The Cresting Wave
A tsunami of chronic disease is upon us
In a previous post I discussed the Cascadia Subduction Zone and the tsunami that it has produced in the past and will spawn again sometime in the future. I also made the analogy to the pandemic of metabolic illnesses which primarily result from malnutrition. The public health statistics clearly document that some fault has slipped, producing a massive tsunami of illness.
‘…half of all US adults, and roughly one in three Americans, are known to have [insulin resistance]. However, this number could be as high as 88% of adults!”
Unlike the a tsunami from a magnitude 9+ earthquake along the Cascadia Subduction Zone which will severely impact the Pacific Northwest region of North America, this tsunami is worldwide in its impact. Any serious conversations about public health & healthcare reform, food systems & policies, and sustainability must address this crisis.
Professor Benjamin Bikman’s book Why We Get Sick is one of the books I recommend (US Amazon links). Bikman starts his first chapter with this quote:1
“INSULIN RESISTANCE is the epidemic you may have never heard of. Though many of us are unfamiliar with it, our unawareness belies how common it really is: half of all US adults, and roughly one in three Americans, are known to have it.1 However, this number could be as high as 88% of adults!2”
(original citations below in footnotes)
A more recent estimate suggests it could be as high as 93%.2
It’s common to hear “insulin” and think of diabetes, both Type 1 diabetes, once known as juvenile diabetes or insulin-dependent, and Type 2 diabetes, which used to be called adult-onset or non-insulin-dependent diabetes. Many perhaps understand that insulin resistance is a fundamental condition of Type 2 diabetes, but it appears to be intimately associated with virtually every chronic disease. “Every chronic disease” sounds like hyperbole, doesn’t it? Well consider these comments from Professor Jeff Volek, PhD RD:
“The reality is when you look at most chronic diseases, they have an underlying metabolic impairment as part of their pathophysiology or pathogenesis”
The link should open at the 8.47 mark as he starts the quote. The entire video is worth watching.
Or consider this quote from Ben Bikman:
“Virtually every chronic disease has some connection to insulin resistance, where the insulin resistance is either explicitly causing the problem or it’s exacerbating it or accelerating the problem.”
The link should open at the 4:15 mark, but listen to the entire piece. And check out Tracey’s Substack.
Catherine Crofts’ paper “Hyperinsulinemia: A unifying theory of chronic disease?” was published in 2015. I used her list of “Biological systems and disease states affected by hyperinsulinemia” to create the following slide. I’ve used this slide many times to make the point that, if hyperinsulinemia and insulin resistance is the driver of many chronic diseases, then it’s the “short stave,” and must be the priority focus if truly sustainable healthcare is to be achieved. Extensive, systematic changes in mindsets, policy, funding, and institutions will be required.
Unlike the inevitable Pacific Northwest tsunami, this tidal wave of chronic disease can be arrested - at least by individuals in their own lives. The extensive evidence already in the scientific literature documenting the efficacy of Therapeutic Carbohydrate Reduction and Therapeutic Ketogenic Nutrition in the treatment of so many conditions, however, is really good news. Additional research is on-going. There is cause for optimism.
The emerging discipline of Metabolic Psychiatry is one of these bright spots on the horizon. I whole-heartedly recommend reading Dr. Georgia Ede’s book Change Your Diet Change Your Mind (US Amazon link). Its subtitle, “A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health,” announces the good news Dr. Ede proclaims.
The foundation of this systematic change is the recognition of the key role that chronically elevated insulin and insulin resistance plays in so many conditions. Dr. Ede presents the following table in her book:
(original citations below in footnotes)3
Reading this got me wondering: How many people are afflicted with this underlying condition and its multiple manifestations? What proportion of medical expenses are attributable to this underlying condition? Is it possible to estimate the environmental burden that results?
Future posts will share the development of answers to these, and other, questions.
Bikman, Benjamin. Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease--and How to Fight It (p. 3). BenBella Books. Kindle Edition.
Menke, A., et al., Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA, 2015. 314(10): p. 1021-9; McClain, A.D., et al., Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status. Diabetes Obes Metab, 2013. 15(1): p. 87-90.
Araujo, J., J. Cai, and J. Stevens, Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016. Metab Syndr Relat Disord, 2019. 17(1): p. 46-52.
O’Hearn, M., B. N. Lauren, J. B. Wong, D. D. Kim and D. Mozaffarian (2022). "Trends and disparities in cardiometabolic health among US adults, 1999-2018." Journal of the American College of Cardiology 80(2): 138-151.
11 Gordon I. Smith et al., “Insulin Resistance Drives Hepatic De Novo Lipogenesis in Nonalcoholic Fatty Liver Disease,” The Journal of Clinical Investigation 130, no. 3 (2020): 1453–60, https://doi.org/10.1172/JCI134165.
12 Mohamed H. Ahmed and Asif Ali, “Nonalcoholic Fatty Liver Disease and Cholesterol Gallstones: Which Comes First?,” Scandinavian Journal of Gastroenterology 49, no. 5 (2014): 521–7, https://doi.org/10.3109/00365521.2014.894119.
13 Pedro L. Mangabeira Albernaz, “Hearing Loss, Dizziness, and Carbohydrate Metabolism,” International Archives of Otorhinolaryngology 20, no. 3 (2016): 261–70, https://doi.org/10.1055/s-0035-1558450.
14 Valeska Ormazabal et al., “Association Between Insulin Resistance and the Development of Cardiovascular Disease,” Cardiovascular Diabetology 17, no. 1 (2018): 122, https://doi.org/10.1186/s12933-018-0762-4.
15 Kornelia Kotseva et al., “EUROASPIRE IV: A European Society of Cardiology Survey on the Lifestyle, Risk Factor and Therapeutic Management of Coronary Patients from 24 European Countries,” European Journal of Preventive Cardiology 23, no. 6 (2016): 636–48, https://doi.org/10.1177/2047487315569401.
16 Hubert Kolb et al., “Insulin Translates Unfavourable Lifestyle into Obesity,” BMC Medicine 16, no. 1 (2018): 232, https://doi.org/10.1186/s12916-018-1225-1.
17 Giliola Calori et al., “Prevalence, Metabolic Features, and Prognosis of Metabolically Healthy Obese Italian Individuals: The Cremona Study,” Diabetes Care 34, no. 1 (2011): 210–5, https://doi.org/10.2337/dc10-0665.
18 Chung-Jyi Tsai, Michael F. Leitzmann, Walter C. Willett, and Edward L. Giovannucci, “Macronutrients and Insulin Resistance in Cholesterol Gallstone Disease,” The American Journal of Gastroenterology 103, no. 11 (2008): 2932–9, https://doi.org/10.1111/j.1572-0241.2008.02189.x.
19 Lisa D. Yee et al., “Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin,” Frontiers in Endocrinology 11 (2020): 58, https://doi.org/10.3389/fendo.2020.00058.
20 Paolo Giovanni Vigneri et al., “The Insulin/IGF System in Colorectal Cancer Development and Resistance to Therapy,” Frontiers in Oncology 5 (2015): 230, https://doi.org/10.3389/fonc.2015.00230.
21 John C. Marshall and Andrea Dunaif. “Should All Women with PCOS be Treated for Insulin Resistance?,” Fertility and Sterility 97, no. 1 (2012): 18–22, https://doi.org/10.1016/j.fertnstert.2011.11.036.
22 Wolfgang Kopp, “Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?,” Nutrition and Metabolic Insights 11 (2018): 1178638818773072, https://doi.org/10.1177/1178638818773072; J. Hammarsten and B. Högstedt, “Hyperinsulinaemia as a Risk Factor for Developing Benign Prostatic Hyperplasia,” European Urology 39, no. 2 (2001): 151–8, https://doi.org/10.1159/000052430.
23 Rajeev Sood et al., “The Correlation Between Erectile Dysfunction and Metabolic Syndrome in an Indian Population: A Cross-Sectional Observational Study,” Arab Journal of Urology 17, no. 3 (2019): 221–7, https://doi.org/10.1080/2090598X.2019.1600990.
24 Peng-Fei Ding, “Insulin Resistance in Ischemic Stroke: Mechanisms and Therapeutic Approaches,” Frontiers in Endocrinology 13 (2022): 1092431, https://doi.org/10.3389/fendo.2022.1092431.
25 David Unwin et al., “Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care,” International Journal of Environmental Research and Public Health 16, no. 15 (2019): 2680, https://doi.org/10.3390/ijerph16152680.
26 Ming-Sheng Zhou, Aimei Wang, and Hong Yu, “Link Between Insulin Resistance and Hypertension: What Is the Evidence from Evolutionary Biology?,” Diabetology & Metabolic Syndrome 6, no. 1 (2014): 12, https://doi.org/10.1186/1758-5996-6-12.
27 Nazik H. Hasrat and Asaad Q. Al-Yassen, “The Relationship Between Acne Vulgaris and Insulin Resistance,” Cureus 15, no. 1 (2023): e34241, https://doi.org/10.7759/cureus.34241.