In an essay published last November in Canada's Maisonneuve journal, physician Kevin Patterson described his experiences working as an internist-intensivist at the Canadian Combat Surgical Hospital in Kandahar, Afghanistan.
One detail he noticed: The Afghan soldiers, police and civilians he 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 pounds 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," Patterson says. "Of course, when we operated on Canadians or Americans or Europeans, what was normal was to have most of the organs encased in fat. It had a visceral potency to it when you could see it directly there."
In a conversation on Fresh Air, Patterson tells Terry Gross that the effects of urbanization are making people everywhere in the world both fatter and sicker.
"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.
Patterson explains that in his Canadian practice, where he takes care of indigenous populations near the Arctic Circle, there is a marked increase in the number of diabetic patients he sees.
"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.
"There's no roads or rail access to any of those communities," he says. "So a 4 liter jug of milk can cost you $10 or $11. But there's a very clear parallel between that and the inner city. In poorer neighborhoods in North American cities, fresh food is either not available or extremely expensive compared to — on a calorie-by-calorie basis — compared to fast food available on every street corner."
And the diabetes epidemic correlates to a strain on health care systems around the globe, says Patterson.
"No country in the world has the resources to continue to treat diabetics the way that they're being treated now, if the prevalence rates increase at the rates that they're increasing for much longer," he says. "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."
Patterson fictionalized his experiences working with the Inuit in Canada in his novel, Consumption, about an Inuit woman who spends her teen years in a sanitarium. His other books include Outside the Wire: The War in Afghanistan in the Words of its Participants and the short story collection Country of Cold, which won the Rogers Writers' Trust Fiction Prize in 2003.
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