A bad pancreas day

That would be yesterday. Three patients in for discussions on their newly diagnosed type 2 diabetes, and two more for the 'you're on the way there' talks.

I gave them all my 'right genes/wrong eon' lecture. Basically, here's the scoop when our 'Ice-Age genome' meets the 21st century:

• The human genome evolved within an environment of high physical activity.
• Our cultural evolution has proceeded too rapidly for genetic accommodation.
• This mismatch between biology and lifestyle fosters development of chronic disease such as diabetes and heart disease.

In other words, our physiology was perfected during the Ice Age for cold, famine, and high activity. Now, we're not cold, we're not hungry, and we're triumphant if we park the car at the far end of the grocery store lot before we go 'hunting' through the aisles to supply our family with food.

Our bodies, meanwhile, are storing our extra calories for the coming famine which never comes. All that fat to waist sets up a metabolic nightmare that takes high intensity physical exercise to unravel. Those of us whose ancestors were clever enough to take down mammoths (and that would be all of us) are most likely to go down this road.

This diabetic news was not news to any of my patients with whom I spoke yesterday. They all had screaming warning signs for years on their lab printouts and around their midriffs. If you have elevated triglycerides as in more than 150 on a fasting sample, an abnormal fasting blood sugar (100 or above), and/or your waistline is the first part of your anatomy to walk through the door, don't wait for a bad pancreas day, eat less and move more now.