Cardiovascular Health by M. N. D. Cohn

Author:M. N. D. Cohn
Language: eng
Format: epub
Tags: undefined
Publisher: Rowman & Littlefield Publishers
Published: 2012-04-08T04:00:00+00:00

Why Is the Incidence of Diabetes Rising?

There is no question that diabetes is more common in American society than it was in the past. Whereas Type 2 diabetes, the kind associated with resistance to the action of insulin, used to be confined predominantly to an older population, the disorder is now appearing more commonly in children and young adults. Have the genes changed or is it the environment?

The metabolic marker for diabetes, the blood sugar, is critically dependent on food intake. If a person has inherited modest insulin resistance but consumes a low-carbohydrate diet, the blood sugar may well remain within the normal range. No diabetes is detected. But if that same individual is addicted to candy bars and eats a dozen a day, the carbohydrate load will undoubtedly overwhelm the insulin control system and result in a rise in blood sugar and an abnormal hemoglobin A1C level. Diabetes is diagnosed.

The genes have stayed the same. Insulin resistance is present, but now dietary indiscretion has precipitated an abnormal blood sugar. Is that elevated blood sugar the culprit in increasing the risk of cardiovascular disease in diabetes, or is it the insulin resistance, which is there with or without an elevated blood sugar? Multiple studies over the years have failed to confirm a robust relationship between lowering blood sugar by diet or drugs and the incidence of heart attacks and strokes. These studies do, however, suggest that kidney disease and eye disease in diabetics are accelerated by poor blood sugar control. For heart attacks and strokes, however, the genetic predisposition to diabetes may be the culprit, not the blood sugar.

So why is the prevalence of diabetes rising in young people? It may not be. What is being observed is an increase in blood sugar because of dietary indiscretion. It is possible that the rising blood sugar may have a subtle accelerating effect on the progression of cardiovascular disease that is initiated by the insulin resistance. But that effect has not yet been documented. Prudence would encourage people with insulin resistance to resist carbohydrate binging, but the warnings about an epidemic of new-onset diabetes are probably misleading.

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