Type 2 Diabetes—An Environmental Illness

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Most doctors and health writers blame Type 2 diabetes on bad genes, bad behavior, or both. Diabetes is all your fault—either you’re doing something wrong, or there’s something wrong with you.

But, as I explain in my new book Diabetes: Sugar-coated Crisis, rates of Type 2 diabetes are soaring all over the world. The number of people with diabetes has tripled in only 30 years. People’s genes have not changed in 30 years. Nor have we all become a gang of gluttons, eating ourselves sick. What has changed is the environment we live in. That’s where all the Type 2 diabetes (and the high blood pressure and heart disease) are coming from.

Our modern environment causes diabetes in at least three ways: stress, barriers to physical activity, and unhealthy food. High-calorie, low-nutrition food is available everywhere, and it’s cheap. Healthy food is less available and more expensive. High-sugar breakfast cereals and high-fat fast foods are marketed heavily to children, so kids learn unhealthy eating before they even get to school.


At the same time, physical activity is getting harder to do. We used to walk to work and do physical labor once we got there. We would entertain ourselves with games and sports. Now we drive to work or school, sit at a desk or stand at a counter all day, drive home, and watch TV. Most of us don’t even get the activity of walking to a bus. As one teacher told me, “Kids used to play basketball. Now they play video basketball.”

Just as bad as the food and exercise environments is the stress built into modern life. In small doses, stress is a lifesaver. When we are threatened, stress prepares us to run or fight by raising our blood glucose and blood pressure and increasing insulin resistance. None of us would have survived without stress. (An interesting article on the topic can be found here.)

But in modern society, we can’t run from or fight against threats. If you can’t pay the mortgage, or you’re threatened with losing your job, or your child is in the military, there’s nothing to run away from. You just worry, and you probably eat high-carbohydrate “comfort foods” to feel better. Over time, these kinds of stresses build your insulin resistance and give you lots of abdominal fat. You’re on the way to Type 2 diabetes. For more about the stress-diabetes connection, see my article at

Stress is not evenly spread through society. Since stress is a response to threats we cannot control, the less control we have, the more stress we will have. Those with the least power have the most stress and the most Type 2 diabetes. Scientists cite Native American and African-American communities, where 20% to 70% of adults have diabetes, as proof of a genetic cause. But I would argue that these communities have the most Type 2 because they have the least power.

Of course, genes and behaviors are important. It is possible to eat a healthy diet, get regular exercise, and reduce stress even though the environment is against it. If you are able to do this, you will do much better at managing your diabetes. But those of us with more power—money, education, support, self-confidence—find it easier to go against the environment.

So if we want to prevent Type 2 diabetes or manage it once we have it, we need to empower ourselves by finding resources and support and building self-confidence. If we want to stop the diabetes epidemic, we need to change the unhealthy environments that cause it. This will be a job for governments, employers, schools, churches, health-care systems, communities, and all of us.

What are you doing about stress, lack of activity, and unhealthy food? How do you find the strength to live right in an unhealthy environment? Please post questions or comments to this blog.

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