We’re About to Start Seeing More Early Deaths from Diabetes

A Tribe Called Quest's Malik Taylor, aka Phife Dawg, died on Wednesday at age 45 from complications of diabetes. Phife was known for being a pioneer of hip-hop, and, to a much lesser extent, as having a sweet tooth. (A few bars into the 1991 track "Buggin Out," he notes, I drink a lot of soda so they call me Dr. Pepper.) Taylor was diagnosed with the disease in 1991, at the age of 20.

A 20-year-old diagnosed with diabetes was once exceedingly rare—the disease was called "adult-onset" diabetes for a reason. But increasingly children and young adults are being diagnosed in alarming numbers. The rise was noted with concern back in 2000, when the American Diabetes Association published a consensus statement on the subject. A 2014 study found that the prevalence of type 2 diabetes among ten to 19-year-olds rose 30 percent between 2001 and 2009. By 2012, fully one half of the entire US adult population had either diabetes or pre-diabetes.

There's a common perception that people who have diabetes can just take meds and live a normal life. A growing industry normalizes the disease with lotions, supplements, medications, magazines, and food and drinks that cater to a diabetic population. But as Taylor's death illustrates, diabetes is not something to take lightly, and this is especially true for those diagnosed young, since living with the disease for longer can lead to worse outcomes. Complications include blindness, end-stage kidney failure, stroke, and numbness in the extremities—which means wounds go unnoticed, get infected, and can result in amputations. Taylor was so sick that in 2008 he required a kidney transplant from his wife, Deisha Taylor.

In the US, rates of childhood and adolescent diabetes are highest among blacks, Hispanics, Asians, and Native Americans. (This is also the case for the adult population.) One out of every two black babies born in the year 2000 is expected to develop type 2 diabetes. A 2005 report in the The New England Journal of Medicine predicts that obesity and its related ailments could result in the current generation of children having shorter lifespans than their parents—for the first time in two centuries. Taylor's mother puts a face on this tragic reality. She posted a note on her Facebook page that read, "Family, my heart is shattered at the loss of my beautiful son."

According to the Centers for Disease Control, in 1980 there were fewer than 6,000 diagnoses of diabetes annually in the US; in 2010 there were nearly 22,000 diagnoses—and likely many more, given that as many as one-third of people with the disease remain undiagnosed.

Why the dramatic shift?

So much has changed about our food supply in the past 60 years, it's hard to know where to begin. The transition to our ultra-processed diet began in the late 50s, but it was the 1980s when Big Food really took off. New substances in the food supply proliferated, including high fructose corn syrup (HFCS), trans fats, antibiotics, and growth hormones in the meat and milk supply, and myriad other chemical additives and preservatives. There was an explosion of concentrated feeding animal operations, or CAFOs, supplying cheap meat to the ever-increasing fast food market, and soda consumption was at an all-time high. At that time, with the exception of some back-to-the-land types, little fuss was made over feeding children things like brightly-colored sweet cereals for breakfast, or allowing them to drink soda every day.

Certainly, the case against HFCS has been well documented and its role in the development of type 2 diabetes is known. Sugar in general has taken the heat in recent years, with some experts, like UCSF endocrinologist Robert Lustig, pinning our health crises on a national increase in sugar consumption. This may in fact be true, but it is only part of a much more complex and worrisome picture.

Some researchers believe that there are additional factors at play. For instance: Bacteria-killing elements in our food supply—be it antibiotic residue and pesticide residues in our foods, or certain food additives—are possibly wreaking havoc on the trillions of bacteria residing in each of our guts. This important invisible ecosystem, called the microbiome, is responsible for maintaining human health in a variety of ways, and early research suggests that changes in our gut bacteria may be making us more susceptible to obesity, diabetes, and other metabolic dysfunction. "There is evidence that prescribed antibiotics are associated with increased risk of type 2 diabetes," Martin Blaser, professor of microbiology at New York University's School of Medicine, told VICE. Antibiotic residue in food could play a role, too, he says, but much is still uncertain. There's also early evidence that emulsifiers commonly found in packaged foods, like carboxymethylcellulose (CMC) and polysorbate 80, can disrupt gut bacteria and lead to metabolic diseases.

It goes even beyond sugar and bacteria, though. Endocrine-disrupting chemicals, or EDCs, are ubiquitous in the food supply and our general environment, from pesticides to the plastic used in food packaging. Bisphenol-A, or BPA, one of the most common and most studied, is everywhere—including the Dr. Pepper bottles and cans that Taylor loved so much. The CDC found that "nearly all" Americans tested had levels of BPA in their blood—a frightening reality when you consider that BPA can cause excess insulin production, which in turn can lead to diabetes. "Rodent studies have shown that environmental chemicals can induce obesity, type 2 diabetes, and other aspects of metabolic syndrome," Laura Vandenberg, an assistant professor of environmental health sciences at the University of Massachusetts, told VICE. "Typically, these studies have involved low-level exposures during gestation or infancy. The kinds of chemicals that can induce these metabolic diseases include BPA, some phthalates, pesticides, and other industrial chemicals."

People living in poor communities tend to have higher rates of exposure to environmental pollutants, and these include a great many EDCs. Reliance on a highly processed food diet means greater exposure to the plastics in food packaging, as well as things like pesticide residue, antibiotic residue, and harmful food additives, often in high amounts and acting in combination. The food industry will point to studies that show that the "low doses" of additives and chemicals we are all exposed to are harmless—but a large amount of literature on EDCs challenges this idea, Vandenberg said. What's more, we are all exposed to combinations of chemicals every day and combinations are not currently being tested. "Humans are exposed to many, many chemicals at once," Vandenberg said. How many is anyone's guess, but the the vast majority are largely unregulated and have not been tested for safety.

Taylor grew up in this kind of food environment, as did many of us raised in the 70s, 80s, and 90s. And for Taylor, growing up in a predominantly black neighborhood in Queens, the options for healthy eating were likely much narrower than they were for those growing up in more affluent white areas. Today, those discrepancies appear to have worsened dramatically. A 2014 report by the Harvard School of Public Health found that while diet quality improved among people of high socioeconomic status, it deteriorated among those at the other end of the spectrum, and the gap between the two doubled between 2000 and 2010.

Where does this leave us? In the case of Taylor, his death illustrates the tragic outcome of living in a dangerous food environment. Taylor, born in 1970, was part of an early generation of unwitting test subjects for an unregulated industrial food system. We are only just beginning to see the results of this experiment gone wrong.

Kristin Wartman is writing her first book, Formerly Known As Food, a critical look at how the industrial food system is changing our minds, bodies, and culture. It will be published by St. Martin's Press. She has written for the New York Times, the Atlantic, and Newsweek, among many other publications.