The following essay by yours truly was originally posted by Scott Strange @ Strangely Diabetic. A friend and fellow traveler with Type 1 diabetes, Scott is an astute observer of the medical scene and passionate patient advocate. His blog and tweets (@Strangely-T1) are well-worth reading.
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What caused killer t-cells to attack the beta cells in my pancreas, preventing them from producing insulin, making my blood sugar skyrocket, and triggering my Type 1 diabetes? That was in 1962. No one has come up with a convincing explanation yet. Scientists aren’t even close to figuring out the interactions between the environment, genes, the immune system and who-knows-what-else that result in Type 1 (T1) or Type 2 (T2) diabetes. If you travel around the Internet, it appears that the entire world is one big “risk factor” for these conditions.
Suspects identified by researchers that might play a role in T1D include the smoked mutton consumed by Icelanders between Christmas and New Year’s, various viruses, early childhood respiratory infections, whey, cow’s milk proteins, the timing of solid foods in infants, psoriasis, low levels of Vitamin D, and many more. Risk factors for T2D, besides the well-known ones like obesity, could include not enough sleep and phthalates in soaps, lotions, plastics and toys.
But the culprit that interests me the most doesn’t get much attention in the research labs: trauma and major stress. When I was a kid, the conventional wisdom was that traumatic events –loss of a loved one, accidents– played an important role in diabetes onset. This appeared to be substantiated by a number of population studies in the ensuing decades, but the evidence hasn’t impressed major players in diabetes research. In a long summary of biochemical and environmental risk factors for T1D, the NIH barely touches upon the matter, gives it a few throwaway lines:
Although investigations of stress and IDDM [insulin dependent diabetes] have, in general, reported positive associations, most studies have been retrospective and suffered from methodological difficulties in assessing stress and measuring its frequency, intensity, and duration. Thus, prospective evaluations of the interaction among stress, the immune system, and the occurrence of autoimmune diseases are warranted.
Sorry, NIH, but I am convinced that a specific traumatic event played a major, albeit partial, role in triggering my diabetes.
In a blog post that was mainly about my mother and Sonya Sotomayor’s parents, I described the onset of the disease 51 years ago. It happened very soon after my grandfather died. In my grandmother’s apartment in Manhattan, I was so terrified by the mournful screams from my mother and grandmother when they embraced that I ran away and hid. Within two days, after an earache, sniffles, a sore throat and ravenous thirst, I was hauled to a hospital and suddenly became a kid with a scary disease.
By now, I understand that the trauma of mourning contributed to a process that was probably primed to happen anyway. Maybe my pancreas was already getting ravaged before my grandfather died and before any symptoms appeared. Maybe I would have been hospitalized at about the same time even if the women I loved hadn’t shocked me with their keening. Hard-nosed, data-driven scientists might call it a coincidence that those screams occurred just before the diagnosis. As the NIH notes, more research is needed on this one.
But was it a coincidence that after a major earthquake in California, in 1994, the Children’s Hospital of Los Angeles experienced a sudden, unusually large influx of kids with newly diagnosed T1D? Or that after Israel’s second war with Lebanon, the post-war incidence of T1D was higher than normal in areas in northern Israel that had been attacked, and there was no change in other regions? Or that, in Denmark, the children of mothers who were bereaved during their pregnancies were more likely to develop T1D, according to one study?
Or that the British physician Thomas Wills, in the 17th century, noticed that “Sadness, or long sorrow, as likewise convulsions, and other depressions and disorders of the animal spirits, are used to generate or foment this morbid disposition [diabetes]”?
According to one theory, psychological and/or physical stress are among the factors that cause beta cell “stress” and “accelerate the auto-immune process that leads to their own destruction,” as one researcher puts it. There is at least some evidence that infants under stress have a higher incidence of the “auto-antibodies” –cells that turn around and destroy healthy cells—that are associated with this morbid disposition.
That’s enough evidence for me. But even if you doubt that my reaction to those screams was related to the destruction of my beta cells, you cannot possibly come up with a credible argument against psychologist David Felten, who tells us: “We can no longer pretend that the patient’s perceptions don’t matter… Your mind is in every cell of your body. And your emotions are the bridge between the mental and the physical, or the physical and the mental. It’s either way. Now there is overwhelming evidence that hormones and neurotransmitters can influence the activities of the immune system, and that products of the immune system can influence the brain.”
This is hardly headline news. But thinking of the bodymind as one, integrated entity has never come naturally to me. I am, at heart, a Western guy, who has stayed alive mainly by doing what conventional Western physicians have told me to do. I reflexively consider balancing diet, insulin and exercise as the regimen needed to help my diabetic body. But meditation, and doing xi kung, and telling myself not to get angry at the guy who cuts in front of me on the movie line somehow feel like they are meant to help…something else, something I can’t locate, something that is closer to my authentic self than the clanking, flawed, corroding body that is wrapped around it.
Reading more, of late, about diabetes, the brain and behavior has helped to remind me that the physical aspects of this condition should not be placed in a category that is separate from the psychological aspects; they are part of the same condition. But the quickest way to remember that is to picture a frightened seven year old boy, running down a hallway in Manhattan. I am still doing my best to help him feel better, and that means dealing with everything that is churning within him, from high blood sugar to the terror that his cells have not forgotten.