Lighten up

I'm referring to your body. No doubt you've heard about this projection from CDC that 1/3 of U.S. adults could have diabetes by 2050. As I always say, if there's one thing that's hard to predict, it's the future. So I wouldn't worry too much about the quantification. But it's an natural born true fact that we have a ridiculously high and growing prevalence of diabetes -- currently 10.7% of all people 20 and older, and over 23% of people 60 and older.

The diagnosis of diabetes, however, is just a signpost for something broader. The risk factors for diabetes are pretty much the same as the risk factors for cardiovascular and cerebrovascular disease (except that tobacco also contributes to the latter), while diabetes itself also compounds heart disease risk. But wait, there's more. Obesity, the major risk factor for diabetes, is also associated with some cancers.

But wait, there's more. I'm afraid I can't give you a link, but Marcus Richards and Carol Brayne in the new BMJ review an emerging paradigm of Alzheimer's disease. The association between the cognitive deficits of Alzheimer's and the neuropathological changes generally thought to be it's diagnostic signs -- accumulation of beta amyloid protein and neurofibrillary tangles -- is actually pretty loose. Some people who have the signs on autopsy were cognitively intact at death, others with considerable dementia have limited pathological signs. On the other hand there is a strong association between Alzheimer's and atherosclerosis, and cerebrovascular disease; in many cases Alzheimer's may really be cerebrovascular disease.

And again, the same risk factors are at work: obesity, inactivity, "bad" cholesterol (dyslipidemia) which comes in part from obesity and inactivity and also eating the wrong foods.

I don't know about you but without my fabulous wetware, I got nuthin'. But other complications of diabetes -- blindness, loss of extremities -- don't appeal to me either.

This is in fact a national crisis, as urgent as any that we face. We just can't allow this to happen to us. The nation cannot possibly afford to take care of 100 million people with these awful diseases, none of us wants to be there or see people we care about living with stroke, dementia, heart disease, blindness, immobility . . . But what do you think are the chances of the kind of major national mobilization that would be required to save our lard butts?