Diabetes, the 21st Century Epidemic

Type 2 diabetes is the fourth leading cause of death in most developed countries. Complications from diabetes, such as coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure and blindness are resulting in increasing disability, reduced life expectancy and enormous health costs for virtually every society. Diabetes is one of the most challenging global health problems in the 21st century. A person with type 2 diabetes is two to four times more likely to get cardiovascular disease, and 80% of people with diabetes will die from it. Premature mortality caused by diabetes results in an estimated 12 to 14 years of life lost. A diabetic incurs medical costs that are two to five times higher than those of a person without diabetes. The annual direct healthcare costs of diabetes worldwide are estimated to be as much as 825 billion.

Last summer I spent nearly a month touring Middle East. One evening I had dinner with a physician from Kenya who was interested in our self care approach to health. I asked Dr. Ken who had been working at a hospital outside of Nairobi for 10 years what were the most common health challenges he encountered. I expected, he would say infectious diseases. Silly me? He responded with Diabetes, heart attack and stroke. The same chronic and preventable diseases that account for 70% of deaths globally. He explained that Diabetes was increasing in the population at an alarming rate over his 10-year tenure in Nairobi. I don’t know why I was so surprised by his answer and this prompted me to do a little more research on the incidence of type 2 diabetes. A recent publication from the National Institute of Health states, the most dramatic increases in type 2 diabetes have occurred in populations where there have been rapid and major changes in lifestyle, demonstrating the important role played by lifestyle factors and the potential for reversing this global epidemic.

A recent study in The Lancet (April 2016) reported for the first time in human history obese people outnumber underweight people. These statistics were gathered from 200 countries and nearly 20 million people for over 20 years.  According to the Organization for Economic Cooperation and Development, the U.S. is the most obese nation in the world, just ahead of Mexico. Their report states 2/3rd’s of U.S. adults are overweight or obese (69 percent) and one out of three are obese (36 percent) and 1/3rd of children are overweight. If trends continue unabated, by 2030, estimates predict that roughly half of all American men and women will be obese. Almost 90% of people living with type 2 diabetes are overweight or obese. People who are overweight or obese have added pressure on their body's ability to use insulin to properly control blood sugar levels, and are therefore more likely to develop diabetes.

The answer to prevention is one that we have been taught since we were children. Life style changes, diet and exercise. There is overwhelming evidence from studies in the USA, Finland, China, India and Japan that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes. But are diet and exercise the only aspects that we need to consider? Through the concept of self care and the Self Care Awakening’s call to action, Being Healthy by Choice, not by Chance, there are other key factors that can lead to weight gain, obesity and diabetes.

Water Matters

Hydration is one factor that can lead to weight gain. Often when we perceive hunger we are thirsty. As little as a 2.5% drop in hydration is sufficient to lower our energy level 25%. This usually triggers a perceived need for high energy, high caloric foods, when actually we are just thirsty.  A 2016 study from the University of Illinois at Urbana-Champaign examined the dietary habits of more than 18,300 U.S. adults and found that the majority of people who increased their consumption of plain water by 1 percent reduced their total daily calorie intake as well as their consumption of saturated fat, sugar, sodium and cholesterol.1

1. An R, McCaffrey J. "Plain water consumption in relation to energy intake and diet quality among US adults, 2005–2012." Journal of Human Nutrition and Dietetics, 2016.

Dehydration affects the ability of our body to burn fat, encourages excessive calorie consumption and slows down metabolism.

Drinking more water will help you lose weight a few ways. One, as a hunger suppressant, you will not be as hungry when drinking water through the day as your stomach will constantly have something flowing through it. Two, when your body realizes it is getting enough water, it will allow you to release retained waters from your cells through digestion and elimination. Drink half your body weight in ounces per day. Start you day with a nice healthy glass of water.

Sleep Matters

Certain sleep problems or lack of sleep may contribute to obesity. Moreover, disrupted or inadequate sleep may lead to insulin resistance and an increased risk for diabetes. A study in the American Journal of Clinical Nutrition found that when people were sleep deprived, late-night snacking increased and they were more likely to choose high-carbohydrate snacks. Another study done at the University of Chicago, sleep-deprived participants chose snacks with twice as much fat as those who slept at least 8 hours.

Skimping on sleep can lead to bad decisions and dulls activity in the brain’s area responsible for decision-making and impulse control. You might be able to ignore cravings for comfort food when you’re well-rested, but a sleep-deprived brain may have trouble saying no to a late-night bowl of ice cream.  A review of 18 research studies found that a lack of sleep led to increased cravings for energy-dense, high-carbohydrate foods. In summary, a sleepy brain appears to crave junk food while also lacking the control to say no.

Sugar Matters

One of the main problems as I see it is excess sugar consumption. To put this into context, the average daily consumption of sugar by Americans in 1822 was 9 grams a day. It is currently 152 grams a day per individual. This is nearly a 17-fold increase in less than 200 years. We change very slowly biologically, yet we have drastically altered what we are eating and the amount of sugar we are consuming. There are over 600,000 food items sold in the U.S and over 80% of these have added sugar. If you want a self care awakening look at the nutrition facts label on the food in your cupboards, refrigerator and freezer. It will list sugar content expressed in grams per serving. Let’s use a few examples, one soda can have as much as 45 grams of sugar per 12 ounce serving, that is equivalent to nearly 12 teaspoons of sugar. Popular breakfast cereals are spiked with sugar, some being as much as 55% sugar.

Read labels and limit your daily consumption of sugar to nine teaspoons for men (36 grams) and 6 teaspoons (24 grams) for women.

Self Care Solutions

On a personal note, last April I was speaking at an event in Orlando, FL and I came to my own Self Care Awakening. After my presentation one of the attendees asked if she could do a short video with me talking about Self Care. She later sent me the video and while I was watching I noticed how heavy I looked. Really, all I saw was my belly! That was April 2016, and I weighed 223 pounds. For a 5’10”, 64 year-old man this was not acceptable or healthy. This was more than enough incentive for me to make a few changes. The changes were simple self care principles and easy to incorporate into my daily routine.

First, I increased the amount of water I consumed daily and made water my primary beverage choice. I drank half my body weight in ounces per day, about 14 cups. I accomplished this by sipping on water throughout the day. 

Second, I established a sleep schedule where I went to bed earlier and at the same time each night and got up earlier in the morning. I made sure I got at least 8.5 hours a sleep. This was quite a change for a life-long night owl, but I adapted in a short period of time and felt better rested, more energetic and more productive throughout the day.

Third, I monitored my sugar consumption to approximately 25 grams of sugar a day by reading labels and making healthier choices. I started each day with an organic vegetable protein shake for good nutrition and help curb any sugar or carbohydrate cravings. I replaced two meals a day with the shake and ate one healthy meal.  I initially had two shakes a day for about three months. Currently, I have one shake a day for breakfast. I did not increase my level of exercise but I must say I started doing more, moving more and most likely burning more calories with the increase in energy that I had. By October of 2016, I weighed 180 pounds and more importantly I have maintained this weight by incorporating these simple principles of good hydration, sleep and limiting sugar consumption.

Be Healthy by Choice, not by Chance

Author:  Gary Lindner, PhD