Why is type 1 diabetes on the rise?

Why is type 1 diabetes on the rise?

Type 1 diabetes, also called "childhood" or "insulin-dependent" diabetes, is on the rise.

Type 2 diabetes, or "adult," diabetes, is also sharply escalating. But the causes for this are easy-to-identify: overconsumption of carbohydrates and resultant weight gain/obesity, inactivity, as well as genetic predisposition. A formerly rare disease is rapidly becoming the scourge of the century, expected to affect 1 in 3 adults within the next several decades.

Type 1 diabetes, on the other hand, generally occurs in young children, not uncommonly age 3 or 4. Type 1 diabetes also shares a genetic basis to some degree. But the genetic predisposition should be a constant. Obviously, lifestyle issues cannot be blamed in young children.
Then why would type 1 diabetes be on the rise?

For instance, this study by Vehik et al from the University of Colorado documents the approximate 3% per year increase in incidence in children with type 1 diabetes between 1978 and 2004:


(From Vehik 2007)

(For an excellent discussion of the increase in type 1 diabetes in the 20th century, see this review.)

This is no small matter. Just ask any parent of a child diagnosed with type 1 diabetes who, after recovering from hearing the devastating diagnosis, then has to stick her child's fingers to check glucose several times per day, mind carefully what he or she eats or doesn't eat, watch carefully for signs of life-threatening hypoglycemic episodes, not to mention worry about her child's long-term health. Type 1 diabetes is a life-changing diagnosis for both child and parents.

Various explanations have been offered to account for this disturbing trend. Some attribute it to the increase in breast feeding since 1980 (highly unlikely), exposure to some unidentified virus, or other exposures.

I'd like to offer another explanation: wheat.

Lest you accuse me of becoming obsessed with this issue, let me point out the four observations that lead me to even consider such an association:

1) Children diagnosed with celiac disease, i.e., the immune disease of wheat gluten exposure, have 10-fold greater likelihood of developing type 1 diabetes.

2) Children diagnosed with type 1 diabetes are 10-fold more likely to have abnormal levels of antibodies (e.g., transglutaminase antibodies) to wheat gluten.

3) Experimental models, such as in these mice genetically susceptible to type 1 diabetes, showed a reduction of type 1 diabetes from 64% to 15% with avoidance of wheat.

4) The increase in type 1 diabetes corresponds to the introduction of new strains of wheat that resulted from the extensive genetics research and hybridizations carried out on this plant in the 1960s. In particular, unique protein antigens (immune-provoking sequences) were introduced with the dwarf variant attributable to alterations in the "D" genome of modern Triticum aestivum.

Proving the point is tough: Would you enroll your newborn in a study of wheat-containing diet versus no wheat, then watch for 10 years to see which group develops more type 1 diabetes? It is a doable study, just a logistical nightmare. Perhaps the point will be settled as more and more people catch onto the fact that modern wheat--or this thing we are being sold called "wheat"--is a corrupt and destructive "foodstuff" and eliminate it from their lives and the lives of their young children from birth onwards. Then a comparison of wheat-consuming versus non-wheat-consuming populations could be made. But it will be many years before this crucial question is settled.

Yet again, however, the footprints in the sand seem to lead back to wheat as potentially underlying an incredible amount of human illness and suffering. Yes, the stuff our USDA puts at the bottom, widest part of the food pyramid.

Comments (43) -

  • Marc

    2/16/2011 1:22:50 PM |

    Don't know about obsessed...but how can we not be "blown away" continuosly by everything we see all around us.

    I'm disgusted with the school system feeding my kids nothing but candy and cupcakes on an almost daily basis.

    Maybe youre right maybe wheat is the big villain, but mostly all I can really see is that what's being consumed as food...has nothing to do with actual food.

    I'm getting sadder by the way about it...but all i can do is live by example....and share some resources for people to look into...only if they ask.

    Thanks for all you do Doc.

    Marc

  • Steve Cooksey

    2/16/2011 1:50:42 PM |

    Dr. Davis,

    I think the rise in Type 1 Diabetes  *could* be a combination of several factors.

    1) Increase in inflammation due to wheat, sugar etc.

    2) Reduced D3 levels AND exposure to sunshine

    3) Reduced Cholesterol levels, which further impacts the D3 processing.

    Thoughts?

    Steve

  • Pater_Fortunatos

    2/16/2011 1:52:36 PM |

    In Romania there was even a campaign for small kids (6-10 years), named "Pretzel and Milk" (Cornul și laptele).
    Every kid got a daily pretzel and one dose of milk. The perfect recipe for addiction, ADHD, obesity and eventually a few autoimmune diseases.

    And of course, diabetes!
    ............................
    http://arthritis-research.com/content/12/6/147

    The autoimmune tautology refers to the fact that autoimmune diseases share several clinical signs and symptoms, physiopathologic mechanisms, and genetic factors and this fact indicates that they have a common origin (Table 1). In the previous issue of Arthritis Research & Therapy, Eyre and colleagues [1] report that variation within the TAGAP gene, at 6q25.3, is associated with three autoimmune diseases, namely rheumatoid arthritis, type 1 diabetes, and coeliac disease, in Caucasians.
    .......................

    This link provide a few important details:

    http://www.mucosalbarrier.com/

    ............................
    Mainstream medical knowledge, ignores gliadin capacity to increase Zonulin secretion, therefore increasing mucosal permeability.

    Same eeffect for lactose, but another mechanism

  • The Naked Carnivore

    2/16/2011 2:10:59 PM |

    It would also be useful to examine the carb load in the mother's diet. All that blood sugar is "feeding" the fetus.

  • Anonymous

    2/16/2011 2:14:13 PM |

    A good friend of mine who researches diabetes for a big pharma company in the Northern Illinois area told me there is evidence that if type 2 is not diagnosed it can eventually damage the pancreas and shut it down, causing type 1. It works by damaging a cellular function, which I, not being a scientist, cannot remember the term for. I would bet many children and young adults have the symptoms of type 2 and are oblivious to them, which in some may lead to type 1.

  • Anne

    2/16/2011 2:15:00 PM |

    There is more on T1DM and gluten in The Gluten File  Be sure to also check out "the more on Type 1 Diabetes" link

    One abstract is a case report:"We report on a 15-y-old adolescent boy affected by silent coeliac disease, abnormalities in glycoregulation and with autoantibodies specific to diabetes mellitus type 1 (ICA: islet cell antibodies) and GAD 65 (autoantibodies against glutamic acid decarboxylase), in whom normalization of glycoregulation and disappearance of the immunological markers of pre-diabetes were observed after 6 mo on a gluten-free diet. The patient was followed-up for 36 mo and showed a normal insulin response to an intravenous glucose tolerance test and no markers of autoimmunity. It is possible that undiagnosed coeliac disease over a long period could lead to a direct autoimmune mechanism against pancreatic beta cells. Conclusion: Our findings seem to confirm the theory that undiagnosed coeliac disease can induce an autoimmune process against the pancreatic beta cells and that, following a gluten-free diet, the immunological markers for diabetes mellitus type 1 will disappear." PMID: 12434905 2002

  • Brent

    2/16/2011 2:47:05 PM |

    If modern wheat is causing an increase in type 1 diabetes, it would have to be from an effect OTHER than the blood sugar spikes it causes.

    Two days ago I tried a pasta made from 100% einkorn, a grain unaltered for thousands of years.  The blood sugar results were terrible:

    Before meal:    108
    30 min after:   149
    45 min after:   132
    60 min after:   170
    120 min after:  180

    I do not dismiss that some component of modern wheat may be causing the increase in type 1 diabetes, but it is certainly not the blood sugar spikes as these seem to occur with old world wheat as well as modern.

  • Dr. William Davis

    2/16/2011 3:12:17 PM |

    Hi, Steve--

    Yes, indeed. The vitamin D issue is a real issue, as well, that has been shown to be involved in the type 1 occurrence.

    However, I am skeptical that this is responsible for the increase in incidence.

  • Dr. William Davis

    2/16/2011 3:34:14 PM |

    Thanks, Anne. A very persuasive case.


    Brent--The effect would likely have to be due to the gluten, since that is the most immunogenic of all wheat-related proteins.

    "Gluten" is really a large family of proteins that vary in structure and is highly immune-stimulating.

  • Anonymous

    2/16/2011 4:05:56 PM |

    Should I be tested for celiac disease?  I just learned about the possible connection between autoimmune diseases and grains two weeks ago.  I have allopecia areata and hashimoto's thyroditis and no doctor ever mentioned this possible connection.  Since I heard this two weeks ago I've been trying to learn more and have also started cutting out wheat (but I might still be getting some, I'm new at this) and to some extent other grains.  Then I read that in order to be tested I have to be eating gluten.  Some internet articles say it is important not to stop wheat before getting tested because then going back on gluten to do the test could cause "irreparable damage".  That scared me.  But won't I be doing damage continuing to eat wheat also? I have a dr appt. in 1 month.  Should I start eating wheat again in hopes that my doctor will be interested enough in this to test me at that time?  Wouldn't continuing to eat wheat for a month also cause damage?  I'm confused by the various recomendations and will have to wait a month to talk to a doctor face to face.  I also am nervous that my doctor might not be up on this research because he has never mentioned any possible grain/autoimmune connections so far.   Thanks for any insight you can provide.

  • Nigel Kinbrum

    2/16/2011 4:50:33 PM |

    I second Steve Cooksey.

    Both decreasing Vitamin D status & increasing wheat consumption adversely affect tight junctions in the gut. See Keep 'em tight.

  • Josh

    2/16/2011 4:56:03 PM |

    There has also been a big increase in gestational diabetes.

    Perhaps this is activating T1D genes in utero?

  • Might-o'chondri-AL

    2/16/2011 5:24:06 PM |

    T1DM "... occurs age 3" (or  4)suggests to me a pre-natal epigenetic program keyed to kick in post-natal, after certain developmental (infancy) physical consolidation, yet  before adolescent growth spurt (6?). Wheat can concievably share getting the blame of pushing child's metabolism over the edge with a host of other modern environmental insults, that are themselves capable of engendering epigenetic distortion pre- & post-natally.

  • Anonymous

    2/16/2011 7:16:51 PM |

    If, indeed, wheat is responsible for Type 1 diabetes it should be clearly visible in cross-country studies. The Japanese along with many other Asian countries (but not, e.g. northern China) consume little wheat. What's happening to them with regard to Type 1 diabetes?

  • water

    2/16/2011 11:05:32 PM |

    This study showed that avfoiding casein can help children at risk for T1. (this doesn't exonerate gluten, of course.)

    http://www.nejm.org/doi/full/10.1056/NEJMoa1004809

    "Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children."

  • Dr. William Davis

    2/16/2011 11:40:36 PM |

    Anonymous about testing for celiac markers--

    This is a fairly complicated discussion that will be covered in a future post.

    In the meantime, it is a rock and a hard place issue. You do indeed need to consume wheat gluten for around 6 weeks to regenerate positive gluten markers like endomysial antibody.

  • revelo

    2/17/2011 1:10:12 AM |

    Several people (including Colin Campbell of "The China Study" fame, I know you don't think too highly of him) suggest that cow's milk is the problem. Cow's milk contains some proteins that are very similar to human proteins. When the human body attacks these milk proteins, it also attacks the pancreas as a side-effect. Colin Campbell supports this theory with the following evidence. Type I diabetes (and a number of other chronic diseases) were common in the 19th and early 20th century among Scandinavians living in the inland mountainous area, who ate a great deal of dairy products, but rare among those living near the coast, who ate little dairy but lots of fish.

    Fish consumption would also boost vitamin D, but I am skeptical that vit D deficiency is the cause of type I diabetes, for the following reason. Rickets due to Vitamin D deficiency was widespread among the poor in big cities of the northern United States in the late 19th century, especially among dark-skinned people. But I don't recall reading of a scourge of type I diabetes among the poor back then. The poor couldn't afford much milk then, but now they can, and the milk is now fortified with vitamin D. So we get,

    Then: no cow's milk for the poor, record of widespread rickets indicating widespread vitamin D deficiency, no record of widespread type I diabetes.

    Now: plenty of cow's milk consumption, cow's milk is now fortified with vitamin D, rickets eradicated, rising incidence of type I diabetes.

  • Anonymous

    2/17/2011 2:10:22 AM |

    research on gluten's role in T1:

    http://www.ohri.ca/profiles/scott.asp

  • Daniel A. Clinton, RN, BSN

    2/17/2011 2:27:58 AM |

    Clearly, the cause of Type I diabetes, and its rising incidence, is multifactorial. I think the data implicating Vitamin D deficiency is strong, and a reasonable mechanism is there. It seems likely to me more than one mechanism is capable of producing beta cell destruction, and certainly it requires an overlapping set of phenomena to trigger the immune system to attack the beta cells of the pancreas. I do believe those phenomena are less likely to occur in a child with adequate Vitamin D levels.

  • Patricia D.

    2/17/2011 3:17:38 AM |

    While I believe it clear that wheat plays a role in type II diabetes - I think it's less clear that it plays any role in the onset of type I diabetes. I can't say that wheat doesn't become a factor after onset though.  

    However, this presentation by the late, great Dr. Frank Garland explores the striking role of VD3 deficiency on the rate of diabetes type I in children in Finland.  
    http://www.ucsd.tv/search-details.aspx?showID=15771

    And there seems to be a clear role of VD32 deficiency in Type II diabetes as well - though not as dramatic.
    http://www.vitamindcouncil.org/researchDiabetes.shtml

    So while I personally believe that Wheat is clearly a factor in diabetes type II - it seems that VD3 deficiency magnifies and complicates the risk.

  • anonymous re celiac testing

    2/17/2011 3:23:10 AM |

    Thank you for your response Dr. Davis.  It is frustrating to be in between a rock and a hard place but ultimately I feel lucky that I have this information and can start exploring it further.  I feel hopeful now that there may be more I can do besides just cross my fingers and hope for the best.  Thank you for your blog, I look forward to your future posts!

  • Patricia D.

    2/17/2011 3:36:23 AM |

    Okay - this is England - not Colorado - but it makes a point.  BABIES going to the emergency room with brain seizures as a result of Vitamin D deficiency.  Kids just aren't getting outside anymore - and often when they do they're slathered in sunscreen which stops VD3 production in the skin.

    http://www.thisislondon.co.uk/standard/article-23876481-children-who-shun-the-sun-go-to-casualty-with-seizures.do
    *

  • Art Sands MD

    2/17/2011 4:48:37 AM |

    Dr. Davis - recent study in Finland   - they increased RDA of D3 to 2000 IU - decreased Type 1 DM in kids by 76%

    Art Sands MD

  • reikime

    2/17/2011 6:13:58 AM |

    Anonymous,

    There is a great book called "Celiac Disease, A Hidden Epidemic" by Peter H.R. Green MD. He is a nationally recognized expert.
    It is a very well written book for patients AND Docs who can admit if they don't have all the current info on celiac. The number who can't is staggering! (sorry docs out there) lol

    Read it first, then if your doctor doesn't agree with him,  consider getting another opinion. IMHO..as an RN deeply involved with celiac research.
    Good Luck!

  • Anonymous

    2/17/2011 7:09:34 AM |

    Type 1 diabetes can also be on the rise because - I don't know - MORE CHILDREN ARE BEING BORN?

    And grains/wheat are not the killer, as study after study shows that people who eat grains/wheat live longer than those that don't.

  • Lisa

    2/17/2011 3:13:02 PM |

    Revelo
    Another difference between "then" and "now" might be what the cows were eating. Probably grass then and grain now, which leads to them needing antibiotics, etc.

  • Anonymous

    2/17/2011 4:27:31 PM |

    Gluten and a particular beta-casein (BCM7 in A1 milk)
    have a similar negative effect biologically. Please see this:

    "His work related to both gluten,
    which is somatically quite similar to the BCM7 as well as to milk and casein, and the agribusiness industries over there were very, very negative"

    http://www.guernsey.net/~wgcf/PageMill_Resources/Acres_Woodford.pdf

  • reikime

    2/17/2011 6:55:56 PM |

    Anon,
    I can't get your link to work regarding the guernsey.net...

  • Might-o'chondri-AL

    2/18/2011 5:31:10 AM |

    About that A1 beta casein peptide implicated in health refered to earlier.

    A cultured milk, especially one of mixed bacteria and mycotic microrganisms like Kefir, might have enough proteolytic action(protein cleaving) to render a different peptide. Bacteria use their amino-peptidase enzymes to get amino acids they can use from protein molecules (peptide chains).

    The theory of A1 cow's casein causing "x" disease in lab animals should have a Kefir
    cultured A1 milk control. It would be a step toward proving no one's individual gut
    microbiome has a chance to neutralize A1 casein.

  • Anonymous

    2/18/2011 3:33:05 PM |

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  • Daniel

    2/18/2011 3:45:53 PM |

    Two othe rmajor things have changed in the last 50 years...  

    1.  Vit D levels have dropped due to sun-avoidance and the proliferation of indoor jobs.

    2.  Linoleic acid (omega 6) consumption has risen dramatically.  At the same time, omega 3 consumption has fallen.

    I'm not saying gluten is also a factor (and maybe a big one), but I suspect vit D and polyunsaturated fat are the more important culprits.

  • reikime

    2/18/2011 5:25:19 PM |

    Got it, thanks Nigel!

  • Against the Grain

    2/18/2011 6:12:31 PM |

    Dr. Davis, I was just wondering how your theory correlates with historical wheat intake.

    According to the USDA, per capita wheat consumption in the U.S. was 225 pounds in 1879.  In 1997, it was 147 pounds.  It has, however, been on a rise since bottoming out at 110 pounds in 1972.

    I'm not a data cruncher so I can't interpret these numbers.  But perhaps another HSB reader can.

    http://www.ers.usda.gov/briefing/wheat/background.htm

    Scroll down to "U.S. Wheat Use."

  • Against the Grain

    2/18/2011 8:58:42 PM |

    A chart with the above info graphed.

    http://www.ers.usda.gov/briefing/wheat/Gallery/Consumption/WheatConsumption.jpg

  • Might-o'chondri-AL

    2/18/2011 9:05:00 PM |

    Help me out here, please, on the vitamin D trail.

    Osteo-calcin, a hormone from bone osteo-blasts, raises pancreas Beta cell insulin production and makes fat cell raise adiponectin level for better insulin sensitivity. But, in insulin resistance (diabetes prelude) patients have low circulating osteo-calcin and low numbers of osteo-blasts.

    Osteo-blasts, bone builders,   have their own insulin receptors. They also respond to acidic pH conditions. Maybe a reader knows how acidic things have to get for them (osteo-blasts) to go and trigger osteo-clasts to resorb bone.

    The relevance of the preceeding is: this bone dynamic, of osteo-blasts influencing osteo-clasts goes on to then put osteo-calcin into circulation as an "active" hormone.

    Type 1 diabetic children are susceptible to weak bones; their osteo-clasts apparently provoke re-uptake of excessive bone - a pH driven reaction. And their poor insulin sensitivity seems to indicate osteo-calcin is not at work. I'm stuck on a paradox here somebody might understand.

    Now, diabetics show excessively elevated glycated haemoglobin (HbAC1 indicates high blood glucose persistant enough to stick to haemoglobin). High HbAC1is also seen in low "active" vitamin D individuals. It seems low active D is responsible for D's upstream default on maintaining enough osteo-calcin.
    Raise active D and HbAC1 drops, because osteo-calcin doing it's job improving insulin sensitivity to keep blood glucose controled.

    If someone can connect the way we normally get enough osteo-calcin active  without osteo-clasts tearing down bones please do tell. Is vitamin D able to keep bone pH in a just right
    "sweet spot" by controlling
    calcium ion homeo-stasis in the
    skeleton?

  • Dr. William Davis

    2/19/2011 12:53:00 AM |

    Re: dairy products

    I agree that the product of bovine mammary glands are a problem, as well. However, the magnitude of the problem, I believe, is several orders less than that of wheat.

    Beyond lactose intolerance and allergies to various dairy proteins, I worry about its 1) minor exorphin effect, and 2) the insulinotrophic (insulin-provoking) effect. But, all in all, I still think that wheat--modern wheat--is king in generating adverse effects.

  • Cherry Chapman

    2/20/2011 3:08:26 PM |

    quDear Dr. Davis,
           I do not live in the states anymore, but in addition to the every present processed wheat that we can blame, the diets of American children are just plain pitiful, sky high is all sorts of sugars and processed foods.
    I know that there is a small minority of food conscious American parents, but the vast majority  of children are hooked on juices, sugar sodas, kool aid, fake ice cream, sugary processed cereals, fast foods, chips, sugared salad dressings, and canned and boxed this and that, along with factory breads, and sweets.
    Fruits and vegetables are bred for shelf life rather than taste in the US. To me they taste like plastic in comparison to the fruits and vegetables here in France.
    American children are fed processed junk in  the schools supplied by the USDA.
    Here in Paris, all schools use organic meats and vegetables, The children have 1 and half to 2 hours for lunch. The menus  are given to the parents and are online.  They are 5 courses, including a cheese and fruit
    course and sound like a gourmet restaurant menu!!
    Healthy eating is very highly promoted to children here from a very early age.
    Paradoxically, you rarely see wheat bellies here, though the French usually start their day with a half baguette, thickly buttered in addition to bread at each meal. Big difference is most families buy artisanal bread from highly talented bakers, who generally do not use industrial grade flours.
    I could drone on, but American parents need to start cooking real foods , make family meals a time of sharing at a table, and not gobbled in front of the TV.
    What you grow up eating at home and at school will dictate your food tastes and preferences in the future, so you have to present healthy foods from infancy.
    Keep fighting to present the truth Dr. Davis!
    Cherry Chapman

  • Nigel Kinbrum

    2/21/2011 4:45:54 PM |

    revelo said...
    "Now: plenty of cow's milk consumption, cow's milk is now fortified with vitamin D, rickets eradicated, rising incidence of type I diabetes."
    1) UVB exposure (& supplementation) dictates Vitamin D levels in the body, not food/drink.
    2) Lack of rickets =/= Sufficient Vitamin D for proper gut permeability.

  • cwells

    2/21/2011 10:54:49 PM |

    pure bunk as many adults are becoming type 1 diabetics and it is no longer revered to as Childhood or Juvenile diabetics as many adults such as my self are becoming type 1's, (at age 24), for no discernible reason, It's simply refereed to as type 1 diabetes as it is the same disease, weather you get it as a child or adult it's the same thing.

  • Reijo Laatikainen

    2/22/2011 1:11:32 PM |

    @Art Sands MD .This vitamin D data bases on data from 1970s and is a cohort study (not RCT). Interesting though: and here is the link to the study: http://www.ncbi.nlm.nih.gov/pubmed/11705562

  • Yvonne

    5/17/2011 4:40:48 PM |

    I agree with wheat being a major reason for type 1 diabetes being on the rise. Another possible major player:  Untreated or undertreated hypothyroidism.  I believe that the increasing numbers of morbidly obese people walking on the streets in America may be hypothyroid, either undertreated or untreated, and iodine deficient due to drinking and bathing in fluoridated water.

    Many years ago, Dr. Broda Barnes noted several connections between diabetes and hypothyroidism. In his book, Hypothyroidism: The Unsuspected Illness, he wrote:  "I argue emphatically that since so many of the symptoms and complications of hypothyroidism are identical with those of diabetes, every patient with diabetes should have a basal temperature check and, if the temperature is subnormal, a trial of thyroid therapy." He further said that his diabetic patients who also received thyroid therapy were remarkably free of diabetic complications such as peripheral neuropathy, retinopathy and so on.

  • Dismayed American

    8/9/2011 4:36:04 AM |

    http://www.realmilk.com/raw.html

    http://realmilk.com/milkcure.html

    http://realmilk.com/why.html

    http://www.realmilk.com/testimonials.html

    http://www.realmilk.com/abc-news-raw-milk-story.html

    These are great reads for opening eyes. As an american I believe that what we need is a real milk campaign!

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