The latest statistics about diabetes released by the Centers for Disease Control and Prevention are staggering: 25.8 million Americans have diabetes, and another 79 million with prediabetes are waiting in the wings to develop it. This rise in cases is exponentially greater than what was predicted even a decade ago, and the increase in diabetes a worldwide trend, not just a North American one. At current rates, everyone around the globe will have diabetes or prediabetes before the end of this century.
People are quick to point their fingers at weight gain, fast food gluttony, and slothful lifestyles as being the main culprits, but what if it’s more than that? Is there anything that can be done to abate this looming health crisis? In his recent book, Diabetes Rising, author and journalist Dan Hurley examines five potential reasons behind what has become a modern pandemic. At this point, his five hypotheses—revolving around weight gain, cow’s milk, persistent organic pollutants (POP), vitamin D, and hygiene—warrant further discussion.
The first is the Accelerator Hypothesis, which revolves around body weight and insulin resistance. Some researchers are actually beginning to believe that type 1 and type 2 diabetes–heretofore considered to be caused by autoimmune destruction of insulin-producing beta cells and a high level of insulin resistance, respectively–may actually be the same disease. He postulates that the recent rise in cases of both types of diabetes have been accelerated by weight gain (an environmental factor), but are modulated by genetic factors, including the tendency to have a highly reactive immune system and the tendency to develop insulin resistance in response to weight gain. The jury is still out on whether weight gain is a direct casual factor, but we do know that type 2 diabetes risk can be lowered greatly by even a small (5-7%) decrease in body weight.
The Cow’s Milk Hypothesis relates more directly to the development of type 1 diabetes and could more accurately be called the Foreign Protein one. In essence, early exposure in infancy to any proteins other than the ones found in human breast milk appears to make the body’s immune system more permissive toward autoimmunity and the ultimate destruction of the insulin-producing beta cells in the pancreas. An easy (and economical) approach is to promote the breast feeding of all infants as long as possible during the first year of life.
Hurley’s discussion of the risks associated with organic pollutants in the POP Hypothesis is quite compelling and is picking up steam. POPs originate from pesticides, but also from solvents, pharmaceuticals, paints, pollution, and even plastic. These compounds accumulate in body fat, so levels are higher farther up the food chain. One study actually showed a 38-fold increase in diabetes incidence when comparing the lowest and highest quartiles of POP exposure, and a follow-up study suggested that obesity leads to diabetes only when a person has POPs above a certain level—which are stored in body fat. In that case, keeping body fat lower may actually be quite effective in lowering diabetes risk by decreasing the amount of POPs stored in the body.
The Sunshine Hypothesis is not a new one where type 1 diabetes is concerned as it was noted several decades ago that its incidence is higher at northern latitudes compared to southern ones. However, the role of the sun (and vitamin D) in type 2 diabetes development (and even in prediabetes) is a more recent hypothesis. Most vitamin D is manufactured in the body following exposure to sunlight, and the rise in diabetes parallels greater use of sunscreen and less time spent outdoors. The evidence is compelling enough that recommended vitamin D intakes were recently raised for the population as a whole, based on age: 600 International Units (IU) daily for children and adults up to 70 years old, 800 IU a day for ages 71 and older.
Finally, the Hygiene Hypothesis suggests that making our environments too sterile may actually be increasing our risk of developing diabetes. In fact, people living in lesser developed regions around the world have a lower incidence of type 1 diabetes, allergies, and asthma. Exposure to some bacteria and other germs appears to strengthen the immune system and keep it less likely to start attacking parts of the body.
While these theories are interesting, what we really need to know is how to reverse the potential tsunami of diabetes cases while there is still time. Hurley postulates on “curing” diabetes with an artificial pancreas and with bariatric surgery, but neither of these solutions is really a cure, nor is either feasible on a worldwide scale.
At this point in time, the ultimate key to ending the diabetes pandemic is prevention, and that “cure” is only going to come through united action to make living healthier. Collectively, we are going to have to make personal choices to eat healthier foods and demand access to healthier (and less caloric) fare; make physical movement a requirement rather than an option (in schools and in the workplace); find government-directed ways to reduce our exposure to environmental pollutants of all types; stop oversterilizing our personal environments; and spend a little more time in the sun without overdoing the sunscreen. Furthermore, it’s likely going to take community uprisings and the use of political clout to change some of the policies in place. Time to get busy!