It is now clear that not only do these conditions share the same underlying causes—and thus require the same treatment—but they are also 100 percent preventable and, in many cases, entirely reversible.
Diabetes and obesity share the same underlying causes and, in many cases, they’re entirely preventable. Find out how diabesity has grown to the epidemic problem it is today. #healthylifestyle #wellness #chriskresser
What You Should Know about Diabesity
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 with no relief from cravings for sugar
- Fatigue after meals
- Frequent urination
- Increased thirst and appetite
- Difficulty losing weight
- Slowed stomach emptying
- Slowed wound healing
- 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. That’s not true. Thin people can suffer from the entire spectrum of blood sugar imbalances, all the way up to bona fide type 2 diabetes. The term sometimes used for people who are thin, yet have insulin resistance, hyperglycemia, and dyslipidemia, is “metabolically obese.” In short, their metabolisms behave as though they’re obese, even when physically they’re not.
Is Diabesity the Number One Cause for Deaths in the U.S.?
It’s almost impossible to overstate how serious and far reaching a problem diabesity is:
- More than 93 million Americans are obese (2)
- Over 30 million Americans have diabetes (3)
- Over 84 million American adults have prediabetes, characterized by slightly elevated blood glucose levels (4)
- Worldwide, diabetes affects 451 million adults, and more than 2.1 billion people are overweight or obese (5, 6)
Diabesity is the leading cause of modern, chronic disease. The “diabese” have increased risk of: (7, 8, 9, 10, 11)
- Cardiovascular disease
- Respiratory disorders
- Dementia and Alzheimer’s disease
- Kidney failure
- Digestive disorders
In Dr. Bernstein’s Diabetes Solution, Dr. Richard Bernstein claims that diabetes is now the third-leading cause of death. But death certificates don’t 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, it’s quite possible that diabesity is not only the leading cause of disease, but also the leading cause of death.
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The High Costs of Diabesity
Diabesity is literally bankrupting the American health care system. The direct and indirect costs of type 2 diabetes were $327 billion in 2017, up from $174 billion just 10 years prior. (13) The yearly cost of obesity surpasses $340 billion. (14) So the total cost of diabesity to society can be conservatively estimated at $650 billion per year. To put that into perspective, the health care costs of the United States in 2018 totaled $3.6 trillion. (15) We spend more per person on healthcare than any other developed nation, yet our health continues to decline.
With numbers like these, you’d expect a state of emergency to be declared. You’d think we’d 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 three decades, not to mention the equally alarming projections for the future.
Kids Are Impacted by the Diabesity Epidemic Too
Reports suggest that more than one-third of Americans born in the year 2000 will develop diabetes within their lifetimes. (15) 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, but those days are long gone:
- The prevalence of type 2 diabetes in kids rose by 30 percent between 2000 and 2009 and continues to climb (16)
- The number of new cases of type 2 diabetes in kids is expected to quadruple in the next several decades (17)
Each year, kids are gaining more weight. Childhood obesity has more than tripled since the 1970s: (18, 19)
- Among American children two to five years of age, almost 14 percent are now obese
- From ages six to 11, 18 percent of children are obese
- 20 percent of adolescents and teenagers ages 12 to 19 are obese
Most alarming is the rise of obesity in children under five years of age. Research shows that early childhood obesity rates have doubled since 1980. (20) And this isn’t because babies are eating more donuts and cheese doodles while cutting back on their workouts, either. Let’s look at why there’s more to the diabesity story than eating junk food and not exercising enough.
Why We Need to Change Our Behaviors and Lifestyles
From 1993 to 2017, the number of people in the world with diabetes increased 12-fold from 35 million to 450 million and is expected to rise to 690 million by 2045. (21) This is roughly 18 times the number of people affected by HIV/AIDS worldwide. In the United States, the incidence of diabetes is projected to increase to 60 million by the year 2060. (22)
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 today. Einstein once defined insanity as doing the same thing over and over again and expecting a different result. Clearly, we need to shift our thinking away from the conventional approach, challenge our current beliefs, and embrace more unconventional options, like:
- Optimizing gut health
- Embracing a Paleo diet
- Trying high-intensity intermittent training (HIIT)
Better supplementation. Fewer supplements.
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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.
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.
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.
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!
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.
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!
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.
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.
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.
PaNus take on the Kitavans..
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.
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?
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.
“Diabetes isn’t caused by eating too many carbohydrates.”
Ok then, what is the cause?
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…
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.
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!
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.
Don’t worry, we’ll be talking plenty about “skinny diabetes” and other metabolic problems that don’t necessarily present with obesity.
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.
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.
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!