By Sam Yang - Get similar updates here
It used to be, diabetes automatically meant type 1 diabetes. Type 1 diabetes is an autoimmune disease that may be caused by genetic, environmental, or other factors. Previously called insulin-dependent or juvenile-onset diabetes. There is no known way to prevent it, and effective treatment requires the use of insulin. It accounts for up to 5% of diabetes cases.
Type 2 diabetes, previously called non-insulin-dependent or adult-onset diabetes is more of a lifestyle disease. It can be treated with insulin or oral medication, but best options are healthy lifestyle choices. It now accounts to about 95% of diabetes cases and is the leading form of diabetes in youth. When people say diabetes epidemic, they mean type 2. So in this article I will be speaking mainly about type 2 diabetes when I reference diabetes as this has become the new common meaning and how most of the population understand it.
We used to believe you became obese, then you developed diabetes. It is now more accurate to say, the lifestyle choices that lead to diabetes may also eventually lead to obesity. This is a very important distinction.
The common paths are high stress, lack of sleep, late night eating, sedentary life, lack of exercise, but the key difference is the influence of sugar. If you believe it's obesity then diabetes, you may believe it's related to calories. If you believe it's related to sugar consumption, then you may have been headed to diabetes whether you got obese or not.
Being skinny makes the issue less obvious but more dangerous
In fact normal weight people are just as likely to develop diabetes, and they have double the risk of dying of heart disease and other diseases in comparison to their obese counterparts.
The reason may be, the normal weight people who develop diabetes may have less muscle and more visceral fat but similar sugar consumption. If you're body's not storing sugar as weight, then it's causing a more deadly issue. Being skinny fat in some ways is more dangerous than being overweight and fat.
When skinny people develop type 2 diabetes, since they're not obese, many doctors then believe it must be hereditary (that's a nonscientific assumption based on eliminating obesity as the cause, which only leaves heredity). They don't get the same blame as overweight people do (you're lazy and you eat too much). And since it was explained as hereditary, there's less of a need to control the situation because it was out of their control to begin with. This creates a dangerous situation.
Sugar not calories
In this interactive map (http://storymaps.esri.com/stories/diabetes/), you can see the relationship between obesity and diabetes. Harvard's Dr. Walter Willett, Yale's Kelly Brownell, UC San Francisco's Dr. Robert Lustig advocate a low sugar diet (as opposed to the standard low fat diet). They don't think sugar is bad for you because it's empty calories (which is the caloric explanation), they believe sugar is bad for you because in it's current form, it's toxic to our system. You can eat a low calorie diet, but if it's high in sugar, you may still develop diabetes and gain weight. Sugar leads to diabetes and obesity. If you eat high calories and low sugar, it may lead to obesity but unlikely to lead to diabetes. That's the difference, and that small difference creates big differences in treatment and prevention options.
The difference is in the low fat diet idea
If you believe it's about calories, then you may go on a low fat diet because a gram of fat has more calories than a gram of sugar. If you believe it's sugar, you may go on a less processed diet which may or may not always be low in calories based on your meat consumption. Conventional wisdom believes more calories, more energy consumed, which leads to more weight, and more weight leading to diabetes. Sugar is only considered bad in that it has no nutrients, so it's empty. But as long as you keep calories low, it's benign.
The idea that it's about sugar believes more sugar, a quicker absorbing type of energy that overloads your system, which leads to fat accumulation, insulin resistance, which leads to diabetes and weight gain. Sugar is not just empty, it damages our body. That's a big difference of opinions. Since the low fat policy was adopted, diabetes and obesity has skyrocketed. The low fat diet has been considered a contributing factor in diabesity (diabetes and obesity) and prevailing recommendations may be increasing the obesity of people with diabetes.
Blaming the fat guy
This idea that it's about calories also puts a lot of the blame on the patient. If it's about calories, then diabetes is a product of you being lazy and eating too much. The skinny guy gets the pass just as sugar gets the pass. Fats and fat guys get the blame. Dr. Peter Attia thought so until it affected him. He was exercising and following the food pyramid to the letter, yet he was gaining weight and becoming pre-diabetic. Something was wrong here. He looked at the science and his own compassion as a doctor. He didn't blame a cancer patient for their cancer, but he did blame the diabetic patient, which affected how much compassion he showed. That's what he was taught but he realized what he was taught was wrong.
He also over-exercised (calories out) and ate too little (calories in), which exacerbated the situation by causing inflammation. But that's what he was told to do.
In 1980 new there were 493,000 new cases of diabetes. In 2009 it went up to 1,812,000 and still rising. The CDC has projected by 2050, 1 in 3 Americans will have diabetes.
It's a world epidemic
It's not just here in the US, it's also exploding in the UK where it's four times as common as all forms of cancer, and causes more deaths than breast and prostate cancer combined. In Australia, it will become the top cause of death within the next few years.
Even in countries with low meat consumption (which was thought to be a cause of many diseases), it's on the rise. China has already surpassed the US in diabetes. In 1980 the prevalence of diabetes in China was below 1%. In the next 15 years, India is likely to surpass China. The main reason: sugar became cheaper and there are no moral standards against sugar as there are with the consumption of alcohol or meat.
Sugary foods is also one of America's chief exports. There is a financial incentive to keep the focus on exercise and calories.
Diabetes is a linchpin disease. Meaning diabetes itself may kill you but it also leads to other diseases such as heart disease, stroke, kidney failure, cancer, neurodegenerative diseases, and many others. Once you develop this, it's a breeding ground for many other risk factors. The lifestyle that got you diabetes itself may also contribute to other diseases. Diabetes being the gateway. Heart disease is currently the leading cause of death in the US, but since this is something you get towards the end, it doesn't really lead to other issues. Same could be said of cancer. You don't typically get heart disease, then diabetes, or Alzheimer's then diabetes. It's normally diabetes then heart disease, diabetes then Alzheimer's. Diabetes is unique in this way, it's chronic and the longer you have it the worse it gets, and the more likely you are to develop other issues.
This is why diabetes will be the true leading cause of death in the world unless we change how we live and eat and stop the calories in calories out model.
Gestational diabetes (diabetes during pregnancy) is also on the rise, currently estimated at 18% of US pregnancies.
About half of the women who get gestational diabetes may develop type 2 diabetes. Gestational diabetes also puts the baby at risk for a series of medical complications including diabetes.
Alarmingly there has also been an increase in type 1 diabetes in people ages 14-34 (you used to only get it prior to 14). This coincides with the rise of autoimmune diseases. The immune system is attacking insulin-producing cells and killing them. This may be due to inflammation from lifestyle, diet, or influences from the parents.
Diabetes is scary because it seems so nonthreatening
"The greatest trick the Devil ever pulled was convincing the world he didn't exist." - Keyser Söze
Risk of stroke doubles for someone with diabetes, risk of cardiovascular disease quadruples, 20-30 percent of people with diabetes will eventually get kidney failure, the damage to blood vessels and nerves can lead to blindness, foot wounds and ulcers (which can lead to amputations), and all the risks associated with obesity are also associated with diabetes.
Dr. Max Pemberton wrote a column about how in a lot of ways, diabetes is more dangerous than even HIV. In it he stated, "Many people are complacent about diabetes in a way that would seem reckless with HIV. People consider type 2 diabetes an irritant — something that can be easily fixed with tablets. But this is wrong. Regardless of how well it is controlled, type 2 diabetes is a progressive disease, which results in the need to increase pharmacological therapies over time."
Treatment for HIV is mostly pharmaceutical and people take HIV with much more seriousness. With diabetes, it means lifestyle changes which are hard to begin with and it won't be taken as gravely as an illness like HIV. Compare the number of charities and events for cancer and HIV compared to charities for diabetes? It's based on how serious we believe the threat is. If we can change it with lifestyle, we can change it whenever we want, which leads us to wait until it's too late. Currently people with HIV (an incurable disease) are projected to outlive people with diabetes (preventable and curable).
That is a truly scary thought indeed. A fear we're not even aware of, which is the most dangerous of all.
Sam Yang from an early age has been obsessed with connecting the dots between martial arts and efficiency, health, mindset, business, science, and habits to improve optimal well-being. For more info, join his newsletter. You can also connect to All Out Effort on Facebook and Twitter.