I see fat people.

The big taboo in the US is being fat and smoking.
But seeing overweight people in the Philippines is a new phenomenum.

What has changed? Well, in the past, people walked. Now they have cars or take a tricycle. Before they had “street food” for snacks.Now they have Jolibee and McDonalds.
And of course, with globalization the younger people don’t want to work on the farms and eat rice with a little soup or fish in the evening. They go to Manila to work in a factory and eat supper at Jolibee. Or they are supported by relatives working in Saudi, who sends money for school fees so their younger sister can emigrate to Canada. Farming? The work is too hard. With Land reform, you own your own fields, but the result is that your kids can finish school and has more opportunities and prefers easier work.
So Diabetes is now a problem in the Philippines, although not yet widespread in this rural area, except among businessmen.

In the past, all we heard about was starving people; but now the story is obesity.The BBC today has a “scare story” on how Diabetes is wiping out “indigenous people”. LINK

Why yes. I spent ten years in the Indian Health Service. It’s called “Metabolic syndrome” or “syndrome X”.
Metabolic syndrome is found in about one third of the population. And the scientists are just starting to discover about it.

We all know women who claim they can’t help being fat, and blame it on their genes. They diet and their weight ping pongs up and down.
They are probably fighting Metabolic syndrome.

Probably, in the distant past, those who had Metabolic syndrome tended to use their food more efficiently, putting on weight during the good times, and living off their fat when food was not as plentiful, such as during early spring and during times of famine.

But when there is plenty of food, the fat never leaves.

You can identify people with Metabolic syndrome, because they have no waist (“apple” shape, not “pear” shape). These people tend to put fat on to their trunk. They have no waist, and thin arms and legs.
If they are Native American, often they have “dirty neck syndrome”, AKA “Acanthosis nigricans”, where the skin in the folds of the back of the neck, axilla, and between the legs becomes thick, velvety and greyish in colour.

Metabolically, they tend to be “insulin resistant”, that is, if you measure their insulin, it is higher than normal, but doesn’t move the sugar into the cells to be used as efficiently as in a normal person.
This results in all sorts of problems. Their sugar tends to go up, which causes the cholesterol to go up, and you develop fat deposits in the arteries. This leads in time (usually it takes 20 years ) to heart attacks, strokes, and a lot less blood circulating to the feet.

The high sugar damages the kidneys, so they “leak” protein into the urine and the blood pressure goes up. This high blood pressure causes more kidney damage, and puts stress on the heart and makes one prone to strokes.
The kidney damage leads to kidney failure, so 20 to 30 years after you develop Diabetes, your kidneys fail and you end up on dialysis.

The high sugar means that if you get an infection, the germs grow faster with all that sugar; combine it with lower blood supply and voila, gangrene of the feet.
The artery blockage in the eyes causes new blood vessels to grow into the eyeball; these are fragile and bleed easily, so you can become blind. And the high sugar also causes cataracts.

However, many of the “indigenous” people have had their traditional ways of work disrupted by modern times, and the “do gooders” who gave them welfare or high fat commodities to “improve their nutrition”. So instead of working the fields or fishing, they sit home and develop a sedantary life style.
The treatment is prevention. Decent diet, exercize, keep the weight down.

Some people gingerly use diet drugs. There are always new medicines, and perhaps one day there will be found one that actually works.

And there are certain Diabetic medicines that improve the “insulin resistance”; the hope is that one of these will prevent Diabetes and obesity from developing, if given to younger people. Another “drastic” prevention measure is stomach reduction surgery, but like diet drugs and other experimental methods, it is unknown if these will work over time.
So we are back to the basics: diet and exercize

Many Indian tribes are investing in gyms and health centers with treadmills, stationary bikes, and indoor walking.
Why not just walk around the house, I once asked one of my elderly diabetics…”I’m afraid of the bears” she replied…and indeed, there were bears in the area that had attacked people. And, of course, this was an area where it went 30 below, which discourages jogging.

Are all American Indians prone to Diabetes?
Well, it was not that common when I worked with the Apache. They were a proud people, and many continued to ranch, or worked at the local ski areas or casino, rather than to move to the cities or stay home and live off government checks.

The lack of jobs is part of the reason for the high Diabetes in the Sioux and Chippewa, but ironically the casinos have given enough self reliance to provide jobs so more young people can stay and work, and the added income enables the tribes to invest in other infrastructure and jobs.
So the irony is that Diabetes is a disease of modern diet, but the cure may be another disease: Legalized gambling, resulting in jobs, self reliance, and taking care of one’s health.

—-Nancy Reyes is a retired physician living in the Philippines with her husband, eight dogs, three cats, and a large extended family. Her website is FInest Kind Clinic and Fishmarket

Be Sociable, Share!