Thursday, April 22, 2010

What Causes Diabetes?

Type 1 diabetes usually develops due to an autoimmune disorder. This is when the body's immune system behaves inappropriately and starts seeing one of its own tissues as foreign. In the case of type 1 diabetes, the islet cells of the pancreas that produce insulin are seen as the "enemy" by mistake. The body then creates antibodies to fight the "foreign" tissue and destroys the islet cells' ability to produce insulin. The lack of sufficient insulin thereby results in diabetes.

It is unknown why this autoimmune diabetes develops. Sometimes it is a genetic tendency. Sometimes it follows a viral infection such as mumps, rubella, cytomegalovirus, measles, influenza, encephalitis, polio, or Epstein-Barr virus. It has been shown through studies that children who develop DM 1 have a higher number of life stress events than controls. Cow's milk has been implicated. Other less common (very rare) causes of type 1 diabetes include injury to the pancreas from toxins, trauma, or after the surgical removal of the majority (or all) of the pancreas.

The medical community still does not know the cause of DM 2, or what makes one person's cells become resistant to insulin and not another person. However, there are various factors that have been shown to increase the risk of getting DM 2.

The first risk factor is genetics. About 5 to 11% of people who have DM 2 have a family history of it. People who have DM 2 in their family history are 25% more prone to getting it than those who don't.

The medical community claims that eating sweets does not cause diabetes. They do admit, however, that if eating sweets leads to obesity, then eating sweets may be related to diabetes because there is a much increased risk of DM 2 when a person is obese.

Increasing age is another risk factor, as is smoking and drinking caffeine. Interestingly, using artificial sweeteners has also been shown to increase the risk of DM 2.

Race is also a risk factor. Native Americans, Eskimos, African-Americans, Hispanics, Asian-Americans and those of Pacific Island descent are at increased risk of DM 2.

High emotional stress has also been shown to be a risk factor, because elevated levels of cortisol which comes from chronic stress increase the insulin levels. Also, adrenaline from anxiety causes a rapid release of glucose into the bloodstream, causing chronic elevation of blood glucose.

My personal theory is that diet DOES play a very important role in creating the disease process of DM 2. The two problems in diet are 1) eating too much, and 2) eating too many refined carbohydrates. If a person has a family history or other risk factors, a poor diet can often “turn the switch” and start the disease process. It can also affect those without a family history.

Eating too much puts a strain on the pancreas in both digestive enzyme production and in insulin production. It increases fat cells which also cause impaired glucose uptake.

Eating too many refined carbohydrates (sugar, sugar sweets, processed foods with a lot of sugar and flour, eating a lot of bread—flour is a refined carbohydrate) causes a rapid rise in blood glucose. This causes an excess of insulin to be secreted.

Too much insulin drives the blood glucose down so quickly that often low blood sugar (hypoglycemia) results. When a person has low blood sugar they crave more refined carbohydrates, and there is a yo-yo effect of blood sugar and insulin levels bouncing up and down.

The brain doesn't like low blood sugar. The rest of the body has ways to make energy when glucose isn't available, but the brain doesn't. That's why we often feel tired and can't think straight when our blood sugar is low. If it goes too low, the brain shuts down and we can go into a coma (a diabetic coma is not caused by the blood sugar being too high, but by being too low because of medication or insulin usage).

Symptoms of low blood sugar can include (most people don’t have all of these but they do have some): anxious feelings, unusual tiredness or weakness, difficulty in concentrating, drowsiness, excessive hunger or cravings, headache, shakiness, nausea, anxiety and nervousness, blurred vision, cold sweats, confusion, cool pale skin, fast heartbeat, nightmares, restless sleep, slurred speech, and behavior change similar to being drunk. Blood sugar that drops too low can lead to complete unresponsiveness (coma).

So the body tries to compensate for the problem of low blood sugar by becoming resistant to the elevated levels of insulin. If the cells don't respond to the higher levels of insulin so easily, then the blood sugar doesn't drop as rapidly, saving the brain from problems.

However, the insulin resistance keeps the higher levels of glucose (from eating too much or from eating too many refined carbohydrates) in the bloodstream. This causes hyperglycemia, and leads to DM 2.

This theory explains the rapid rise in cases of DM 2 in the last fifty years, and why it is still rising. Up to 75 years ago, sugar was not as easily available. There were few processed foods with sugars and refined carbohydrates. People ate whole foods and cooked from scratch. Desserts were a treat, not a diet. The amount of high fructose corn syrup in sodas, drinks and other treats has dramatically increased in the last ten years. High fructose corn syrup has been shown to cause obesity, diabetes and heart disease even above table sugar.

Since that time, with an increase in sugar and processed food and drinks, children are eating sugar cereal (both the sugar and the cereal are refined carbs) for breakfast, sandwiches and chips and chocolate milk and desserts for lunch (bread and chips are refined carbs, and a hamburger, fries and a sugary or artificially sweetened caffeine soda for dinner (fries are also considered a refined carbohydrate). Even so-called “healthy” snacks like fruit snacks and granola bars are usually made with high-fructose corn syrup and other refined carbohydrates.

The diet of the modern first-world countries with an ever increasing amount of refined carbohydrate processed foods, high-fructose corn syrup drinks, chemicals and sweeteners is predisposing our population to a dramatically increased risk of insulin and blood sugar problems. Add to that the chronic, increased stress of our modern society and we have an excellent recipe for the creation of diabetes.

My next blog will be on how diabetes is diagnosed.

Until we meet again,
Dr. Judi


ken said...

Dr. Moore, I have a 27 yo daughter with an 18 month old baby who is having severe depression type issues. The doctors in Ogden, UT are leaning toward a diagnosis of Schizotypal disorder. They are recommending she be placed into the Provo Mental Health Hospital for treatment. I have read online about the signs of this disorder and from what I have observed in my daughter I see more of a severe depression or PPD symtoms than Schizotypal. I am no doctor but I am so very concerned my daughter may be misdiagnosed. How are PPD and Schizotypal different?

Dr. Judi said...

Postpartum Depression (PPD) is clinical depression that occurs after the birth of a baby, often triggered by hormonal and chemical changes in the body, but can be related to past experiences and beliefs that haven't been really dealt with previously. It involves sadness, anxieyt, loss of interest in things previously enjoyed,lack of motivation, fatigue, and persistant negative thinking. In it's most severe form PPD can lead to postpartum psychosis, in which there is a loss of reality. This is an emergency and requires hospitalization.

Schizotypal personality disorder is a disorder in which the person is very inward focused, and cannot relate to others or form normal relationships with others. Because of this difficulty forming normal meaningful relationships they often have severe social anxiety. Depression causes people to withdraw from others, and to become anxious around others, but they can form normal, meaningful relationships.

A person with schizotypal personality disorder has odd behaviors and thoughts that may be viewed as eccentric, erratic, and bizarre. They may have brief psychotic episodes, or a loss of reality. They often focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypal's unconscious way of coping with the social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations.

If you truly feel that she is being misdiagnosed, you may be interested in bringing her into my office and I could give a second opinion. My office number is 801-254-4600.