The Paradox of Progress: Environmental Disruption of Metabolism and the Diabetes Epidemic

  1. Robert M. Sargis2
  1. 1Committee on Molecular Pathogenesis and Molecular Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
  2. 2Kovler Diabetes Center, Committee on Molecular Metabolism and Nutrition, Institute for Endocrine Discovery and Clinical Care, Department of Medicine, University of Chicago, Chicago, Illinois
  1. Corresponding author: Robert M. Sargis, rsargis{at}medicine.bsd.uchicago.edu.

As the tide of chemicals born of the Industrial Age has arisen to engulf our environment, a drastic change has come about in the nature of the most serious public health problems.Rachel Carson, Silent Spring, 1962

Worldwide rates of diabetes and other metabolic diseases have exploded over the last several decades. Globally, more than 170 million individuals currently suffer from diabetes, and this number is projected to reach a staggering 366 million by 2030 (1). This scourge results in significant individual morbidity and mortality while contributing to the economic fragility of healthcare systems across the globe. In the U.S. alone, annual costs associated with diabetes are estimated to be $174 billion (2). As such, every effort must be made to understand the factors underlying this emerging metabolic disaster in order to mitigate its deleterious impact on the individual and society. Recently, an expanding body of scientific evidence has begun to link exposure to synthetic chemicals with a wide variety of diseases, including reproductive tract disorders and neurobehavioral diseases. The present work discusses epidemiological links between chemical exposure and disorders of glucose homeostasis, experimental data demonstrating chemical-induced changes in insulin action, and challenges facing the field of metabolic disruption as well as approaches for addressing those challenges.

Originally articulated in the early 1990s, the environmental endocrine disruptor theory proposes that some exogenous chemicals interfere with endogenous hormonal axes (3). The recognition of this potential mechanism of action was a paradigm shift in toxicology that had previously focused on a chemical’s capacity to induce acute toxicity or to cause cancer via mutagenesis. The Environmental Protection Agency (EPA) defines an endocrine disrupting chemical (EDC) as “an exogenous agent that interferes with the production, release, transport, metabolism, binding, action, or elimination of natural hormones in the body responsible for the maintenance of …

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