Jeffrey Bland introduces type 2 diabetes trends from 1980 to 2012, noting epidemic growth in the 1990s followed by a plateau. He argues that while obesity rates have leveled off, abdominal fat and metabolic inflammation keep rising, requiring personalized treatment strategies.
For those of you that are Functional Medicine Update subscribers and our audio magazine of the last 33 years, you're excited to know that we're doing this mini series on type 2 diabetes. Its origin, it's the way that it expresses itself, the mechanisms and the treatment in a personalized way. And we're being lifted in understanding with extraordinary new information that's being published every day. And I want to cite this extraordinary, interesting paper that was just published in the Journal of the American Medical association. This was in September 2014, in which it's a review of the prevalence of type 2 diabetes over the last 20 years. There's an interesting feature of this. We all know about the ever increasing prevalence. But what you may not know, and I don't think I fully understood, that if you look at the data from 1980 to 2012, that the 1980s had a very small relative increase in the prevalence of type 2 diabetes. However, from 1990 to 2008, there was an extraordinary increase in the both prevalence and incidence of type 2 diabetes. It was epidemic. In fact, you can almost model it like an infectious disease. However, from 2008 to 2012, it leveled off. It stopped increasing, which is good news. But it begs the question why this extraordinary epidemic increased from 1990 to 2008. And there are many potential answers to that question. One of those was the suggestion that it was directly related to the rising prevalence of obesity that relates to this type 2 diabetes increase. And we know that if you look at the statistics on diabetes and its relationship to obesity, that they're very closely correlated. And in fact, as obesity has gone up over those years, we've also seen this similar tracking of increase in diabetes. And we know from recent reports that just appeared within the last few months that the obesity epidemic, the good news is it's kind of flattened out you in terms of its rising prevalence as well. So people have said, oh, this is just a manifestation that we're getting on top of the obesity epidemic by behavioral modification, exercise, changing serving sizes. More news for people to be concerned about obesity. And therefore that's having a favorable effect on diabetes prevalence. Well, I think that's partly true, but I think there is more to the story. And this is where I think we need to dig in a little deeper, because within the Journal of the American Medical association recently is another paper, this was September 17, 2014, looking at trends in mean waist circumference and abdominal obesity among US individuals from 1999 to 2012. So in this particular report, which comes from the center for Disease Control in Atlanta. They do again, talk about the fact that the prevalence of diabetes, this relationship to obesity, has started to go down in terms of its increase. So we're seeing less increase in the population of obesity. That doesn't mean less frequency of obesity, but less increase. But if you actually look at the population in a more kind of stratified way and look at central adiposity, it's what I call angry fat, the one that's most associated with metabolic diseases, that has not decreased and it's still rising very rapidly. So the overall rate of obesity increase may have changed, but the actual problems as it relates to this central adiposity, this intraorgan abdominal adiposity that's associated with angry fat, and the states of metabolic inflammation has actually continued to rise. So people have asked, why is that? Well, it probably is a consequence of many factors. It probably is associated with sleep patterns and stress patterns. It's probably associated with the association with xenoestrogens and various types of xenoharmetic chemicals that are in the environment, so called persistent organic pollutants. It probably has to do also with the nature of again, our diets being heavily shifted towards refined carbohydrates and particularly simple sugars, all of which then contributes to this rising of the angry fat, the turning on of the kind of the antagonism between our immune system, our macrophages and monocytes, and our adipocytes, our fat cells, that then creates this state of systemic metabolic inflammation. So good news is that the rate of increase of obesity and diabetes is flattening out. The bad news is that we still seem to be having, particularly in certain individuals of different ethnicities, African Americans, Hispanics, I mean, different kinds of genotypes that are related to this increasing of metabolic inflammation, which systemically increases the risk for cardio metabolic disease, that's type 2 diabetes, cardiovascular disease, and various types of things, including dementia. So, good news, bad news story. And I think the key is to focus now on stratification and individual treatment of patients who have this central adiposity, this angry fat phenotype, so that we can make sure we don't lose them and we're focusing on their specific needs.
