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VVVVVVVVVVV 38 2 Globalizing the Chronicities of Modernity Diabetes and the Metabolic Syndrome DENNIS W IEDMAN For most of human history as hunters, gatherers, and agriculturalists, humans maintained an active physical lifestyle that varied with seasonal resources and promoted cardiovascular and metabolic fitness. But for the past five hundred years, since early European imperialism, there have been major changes in everyday life and, in consequence, in health. Early industrialization and globalization diffused commodities and labor-saving technologies for work and home throughout the world. In recent decades, this process has gained extraordinary momentum: With modernity, large numbers of people now live a life of low physical activity, consistent energy intake from foods, and chronic levels of psychosocial stress. These in turn result in an array of metabolic disorders, including diabetes mellitus and associated chronic conditions. In ancient Greece, diabetes as a disease was associated with the elite managerial class; by the 1970s it was characterized as a “disease of civilization,” affecting mostly lower classes and ethnic minorities. Once blamed on the genetic, mental, and cultural maladaptations of indigenous peoples, ethnic minorities, and inner-city poor, it now affects the full spectrum of social classes and ethnic groups. Thirty years later, diabetes is associated with the metabolic syndrome (MetS), the co-epidemic of obesity and heart and kidney disease that is increasingly prevalent in developed and developing nations. No particular foods, genes, socioeconomic class, ethnicity, or other inequality can consistently explain the initiation of metabolic disorders in modernizing populations worldwide. In this chapter, I develop a theory of chronicity to reconceptualize and explain the global pandemic of MetS, by arguing that its underlying cause is the dramatic shift from “seasonality” of hunters, gatherers, and agriculturalists to the “chronicities of modernity.” This perspective builds upon Susan Estroff’s use of chronicity “to refer to the persistence in time of limitations and suffering that results in disabilities as they are socially and culturally GLOBALIZING THE CHRONICITIES OF MODERNITY 39 defined and lived” (Estroff 1993: 250). This theory of chronicity focuses on sociocultural explanations for metabolic disorders, rather than the current genetic and biological explanations that are predominant today. As an embodiment of modernity, the chronic metabolic disorders reflect the physical body’s response to the chronicities of modernity. Metabolic Syndrome Defined Diabetes mellitus and associated chronic metabolic disorders were relatively unknown prior to modernization, even though the physical characteristics of diabetes were mentioned as early as 1500 BC in Egyptian medical writings and a Greek physician provided the first complete clinical description of diabetes in the second century AD. His patient was the manager of a granary, an elite member of the community (Papaspyros 1964: 4–6). Like our knowledge of most diseases, the biopathological understanding of metabolic disorders began in the mid-nineteenth century. In 1849 Claude Bernard identified glycogen in the human body as similar to the sugar in grapes and found in the urine of those with diabetes. In 1869, the pancreas was associated with the metabolism of carbohydrates. In 1921, the extracted hormone insulin from the pancreas was discovered to lower blood sugar. By 1923 a test was being used to determine blood sugar levels and insulin was being used to treat diabetes. This led to the identification of insulin resistance as type 2 diabetes, and subsequently, in the early 1950s, to the development of oral hypoglycemic medicines (Papaspyros 1964). A significant paradigm shift in the scientific explanation for diabetes followed Kelly West’s comparative study of twelve different nations of the world (West 1978). Finding a consistent association of diabetes with body fat, irrespective of the source of calories, West shifted the theoretical paradigm that diabetes was the result of “sugar consumption” to the most often used explanation today: “obesity” (West 1974a). The clustering of risk factors for obesity, diabetes, dyslipidemia, gall bladder disease, and hypertension has focused researchers on portraying these as metabolic disorders with a common defect. Over the years, these were variously conceptualized as “Insulin Resistance Syndrome,” “Syndrome X” (Reaven 1988), “New World Syndrome” (Weiss et al. 1984), and “Multiple Metabolic Syndrome” (Young et al. 2002). In 1999, the World Health Organization (WHO) reconceptualized the cluster of the disorders as MetS. The International Forum on Diabetes in 2005 defined the core components of MetS as central body obesity plus two of the following: raised blood lipids, hypertension, glucose intolerance, or reduced high-density lipoprotein (HDL) cholesterol (Alberti and Zimmet 2005; Alberti et...

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