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Introduction
Diabesity: What You Don’t Know May Kill You

What’s in a name: insulin resistance, metabolic syndrome, syndrome X, obesity, pre-diabetes, adult-onset diabetes, type 2 diabetes. These are all essentially one problem; some vary by severity but all can have deadly consequences. The diagnosis and treatment of the underlying causes that drive all these conditions are actually the same.

Diabesity is a more comprehensive term to describe the continuum from optimal blood sugar balance toward insulin resistance and full-blown diabetes.

Nearly all people who are overweight (over 70 percent of adult Americans) already have “pre-diabetes” and have significant risks of disease and death. They just don’t know it. Even worse, while 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 “underlean” (not enough muscle) instead of “overweight” and have a little extra weight around the middle, or “belly fat.” Currently there are no national screening recommendations, no treatment guidelines, no approved medications, and no reimbursement to health care 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, which, along with smoking, causes nearly all the major health care burdens of the twenty-first century, including heart disease, stroke, dementia, and even cancer. But here is the good news— there is a scientifically proven solution that I have mapped out for you in this book.

Our current medical practice has not caught up with our knowledge. In 2008, the American College of Endocrinology and the American Association of Clinical Endocrinologists gathered twenty-two experts and reviewed all the scientific data on pre-diabetes and diabetes. They heralded a wake-up clarion call for individuals, the health care community, and governments around the world. Their conclusions were as follows:

1. The diagnosis of pre-diabetes and diabetes is arbitrary. A fasting blood sugar over 100 mg/dl is considered pre-diabetes, and a blood sugar over 126 mg/dl is considered diabetes. However, they found these cutoffs don’t reflect the whole spectrum of risk—including heart disease, cancer, dementia, stroke, and even kidney and nerve damage— which starts at much lower numbers, numbers most people consider normal.
2. The DECODE study of 22,000 people examined the continuum of risk measured not by fasting blood sugar, but by blood sugar after a big sugar drink (the best way to diagnose the problem). The study found that even starting at blood sugar levels that were perfectly normal (95 mg/dl), there was a steady and significant risk of heart disease and complications well below the accepted abnormal of less than 140 mg/dl for pre-diabetes and long before people reached the diabetic cutoff of 200 mg/dl.

Bottom line: Even if you have perfectly normal blood sugar, you may be sitting on a hidden time bomb of disease called diabesity, which prevents you from losing weight and living a long healthy life. Insulin resistance is the major cause of aging and death in the developed and most of the developing world. This book will help you identify and reverse this explosive situation for yourself. It also lays out a plan for greater collective action to solve this problem individually and collectively by getting healthy together.

Part I
Understanding the Modern Plague

For this we must make automatic and habitual, as early as possible, as many useful actions as we can, and guard against the growing into ways that are likely to be disadvantageous to us, as we should guard against the plague.
— William James, “The Laws of Habit,” The Popular Science Monthly (February 1887)

It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.
— Mark Twain

1
A Hidden Epidemic: The United States of Diabetes

Diabesity, the continuum of health problems ranging from mild insulin resistance and overweight to obesity and diabetes, is the single biggest global health epidemic of our time. It is one of the leading causes of heart disease, dementia, cancer, and premature death in the world and is almost entirely caused by environmental and lifestyle factors. This means that it is almost 100 percent preventable and curable.

Diabesity affects over 1.7 billion people worldwide. Scientists conservatively estimate it will affect 1 in 2 Americans by 2020, 90 percent of whom will not be diagnosed. I believe it already affects more than 1 in 2 Americans and up to 70–80 percent of some populations.

Obesity (almost always related to diabesity) is the leading cause of preventable death in the United States and around the world. Gaining just 11–16 pounds doubles the risk of type 2 diabetes, while gaining 17–24 pounds triples the risk. Despite this, there are no national recommendations from government or key organizations advising screening or treatment for pre-diabetes. We are becoming the United States of Diabetes.

The prevalence of type 2 diabetes in America has tripled since the 1980s. There are now 27 million Americans with diabetes (25 percent of whom are not diagnosed) and 67 million with pre-diabetes (90 percent of whom are not diagnosed). African-Americans, Latin Americans, and Asians have dramatically higher rates of diabesity than Caucasians do. By 2015, 2.3 billion people worldwide will be overweight and 700 million will be obese. The number of diabetics will increase from 1 in 10 Americans today to 1 in 3 by the middle of this century.

A Childhood Problem

Perhaps most disturbing, our children are increasingly affected by this epidemic. We are raising the first generation of Americans to live sicker and die younger than their parents. Life expectancy is actually declining for the first time in human history.

Here are some startling statistics:
• One in three children is overweight in America.
• Childhood obesity has tripled from 1980 to 2010.
• There are now more than 2 million morbidly obese children above the 99th percentile in weight.
• In New York City, 40 percent of the children are overweight or obese.
• One in three children born today will have diabetes in their lifetime.
• Childhood obesity will have more impact on the life expectancy of children than all childhood cancers combined.

A Global Problem

Diabetes is just as widespread in other parts of the world: In 2007, it was estimated that 240 million people worldwide had diabetes. It is projected to affect 380 million by the year 2030, about 10 times the number of people affected by HIV/AIDS. Sadly this is a gross underestimate. Estimates in 2011 put the worldwide total at 350 million. In China alone, rates of diabetes were almost zero 25 years ago. In 2007, there were 24 million diabetics in China, and scientists projected that by 2030 there would be 42 million diabetics in China. However, by 2010, there were 93 million diabetics and 148 million pre-diabetics in China, almost all of whom were previously undiagnosed. Imagine if we had 148 million new cases of AIDS overnight in one country.

Special Note: Childhood Obesity and Diabetes — The Blood Sugar Solution for Children

The biggest tragedy is the global spread of childhood obesity and “adult”-onset or type 2 diabetes in little children. We are now seeing eight-year-old children with diabetes, fifteen-year-olds with strokes, and twenty-five-year-olds who need cardiac bypass. While The Blood Sugar Solution is a program mostly for adults, it is also powerful and effective for children. The whole family must be part of the solution, and we have to make our homes, communities, and schools safe for our children.

The Blood Sugar Solution includes many child-friendly recipes. And when it comes to supplements, there is something for everyone, even infants and children. In fact, any child over twelve years of age with diabesity can follow the basic Blood Sugar Solution plan. Children younger than twelve or those who qualify for the Advanced Plan should work with an experienced functional medicine practitioner. See www.bloodsugarsolution.com for how best to support your children’s health if they are overweight or have type 2 diabetes.

Sixty percent of the world’s diabetics will eventually come from Asia because it is the world’s most populous region. The number of individuals with impaired glucose tolerance or pre-diabetes will increase substantially because of increased genetic susceptibility to the harmful effects of sugar and processed foods. Interestingly, people in this Asian population (who are uniquely susceptible to diabetes even though they may not be obese) are increasingly affected as they adopt a more Western diet. Weaker environmental laws and regulations also expose them to increasing levels of toxins, which, as we will see later, are a significant cause of diabesity.

Ponder this: From 1983 to 2008, the number of people in the world with diabetes increased sevenfold, from 35 to 240 million. In just three years, from 2008 to 2011, we added another 110 million diabetics to our global population. Shouldn’t the main question we ask be why is this happening? instead of what new drug can we find to treat it? Our approach must be novel, innovative, and widely applicable at low cost across all borders. Billions and billions have been wasted trying to find the “drug cure,” while the solution lies right under our nose. This is a lifestyle and environmental disease and won’t be cured by a medication.

Diabesity: The Major Cause of Chronic Disease and Decreased Life Expectancy

Diabesity is one of the leading causes of chronic disease in the twenty-first century, including heart disease, stroke, dementia, and cancer.

Consider the following:
• One-third of all diabetics have documented heart disease.
• It is estimated that nearly everyone else with type 2 diabetes has undiagnosed cardiovascular disease.
• People with diabetes are four times more likely to die from heart disease, and the rate of stroke is three to four times higher in this population.
• Those with pre-diabetes are also four times more likely to die of heart disease. So having pre-diabetes isn’t really “pre” anything in terms of risk.
• There is a fourfold increased risk for dementia in diabetics. And pre-diabetes is a leading cause of “pre-dementia,” also known as mild cognitive impairment.
• The link between obesity and cancer is well documented and is driven by insulin resistance.
• Diabesity is the leading cause of high blood pressure in our society. Seventy-five percent of those with diabetes have high blood pressure.
• Diabesity is also the leading cause of liver failure from NASH (nonalcoholic steatohepatitis), also known as fatty liver. It affects 30 percent of our general population (about 90 million) and 70–90 percent of those who have diabesity. Those with fatty liver are at much greater risk of heart attack and death.
• Diabesity is an important cause of depression and mood disorders. Women with diabetes are 29 percent more likely to develop depression, and women who took insulin are 53 percent more likely to develop depression.
• Nervous system damage affects 60–70 percent of people with diabetes, leading to a loss of sensation in the hands and feet, slow digestion, carpal tunnel syndrome, sexual dysfunction, and other problems. Almost 30 percent of people age forty or older with diabetes have impaired sensation in their feet, and this frequently leads to amputations.
• Diabesity is also the leading cause of blindness among people ages twenty to seventy-four.
• Diabesity is the leading cause of kidney failure—accounting for 44 percent of new cases each year.
• People with poorly controlled diabetes are three times more likely to have periodontal or severe gum disease.

A recent remarkable study published in the New England Journal of Medicine examining 123,205 deaths in 820,900 people found that diabetics died an average of six years earlier than nondiabetics and 40 percent of those did not die from heart disease or the usual diabetes-related causes. They died from other complications not obviously related to diabetes, complications most wouldn’t necessarily correlate with the disease. Yet it makes perfect sense given that diabesity is the underlying cause that drives most chronic illnesses.