Diet Detective: Why focus on diabetes?
Diabetes can lead to blindness, heart disease, stroke, kidney failure, amputations and nerve damage. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) reports that more than 23 million people, or nearly 8 percent of the U.S. population, have type 1 or type 2 diabetes, and both types are on the rise. Diabetes is a metabolic disorder affecting the way the body uses and digests food. The food you eat is broken down into glucose and circulated in the blood as sugar - the body's source of fuel. Once there is sugar in the blood, insulin (produced by the pancreas) moves the glucose/sugar from the blood into the cells. If you have diabetes, however, your pancreas produces less or no insulin. Then, according to the NIDDKD Web site: "Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose."
In his new book, Diabetes Rising, medical journalist Dan Hurley sheds some light on this mysterious disease.
Diet Detective: Why focus on diabetes?
Dan Hurley: I have had type 1, or “juvenile,” diabetes since 1975, and I simply got sick and tired of reading and seeing so much information that is outdated and/or dead wrong. The main message we hear over and over again is that diabetes is totally manageable if you just take care of yourself, so any problems that develop are your own fault. And that’s a terrible lie. Diabetics walk around feeling guilty for “screwing up” all the time. The truth is that diabetes is a nightmare to manage, and all a person can do is try his or her best. I’m not being negative; I’m just being honest.
Diet Detective: How big a problem is diabetes?
Dan Hurley: Huge and growing. Type 1 diabetes is now twice as common as it was in the 1980s, five times more common than in the 1950s, and 10 times more common than a century ago. It continues to increase at 3 percent per year. As for type 2, or what used to be called “adult onset,” it’s now projected that 33 percent of all boys and 39 percent of all girls born in the year 2000 will develop diabetes in their lifetime. With all the fuss over H1N1, only about 10,000 deaths around the world have been officially attributed to it so far, whereas 1.1 million people die of diabetes every single year.
Diet Detective: What are the two types of diabetes?
Dan Hurley: Cars run on gas; bodies run on glucose -- the sugar in your blood that supplies every cell with energy. But glucose can’t get into those cells without insulin, the hormonal key that unlocks the cell walls. In both kinds of diabetes, too much glucose is floating around in your blood with nowhere to go, causing what’s known as a high “blood-sugar” level. The causes of the two types of diabetes are very different. With type 1 diabetes, your body stops producing insulin because of an autoimmune attack in which white blood cells in the immune system target and destroy the insulin-producing cells in the pancreas. Type 1 diabetics must take insulin for the rest of their lives. With type 2, as your weight and age increase, your body develops resistance to normal insulin levels, and your insulin-producing cells slowly grow weaker and weaker. Many people can prevent or reverse the early stages of type 2 through diet or exercise. When that doesn’t work, pills are often necessary, and sometimes insulin.
Diet Detective: If diet, insulin or pills can treat diabetes, what’s the problem?
Dan Hurley: The treatments hold diabetes at bay, but they don’t “cure” you. Most diabetics still have higher blood-sugar levels on average than people without the disease. The result is serious damage to your eyes, the nerve endings in your feet, your kidneys and your heart. In fact, diabetes triples your risk of heart disease. Keeping your blood-sugar levels as near to normal as possible lowers these risks.
Diet Detective: Does eating sweets cause diabetes, as many people believe?
Dan Hurley: That is a terrible myth. Neither kind of diabetes is caused by sugar. It’s true that eating something sweet can raise your blood-glucose level quickly, but then so can eating a plate of french fries or even eating a banana. People get obsessed with the idea that if they just avoid sugar, everything will be fine. It’s far more important to watch your total calories, and in particular your total intake of carbohydrates.
Diet Detective: So why does type 2 diabetes occur?
Dan Hurley: There’s no question that the older and heavier you are, the greater your chances for developing type 2 diabetes. But there is also a strong genetic link, so if your brother or mother has it, you are more likely to get it. And studies have shown that exposure to common pollutants also strongly raises your risk.
Diet Detective: What are the most plausible theories for why type 1 diabetes is increasing, based on your investigation?
Dan Hurley: Decades of research have established that type 1 is an autoimmune disease. Figuring out why it’s increasing means asking what could be triggering the autoimmune response. One possible trigger is that kids who develop type 1 diabetes seem to be, on average, slightly taller or heavier than kids who don’t develop it not obese; just a little bit bigger than average. That surprises many people, so let’s be clear: Nobody is saying that weight “causes” type 1; plenty of thin kids get it, too. But some researchers do believe that our overall trend toward increasing size over the past century is linked to the rising rate of type 1. Another possible factor is our low levels of vitamin D, the “sunshine” vitamin, because we all spend so much less time outside than people did years ago. Yet another possible factor is feeding infants baby formula rather than breast milk. Kids who were given formula with cow’s milk or soy milk in the first six months of life seem to have a slightly increased risk of getting type 1. (“Highly hydrolyzed” formula, available at most stores, avoids this risk.) All these theories are being aggressively investigated.
Diet Detective: Can you explain this part of the subtitle, "How a Rare Disease Became a Modern Pandemic"?
Dan Hurley: Since ancient times, and as recently as the Civil War, diabetes was so rare that doctors could go their whole career without seeing more than one or two cases. When insulin was discovered in 1922, doctors thought it was a cure. But the number of people diagnosed with the disease, and dying due to it, has continued rising ever since. Type 2 has now reached epidemic levels in almost every country in the world, which is why doctors now call it a “pandemic.” It’s especially troubling when you consider that rates of every other major disease, including cancer and heart disease, have been slowly but steadily dropping.
Diet Detective: Can a person cure type 2 diabetes by following a good diet?
Dan Hurley: It’s possible, but difficult. We’re living in what I call a “diabetic nation,” where it’s easy to snack and eat junk food, and hard to find the time to get out and be active. And let’s get real: People who were couch potatoes for the first 40 years of their lives are going to find it hard to change their ways. You can usually hold type 2 diabetes at bay for a while by going on a modest diet and getting more active. But long term, it will just keep getting tougher and tougher. That doesn’t mean you shouldn’t try. But it’s important to recognize what you’re up against.
Diet Detective: So are you saying that many people do not take their diabetes seriously enough?
Dan Hurley: My experience is just the opposite most people with either type 1 or type 2 diabetes get consumed with worry and guilt. They try and try and feel like failures. We need to stop putting the blame on individuals and start working together as a society. To prevent type 2 and improve our overall health we need to change our communities, make sure sidewalks and bike lanes are available, put well-lit, inviting stairways in malls, offices and airports so that exercise becomes part of our normal lives. If healthy food were as cheap and convenient as fast food, more people would eat it. Throwing pills at type 2 diabetes is not going to fix it. We need a lifestyle revolution.
Diet Detective: Meanwhile, is there a diabetes cure coming? Or is management our only hope in the next five to 10 years?
Dan Hurley: If you have ever heard the sports term “winning ugly” you’ll understand what I mean when I say that, right now, there are some “ugly” cures for both kinds of diabetes. As drastic as it sounds, bariatric surgery on the intestines has been shown to “cure” type 2 diabetes in a matter of days or weeks, even before the person loses weight. It’s not for everyone, but for some it beats a lifetime of pills and struggling. And for type 1, researchers have now developed an electronic “artificial pancreas,” an external device the size of an iPod that senses your blood-sugar level and automatically gives you only as much insulin as you need. I participated in a clinical trial of this device last year, and it’s totally amazing. FDA approval of at least a preliminary version of the artificial pancreas is expected in the next two years.
Diet Detective: You mentioned that vitamin D and exposure to sunshine might lower the risk for type 1 diabetes. Should we be taking supplements? Baking in the sun? Please explain.
Dan Hurley: Studies have shown that the closer you live to the equator, the lower your chances of developing type 1 diabetes. And children are more likely to get diagnosed with type 1 in the winter, when there is less sun than in the summer. So if anyone in your family has had type 1 diabetes, vitamin D supplements are something to consider, in consultation with your physician. As for sunshine, it’s always healthy to get out in the fresh air.
Diet Detective: What is the biggest secret that health care professionals are not telling us about diabetes?
Dan Hurley: The biggest secret is how hard diabetes is to control. Doctors act like you’re just being naughty and willful if your blood-glucose level goes high. But I know from personal experience that watching every bite of food you eat is a real pain and drives us diabetics crazy.
Diet Detective: You suggest that focusing on "personal responsibility alone has not stopped, and will never stop, the rise of diabetes. ..." Can you please explain?
Dan Hurley: I don’t mean to say you should do whatever you want and ignore the risks associated with diabetes. I jog, I watch my weight, I test my blood-sugar levels frequently I do everything I can to stay healthy, and I encourage every other diabetic to do the same. But we’re all in this diabetic nation together. Blaming the victim only adds insult to injury. It’s time we worked together to make our communities healthier places, so that living well becomes the default option.
Can you tell us a bit about your health habits?
Diet Detective: What’s your favorite healthy ingredient?
Dan Hurley: Raw asparagus. It’s not as expensive as it used to be, and it’s so healthy and refreshing as crunchy as potato chips.
Diet Detective: If you could eat one unhealthy food whenever you wanted without gaining weight, what would it be?
Dan Hurley: My wife’s pecan pie is to die for. Heaven help me, resistance is futile!
Diet Detective: What’s your favorite “junk food?”
Dan Hurley: Sometimes I buy a box of Goobers at the movie theater. At least it’s dark, so nobody can see!