EP051: The Diabetes Epidemic
The Diabetes Epidemic: How We Got Here And How We Turn It Around
“Our biology didn’t change. Our environment did.”
Today, we’re zooming out. Usually we talk about what you can do this week for your blood sugar. This time, we’re asking a bigger question: Why does the diabetes epidemic exist—and what can we do together to fix it?
Set the scene. It’s 1926. Most people live in small towns. Food is cooked at home. People walk a lot. Insulin is brand new. Fewer than 1 in 100 Americans have diabetes.
Fast-forward to 2026. The CDC reports 38.4 million Americans have diagnosed diabetes. Another 97.6 million adults have prediabetes. That’s about half of U.S. adults with impaired glucose metabolism. Most people with prediabetes don’t even know they have it.
Our biology didn’t change. Our environment did.
Act 1: The Baseline (1926–1945)
Food was simple: whole grains, beans, veggies, eggs, dairy, small amounts of meat. Lots of fiber. Almost no ultra processed food.
Movement was built in: farming, walking to school, hanging laundry, manual work.
Skeletal muscle is the body’s biggest glucose “sponge.” When you move, GLUT4 transporters help pull sugar into muscle—even without much insulin.
Result: high insulin sensitivity, stable blood sugar, diabetes prevalence under 1%.
Act 2: First Cracks (1945–1970)
Suburbs grew fast. Cars replaced walking. Incidental movement quietly disappeared.
Food industrialized: canning and freezing at first, then convenience culture started. Fast food and frozen dinners spread.
Fiber started falling as refined products replaced whole foods.
Why fiber matters:
Slows glucose absorption and insulin spikes.
Feeds gut bacteria that make butyrate, lowering inflammation.
Increases fullness.
Big evidence: Higher fiber intake links to 15–30% lower risk of type 2 diabetes, heart disease, and all-cause mortality. Yet fiber was stripped from the food supply.
Act 3: Acceleration (1970–1995)
Force #1: The low-fat era
Fear of fat led to low-fat products loaded with sugar and refined carbs.
Low-fat yogurt became high-sugar dessert. Fat-free dressings became chemistry sets.
Metabolically, this was worse for glucose control.
Force #2: High fructose corn syrup (HFCS)
Cheap, sweet, everywhere—especially in drinks.
In the liver, excess fructose drives new fat creation, visceral fat, insulin resistance, and fatty liver.
Fruit is not the problem. HFCS and ultra processed foods are.
Force #3: The “calories are calories” myth
A gold-standard NIH study showed people ate ~500 more calories/day on ultra processed diets vs unprocessed diets—same macros offered, but processed foods hijacked satiety.
The food matrix, speed of digestion, hormones, and fiber matter. Ultra processed foods are engineered for overconsumption.
Force #4: Physical education (PE) declines
Daily PE used to be common. Evidence shows movement boosts learning and brain function.
Testing pressure cut PE and recess. Kids sat more, moved less.
That removed a major daily glucose sink for a whole generation.
Act 4: Explosion (1995–2015)
Ultra processed food dominated—now ~58% of U.S. calories and ~90% of added sugar.
Movement fell across ages. Screens rose. Shift work grew.
Sleep eroded with always-on tech.
Chronic stress became the norm, especially where resources are few.
Sleep and stress hit metabolism hard:
One week of 4-hour nights can push healthy young adults toward prediabetic patterns.
Poor sleep raises cortisol and hunger hormone (ghrelin), lowers satiety hormone (leptin), drives cravings, and weakens impulse control.
Chronic stress keeps cortisol high, raises glucose, increases belly fat, disrupts appetite, harms sleep, and creates a vicious cycle.
Health gaps are system gaps:
Diabetes rates are highest where people face food deserts, low incomes, limited care, unsafe places to move, and more stress.
This isn’t 136 million people “failing.” It’s systems failing people.
Act 5: Hidden Machinery—Microbiome and Inflammation
Your gut microbiome is like a 2–4 pound metabolic organ.
People with type 2 diabetes often have lower diversity and fewer butyrate-producing bacteria.
Low fiber and ultra processed foods starve the “good guys” and feed microbes linked to inflammation.
Chronic low-grade inflammation drives insulin resistance. Cytokines like TNF-α and IL-6 can blunt insulin signaling.
Bottom line: Type 2 isn’t just “high sugar.” It’s a whole-body metabolic disease involving insulin resistance, beta-cell strain, inflammation, mitochondria, hormones, and gut-immune crosstalk.
Act 6: What about genetics?
Genetics load the gun. Environment pulls the trigger.
In 1958, diagnosed diabetes was ~1.5%. Today it’s >11% (and about half of adults have diabetes or prediabetes).
Genes didn’t change that fast. The environment did.
The hopeful part: When we change the environment (food, movement, sleep, stress), the body often improves—sometimes quickly.
Act 7: A note on Type 1 diabetes
Type 1, an autoimmune disease, is also rising ~3% per year globally.
Likely a mix of genetics plus environmental triggers: some viral infections, early microbiome disruption, less outdoor time/vitamin D, hygiene hypothesis, possible toxins.
Even here, environment matters.
Act 8: A 100-Year Snapshot
1926: Whole food, daily movement, solid sleep, very low diabetes.
1950s–70s: Cars and suburbs, industrial food, low-fat–high-sugar era, HFCS arrives, fiber falls.
1980s–2000s: PE cut, screens soar, sleep drops, stress rises, fast food normal, food deserts grow.
2010s–2020s: Smartphones everywhere, sitting is default, ultra processed food rules, microbiome research reveals the damage.
Result: A diabetes epidemic in the richest country on earth.
So who’s the “villain”?
There isn’t one. It’s the sum of systems—food, education, transport, economics, healthcare—each making choices that seemed reasonable alone but were harmful together. The most damaging myth is blaming individuals. As long as we do that, we won’t fix the systems.
Act 9: What it would take to reverse the diabetes epidemic
Food policy
Incentivize whole foods (fruits, veggies, legumes, whole grains) the way we subsidize corn and soy.
Clear, science-based labels people can trust.
Limit junk-food marketing to kids.
Fix institutional food: schools, hospitals, prisons, bases.
Movement by design
Walkable towns, safe bike lanes, parks and green space.
Bring back daily PE and teach nutrition in schools.
Design daily life so moving is the default.
Healthcare that prevents, not just treats
Earlier, smarter screening: fasting glucose plus fasting insulin, A1C, lipids, inflammation markers.
Coverage for nutrition counseling and lifestyle medicine.
Use CGMs for at-risk people with qualified guidance.
Train clinicians in metabolic and nutrition basics.
Address the social drivers
You can’t fix diabetes without tackling poverty, food insecurity, housing instability, and structural racism.
The social determinants of health are the metabolic determinants of health.
Culture change
Movement is a fundamental need, not a luxury.
Cooking is a life skill, not a hobby.
Sleep is health, not laziness.
Retire the willpower myth. Shame doesn’t heal.
What you can do this week
Add fiber first: beans, lentils, oats, veggies, berries. Aim for 25–38 grams/day. Increase gradually and hydrate.
Move most hours: short walks after meals, light strength work, take the stairs, stretch breaks.
Guard your sleep: dim lights at night, set a wind-down routine, keep the room cool and dark.
Turn down stress: short breaths out, walks outside, journaling, quick chats with a friend, simple boundaries.
Cook simple: one-pan meals, batch cook beans and grains, frozen veggies are great.
Share this message: Send this post to someone who needs to hear “it’s not your fault—and there is a path forward.”
Two asks from us
Send this to at least one person with diabetes or prediabetes who needs relief from the blame game and a clear path.
Share this with your local, state, and federal representatives. Half their voters are affected now or soon. Policy can change outcomes. You can find contacts for your elected officials at https://www.usa.gov/elected-officials.
Hope, not hype
Type 2 diabetes often develops over years. The good news: the body responds when the environment improves. In studies, lifestyle programs cut diabetes risk by 58%—better than metformin alone. We see this in our community all the time. Change the inputs, and your biology starts working for you again.
It’s not your fault. But it can be your fight. It’s our fight, together. And we’re here for it. Reach out to us at [email protected].
Take courage. We can do this, and you can help.
Disclaimer
The information in this blog post and podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.
Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.
We strive for accuracy, but health information changes over time. We make no guarantees regarding completeness, timeliness, or suitability of the content and assume no liability for actions taken or not taken based on this material. Use of this content is at your own risk.
Links or references to third-party resources are provided for convenience and do not constitute endorsement. By reading, listening, or using this information, you agree to these terms and understand that you are responsible for your own health decisions in partnership with your licensed healthcare provider.
