1 1 :

NATURE'S Infinite Boor

NATURAL
HISTORY

Ellen Goldensohn
Managing Editor
Thomas Page
Designer

Robert B. Anderson. Florence G. Edelstein,

Rebecca B. Finnell. Jenny Lawrence.
ViTTORio Maestro, Richard Milner.

Sweet Death
Judy Rice, Kay Zakariasen (Pictures)
Board of Editors

LesLine.Samuel M.Wilson
Contributing Editors

Doreen E. Mangels
Copy Editor Genes that used to help us survive starvation may be causing
PeggyConversano the current diabetes epidemic in well-fed westernized societies
Asst, Designer

Mary ErinCullen
Editorial Assl.
by Jared Diamond
DebraL. Baida
Picture Asst.

Carol Barnette
Text Processor
For my wife and me, taking our five- life. Among its secondary consequences,
year-old twin sons to the supermarket is the leading cause of adult blindness i
Sioux M. Logan
Receptionist means traversing a minefield of dietary the United States, the second leadin
dangers. Among breakfast foods, my kids cause of nontraumatic foot amputation
are tempted by the choice between Apple and the cause of one-third of our cases c

Bari S.Edwards Cinnamon Cheerios and Froot Loops, re- kidney failure. The estimated number (
General Manager

Ernestine Weindorf
spectively 85 percent and 89 percent car- diabetics in the United States ranges froi
Asst. to the Publisher bohydrate according to their manufactur- 4 to 12 million people; worldwide, tl
Edward R.BuLLER ers, with about half of that carbohydrate number is probably more than 100 millic
Business Manager

Gary Castle in the form of sugar. Boxes picturing the people.

Circulation Director famous turtles with Ninja powers seduce The most prevalent form of diabeti
Ramon E.Alvarez
Direct Mail Manager
children to ask for Teenage Mutant Ninja arises from the collision of our old hunte
Judy Lee Turtles and Cheese Pasta Dinner, 81 per- gatherer genes with our new twentieth
Circulation Coordinator
cent carbohydrate. Snack choices include century life style. It thereby serves as
Brum lda Ortiz
Fulfillment Coordinator
Fruit Bears (93 percent carbohydrate, no model for other noncommunicable di

Mark Abraham protein) and Teddy Graham's Bearwich eases, such as heart attack, stroke, ar
Production Director
chocolate cookies with vanilla cream (71 cancer, that have similarly catapulted i

LisaStillman
Asst. Production Manager percent carbohydrate); both list com frequency to become the leading causes (

John Matthew Ravida syrup, as well as sugar, among their in- death in westernized societies. But ho
Advtg. Production Coordinator
gredients. All of these foods contain little did genes that produce a serious diseas
Advertising Sales(212) 599-5555 or no fiber. Compared with the diet to become so prevalent, despite the ongoir
310MadisonAvcnue,NewYork.N.Y. 10017 which our evolutionary history adapted operation of natural selection to eliminat
GeraldG, Hotchkiss
AdvertisingSales Director us, they differ in their much higher con- harmful genes? Could it be that the gem
Edgar L. Harrison now giving us diabetes were actually goo
New York Sales Manager
tent of sugars and other carbohydrates (7
GordqnG. Bring, Jr., to 95 percent instead of about 15 to 55 for us before our plunge into the moder
Kim J. Hewson. Ursula Webster
Account Managers percent), much lower protein and fiber life style?
CAicogo, Jerry
ZV/TO//
Grecoi Assoc. (312) 263-4100
Norma Davis(3t 3)647-791
content, and in other respects. I mention You may recall that the primary man
Lai/4n^W«, Globe Media Inc. (213)850-8339 these particular brands, not because they festation of diabetes is high concentn
Son Francisco: G\a\x Media Inc. (41 5) 362-8339
Tbronio American Publishers Reps. (416) 363-1388
are unusual, but precisely because their tions of the sugar glucose in the bloo(
content is typical of what is available. with the result that glucose spills over int

American Museum With foods like these so popular, it is no urine. From this manifestation stems th
OF Natural History wonder that most Natural History read- disease's name, diabetes mellitu;
full
George D.Langdon, Jr. William T. Golden ers will die of diet- and life-style-related based on the Greek words meaning "rur
President and Chairman
Chief Executive Board of Trustees diseases, including diabetes, the common- ning-through of honey." About 10 percer
Natural History (ISSN 0028-07 2) is published monthly by the
1
est disease of carbohydrate metabolism. of cases in the United States represent sc
American Museum of Natural Hislory, Central Park West at 79th
Sirecl, New York. N.Y 10024. Subscriptions: $25.00 a year. In Granted, diabetes isn't infectious or rap- called juvenile-onset, or type I, diabetes
Canada and
paid at New
all other countries: $34.00 a year. Second-class postage
York, N.Y.. and at additional mailing offices. Copy-
idly fatal, so it doesn't command press in which the body destroys the pancreati
right O 1992 by American Museum of Natural Hislory, All rights headlines, as does AIDS. Nevertheless, cells that produce the hormone insulir
reserved. No part of this periodical may be reproduced without
written consent of Natural Hislory. Send subscription orders and the world epidemic of diabetes today This form of diabetes is distinct not only i:

undeliverable copies to ihc address below. Membership and sub-

scription information: Write to address below or call (800) 234-
eclipses the AIDS epidemic in its toll of its cause and treatment but also in it
5252 if Postmaster; Send address changes to Natural
urgent.
death and suffering. Diabetes disables its evolutionary origins (a subject I'll save fo
History. Post Office Box 5000. Harlan. lA 51537-5000.
victims slowly and reduces their quality of another piece). For now, I'll discuss ir

2 Natural History 2/92

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ALASKA
lie pancreas to release insulin. The insulin
1 turn signals muscle and liver and fat
ells to take up the glucose (thereby halt-
ig the rise in blood glucose) and store it as
lycogen or as fat, to be used for energy
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The hallmark of adult-onset diabetes is enjoy attentive European-style service, superb
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oills and diabetic damage
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)kidneys and eyes and other tissues grad- " Ships' registry: Bahamas

ally develops. That damage is the result,

t least in part, of those chronically high
;vels of blood glucose.
More than 2,000 years ago, Hindu phy-
cians noticing cases of "honey urine"
3mmented that such cases "passed from
5neration to generation in the seed" and
Iso were influenced by "injudicious diet."

hysicians today have rediscovered those

iadly accurate insights, which we now
REGENCY^iCRUISES
 —
rephrase by saying that diabetes involves while remaining in their original home- reached an epidemic 33 percent, ten time
both genetic and environmental factors. lands similarly developed diabetes, in- the U.S. rate and topped only by the Pirn
Evidence for a role of genes includes the cluding many Native American groups, epidemic.
increased risk of getting diabetes, ten native (aboriginal) Australians, and Mi- The Nauru islanders and Pima Indian:
times higher, you have a diabetic first-
if cronesians and Polynesians. and the many other peoples whose exii
degree relative than if you don't. Further These proofs of an environmental role tence suddenly became westernized as
evidence is that, in Western society, the in diabetes are illustratedby the tragedies result of either migration or new cond
so<alled concordance for diabetes be- of the two peoples with the highest rates of tions at home, experienced a characterii
tween identical twins, who are identical in diabetes in the world: Pima Indians and tic suite of linked simultaneous changes i

their genes, is very high. That is, usually Nauru islanders. To consider the Pimas life style and diet. All these peoples bf
either both twins develop diabetes or nei- first, they survived for more than 2,000 came less active physically. They ir

ther does. In fraternal twins, who share years in the deserts of southern Arizona, creased their average daily calorie intaki
only half of their genes, such concordance using agricultural methods based on Their food consumption became mor
is correspondingly lower. While these ob- elaborate irrigation systems, supple- regular: they ate three meals a day, eatin
servations are compelling evidence for ge- mented by hunting and gathering. Be- each time until they were full, instead c
netic predisposing factors, the exact mo- cause rainJFall in the desert varies greatly eating whatever was available whenevc
lecular effect of the diabetes-producing from year to year, crops failed about one they could get it. More of their calorie
genes is not yet known. year in every five, forcing the Pimas then came to be form of sugar and k
in the
But diabetes also depends upon envi- to subsist entirely on wild foods, especially (especially saturated fat), and less in th
ronmental factors. Even if you are geneti- jack rabbits and mesquite beans. Many of form of complex carbohydrates and fibe
cally predisposed to diabetes, you won't their preferred wild plants were high in They consumed more salt. All these fa(

necessarily get the disease, as would be fiber, low in and released glucose only
fat, tors are so inextricably Unked in the phi
the case if you carried a pair of genes for slowly; thus they represented an ideal nomenon we call westernization that it

muscular dystrophy or Tay-Sachs disease. antidiabetic diet. After this long history of unclear which particular ones have cause
And the risk of developing diabetes does periodic but brief bouts of starvation, the the resultant epidemic of diabetes.
increase with age, and with having dia- Pimas experienced a more prolonged bout Clearly, though, new factors of tt
and with being
betic first-degree relatives, of starvation beginning in the nineteenth Western life style unmasked effects (

bom of a diabetic mother, which we can't century, when white settlers diverted the preexisting genes, since the consistent r
do anything about. But other risk factors water supply on which their agriculture suit has been diabetes within a few d
that predict diabetes are under our con- depended. Today, they eat store-bought cades or less — far too rapid to attribute i

trol, including being overweight, how food. altered gene frequencies. The role of pr
much we eat, and what we eat. Most di- Observers who visited the Pimas in the existing genes is well illustrated by studii
abetics (I emphasize again, most adult- early 900s reported obesity to be rare and
1 carried out on the Mexican population i

onset diabetics) can reverse their symp- diabetes almost nonexistent. Since the San Antonio, Texas. Modem Mexicaj
toms by minimizing those risk factors 1960s, obesity has become widespread arose from the mixture of Mexico's pr
especially by reducing their consumption among the Pimas, some of whom now 1500 Indian population with white Spa
of concentrated sugar and fat and total weigh more than 300 pounds. Half of iards who began to arrive with Cortes
calories, and thereby losing weight. them exceed the U.S. ninetieth percentile 1519. Depending on the particular tow
The same environmental risk factors for weight in relation to height. Pima or even suburb, in Mexico where oi
that predict diabetes in individuals also women consume about 3,160 calories per looks, one can still find local populatioi
predict it in whole populations, hence the day (50 percent over the U.S. average), 40 that are largely white and others that ai
worldwide rise in those risk factors under- percent of which is fat. Associated with largely Indian, as indicated by genetic ar
lies the current worldwide epidemic of this obesity, Pimas have achieved notori- other markers. The Mexican populatioi
diabetes. Disease rateshave recently been ety in the diabetes literature by now hav- of three different neighborhoods of Ss,

shooting sky-high in many groups of mi- ing the highest frequency of diabetes in Antonio, estimated to be on the avera§
grants whose move shifted them from a the world, nineteen times that of U.S. 46 percent, 27 percent, and 18 percei
vigorous Spartan life style to a sedentary whites. Half of all Pimas over age thirty- Indian in their genes, have been compare
one based on abundant supermarket food. five, and 70 percent of those at age fifty- with each other and with Anglo white Te;
A dramatic example involved the Yemen- five to sixty-four, are diabetic. ans (0 percent Indian). The frequency <
ite Jews who were airlifted to Israel by The case of Nauru, a small, remote diabetes turns out to fall in the same &
Operation Magic Carpet in 1949 and island in the tropical Pacific, is only quence: 15 percent, 10 percent, 5 percen
1950, and were thereby plunged abruptly slightly less extreme. Nauru islanders and 3 percent. Even after controlling f(

from medieval conditions into the twenti- used to work hard to feed themselves by obesity, the frequency remains seven
eth century. Although Yemenite Jews fishing and gardening, until it was discov- times higher in Mexicans than in Anglo
were almost free of diabetes on reaching ered that Nauru rock has the world's high- This parallel between the frequency c

Israel, 13 percent of them then became est concentration of phosphate, an essen- diabetes and the estimated proportion c

diabetic within two decades. Other mi- tial ingredient of fertilizer. Nauru today is Indian genes suggests that genes predi
grants who sought opportunity and in- independent, and its per capita wealth, posing under westernized conditions to d
stead found diabetes include Mexicans derived from phosphate revenues, is abetes occurred at a higher frequency i

and Japanese moving to the United among the world's highest. Nauru citizens Mexico's native Indian population than i

States, Polynesians moving to New Zea- get little recom-

land, Chinese moving to Mauritius, and
Asian Indians moving to Fiji, South Af-
rica, and Britain. Still other peoples who
exercise, eat double their Spanish immigrants. The same conclusioj
mended shop in supermar-
calorie intake, emerges from comparisons of diabet^
kets, and heap their shopping carts with rates and white admixture among Nativ
big bags of sugar. The incidence of dia- Americans in North Dakota, Nauru i;|

experienced westernization of life style betes among Nauru adults has now landers, and native (aboriginal) Austr

4 Natural History 2/92

 — .

Let this spunky

woodland favorite
brighten your
home

Handcrafted in fine porcelain,

painted by hand in nature's hues.
There's a snap of autumn in the air.
And high in a stately red oak, there's
a flurry of action,shaking the
leaves. It's chipmunk, scur-
a frisky
rying from branch to branch in
search of winter food. Suddenly, he
spots two perfect acorns. In a
moment, he'll have them safely
stored away.
Now, this delightful scene from
nature has been recreated with such
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of the fall leaves. Autumn Adventure
is a fine porcelain sculpture from

Lenox that is as endearing as the

chipmunk himself.
The artists of Lenox have por-
trayed this woodland favorite with a
wonderful sense of personality. He's
totally intentupon getting his acorn.
Look at the nimble paw grasping
the branch —
and the one that is
poised, just ready to move. His ears
are perked up, and his eyes are
bright and expressive.
Careful, precise brushstrokes com-
plete the illusion of life, portraying © Lenox, Inc. 1992
the rich brown markings that high-
light his eyes and accent the white create the slender stem where the it. This imported work of art will

stripes along his back. The vivid acorns hang. The effect is just right bear the prized Lenox® trademark
hues of the leaves make a lovely and just the extra touch you would in 24 karat gold. Altogether a re-
contrast to the acorns' soft colors. expect from Lenox. markable value for $45, payable in
And the little capped acorns have Autumn Adventure convenient installments.
the smooth nut-brown look of life.
will add an enchant- Welcome this little chipmunk into
For added realism, artisans use ing view of nature your home. Return your reser\'ation
hot-cast bronze with porcelain to wherever you display by February 29, 1992. 674507
/I
I

Autumn Adventure Please mail by February 29, 1992.

Please enter my reservation for
Autumn Adventure, an original Name
PLEASE PRINT
work of art from Lenox, to be
crafted for me in fine porcelain Address
and bronze.
need send no money now.
I
City.
1 be billed in three monthly
will
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the first installment due just State. . Zip_
before shipment.
Mail to: Lenox Collections
*Plus $3.98 per sculpture for shipping, handling and
RO. Box 3020, Langhome, PA 19047-9120

SINCE
insurance. Sales tax will be billed if applicable.

N O X 8 9
 :

lians. Recall that westernized Japanese, eral days, as a result of the failure of my based Westem precisely be
life style as
Chinese, Asian Indians, and Polynesians arrangements for food delivery to our cause it among Europeans am
arose first

also suffer higher diabetes rates than
equally obese or lean westernized Europe-
ans living in the same towns. For whatever
reason (I'll speculate in a moment), this
hints that diabetes-predisposing genes are
now less frequent among Europeans than
among many other populations.
This brings us to an obvious question:
why did genes leading to such a debilitat-
ing diseasecome to be so
so many human populations? If rates of
diabetes were as low as those of muscular
do The first time this happened,
campsite.
when we reached a remote but empty
campsite at sunset after a hard all-day
climb, I expected to be lynched on the
spot. Instead, my New
Guinea compan-
ions were philosophical: "Orait, no gat
kaikai, yumi sleep nothing" ("OK, so
there's no food, we'll just sleep on empty
stomachs"). Conversely, every year or two
common among my New Guinea friends manage to have a
gluttonous feast lasting several days,
food consumption shocks even me
white Americans and is only now spread
ing to other peoples. Perhaps diabetes
related genes have been undergoing elimi
nation in Europe for centuries, as a resul
of many infants of diabetic mothers dyini
i at birth, diabetic adults dying younge
than other adults, and orphaned childrei
and grandchildren of those diabetic adult
dying of neglect. Altematively, Europe
ans and Middle Eastemers may have de
when rived less advantage from a thrifty gene
(rated type ever since the rise of agriculture, i

dystrophy (about 1 in 10,000), the genes' by my friends as a bottomless pit) and a that area's diversity of planted crops, dc
frequency could be explained as nothing few people die of overeating. mestic animals, and fish made starvation
more than the product of a recurring mu- Under these traditional conditions of less acute threat than elsewhere in th'

tation: that is, babies with a new mutation starve-and-gorge existence, those people world.
being bom at the same rate as older bear- with a thrifty genotype would be at an I said at the outset that I view diabete
ers of such mutations die of the disease. advantage, because they could store more as a paradigm of modem death. Peopl
However, no mutation occurs so fre- fat in surplus times and hence better sur- used to die mainly of infectious disease
quently as to appear anew in 3 to 50 per- vive subsequent starvation. Among Pima and violence. Now, the leading killers i
cent of all babies, the actual frequency Indians, only those with the thriftiest the West are noncommunicable disease
range for diabetes in westernized soci- metabolisms could survive their regular that are almost unknown among huntei
eties. Wemust instead assume that the bouts of starvation every five years, or gatherers and peasant farmers. Beside
genes now predisposing to diabetes must their longer bout of starvation when diabetes, these new killers include heai

actually have been favored by natural se- whites cut off their water supplies. The attack, stroke, hypertension, and cancer
lection before our sudden shifts to a west- Micronesian and Polynesian populations of the lung, colon, and cervix. As I prev
ernized life style. What good did diabetes- of remote Pacific islands, including
all ously reasoned in the case of hypertensio
linked genes formerly do for us, and why Nauru, are descended from survivors of {see "The Saltshaker's Curse," Nature
do they get us into trouble now? long canoe voyages, in the course of which History, October 1 99 ), all these new kil
1

Recall that the net effect of the hor- many emigrants died and only those ini- from the collision between our oil
ers arise
mone insulin is to permit us to store the tially the fattest survived. The same genes and our new life style a collision i —
food that we and to spare
ingest at meals starve-and-gorge cycles in less extreme which our bodies come off the losers.
breakdown of our accumulated fat re- form molded modem hunter-gatherers, Yet we're not inevitably the losers, bii

serves. Thirty years ago, these facts in- such as native Australians, and many cause we ourselves created the new lil
spired geneticist James Neel to speculate modem peasant farmers, such as Asian style. Some help will come from moleci)
that diabetes stems from a "thrifty geno- Indians, Japanese, Chinese, and Native lar biological research, aimed at linkiiil

type," making its bearers especially effi- Americans besides the Pima. To most particular risks to particular genes, art
cient at storing dietary glucose as fat. For humans until recently, our modem West- hence at identifying for each of us th
example, perhaps some of us have espe- em fear of obesity and our diet clinics which our particula
particular dangers to
cially hair-triggered release of insulin in would have seemed ludicrous. genes predispose However, society as
us. i

rapid response to a small rise in blood Thus, genes that today predispose us to whole doesn't have to wait for such Tt
glucose concentration. That genetically diabetes may formerly have helped us to search. It is already clear what change
determined quick release would enable survive famine. Animal experiments sup- would minimize many (though not all
those of us with such a gene to sequester port the plausibility of this hypothesis. risks for most of us. Those changes in
dietary glucose before its blood concentra- Laboratory mice with genes for diabetes elude: not smoking; exercising regularl]
tion rose high enough that glucose began survive starvation better than do normal limiting our intake of total calories, alec
to spill over into our urine. mice. Zoos recognize diabetes as a big hoi, salt, sugar, and saturated fats; am
Today, when many of us regularly con- problem for their captive monkeys, whose increasing our intake of fiber, calcium
sume high-sugar meals and rarely exer- lazy existence and regular feedings are the and complex carbohydrates.
cise, such a gene is a blueprint for disaster. monkey equivalent of the All-American This advice is so banally familiar tha
We become fat; our pancreas releases in- life style. it's embarrassing to repeat it. Repetitio;
sulin constantly until it loses its ability to However plausible, this line of reason- merely reemphasizes that the sweet deat)
keep up or until our muscle and fat cells ing doesn't entirely explain why today's of diabetes, and other leading twentietK
become resistant; and we end up with dia- white Europeans have a relatively low fre- century killers, kill us only with our ow)
betes. But consider how almost all people quency of diabetes-predisposing genes, permission. The words of Ralph Waldi
lived throughout human evolution until when most Europeans too lived as peasant Emerson, written in another context, ap
recently. Instead of three predictable, un- farmers until recently. The simplest an- ply as well to dietary sugar today and t
Umited, sugar-rich meals each day, fre- swer may be that current developments diabetes-linked genes yesterday: "Ever
quent food shortages and rare gluts were among the Pimas and Naum islanders are sweet has its sour, every evil its good."
the pattern of life. For example, several telescoping into a single generation the life

times in the course of my fieldwork in style changes that developed over the Jared Diamond studies evolutionary biol
New Guinea, a group of New Guineans course of many centuries in Europe. We ogy and teaches physiology at UCL/
and I went virtually without food for sev- refer to our indolent, obese, supermarket- Medical School.

6 Natural History 2/92