Here we sit, we Americans, at our computers, a cup of coffee and creamer and the crumpled up wrapper of the sugar-coated donuts we just ate beside us. Our only exercise has been the walk from the parking lot to the office, and we’re thinking about eating out at the new catfish place in the evening. It’s a day of sugar, fat, salt and sitting, and guess what — we feel just fine.
Great, maybe — until we fall over at our desk, as endocrinologist Dr. Phil Peters put it.
Peters, one of those hands-down “winners” in the Times’ survey of his peers, splits his practice between the treatment of diabetes and glandular illnesses. Because the epidemic of obesity has left so many American adults and children flirting with it, we focused on diabetes in our interview with him.
Seven in 100 Americans are full-blown diabetic, Peters said. Of those seven, two or more don’t even know they’re sick. While we’re feeling good, our endocrine system of sugar- and fat-regulating hormones and proteins may be feeling like hell. It’s a system designed to fuel and heal a body that spends more time exercising than eating, by hunting animals, planting foods, weaving clothes, chopping wood, traveling on foot … a body whose mind hasn’t created machines to take the place of its labor. Pizza, biggie meals and DVDs weren’t factored in.
Today, thanks to what one medical journal dryly referred to as “hyperalimentation,” nearly one in four Americans has a pre-diabetic condition called metabolic syndrome. Obesity is giving smoking a run for its money as the most preventable cause of death in America.
The adult sitting at his desk with doughnuts, the child at the television with one hand in a bag of Cheetos and the other wrapped around a soft drink that contains 10 teaspoons of sugar, are candidates for what’s called Type II diabetes. (It used to be called adult onset until the children of America traded in their bikes for video games. Now more children have Type II diabetes than Type I, the form that appears in children unable to make insulin.)
Though dad’s told he’s risking a 50-50 chance of heart disease or that his child may spend more time on dialysis than dating in his young adulthood, patients tend to deny that a “little sugar” or that an increase in the level of low-density lipoprotein cholesterol is going to do them much harm. When you feel good, it’s hard to throw off bad habits. It’s only human.
So we may laugh off the dangers of sugar and fat and order a piece of pie. But, as Peters explained it, if we do that habitually, our organs are discontent. The good life and genes that make us accumulate fat in our abdomen — fat that is worse for health than fat that accumulates elsewhere — make for bad results.
The doughnuts we just ate have sweetened our blood with glucose. We like sweets, but the body can only use so much. The doughnuts down, the opening whistle blows at the insulin factory, located in the pancreas. Beta cells will get busy to secrete extra insulin to take the new glucose and transfer it to our muscles, like gassing up the car. If we keep packing the carbs away, we make more sugar and more insulin to handle it, and after awhile, our insulin-producing beta cells are beat. Now, the muscle is not able to take up all the glucose. High glucose levels trigger sodium retention in our vessels and kidneys.
The sodium crowds the blood, raising the pressure in the vessels and aorta, and that pressure is like a high-power hose aimed at a wall, Peters said, battering away, making the once-smooth surface rough and more susceptible to plaque. The elevated glucose is also causing the release of cytokines, making our blood platelets sticky and inflaming the lining of the vessels. That darn doughnut habit may have increased our blood’s level of “bad” dense cholesterol, low-density lipoproteins that invade the cells and help form plaque.
Now, our happily swishing blood flow through our vessels and arteries is not swishing so well. Waxy cholesterol, salt in solution, abnormal clots — that’s not what our heart wants. More than 70 percent of diabetics have vascular disease.
Salt begins to collect in the kidneys. Peters’ analogy: Just as you can pour more sugar into your tea than will dissolve, you can put too much salt in the kidneys. Proteins begin to build up. Blood flow in the small vessels of the eye and to our extremities become impaired. Kidney function is compromised, eyes are going without the blood they need, feet become numb. You step on a tack, and don’t know it until necrosis sets in. More than half the amputations done in hospitals unrelated to trauma are caused by diabetes.
The number of patients Peters now treats for coronary disease that’s resulted from diabetes has jumped “tremendously” since he first went into practice in Little Rock 25 years ago.
So what can a patient do if he’s got metabolic syndrome — if his blood sugar count is above 110, his blood pressure higher than 135/80, his LDL cholesterol higher than 100, rising triglycerides in the blood and extra fat in the belly — to get his body back in healthy synchrony and avoid the risk of heart attack and diabetes?
Exercise and eat right. It’s a solution, Dr. Peters regrets, that is harder to achieve than quitting smoking. After “the horse is out of the barn” — metabolic syndrome turns to diabetes — it may be too late to return to health without the aid of medicine, which is not only costly, but an admission of illness that some people don’t want to make and sometimes ignore.
Peters sees two health crises looming: The increase in obesity and a sedentary lifestyle, which is leading to greater health problems among a growing number of Americans at an earlier age — Type II diabetes is now being diagnosed in adults in their 40s and children at 15 — and the decline in the number of doctors, especially specialists. Only one new medical school has been opened in the last 25 years, he said.
“The bottom line is that a larger and larger population is sick. It would behoove government and insurance to pay” for intervention, such as weight-loss programs.
“Insurers and employers need to get on the bandwagon to understand that evidence-based medicine says prevention and early intervention can prevent complications and is cheaper in the long run.” They don’t now, Peters said, because people change health care plans so often — one plan ends up paying for an illness developed under a previous plan — and stockholders take a short term view on profits.
“We need to change how we think about this. I’m not saying we need to abandon the private system, but we’ve got to change the mindset.” In the long run, a sicker population creates stress on the economy. “It’s bad public policy,” Peters said, to rule out reimbursement for preventive care.