Dr. Kent Thornburg

Diabetes rates in Oregon have tripled since the 1990s. That statistic alone is alarming. Even more concerning is the relationship between diabetes and America’s leading cause of death – heart disease.

Almost 70% of diabetics will die of cardiovascular disease, according to the American Heart Association. As diabetes rates climb, heart disease will follow. The Oregon Health Authority expects heart disease to affect more than a million Oregonians by 2030. That’s almost double the entire population of Central and Eastern Oregon.

Diabetes is essentially a disease of the blood vessels caused by too much blood sugar. The pancreas, a small organ next to the stomach, produces a hormone called insulin that helps cells absorb the glucose, or sugar, that comes from food. The body uses glucose as its main source of energy. When the pancreas doesn’t make enough insulin, or when the body’s cells become resistant to the effects of insulin, high levels of glucose remain in the blood and not enough makes it into the body’s cells. High blood sugar then circulates throughout the body and causes a variety of complications. The most serious among these complications is blood vessel damage and heart disease.

People with diabetes tend to develop heart disease at a younger age than those without diabetes, and those who have their diabetes under control are still twice as likely to have a heart attack or stroke than those without diabetes. Diabetics are also more likely to have high blood pressure, cholesterol and triglycerides - all of which increase the risk for heart disease.

So why do some people get diabetes, while others don’t? We now understand that the seeds of chronic diseases like diabetes are sown much earlier than previously thought. In fact, much of a person’s risk for chronic disease is established before birth. Individuals are at an increased risk for developing diabetes, along with other chronic diseases like obesity and high blood pressure if their mothers had diabetes. They are also at greater risk if they had poor nutrition during their time in the womb and in the first two years of life. This is because the nutrition received during this time affects how robustly organs and bodily systems develop. It can also activate or silence genes that promote health or genes that harm health.

However, much of that initial risk can be overcome if people consume a nutritious diet throughout their lives.

As American diets have changed over the past half-century, from home-cooked meals to processed and fast food, our risk for developing chronic diseases as adults is rising. That risk is then passed on to the next generation when adolescents who were raised on sugary beverages and high-calorie, low-nutrient food products become parents. We are now part of the third generation to be eating poor diets high in processed foods, and we are seeing that each generation is more vulnerable than the last for developing chronic diseases. Thus, obesity, diabetes and heart disease are continually rising and in order to turn the tide, we must begin focusing on prevention.

Heart disease is the most expensive chronic disease to treat. The development of innovative treatments by groups like the OHSU Knight Cardiovascular Institute keep people alive much longer, but that comes at a steep cost. According to the American Heart Association, heart disease costs the U.S. well over $1 billion per day in direct and indirect costs. By 2035 that is expected to rise to over $2 billion per day.

However, not only will the costs overwhelm us, but if we continue on our current trajectory, our health system will be unable to absorb the influx of heart disease patients.

That’s why groups like the OHSU Bob and Charlee Moore Institute for Nutrition & Wellness are working to increase the knowledge of how chronic disease risk takes root. Translating this knowledge into programs and policies with the help of local communities will improve the health of all Oregonians.

Working together, we can focus on prevention efforts now - before our communities, workforce and health system are overwhelmed. The first step in ending chronic diseases where they begin is to ensure all Oregonians have access to nutritious, whole foods so that families and children get the nutrition they need in order to thrive. Supporting organizations, programs and policies that increase access to healthy foods at all levels, from schools to church potlucks and hospitals to government cafeterias will improve the health of all Oregonians now and in future generations.

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Kent Thornburg, Ph.D., is the director of Oregon Health & Sciences University's Bob and Charlee Moore Institute for Nutrition & Wellness and the Center for Developmental Health, OHSU Knight Cardiovascular Institute.

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