by Mona Morstein, ND, DHANP
There are many reasons that a person may become insulin resistant, putting themselves at risk for developing Type 2 Diabetes (T2DM). The following are the 13 most common risk factors. This article is excerpted from Dr. Mona Morstein’s new book: Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes (Chelsea Green Publishing, 2017) and is reprinted with permission from the publisher.
13 Risk Factors for Type 2 Diabetes
Unlike Type 1 Diabetes, which has a minor familial genetic connection, T2DM has an established genetic inheritance. A genetic risk factor essentially means that a person is more likely to develop a condition that his or her relatives had, especially if other factors are involved. Many medical conditions are genetically associated, including arthritis, autoimmune diseases, cardiovascular disease, cancers, and T2DM.
Luckily, genetics does not mean a person is guaranteed to develop diabetes; eating well and having a positive, active, healthy lifestyle can absolutely prevent the occurrence of the condition.
Overeating is one of the biggest risk factors for developing diabetes. Overeating can easily cause someone to become overweight or, even worse, obese.
3. Central Obesity
When we discuss obesity and T2DM, we are mainly focusing on abdominal obesity, also known as truncal obesity and visceral fat. This is fat that is stored in the abdominal cavity around organs like the liver, pancreas, and intestines. This type of fat is worse for promoting insulin resistance than subcutaneous fat, which lies under the skin, or female fat around the hips and thighs. It is likely you have excess abdominal fat if your waist is more than 37 inches if you are male, and more than 35 inches if you are female. Simply put, abdominal obesity causes insulin resistance, which causes more abdominal obesity. And, insulin resistance causes abdominal obesity, which causes worsening insulin resistance. It’s a vicious cycle.
4. Nutritional Deficiencies
The body’s blood sugar–regulating metabolism requires many nutrients to work smoothly and healthily. Many people are deficient in these same nutrients. The CDC’s “Second Nutrition Report” showed that in the United States, the most common nutrient deficiencies are vitamin B6, iron, vitamin D3, vitamin C, and vitamin B12. The Journal of Nutrition reported that Americans are also not getting enough omega-3 fatty acids from their foods.
Nutrient deficiencies contribute to diabetes in the following ways:
- Cause lower energy and lower motivation to work out
- Cause irritability, depression, anxiety, and need to seek comfort in food
- Increase the risk of developing insulin resistance
- Cause problematic food cravings leading to weight gain
- Prevent antioxidative protection of the body from higher glucose or insulin, causing damage to tissues
- Lead to reliance on caffeine for energy, which interferes with sleep, increasing risk of weight gain and carbohydrate craving
- Lower metabolism and ability to burn fat
- Negatively affect the functioning of organs and regeneration of healthy tissue
6. Lack of Exercise
In several studies, lack of exercise has been shown to be a greater factor in the development of obesity than overeating, and a main factor in the development of insulin resistance. But even thirty minutes of effective exercise a day can be enough to prevent weight gain in otherwise sedentary adults. Plus, exercise increases endorphins, chemicals that improve our mood, boost our self-esteem, and give us more energy.
7. Hormone Imbalances
Many hormones like cortisol, testosterone, and estrogen can be thrown out of balance for many reasons. Imbalanced hormones can help initiate obesity and insulin resistance, and in turn insulin resistance and obesity can help create hormone imbalances. A good naturopathic or integrative physician should fully evaluate the hormone levels in both prediabetic and diabetic patients.
8. Increased Saturated Fat and Increased Refined Carbohydrates
Many countries in Asia, including Japan, are experiencing a rapid increase in obesity, insulin resistance, and diabetes, though their traditional diets have been composed of 70 percent carbohydrates, mostly white rice, for hundreds of years. Why now are they developing these problems? The answer is saturated fat, largely imported from American fast-food restaurants in the form of what we call “agri-industry” meat.
Saturated fat in moderation is not bad for you, but when it is so out of balance in your diet, it can definitely promote insulin resistance. Saturated fats are found in other foods as well, including dairy, eggs, lard, nuts, and seeds, and in cooking oils used for deep-frying. Studies show that replacing saturated fat with monounsaturated and polyunsaturated fats significantly reduced the onset of diabetes. Reducing saturated fat intake is very healthful and very important in getting T2DM under control.
Refined carbohydrates, such as high fructose corn syrup, are also associated with insulin resistance. One researcher, Dr. Liu, analyzed the American diet over a span of decades and found high fructose corn syrup and decreased fiber intake to be leading factors in the development of diabetes. According to the Health and Human Services of the US government, the average American ate only 2 pounds of sugar a year two hundred years ago. Today the average Americans eats 152 pounds of sugar a year! This statistic should help everyone understand why so many people are overweight and diabetic.
Gut bacteria help dictate how much energy a person absorbs from their diet. Obese people have been found to have different proportions of bacteria in their intestines than lean people. The changes make the obese person more likely to have intestinal permeability, allowing more absorption of gut toxins, and leading to an increase in systemic inflammation, causing insulin resistance. Obese people have enzymes in their microbiome that allow for the better breakdown of generally indigestible carbohydrates; that is, the obese microbiome harvests more energy from food. These processes are made worse on a diet high in fats and high fructose.
10. Gestational Diabetes
The mother-fetus connection is very strong, especially with regard to the health of the mom related to the future health of her child. Mothers who become diabetic during their pregnancy give birth to a child who has a much higher risk of becoming overweight and developing diabetes. Being exposed to higher levels of glucose in the uterus sets the child up for becoming overweight and diabetic at a younger age. The good news is that breastfeeding, feeding your child a healthy diet, getting exercise, having regular doctor visits, and, most importantly, parents who set a great example, are all ways to overcome the problematic uterine environmental impact on the child.
11. Chronic Hepatitis C
Chronic hepatitis C affects 3 percent of the world’s population and around 3.2 million Americans. Chronic hepatitis C can cause the liver to become progressively fattier, develop fibrosis (scar tissue), and eventually lead to cirrhosis.
There are several reasons why hepatitis C may increase the risk of developing T2DM. For one, hepatitis C increases some of the same pro-inflammatory chemicals also produced by abdominal fat, like TNF-a or IL-6, that cause insulin resistance in the body. Further, liver fibrosis can cause the liver to become insulin resistant, which in turn can initiate T2DM. Lastly, hepatitis-C-induced fatty liver can cause the liver to increase glucose production and promote development of fibrosis. Getting diabetes under control relies on getting hepatitis C under control, as well.
12. Environmental Toxicity
Our society is polluted. Persistent organic pollutants (POPs) are very common chemicals, and they include pesticides and herbicides used on farms and inside and outside our homes. POPs are called “persistent” because they resist biodegradation and are ultimately stored in our fatty tissue.
Environmental toxins highly associated with T2DM include phthalates, bisphenol A, and polychlorinated biphenyls (PCBs). The World Health Organization has stated that heavy metals, such as arsenic and lead, can induce insulin resistance at the cellular level and significantly increase the risk of T2DM.
13. Lack of Sleep
In the busy world of stress and overworking, it’s very common for people to get insufficient sleep. Getting less than five hours of sleep a night has been shown to increase one’s risk of developing obesity by 235 percent (!), and not getting six to nine hours of sleep each night significantly increases one’s risk for insulin resistance.
Dr. Mona Morstein, ND, DHANP is a naturopathic physician with a medical practice focused in integrative diabetes treatment. Her clinic, Arizona Integrative Medical Solutions, is located in Tempe, Arizona, where she sees patients of all ages and genders for acute and chronic conditions. An expert on prediabetes and diabetes, she is a frequent lecturer at conferences and webinars, and is the founder and executive director of The Low Carb Diabetes Association. Dr. Morstein is also a member of the Arizona Diabetes Coalition. Her new book is Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes (Chelsea Green Publishing, 2017).
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