The comprehensive article on diabetes in Canada's First Nations by Kue Young and colleagues describes a modern epidemic.1 However, it seems that little has been said about the situation from a historical perspective other than by Chase,2 to whose reflections Young and colleagues refer. Writing in 1937, Chase noted that “Indians are not subject to diabetes … not because they are all thin … some older Indian women are very fat.”2 If, as many maintain, genetic factors play a role, it is curious that the epidemic was not noted earlier.
In addition, the 2 most devastating complications of diabetes, retinopathy and nephropathy, appear to have been infrequent early in the 20th century. In a classic textbook of the pathology of diabetes published in 1938 it is difficult to locate any reference to these.3 In a long chapter on diseases of the kidney in his 1945 edition of Pathology of Internal Diseases, Boyd devoted only a single paragraph to Kemmelsteil–Wilson nephrosclerosis.4
If the triad of elevated blood sugar, overeating and lack of exercise contributes to diabetes and its microvascular complications then why was such a cause-and-effect relationship not apparent prior to World War II? Perhaps the blame should not be on eating and exercise habits, but on the quality of “white man's food.” Could there be nutritional deficiencies or toxic additives in modern food that are at least partly responsible for the increased frequency of the disease and its complications?