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Betting On Ways To Counteract The Effects Of Diabetes
I held a pair of deuces, a club and diamond, a 7 of hearts, and nothing else that could bring me closer to that pile of chips in the middle of the poker table. There must have been 30 or 40 bucks in that bad boy at the time. To put it mildly, I did not have diddly-squat. My friend Vinnie was dealing — mind you, nothing in my direction — and started jabbering about how he read something that 50 percent of Americans now have diabetes, whether they knew it or not. Quickly, I scanned my paltry hand looking for the BS card to throw out on him. Sadly, like I said, I had nothing.
Interestingly though, while he was expelling this cacophonous pseudo intello-babble into the smokeless air (as all of us are providers of healthcare and we do not smoke), he was jamming his pie hole full with a big piece of flourless, gluten-free chocolate cake and about to slosh it down with a big mug of pilsner (see any contradiction there?). Now on the left side of my buddy Vinnie was Little Neal (he weighed at least 350 lbs. and stood a whopping 5-foot-nothing), and on his right was Tommie the Twig. Tommie was 6’5” and was svelte until he hit 40 and then he started emulating the morphology of Little Neal. The “twig” just stayed with him nomenclature wise as “Tommie the Boulder” just did not catch on.
“Where in the hell did you hear that?” I challenged him about the diabetes statistic. Trying to clear the amber-brown sludge from his mouth to answer, he held up his hand for us to hold on. The intellectual excitement in the air was palpable while he cleared his pipes.
“Read it in JAMA, dude, last week,” he exclaimed while a sludge bubble was forming at the side of his mouth and expanding with every syllable.
All sides of the table lobbed expletives in his direction until Little Neal piped up. “You read it in JAMA or you read something while in your pajamas?” We all exploded in laughter. Now that was good as Little Neal was known more for his knowledge of internal medicine rather than any semblance of humor. You would think he might check his own thyroid.
So while sludge bubbles continued to form and verbal assault continued, I did what anybody does when they need the BS card. I pulled out a smartphone. Sure enough, there it was with a quick Google search: “Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012.”1 Now I did not have a lot of time to really get to the dirt on all this while they were dealing cards but what I did glean was a little different than what my esteemed colleague originally proffered. Sure enough, when you combined the researchers’ findings for diabetes and pre-diabetes, which they did with very lenient criteria (A1c >6.5% for diabetes and A1c 5.7%-6.4% for pre-diabetes), they found an estimated prevalence of diabetes at 12 to 14 percent of the U.S. adult population. While this was not quite 50 percent, it was, sadly, very high. In the non-Hispanic black population, diabetes was prevalent in 21.8 percent of the population and diabetes affects 22.6 percent of Hispanics in the U.S. They also pointed out that in every subgroup, the incidence of diabetes has increased over the last 27 years.
As karma would have it, the next day in the airport, I stumbled upon a new issue of Scientific American. Since I could not reach the top shelf where the good stuff was, I settled for the newest issue. In this issue, there was an article by Johnson and Andrews titled “The Fat Gene.”2 They present some very interesting things in this article about why we are where we are diabetically speaking and why we are clearly headed for more disaster. Evidently, in a common ancestor (read ape here) about 17.5 million years ago, a cold snap in Europe caused a genetic mutation upon the genome. That meant there was less fruit and the ancestors had to store more fat for the winter. They finally ended up just dying or moving out of Europe, heading back to warmer climates and more fruit. However, by this time, a new genetic phenomena had occurred that continues to this day in us hominids.
Now fruit is fructose, the demon of all nutritional demons. So this “thrifty” gene, as Johnson and Andrews call it, was a mutation in the encoding of the enzyme uricase, which allowed a faster transfer from fructose to fat (i.e. storage). Interestingly, fructose generates uric acid (the biochemical guys say it is the only sugar to do that), and the uricase mutation prevents the breakdown of uric acid. Now as uric acid builds up, it enhances the effect of fructose so we get fatter. As a side note, we all know that increased uric acid causes gout, right? Back in the day, gout only hit the aristocrats as they had a lot of fruit and table sugar (read fructose here).
Increased uric acid levels also increase blood pressure, heart disease, insulin resistance and kidney disease. So this led to pilot trials in which patients went on allopurinol, and low and behold, good stuff happened. There were lower blood sugars, lower blood pressures and weight loss. How could this be? Do we need to start putting folks on allopurinol?
I do not know about you but this stuff not only excites me, it makes me hungry. I am heading for IHOP for a big stack of pancakes slathered with maple syrup. Just to clear up the suspense, while Vinnie was blowing sludge bubbles, I bluffed them with a pair of deuces.
References
2. Johnson RJ, Andrews P. The Fat Gene. Scientific American. 2015; 313(4).
