"Diseases of Affluence," by Dr. Kevin Patterson. November 15, 2010, Maisonneuve Magazine
The Afghan soldiers, police and civilians that Dr. Kevin Patterson treated in Kandahar had radically different bodies from those of the Canadians he took care of back home.
"Typical Afghan civilians and soldiers would have been 140 pound or so as adults. And when we operated on them, what we were aware of was the absence of any fat, or any adipose tissue underneath the skin.
Of course, when we operated on Canadians or Americans or Europeans, what was normal was to have most of organs encased in fat. It had a visceral potency to it when you could see it directly there."
--excerpt from Kevin Patterson's interview on WHYY's Fresh Air, March 24, 2011. "How Western Diets are Making the World Sick"--
My blog-reader-friend Tom often sends me hot-off-the-press-interesting health-related research and articles--but, more than I'd ever have time to share with you.
But the link he sent me yesterday to Terry Gross' Fresh Air interview with physician Kevin Patterson, is a must-share.
Thanks, Tom. Since I always work late on Thursdays, I would have missed Terry Gross' interview with Patterson--as well as the eye-opening essay he wrote for Montreal's Maisonneuve Magazine last November. Want to hear the interview, read the transcript & the essay? Look no further!
- The Maisonneuve Magazine essay, "Diseases of Affluence"
- The Fresh Air broadcast & summary
- The Fresh Air Interview Transcript
Who exactly is Dr. Kevin Patterson?
Patterson is a Canadian physician who has witnessed first-hand the spread of diabetes among the Inuit living near the Arctic Circle, and among the Pacific Islanders. He blames it on obesity--caused by an increasing reliance on processed foods and increasingly sedentary lifestyles, as traditional lifestyles disappear.
He lives in British Columbia on Salt Spring Island. But for the past 16 years, he has spent part of each year practicing medicine in the Arctic along the Hudson Bay. He's also treated soldiers in Afghanistan, working as an internist and intensive care doctor at the Canadian Combat Surgical Hospital in Kandahar.
How is our Western Diet making the world sick?
Hint: The cheap high-calorie-fat-laden-sugary processed food, coupled with the loss of "normal" strenuous daily activity has become a lethal combination.
"Type 2 diabetes historically didn't exist, only 70 or 80 years ago," says Patterson.
"And what's driven it, of course, is this rise in obesity, especially the accumulation of abdominal fat. That fat induces changes in our receptors that cells have for insulin. Basically, it makes them numb to the effect of insulin."
For a long time, the human body can compensate — the pancreas secretes even larger amounts of insulin, which regulates blood sugar levels. But over time, the pancreas begins to fail to secrete enough insulin, and that is when diabetes develops.
He explains that the increase in abdominal fat has driven the epidemic of diabetes over the last 40 years in the developed world — and that he's now seeing similar patterns in undeveloped regions that have adapted Western eating patterns.
What were the striking physical differences that Patterson observed between the Canadians he treats at home--and the Afghanis?
Typical Afghan civilians and soldiers would have been 140 pounds or so as adults. And when we operated on them, you know, what we were aware of so dramatically was almost the absence of any fat or adipose tissue - or just trace amounts underneath the skin.
But when we operated on Americans or Canadians or Europeans--what was normal was to have most of the organs encased in fat.
The body fat percentages of the Afghanis were a third or a quarter of what North Americans typically are.
Heart attacks are almost unknown among traditional peoples like the Pashtun, while half of us will spend our last minutes with the impression that a large kitchen appliance is sitting on our chests.
Afghans die through causes that are widely considered avoidable—war being chief among those, but also tuberculosis, complications of childbirth, measles, meningococcus and polio. This fact is revealed conclusively by the life expectancy in Afghanistan, the lowest in the world: thirty-nine.
Westerners are made ill by diseases the Afghans avoid—even among the very elderly, traditional peoples do not suffer cardiovascular disease—while the Afghans perish from diseases we are too rich to tolerate.
And what about the health of the Canadians that Patterson treats?
"Back home, I was used to seeing organs stand out with some prominence from the abdominal fat. In fact, in Canadians, the state of the kidneys can be partly assessed by the degree of inflammation in the perinephric fat that envelops them.
It’s the same with the pancreas--and the liver often looks like it belonged to a French goose fattened for foie gras.
Excessive fattiness is precisely why, when caring for the critically ill in North America, glucose levels are tightly controlled with insulin—a procedure necessary even for those not thought to be diabetic.
Stressed by the infection, or the operation that has brought us to the intensive care unit, our sugar levels rise, paralyzing our white blood cells and nourishing the bacteria chewing upon them.
But it was never necessary to give the Afghans insulin, no matter how shattered they were."
Patterson compares North American "normal" to Afghani "normal".
North American Normal
Among North American adults, 40 percent of us maintain normal glucose levels only by secreting larger than normal quantities of insulin from our pancreas. So we wander in and out of our family doctors’ offices and, if some blood work is done, we are reassured that our glucose levels are normal, that we don’t have diabetes. Mostly, they are and mostly, we don’t. But our bodies are not normal.
Our Normal: 40 percent of North American adults have metabolic syndrome. The syndrome is caused by being fat, even at levels North Americans would not recognize as abnormal.
Obesity prompts the receptors that insulin acts upon to become numb to its effects. As we grow fatter, and insulin resistance proceeds, higher and higher levels of insulin are necessary to get the sugar out of the blood.
Eventually, overt diabetes may supervene, as it has for 8 percent of North American adults, a tenfold increase since the turn of the last century. But even prior to the development of diabetes, metabolic syndrome insidiously eats away at the bodies of those it affects.
Metabolic syndrome’s elevated insulin level is why we order a second Whopper--getting fatter, cruelly--because it stimulates our appetite.
It is also why high blood pressure is more common among Westerners, too, and why our cholesterol panels are more alarming.
But our bodies are not normal.
The Afghani's bodies are normal.
We are so commonly ill--we take it to be normal.
Throughout Patterson's visits to the South Pacific Islanders and the Inuit near the Arctic Circle--he has seen how our cheap Western food has brought obesity, diabetes, and kidney disease.
There is a marked increase in the number of diabetic patients he now sees among indigenous people.
"The traditional Inuit culture of relentless motion and a traditional diet consisting mainly of caribou, Arctic char, whale and seal has been abandoned over this period of time for Kentucky Fried Chicken and processed food and living a life very similar to ours," he says. "[They're] spending a lot of time in front of a glowing screen."
Part of the problem, says Patterson, is that it's so much cheaper for processed food to be flown into the Arctic Circle than fresh food.
"I worked in Saipan, which is in the Marianas Island in the Pacific, and there, the dialysis population was increasing at about 18 percent a year, all as a consequence of diabetes and acculturation — exactly the same process as what's going on with the Inuit.
"When you look at the curves, it's clear how unsustainable it is. In 20 or 30 years, everybody on that island will either be a dialysis patient or a dialysis nurse unless something fundamental is done about the rise in diabetes. That's no less true in Canada and in Samoa and Hawaii, and even in Omaha and Toronto. We all have exactly the same problem when we plot out those curves."
What's driving the diet changes among the native people of the Manitoba hinterlands?
Take a look at the Cree, who live in a forested area that borders Lake Winnipeg. The traditional diets of moose or fish are unsustainable--and can't adequately feed the population that lives there.
Ten thousand people require much more food than the forest & lakes are able to provide--and mostly what the Cree eat are Cheez Doodles and Pepsi. They are among the least expensive foodstuffs available. It's not much different than what's going on in the poorest parts of U.S. cities.
Milk is three dollars a litre. Bread, two dollars a loaf. Anything perishable is flown in and carries its air freight in the price. The pop and the chips are trucked in over the ice on winter roads and last all year. It is precisely the same circumstance that prevails on the Pacific Islands of Hiva Oa, Nauru and Saipan.
As a result, forty percent of adults have type-2 diabetes. Kids as young as nine have “adult onset”—obesity-related, type two diabetes. Twenty-two-year-olds are on dialysis.
Putting the Pieces Together - Patterson, Lustig, Nissen, Esselstyn & Campbell - Eat & Move Like a Real Native
I couldn't help but link Patterson's interview & essay to what I learned a few weeks ago from Dr. Lustig's lecture about obesity & diabetes in "The Bitter Truth About Sugar"--and to link that to what I learned last month from world-renowned cardiologist Dr. Steven Nissen about the alarming degree of atherosclerosis in our arteries when viewed via intravascular ultrasonography (IVUS)--and to link that to everything I've learned over the past three years from Dr. Caldwell Esselstyn and from Dr. T. Colin Campbell. The picture is pretty clear.
Nissen's factoid about who has atherosclerosis:
- 17% of under 20's
- 33% of those between 20-29
- 60% of those between 30-39
- 71% of those between 40-49
- 85% over 50
A 5 year old with clean-as-a-whistle arteries has an average LDL of 50. That's normal.
Bottom line: If you eat a Western diet, plan on having atherosclerosis--and it starts early.
And add too many processed carbohydrates, sugar, fat, and salt into the mix.... and you know what you can expect.
Michael Pollan says it best:
Not too much.
Don't eat anything that your great-grandmother would not recognize as food.
That, more of less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy."
And don't forget to move!
Obesity. Diabetes. Hypertension. Heart Disease. Kidney Disease. And we're exporting it all over the world.