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05 - Death by Chocolate
14 Plays6 days ago
India is now the Type 2 diabetes capital of the world, with over 100 million estimated adult cases, and perhaps equally large numbers not yet diagnosed. In some Indian states, the age-specific prevalence of metabolic syndrome among elderly women is as high as 90%.
Barry Popkin, a nutrition and population expert at the University of North Carolina, suggested that, after economies improve and famine recedes, patterns of food consumption and physical activity shift in ways that promote the emergence of obesity and its cardiovascular and diabetes complications. Basically, we are seeing a Westernization of disease patterns all over the world.
A tsunami of cancer cases related to these shifts in the economy, and patterns of eating and exercising, are likely to affect not just India, but all of the Global South, including Mexico, Brazil, Indonesia and elsewhere.
Chocolate might seem to be our friend. But along with fentanyl, vodka, weed and everything else that takes away our pain, it’s just palliative care.
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Transcript
Dramatic Desserts: A Bangalore Experience
00:00:10
Speaker
I heard dessert arriving before I actually saw it. The sizzling chocolate cake, bloated into the dining room, hissing cardamom smoke and oozing chocolate icing that flowed off the flat circular top and pooled around the huge dinner plate where it rested like a volcano caldera.
00:00:34
Speaker
The two twenty-something tech bros at the table near me had ordered it, one for each of them.
The Health Risks of Indulgence
00:00:40
Speaker
I stole glances as I finished my own lunch at a vegetarian restaurant in Bangalore, in India, fascinated and horrified at the same time.
00:00:51
Speaker
I was watching two metabolic bombs of sugar and fat being primed for detonation in a few years, with diabetes and early cardiovascular death almost certain in the future of these two guys.
00:01:08
Speaker
I watched them both finish their entire servings. And then, I'm sure they went back to their offices where they sat for another eight hours in front of computer screens writing code.
Connecting Diabetes and Cancer in India
00:01:23
Speaker
I'm just back from two weeks in India where I've been working with colleagues to understand how type 2 diabetes is driving more aggressive behavior in cancers like breast cancer.
00:01:36
Speaker
Type 2 diabetes, a chronic metabolic disorder, is usually driven by energy imbalance, too many calories eaten, and too few expended in physical activity.
00:01:49
Speaker
A nutrition and population expert at the University of North Carolina at Chapel Hill suggested that after economies improve and famine recedes, patterns of food consumption and physical activity shift in ways that promote the emergence of obesity and its cardiovascular and diabetes complications.
Historical Influences on Modern Diets
00:02:10
Speaker
Perhaps just as significantly, Indian memories of famines, real or threatened during past centuries, may persist in ways that promote the buffet dining model.
00:02:22
Speaker
Perhaps unconscious fear of deprivation prompts that second helping.
00:02:28
Speaker
Early cardiovascular death and cancer, particularly breast cancer, strongly associates with such metabolic abnormalities. Already, about a third of urban South Asians show evidence of metabolic syndrome, a worrisome precursor of type 2 diabetes.
00:02:44
Speaker
In some Indian states, the age-specific prevalence of metabolic syndrome among elderly women is as high as 90%. Unlike in European origin or African origin adults, fat deposition in South Asians, Koreans, Chinese, and other Pacific groups of people is not necessarily and into the reservoirs we recognize in North America and Europe.
00:03:07
Speaker
The big thighs, the rolling gut, the flabby butt, the waggling underarms.
Unique Health Risks for South Asians
00:03:12
Speaker
Instead, fat is deposited internally in visceral organs like liver, kidneys, and around the heart.
00:03:19
Speaker
where it wreaks tremendous metabolic damage to the whole person. South Asian adults need not reach high body weights to experience dangerously elevated risks for cardiovascular disease, stroke, and diabetes as a much heavier Western person might.
00:03:36
Speaker
For this body type, a chocolate kiss could literally provide a pre-taste of early death. Diabetes and premature death is becoming a hidden cost of economic development Broad and obvious measures of increased manufacturing output, disposable income, quality housing, indoor plumbing, and reduced infant mortality are great, but may conceal hidden metabolic danger.
Lifestyle Diseases and Westernization
00:04:03
Speaker
Basically, we are seeing a westernization of disease patterns all over the world. A sedentary lifestyle may be a much more serious health issue for the well-fed Bangalore call center employee than for their American counterpart.
00:04:19
Speaker
Growing energy imbalance, that is calories versus activity, in Asia-Pacific countries is occurring among populations with high insulin sensitivity. These humans have a superb ability to store glucose rapidly and efficiently after a meal, so a slight excess of calories consumed is a big deal.
00:04:38
Speaker
A tsunami of cancer cases related to these shifts in the economy and patterns of eating and exercising are likely to affect not just India, but all of the global south, including Mexico, Brazil, Indonesia, and elsewhere.
Positive Health Trends in Bangalore
00:04:53
Speaker
On the other hand, physical beauty, lean muscularity, and healthy skin are universally desirable traits. Lately, I've noticed an uptick in gym usage in Bangalore.
00:05:05
Speaker
Weight training and attention to diet is popular among the smart and wealthy professionals that make Bangalore Such an appealing destination for young Indian adults with ambition.
00:05:15
Speaker
This is good news. But the real challenge across the global south and in America is rooted in the neoliberal economic model that extracts maximum effort from workers, provides minimum income, and whittles away at available free time to shop carefully, take advantage of a gym membership, enjoy a walk with the dog, and maintain energy balance.
Job Status and Health Outcomes
00:05:42
Speaker
A well-known study of the British Civil Service found that higher status positions associate with better health and longevity. Conversely, stressful overworked lives prompt increased consumption of cookies, ice cream, greasy fried foods, potato chips, beer, and every variety of comfort food.
00:06:02
Speaker
The lower the status of the worker, the worse the conditions and the stress.
Economic Stress and Health Consequences
00:06:12
Speaker
So, as the tech oligarchs and billionaires extract economic value from labor, they leave behind vast, seething underclass of stressed and underpaid workers who are gaining weight, developing diabetes and cancer, who are hopelessly trapped in the rust belt cities of America,
00:06:35
Speaker
They are physically inactive, insecure in housing and health, many are prone to addictions, and are angry and abandoned by the political elites is surely the most visible outward sign of American inequality.
00:06:52
Speaker
Without a major realignment and reform, I think we can expect a tsunami of cases of diabetes-related cancers to engulf America too in coming years, driven also by stress, lack of sleep, increased pollution as environmental protections are stripped away, lack of cancer screening, and insufficient prevention.
00:07:17
Speaker
This will be made worse by the astronomical cost of cancer care and diabetes care over years.
Healthcare Challenges in America
00:07:26
Speaker
Shockingly, there were 539,000 medical bankruptcies in America last year alone.
00:07:34
Speaker
How can Americans tolerate this abuse? Where is the popular outcry? Not only is wealth and working hours, but health itself is extracted from an increasingly stressed, resentful, and desperate American working class.
00:07:52
Speaker
Chocolate might seem to be our friend, but along with fentanyl, vodka, weed, and everything else that takes away our pain, it's just palliative care.
00:08:06
Speaker
Take good care of yourself.