Risk Factors for Disease

There are a lot of factors which influence the development of disease processes in our body throughout our lifetime. Your genetic background is a very important factor. However, nutrition and activity level also exert a very significant influence.

Human cells have 46 chromosomes, half from the mother and half from the father. These chromosomes determine the characteristics and disease patterns in the human body. Each chromosome has 32,000 genes, which allows a lot of mutations or inheritance patterns to occur. There are single or multiple mutations, as in Sickle Cell disease versus diabetes. Specific total chromosomal mutations can account for diseases such as Down’s Syndrome (No. 21 defect).

In the case of diabetes, there can be incomplete or complete “penetrance” of the genes to cause a person to be either pre-diabetic or diabetic, depending on their body characteristics, nutrition, and activity level. Eighty percent of the population in this country is overweight, and there are many cases of pre-diabetes and full clinical diabetes. About one-fourth of all American adults have pre-diabetes and thus have a 15 times greater chance of developing diabetes. It is important to predict each person’s risk factors so that they can prevent the progression to clinical diabetes, which increases risk of heart disease, stroke, kidney failure, neuropathies, and vision loss.

Diabetes comes in two forms, Type I and Type II. Type I diabetes is usually but not always congenital and is characterized by minimal or no insulin output by the pancreas. Type II diabetes accounts for 90 percent of all diabetes and is often predictable in occurrence based on dietary intake and body type. An obese person is 80 times more likely to develop Type II diabetes than a person with normal body weight. In Type II diabetes, there is usually plenty of insulin made, but because of the body’s fat content, it’s just not as effective as it would be in a thinner person.

You can measure blood insulin levels, and about seven units would be normal, whereas pre-diabetes is 11 or 12, and clinical diabetes is over 25. Fasting blood sugar levels also help predict pre- versus clinical diabetes. A glucose tolerance test requires fasting for 12 hours, drinking glucose solution, and measuring 1-, 2-, and 3-hour blood sugar readings. If your 2-hour level is over 160, you are diabetic. Another predictor for diabetes is hemaglobin A1c, which is caused by the glucose binding and interacting with the oxygen-carrying hemaglobin in your blood cells. There are studies that show that HbA1c predicts your risk for a heart attack, stroke, or other medical problems associated with diabetes. Pre-diabetic levels are about seven, whereas clinical diabetes levels are over seven.

You can predict whether or not a given person will develop diabetes based on blood tests as noted, body type, and nutritional intake. A waist measurement of over 40-inches in men and 35-inches in women, eating starchy foods and regular soft drinks, and no exercise are other predictors of risk. A BMI (weight-to-height ratio) over 30 indicates a strong likelihood for developing diabetes, and a BMI over 25 puts you at risk. If the body fat is over 31 percent, it indicates increased risk. But your risk can be decreased if you increase your muscle mass and reduce excess fat with aerobic exercise.

Those of you who have read these articles over the years know that I am an advocate of a balanced meal type diet, the Zone Diet. On this diet, you eat low-sugar protein-type snacks, add a small amount of protein and fat to every meal, and eat whole grains that haven’t been processed in addition to avoiding processed foods with transfats, sugars, and especially high fructose corn syrup. To this take supplements that can lower your risk of problems with blood sugar control. These include chromium, biotin, alpha lipoic acid, magnesium, and vitamin D.   

Predicting how healthy you will be can be done best by working with your physician to do a total risk assessment and then interact with him/her with all of this information available to you. Unfortunately, about 26-28 million children and adults have diabetes in the U.S. This is nearly 10 percent of the population. There are an additional 79 million pre-diabetics, and the progression of this disease could be greatly influenced by improved nutrition and increased activity levels. Heart disease accounts for disability or death in nearly 70 percent of diabetics, with kidney failure being a major problem. We are spending close to $200 billion a year for clinical diabetes and another $50 billion for pre-diabetic treatment and diagnosis pathways. The total cash cost for Medicare alone in the U.S. is $1300 billion per year. At $250 billion, diabetes or pre-diabetes consumes approximately one-fifth of that total budget.

Since increased medical care spending is helping to drive us headlong into greater national debt, the more we can do as individuals to predictably improve our risk for a disease such as diabetes is an important step in the right direction. Not only can you personally improve your risk for this disease, but also you can significantly influence your family and friends. This is what it will take to really get the nation moving in the direction of better predictable risk levels for one single disease. Otherwise, diabetes may contribute greatly to bankrupting the U.S. health care system. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 or visit http://www.aestheticskincarecenter.com/carraway.htm for more information.

James H. Carraway, M.D.

Dr. James Carraway is a full-time academic and practicing clinical plastic surgeon.  He is Director of the Cosmetic & Plastic Surgery Center of EVMS, is board certified in surgery and plastic surgery, and is a fellow of the American College of Surgeons.  Dr. Carraway has been teaching and practicing for 30+ years and has been director and chairman of residency training programs and fellowship programs in plastic surgery.
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