High-Risk Populations
Aboriginal Populations
Diabetes among aboriginal people was virtually unheard of in the 1940s, but today the risk of Type II diabetes among aboriginal populations in North America is estimated at three to five times higher than for non-natives. And the number of cases of diabetes is expected to triple over the next 20 years. Diet, lack of exercise, genetics, and stress contribute to the problem, as does lack of access to fresh food in aboriginal communities, especially in the North.
In terms of diet, aboriginal people have undergone a rapid transition from a hunter-gatherer diet (low carbohydrate) to a diet high in refined carbohydrates. At the same time, a hunter-gatherer genetic profile (sometimes called ‘thrifty genes’) promotes fat storage and excess weight for utilization during times of scarcity. Since, in modern society, scarcity is rare for the majority, this thrifty genetic makeup increases the risk of obesity and diabetes.
Also of note is that foods high in trans fats, high in sugar, high in salt, and high in chemical preservatives are very inexpensive and have a long shelf life, often making them more affordable and more available to First Nations peoples in remote locations. At the same time, modern convenience has reduced the need to expend high amounts of calories to survive.
It has been estimated that an average hunter/gatherer existence requires the expenditure of 5000-6000 calories per day, whereas 2000-3000 calories per day of energy expenditure is more typical of an industrialized society with a predominance of activities requiring little physical exertion. In addition, traditional native food sources have been shown to be much more nutrient dense and provided many times the current RDA levels for most vitamins and minerals. For example, Linus Pauling estimated that the average vitamin C consumption of a hunter-gatherer from fresh berries and other available fruits and vegetables was in the order of 6000 to 12,000 mg of vitamin C intake per day. By comparison, the current RDA for vitamin C is 75 to 90 mg per day for adults.
Rates of obesity and diabetes in some aboriginal communities are up to 50% higher than the North American average (which is already unacceptably high), but experience has shown that reverting to a more traditional diet may help address the problem. For some aboriginals, cutting down on carbohydrates isn’t so much a fad diet as it is modern version of the traditional diet eaten by their ancestors for thousands of years.
Other peoples have had thousands of years and many generations to become accustomed to a diet that is higher in refined carbohydrates. Grains, for instance, were first cultivated in the Tigris/Euphrates region approximately 15,000 years ago. Aboriginals, on the other hand, ate mainly berries, nuts and animal or fish protein, up until European trade developed no more than 500 years ago. Fortunately, many native groups are now promoting traditional diets, increased activity levels, and the use of traditional herbs in the prevention and treatment of Type II diabetes in the native community.
Children and Adolescents
According to the NIH’s National Diabetes Education Program, diabetes is one of the most common chronic diseases in school-age children. In the United States, about 176,500 people under 20 years of age have diabetes. Currently, about 1 in every 400 to 600 children has Type 1 diabetes. However, because 10% to 15% of children and teens are overweight, increasing numbers of young people are developing type II diabetes.
In several clinic-based studies, the percentage of children with newly diagnosed diabetes classified as Type II has increased from less than 5% before 1994 to 30% to 50% in subsequent years. By far, most children and adolescents diagnosed with Type II diabetes are overweight or obese and insulin resistant with a family history of Type II diabetes. Of concern is that undiagnosed Type II diabetes in children and adolescents may place these young people at early risk for cardiovascular disease and other diabetic complications. In essence, the increased incidence of Type II diabetes in youth is a direct consequence of the obesity epidemic among young people. This is a significant and growing public health problem.
Type II diabetes in youth has been recognized for some time, but researchers are warning that new cases of diabetes in the second decade of life (teens and pre-teens) are sharply on the rise. This is largely accounted for by minority populations with higher risk and increasing rates of childhood obesity. For example, among Japanese schoolchildren, Type II diabetes has increased more than thirtyfold over the past 20 years, concomitant with changing food patterns and increasing obesity rates. If this trend is not stopped and reversed soon, the full effect of this epidemic will be overwhelming as these children become adults and develop the long-term complications of diabetes.
Herbicide Exposure
Exposure to herbicides during the Vietnam War, particularly Monsanto’s defoliant Agent Orange (dioxin), may be associated with the development of diabetes. Agent Orange was used to reduce tree cover to expose the position of North Vietnamese soldiers. Of the 2.6 million people who served in Southeast Asia between 1962 and 1975, 8% to 11% now have diabetes. According to figures published by the American Diabetes Association, this represents as much as a 5% increase beyond the incidence in the general American population. Since diabetes increases with age, the percentage of those affected is likely to continue to rise.
In 1991, the U.S. Congress passed the Agent Orange Act, which established a system for evaluating the effects on its soldiers. About 8500 Vietnam veterans have been financially compensated under this Act, many for diabetes-related health damages. Agent Orange is not only found in the tissues of soldiers from the Vietnam war, but according to an EPA study in 1982, it is also found in the tissues of 76% of the general American public.
