Treating Diabesity: Breaking Down this Health Epidemic

By Mark Hyman, MD

Insulin resistance. Prediabetes. Metabolic syndrome. Obesity. Syndrome X. Type 2 diabetes mellitus.

Although varying in degree of severity, these diagnoses share the same underlying cause. I’ve set them aside in favor of the term diabesity to describe the state of metabolic imbalance and disease ranging from a little bit of belly fat to insulin resistance to full-blown diabetes.

A health epidemic

The term diabesity has been around since the 1970s, but data collected over the last two decades has brought it to the forefront today.

The sheer increase in cases of diabetes and obesity tells us something has changed. Worldwide, more than 100 billion people suffer from diabesity. And in the U.S., more than 100 million people are affected, including half of all people over age 65.

Research increasingly points to sedentary living, high stress and poor diet as factors responsible for diabesity. As a Functional Medicine practitioner, we add the interaction of environmental toxins with each person’s unique genetic susceptibilities to that list.

New studies are raising the red flag on an increase in environmental toxins as a key etiologic factor in diabesity. Toxins can disrupt cholesterol and glucose metabolism, and create insulin resistance.

Alarmingly, a 2010 study by the Environmental Working Group found that industrial pollution begins in the womb with exposure to potentially neurotoxic or carcinogenic pesticides, phthalates, bisphenal A, flame retardants, mercury, lead and arsenic.

Getting to the root of the problem

Understanding a person’s biology is the basis of Functional Medicine, which is grounded in the field of systems biology. In the Cleveland Clinic Center for Functional Medicine, we ask each patient to answer 10 questions related to diabetes.

The questions include:

• Do you have a family history of diabetes, heart disease or obesity?
• Do you have extra belly fat?
• Do you have high triglycerides or low HDL (or good) cholesterol?
• Do you crave sugar and refined carbohydrates?
• Are you inactive?
• Do you suffer from infertility, low sex drive or sexual dysfunction?

Patients’ answers inform our understanding of the role lifestyle, health conditions and genetics plays in their disease.

Bringing biology into balance

Because it is a direct outcome of diet and lifestyle, diabesity is 100 percent reversible in the vast majority of cases. Most patients need to eliminate the things that are sending their biology out of balance and to include what’s needed to help the body rebalance itself.

Functional Medicine — with its focus on the interconnectedness of all systems in the body — helps patients find out what they need to rebalance their systems.

For many, the interventions required can be simple and extraordinarily effective. At its most basic level, treatment for diabesity focuses on using food as medicine to reset metabolism and reverse insulin resistance using a low glycemic higher fat whole foods diet, the right supplements, and exercise.

But to truly solve the issues underlying diabesity as a society, we must address its underlying causes not just in the clinical setting, but at the policy level. Our food system and policies drive the production and consumption of high sugar, high starch and high refined oil diets that drive disease.