Wouldn’t you like to know the primary cause of type 2 diabetes?
Type 2 diabetes is caused by a myriad of factors. Usually an interplay of risk factors work together to bring about diabetes in an individual and we will talk about that in a minute.
However, if you want to drill down to the primary cause or root cause of type 2 diabetes, then we have to say it’s, you guessed it, Insulin Resistance.
Yes, emphatically insulin resistance is the primary cause of type 2 diabetes.
The origins of Type 2 diabetes are like a slow-moving train treading along menacingly if you like.
The ‘first station for the diabetes train’ being insulin resistance.
Next ‘stop’ after insulin resistance is pre-diabetes station.
Final ‘stop for this train’ is type 2 diabetes in the long run. There is another dreaded ‘stop’ though if you do not put a halt to that train. That ‘unwanted stop’ is the complications of diabetes. Complications of diabetes develop in the ensuing years when type 2 diabetes is managed poorly.
Now because you cannot have type 2 diabetes without developing insulin resistance first, then it makes sense to talk about insulin resistance as an entity in itself.
What do researchers say is the biggest primary cause of Type 2 diabetes?
The answer to this question of what the research says lies in 2 studies. One study was carried on female subjects (nurses) and the other on male subjects (male health professionals).
The female study lasted 16 years which is a fairly long time to follow up individuals. The male study was slightly shorter but long enough for the findings to be reliable. The male study lasted 12 years.
The idea behind both studies was to identify possible risk factors that can be linked to how type 2 diabetes develops.
The female study whose participants were Nurses showed that if you were a low risk woman you had a 90 percent less likelihood of becoming a type 2 diabetic.
So you gotta ask the question, what is a low risk woman?
A low risk woman by the study definition was someone with a body mass index of less than 25, ate low glycaemic food, ate foods low in trans fat, engaged in moderate to vigorous exercise for at least 30 minutes and at least 3 times a week.
The male study had a focus on diet – typical Western diet Vs Healthy diet lacking in processed food but eating more natural foods high in fiber, grains, vegetables and fruits.
Both studies were robust in terms of size and of course the length of both studies was appreciable for the studies’ findings to be meaningful.
Risk factors causing diabetes that were common to both studies were obesity, lack of exercise and poor diet. Smoking was identified as a risk factor in the female study.
Of all the risk factors identified, a high body mass index suggestive of being overweight or obese constituted the single most important predictor of type 2 diabetes.
Obesity as a cause of pre-diabetes and type 2 diabetes
If being overweight or obese is a significant risk factor for type 2 diabetes, you have got to wonder why this is. Let’s try and rationalize why this is the case.
For a start, two other risk factors identified were lack of exercise and poor diet, right?
Without trying to stereotype any individual, what’s the most likely scenario when an individual is not the most physically active? They probably consume a significant amount of processed foods too, don’t they?
…and these processed foods do have trans fat in them.
All of these can only lead to one thing – obesity.
Is it any wonder why obesity is a leading cause of type 2 diabetes?
That’s because being overweight or obese, significantly increases your risk of developing insulin resistance which ultimately leads to pre-diabetes and type 2 diabetes.
The problem is that a vicious circle is triggered with obesity and insulin resistance. How?
Well, obesity causes insulin resistance. When insulin levels are elevated in blood circulation, fat storage is promoted because insulin is actually a fat storage hormone, so more fat gets stored in the body further compounding the obesity situation which further worsens insulin resistance again.
If research has identified obesity as a number one cause of type 2 diabetes mellitus, could there be some other forces at play too?
Let’s check them out.
Genetics as a primary cause type 2 diabetes
Well yes, genetics do have a role. The only thing to note here is that the role of genetics can be overridden to avert developing type 2 diabetes.
Yes, having one or two parents only predisposes you to becoming a diabetic in later life. But it doesn’t necessarily mean you will become a diabetic if this scenario applies to you. This is especially true if you take active steps (pun intended) to prevent that from happening.
There are stories of twins who generally have had diverse life outcomes even though both twins have the same genetic makeup, had the same upbringing, shared the same childhood experiences which extends to the teen age years until they left home.
Grown up together, shared everything together in childhood and parents ensured they were treated as one and the same in every way possible until they drifted apart in later years having flown the nest.
Yet Barbara and Christine now exhibit different personas which are almost diametrically opposed. One twin is more confident than the other. One is lot more conscientious in the way she applies herself. One suffers from depression whilst the twin sister has no such problem.
Professor Tim Spector, head of twin research at King’s College, London who is conducting a long running twins research says
“We see it in so many different ways. For example, our research has shown that twins rarely die of the same disease. Yet they share many other features, such as height. It is not a straightforward business.It sounds baffling. After all, identical twins have the same genes, share the same womb and usually experience the same childhoods. Most of the twins recruited to our study went to the same school and lived together, eating the same food for the first 18 or so years of their lives. But the outcomes of their lives are often very different indeed.”
I do know of a set of identical twin brothers who are in their 40s. Same upbringing and early life experiences until they flew the nest at 18. Yet one of them is currently diabetic and the other isn’t.
How does one explain that?
I suppose it’s all to do with the tussle between nature and nurture. How genes behave or express themselves can be influenced significantly by the environment.
It would appear that genetic expression can be seriously altered by environmental factors, in particular our lifestyle choices. In the case of those twin brothers, the diabetic twin had a lifestyle that preconditioned him to developing diabetes. He was considerably heavier than his twin brother who had a more athletic physique.
If further evidence was needed that obesity is leading cause of type 2 diabetes probably ahead of genetics, there it is.
A set of these identical twin brothers – one is type 2 diabetic, the other isn’t. I suppose this brings home the concept of same difference. Bewildered? Don’t be.
Why does lack of exercise cause type 2 diabetes?
Some people often wonder why lack of physical activity or exercise causes type 2 diabetes. In truth lack of exercise is not main cause of type 2 diabetes.
However lack of exercise is a great contributor to the most common cause or leading cause of type 2 diabetes – obesity leading to insulin resistance.
Something to realize is that a common scenario is people who don’t exercise or perform any form of physical activity tend to adopt poor nutrition too.
This is not always the case, I hasten to add.
But it is fairly common to have a combination of unhealthy diet with absent physical activity. By unhealthy diet I am referring to high consumption of processed food which tend to have trans fat as part of the package.
So with an unhealthy combination like that, the result is usually obesity which should not come as a surprise. Because we already know, through research that obesity (or just being overweight) is the most significant risk factor for developing type 2 diabetes. So there’s the link between lack of exercise and type 2 diabetes.
But it is more than that.
The converse is also true.
When you exercise you expend energy. Expending energy means you can induce calorific deficit especially if you become particularly conscientious at what you eat, watching those calories, that is. Being calorie efficient would very casually lead to weight loss without trying too hard.
As you probably know the trick to losing weight efficiently is to burn more calories by your daily activities than you consume. Calories out should exceed calories in.
And one guaranteed way to expend more calories is by engaging in physical activities or exercising. If you don’t, then you are essentially increasing your risk of type 2 diabetes as your daily calorie intake is likely to exceed your daily calorie burn leading to weight gain in the long run.
One more thing and this is discussed in much more detailed elsewhere on this website. Exercise and other vigorous physical activities have been conclusively proven to reverse the effects of insulin resistance which ultimately leads to type 2 diabetes.
The opposite of insulin resistance is insulin sensitivity. Exercise is one of the cheapest ways to improve your insulin sensitivity without spending a dime.
By making yourself more insulin sensitive through exercise, you reduce your risk of developing type 2 diabetes. The converse being if you don’t take steps to increase your insulin sensitivity via engagement in physical activity, you increase your risk of developing type 2 diabetes.
Now you know why lack of exercise or physical activity can lead you on a path to type 2 diabetes. So you need to get up and go, buddy. You can start slow and build it up gradually.
Let’s talk about what causes type 2 diabetes to develop. Discussing the causes of type 2 diabetes is just as important as putting fuel in your car. If you ignore fuelling your car, you will pay the price. Not pleasant!
In the same vein, if you ignore the origin of type 2 diabetes (which you may be guilty of by the way), it could hunt you down. Type 2 diabetes has become a worldwide scourge.
I have a feeling if you take a walk along your street, your neighbour 4 or 5 doors down the road may be courting type 2 diabetes, if he/she hasn’t got it already.
When you take a close look at the causes of type 2 diabetes, it becomes clear that a number of reasons work synergistically for type 2 diabetes to develop.
The unfortunate underscore to the origin of type 2 diabetes is that it is not an event. Type 2 diabetes is a process that is amenable to being halted or better still, put in reverse.
With the world becoming one big global village, it has also become obvious to anyone taking notice that type 2 diabetes is spreading from west to east and north to south with a little help from industrialization. I haven’t written that direction of spread randomly. That’s the way diabetes is spreading globally at the moment.
Governments and individuals must take proactive steps in tackling the reasons why type 2 diabetes develops. It is thought that there will be a 69% increase in the number of diabetes cases in developing countries between 2010 and 2030 and a 20% increase is expected during the same period in developed countries.
In ballpark figures, the prevalence of diabetes currently stands at 285 million, but projected to hit the 439 million mark by that 2030. With staggering figures like these, shouldn’t we be taking steps to reduce the risks of type 2 diabetes?
The Gordon Ramsay and Type 2 diabetes In Action?
Okay, here I was watching an episode of Gordon Ramsay’s Kitchen nightmares the other day and it was interesting how the problems the restaurant owners in this episode were unravelling.
If you are not familiar with this TV program, it is basically a concept of restaurants in financial trouble usually due to a myriad of reasons and Gordon Ramsay attends to troubleshoot and save the day…hopefully.
Anyway this episode involved a restaurant called El Greco, The Greek Tavern. The restaurant was owned by a Mother and Son. Well, the mum owned it really. After all, she guaranteed the $800,000 loan investment to get the business off the ground and rolling.
For argument sake we will say it was owned by Mother & Son. The restaurant was located less than a mile away from the University of Texas. Now you couldn’t ask for a better location even if you tried. With a huge student population at your doorstep and an urban footfall, success was written all over this project.
But success it wasn’t. Why?
So much in-fighting between Mother and Son, it was painful to watch the never-ending bickering between the two of them. The mother was overbearing and the son lacked commitment. The result – food quality was a mess and the restaurant was in financial trouble.
Enter Gordon Ramsay who did a good job calming everyone down and more importantly making Mother and Son to start co-operating together again for the good of the restaurant. The menu was re-structured and the restaurant re-decorated.
The turn-around was brilliant. There was buzz around the place again and of course things were looking up or so it seems.
At the end of the program, there is usually an update that tells viewers what happened after Gordon had departed the scene months later.
Sadly, the update was that El Greco, The Greek Tavern Restaurant had to close because the debt burden owed the Bank had become too heavy to carry. It was a rather sad end to what I thought was going to be a beautiful turn-around in fortunes for the Mother and Son Enterprise.
Now that got me thinking.
Had Gordon Ramsay arrived say 3 years earlier, maybe the El Greco, The Greek Tavern would have been standing tall today still making good meals and making some good money in return for a decent service.
The El Greco would have been in a better state of health…hopefully.
Of course Gordon Ramsay was not to blame for the demise of what was supposed to be fledgling enterprise. He was called in too late.
What has this Gordon Ramsay story got to do with Type 2 diabetes and how it develops?
Type 2 diabetes does not develop in one day, one week or one month. The problems of that restaurant did not develop in one day, one week or one month for that matter. They took years to gain foothold and that’s the same behaviour that type 2 diabetes adopts.
Type 2 diabetes could actually be described as a process. Just like the El Greco Restaurant gradually sank itself into business oblivion, that is how type 2 diabetes gradually creeps in on the affected individual.
Early intervention means you can stop it in its tracks and actually reverse it. Type 2 diabetes is a continuum stretching from insulin resistance on one end to frank type 2 diabetes on the other. With pre-diabetes conveniently sandwiched in the middle.
So what causes type 2 diabetes to develop?
In talking about how type 2 diabetes develops, it’s probably better to discuss this in the realms of risk factors for type 2 diabetes. In truth the way type 2 diabetes develops is multifactorial. It is unlikely that one single factor is the reason your type 2 diabetes came about. The more risk factors you have over time, the more the likelihood of having type 2 diabetes.
Type 2 diabetes inheritance
We can’t choose our parents, can we?
Having parent(s) with diabetes is a predictor for developing type 2 diabetes. This is not a direct cause of type 2 diabetes but an indirect cause because other factors are at play here for this to materialize.
The point being it is not a given that you will later on develop type 2 diabetes especially if you take steps to prevent it.
We do know that inheritance may be a factor in the causation of diabetes, meaning you are more likely to become diabetic if one or both your parents suffer from the condition, but there’s much more to it than that.
Does diet and or lifestyle cause type 2 diabetes?
What has become clear as research has revealed is that, how you live your life has a huge contributory influence on whether you become diabetic or not especially as you hit the middle age territory. I’m talking diet and lifestyle.
One research followed up 84,941 female nurses (that’s quite a robust study size) for 16 years. The idea was to monitor their diet and lifestyle over that 16-year period. Their diet and current lifestyle were updated as the years rolled by.
In all, 3300 cases of diabetes were diagnosed during the follow up period. Majority of the women who developed diabetes during the study period were from the overweight category. Low-risk women had a 90 percent less chance of developing diabetes.
To qualify as a low-risk participant, you have to have a BMI of less than 25, have a diet high in fiber, high in polyunsaturated fat, low in trans fat as well as have a low glycaemic diet. Low-risk also meant 30 minutes daily exercise of moderate to vigorous nature, be a non-smoker and have a moderate level of alcohol consumption habit.
To be eligible for the study, all the participants had to be disease-free at the beginning of the study. Disease-free means being free from cardiovascular problems, cancer and diabetes.
This Nurses’ Study identified a couple of risk factors for diabetes at least in women anyway.
The risk factors identified from the study included:
Poor diet
Lack of physical activity
Smoking
Being overweight or obese. A high BMI was thought to have a higher association with development of diabetes than the other risk factors.
Interestingly being teetotal was a risk factor for diabetes. Who would have thought that, huh? I do not think that’s an excuse for you to hit the bottle, by the way. You could be courting other problems if you do. Okay, 3 glasses of wine is all you are allowed a week. Feeling better already?
Not to be left out, a similar study was carried out for the men enlisting 42,504 male health professionals who were followed up for 12 years. Just like the female study, participants had to be disease-free at the entry point of the study.
1321 new cases of type 2 diabetes were diagnosed in the male study. Again diet played a significant part here in those who developed diabetes. In this male study the “Western diet” was the diet to blame. Similar risk factors like lack of physical activity and obesity were also identified as being contributory to how type 2 diabetes develops in men.
Evidence that western diet is a risk factor can be seen anecdotally in countries that had low rates of diabetes back in the day only to see a surge in the rate of diabetes in those countries currently. A good example is China that hitherto had a low diabetes incidence but is now seeing a rising trend in type 2 diabetes.
Why…because the western diet has gradually infiltrated into the core of China and a lot of Chinese people living in China now embrace a more sedentary lifestyle on account of industrialisation. The same situation is applicable to some other 3rd world countries where type 2 diabetes is on the rise.
does age cause type 2 diabetes
Does age cause type 2 diabetes?
A lot of things head south as you age sadly. Type 2 diabetes doesn’t want to feel left out, so it gets in on the act too. Someone asked me a question the other day; what age can type 2 diabetes start?
Well type 2 diabetes can start at any age from the mid-twenties but it is much rarer at such a young age. Having said that even teen agers are being diagnosed with type 2 diabetes lately and this is of course diet-related.
The real age where type 2 diabetes assumes prominence is 45. That’s why this type of diabetes was christened ‘Maturity-Onset Diabetes’ in the past.
From 45 onwards, type 2 diabetes risk rises gradually. This risk accelerates from the age 65. I suppose one could explain this from the point of view of other factors that may be stressing out your pancreas over the years. On this account I truly believe that every 50-year-old should be screened for type 2 diabetes.
In time, the pancreas being subjected to prolonged insult may just decide to just pack it in, as the beta cells in your pancreas succumb to the toxic effects of high blood sugar levels resulting from insulin resistance. We will talk about this some more in a future post.
Gestational Diabetes and type 2 diabetes
Some women become diabetic when they are pregnant but this resolves soon after delivery – a condition known as gestational diabetes. In truth a vast majority of these women are actually at the stage of insulin resistance before proceeding to pre-diabetes and frank type 2 diabetes in later life.
However, the lack of follow up years later after pregnancy means the opportunity to make an early diagnosis probably at the pre-diabetic stage is missed until they develop full-blown type 2 diabetes further down the line. One thing is clear, having diabetes whilst you are pregnant is clear signal that you are more likely going to have type 2 diabetes in later life.
Polycystic ovaries as a risk factor for type 2 diabetes
If you run a blood test on a woman with polycystic ovaries to check her blood insulin levels, the result is most certainly going to demonstrate high blood insulin levels. What this means is women with polycystic ovaries as part of their syndrome usually have high insulin levels from being insulin resistant.
As I have discussed elsewhere on this site, insulin resistance is a precursor to the development of type 2 diabetes. So if you suffer from polycystic ovaries, your risk of developing type 2 diabetes goes through the roof.
Ethnicity and type 2 diabetes
So, what’s race and ethnicity got to do with type 2 diabetes?
Observational studies have shown type 2 diabetes to be more common in some races compared to others.
The Afro-Carribbean race, Hispanics, Native Americans and South Asians have particularly higher tendency to become type 2 diabetics than other races. In fact, some studies like this one have shown children do exhibit the similar racial and ethnic differences in medical conditions associated with body fat percentage.
The study goes ahead to recommend BMI and waist circumference adjustment in kids when attempting to identify children at risk of health conditions attributable to fat.
Another study comparing insulin sensitivity in African-American women with their White cohort showed a lower insulin sensitivity in the African-American group compared with the Whites. This is regardless of the fact that the White women in the study had a higher Intra-Abdominal fat percentage and correspondingly higher inflammatory markers.
What these studies demonstrate is that some races are more tolerant of higher body fat than others before succumbing to type 2 diabetes.
So as said before, developing type 2 diabetes is the results of usually several forces conspiring to drag you into the net kicking and screaming.
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By Dr Joe
Dr. Joe