Lately quite a few people have asked me to explain how I became interested in nutrition, and in preventing diabetes (type 2) and obesity.  Some time ago, after I had been practicing medicine for a few years, I noticed something very odd.  Not only had I recently diagnosed more than the usual number of cases, but they were mostly in a select group of new patients.  This select group consisted almost entirely of spouses of my diabetic patients.  Now I had learned in medical school that the tendency to develop diabetes is genetic.  That means you would be more likely to become diabetic if one or especially if both of your parents were. 

But none of my professors had said anything about spouses.  Spouses are not generally related to one another.  But here it was.  One after another, the spouses of diabetic patients were arriving at my office with diabetes.  What did these husbands and wives have in common?  It was not their genes, of course.  It was their eating patterns. 

So I started to look at how, what, and when they ate.  They kept food logs.  They checked their blood sugars before meals, after meals, even in the middle of the night on occasion.  They collected nutrition labels and we worked together to make sense of them.  Then they began to make changes, big and small.  These changes developed into the four recommendations that I promulgate for preventing diabetes and obesity. 

There is more to this story.  Years later I, like all of America, watched the people of New Orleans struggle to survive in the aftermath of Hurricane Katrina.  I stared, horrified, at one particular news photograph of a blanket-covered, wheelchair-bound body, flattened over itself as if tying its orthopedic shoes for eternity.  My physician’s eye was seeing a second, deeper layer of tragedy below the surface, but what?  I continued to stare at the photograph until I realized that it symbolized to me the awful consequences of uncontrolled diabetes. 

For the individual in the photograph, Katrina was likely the last in a long series of humiliations.  The disease’s destructive course speeded up by the storm, there was no alternative ending.  Diabetes stole her ability to regulate her fluids, to monitor her sugars, to stand and walk.  Diabetes destroyed her ability to adapt to the environment.  Then came the storm.  Unable to survive the heat, dehydration, starvation and immobility in this inhospitable place from which there was no escape, she died. 

The twin tragedies of Katrina and diabetes became linked in my mind.  As harsh a blow as the storm was to the people of New Orleans, diabetes made it even more difficult to survive.  Diabetes does that.  No matter what your circumstances, it makes it that much harder to survive.  Katrina didn’t make diabetes more destructive, but it did show me how profound that destructiveness is — and how urgent is the need to prevent it.  After Katrina, I became more committed than ever to preventing diabetes.

Annual diabetes costs in the U.S. topped $218 billion in 2007 and are expected to rise to $336 billion by 2034.  Diabetes is devouring our healthcare dollars, felling our workforce, and exhausting the resources of millions of families.  Diabetes affects almost 21 million Americans, an estimated 6 million of whom have not yet been diagnosed.  It is the number one cause of acquired blindness, non-traumatic leg amputation, and kidney disease leading to dialysis.  Two-thirds of diabetic individuals die from cardiovascular disease, the number one cause of death in this country.  Diabetics are two to four times more likely to suffer a heart attack or stroke than non-diabetics.

If we are going to optimize our overall health as a nation, direct public health resources most effectively, and be in the best possible shape to prepare for emergencies if and when they do occur, we must all learn to tell the difference between real food and manufactured calories. 

I tell patients that my goals are a little different from theirs.  My goals include maintaining normal blood pressures, preventing kidney damage, monitoring blood sugars, updating immunizations and screenings.  But you have just one goal — to dance at your grandchildren’s weddings.  That is my wish for you.  To your good health!