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#558 - Diabetes is Increasing, 06-Aug-1997

A new study confirms that Vietnam veterans have an increased likelihood
of getting diabetes if they have elevated levels of dioxin in their
blood.[1] Dioxin is a powerful hormone-disrupting chemical found in
Agent Orange, an herbicide sprayed by American forces during the
Vietnam war.

Recent studies have also indicated that diabetes is increasing among
the general population in the U.S.[2] and worldwide. The increase is
especially rapid among children.[3,4] At the recent 16th International
Diabetes Conference in Helsinki, Finland, researchers said that
diabetes is becoming a global epidemic. "I think we can truly say that
the epidemic is here and now," said Paul Zimmet, chief executive
officer of the International Diabetes Institute.[5]

Diabetes is a disease of the endocrine system.[6] Specifically,
diabetes is a disorder of the pancreas, which is a long, thin organ
(roughly 7 inches long), behind your stomach. The pancreas produces
hormones that help digest your food, but the pancreas has another
important function as well: it creates hormones that regulate your
body's use of glucose, a form of sugar that fuels most of the daily
activities of all your body's cells.

The pancreas produces three hormones: insulin, glucagon, and
somatostatin. When the concentration of sugar rises in your blood (for
example, after a meal), insulin stimulates muscle and fat cells to
remove glucose from the blood and store it. Insulin also stimulates
storage of excess glucose in the liver in the form of a starch called
glycogen.

When more sugar is needed in the blood, the pancreas produces the
hormone glucagon to break down glycogen in the liver and turn it back
into sugar, which is then released into the blood stream. The third
pancreatic hormone, somatostatin, is not so well understood as the
other two but is thought to help regulate sugar levels in the blood.

When the pancreatic system fails to control glucose properly, the blood
can end up containing too much sugar --a condition called
hyperglycemia. Eventually the excess sugar is measurable in the urine.
When a person's body is not able to use up the available glucose in the
blood, the person has DIABETES MELLITUS (Greek words for 'honey that
passes through').

There are two kinds of diabetes --insulin-dependent diabetes mellitus
(IDDM), and non-insulin dependent diabetes mellitus (NIDDM). IDDM is
also called Type I diabetes, or juvenile-onset diabetes because it
usually appears during childhood. As the name implies, IDDM requires a
person to take insulin, usually by daily injections. Ten percent of
diabetics have IDDM.

The other kind of diabetes --NIDDM --does not require a person to take
insulin injections. The person's insulin levels are about normal, but
their body seems unable to make good use of insulin. They must control
their blood sugar by controlling their diet. NIDDM is also called
adult-onset diabetes, or Type II diabetes. It usually appears after age
40, and the people who get it are usually obese. Ninety percent of
diabetics have NIDDM.

Diabetes is a serious illness. Its main effect is to cause changes in
the body's small and large blood vessels. These changes, in turn, lead
to other problems: coronary artery disease, heart disease, high blood
pressure, stroke, deterioration of nerves and blood vessels in the
extremities (sometimes requiring amputation), blindness, kidney
disease, and death.

The symptoms of diabetes are vague --tiredness, thirst, and a need to
urinate frequently as the body tries to flush away excess blood sugar.
For this reason, many people have the disease for years without knowing
it. There are 10 million known diabetics in the U.S. and perhaps 5
million more who have not been diagnosed.[6]

Vietnam veterans

The new study of Vietnam veterans looked at dioxin levels in their
blood and related that to sugar and insulin levels in their blood, and
to the prevalence of diabetes and the time-of-onset of diabetes.[1] The
study compared 989 veterans who had participated in Operation Ranch
Hand (spraying roughly 12 million gallons of Agent Orange over 10% of
South Vietnam during the period 1962 to 1971) vs. a control group of
1276 Air Force veterans who served in Southeast Asia during the same
period but did not participate in the herbicide spraying program.
During manufacture, Agent Orange was contaminated unintentionally with
dioxin at a level of about 3 parts per million (ppm).

The median dioxin level in the serum of the Ranch Hand group was 12.2
parts per trillion (ppt) and the median dioxin level in serum of the
control group of veterans was 4.0 ppt. (Blood serum is the fluid
remaining after cells are removed from blood.)

The researchers found that the Ranch Hand veterans were about 50% more
likely to get diabetes, compared to the control group. In addition the
severity of diabetes increased within the Ranch Hand group as the level
of dioxin in blood increased. And lastly, the time-to-onset of diabetes
was less among the Ranch Hand veterans who had more dioxin in their
blood. The study found consistent increases in the likelihood of
glucose (blood sugar) abnormalities with increasing dioxin.

Among the control group, the researchers noted an increasing likelihood
of abnormally high levels of insulin in blood serum as dioxin levels
increased.

Previous studies of industrial workers exposed to dioxin had given
mixed results. Some showed increases in likelihood of diabetes with
increasing dioxin,[7] while others had shown no such increases.[8] Six
studies of three species of laboratory animal (rats, mice, and Guinea
pigs) have shown alterations in glucose metabolism with low levels of
dioxin exposure, thus increasing the biological plausibility of the
idea that dioxin might cause diabetes.[9]

General population

As indicated above, IDDM is largely a disease of children. On the other
hand, NIDDM, is largely a disease of adults. Now, however, NIDDM is
striking more and more children. Prior to 1992, among pediatric
patients with diabetes, only 2% to 3% had NIDDM. In other words, 97% to
98% had IDDM.[3] In recent years, however, there has been a dramatic
increase in the number of children diagnosed with NIDDM. In a study of
youngsters in Cincinnati, Ohio, in 1994, NIDDM accounted for 16% of all
new diabetes cases. Among diabetes patients 10 to 19 years of age in
Cincinnati, NIDDM accounted for 33% of diagnoses of diabetes in 1994.
[3] This represents a 10-fold increase in NIDDM among children in
recent years.

Obesity has been increasing among children in recent years as well.
Between 1980 and 1990, the proportion of children defined as obese
increased from 15% to 21%.[4] The Cincinnati researchers clearly see
these two trends as linked.

The Cincinnati researchers asked themselves whether their results could
be caused by greater general awareness of NIDDM among physicians. Or by
earlier detection and referral. Or by changes in the general population
of Cincinnati in recent years. They ruled out all these potential
confounders and concluded that the increase in NIDDM among children is
very likely a real increase.

Why are more children getting this adult disease? Many researchers have
noted a relationship between obesity and diabetes in both adults and
children. Indeed, in the Cincinnati study, 92% of 1027 children with
diabetes were obese.

However, there is, so far, no known biological mechanism to explain how
the presence of excess body fat might cause diabetes.

The finding that an endocrine-disrupting chemical like dioxin may be
able to promote diabetes opens up new avenues for thought about this
rapidly-increasing disease. Perhaps it isn't fat itself that causes
diabetes --perhaps it is the toxic chemicals stored in our fat that
cause disease. It has been known for a long time that human fat
accumulates toxic chemicals. For example, the U.S. Public Health
Service has been collecting samples of fat from humans for 20 years and
analyzing them for halogenated hydrocarbons,[10] including dioxin,
beta-hexachlorocyclohexane, heptachlor, DDT, DDD, DDE, PCBs,
trichloroethylene, perchloroethylene, 2,4-D, methyl chloride, vinyl
chloride, polyvinyl chloride (PVC), and chloroform, among others. We
each carry literally hundreds of exotic toxic chemicals in our body
fat. For any particular chemical, our fat often has a concentration 100
times as high as the concentration in our blood serum. It is also known
that chemicals can be released from fat to re-circulate in the blood
stream during times of pregnancy, stress, illness or fasting. Many fat-
stored organohalogens are known to interfere with our endocrine systems
by mimicking or blocking natural hormones.[11]

Diabetes is on the rise worldwide. "I expect diabetes to be one of the
major killers of the world in the year 2010," says Jak Jervell,
president of the International Diabetes Federation.[5] Worldwide, an
estimated 135 million people have been diagnosed with diabetes. By
2025, the World Health Organization predicts, the number will be 300
million. "What is bothering me is that the developing world will bear
the brunt of this increase," says Jervell. He was referring to people
adopting an American lifestyle: fatty fast food, with little or no
physical exercise. But there's another key feature of American life
that we often don't advertise: from exposure to water, food, and air,
we all take a bath more or less continuously in low levels of exotic,
poorly-understood toxic chemicals, many of which interfere with our
hormones. No doubt about it, for many people it's a wonderful life. But
the price we pay in chronic disease is high and steadily rising.[12]

--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)

=====

[1] Gary L. Henriksen and others, "Serum Dioxin and Diabetes mellitus
in veterans of Operation Ranch Hand," EPIDEMIOLOGY Vol. 8, No. 3 (May
1997), pgs. 252-258. Earlier studies suggesting that Vietnam Veterans
have an increased likelihood of diabetes are reviewed in Institute of
Medicine, VETERANS AND AGENT ORANGE: HEALTH EFFECTS OF HERBICIDES USED
IN VIETNAM (Washington, D.C.: National Academy Press, 1993), pgs. 11-
12, 11-13, and 11-15 through 11-17; see also Chapter 6.

[2] J.A. Fain, "National trends in diabetes. An epidemiologic
perspective," NURSING CLINICS OF NORTH AMERICA Vol. 28, No. 1 (March
1993), pgs. 1-7.

[3] Orit Pinhas-Harniel and others, "Increased incidence of non-
insulin-dependent diabetes mellitus among adolescents," THE JOURNAL OF
PEDIATRICS Vol. 128, No. 5, Part 1 (May 1996), pgs. 608-615. And see
Associated Press, "Adult Diabetes Type on Rise in Young," NEW YORK
TIMES July 8, 1997, pg. C7.

[4] Carla R. Scott and others, "Characteristics of Youth-onset
Noninsulin-dependent Diabetes Mellitus and Insulin-dependent Diabetes
Mellitus at Diagnosis," PEDIATRICS Vol. 100, No. 1 (July 1997), pgs.
84-91.

[5] Maggie Fox, "World suffering diabetes epidemic, conference told,"
Reuter World Service July 21, 1997. (Available in File 611 of the
Dialog online database. Phone: 1-800-334-2564.)

[6] "Your Endocrine System," in David E. Larson, editor, MAYO CLINIC
FAMILY HEALTH BOOK Second Edition (New York: William Morrow, 1996),
pgs. 923-952, especially pgs. 925-936.

[7] M.H. Sweeney and others, "Prevalence of diabetes and elevated serum
glucose levels in workers exposed to 2,3,7,8-tetrachlorodibenzo-P-
dioxin (TCDD)," ORGANOHALOGEN COMPOUNDS Vol. 10 (1992), pgs. 225-226.

[8] Andreas Zober and others, "Morbidity follow up study of BASF
employees exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) after a
1953 chemical reactor incident," OCCUPATIONAL AND ENVIRONMENTAL
MEDICINE Vol. 51, No. 7 (July 1994), pgs. 479-486. But see also M.G.
Ott and others, "Laboratory results for selected target organs in 138
individuals occupationally exposed to TCDD," CHEMOSPHERE Vol. 29
(1994), pgs. 9-11.

[9] The animal studies are listed in notes 16-21 of reference [1].

[10] Lenore Kohlmeier and Martin Kohlmeier, "Adipose Tissue as a Medium
for Epidemiologic Exposure Assessment," ENVIRONMENTAL HEALTH
PERSPECTIVES SUPPLEMENTS Vol. 103, Supplement 3 (April 1995), pgs. 99-
106.

[11] See, for example, Robert M. Bigsby and others, "Xenobiotics
Released from Fat during Fasting Produce Estrogenic Effects in
Ovariectomized Mice," CANCER RESEARCH Vol. 57, No. 5 (March 1, 1997),
pgs. 865-869.

[12] See REHW #536.

COME BEAR WITNESS TO INJUSTICE

Next Thursday, August 14 at 4:30 p.m. a silent vigil will help us all
bear witness to the huge injustice represented by the WTI incinerator
in East Liverpool, Ohio. (See REHW #255, #287, #288, #298, #315, #320,
#325, #326, #328, #341, #542.)

At 6:30 that evening, the U.S. EPA will once again hold a public
hearing to explain to the citizens of East Liverpool why their children
must attend an elementary school 1100 feet from the stack of the
largest hazardous waste incinerator in America.

On May 8 EPA released its 3800-page risk assessment on the WTI
incinerator and sent one copy to one citizen in East Liverpool. On May
9 EPA held a public hearing in East Liverpool to take testimony on the
risk assessment that no one had seen, much less read. Peer reviewers
were given 10 days to review the 3800 pages and send their comments to
EPA. One day after the deadline for peer review comments -- May 20th --
EPA issued the full commercial operating permit to the WTI incinerator.

Words cannot express the outrage and disgust that we feel. Has there
ever been a government agency more arrogant or more cynical than
William Jefferson Clinton's (and Carol Browner's) EPA? Come bear silent
witness with us. At the East End Elementary School in East Liverpool,
Ohio at 4:30 pm. (Don't know where it is? Come to town and ask.) And at
the EPA public hearing in City Hall at 6:30. Be there if you can. This
is one of the most important citizen fights of this century. We must
never concede victory to the forces of evil -- the Von Roll Corporation
and its corrupt acolytes in Washington. --Peter Montague

Descriptor terms: vietnam vets; agent orange; dioxin; diabetes
mellitus; pancreas; hormone disruptors; insulin; glucagon; glycogen;
hyperglycemia; iddm; niddm; ranch hand; operation ranch hand;
cincinnati; disease statistics; mortality; morbidity; obesity;
somatostatin; wti;