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Understanding THE American Disease, Diabetes

DIABETES IS a disease that affects close to 19 million people (2010) in the United States alone. This is an increase of approximately 4 million cases since I first wrote this article in 2006. But the 19 million only account for those who have seen a doctor and been diagnosed, it is estimated that another 7 million remain undiagnosed. Diabetes continues to be a leading cause of death by disease and remains a growing health care epidemic across this country. Understanding this disease, its long-term consequences, risk factors, diagnosis and treatment is no small endeavor. Therefore I have chosen to dedicate the next three Bodies in Balance articles to this topic.

This disease is known by a more formal name, Diabetes Mellitus, and by definition is a metabolic disease in which blood levels of glucose are abnormally high because the body does not release, use or respond to insulin adequately. There are two distinct types; Type I is characterized by an absence of insulin production. Type II is different in that there may still be insulin production but the body becomes resistant to its message. Type I accounts for approximately 10% of all diabetics and its onset is commonly before age 30. Type II therefore accounts for the other 90% and is more common in those older than 20, BUT sadly numbers in young people are currently rising dramatically. Here is an update on the numbers affecting young people. 1.9 million new cases were diagnosed in people aged 20 and older in 2010, with a total of 11.3% of this population affected. For those under 20 it affects 1 in every 400 or 0.26% and rising!

Let’s talk about the pancreas. This is a digestive organ lying across the width of the abdomen just below the ribs. To simplify, this organ does two jobs; it releases enzymes into the small intestine which digest food and it releases insulin into the blood to regulate blood sugars. The release of insulin is triggered via the nervous system (seeing and smelling food) as well as the digestive system (digestive enzymes) and blood sugar levels. The pancreas is busy monitoring all these stimuli to read the needs and assess the balance between what’s available from our food in the gut and what is needed in the blood…no small job! Once insulin is released it binds to cells throughout the body signaling them to store away the digestive breakdown products (glucose, lipids and amino acids). If insulin is working correctly those digestive bi-products will be stored away and blood sugars will return to pre-consumption levels within 2 hours. When there is insulin resistance (i.e. the cells are not responding to insulin‘s message) blood sugars remain high, which over time can begin to cause damage throughout the body.

The long-term consequences of diabetes is what makes it such a concerning disease. Over time the continuously heightened blood sugars are especially hard on the blood vessels causing inflammation, micro tears, thinning of vessel walls, weakness, and leaking. Throughout this process the body attempts to heal the damage by laying down a protective layer, otherwise know as athreosclerotic plaques. Think of high blood sugars like rust in the pipes of your house; at first the thin, most delicate rusted pipes will give out, although over time all pipes will likely suffer damage. Likewise, blood vessel damage is the key to consequences throughout the body. It starts with the smallest vessels in places like the eyes, kidneys, and nerves. Early damage can result in poor eyesight, increased urination, and poor sensation in the feet. Eventually if left untreated problems can exacerbate to blindness, kidney failure and numbness or weakness of the limbs. When larger blood vessels supplying the heart, liver, and skin begin to suffer, we begin to see skin ulcerations, and heart and liver disease. And secondary to poor blood health and damaged vasculature the body is slow to heal, which clearly just compounds these problems.

So wondering why the body stops producing insulin or receiving its message in the first place? Good question! For those who have Type I, studies find that 75% of these people have antibodies to the cells that produce the insulin, i.e. their own immune system is attacking the pancreas. Genetics may also play a role in Type I, but that role is even more profound in Type II. Theories about insulin resistance in Type II abound; again the immune system may play a role in that antibodies to foods, virus’, bacteria, etc. may be obscuring or damaging the receptor sites where insulin should be binding. But more noteworthy is the link between Type II diabetes and western lifestyle, in my opinion this connection is paramount. Obesity is found in 90% of those with Type II making it the greatest risk factor for the development of diabetes. Type II diabetics often have poor quality diets with little fiber, excessive simple carbohydrates, and little to no activity or exercise. But as with all disease it is a complicated multifactorial process.

To summarize what we’ve covered here, there are two types of diabetes, the second of which is far more common and an ever growing health crisis. Our overworked pancreas’ are trying as hard as they can to keep up with our over-processed carbohydrate rich diets but for those affected the message is not being heard. This is causing damage throughout the body as the blood vessels are the primary target. In the next episode we will explore risk factors, signs and symptoms and what tests to talk to your doctor about regarding diabetes…so stay tuned…

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

By Tracy Erfling

Dr. Tracy Erfling is a naturopath physician in the Lower Columbia Region. Questions?