Diabesity: The #1 Cause of Death and Disease? | Chris Kresser
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Diabesity: The #1 Cause of Death and Disease?

by Chris Kresser

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Obesity, insulin resistance, metabolic syndrome and type 2 diabetes have reached epidemic proportions. There’s not a person reading this article who isn’t affected by these conditions, either directly or indirectly. Yet as common as these conditions are, few people understand how closely they’re related to one another.

It is now clear that not only do these conditions share the same underlying causesand thus require the same treatmentthey are 100 percent preventable and, in many cases, entirely reversible.

Because of these similarities, Dr. Francine Kaufman coined the term diabesity (diabetes + obesity) to describe them. Diabesity can be defined as a metabolic dysfunction that ranges from mild blood sugar imbalances to full-fledged type 2 diabetes.

Diabesity is a constellation of signs that includes:

  • Abdominal obesity (i.e. spare tire syndrome)
  • Dyslipidemia (low HDL, high LDL and high triglycerides)
  • High blood pressure
  • High blood sugar (fasting above 100 mg/dL, Hb1Ac above 5.5)
  • Systemic inflammation
  • A tendency to form blood clots

The subjective symptoms of diabesity include (but aren’t limited to):

  • Sugar cravings, especially after meals
  • Eating sweets does not relieve cravings for sugar
  • Fatigue after meals
  • Frequent urination
  • Increased thirst and appetite
  • Difficulty losing weight
  • Slowed stomach emptying
  • Sexual dysfunction
  • Visual problems
  • Numbness and tingling in the extremities

The term diabesity is misleading in one respect: it suggests one must be obese to experience the metabolic problems I just described above. Thats not true. Thin people can suffer from the entire spectrum of blood sugar imbalances, all the way up to full-fledged type 2 diabetes. The term sometimes used for someone who is thin, yet has insulin resistance, dysglycemia and dyslipidemia is metabolically obese. Their metabolism behaves as if theyre obese, even when theyre not.

Its almost impossible to overstate how serious and far-reaching a problem diabesity is. It affects more than one billion people worldwide, including 100 million Americans and 50 percent of Americans over 65. (1)

More than 93 million Americans are obese, and over 30 million have diabetes. (23)

Diabesity is the leading cause of modern, chronic disease. The diabese have increased risk of heart disease, stroke, dementia, cancer, kidney failure, and blindnessto name only a few.

In the U.S. today, every 10 seconds someone dies from diabetes-related causes. (4) Diabetes and cardiovascular disease have now outpaced infectious disease as the primary cause of morbidity and mortality worldwide. In Dr. Bernstein’s Diabetes Solution, Dr. B claims that diabetes is now the third leading cause of death. But death certificates dont list diabetes or hyperglycemia as the underlying cause of heart attacks, strokes, or fatal infections. Nor do they consider the role of obesity, insulin resistance, and inflammation in these conditions. If they did, its quite possible that diabesity is not only the leading cause of disease, but also the leading cause of death.

Diabesity is literally bankrupting our health care system. The direct and indirect costs of type 2 diabetes were $174 billion in 2007. The cost of obesity in that same year was $113 billion. So the total cost of diabesity to society can be conservatively estimated at nearly $300 billion per year. (5) To put that in perspective, diabesity has cost the U.S. $3 trillion over the past decade. Thats three times the estimated cost of fixing our entire health care system. And its only going to get worse. The projected cost of diabetes alone is expected to rise to more than $330 billion by 2034. (6)

With numbers like this, youd expect a state of emergency to be declared. Youd think wed be doing everything in our power to figure out the cause of these conditions and how to treat them successfully.

But the reality is that the conventional treatment of diabesity has been a dismal failure. This is reflected in the shocking growth of the conditions that fall under the diabesity umbrella over the past two decades, and the equally alarming projections for the future.

Reports suggest that one-third of people born in 2010 will develop diabetes at some point in their lives. (7) What is particularly horrifying about this statistic is that many of those who develop diabetes will be kids. Type 2 diabetes used to be a disease of the middle-aged and elderly. No longer. A recent Yale study indicated that nearly one in four kids between the ages of 4 and 18 have pre-diabetes (glucose intolerance). Some regional studies show type 2 diabetes in kids has jumped from less than 5 percent before 1994 to 50 percent in 2004. (8)

Each year, kids are getting fatter. Among American children 2 to 5 years of age, more than 10 percent are now obese. (9) Even more alarming is the rise of obesity in infants under 2 years of age. Research from Harvard shows infant obesity has risen more than 70 percent since 1980. (10) And this isnt because babies are eating more donuts and cheese doodles while cutting back on their Stairmaster workouts, either. Clearly theres more to the diabesity story than eating junk food and not exercising enough. But I digress. We’ll be covering causes in future articles.

From 1993 to 2008, the number of people in the world with diabetes increased seven-fold from 35 million to 240 million, and is expected to rise to 380 million by 2030. This is 10 times the number of people affected by HIV/AIDS worldwide. In the U.S., the incidence of diabetes is projected to increase to 44 million in the year 2034. (11)

What accounts for such an explosion of new cases? One reason is that the standard treatment for diabesity is not only ineffective, its contributing to the problem. Once they have developed, diabetes and obesity are characterized by insulin resistance, which in turn results in carbohydrate intolerance. Yet prominent organizations such as the American Diabetes Association have been recommending a low-fat, high-carbohydrate diet as a treatment for diabetes for decades. It didn’t work in 1985, and it still doesn’t work. Einstein once said that insanity is doing the same thing over and over, and expecting a different result. Clearly the conventional approach to treating diabesity is insane.

In this series, were going to get the bottom of the diabesity epidemic. Well leave the conventional model of understanding diabesitywhich is now about 40 years oldin the dust and replace it with an updated 2010 model that reflects the current scientific literature. Were going to uncover the real causes of of diabesity, and were going to find out exactly how it can be prevented and even reversed in the majority of cases.

As we go along well be busting a number of conventional and alternative myths about diabesity. Well learn that:

  • Obesity isnt as simple as eating too much and not exercising enough
  • Diabetes isnt always progressive, and can be reversed in many people
  • Diabetes isnt caused by eating too many carbohydrates
  • A fasting blood sugar of 95 mg/dL and Hb1Ac of 5.5% isnt normal
  • Thin people can get type 2 diabetes
  • And more …

As we begin, I’d love to hear from you. Do you have any specific questions about diabesity? Anything you’ve always wondered about but haven’t found the answer to? Leave a comment, and I’ll do my best to address it at some point in the series.


Join the conversation

  1. As a type 1 diabetic and the mother of a 7 yr old type 1 diabetic, I find the word “diabesity” offensive. You mention that it is in reference to type 2, but most people I have run across over my 23 years as a diabetic, don’t even know the difference. You do not do enough to differentiate the two diseases and leave us trying to explain how we got diabetes even though we are not fat and that we take injections/use a pump to survive, not because we don’t want to exercise and eat right.

    • I agree, Jess. I think the public would be better served if we created two separate words for T1 and T2 diabetes. I some respects, they are completely opposite diseases: T1 is too little insulin, and T2 is often too much insulin, and the ensuing insulin insensitivity. T2 is often quickly reversible with weight loss, diet and exercise, but T1 is generally a lifelong condition. People often use “childhood” and “adult-onset” also, but that’s not really accurate either.
      Metabolic syndrome might be a more helpful word to describe T2 than diabesity.

  2. I’m not sure if I have questions yet but am eagerly following this series. As one already suffering from diabesity Ilike both my parents) I’m hoping I’m not too far gone to be able to reverse some of the damage done over the years, and to prevent or slow down future damage. I’ve made a start – losing 110 pounds so far on a low carb diet. Yeah, I do have high LDL, alas – but my HDL is good (66) and so are my triglycerides (49). Probably my biggest problem is *depression* caused by reading all these articles about how I’m going to die young and soon because I’m a diabetic.

  3. I am thoroughly confused….will somebody out there help me. I am not diabetic but am overweight,and just cant seem to deal with it. I have the fear of diabetes or diabesity. i was an overweight kid…then lost all my weight on a low carb diet…kept it off for 12 years…got married and started eating like my husband..and wham….I look like a balloon.Now I just cant seem to cut it…I want to stabilise my blood sugar,lose some weight.I keep wondering if I have some kind of metabolic syndrome…I just dont know.I dont touch wheat and sugar.I eat almost no grains,potatoes etc. What else needs to go ?

  4. Thank you Chris for your quick and thoughtful answers. I think you’re absolutely right on re the kinds of people that respond to low-fat diets. I had not thought of THAT.  For someone like me it was a disaster, I ate all day and was still hungry most of the time. Then I kept losing weight I couldn’t afford to lose.

    To your questions:

    Cortisol test: No – I had requested it (per Schwarzbein Principle) but the lab didn’t do it. I did a saliva test later at my healthfood store but it did not address cortisol specifically. . What is the best type of test for cortisol?

    Insulin test: No –  is the c-peptide test ok for that?

    Stress: I’ve always been a very anxious type of personality and used to get regular migraines at the first sign of an adversity UNTIL I discovered and started practicing MEDITATION. I haven’t had a migraine in 20 years just by staying calm.

    But my life is somewhat stressful as I am caring for my husband who had a hemorrhagic  stroke 10 years ago (he being 5’11 and I only 5’ – I learned a lot about ‘leverage’! The first year was especially demanding while he was in a wheelchair and rehabilitating from right-side paralysis. Full function of his right side has not come back (but he can now walk with a cane) and so he cannot help me with the work that needs to be done daily in maintaining a home. So all that falls on me and motivates me even more to stay strong and healthy. 

    Incidently, over the last 10 years, my TSH bounced around from 3.5 to a high of 9 (while on low-fat/high-carb) and now back to 3.5 (added thytrophin and kelp). I started taking lowest dose of Synthroid 2 years ago.

    One last thing. Over the years my doctor never said anything about my FG since until only recently 126 was the cut-off number for diabetes and I was always below that. And I didn’t have the usual symptoms. It wasn’t until I started testing my self that I realized that I had spikes beyond normal. (My husband was diagnosed as diabetic as a result of his stroke but later became normal on his own and I started testing myself out of curiosity.)

    You’ve already shed more light on my situation than anyone else and I’m looking forward to your indepth write-up.

    Thank you so much! (sorry for this long answer)

  5. REgarding skinny diabetics, this can happen due to decreased insulin production, and especially for I diabetics. Because insulin stimulates fatty acid synthesis and TGL uptake into the cell for storage. SO if your body lacks of insulin, fatty acid synthesis and metabolism is impaired and therefore diabetics can be skinny. But this is more applicable to I, as most type II at least at the early stages produces too much of insulin.
    ALso want to point out that high levels of fatty acids and TGL in the blood stream can reduce insulin sensitivity which can explain that people after high fat low carb meal still have high sugar levels. Moreover, sometimes those fats stay in the blood longer than the next meal and so they could be mixing todays carbs with yesterdays fats which raises blood sugar and over period of time cause matabolic syndrom.

  6. Yes, please do include skinny people. I’ve been prediabetic for at leat 10 years that I know of with fasting BG between 110-120 and spikes after carb meals  to 180 or beyond.
    But I don’t fit the usual pattern:  I’m 67 have no aches or pains and lots of energy – been slender all my life, low BP, TC around 250 but  low triglycerides (35-50) HDL in 70-80….There is no diabetes in my family and I’ve been very health conscious all my life doing exercise, cooking my meals from scratch – never “dieting” – but eating whole foods with whole fats. No junk food and no liking for pastries etc. But I DID – and still do- love FRUITS and ate lots of it – grapes, oranges, apples etc on a daily basis. Maybe that was it – too much fruit.
    There is one question I wish you would address (I’ve asked it many times elsewhere but not gotten an answer).  How can it be that doctors like McDougall, Barnard, Anderson, Ornish, Fuhrmann etc. – having treated thousands of diabetic patients – all have their success stories using exactly the diet you say doesn’t work – low-fat/high carb. I just don’t understand it – except maybe it IS a metabolic thing? I tried McDougall but had to quit because I lost too much weight (I too am just under 5 feet tall and weigh 88 lbs now) and my BS did not go down much.
    I do appreciate the time and effort you put forth in bringing us so much useful and new information.

    • The vast majority of the patients that get put on those diets were doing every single thing wrong that you could do wrong before starting them: eating tons of refined flour, grain, fructose and other dietary toxins, as completely sedentary lifestyle, high levels of stress, etc. etc. Then they go to one of those doctors, or pick up one of their books, and they eliminate many if not all of these triggers. You bet they’re going to see improvement. But that doesn’t mean these diets are optimal, or that they wouldn’t see more improvement adopting a paleo-type diet with fat as the primary energy source.

      In your case, it’s not clear what’s happening. Stress is a huge factor – whether emotional, psychological, or physiological (chronic low-grade infections, gut dysbiosis, etc.). Environmental toxins can be a factor. And certainly a high fructose intake alone is quite capable of causing non-alcoholic fatty liver, which could in turn cause metabolic dysfunction without overweight or obesity. Genetics also play a role, although I believe that role to be quite small in those following a healthy lifestyle such as yourself.

      Have you had your cortisol levels tested? That would be my first thought. High cortisol can cause dysglycemia on its own. Have you had your fasting insulin tested?

  7. Hi Chris,
    We were talking about broken metabolisms with my MIL.  She’s 75 yo, obese, intolerant to carbohydrates (she has just begun to restrict herself to non-starchy veggies in order to maintain normal blood glucose levels).  She has osteopenia, osteoarthritis, is a breast cancer survivor, and has poor thyroid function.
    My MIL moved from the countryside in Mexico to Mexico City in her early 20s.  It was there she raised nine children.  They were very poor and often got by on rice, beans, and tortillas. By her 40s, she was already quite overweight.
    When we look at her history, and try to speculate on what broke her metabolism, in her case we can rule out soft drinks and typical bagged or boxed processed foods.  We’re guessing relying on corn oil to cook with did a lot of damage.  And, lack of nutrient-dense foods causing a level of “starvation” (I’m not counting rice, beans, and tortillas as nutrient dense).  We’re also wondering if nine pregnancies took a major toll & robbed her own body of much needed nutrients.  And, there was also the stress of raising a large family under difficult conditions.
    I hope when you talk about diabesity, you’ll be able to address other causes beyond just the SAD.
    Thank you for the great blog, Maggie

  8. A bit of mythbusting as it relates to health would be nice!    For example
    1)  the whole calories in = calories out, where spending an hour on a treadmill burns very few extra calories that doing nothing.
    2) net carbs – should carbs from fiber (in/soluble) be lumped in as other carbs
    3) high intensity training / vo2 max – is this for real?
    4) subcutaneous fat vs. visceral fat
    5) fat burning / weight loss supplements – niacin, hgh, etc
    6) fructose vs. sucrose – is one better than the other

  9. I am really looking forward to this series.   My family is plagued with this disease and it’s accompanying obesity. I am particularly interested in your take on inflamation and it’s role in the disease process.  .   I especially enjoyed your articles on heart disease and cholesterol and the videos you included.  

    This blog has meant a lot to me and I thank you for the effort you put into it.   Please keep up the good work as there is just not much help out there with ‘mainstream’ medicine.   We need folks like you who can help us to help ourselves

    Congratulations on your recent graduation.   I wish you all the success in the world as you begin your own practice.   Just please don’t forget humble cyber “patients” who live too far away to ever consult you in person.   We are all in your debt for taking the time to share.

  10. Yes, a site-wide comments RSS. Without having to comment on each post first if that’s what you’re talking about. It’s easy to do this for blogs on blogspot even if they don’t provide a link, but I couldn’t figure out how to do it for yours.

  11. Hey Chris, I’d love it if you added a feed for comments. You write great responses to everyone so I don’t like to miss them, and it’s nice using Google Reader to search for info on a specific topic from some of my favorite sources. Thanks.

  12. Ah, I see what was happening now.  I fixed the links in the post.  It should take you to the right reference now.  I’ll fix the link in the comments next.

    More than half of Americans are overweight – reference.

    One-third are obese – reference.

    I’m not as certain as you that overweight isn’t a problem.  It doesn’t necessarily put you at risk, but the prevalence of metabolic problems is certainly higher in those who are overweight and obese.  It’s also true that obesity is not common in traditional, hunter-gatherer peoples that experience much lower rates of the modern diseases that plague us. I don’t think obesity is a normal, healthy state for humans and I believe it does indicate dysfunction – regardless of whether it is necessarily associated with frank disease states.

  13. Yes, that’s the link I’m referring to.  It takes me to a PDF of an article on environmental toxins and type 2 diabetes in Canadian Aborigines by Donald Sharp (both from the post and from your comment).  I read through the article several times now and I’m not finding anything that estimates the health care costs of obesity or diabetes.  Am I missing that content somehow?  I suppose it could also be a technical issue of some kind on my end.

    I appreciate the clarification of your interest in abdominal obesity and its associated problems.  Maybe I’m not reading close enough, but the specificity of that focus didn’t come across to me in the original post.  I guess I’m confused by the scope of a statement like: “More than half of Americans are overweight, and a full one-third are clinically obese.”  Again, not sure where that estimate comes from, what definitions it’s using, and why it’s relevant if you’re interested in metabolic problems associated with a specific kind of obesity, particularly if being overweight, as you said, does not necessarily put you at risk.  Again, though, thank you for the clarification.  I’m not trying to nitpick, I just have an interest in (and, admittedly, a bias against) health writing that seems to imply or assume a simplistic relationship between weight and health.

  14. Hey Chris.  I would also like to know how you are defining the term “obesity.”  Are you depending on BMI? Are you speaking more generally of a certain percentage of body fat?  What studies are you looking at to assume a correlation (or a causative relationship) between increased weight and increased risk of death and disease?  I feel pretty sure that you are aware of all of the criticism that’s been launched at the epidemiological analyses that have claimed that overweight causes illness (by, for instance, Paul Campos in The Obesity Myth).  I love your writing and I particularly value the critical stance you take towards accepted wisdom about health, so I’m really interested to know what sources you’re using to inform your idea of what constitutes a healthy weight. 

    Also, I tried to follow up on the numbers you cited as to the health care costs of “diabesity,” but your 4th footnote links to an article that seems unrelated to that topic – “Environmental Toxins, A Potential Risk Factor for Diabetes Among Canadian Aboriginals.”  I would love to look at the actual source for that estimate.

    • First of all, diabesity can occur without obesity. I know the word is a little misleading that way, but as I said in the article it’s possible for thin people to be “metabolically obese”. It’s also possible for people to be significantly “overweight” without metabolic dysfunction. The problem we’re concerned with in particular is abdominal/visceral obesity, which is strongly associated with metabolic problems that increase morbidity and mortality.

      I’m confused by your comment about the 4th footnote. When I click on (4), I’m taken to this PDF, which is the correct reference.

  15. Oh, and when you talk about carbs, any chance you could be explicit? I see ‘flour’ was mentioned a few times, and while most people are still eating white wheat flour, there are also many people now eating other kinds of flours, both refined and ‘whole’. Likewise, do you differentiate between whole grains and refined grains (eg brown rice and white rice)? The Glycemic Index seems to treat foods solely on the basis of carb content, but does the relative presence or absence of other nutrients also affect metabolism?
    And where do milk sugars fit into all this? (and is there any difference between say raw, whole milk and pasteurised, homogenised milk?).

  16. Hi Chris, I’m looking forward to this series too. I have some questions:
    – can you please define ‘obesity’? Many fat people are now saying that fat doesn’t automatically equate to unhealthy or unwell (fat people can have healthy diets and exercise and still be ‘fat’), and apparently there is research to back this up (I haven’t gone looking yet). Do you think all fat people are obese?
    – can you put up the statistics of fat people who don’t have diabetes?
    – can you look at the role of increased body fat in middle aged/menopausal women, and whether this is normal/healthy because of hormonal changes (specifically that the fat cells take over some of the hormonal functions)?
    – are diabesity and metabolic syndrome different things or the same or what?
    I’m also looking forward to the information on stress too.
    thanks 🙂

  17. I found that lowcarb did not work unless I ditched the ‘fake’ foods like low carb ice cream.  I could not lose even an ounce when still eating that dang low carb ice cream!  Ditched it and the pounds came off.  Now I sub coconut milk and fruit for the ice cream.  Still lotsa calories and fat and even carbs, but yet I can still lose weight.  Those on LC with no weight loss, be wary of milk sugars, nuts, and cheese as any one of those can block LC effectiveness in some people.  Also try ditching all processed foods, low carb or no and also all grain oils.  Other oils are just as tasty if not more so.   There are some things we still don’t understand totally about LC and why it does and does not work at times but it seems certain things can trip up the system, even if they are lowcarb things.  

    Anyway, about the Kitavans, should be interesting.  I suspect metabolic probs result from a variety of sources.  Could be high intake of starches mixed with heavy exercise and no other risk factors might not alone be enough to majorly damage the metabolic system.  But add stress, grain oils, processed food, hormones in the food, sedentary lifestyle, less sunshine, easy access to food, etc, and put that on top of the same high starch diet, then maybe there would be more problems.  PLus I suspect there is also a certain amount of genetic tolerance or lack thereof to be considered.  At some point, I suspect there is a tipping point and where that tipping point is and what exacty most easily triggers it will vary from person to person.

    As for skinny diabetics, I don’t know if there is any research on it, but the skinny ones I have known have also been the ones with the worst cases.  They are the ones that easily pass out and have raging hard to control glucose numbers.  From a scientific perspective, I find that interesting.  I have heard some say that your body puts on fat as a protective measure to help store the excess glucose.  If so, it would make sense that the skinny ones have worse cases.          

  18. I wonder if you will be addressing gastric bypass surgery and why it seems to reverse T2DM. I am one of four children in my family of origin. We all became diabetic inspite of being very active people. My eldest sister (67) just had gastric bypass one year ago and is off all meds and now has no symptoms of diabetes. She is now a size 6.

    I know that it has something to do with Incretins….and some diabetes medications are based on the Incretins.

    My own situation is that I thought I might be diabetic about ten years ago. I found Dr Atkins Book and followed his advice. Lost over one hundred pounds had it off for quite a few years. Then an upheaval happened and I was not able to cook for my self for some months and had to resort to restaraunt food. It took very little time for the weight to start piling back on.

    I still eat very low carb. I was subsequently diagnosed as diabetic. As long as I eat little or no carbs my lipid profile is fine. Inspite of all my efforts now I can not get the weight to budge. Since 2007 I have been on Lantus…as my BG levels began to steadily climb. So my Beta Cells must be just about shot. Gluconeogenesis must have been one of the reasons for the steady climb in BG. Perhaps I was eating too much meat and not enough fat.

  19. I also wanted to add to my previous comment that I am doing the SCD diet- basically NO starches or grains, and that has also made a significant improvement. I seem to be intolerant to all carbohydrates, wheat, corn, all types of rice, even brown rice,  quinoa, amaranth, oatmeal, spelt, even all of the non-gluten grains, sweet potatoes…. except for vegetables and very few fruits, and those naturally occurring in dairy and meat etc.

  20. I just wanted to share my personal story. I have struggled with symptoms of fatigue since I was 20 years old. I am now 23. I have been through a run of doctors, who never find anything ‘severe’ enough in my blood work to diagnose me with anything. They just try and give me antidepressants every time, or pain killers. About a year ago I realized I have almost all of the symptoms diabetes- or some sort of blood sugar dysfunction. Naturally, I went to the Dr. again, and expressed to him my concerns. He told me unless my blood sugar was over 120 then to forget about it. I was tested. And although my blood sugar was fasting, I thought it was a bit high. It was somewhere between 100 and 120. Still, I was told I did not have diabetes and not to worry about it. Fast forward a year of more fatigue and misery and blood sugar imbalance symptoms, and I go to see a natural health care practitioner. She tells me that my pancreas is weak and is not producing enough insulin. Of course, it is still not far advanced enough to be considered a disease by a doctor or to be diagnosed. However now that I am taking some herbs to strengthen my body, particularly my pancreas. I feel MUCH better. And some of my symptoms are slowly, slowly starting to improve, such as the extreme fatigue I would feel after eating. Or the tingling in my extremities. Never ignore your body. I have sensed for years that I have had a blood sugar dysfunction, but no doctor will take me seriously because nothing shows in their blood tests. It can be very disheartening and discouraging. I might add that I am 5 feet tall, yet weigh about 80 lbs. I am very thin, have lost a little weight and absolutely can’t gain any weight. In fact, I would not be surprised if some sort of pancreas or metabolic problem runs in my family, as my father is practically a walking skeleton (very thin and underweight) and has very poor health also. He also had all the same symptoms as mine, but was never diagnosed as being full on diabetic. We seem to fluctuate between being hypoglycemics and diabetics- although not in the western clinical sense. My younger brother also is underweight, and has symptoms of blood sugar imbalance. *sigh* I cannot wait for God to bring his new system so that we can all be healed of these ailments for which there is no cure and for which doctors are ill-equipped to help us.

  21. I can’t wait to read the rest of the series.  My grandmother had full-blown T2 and lost her eyesight and legs to the disease – and she was a skinny little thing her whole life.  Probably never weighed more than 100 lbs soaking wet and pregnant.

    Now I’m 50 yrs old and T2 myself and the only one in the family with it.  I swear on a stack of holy books that I started showing signs of IR while still a child.  Never had a waistline in my entire life.

    VLC diets used to work great, but not since I hit middle age.  Ah, the joys of being female.

  22. Great article!  As retired surgeon I knew very little about diabetes until I got it.  In hindsight, I wasted over ten years of “treatment” because of the boneheads at the American Diabetes Association.  Now, I eat one tenth of their recommended carbs, as vegetable matter, my blood sugar, HgbA1c, and weight are where they are supposed to.  I resent their criminal recommendations, and have told them so in writing.  No answer from them.  Please, keep up the great work, and thanks!

  23. I know you’ll talk about strategies for reversing the trend in individuals. I hope you’ll also talk about the role of stress and sleep deficit in all of this. Thanks for the great ongoing series of series!

    • There will be an entire article devoted to the contribution of stress, and it will be mentioned throughout the series. I agree that it’s very important.

  24. I know from my own experience that carbs result in obesity.  When I go low-carb, I lose or maintain my weight, and never gain an ounce even if I eat 4000+ calories/day.  When I raise the carbs, even natural carbs like potatoes or whole grains, I start gaining weight in a hurry.  It works every time like clockwork.
    However, that doesn’t mean the carbs themselves caused the underlying insulin resistance or leptin resistance or whatever is causing my body to react to carbs that way.  After all, it didn’t always — I wasn’t a fat infant or child — and it doesn’t for many other people.  So there has to be something else that skews the body’s response to carbohydrate in the first place.  Right now, it seems to me the prime candidate for that is inflammation caused by refined carbs and/or industrial seed oils; but there are other theories, so I’m very much looking forward to this series.
    It’s like if you went through a house and removed 80% of the nails, and then it fell down in the next strong wind.  You could say the wind caused the house to fall down, but that would be missing the point.  If the strength of the house hadn’t been reduced from inside in the first place, the wind wouldn’t have affected it.  Carbs (as long as they’re unrefined) seem to be the same way: they aren’t a problem in and of themselves, but they can cause problems for the unhealthy.

    • Very well said, Aaron. I will make essentially the same argument as we go forward. Diabesity is a disease of carbohydrate intolerance, but that doesn’t mean (natural) carbs cause the disease.

      I agree with you about inflammation. We’ll be discussing this at length, among other things!

  25. Thanks for your work and your publishing, Chris.  I’m very grateful for your voice.  Being fairly new to this subject I was struck by the ‘unaware’ proportion spotlighted in this sentence:
    24 million Americans have type 2 diabetes, with one in three unaware that they have it. (2)”
    I’m not trying to take anything away from the statement, and I’m no less struck by the proportion, but isn’t the proportion actually one in four rather than 1 in 3 (cited CDC paper says 6 million out of 24 million).

    • Jon: the one in three statistic is from another source. I’ll look that up and add it to the post. As you can imagine, there are varying statistics.

  26. I went Very Very Low Carb in November, basically all of th PaNu 12 steps. Went from 200lbs to 150lbs.  Would you recommend that I go to 20-25% ‘natural’ carbs at this point?

    • It really depends on what your goals are. If you want to continue to lose significant weight, you could stay on the VLC diet. But if you’re satisfied with weight loss, and you want to avoid the potential metabolic problems that can accompany a VLC diet over the longer term, then yes, I’d suggest 20% of calories from natural carbs.

  27. I’ve read that.  The fact is that it’s not only the Kitavans.  As I mentioned, there are also Asian cultures and other groups around the world that get a higher percentage of calories from carbs than 10-30%.  And starchy tubers have been a part of the human diet for a very long time.  I’m not arguing that everyone should eat 70% of calories from carbs.  In fact, I’d say more like 20-25% is optimal.  But I am saying that eating starchy tubers and fruit like berries (in the absence of modern, processed foods) doesn’t cause diabetes.  I challenge anyone to prove otherwise.

  28. I’m in agreement with Taubes about flour (and sugar, but I’d say fructose specifically), but I disagree with him on “easily digestible carbs” for the reason I stated in my reply to you above (Kitavans and other cultures that get the bulk of their calories from easily digestible carbs and have no metabolic problems).

    I do not think a high natural carb diet is the cause of diabesity.  However, once someone has diabesity, it is often necessary to restrict carbs.  Those are two different things.

  29. I’m aware of the Kitavans and their carb ratios.  Pre-modern cultures that have just enough nutrition from carbs seem to do fine.  Modern cultures that can eat their fill of sugar and carbs tend to not do so well.   Gary Taubes places the blame for metabolic syndrome (diabesity) on ‘easily digestible carbs’ specifically sugar and flour.  Are you in agreement with this?  Or are you working on a different interpretation?

  30. I added the following paragraph to the article to clarify that thin people can also have diabesity:

    The term diabesity is misleading in one respect: it suggests one must be obese to experience the metabolic problems I just described above.  That’s not true.  Thin people can suffer from the entire spectrum of blood sugar imbalances, all the way up to full-fledged type 2 diabetes. The term sometimes used for someone who is thin, yet has insulin resistance, dysglycemia and dyslipidemia is “metabolically obese”.  Their metabolism behaves as if they’re obese, even when they’re not.

    • Stay tuned. I’ll be writing all about it.

      Keep in mind that cultures like the Kitavans and certain Asian groups get up to 75-80% of calories from carbohydrate. Yet they are virtually free of diabesity and are exceptionally lean. So natural carbohydrates like starch are not the problem. Refined carbs like bread, pasta, crackers, etc. are another story…

  31. Looking forward to this series Chris.  Your previous series on heartburn was enlightening for me, and really helped to solidify some things that I had discovered through my own experiences but couldn’t really explain.

  32. I greatly look forward to this series! I was diagnosed with polycystic ovary syndrome which has very similar symptoms and effects of syndrome x, etc. Thankfully, since you pointed me in the right direction I’ve tested my blood sugar after a variety of meals (after switching to a “primal” diet) and I am having great scores and a fasting blood sugar of 82. Thank you!

  33. The solution is simple, stop eating “food” our bodies are not adapted to digesting. Those foods are wheat, rice, legumes and most fruit that has been bred with high sugar content.
    If you don’t spike your insulin, you don’t become insulin resistant and you don’t store too much fat. Your body wants to be lean, but it can’t when all you feed it is carbs.
    Saturated animal fat is good for you, vegetable oil is not.
    Sugar and carbs make you fat and raise your cholesterol.
    Stop counting calories, calories are irrelevant. Count the carbs and keep them at 100 grams a day or less.
    Eat real food.

    • Unfortunately, the “insulin spike” theory doesn’t hold up. Traditional peoples like the Kitavans and certain groups in Asia get up to 70-80% of their calories from carbohydrates, which would most definitely cause insulin spikes. Yet they are virtually free of diabesity and are very lean. I do agree that wheat is problematic, along with industrial seed oils and excessive amounts of fructose.

  34. Don’t worry, we’ll be talking plenty about “skinny diabetes” and other metabolic problems that don’t necessarily present with obesity.

  35. I wish the emphasis wasn’t always on the obesity issue.  Sure, excess fat is an obvious clue that fat storage and energy usage is not working properly and that certain diseases are more likely. But the focus on the obesity too often deflects attention from the fact that quite a few normal weight and even skinny people become diabetic and ill with chronic diseases that relate to metabolic disorders.

  36. I look forward to you sharing what you learn. This is a favorite topic of mine–diabesity runs strongly in my family. And I am always pondering causes and treatments. I know current treatments only make a better diabetic..that is, they do not cure, they merely perpetuate the disease. Also, I look for alternative or unique approaches to our thinking. I would like to challenge you on your point that “thin people don’t get diabetes.” Diabetes is on the rise all over the world. And it occurs in thin and undernourished populations as well. It was diagnosed thousands of years ago in China –“wasting and thirsting syndrome”–as you’ll know from your studies. The reason it is connected with obesity in this country is a statistical correlation (I believe) and not causation. There are thin people cooking up diabetes even as we speak–but they are not being investigated. Obesity and diabetes are cousins, and there is an overlying cause based on toxic load, pollution, poor nutritional habits (following current faulty guidance), and the overall culture of overconsumption (not just of food and drink, but chemicals and stimulation of all kinds). A kind of irresponsible abundance. I also think obesity is an adaptation to the imbalances that cause diabetes–and not the other way around. Big topic, and not so easy as people would have you believe.

    • Susan,

      Good catch! That was a typo. It should read “Thin people can get type 2 diabetes.” I’ll be discussing that in the series.

      I will argue that obesity and diabetes share the same causes. It’s not necessarily a linear chain, because it’s possible to have obesity without the metabolic derangement seen in full-fledged T2DM, and it’s possible to have full-fledged T2DM without being obese. But in general, I’d agree that the metabolic changes associated with diabetes precede the development of obesity. We’ll talk much more about that as we go. I would also argue that overconsumption is as much a symptom of diabesity as a cause. We’ll talk about that too.

      • a couple of things. I am starting a campaign called BEAT Diabesity. Also it is the diabetes that creates the metabolic syndrome. yes you can be a diabetic (type I) ,but most of those who are type II did not take care of themselves and fell into the trap of Sugar! That is the problem. It is the Sucrose, the HFCS. would love to have you be part of this campaign and make this a success and possibly a plan to sue the FDA to take Sucrose off of the Grass List!

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