It is no secret that we are in the middle of an explosive epidemic of obesity and type 2 diabetes, or what 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 Losing Weight, Preventing Disease, and Feeling Great Now!.
What I’ve discovered in my more than 20 years of seeing patients is that whether you are suffering from a little extra weight around the middle or you have been diagnosed with insulin resistance, pre-diabetes, metabolic syndrome, Syndrome X or even type 2 diabetes, all of these conditions are basically the same thing — just with varying degrees of severity.
A new word, “diabesity,” describes this continuum of metabolic imbalance and disease that ranges all the way from mild blood-sugar imbalance to insulin resistance to full-blown diabetes. So, yes, if you have diabetes, you have diabesity. But you don’t have to be a diabetic — or even have symptoms — to be suffering from diabesity.
Nearly all people who are overweight (almost 70 percent 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 those who aren’t overweight can have this problem. These are the “skinny fat” people. They are “under lean” (not enough muscle) instead of “overweight” and often carry a little extra weight around the middle.
Diabesity is a leading cause of most chronic disease in the 21st century. Specifically, those with diabesity are at an increased risk of heart disease, stroke, dementia, cancer, high blood pressure, blindness and kidney failure.
Unfortunately, most people who are suffering from diabesity have no idea that they are suffering from a deadly condition — or that this condition is 100 percent reversible. That’s because, currently, there are no national screening recommendations, no treatment guidelines, no approved medications, and no reimbursement to healthcare providers for diagnosing and treating anything other than full-blown diabetes.
Think about that: Doctors are not expected, trained or paid to diagnose and treat the single biggest chronic disease in America — a disease that, along with smoking, causes nearly all the major healthcare burdens of the 21st century.
So this is a very real and very serious problem — not just for those who suffer from diabesity, but for our communities, our economy, our entire society.
Given all of this, one would think the burning questions on everyone’s mind would be: Why is this happening? What has caused this diabesity epidemic? Why are our current approaches to treating the problem failing so miserably? And 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 answer 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 away from the most important target: the modifiable lifestyle and environmental factors that are driving this epidemic.
Take one of the most important lifestyle factors: nutrition and how you eat. When your diet is full of empty calories and an abundance of quickly absorbed sugars, liquid calories (sodas, juices, sports drinks or vitamin waters), and refined or starchy carbohydrates (bread, pasta, rice and potatoes), your cells slowly become numb to the effects of insulin, and need more and more of it to balance your blood-sugar levels. This problem is known as insulin resistance.
A high insulin level is the first sign of trouble. The higher your insulin levels are, the worse your insulin resistance.
Hypoglycemia, or low blood sugar, is often an early symptom of insulin resistance. If you skip meals or eat too much sugar or too many refined carbs, you will 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 will cause big spikes in sugar and insulin and a quick surge in energy, followed by the inevitable crash as your blood sugar plummets.
Eventually your cells become so resistant to insulin that your blood sugar stays up and 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 insulin levels. Instead, doctors typically measure a person’s fasting blood sugar — the level of glucose present in a blood sample drawn a minimum of eight hours after the last meal.
A recent study showed that anyone with a fasting blood sugar of over 87 mg/dl was at increased risk 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. In fact, 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 — a much more effective way to catch problems before the onset of disease.
Insulin resistance is the single most important phenomenon that leads to rapid and premature aging and all its resultant diseases. High levels of insulin, the fat-storage hormone, tell your body to lose muscle and gain weight around the belly, and you become more apple-shaped over time. High insulin levels also drive inflammation and oxidative stress, and myriad downstream effects including high blood pressure; 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 type 2 diabetes, 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 if you have perfectly normal blood sugar, you may still be sitting on this time-bomb disease called diabesity, which prevents you from 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) Are the Cure
Most of us are taught that diabetes is not reversible and that we are destined to suffer progressive decline. We also believe that it is nearly impossible to treat obesity or to be able to maintain long-term weight loss. We think that the only treatment options are to limit the consequences and reduce the complications. But my clinical experience tells 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 in their promise and often cause harm. Gastric bypass surgery has increased from 10,000 to 200,000 per 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, as well as the social, political and economic conditions at the root of our current chronic-disease epidemic.
Chronic disease results from imbalances in our biology that occur as a result 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 of 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 called “functional medicine.” It is a way of treating the causes, not just the risk factors; of treating the whole system, not just the symptoms; of creating health, not just treating disease.
In fact, if you focus on creating health rather than just treating disease, many diseases — even complex ones like diabesity — often take care of themselves. Simply put, disease goes away 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 next 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 one thing or do this one super exercise and 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 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 offer 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 reduces the toxic burden on the environment.
Through our collective action we can 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 get healthy together
Do You Have Diabesity?
Let’s see if you have diabesity or are at risk for it. If you answer yes to any of these questions, you may already have diabesity or are headed in that direction.
- Do you have a family history of diabetes, heart 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 belly fat? (Is your waist circumference greater than 35 inches for women or greater than 40 inches for men?)
- Do you have sugar and refined carbohydrate cravings?
- Do you have trouble losing weight on a low-fat diet?
- Has your doctor told you your blood sugar is a little high (greater than 100mg/dl) or have you actually been diagnosed with insulin resistance, pre-diabetes or diabetes?
- Do you have high levels of triglycerides (over 100 mg/dl) or low HDL (good) cholesterol (< 50 mg/dl)?
- Do you have heart disease?
- Do you have high blood pressure?
- Are you inactive (less than 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 am a “wholistic” doctor because I take care of patients with a “whole list” of problems. Typically, when someone has multiple complaints, they are told by their doctor, “We can only deal with one problem at this visit.” Or they get referred out to a half-dozen different specialists — one for the skin rash, one for joint pain, one for reflux, one for migraines and so on. 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 you suffer from, you must rebalance the seven key systems in your body that are at the root of health and illness.
Here’s a quick look at each of those key biological systems and how they contribute to diabesity. (My book includes more detailed 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 has 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 nutritional deficiencies that promote the development of diabetes, including vitamin D, magnesium, chromium, zinc and antioxidant deficiencies. Whole, real fresh food that you cook yourself is the most potent medicine you can use to prevent, treat and reverse diabesity.
No. 2: Regulate Your Hormones
Although my book is mostly 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 interact with one another like a big musical symphony. When this symphony is playing out of tune, problems arise.
To overcome diabesity, you must 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
Anything that causes inflammation will, in turn, cause insulin resistance. And anything that causes insulin resistance will cause inflammation. This dangerous spiral is at the root of so many of our 21st-century chronic maladies. Sugar, refined carbohydrates, trans fats, too many 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, environmental toxins, stress, and a sedentary lifestyle all promote inflammation. Of course, which of these factors is the source of inflammation for you is a key question, and the answer is different for everyone. Locating and addressing each of the sources of inflammation in your life is essential not only for overcoming diabesity, but also 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 in 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 in our digestive tracts, and the change has been linked to weight gain and diabetes. Many 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 good bacteria or probiotics; and, finally, Repair the gut lining with omega-3 fats, zinc, glutamine, quercitin and other healing nutrients.
No. 5: Maximize Detoxification
Over the last few years, scientists have uncovered an unexpected fact: Environmental toxins make you fat and cause diabetes. We have found 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 is when toxins block the function of very important receptors on the nuclei of your cells, receptors that are critical for optimal insulin function and blood-sugar control. Scientists have shown 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, and 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 into the energy that fuels every cell in our bodies. This energy is made in little factories in our cells called mitochondria. When your mitochondria are not working properly, you suffer all the symptoms of low energy: fatigue, slow metabolism, weight gain, memory loss, pain, rapid aging and more. People with diabesity don’t produce energy in their mitochondria as well as healthy people do. Often the cause of damage to our mitochondria is something we call “oxidative stress.” We are familiar with the process — it is seen as rust on a car, wrinkles on 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 energy production, and reduce oxidative stress. The even better news is that doing these things can reverse diabesity and insulin resistance.
No. 7: Sooth Your Mind
Stress makes you fat and contributes to the development 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 to skyrocket. Doctors have long known there is a relationship between stress and blood sugar. What we now understand is that, in the face of chronic stress, our levels 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 component of obesity and diabetes treatment.
5 Myths About Obesity and Diabetes That Keep Us Sick
Myth No. 1: Diabetes is genetic.
Although we’ve 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 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 our environment has changed more in the last 100 years than in all of previous human history.
Myth No. 2: Diabetes is not reversible.
Diabetes, especially if it is caught early and treated aggressively with lifestyle changes and occasionally with medications, is absolutely reversible. The problem is that most conventional doctors do not catch diabetes early enough because they focus on fasting blood-sugar levels instead of insulin levels.
Myth No. 3: Pre-diabetes isn’t a problem until it turns into full-blown diabetes.
One of the most important ideas in my book is that pre-diabetes is not “pre” anything. It is a deadly disease driving our biggest killers — heart attacks, cancers, dementia and more. Simply put, pre-diabetes is an earlier stage of diabesity that carries with it nearly all the risks of diabetes.
Myth No. 4: If you start 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 a fat-storage hormone that also drives appetite and inflammation. Blood sugar improves, but overall risk of heart disease does not. That is why insulin should be the last resort in managing diabetes. And if 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 can, under your doctor’s supervision, reverse diabetes and stop insulin therapy.
Myth No. 5: Lowering blood sugar with medication prevents death and heart attacks in diabetics.
Avandia, the world’s No. 1 diabetes drug, contributed to 47,000 incidences of heart attacks, stroke, heart failure or death in the first 10 years of its use. We have to give up on the hope that a magic pill will fix our problems. Recent large trials in the New England Journal of Medicine have confirmed that by treating risk factors with drugs, we may not only be ineffective in preventing heart attacks, diabetes and death, but we may also be creating harm by ignoring the root causes of disease. When applied correctly, lifestyle-based changes are often 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 has been updated. It originally appeared in the April 2012 issue of Experience Life magazine.