November 21, 2002
A Forkful of Trouble
Cut the carbs and cut the risk of diabetes.
Turkey, potatoes and gravy, candied yams -- all the foods you love to pile on your plate come Thanksgiving. But you might want to check your blood sugar before you take another helping of mashed potatoes, because if you are one of the many American Jews at risk for diabetes, that extra forkful could spell a whole lot of trouble.
"I'm an Ashkenazi Jew, a meat-and-potatoes guy," said Los Angeles County Supervisor Zev Yaroslavsky, who was diagnosed with Type II diabetes in January 2001. "All of these things are off my diet now. No potatoes, not even a french fry."
It is no small irony that November is home to both Thanksgiving, our nationally recognized day of gluttony and sloth, and National Diabetes Month. Diabetes, which affects 17 million Americans, is on the rise in the United States. According to Health and Human Services Secretary Tommy Thompson, the number of people with diabetes in the United States has risen by nearly 50 percent during the past decade.
The impact of diabetes in the Jewish community is significant. "The prevalence in the Jewish community is greater than in other Caucasian populations," said Dr. Riccardo Perfetti of Cedars-Sinai Medical Center.
Dr. Francine Kaufman, head of endocrinology at Childrens Hospital in Los Angeles and president of the American Diabetes Association, said that lack of exercise at Jewish day schools is compounding the problem.
Diabetes results when the pancreas cannot create enough insulin, which helps the body convert glucose (a sugar) into fuel. Any additional sugar in the bloodstream, from either sweets or complex carbohydrates (like potatoes or white rice) aggravates the condition and increases the risk of fainting or stroke.
Type I diabetes, once known as juvenile diabetes, is rare and tends to be diagnosed at birth or in childhood. The more common Type II diabetes comprises 90 percent to 95 percent of all cases, and can go undiagnosed in many cases.
Although Yaroslavsky's mother and "everyone on that side of the family" had had diabetes, he didn't think it could happen to him. He dismissed the symptoms -- extreme thirst, fatigue, frequent trips to the bathroom -- as the combined result of stress from his busy schedule and age. Yaroslavksy might never have realized he had the disease if not for a bad cold, which led to a routine blood test.
The doctor told him that with diet and exercise he could manage the diabetes and live a normal life, but "if I didn't, I could have any one of the following: amputation, kidney failure, heart failure, stroke or blindness," Yaroslavsky said.
So he changed his dietary and exercise habits, increasing his jogging routine, and is following a diet of whole-grain bread, chicken, fish, salads and some vegetables and fruits.
Yaroslavsky has no self-pity for the loss of his favorite foods. He calls it "a win-win situation."
"The diagnosis of diabetes will probably add 10 to 15 years to my life, because without it, I would have been eating the junk I ate before and not thinking about the consequences," he said.
Kaufman and Perfetti attribute the large increase in diabetes cases to a lack of physical activity -- "God forbid we take the stairs," Kaufman said. She added that when it comes to exercise, schools are the worst culprits, including Jewish ones.
"In schools across the country, there are not enough physical activities to meet the needs of the students," Kaufman said. "Jewish day schools are the same or even worse, because they demand such a high level of academics. I would think that with the root of our religion being the reverence of life, we would stress taking care of our body as being just as important as academics."
Exercise can make a difference in the treatment of diabetes, Kaufman said, noting that one of her patients, Steve Eidelman, a Beverly Hills High School senior diagnosed with Type I diabetes, plays varsity tennis and even ran a marathon in Rome last summer.
In his spare time, Eidelman helps promote responsibility and activity among newly diagnosed youth. "If you are responsible," he said, "there is no reason you cannot control your diabetes.
A number of promising studies are underway to find a cure for both types of diabetes. Perfetti is working on one involving engineering a man-made gene to promote insulin production. He hopes to begin testing on human subjects some time in the next year.
Kaufman is chairing two multicenter clinical trials for the National Institutes of Health: one aimed at diabetes prevention, the other to determine the best treatment for the growing number of children with Type II diabetes.
Both physicians agree that the increase in the disease is a battle that can be won, if more people pay attention to their eating habits, and if they move away from their sedentary ways.