread; Couscous; Bulgur Wheat; Millet; and Barley. Eight servings per day are recommended.

 

Legumes

Beans (Black, Pinto, or Kidney beans; Chickpeas; Baked beans; Soy beans, Peas, Split peas, Lentils, Fat-free soy products; Fat-free unsweetened soy milk; Fat-free veggie burgers; Textured vegetable protein; Fat-free Tofu; Three suggested servings per day

 

Vegetables

Sweet potatoes; Broccoli; Cauliflower; Spinach; Kale; Collards; Squash; Green beans; Bok Choy; Artichokes; Choose those with a low GI. Four suggested servings per day.

 

Fruits

Apples, Bananas, Grapes, Pears, Peaches, Oranges, Kiwifruit, Berries, etc. Choose those with a low GI. Three suggested servings per day.

 

Keep Glycemic Foods that are rated 55 or less (provided they contain no fat).

 

TYPES OF VEGETARIANS

There is a lot of confusion among the general public as to what vegetarianism is all about. This widespread confusion seems to arise primarily because there are so many types of vegetarians, some of whom are not well known. Some of these include: Flexitarians (people who like vegetarian foods, but eat meat occasionally), raw-food diet enthusiasts where food isn’t cooked above 115 degrees Celsius, and Pescatarians (they avoid meat and all animal flesh but they eat fish). There are also the macrobiotic diet followers where sea vegetables and Asian vegetables are promoted, while all sugar and refined oils are avoided. I would be content if you remember just three basic types of vegetarians: Lacto-vegetarians, Ovo-vegetarians, and Vegans.

When most people think of vegetarians, they think of lacto-ovo-vegetarians: People who do not eat beef, pork, poultry, fish, shellfish or animal flesh of any kind, but do eat eggs and dairy products. “Lacto” comes from the Latin for milk, and “ovo” for egg. This is the most common type of vegetarian in North America.

Lacto-vegetarian is used to describe a vegetarian who does not eat eggs, but does eat dairy products. Many Hindu vegetarians are lacto-vegetarians who avoid eggs for religious reasons while continuing to eat dairy.

Ovo-vegetarian refers to people who do not eat meat or dairy products but do eat eggs. Some people are ovo-vegetarians because they are lactose-intolerant.

Vegan-vegetarian refers to people who do not eat meat of any kind and also do not eat eggs, dairy products, or processed foods containing these or other animal-derived ingredients such as gelatin. Many vegans also refrain from eating foods that are made using animal products that may not contain animal products in the finished process, such as sugar and some wines. There is some debate as to whether certain foods, such as honey, fit into a vegan diet. If you are a diabetic vegan you must consider the effect of honey on your blood sugar. The diabetic should look to the Glycemic Index to see where honey fits in. If a vegan is not diabetic, he or she may well consider the use of honey in a vegan diet.

What follows are the benefits one might obtain from going Vegan.

 

57 Health Benefits of Going Vegan

Vegans are frequently misunderstood as fringe eaters with an unnatural passion for animal rights. While many vegans do feel passionately about animals, its time for others to see that a vegan diet and lifestyle go way beyond animal rights. Following a healthy, balanced vegan diet ensures a host of health benefits as well as prevention of some of the major diseases striking people in North America.

Nutrition

All of the following nutritional benefits come from a vegan diet full of foods such as fresh fruits and vegetables, whole grains, nuts, beans, and soy products.

1. Reduced saturated fats. Dairy products and meats contain a large amount of saturated fats. By reducing the amount of saturated fats from your diet, you’ll improve your health tremendously, especially when it comes to cardiovascular health.
2. Carbohydrates. Carbohydrates provide energy for your body. When you don’t have enough carbohydrates, your body will burn muscle tissue.
3. Fiber. A diet high in fiber (as vegan eating usually is) leads to healthier bowel movements. High fiber diets help fight against colon cancer.
4. Magnesium. Aiding in the absorption of calcium, magnesium is an often overlooked vitamin in importance to a healthy diet. Nuts, seeds, and dark leafy greens are an excellent source of magnesium.
5. Potassium. Potassium balances water and acidity in your body and stimulates the kidneys to eliminate toxins. Diets high in potassium have shown to reduce the risk of cardiovascular diseases and cancer.
6. Folate. This B vitamin is an important part of a healthy diet. Folate helps with cell repair, generating red and white blood cells, and metabolizing amino acids.
7. Antioxidants. For protection against cell damage, antioxidants are one of the best ways to help your body. Many researchers also believe that antioxidants help protect your body against forming some types of cancer.
8. Vitamin C. Besides boosting your immune system, Vitamin C also helps keep your gums healthy and helps your bruises heal faster. Vitamin C is also an antioxidant.
9. Vitamin E. This powerful vitamin has benefits for your heart, skin, eyes, brain, and may even help prevent Alzheimer’s Disease. A diet high in grains, nuts, and dark leafy greens is full of Vitamin E.
10. Phytochemicals. Plant-based foods provide phytochemicals, which help to prevent and heal the body from cancer, boost protective enzymes, and work with antioxidants in the body.
11. Protein. That protein is good for your body is no surprise. It may be a surprise to learn that most Americans eat too much protein and in forms such as red meat that are not healthy ways of getting protein. Beans, nuts, peas, lentils, and soy products are all great ways to get the right amount of protein in a vegan diet.

Disease Prevention

Eating a healthy vegan diet has shown to prevent a number of diseases. Find out from the list below what you could potentially avoid just by switching to a healthy, balanced vegan way of eating.

1. Cardiovascular disease. Eating nuts and whole grains, while eliminating dairy products and meat, will improve your cardiovascular health. A British study indicates that a vegan diet reduces the risk for heart disease and Type 2 diabetes. Vegan diets go far in preventing heart attack and stroke.
2. Cholesterol. Eliminating any food that comes from an animal and you will eliminate all dietary cholesterol from your diet. Your heart will thank you for that.
3. Blood pressure. A diet rich in whole grains is beneficial to your health in many ways, including lowering high blood pressure.
4. Type 2 diabetes. Not only is a vegan diet a weapon against Type 2 diabetes, it is also “easier to follow than the standard diet recommended by the American Diabetic Association.”
5. Prostate cancer. A major study showed that men in the early stages of prostate cancer who switched to a vegan diet either stopped the progress of the cancer or may have even reversed the illness.
6. Colon cancer. Eating a diet consisting of whole grains, along with fresh fruits and vegetables, can greatly reduce your chances of colon cancer.
7. Breast cancer. Countries where women eat very little meat and animal products have a much lower rate of breast cancer than do the women in countries that consume more animal products.
8. Macular degeneration. Diets with lots of fresh fruits and vegetables, especially leafy greens, carrots, pumpkin, and sweet potatoes, can help prevent the onset of age-related macular degeneration.
9. Cataracts. Much the same way macular degeneration is headed off by a vegan diet, cataracts are also thought to be prevented through the intake of the same fruits and vegetables. Produce high in antioxidants are also believed to help prevent cataracts.
10. Arthritis. Eliminating dairy consumption has long been connected with alleviating arthritis symptoms, but a new study indicates that a combination of gluten-free and vegan diet is very promising for improving the health of those suffering from rheumatoid arthritis.
11. Osteoporosis. Bone health depends on a balance of neither too much nor too little protein, adequate calcium intake, high potassium, and low sodium. With a healthy vegan diet, all four of these points set a perfect scenario for preventing osteoporosis.

Physical Benefits

In addition to good nutrition and disease prevention, eating vegan also provides many physical benefits. Find out below how a vegan diet makes your body stronger, more attractive, and more energetic.

1. Body Mass Index. Several population studies show that a diet without meat leads to lower BMIs–usually an indicator of a healthy weight and lack of fat on the body.
2. Weight loss. A healthy weight loss is a typical result of a smart vegan diet. Eating vegan eliminates most of the unhealthy foods that tend to cause weight issues.
3. Energy. When following a healthy vegan diet, you will find your energy is much higher. This blog post in Happy Healthy Long Life describes how NFL tight-end Tony Gonzalez started eating vegan and gained energy–while playing football.
4. Healthy skin. The nuts and vitamins A and E from vegetables play a big role in healthy skin, so vegans will usually have good skin health. Many people who switch to a vegan diet will notice a remarkable reduction in blemishes as well.
5. Longer life. Several studies indicate that those following a vegan or vegetarian lifestyle live an average of three to six years longer than those who do not.
6. Body odor. Eliminating dairy and red meat from the diet significantly reduces body odor. Going vegan means smelling better.
7. Bad breath. Vegans frequently experience a reduction in bad breath. Imagine waking up in the morning and not having morning breath.
8. Hair. Many who follow vegan diets report that their hair becomes stronger, has more body, and looks healthier.
9. Nails. Healthy vegan diets are also responsible for much stronger, healthier nails. Nail health is said to be an indicator of overall health.
10. PMS. When switching to a vegan diet, many women tell how PMS symptoms become much less intense or disappear altogether. The elimination of dairy is thought to help with those suffering with PMS.
11. Migraines. Migraine suffers who go on vegan diets frequently discover relief from their migraines.
12. Allergies. Reduction in dairy, meat, and eggs is often tied to alleviation of allergy symptoms. Many vegans report much fewer runny noses and congestion problems.

Too Much in the American Diet

The typical American diet not only consists of too much food, it also relies on too much of unnecessary food products or toxins. The following list explains how a vegan diet can eliminate these problems.

1. Animal proteins. The average American eats twice as much protein as necessary for a healthy diet and much of that is from red meat. Getting protein from beans and grains is much healthier and reduces the risk for osteoporosis (see above).
2. Cow’s milk dairy. The human body is not designed to digest cow milk and cow milk dairy products, yet the idea of milk being healthy is pushed through advertising. As many as 75% of people in the world may be lactose intolerant and many people suffer from undiagnosed milk allergies or sensitivities. By eliminating cow’s milk from your diet, you are improving your overall health.
3. Eggs. Many nutritionists believe that the number of eggs in the American diet is too high. While sometimes disputed, it has been shown that eggs can raise cholesterol levels.
4. Mercury. Most of the fish and shellfish consumed has mercury in it. While some fish have less than others, it is almost impossible not to be putting mercury in your body when you eat fish.
5. Sugar. Most people have heard that Americans consume way too much sugar. Relying on other sweeteners that are not synthetic, processed, or derived from animal products is a healthier way to eat. Many vegans do not eat processed sugar due to the fact that most of the cane sugar is refined through activated charcoal, most of which comes from animal bones.

Other Benefits

In addition to the health benefits above, following a vegan lifestyle and diet also provides these benefits as well. From helping the environment to avoiding serious bacterial infections, learn other benefits to eating the vegan way below.

1. Animals. Many people begin a vegan diet out of concern for animals. Whether opposed to the conditions of animals intended for food or eating animals in general, going vegan will help your conscience rest easily.
2. Environment. Growing plants takes much fewer resources than growing animals. By eating vegan, you can help reduce the toll on the environment.
3. E. coli. E. Coli comes from eating contaminated red meat and is the leading cause of bloody diarrhea. Young children, those with compromised immune systems, and elderly people can become extremely ill or die from E. coli. Eating vegan means completely avoiding the risk of E. coli infection.
4. Salmonella. Another gastrointestinal illness from animal products, salmonella food poisoning is closely related to E. coli. The most frequent way people contract salmonella food poisoning is through contact with raw eggs or raw chicken meat from chickens infected with salmonella. Again, going vegan means eliminating this risk altogether.
5. Mad cow disease. It’s safe to say that most people would want to avoid contracting a fatal, non-treatable disease. One way to ensure you don’t get Creutzfeldt-Jakob disease is by not eating animals infected with mad cow disease. While the incidence of mad cow disease is not reportedly so high in North America, it does exist.
6. Global food supply. Feeding grain to animals meant as food sources reduces the amount of food that is available to underdeveloped nations. Many people will go hungry while that same food they could be eating is given to animals raised for slaughter. Eating vegan ensures that you have removed yourself from the participation of this imbalance.
7. Hormone consumption. Eating animals that have been given hormones to speed growth (a common practice in the meat industry) means those hormones go into your body. Not only can this disrupt the natural balance of your hormones, but some of the hormones given to animals have shown to cause tumor growth in humans.
8. Antibiotics. Antibiotics are frequently given to feed animals, which can lead to bacterial resistance. Many of the antibiotics used to treat human infections are also used in feed animals.

Healthy Eating

A vegan diet can be a much healthier way to eat. Find out how to combine the vegan diet with other ways of eating for an even more healthy way to go or discover ways to keep your vegan diet healthy but more convenient with the resources below.

1. Raw. A raw diet lends itself to veganism by the very nature of its design. Find out how to combine live and vegan diets with Raw Inspirations.
2. Organic. Eating organic and vegan is super easy to do. Search for some great ideas on how to live and eat organic and vegan. My suggestion—search the internet.
3. Fat-free. Vegan eating is typically pretty low in fats anyway, but the Fat Free Vegan Kitchen shows you how to make some delicious vegan food that is always fat free.
4. Gluten-free. Due to allergies, Celiac’s Disease, or whatever your reason you avoid gluten, find out how to combine the best of gluten-free with vegan cooking in the Gluten-Free blog..
5. Eating out. Eating out isn’t usually associated with eating healthy, but a vegan diet ensures there will be a lot less of the bad things in the food you choose. Many restaurants post their menu on the outside. Before you enter check out the restaurant’s menu in detail. If in doubt—ask questions when ordering.
6. Lunch. Maintaining a vegan diet means you are likely to take your lunch more often than most people. Vegan Lunch Box offers recipes, tools, and ideas for carrying great vegan lunches every day.
7. Dinner. Coming up with new dinner ideas is challenging for everyone–regardless of what type of diet you follow. Check out this amazing selection of vegan dinner recipes accompanied with mouth-watering photos of each preparation on Dinner with Dilip.
8. Dessert. While not all the recipes on My Sweet Vegan are for dessert, you will find a large selection of sweet vegan recipes with the most delicious-looking photos.
9. Wine. Pairing vegan food with wine may be challenging for those who rely on the old standard of “white with fish and red with meat.”
10. Fun. These ladies know how to kick it with vegan cooking. Post Punk Kitchen offers some great recipes with a ton of fun infused in them. Be sure to go through the archives for more yummy food ideas. 

 

Post Script

Part I and II of this series looked at Diabetes in America. Converting to a Vegan diet will be one of the best things you’ve ever accomplished. Change is always difficult and requires effort. Given that scientific research has found tremendous benefits from a Vegan diet, including three to six years of additional life expectancy, I think it’s fair to say that making that effort to a more healthy Vegan diet will be time well spent.

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Diabetes in America [Part I]—Understanding the Disease and Its Root Causes

Introduction

This is Part I of a two-part series on diabetes in America. Part I is intended to provide a portrait of this disease in terms of types of diabetes, the epidemiology of diabetes, its prevalence and who is at risk for the disease. I will also describe my personal experience with diabetes, and provide a better understanding of the roots causes of diabetes, based on our current state of knowledge.

 In Part II of this series I will describe the Vegan Diet, what it is, how it differs from other forms of a vegetarian diet and the many benefits of a Vegan diet, including reversing diabetes and related medical problems.

 As a society we’re closing in on the root causes of this disease and improving its management all the time. There is absolutely new hope for those who suffer from this disease, and there are great steps being launched to prevent it. Like any other thing we do in life—unlocking the mystery of diabetes requires two things: (1) research is the key and (2) human determination and intelligence are the underlying forces for turning that research key in the right direction.

For purposes of this Blog there are two components to understanding the disease of diabetes: (1) Understanding the epidemiological facts surrounding this disease, and (2) Understanding what may be the root causes of diabetes and how one in the 21^st century might better treat and deal with this, at times, dreadful disease. Before launching into the epidemiological facts of the disease and its root causes, I would like to share with you my own experience with this disease. I will then launch into describing the types of diabetes, epidemiological facts, followed by its root causes.

Connections

I have a family history of diabetes.  My father had diabetes (he died at 57 in 1963) and my older brother (age 73) has diabetes. In terms of pre-diabetes, I was 37 years old when a test for glucose tolerance first revealed there was something wrong with my body’s ability to control blood glucose, i.e., blood sugar. This news gave me ample warning that one day I might develop diabetes. Nevertheless, I was slow to react to the news. I didn’t do anything in response to it like suddenly engage in daily exercise, or convert immediately to a more healthy diet. Instead, I continued on my “Fat-food Buffet of Life” with my own special, “See Food diet” i.e., whenever I saw food— I ate it. Eleven years later in 1991 at the age of 48, I paid the ultimate price—I was officially diagnosed with Type II diabetes.

I cleaned up my act for six weeks then fell back upon old habits. In the early to mid-1990s I struggled with seriously coming to grips with my own “up and down” approach to diet and exercise. I had all the excuses, and was lying to myself regarding my efforts to fight this disease. I was constantly struggling with inconsistency in both proper diet and exercise. And such inconsistency led to improvement one month, only to be followed by less successful control the next. As a result, in 1999, I finally had to go on medication (oral hypoglycemics) to get my blood sugar under better control. And, indeed, the medications actually did a very good job in helping me to maintain better blood sugar control.

 By this time I was actively engaged in utilizing the American Diabetes Association’s standard diet which emphasized a low-fat, more complex carbohydrate diet. That was a step in the right direction as it brought my HA1c down from a range of 8.5 to 9 to a better level, 7.5. However, animal protein was still part of the menu (generally, lean cuts of meat, as well as fish and chicken). And, in many recipes it still called for dairy products like eggs, cheese, yogurt and milk (my preference 1%).

In 2006, I started a low carbohydrate diet and would eat in restaurants a lot less often. I started to lose weight 8-12 lbs and was feeling I was really on the right track. My HA1c was bouncing up and down between 7.0 and 7.3. Nevertheless, up until August of 2009, I was still a couch-potato. I started a program of walking 30 minutes a day 5-6 times a week. Where I live there is a beautiful park so it was very pleasant to use the park as my walking course. In January 2010, I began to expand my exercise horizons. That is, I became a member of USA Track & Field and became actively involved in the Master’s Senior Olympics. I still continued, despite the low-carb diet, to use recipes that called for animal protein and fat along with additional fat consumption via the dairy products that I loved so much.

 I now want to tell you about a new way of eating that I think is an improvement for diabetics to follow. It is a Vegan Diet. At the beginning of 2011—I became a Vegan. It’s new to me, but it is a very ancient approach where plant protein sources are the mainstay of eating, not animal sources of protein. Instead of using the old food pyramid the Vegan diet utilizes just four food groups: grains, legumes, vegetables, and fruits.

 A Vegan diet is a stricter form of Vegetarianism, as the latter is a matter of degree to which certain foods are included or excluded regarding animal protein and various dairy products. Typical might be the ovo-vegetarian where dairy products, meat, fish, and fowl are excluded, however, they will still eat eggs. Instead of going into great detail on a Vegan Diet in Part I, I’d rather refer you to an excellent book on the subject that I acquired in December, 2010. The name of the book is, “Dr. Neal Barnard’s Program for Reversing Diabetes.”  This book will provide you with all the detail you need (including the research on which the book’s recommendations are based) in order to get started with a Vegan diet. And, as always, see your physician before embarking on any serious changes to your diet or activity level.

What I’d prefer to do with the rest of the Blog is, as they say, cut to the chase. The question running through your mind is, or should be—why should you do this? What’s so important about making a drastic change in the way one eats and going vegan?  To answer that question I’ll share with you research and the benefits of the vegan diet. For now, I just want to share with you my own personal experience with the vegan diet. For me, I’ve lost 1+1/2 lbs a week since the start of the new year; and my Lipid Profile is outstanding (Total Cholesterol is now 139, HDL is 45, LDL is 67, and Triglycerides are 135).

 In Part II of this series I will provide you with details on what a Vegan diet is all about, including all of its benefits that are known at this time. I want to add that it is also important for the general public as well (not just diabetics) to consider making dietary changes to the Western diet and way of eating. The health of the nation may well depend heavily upon making changes to the way we approach eating food.

Lobbyists in Washington are working very hard, on behalf of certain industries (dairy, cattle, fast foods, etc.) to keep things as they are and maintain a policy of praying at the altar of the all-mighty dollar. Your health and well-being isn’t even a tertiary consideration.

In ending Part I want to describe the root causes of diabetes. For hundreds of years diabetes was thought to be a very mysterious disease whose causes were unknown. Doctors, other health professionals, and those affected by the disease (including close family members) saw the havoc diabetes had on the lives of millions of people; but understanding how this disease comes about and how the human body works was quite another matter. However, in the last 10-15 years our knowledge on the causes of diabetes is beginning to form a picture. As said before, research is the major key to unlocking the mystery of diabetes. I don’t mean to oversimplify what I’m about to present—but I think it provides a clearer picture on the causes of diabetes. While not all pieces of the puzzle are known at the biochemical, cellular, and genetic levels, the following is what we do know.  

 Types of Diabetes

 There are basically three types of diabetes. They are Type 1, Type 2, and Gestational Diabetes. They are defined as:

 

Type 1—This type of diabetes usually manifests itself in childhood or young adulthood. It used to be called childhood-onset or insulin-dependent diabetes. In Type 1 diabetes, something has damaged the pancreas’s ability to produce insulin; therefore there is a need to take insulin, usually by injection. As Dr. Neal Bernard explains in his book, Dr. Neal Bernard’s Program for Reversing Diabetes, it is an autoimmune disease because the damages done to the insulin producing cells of the pancreas are attacked by the body’s own white-blood cells, those substances that are supposed to fight bacteria and viruses. More will be reported later on what triggers that process.

Type 2—This type of diabetes affects 9 out of every10 individuals who are diagnosed with the disease. This used to be called adult-onset diabetes, or sometimes non-insulin-dependent diabetes. Most people with this form of the disease still produce insulin; the problem is that their cells resist it. Insulin tries to bring glucose into the cells, but the cells respond like a door with a malfunctioning lock. In response to these sluggish cells, your body produces more and more insulin, trying to overcome the resistance. If the body’s insulin supply cannot overcome the resistance, glucose simply builds up in your blood. More will be reported later on how to overcome insulin resistance.

Gestational Diabetes —This type of diabetes is similar to Type 2 except that it occurs in women during pregnancy. While it typically disappears after childbirth, it is a sign of insulin resistance, and that means that type 2 diabetes may be around the corner. Steps taken to prevent Type 2 diabetes may be useful also for those women who have gestational diabetes. Two things women should do post-pregnancy is continue monitoring their blood sugar, and give strong consideration to implementing a more healthy lifestyle, and especially—a more healthy diet.  As always, see your primary-care physician first.

The Epidemiology of Diabetes

Epidemiological Facts

 The data presented here are from the 2007 National Diabetes Fact Sheet (the most recent year for which data is available).

Total: 23.6 million children and adults in the United States—7.8% of the population—have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Pre-diabetes: 57 million people

New Cases: 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older each year.

Total Prevalence of Diabetes

Under 20 years of age

• 186,300, or 0.22% of all people in this age group have diabetes
• About 1 in every 400 to 600 children and adolescents has type 1 diabetes
• About 2 million adolescents aged 12-19 have pre-diabetes

Age 20 years or older

• 23.5 million, or 10.7% of all people in this age group have diabetes

Age 60 years or older

• 12.2 million, or 23.1% of all people in this age group have diabetes

Men

• 12.0 million, or 11.2% of all men aged 20 years or older have diabetes

Women

• 11.5 million, or 10.2% of all women aged 20 years or older have diabetes

 

Race and Ethnic Differences in Prevalence of Diagnosed Diabetes

After adjusting for population age differences, 2004-2006 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by race/ethnicity:

• 6.6% of non-Hispanic whites
• 7.5% of Asian Americans
• 11.8% of non-Hispanic blacks
• 10.4% of Hispanics

Among Hispanics rates were:

• 8.2% for Cubans
• 11.9% for Mexican Americans
• 12.6% for Puerto Ricans.

 

Morbidity and Mortality

Deaths

Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.

 Complications

Heart Disease and Stroke

• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.

• In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.

• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.

• The risk for stroke is 2 to 4 times higher among people with diabetes.

 

High Blood Pressure

• In 2003–2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 mmHg, or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.

• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

 Kidney Disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.

• In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.

• In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

 Nervous System Disease (Neuropathy)

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

• More than 60% of non-traumatic lower-limb amputations occur in people with diabetes.

• In 2004, about 71,000 non-traumatic lower-limb amputations were performed in people with diabetes.

Cost of Diabetes

$174 billion: Total costs of diagnosed diabetes in the United States in 2007

• $116 billion for direct medical costs
• $58 billion for indirect costs (disability, work loss, premature mortality)

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

The American Diabetes Association has created a Diabetes Cost Estimator that takes the national cost of diabetes data and provides estimates at the state and congressional district level.

Factoring in the additional costs of undiagnosed diabetes, pre-diabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion.

• $18 billion for the 6.3 million people with undiagnosed diabetes
• $25 billion for the 57 million American adults with pre-diabetes
• $623 million for the 180,000 pregnancies where gestational diabetes is diagnosed

For Additional Information

These statistics and additional information can be found in the National Diabetes Fact Sheet, 2007, the most recent comprehensive assessment of the impact of diabetes in the United States, jointly produced by the CDC, NIH, ADA, and other organizations.

 The Root Causes of Diabetes

 Many people believe that genetics plays the most important role in determining who gets diabetes and who doesn’t. We now know that this isn’t necessarily the case. Why? It’s because environmental factors and human behavior also play a significant role in diabetes. For example, there have been many studies conducted on Twins particularly in psychology so that greater knowledge could be found that better explained heredity versus the environment.  And many Twin studies have been conducted in the field of medicine as well.

Twins have the same genes. Yet, if one twin is diagnosed with diabetes, the other twin should develop the disease if genes are so determinative of disease causation. This however is not the case. The other twin only has a 40% chance of developing diabetes.

Other factors are involved. And, whether someone lives a long life obviously depends on both individual behavior and environmental factors.

Individual behavior, of course, really matters. Recently, the exercise and fitness icon/guru Jack Lalaine died at the age of 96. Jim Fixx, the famous runner of the 1980s, should have died earlier in life if genetics determined everything (His father died of a heart attack at 43). By my standards Jim Fixx also died young; he was only 52 years old. But he still outlived his father by 9 years because of his personal fitness as a marathon runner.

What implication then does environment and behavior, as causal factors, have on the prevalence of diabetes?  As most of you probably know epidemiology is the study of the prevalence and incidence of disease. It is a kind of sociology of medicine where large population studies take place. And, like the research field of psychology or sociology, the research conducted in epidemiology is extraordinarily important.

What I’m presenting in this Blog is only a short summary overview of the causation of diabetes.  

 Epidemiological Clues to Diabetes Begin to Form 

The most common treatment approach for decades has been the diabetic diet and exercise. Lots of exercise is always good and the exercise revolution went into high gear four decades ago. Besides exercise (30 minutes a day most days of the week) the basic recommendation of the medical community was to follow the ADA’s diabetic diet that included very little sugar and limited starchy foods such as bread, potatoes, rice, and pasta. This was logical since starch breaks down into sugar in your digestive track. Diabetic diets generally cut calories so one could simultaneously lose weight and limit certain fats. This would help to reduce heart disease and other complications. Over time however weight loss was generally modest and the diet itself was not enough to bring blood sugar down under excellent control.

 The first clue that something was amiss came from the field of epidemiology based on studies from other cultures. Large population studies revealed that diabetes was rare in Japan, China, Thailand, and other Asian countries. It was also found to be quite rare in parts of Africa. Such studies were showing something else. That is, people in countries where diabetes was rare or uncommon were not following anything like the diabetes diet. The typical Asian diet (and in Africa) did not avoid carbohydrates and included rice and other grains, starchy vegetables, bean dishes, and noodles.

 Despite eating lots of carbohydrates (much more than among North Americans or Europeans) diabetes was relatively rare. Among the Japanese eating their traditional Japanese diet the prevalence of diabetes is 1 percent. Among Americans the prevalence is 30 percent. However, when Japanese move to North America their risk of acquiring diabetes dramatically increases as does their risk of heart disease, obesity, and other medical problems.

 Unfortunately for Japanese living in their homeland, the American way of eating has finally come to them; they now have Burger King, McDonalds, and KFC. Meat, cheese, and other greasy foods, and other Western eating habits, are replacing rice and vegetables.  It turns out that the genes that allow diabetes to occur are surprisingly common among the Japanese, but as long as they stuck to their traditional diet, the disease was held mostly in check.

 The inescapable fact is that the problem is not a diet of lots of carbohydrates (sugar and starch). The causal problem is actually how the body processes them. Type 1 diabetes has an additional problem that I explain below.      

Cause of Type 1 Diabetes

It turns out Type 1 diabetes occurs because of what might be called “friendly fire.” This is the current explanation:

For many years researchers have known that type 1 diabetes occurs when the immune system attacks and destroys the insulin-producing cells in the pancreas. Your immune system, of course, is your defense against viruses, bacteria, and cancer cells. It is not supposed to attack your own healthy tissues, but that is exactly what occurs in type 1 diabetes.

As you probably know your immune system is made up of specialized white blood cells. Evidently, some of the cells engulf invading germs and digest them. Others make antibodies—molecules that attach to invading organisms like harpoons and identify them for other immune cells to attack. If you have Type 1 diabetes, your immune system has made a major error. It has attacked and destroyed your insulin-producing cells, making it what scientists call an autoimmune disease.

Everyone’s question has been—why does this occur? In 1992 a team of Canadian and Finnish researchers reported on an important discovery in the New England Journal of Medicine. They examined the blood samples of 142 children newly diagnosed with Type 1 diabetes. They found that each of the children had antibodies that were primed to attack cow’s milk proteins.

These antibodies had apparently arisen in response to cow’s protein in their infant’s formula, but the antibodies were also capable of attacking the body’s insulin producing cells in the pancreas. A portion of the cow’s milk protein turned out to be an exact match for a portion of human insulin-producing cells. The antibodies thus ended up attacking the children’s insulin-producing cells. This biochemical reaction led to the children being diagnosed with Type 1 diabetes.

Cause of Type 2 Diabetes

 

All humans need energy to live. Consequently, every cell in the body needs energy, including cells in our large muscle groups. How do our cells get this energy? Normally, the foods we eat provide that energy. The food is then converted to blood glucose (blood sugar) and leads to circulation in our blood stream. The pancreas produces a hormone called insulin, and sends it into your bloodstream to travel to the various cells of the body. Insulin then attaches to a receptor on the cell’s surface and causes the cell membrane to permit blood glucose to enter. In Type 2 diabetes this system doesn’t work very well. The insulin gets to each cell; however, when it arrives, it has trouble unlocking the door to each cell and then the cell fails to permit the glucose to enter. Since glucose cannot get into the cells, it then builds up in the bloodstream. This condition is called Insulin Resistance.

The mystery of Type 2 diabetes has always been to find out why Insulin Resistance occurs. We now have a pretty good idea of the cause. So, what is the cause of Type 2 diabetes? Insulin’s ability to work is blocked in the human cell (like gum jamming up a lock as the metaphor suggests) by actual FAT. The cell’s receptors are blocked or jammed by fat. Normally small amounts of fat are stored for energy in an emergency in each cell. However, in a diet (like the Western diet high in fat and cholesterol) excessive fat builds up in each cell creating the jamming process that prevents glucose from entering. If fat, called intramyocellular lipid, accumulates inside the cell, it interferes with insulin’s intracellular signaling process. Tiny organelles, called mitochondria, are supposed to burn fat. But their failure to keep up with the accumulating fat may be the origin of Type 2 diabetes. Fortunately, evidence shows that diet can reduce the amount of fat inside the cell. And, once excess fat is removed, insulin resistance greatly improves by once again allowing blood sugar to enter the cell.

My initial reaction to all this new information was to ask myself why not, rather than diet, find a way to simply increase the important mitochondria in the body first? Bright ideas aren’t quite so bright sometimes, especially when talking about bio-chemistry of the human body. What happens is that, through diet, one can easily add excessive fat (as we do in the American diet).  Traces of fat begin accumulating many years before diabetes manifests itself. Our genes in the body at the cellular level are a blueprint for mitochondria.

It turns out fatty foods actually do more than add excessive fat to each cell—they also interfere by turning off the genes that would help them create mitochondria and thus burn fat. The genes become disabled and do not allow the cells to produce the needed mitochondria. Your ability to eliminate fat inside your cells seems to slow down when you eat fatty foods. Continue this faulty intracellular activity long enough, and guess what—you end up being diagnosed with Type 2 diabetes.  

At the Imperial College of Medicine in London, researchers studied a group of individuals following a vegan diet. They compared the participants to others who were similar in age and body weight but were not following a vegan diet. When the researchers measured the intramyocellular lipid in each participant’s calf muscles, they found it was 31 percent lower in the vegans than in the omnivores. These findings strongly suggest that a vegan diet may significantly alter the problem of insulin resistance.

In Part II of my series on Diabetes in America, I will present details on what a vegan diet is. If you combine exercise with the vegan diet, you will possess two tools to create a permanent one-two punch that will knock diabetes to the canvas while the referee for a healthy life counts it out.

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