In the last few weeks I have seen a 9 year old with frequent colds, a middle aged man with depression, tight hamstrings and debilitating knee pain, a menopausal woman with fatigue and anxiety and an overweight woman with insomnia. Each of these individuals has seen at least three different physicians and one of them has seen 10 different physicians – in each case their primary symptoms have been almost completely resistant to a wide range of treatments. Three of these four individuals are thin or at least of normal weight. Each has a mean sweet tooth.

The emerging epidemic of type II diabetes (and the underlying metabolic disturbances that are associated with insulin resistance) seems certain to cause more pain, suffering and death than any other single disease short of some of the infectious epidemics of past centuries. It is our modern plague.

A short primer: When we eat foods that cause a rapid rise in blood sugar our bodies respond quickly. Blood sugar is essential; it fuels every cell in our body and if it gets too low our brain stops working within seconds. Too high a blood sugar level is just as dangerous- it alters the osmotic balance of our blood and may cause rapid shifts of water from the inside of our cells to the outside and this can cause cell death if it happens too rapidly. Our body has evolved a rapid response system to keep our blood levels within a narrow range and its primary tool is insulin. Insulin is made in the pancreas and released into the blood when blood sugar levels begin to rise. Insulin is a messenger molecule that tells cells to open the sugar gates in their cell membranes to allow sugar to go into the cells where it can be used as fuel. If the sugar levels continue to rise insulin tells the liver to store it.

Insulin works well in the short term. But we can ask too much of it. Repeated surges of blood sugar leads to a condition where the insulin message to cells is blocked. Cells fail to respond. Blood sugar goes higher and more insulin is released. The blood sugar levels linger at higher levels and this leads to a cascade of events that are profoundly unhealthy. More fat tissue is produced. Hormones are metabolized in the fat tissue in unhealthy ways that can influence levels especially of the sex hormones. This has a wide range of unhappy consequences including feminization in men and masculinization in women. The fat tissue releases signals to turn up inflammation. Many people develop joint pains and stiffness. These changes increase the likelihood of atherosclerotic plaque and the risk of rupture of these plaques- the essential components of elevated blood pressure, heart attacks and stroke. These metabolic changes appear to increase the risk for a number of cancers. There appears to be a profound effect on neurotransmitters so that moods can elevate briefly on the rising tide of blood sugar but also the mood can darken on the downside. Many people chase their blood sugar all day with repeated meals of high glycemic index foods (the more rapidly a food causes your blood sugar to rise, the higher its glycemic index).

I suspect that diets of high glycemic index foods have more adverse effects than are currently recognized, especially on the ecology of the gut and consequently on bacterial and fungal overgrowth syndromes that may account for autoimmune illnesses and symptoms that are difficult to account for with other diagnoses.

What is the connection to stress of this illness? The primary stress hormone in the body is cortisol which is released by the adrenal gland. The more stress the more cortisol. Cortisol counters the effectiveness of insulin – impairing its job even more.

A commonly used method to determine how well your insulin is working is to do a glucose tolerance test. In this technique a person drinks a large amount of a very sugary solution and has a series of blood draws to measure blood sugar to see how tightly the body controls the rise. Some physicians like to measure insulin levels as well.  A simpler method is available that gives a very reliable measure of the average blood sugar for the last three months called a Hemoglobin A1c test. HgbA1c level below 5.5% is considered normal. The level defining diabetes is debated between 6.0 and 6.5%.

Each of the people that I mentioned at the start of this column has HgbA1c levels just below 6.  I suspect their very different symptoms arise from the same underlying cause – they eat too much starch and sugar.  A modern plague.