Book review: Diabetes Rising

Diabetes Rising by Dan Hurley (Kaplan Publishing, January 2010)

Let’s start this way: I picked this book up at random at the public library yesterday morning and finished it at 2 o’clock this afternoon, even though we had a ‘home sick’ day today. There might have been Backyardigans involved in the rapid read. I will say, in fairness, that this is more of a synopsis than a review. The book is awesome. Read it (that’s the review part).

This book is a beautiful example of science reporting, in which the illusion of objectivity is shed, scientists and the people suffering from diabetes are presented as all-too-human, and the reporting of research/ideas/plans are actually fair and balanced. It is also a fascinating and enjoyable read, which one might not expect from a subject this urgent. And just in case we think that the use of the word “pandemic” in the subtitle is scaremongering, he spends the first third of the book tracing the emergence of diabetes, and showing convincingly that this is NOT an artifact of reporting, diagnostics, or our culture’s hysterical fear of fat. Diabetes is on the rise, worldwide, in all situations, and at all ages. Type 1, which is an autoimmune disease that was one called juvenile diabetes has increased at the same time as Type 2 has become so prevalent.

The middle of the book looks at five of the most dominant lines of research, one chapter for each. As outlined, the reasons are:
– general increase in weight, possibly including rapid weight AND HEIGHT growth in childhood (Accelerator Hypothesis)
– early feeding of foreign proteins to infants with immature guts (“Cow’s milk hypothesis”)
– exposure to (or a tendency to accumulate) artificial chemicals (POP Hypothesis)
– Vitamin D deficiency (Sunshine Hypothesis)
– Lack of exposure to natural pathogens which in some way help to keep the immune system regulated (Hygiene Hypothesis)

In fact, none of these things cause diabetes. But avoiding them may prevent it. (Got that?) We can reasonably address three of these by 1) following the WHO’s recommendation for exclusive breastfeeding for at least six months, 2) supplementing our diets with Vitamin D (which is also recommended for a number of other chronic illnesses) and 3) not being obsessive about sterilizing our environments.

Those are the easy parts (yeah, I know. exclusive breastfeeding for six months ain’t easy. but, y’know. in principle.) The harder things to control are weight gain and the toxic burdens on our bodies.

He is particularly clear in the section on solving the problem (the last third of the book) that the current tendency to blame Type 2 diabetics for getting fat and developing the disease is… um… unfair, shall we say? In examining the POP hypothesis, for example, he reports the observation that very overweight people with low levels of pollutants may not, in fact, be at increased risk of developing diabetes. In his chapter on the “Public Health Cure”, he quotes Kelly Brownell, Ph.D. (a Yale professor of… wow. A LOT of things: psychology, epidemiology, public health, and Food Policy and Obesity) who compares the ‘personal responsibility’ approach to diabetes prevention to “telling people who live near a factory that’s spewing out pollutants not to breathe the air.” It’s really, really hard to follow any kind of dietary restrictions, even if you are becoming ill as a result of it. (I know. It’s possible to be fat, active and healthy, and skinny, sedentary, and ill. BMI’s below 19 are at greatest risk of mortality. Different post, different time.)

So, I will finish where he does: With the stats. In 1866 the death rate in New York due to diabetes was 1.3 per 100,000 residents. If that had remained steady, by 2006, it would translate to 4,284 deaths nationwide. But in that year, 72,507 deaths in the U.S. were attributed to diabetes. In response to this new reality, Hurley calls for a move beyond ‘personal responsibility’ to joint advocacy: “united action … to face down a public, and therefore political, danger to our well-being, and to the well-being of our children”. (And I’ll let you read the last line of the book yourself. It’s worth it.)