How To Solve the Diabetes Epidemic

Nearly 21 million Americans are believed to be diabetic, according to the Centers for Disease Control, and 41 million more are prediabetic -- their blood sugar is high and could reach the diabetic level if they do not alter their living habits. Nationwide, the disease's cost for 2002 -- from medical bills to disability payments and lost workdays -- was conservatively estimated by the American Diabetes Association at $132 billion. All cancers, taken together, cost the country about $171 billion a year.

The disease could actually lower the average life expectancy of Americans for the first time in more than a century. According to the CDC, one in three children born in the United States five years ago are expected to become diabetic in their lifetime, and a child found to have Type 2 diabetes at age 10 will see his or her life shortened by 19 years.

''Either we fall apart or we stop this,'' said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene. 'I will go out on a limb,'' he said, ''and say, 20 years from now people will look back and say: 'What were they thinking? They're in the middle of an epidemic and kids are watching 20,000 hours of commercials for junk food.' ''

According to the Office of Minority Health and the American Diabetes Association, the threat of diabetes is related to ethnicity and economic class. African Americans are more than twice as likely to be diagnosed with diabetes as non-Hispanic whites. One in every four African-American women over 55 has diabetes. And African Americans are 2.1 times more likely as non-Hispanic whites to die from diabetes.

Similar trends are true for Hispanics who, on average, are 1.7 times as likely to have diabetes as whites, and for American Indians and Alaska Natives, who are 2.2 times as likely as non-Hispanic whites of similar age to have diabetes.

Type 2 (adult onset) diabetes, which accounts for about 90 percent of all diabetics, is pretty clearly a disease of diet and lifestyle. And that's the good news. According to Neal Barnard, M.D. and founder and president of the Physicians Committee for Responsible Medicine (PCRM), a change in diet can not only prevent the onset of Type 2 diabetes, but can reverse the disease and even get some Type 2 diabetics off insulin.

NEAL BARNARD, M.D., is the author of several books:Eat Right, Live Longer; Food for Life; and his latest, Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs.

Terrence McNally: Is it safe to say that lifestyle, nutrition, and prevention were not the cornerstones of medical education when you were in med school?

Neal Barnard: Well, not only were those things neglected in medical school, they were completely neglected in my personal life. I grew up in Fargo, North Dakota. My grandfather was a cattle rancher. My father grew up on a cattle ranch, and all my uncles and cousins are still in that business. I think I ate roast beef, baked potatoes and corn every day of my life -- except for special occasions, when it was roast beef, baked potatoes and peas.

When I went to medical school, we learned a great deal about how to diagnose conditions, how to manage them medically, and how to prescribe drugs. Unfortunately, one thing we did not pay much attention to was how to prevent conditions like cancer or heart disease. The number one thing when it comes to preventing illness is what we eat. Diet plays a more substantial role than smoking for most major cancers. But with regard to public awareness, even among physicians, with diet we're now where we were in about 1940 with tobacco. People have inklings -- "maybe I should do something..." -- but no one is doing much about it.

When people finally figured out that tobacco caused lung cancer, they got serious and took action -- not only individually but as businesses, as schools, and as a country. I'm optimistic. I think we're on the cusp of making a major diet change.