Back in 2010, diabetes mellitus was a hot topic among practitioners and the public. Estimates were released that ascribed mind-numbing numbers to prevalence and costs of future care. Currently, other diseases have captured our attention, but for diabetes, the future is now and (most alarmingly) the environment that originally set the fire burning has not significantly changed.
Diabetes Still Runs Rampant
Diabetes has been defined by the Centers for Disease Control and Prevention as an epidemic; yet properly defined, it has reached pandemic proportions. Here are some of the facts: In 1985, there were approximately 30 million diabetics in the world; in 2000, there were approximately 200 million diabetics worldwide. According to the International Diabetes Federation, there are now 415 million adults who have diabetes and another 318 million who have impaired glucose tolerance, which puts them at high risk for developing diabetes in the future. By 2040, the number of adults with diabetes is expected to reach 642 million (10 percent of the world population) and impaired glucose tolerance could reach 482 million adults (7.8 percent of the world population). In 2015, it is estimated that 5 million people died from the consequences of high blood sugar.
A few years ago, I attended a medical conference where diabetes was the focus. A group of outstanding and well-known speakers presented potential causes and nonpharmacological treatments for diabetes as well as preventive measures. One interesting facet discussed was the link between diabetes and persistent organic pollutants. Data supporting this association, in addition to data exploring its relationship to cardiovascular disease, attention deficit disorder (ADD), and attention deficit hyperactivity disorder (ADHD), were obtained from large, multi-centered studies and national health surveys. The results of these analyses were published in the Journal of the American Medical Association (JAMA), Lancet, Diabetes, and Diabetes Care, as well as other mainstream journals. The presentations reviewed the findings published in these leading journals.
A Widespread Source of Dysfunction
The causal connection between persistent organic pollutants and disease cannot be ignored. Lecturer Ted Schletter, MD, MPH, showed the various links to diabetes that day in a memorable presentation. He noted that as far back as 1971, a published study linked abnormal glucose tolerance tests to occupational exposure to carbon disulfide (an industrial chemical used to make Rayon, extract oils and waxes from plant matter, and as raw material to build other molecules). From 1995 to 2000, six studies showed that arsenic in drinking water increased the incidence of type 2 diabetes. Arsenic was used in most chicken feed to help the meat appear plump and develop coloration that was more appealing to consumers. It works by causing the stomachs of fowl to swell. The chicken eats more and develops more fat. These chickens are then sold by weight. It is only within the past 5 years that use of the four agricultural drugs containing arsenic has been discontinued, the last of which was illegalized December 31, 2015.
Eight published studies from 1981 to 2000 showed that dioxin increases the incidence of type 2 diabetes. From 1997 to 2008, five studies of Vietnam veterans exposed to the herbicide Agent Orange (a type of dioxin) showed increased incidence of type 2 diabetes. From 2000 to 2010, 10 studies found elevated levels of a dioxin derivative, known as DDE, in patients with type 2 diabetes. In 2000, the National Academy of Sciences published that there was a “limited/suggestive evidence of association of dioxin and type 2 diabetes.”
Persistent organic pollutants also include pesticide residues and bisphenol A (BPA), found in plastic bottles, the lining of canned foods and drinks, heat-printed register receipt paper, and paper money. BPA is detectable in 94 percent of all Americans. A study from Harvard published in JAMA on November 22, 2011, showed a 1000 percent increase of BPA levels in volunteers who ate one serving of canned soup a day for 5 days as compared to another group who ate soup freshly prepared from scratch. To quote a 2004 study published in the journal Biomaterials: “Our results indicate that Bisphenol A at concentrations >0.1 μmol causes an extreme depletion of intracellular glutathione as well as increasing apoptosis.” (Apoptosis is the name for programmed cell death.)
So, why is glutathione depletion so important? Jeffrey Bland, PhD, a pioneer in application of systems medicine, reviewed glutathione metabolism and showed that it is the most potent antioxidant we produce at the cellular level. In other words, as a molecule created by the body, glutathione is the most important molecule for binding to and clearing toxic substances from the body. Pesticides are a classic example of a glutathione target, as are alcohol and damaging end products that result from normal cellular metabolism.
Depletion of glutathione leaves us vulnerable to chronic disorders, including type 2 diabetes, Alzheimer’s disease, and cardiovascular diseases. It comes down to the mitochondria in cells, as these are the cellular organs that produce ATP—the energy molecule that drives all activity within the cell.
Metabolic syndrome and obesity result from mitochondrial dysfunction caused by the toxic influence of persistent organic pollutants. Various studies have examined this relationship, from research documenting lead exposure in gas-station workers to a study citing the damage done to the DNA of immune cells by glyphosate (the active ingredient in the herbicide Roundup). In this latter study, glyphosate was shown to inhibit mitochondrial function. More than 100 million tons of products containing glyphosate are used in the United States annually.
Pharmacological medications to treat type 2 diabetes can also be dangerous. For example, the well-known drug rosiglitazone (Avandia) first came out in 1999. In 2007, an article published in the New England Journal of Medicine showed that rosiglitazone caused a 64 percent higher risk of cardiac death and a 43 percent higher risk for heart attacks compared to other treatments. Even at the urging of a number of major medical institutions to have rosiglitazone removed from the market, the FDA continues to allow it to be prescribed, whereas the European Medicine Agency has banned the drug. We know that drug management of diabetes lowers blood sugar but is associated with higher mortality, more heart disease, increased risk of sudden death, and weight gain, among other effects.
An interesting 2008 study published in Metabolism showed that berberine, a natural plant alkaloid, is as effective as the diabetes drug metformin in the regulation of glucose metabolism, including fasting blood sugars, hemoglobin A1C levels, and fasting insulin. As to lipid metabolism, berberine was superior to metformin in reducing total cholesterol and triglycerides. Chromium piccolinate, vitamin D3, cinnamon, green tea polyphenols, alpha lipoic acid, carnitine, and others can all help as nonpharmacological support in the treatment, and in some cases, the prevention of diabetes. Outside the sphere of nutrition, there is also evidence that hyperbaric oxygenation treatment and sauna detoxification are effective in diabetes management.
Another factor to take into consideration when discussing diabetes is the associated costs. The cost of diabetes to individuals and to society is substantial. The International Diabetes Federation has suggested that healthcare expenditures are two to three times higher for diabetics than those without the disease. Expressed in international dollars (ID), which corrects for differences in purchasing power among countries and currencies, it is estimated that global expenditures on diabetes reached $418 billion ID in 2010 and will be at least $561 billion ID in 2030. An estimated average of $878 ID per person was spent on diabetes in 2010 globally.
For the United States, the numbers are no less considerable. We spent $320 billion USD for diagnosed diabetes in 2015 for 29.3 million Americans, or 9.2 percent of the population. The costs of undiagnosed diabetes, prediabetes, and gestational diabetes only add to that burden.
Diabetes remains a critical concern in the scope of global health care issues. We would be remiss to let ourselves be distracted by sensational developments on other disease fronts, when such great impact can be derived from fighting diabetes—not with groundbreaking science, but with scientifically proven, foundational concepts that impact it the most: diet and nutrition, exercise, clean environments, and detoxification.
By Andrew Campbell, MD