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Health Matters: Diabesity, a common disease

Conway McLean, DPM, Journal columnist

We are experiencing an epidemic, but this is not the disease you’re thinking of. This one is largely self-inflicted, although it has nothing to do with PPE use. I refer to the epidemic of ‘diabesity’, a new term applied to the combination of adult-onset diabetes and obesity. These two conditions share some important mechanisms regarding how they cause disease changes in the body. Getting the diagnosis of diabesity carries important ramifications for your well-being.

The percentage of the American population with obesity has sky-rocketed. And the incidence continues to soar. Some estimates claim, within years, more than 60% of all adults in America will have, or be at risk for, type 2 diabetes or obesity. This obesity epidemic has led to recognition of another condition termed metabolic syndrome. This is a cluster of conditions, which includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, all of which increase the risk of heart disease, stroke, and diabetes.

Metabolic syndrome is a serious health condition that affects about 23 percent of adults. Unfortunately, aside from an increasing waist circumference, most of the disorders associated with metabolic syndrome have no symptoms. Too often, it goes unrecognized and untreated. The result is progression of the pathologic changes, leading too often to heart disease or a stroke.

Diabesity is a modern epidemic and it’s a deadly one. It’s primarily the combination of the two that leads to the diagnosis of metabolic syndrome. Diabesity and metabolic syndrome are precursors for other serious health issues, including heart disease, stroke, and so many other consequences of the Western lifestyle.

This is a disease that’s making us fat, sick, and killing many of us. To make matters worse, 90 percent of the people currently with diabesity don’t even know they have it. Sure, their clothing size has changed but there are often no obvious symptoms. No fevers, no aches, but changes easily chalked up to age.

Like so many things, the disease is on a continuum of abnormality, ranging from mild insulin resistance to full-blown, insulin-dependent diabetes. All of these changes are a consequence of bad dietary choices, unhealthy lifestyles, environmental toxins, and our own unique, individual genetic constitution. Stress, in all its variations, is also likely a major player.

The spectrum of diabesity is the summation of all these factors, and there are a multitude, but some of the most consequential seem to be, once again, diet and lifestyle. We have control of these, while your upbringing, the proverbial ‘nurture,’ can be challenging to redirect, to correct. Although an amusing cliché, ‘baby steps’ is a good rule of thumb when it comes to altering your diet and exercise regimen. Any change in either category should be made gradually, and for the long term.

Insulin resistance is one of the consequences of poor choices. They produce a condition where muscle tissue requires ever-increasing amounts of insulin to take up the glucose (the body’s favorite form of sugar) they need to function. This occurs because too many of the foods that have been consumed over the years were loaded with simple sugars, easily broken down and absorbed into the blood stream. This flood of sugar takes place repeatedly, multiple times a day for many Americans. The result: insulin resistance.

The style of dietary intake we are discussing has become the norm in many parts of the world. Those fast and processed foods, junk food and snack food, foods needing no assembly, no cooking required. Just expose it to a bit of radiation: your omnipresent microwave. These foods generally have inadequate nutritive value, but more importantly to our piece, have an abundance of simple sugars and carbohydrates (pasta, bread, potatoes, rice). Your cells slowly become resistant to the repeated flooding of insulin, a response to the blood stream being inundated with sugar.

The result of this process is the development of insulin resistance. An early sign of these proceedings, quite naturally, are high insulin levels. The higher the levels, the worse the resistance. An eventual consequence is the deterioration of the body, especially premature aging. Many scientists believe insulin resistance is the most important phenomenon leading to this advancing senescence. Many other diseases are more likely to develop as a result of these mechanisms, including heart disease, stroke, cancer, even dementia.

As our insulin levels rise, it leads to increasing appetite, with weight gain the result. Where this weight is carried turns out to be of particular importance. If it is around the belly, there will be higher levels of inflammation leading to high blood pressure, high cholesterol, high triglycerides. The clinical consequences include thickening of the blood, increased risk of cancer, Alzheimer’s, and depression. Apparently so many of these problems are primarily a result of insulin resistance. The question that needs to be asked, can these conditions be reversed?

Science has not been able to determine how much all the different factors contribute to metabolic syndrome. There is some controversy about the degree to which diet and exercise can alter an individual’s health when afflicted with this condition. The popular opinion says this condition can be controlled with diet and exercise, yet abundant evidence claims this is not the case. The real problem for most is metabolic dysfunction, a disturbance in the chemical reactions that keep us alive. This is not a function of behavior but is an actual medical condition.

The connection between inflammation and diabesity is a hot topic in current scientific literature. Good evidence points to a strong association between elevated levels of the body’s chemical messengers for inflammation and future weight gain. The administration of these inflammatory messengers into healthy, normal mice produced insulin resistance in one study. Also discovered is that humans are more likely to develop type 2 diabetes if they have certain chronic inflammatory conditions.

Should you be given this diagnosis, metabolic dysfunction, or any of its corollaries (diabetes or morbid obesity), steps can and should be taken. These can be life-saving changes, especially alterations in diet and activity levels. Learn about good nutrition and don’t buy junk. Eliminate sugar and processed carbohydrates, with veggies predominant on your plate. Cook with real foods. Reduce your intake of meat, primarily buying lean sources (chicken or fish), with other important foods including nuts, whole grains, seeds, and beans.

As to a simple cure, there is unlikely to be one. The contributing factors are too many. But we know enough about wellness to say diet and exercise are some of the pillars to good health. And they are the two over which we have the most control. You can’t choose your family, highlighting that your genetic constitution is out of your hands. Perhaps someday we’ll be able to change that, but until then, make the most of what you have. Take care of your body and your health. It’s what you have to live with.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.

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