Diabetes: The Toxin Connection

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Donna Jackson Nakazawa Did toxins cause your diabetes? Could they be causing other diseases, and is there anything you can do to reduce that risk? Many people have never considered these questions — autoimmune diseases, in which the body’s immune system mistakenly attacks healthy tissue, remain largely under the nation’s radar even though they affect nearly 24 million Americans.

That may soon change thanks to The Autoimmune Epidemic: Bodies Gone Haywire in a World Out of Balance and the Cutting-Edge Science That Promises Hope, by Donna Jackson Nakazawa. Diabetes Self-Management‘s Quinn Phillips talked with Nakazawa about how autoimmune diseases — which include Type 1 diabetes — occur and what, in her view, should be done about them.

Quinn Phillips: Why should people, especially those with diabetes, be concerned about autoimmune diseases?

Donna Jackson Nakazawa: People with one autoimmune disease have a higher risk of developing others. Type 1 diabetes is, of course, an autoimmune disease, and it has been studied more thoroughly than other autoimmune diseases, so it’s sort of a litmus test of what might be happening to our immune systems in general. And the news is frightening: The number of people with Type 1 diabetes is going up exponentially, increasing 6% a year for children four and under, and 4% for children ages 10-14. We’re also starting to understand the triggers of Type 1 diabetes better. Studies have shown that eliminating milk protein from the diet and adding essential fatty acids can reduce the rate of Type 1 diabetes for infants who are considered high-risk because of family members with diabetes. We know that long-term pesticide exposure can increase the risk of Type 1 diabetes, lupus, and other autoimmune diseases. The research is coming together so that we now know not only that the numbers are going up, but what to do about it.

COMMENT: Do you think chemicals — or certain foods — played a role in your developing diabetes?

QP: How does exposure to certain substances lead to an autoimmune response?

DJN: The immune system’s job is to protect us all of the time, and to do this it has to decide whether a substance it comes across is safe or is a foreign substance, an antigen, that needs to be attacked. That might be a bacterium, a chemical, a food, a virus. In autoimmune disease, what happens is that the immune system goes on, after attacking the antigen, to attack the body’s own tissues and systems. All of our body’s tissues and systems have a sort of “bar code,” a protein sequence, that identifies it to the body, and the theory is that autoimmune disease happens when a foreign substance has a “bar code” that is very similar to one in our body. So we’ve outpaced our evolutionary ability to handle exposure to so many foreign substances — there are just too many chemicals and pollutants in the world around us. Genetics plays a role, but exposure to antigens is what ends up triggering autoimmune disease.

QP: You mention in your book that U.S. policy tends to require solid proof of harm to regulate a substance, whereas Europe uses the “precautionary principle.” Is their system better?

DJN: The latest European law, REACH, was put in place in June of 2007. It basically says we need proof that a chemical is safe before we allow it to reach the public, and if something is suspected to be bad, we’ll take it off the market until it’s proven to be safe, and if it’s not, then we need to find an alternative. And guess who pays for the testing? The company that makes the chemical. In the United States, we need “the tobacco story” before we take something off the market — we need to see a large number of people becoming very ill. We don’t want to make companies pay for testing, and we don’t want the government to pay for testing. So around 1,700 new chemicals a year are approved with almost no testing. We have it all twisted. And the precautionary principle is really so commonsense: You need to prove it’s safe before you put it into baby bottles, nail polish, bug spray. I think following the European model would be a great first step in protecting our immune systems.

COMMENT: What do you think of the “precautionary principle”?

QP: Many people claim that requiring extensive testing of chemicals would stifle innovation and make industries under the regulations less competitive. How do you respond to this?

DJN: REACH has been implemented very successfully in Europe, so we already have a working model. Companies can and do adapt to new rules, just as the auto industry is adapting to fuel efficiency standards. Meanwhile, the only alternative to the precautionary principle is to wait and see how many people fall ill, which is more or less our policy right now. We do nothing because we say we have to “prove” that a chemical causes disease in a significant number of people first. Yet proving conclusively that a chemical is harmful based on its effects in a human population is not a simple task, especially with autoimmune diseases. Because the exposure that leads to disease is so often chronic — and from multiple sources — it is difficult, if not impossible, to single out the cause after the fact. And there are other hurdles, as well.

In my book, I write about a stunning incidence of lupus in a neighborhood surrounding a toxic waste site in Buffalo, New York. Because stress is a factor in autoimmune diseases, the Buffalo cluster might also have been blamed on the low-income neighborhood being a highly stressful place to live — which it no doubt was. Epidemiologists working on the cluster also found it difficult to track patients in an underprivileged neighborhood where people frequently moved away or died without having had a proper diagnosis. You can see when we look at clusters why proving a solid link is so difficult. If we don’t start to test chemicals for their effects on the immune system and instead wait for proof of harm, that day of proof may never come. And we will pay far too high a price for sitting idle in the face of a gathering storm.

COMMENT: Do you think we regulate chemicals enough? Too much?

QP: You note that autoimmune diseases are more common in the U.S. than cancer, yet most people aren’t as aware of them, and there are far fewer efforts to track, study, and fight autoimmune diseases. Why is this?

DJN: We’re really “late out of the gate” with these diseases. They weren’t even widely taught in medical schools until the 1980’s. Once they were identified, we passed them on to specialists: Rheumatologists got lupus, neurologists got multiple sclerosis, and so on. We’ve never had much oversight regarding how prevalent these diseases are. We have no national autoimmune disease center the way we do for cancer and heart disease. We do have a diabetes clearinghouse, but for autoimmune disease in general, we’re going to need these diseases to “band together” so that we get a real sense of these numbers. A lot of scientists think that the estimate of 24 million people affected is probably too low.

Autoimmune diseases affect more than twice as many people as cancer yet get one-tenth the funding. Historical reasons help explain this, but I think there’s also something else: that the
se are largely women’s diseases. Almost 80% of people afflicted are women, and I think that has something to do with it. These are difficult-to-diagnose diseases, and for a long time people who were diagnosed with them were considered to be malingerers or hypochondriacs because the diagnoses were difficult to confirm. The average woman sees six doctors over four years before she gets a diagnosis. What’s happened in the last decade to change this is that we now have much better autoantibody tests [autoantibodies are proteins present in an autoimmune attack]. Although it can still take several years — doctors who aren’t well versed in these diseases dismiss patients to this day — with specific autoantibody counts, you can’t say to someone, “It’s just in your head.”

COMMENT: Do you think women are taken less seriously as patients?

QP: A recent study found that exposure to certain pesticides increases the risk of Type 2 diabetes, and separate studies have shown that about 10% of people with Type 2 diabetes have autoantibodies usually associated with Type 1 diabetes. Do you think we will find autoimmune connections to conditions that we don’t recognize now as autoimmune diseases?

DJN: That is happening right now with atherosclerosis. We know that in atherosclerosis, when the plaque breaks off the artery wall, there is an autoimmune response involved. Imagine if we took everyone with atherosclerosis and included them in autoimmune disease numbers — it would be huge. We haven’t done that yet, but we probably will within 10 years, or at least recognize that there is an autoimmune reaction involved. Certain reactions to viruses also turn out to be autoimmune in nature. So I think that we’re going to see the “autoimmune umbrella” include more diseases.

QP: What do you think are the top two or three ways for people to protect themselves from environmental triggers of autoimmunity?

DJN: First, for any autoimmune disease, having a good diet is hugely important. You can look into any “anti-autoimmune diet” — I have one in my book. They’re basically whole-foods diets that are gluten-, dairy-, additive-, yeast-, sugar-, and alcohol-free. Second, look around at things you come into contact with every day. What are you cleaning with? There are so many “green” cleaning products now, there’s no reason not to “clean green.” You can avoid cosmetics with parabens and phthalates in them. You can avoid drinking coffee in plastic-coated paper cups. You can unclog a drain with vinegar and baking soda. You can go to an organic dry cleaner. Little choices like these don’t seem like a lot, but over time they add up.

I’ll introduce an analogy: Think of the immune system as a barrel that gets filled with potential environmental triggers. You can fill that barrel pretty high, but as long as it doesn’t overflow, you’re fine. You just have to take enough out of the barrel so that it doesn’t overflow. Stress is also an important autoimmune trigger, so don’t let eliminating potential triggers create more stress — it’s not worth it. Try to develop some sort of antistress routine, such as yoga, meditation, a daily walk, visualization, or prayer. So I think limiting risk takes a three-prong approach: managing diet, chemical exposure, and stress.

COMMENT: Do you take precautions to limit your autoimmune disease risk? Will you?

The Autoimmune Epidemic For more information about Donna Jackson Nakazawa and The Autoimmune Epidemic, visit

Related links:
Diabetes Definitions: Autoimmunity
EPA EnviroMapper
Blog: Eating fruits and vegetables

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