Immunity, Obesity and Type Two Diabetes

Type two diabetes (which accounts for 90% of diabetes cases) is linked to obesity; 80 percent of people with type two diabetes are obese. About 43 million Americans are obese.

Historically, the only causal ways to control type two diabetes have been diet (with a focus on blood sugar level impacts) and exercise (to reduce obesity). Now, there are additional tools available and the promise that more may be developed as our understanding ripens.

Obesity Is Complex, As Are Its Consequences

Multiple lines of research have established that being fat (i.e. obesity) and a variety of health consequences associated with being fat, involve more complex mechanisms than simply eating more makes you fat, while eating less makes you less fat.

One notable genetic factor in obesity is taste bud sensitivity to certain kinds of tastes, which can predispose people to be reluctant vegetable eaters who favor rich bland foods. This taste bud impact on diet preferences, one component of appetite, in turn, tends to lead to obesity and health problems associated with it. Appetite and metabolism (including insulin levels central to diabetes) are also regulated, in part, by a little known chemical messenger in the body called SH2B1 for short. Eating breakfast can also reduce obesity by regulating appetite and metabolism. Low energy density foods also "trick" your body's appetite system. Soda, in contrast, is an important factor in childhood obesity. Diet factors have disproportionate impacts on groups of people like African American women.

The nutrients associated with orange, yellow and dark green vegetables are absorbed much better by your body if they are consumed with some fat, a factor that complicates a simple strategy of avoiding fat all together. Also, high protein diets (like Atkins and South Beach) are more successful at producing weight loss than diets focused on fat reduction (the "unfad" diet favored by Weight Watchers).

We also know that the percentage of the energy content of food that ends up being absorbed by a person's body, rather than passed through a person's digestive system as waste, is a function of the makeup of that person's symbiotic gut bacteria (which the appendix appears to exist to reboot when it is wiped out).

Modest levels of consumption of aspirin and alcohol, and quite possibly compounds found in certain kinds of alcohol like red wine, independently dramatically reduce the cardiovascular system risks (e.g. heart attacks and strokes) associated with high fat diets. It also turns out that not all fats are created equal from a health perspective.

Chinese herb Cape Jasmine has also recently been documented to have positive effects in treating type two diabetes.

About 21% of cases of type two diabetes are statistically attributable to a quite common (38% of Americans have one copy of the gene and 7% have two copies), but simple genetic risk factor found in some people.

Even getting enough sleep can reduce obesity.

Notably, some studies show that merely being overweight, as opposed to obese, isn't a health risk at all. And, I have seen studies that show that a highly disproportionate share of the health risk associated with obesity is attributable to those who are morbidly obese, as opposed to marginally obese.

Immunity's Role

Stokes and heart attacks aren't the only health consequences of obesity. Another condition closely associated with obesity is diabetes, which is essentially poor blood sugar regulation as a result of a problem with the chemical signals in generated by the body's insulin system (something centered in the body in the pancreas). The fatter you are, the more likely you are to develop type two diabetes (type one diabetes is congenital rather than diet related), and liver disease.

But, this relationship is also not quite that simple. Both obesity and type two diabetes are associated with activity in part of your body's immune system, called mast cells, which is also active in people suffering from certain kinds of allergies. T cells, another part of the immune system that normally restrains autoimmune reactions, in contrast, appear to be low in people who are obese. These studies suggest that type two diabetes associated with obesity, or perhaps obesity itself, has an autoimmune component, in which your body's immune system overreacts to a situation and starts to harm healthy parts of your body.

Reactions from pain neurons in the pancreas, a type of autoimmune response, may be key to the mechanism of both type one and type two diabetes. This response has been successfully treated in mice with a single injection of capsaicin, the active ingredient in hot chili peppers. Of course, injecting capsaicin into an internal bodily organ is not something you can do yourself at home. The active ingredient may be cheap and easy to produce, but getting it to the right destination is not.

Indeed, bringing surprisingly complex phenomena of obesity, which many physicians describe to patients as a simple function of calorie consumption mediated only by determination, metabolism itself is influenced by a person's T cell functionality.

Vitamin D, linked to sun exposure and diary consumption, which is comparable in importance to your immune system to Vitamin C, which is associated with citrus consumption, not surprisingly, given the immune system link in diabetes, is also reduces diabetes risk.

The Practical And Theoretical Consequences

The good news is that two over-the-counter allergy medications, Zaditor or cromolyn, as well as allergy injections, counter both obesity and type two diabetes associated blood sugar issues in mice. Mice lose weight on the drugs, even if eating precisely the same diet that caused them to become fat in the first place. There is also no obvious reason that this result should be different in humans.

Thus, it looks likely that medical science has not only found new diabetes and obesity drugs, which are two of the most prevalent health issues in modern America, but that the drugs are also cheap and widely available over-the-counter drugs, just like children's aspirin, which reduces cardiovascular risk.

These drugs work in a different way than most diet drugs, which operate on appetite and metabolism systems, so they may have an independent, cumulative effect on obesity and diabetes.

Cheap solutions matter a lot, because type two diabetes, is common, is expensive to treat, tends to be chronic and is easy to screen for a propensity to develop.

Diabetes is also a problem that charity care in emergency rooms, the backstop system our country has for treating trauma and acute illnesses in uninsured people, doesn't work well to handle. This makes diabetes both a pressing problem that makes universal health care urgent and a major barrier to any system of private universal health insurance that is divorced by employment or some other large risk pool. From an insurance company's point of view, diabetic and pre-diabetic applicants for health insurance are pre-existing conditions that pose classic adverse selection/moral hazard risks for them if they don't factor these risks into their rates (something required by a system of "community rating," for example). Even when actual premiums can't be influenced by these factors, health insurance companies have an incentive to design plans that indirectly discourage predictably high cost consumers to choose their plan, for example, with additional bureaucracy. Any cheap treatment for diabetes makes it much easier economically to use the private sector to provide universal health care.

The news is also good basic science. Science is dramatically rethinking what is going on at a biochemical and anatomical level when people get fat and develop diabetes. While the complexity of the issue in the body means that it has taken a fairly long time to reach our current level of understanding, this complexity has also increased the number of ways that obesity and type two diabetes can be addressed medically.

UPDATE JULY 29, 2009 at 4:52 P.M.: As a footnote, no amount of science matters when you attribute your 11 year old's diabetes to God and conclude that the solution is prayer. The girl died. The mother was convicted of a serious offense in connection with the incident and the father still faces trial on similar criminal charges. The Wisconsin family has three other children; this girl was their youngest.