Friday, October 19, 2007

The Other Diabetes

Although people usually think diabetes is caused by a lack of insulin, the hormone that lowers blood sugar, more often than not the disease is characterized by too much rather than too little insulin. In fact, nine out of ten cases in the United States are type 2 (adult-onset) diabetes, which typically starts out with high insulin levels. But people are more familiar with the less-common type 1 (insulin-requiring) diabetes, because it is an immediate threat to life: If you don't get insulin you die. The other, diabetes is more insidious — half of the people who have type 2 diabetes don't even know it. As expert Dr. James Gavin puts it, type 2 diabetes "takes its victims a little piece at a time."

Too much body fat sets the stage for type 2 diabetes by decreasing the body's ability to use insulin. As we all well know; extra fat is the result of taking in more calories than we burn, which means that too much food and too little exercise are big contributors to type 2 diabetes. But not everyone with a spare tire gets type 2 diabetes, genetics also play a role. And from the current epidemic — an estimated sixteen million cases — it appears that the underlying genetic tendency is not all that rare.

To understand why type 2 diabetes is becoming more common, it helps to step back and take a look at the big picture — where and when the disease occurs. If you have type 2 diabetes, you are not alone. By the year 2000, experts predict that the epidemic we are seeing in the United States will have spread worldwide. How could this be when we are talking about an inherited disorder, not a contagious disease? What is contagious is technology; which creates theenvironment that causes the disease to surface.

Type 2 diabetes is widespread in industrialized nations, such as the United States, the United Kingdom, and Finland, whereas nations with third world economies, as in parts of Asia and Africa, do not have such epidemics. "If you look at the spread of the scurge around the world, type 2 diabetes occurs as a country advances technologically, when people come out of the fields and sit behind desks," say Dr. Irwin Brodsky. Brodsky, a diabetes researcher and clinician who directs the Diabetes Treatment Center at the University of Illinois at Chicago, explains, "It's almost a sign of coming of age; in Saudi Arabia, for example, where oil money started flowing in the late sixties and seventies, we saw a blip in the occurrence of type 2 diabetes about ten years later." Simply said, too much food and too little activity are pushing more and more people with the underlying tendency for type 2 diabetes over the edge.

An industrial economy is a double-edged sword, providing a calorie-rich food supply with little need for physical work to bring home the bacon. Technological advances such as refrigeration, improved agricultural techniques, better transportation, and food processing plants all help make more food readily available to most of the world's population. Initially, these advances have a positive impact on a nation's health by feeding the hungry; but eventually, a richer food supply leads to new health problems.

A Century of Progress

Before the Industrial Revolution, food was often scarce, and what was available did not always provide the balance of nutrients needed to prevent deficiency diseases. In nineteenth-century England, for example, hundreds of thousands of children died of malnutrition. Among the poor, bread, potatoes, and porridge provided the bulk of the calories. Often the only meat was a small bit of bacon cut up with the potatoes; the poorest subsisted on potatoes alone. Those who survived on the poverty-line diet often suffered from scurvy; a deficiency of vitamin C from the lack of fresh fruits and vegetables; rickets, from lack of sunlight and vitamin D; and tuberculosis, a bacterial infection that thrives in a malnourished host. When the great potato famine hit in the 1840s, hundreds of thousands of poor Irish and English immigrants came to America, where there was plenty of land and a promising new agricultural economy.

As homesteaders were given the opportunity to grow their own food on their own land, wave upon wave of immigrants settled farther and farther west. It was a hard life, and the diet of the settlers was one of subsistence based on easily transportable foods that would keep. The typical meal in Laura Ingalls Wilder's memoir Little House on the Prairie consisted of coffee, cornmeal cakes, and salt pork. She described a special meal that her family shared around 1880:

There was stewed jack rabbit with white-flour dumplings and plenty of gravy. There was a steaming-hot, thick cornbread flavored with bacon fat. There was molasses to eat on the cornbread, but because this was company supper, they did not sweeten their coffee with molasses. Ma brought out the little paper sack of pale-brown store sugar.

Don't be fooled by the bit of bacon fat and sugar; the extra calories provided by such meals were still barely enough to sustain a hard-working frontier family. Today a special meal is likely to include several courses; generous servings of meat, drinks, and dessert; and needless to say, many times more calories than meals served in an era when work was physical and type 2 diabetes was unknown.After the Civil War and the Industrial Revolution, the need to provide more food for the expanding population spawned a wave of technological advances. By the 1890s, there were improved canning, flour milling, plant breeding, and refrigeration techniques as well new disease-resistant varieties of wheat and the first gasoline-driven tractors. In the 1920s, Clarence Birdseye introduced a method for freezing produce; by the 1960s, we had high-powered machinery, new fertilizers and pesticides, poultry raised in completely controlled environments, new breeds of heat-resistant cattle, McDonald's burgers and fries, and the heart disease epidemic. In 1983, one in four Americans was overweight; in 1995, it became one in three. From 1958 to 1993, the incidence of type 2 diabetes tripled. All in all, it had taken about a hundred years for over-nutrition to become as big a killer as under-nutrition.

Excerpted from

The Other Diabetes: Living And Eating Well With Type 2 Diabetes
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Healthy menus for Diabetes at