Cutting diabetes off at its root
A recent CNN.com article highlighted the growing number of diabetes cases in the United States and the enormous related health care costs that accompany the disease. It pointed to the greater risk of developing diabetes among African-Americans, American Indians and Asian-Americans vs. Caucasians. In the article, Matt Petersen, the American Diabetes Association's managing director of medical information, stated that, "People fundamentally can't do anything about susceptibility [because of its genetic link]."
This comment raises questions. Is this really true? Do people have the power to change their susceptibility to diabetes? What should our collective narrative be – one of hope or one of resignation?
I'm not arguing against genetic links. But it's long been known that there both are genetic and environmental influences on health and disease. Social determinants, such as access to nutritious food, chronic stress and race, have powerful impacts on health. The environments in which people are born, grow, live, work and age underlie avoidable health inequities.
The westernization of diet, full of sweets and harmful fat, brought diabetes to groups such as the Pima Indians who live mostly in Arizona and now have, perhaps, the highest rate of diabetes in the world. Some 95% of the population is overweight and 50% are diabetic, the latter percentage predicted for the American population by 2050 according to the CDC. It is clear just by examining the CDC map of the prevalence of diabetes in the United States that diabetes cannot be easily blamed on genes alone unless you argue that people in the South have all the bad genes.
Evidence suggests that if vulnerable groups were able to get back to their traditional diet – a diet based on garden grown fruits and vegetables and whole grains – their diabetes would gradually disappear. In places such as Japan, Crete, Southern Italy and Southern France where people have eaten well over many generations and continue to do so, diabetes is virtually nonexistent. So why are people vulnerable now?
An enormous body of evidence points to nutrition before birth as a dominant culprit in this disturbing health trend. Both low birth weight and excessive birth weight lead to hypertension and diabetes. In a well-known British study male babies born at 5.5 lbs were found to have an eight times higher risk of developing Type 2 diabetes than those born at 9lbs. This 800% increase in risk is higher than any other reported factor in predicting the disease. In a Danish twin study, genetic links to the disease were minor compared to environmental factors; growth before birth was found to be the most important driver of the disease among the twins, not genes.
Now is the time of all Americans to examine our collective way of life. Every woman of reproductive age should know the elements of a healthy diet and should have access to wholesome foods. We should tackle the social causes of stress which also leads to low birth weight. We are in a privileged position – we know the cause of diabetes and we should cut it off at its root.
Kent L. Thornburg, Ph.D.
Kent L. Thornburg, Ph.D.
Interim Director, OHSU Moore Institute
M. Lowell Edwards Chair for Research
Professor and Associate Chief for Research, Division of Cardiovascular Medicine
Director, Heart Research Center