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United States of Diabesity


One in two Americans is suffering from diabesity, and most of them don’t even know it. Why? Because most doctors are not trained to treat the single biggest chronic disease in America. The good news? Diabesity can be prevented, treated and reversed. Dr. Mark Hyman explains how.

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! (Little, Brown and Company, 2012).

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.