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Part I

Update on Diabetes in America
[Epidemiology and New Research Findings]

Introduction

This is Part I of a two-part series on diabetes in this country. Part I will be an epidemiological look at this disease in terms of statistical estimates disaggregated by age, race, and gender.

Part II of the series will concentrate on presenting some of the new research findings as they relate to Type II diabetes, insulin resistance, obesity, and a new factor that is emerging as important—Inflammation.

2011 National Diabetes Fact Sheet

Diagnosed and undiagnosed diabetes in the United States, all ages, 2010

Total: 25.8 million people, or 8.3% of the U.S. population, have diabetes.
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people

Estimation Methods

The estimates in this fact sheet were derived from various data systems of the Centers for Disease Control and Prevention (CDC), the Indian Health Service’s (IHS) National Patient Information Reporting System (NPIRS), the U.S. Renal Data System of the National Institutes of Health (NIH), the U.S. Census Bureau, and published studies.

The estimated percentages and the total number of people with diabetes and prediabetes were derived from 2005–2008 National Health and Nutrition Examination Survey (NHANES), 2007–2009 National Health Interview Survey (NHIS), 2009 IHS data, and 2010 U.S. resident population estimates.

The diabetes and prediabetes estimates from NHANES were applied to the 2010 U.S. resident population estimates to derive the estimated number of adults with diabetes or prediabetes. The methods used to generate the estimates for the fact sheet may vary over time and need to be considered before comparing fact sheets. In contrast to the 2007 National Diabetes Fact Sheet, which used fasting glucose data to estimate undiagnosed diabetes and prediabetes, the 2011 National Diabetes Fact Sheet used both fasting glucose and hemoglobin A1c (A1c) levels to derive estimates for undiagnosed diabetes and prediabetes. These tests were chosen because they are most frequently used in clinical practice.

Diagnosed and undiagnosed diabetes among people aged 20 years or older, United States, 2010

Age 20 years or older: 25.6 million, or 11.3% of all people in this age group, have diabetes.

Age 65 years or older: 10.9 million, or 26.9% of all people in this age group, have diabetes.

Men: 13.0 million, or 11.8% of all men aged 20 years or older, have diabetes.

Women: 12.6 million, or 10.8% of all women aged 20 years or older, have diabetes.

Non-Hispanic whites: 15.7 million, or 10.2% of all non-Hispanic whites aged 20 years or older, have diabetes.

Non-Hispanic blacks: 4.9 million, or 18.7% of all non-Hispanic blacks aged 20 years or older, have diabetes.

Sufficient data are not available to estimate the total prevalence of diabetes (diagnosed and undiagnosed) for other U.S. racial/ethnic minority populations.

Diagnosed diabetes in people younger than 20 years of age, United States, 2010

About 215,000 people younger than 20 years have diabetes (type 1 or type 2). This represents 0.26% of all people in this age group. Estimates of undiagnosed diabetes are unavailable for this age group.

Racial and ethnic differences in diagnosed diabetes

National estimates of diagnosed diabetes for some but not all minority groups are available from national survey data and from the IHS NPIRS, which includes data for approximately 1.9 million American Indians and Alaska Natives in the United States who receive health care from the IHS. Differences in diabetes prevalence by race/ethnicity are partially attributable to age differences. Adjustment for age makes results from racial/ethnic groups more comparable.
• Data from the 2009 IHS NPIRS indicate that 14.2% of American Indians and Alaska Natives aged 20 years or older who received care from IHS had diagnosed diabetes.

• After adjusting for population age differences, 16.1% of the total adult population served by IHS had diagnosed diabetes, with rates varying by region from 5.5% among Alaska Native adults to 33.5% among American Indian adults in southern Arizona.

• After adjusting for population age differences, 2007–2009 national survey data for people aged 20 years or older indicate that 7.1% of non-Hispanic whites, 8.4% of Asian Americans, 11.8% of Hispanics, and 12.6% of non-Hispanic blacks had diagnosed diabetes. Among Hispanics, rates were 7.6% for both Cubans and for Central and South Americans, 13.3% for Mexican Americans, and 13.8% for Puerto Ricans.

• Compared to non-Hispanic white adults, the risk of diagnosed diabetes was 18% higher among Asian Americans, 66% higher among Hispanics, and 77% higher among non-Hispanic blacks. Among Hispanics compared to non-Hispanic white adults, the risk of diagnosed diabetes was about the same for Cubans and for Central and South Americans, 87% higher for Mexican Americans, and 94% higher for Puerto Ricans.

New cases of diagnosed diabetes among people aged 20 years or older, United States, 2010

About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010.

New cases of diagnosed diabetes among people younger than 20 years of age, United States, 2002–2005

SEARCH for Diabetes in Youth is a multicenter study funded by CDC and NIH to examine diabetes (type 1 and type 2) among children and adolescents in the United States. SEARCH findings for the communities studied include the following:
• During 2002–2005, 15,600 youth were newly diagnosed with type 1 diabetes annually, and 3,600 youth were newly diagnosed with type 2 diabetes annually.

• Among youth aged

• Non-Hispanic white youth had the highest rate of new cases of type 1 diabetes (24.8 per 100,000 per year among those younger than 10 years and 22.6 per 100,000 per year among those aged 10–19 years).

• Type 2 diabetes was extremely rare among youth aged 9%) were 2.9 times more likely to have severe periodontitis than those without diabetes. The likelihood was even greater (4.6 times) among smokers with poorly controlled diabetes.

• About one-third of people with diabetes have severe periodontal disease consisting of loss of attachment (5 millimeters or more) of the gums to the teeth.

Complications of pregnancy
• Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. On the other hand, for a woman with pre-existing diabetes, optimizing blood glucose levels before and during early pregnancy can reduce the risk of birth defects in their infants.

• Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other complications
• Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.

• People with diabetes are more susceptible to many other illnesses. Once they acquire these illnesses, they often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

• People with diabetes aged 60 years or older are 2–3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework compared with people without diabetes in the same age group.

• People with diabetes are twice as likely to have depression, which can complicate diabetes management, than people without diabetes. In addition, depression is associated with a 60% increased risk of developing type 2 diabetes.

Preventing diabetes complications

As indicated above, diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner.

Glucose control
• Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1c blood test results (e.g., from 8.0% to 7.0%) can reduce the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%. The absolute difference in risk may vary for certain subgroups of people.

• In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.

Blood pressure control
• Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among people with diabetes by 33% to 50%, and the risk of microvascular complications (eye, kidney, and nerve diseases) by approximately 33%.

• In general, for every 10 mmHg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.

• No benefit of reducing systolic blood pressure below 140 mmHg has been demonstrated in randomized clinical trials.

• Reducing diastolic blood pressure from 90 mmHg to 80 mmHg in people with diabetes reduces the risk of major cardiovascular events by 50%.
Control of blood lipids
• Improved control of LDL cholesterol can reduce cardiovascular complications by 20% to 50%.

Preventive care practices for eyes, feet, and kidneys
• Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.

• About 65% of adults with diabetes and poor vision can be helped by appropriate eyeglasses.

• Comprehensive foot care programs, i.e., that include risk assessment, foot-care education and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.

• Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with particular medications for hypertension called angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is more effective in reducing the decline in kidney function than is treatment with other blood pressure lowering drugs.

• In addition to lowering blood pressure, ARBs and ACEIs reduce proteinuria, a risk factor for developing kidney disease, by about 35%.

Post Script

In Part I, data were presented on diabetes in order to give the reader an epidemiological look at this disease. In Part II data will be presented on some of the research looking to understand, or at least better treat, this dreadful disease. It is hoped that as each year passes, researchers will eventually find the cure for diabetes.

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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 21st 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 1This 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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