It is no secret that we are in the middle of an explosive epidemic of obesity and kind 2 diabetes, or things i call “diabesity.” As a physician, scientist, educator and citizen, I have been motivated to find a comprehensive solution. That is what spurred me to write my new book, The Blood Sugar Solution: The UltraHealthy Program for weight reduction, Preventing Disease, and Feeling Great Now!.
What I’ve discovered within my more than 20 years of seeing patients is the fact that whether you are suffering from a little extra weight round the middle or you have been identified as having insulin resistance, pre-diabetes, metabolic syndrome, Syndrome X or perhaps type 2 diabetes, all of these conditions are basically the same thing — just with varying examples of severity.
A new word, “diabesity,” describes this continuum of metabolic imbalance and ailment that ranges all the way from mild blood-sugar imbalance to insulin potential to deal with full-blown diabetes. So, yes, for those who have diabetes, you have diabesity. But you don’t need to be a diabetic — or even have symptoms — to become suffering from diabesity.
Nearly all people who are overweight (almost 70 % of Americans) already have “pre-diabetes,” which, in short, is an earlier stage of diabesity that carries with it significant risks of disease and death. And, although the word diabesity is made up of the concepts of obesity and diabetes, even people who aren’t overweight can have this problem. These are the “skinny fat” people. They are “under lean” (not enough muscle) rather than “overweight” and often carry a little additional weight around the middle.
Diabesity is a leading reason for most chronic disease in the 21st century. Specifically, those with diabesity are at a heightened risk of heart disease, stroke, dementia, cancer, high blood pressure, blindness and kidney failure.
Unfortunately, many people who are suffering from diabesity have no idea that they're suffering from a deadly condition — or that this condition is 100 percent reversible. That’s because, currently, there aren't any national screening recommendations, no treatment guidelines, no approved medications, with no reimbursement to healthcare providers for diagnosing and treating anything other than full-blown diabetes.
Think about that: Doctors aren't expected, trained or paid to identify and treat the single biggest chronic disease in America — a disease that, along with smoking, causes nearly all the major healthcare burdens from the 21st century.
So this is a very real and incredibly serious problem — not just for those who are afflicted by diabesity, but for our communities, our economy, our entire society.
Given all of this, one would think the burning questions about everyone’s mind would be: How can this be happening? What has caused this diabesity epidemic? How come our current approaches to treating the issue failing so miserably? And just what new approaches could we take that would more effectively treat the problem?
In fact, not nearly enough people are asking those questions. But if you’re interested, keep reading: I’ll respond to them here.
Insulin Resistance: The Real Cause of Diabesity
While there are some predisposing genes, type 2 diabetes is almost entirely induced by environmental and lifestyle factors. Therefore, a search for the diabetes gene and the magic-bullet drug or gene therapy to treat it will lead us nowhere. While understanding our genes can help us personalize our approach to metabolism and weight loss, it can also shift our focus from the most important target: the modifiable lifestyle and environmental factors which are driving this epidemic.
Take one of the most important lifestyle factors: nutrition and just how you eat. When your diet is filled with empty calories and an abundance of quickly absorbed sugars, liquid calories (sodas, juices, sports drinks or vitamin waters), and delicate or starchy carbohydrates (bread, pasta, rice and potatoes), your cells slowly become numb to the effects of insulin, and need increasingly more of it to balance your blood-sugar levels. This issue is known as insulin resistance.
A high insulin level may be the first sign of trouble. The higher your levels of insulin are, the worse your insulin resistance.
Hypoglycemia, or low blood sugar levels, is often an early symptom of insulin resistance. If you skip meals or eat too much sugar or too many refined carbs, you'll experience swings in blood sugar that make you feel anxious, irritable and tired, and that can even cause palpitations and panic attacks. Stuffing down a big cinnamon bun or swigging a 20-ounce soda may cause big spikes in sugar and insulin along with a quick surge in energy, followed by the inevitable crash as your blood sugar plummets.
Eventually your cells become so resistant against insulin that your blood sugar stays up as well as your pancreas can’t produce enough insulin to fight against the high blood sugar and get a message through your numb cells. That’s when you cross the line to diabetes.
The problem? Most doctors don’t catch diabetes in the early stages because they never test levels of insulin. Instead, doctors typically measure a person’s fasting blood sugar — the level of glucose present in a blood sample drawn no less than eight hours after the last meal.
A recent study demonstrated that anyone with a fasting blood sugar levels of over 87 mg/dl was at increased chance of diabetes. Yet most doctors are not concerned until the blood sugar is over 110 mg/dl or, worse, 126 mg/dl, the level that technically signals diabetes.
Unfortunately, diagnosing problems with insulin resistance and blood-sugar control at this point occurs too late in the game. Actually, your blood sugar is the last thing to go up. Your insulin spikes first, and despite being the simplest way to detect problems early, doctors rarely order the two-hour glucose tolerance test, which measures not only glucose but also insulin levels at fasting, and one and two hours after a sugar drink — an infinitely more effective way to catch problems before the start of disease.
Insulin resistance is the single most important phenomenon that leads to rapid and premature aging and all its resultant diseases. High amounts of insulin, the fat-storage hormone, inform your body to lose muscle and put on weight around the belly, and you be apple-shaped over time. High insulin levels also drive inflammation and oxidative stress, and myriad downstream effects including hypertension; high cholesterol; poor sex drive, infertility; and increased risk of cancer, Alzheimer’s and depression.
I recommend early testing for anyone who has a family history of diabetes type 2, belly fat or increased waist size, or abnormal cholesterol. Don’t wait until your sugar is high. By then, too much damage has been done. Even though you have perfectly normal blood sugar, you may still be sitting on this time-bomb disease called diabesity, which prevents you against losing weight and living a long, healthy life.
Keep in mind: Insulin resistance is the major cause of aging and death in the developed (and most of the developing) world.
Lifestyle Measures (Not Drugs) Would be the Cure
Most of us are taught that diabetes is not reversible and that we are destined to suffer progressive decline. We believe that it is nearly impossible to treat obesity in order to be able to maintain long-term weight loss. We believe that the only treatment options are to limit the consequences and reduce the complications. But my clinical experience informs me none of this is true.
Although the statistics are grave, diabesity can be prevented, treated and reversed. New and better drugs or procedures are not the solution, though. Blockbuster drugs like Avandia fail within their promise and often cause harm. Gastric bypass surgery has grown from 10,000 to 200,000 each year in the last decade. But how many of the 1.7 billion overweight citizens of the world can undergo gastric bypass? And how many of those will gain back most of the weight they lost?
Our current problem-solving tools, methods of diagnosis and ways of treating patients are still based on 19th- and 20th-century ideas about the origins of disease. They overlook the complex web of biology, along with the social, political and economic conditions at the root of our current chronic-disease epidemic.
Chronic disease is a result of imbalances in our biology that occur because of the interactions between our genes and our environment. To reverse it, we first must focus on the causes (poor diet, stress, toxins, microbes, infections) that disturb our whole system. We must work with the network in our biological systems that become imbalanced because of the effects of the environment in which we live. We must use a new map to navigate chronic disease, one that is based on a new model of treating chronic illness.
This map is known as “functional medicine.” It is a method of treating the causes, not just the risk factors; of treating the entire system, not just the symptoms; of making health, not just treating disease.
In fact, should you focus on creating health rather than just treating disease, many diseases — even complex ones like diabesity — often look after themselves. Simply put, disease disappears as a side effect of getting healthy.
Take Back Our Health
Health is a human right that is neglected and undervalued. It's time to take it back.
No single change will help us take back our health. Pharmaceutical companies continually promise the following breakthrough on diabetes, obesity and heart disease, yet we inevitably end up disappointed. Likewise, the food and diet industry constantly peddles quick fixes – just eat this or do this one super exercise as well as your problems and pounds will melt away – but there will never be one quick fix.
It is the hundreds of little choices we make every single day that will transform our collective health. By making choices as individuals, families and communities, we can force change. Demand for healthier food, for example, has convinced Walmart to provide organic products. It's that kind of collective pressure that both forces change in large swaths of the economy (including food growers and producers) and cuts down on the toxic burden on the environment.
Through our collective action we are able to help create change at the local and national levels. Please join me at www.takebackourhealth.org to join the movement and follow me on Twitter @markhymanmd and on Facebook at facebook.com/drmarkhyman to learn more about how we can and must improve your health together.
Do You Have Diabesity?
Let's see if you've diabesity or are at risk for it. If you answer yes to the of these questions, you may already have diabesity or are headed for the reason that direction.
- Do you have a family history of diabetes, cardiovascular disease, or obesity?
- Are you of nonwhite ancestry (African, Asian, Native American, Pacific Islander, Hispanic, Indian, Middle Eastern)?
- Are you overweight (BMI or body mass index over 25)?
- Do you have extra stomach fat? (Is your waist circumference greater than 35 inches for women or more than 40 inches for men?)
- Do you've sugar and refined carbohydrate cravings?
- Do you've trouble losing weight on a low-fat diet?
- Has your physician told you your blood sugar is just a little high (greater than 100mg/dl) or have you really been diagnosed with insulin resistance, pre-diabetes or diabetes?
- Do you've high levels of triglycerides (over 100 mg/dl) or low HDL (good) cholesterol (< 50 mg/dl)?
- Do you've heart disease?
- Do you have high blood pressure?
- Are you inactive (under 30 minutes of exercise four times a week)?
- Have you had gestational diabetes or polycystic ovarian syndrome?
- Do you suffer from infertility, low sex drive or sexual dysfunction?
7 Steps to Treating Diabesity
I often joke that i'm a “wholistic” doctor because I take care of patients with a “whole list” of problems. Typically, when someone has multiple complaints, they're told by their doctor, “We are only able to deal with one problem only at that visit.” Or they get referred to a half-dozen different specialists – one for the skin rash, one for joint pain, one for reflux, one for migraines and so forth. No one asks, “How is everything connected?” It's no wonder that the average Medicare patient has six doctors and is on five medications.
The trick is to see the connections. When we are out of balance, illness occurs, whether it's weight gain, diabetes, heart disease, cancer or anything that may be on your “whole list.” The key is not to treat each thing separately, but to look for and treat the fundamental underlying causes.
To heal from diabesity, or overcome any of the other chronic illnesses a person suffers from, you must rebalance the seven key systems within your body that are at the root of health and illness.
Here's a quick look at simultaneously key biological systems and how they contribute to diabesity. (My book includes more in depth information, plus quizzes and recommendations that will help you develop a personalized self-care plan.)
No. 1: Boost Nutrition
The main driving factor of our diabesity epidemic is our nutrient-poor, calorie-rich, low-fiber, high-sugar Standard American Diet. It's led to a nation of overfed but undernourished people. In fact, there are so few nutrients in our diet that we now have an epidemic of lack that promote the development of diabetes, including vitamin D, magnesium, chromium, zinc and antioxidant deficiencies. Whole, real fresh food that you cook yourself is probably the most potent medicine you can use to prevent, treat and reverse diabesity.
No. 2: Regulate Your Hormones
Although my book is mainly focused on the hormone insulin, balancing all of your hormones, including sex hormones, adrenal or stress hormones, and thyroid hormones, is important if you want to heal. They are all interconnected; they communicate with one another like a big musical symphony. If this symphony is playing out of tune, problems arise.
To overcome diabesity, you have to identify and treat thyroid imbalances that control your metabolism, overactive stress hormones that worsen insulin resistance and blood sugar, and insulin imbalance and its harmful effects on your sex hormones.
No. 3: Reduce Inflammation
Something that causes inflammation will, consequently, cause insulin resistance. And something that causes insulin resistance will cause inflammation. This dangerous spiral reaches the root of so many of our 21st-century chronic maladies. Sugar, refined carbohydrates, trans fats, a lot of inflammatory omega-6 fats from processed plant oils (like soybean or corn oil), artificial sweeteners, hidden food allergies and sensitivities, chronic infections, imbalances in gut bacteria, toxins in the environment, stress, and a sedentary lifestyle all promote inflammation. Of course, which of these factors is the source of inflammation for you is really a key question, and the response is different for everyone. Locating and addressing each of the sources of inflammation in your life is important not only for overcoming diabesity, but in addition for addressing virtually every other health-related issue.
No. 4: Improve Digestion
New evidence points to an unexpected source of metabolic problems and diabesity – a toxic digestive system. Our diet has changed dramatically within the last 10,000 years, and even more so in the last 100 years, with the industrialization of our food supply. This highly processed, high-sugar, high-fat, low-fiber diet has substantially altered the bacteria that historically grew within our digestive tracts, and the change continues to be linked to weight gain and diabetes. A number of other modern inventions – including antibiotics, acid blockers, anti-inflammatory medication, aspirin and steroids – injure the gut, alter our gut flora and lead to systemic inflammation. What we in functional medicine call the 4R program works very well: Remove the bad bugs, drugs and food allergens; Replace needed enzymes, fiber and prebiotics; Reinoculate your gut with higher bacteria or probiotics; and, finally, Repair the gut lining with omega-3 fats, zinc, glutamine, quercitin along with other healing nutrients.
No. 5: Maximize Detoxification
Over the last few years, scientists have uncovered surprise fact: Environmental toxins make you fat and cause diabetes. Recommendations that environmental toxins interfere with blood sugar and cholesterol metabolism, and cause insulin resistance. One of the key mechanisms that leads to insulin resistance and diabesity happens when toxins block the purpose of very important receptors on the nuclei of your cells, receptors that are critical for optimal insulin function and blood-sugar control. Scientists show that toxins cause increases in glucose, cholesterol and fatty liver, and slow down your thyroid function. They also may cause an increase in appetite and problems with brain signals that control hunger. This is no longer something that can be ignored: Toxins make you fat and cause diabesity, plus they must be addressed in any treatment program for diabesity.
No. 6: Enhance Energy Metabolism
Our metabolism directly affects our risk for diabesity. Metabolism turns calories and oxygen in to the energy that fuels every cell in our bodies. This energy is created in little factories in our cells called mitochondria. When your mitochondria are not working properly, you suffer all the the signs of low energy: fatigue, slow metabolism, putting on weight, memory loss, pain, rapid aging and more. People with diabesity don't produce energy within their mitochondria as well as healthy people do. Often the cause of damage to our mitochondria is something we call “oxidative stress.” We're familiar with the process – it's seen as rust on a car, wrinkles in your face, an apple that turns brown in the air. But you can wrinkle on the inside, too. The good news is that there are ways to enhance and optimize mitochondrial function, boost wind turbine, and reduce oxidative stress. The better still news is that doing these things can reverse diabesity and insulin resistance.
No. 7: Sooth Your Mind
Stress enables you to fat and contributes to the introduction of diabesity. When I worked in the emergency room, I frequently saw patients with high blood sugar. These people were not diabetic. Acute stress had caused their blood sugar levels to skyrocket. Doctors have long known there is a relationship between stress and blood sugar levels. What we now understand is that, in the face of chronic stress, our amounts of insulin, cortisol and inflammatory compounds all increase. This drives the relentless metabolic dysfunction that leads to weight gain, insulin resistance, and, ultimately, diabetes. Thus, managing stress – whether through relaxation therapies, meditation, yoga, massage, exercise, laughing or much more – is a critical element of obesity and diabetes treatment
5 Myths About Obesity and Diabetes That Stop us Sick
Myth No. 1: Diabetes is genetic.
Although we have been led to believe that type 2 diabetes is a genetic disorder, it is almost entirely brought on by environmental and lifestyle factors. From 1983 to 2008, the number of people in the world with diabetes increased sevenfold, from 35 million to 240 million (and that i actually believe this is a serious underestimate). This could not happen with a purely genetic or inherited disorder. Genes change only 0.2 percent every 20,000 years – but the environment has changed more in the last 100 years than in all of previous history.
Myth No. 2: Diabetes is not reversible.
Diabetes, particularly if it is caught early and treated aggressively with changes in lifestyle and occasionally with medications, is absolutely reversible. The problem is that most conventional doctors don't catch diabetes early enough simply because they focus on fasting blood-sugar levels instead of insulin levels.
Myth No. 3: Pre-diabetes is not a problem until it turns into full-blown diabetes.
One of the most important ideas in my opinion is that pre-diabetes is not “pre” anything. It is a deadly disease driving our biggest killers – cardiac arrest, cancers, dementia and more. Simply put, pre-diabetes is definitely an earlier stage of diabesity that carries with it nearly all the risks of diabetes.
Myth No. 4: If you begin taking insulin, there is no going back.
Insulin treatment in diabetes is a slippery slope, because increased insulin dosage often leads to increased weight gain, higher blood pressure and elevated cholesterol. Remember, insulin is really a fat-storage hormone that also drives appetite and inflammation. Blood sugar improves, but overall chance of heart disease does not. That is why insulin ought to be the last resort in managing diabetes. And when you have to be on insulin, get on the lowest dose possible. The good news is that, with aggressive lifestyle intervention and dietary change, you are able to, under your doctor's supervision, reverse diabetes and stop insulin therapy.
Myth No. 5: Lowering blood sugar levels with medication prevents death and heart attacks in diabetics.
Avandia, the world's No. 1 diabetes drug, led to 47,000 incidences of heart attacks, stroke, heart failure or death within the first 10 years of its use. We have to give up on the hope that a fast solution will fix our problems. Recent large trials in the New England Journal of Medicine have confirmed that by treating risks with drugs, we may not just be ineffective in preventing cardiac arrest, diabetes and death, but we may also be creating harm by ignoring the root causes of disease. When applied correctly, lifestyle-based changes in many cases are the best medicine, and they are the only thing that will get us started on the road to reversing this global health crisis.
This article continues to be updated. It originally appeared in the April 2012 issue of expertise Life magazine.