The Korean Paradox

Patient Expert

South Korea is different from the United States.

In some important respects this Asian country is more like America than most of us would think. This country is a democracy with a booming economy.

But the  differences are great and go beyond Korea's use of a different language and even a different alphabet than Westerners use. The differences go far beyond    history and tradition. The biggest differences that I have seen during my visit this month are in  the people themselves.

I saw with my own eyes how thin almost all Koreans are. Coming from the United States -- even though I live in the thinnest state -- I have been amazed to see almost no obesity here.

So, of course, I expected that almost no one in Korea would have diabetes. After all, didn't the American weight problem  lead to  the rapid rise of diabetes in our country?

We know that some sort of link between being overweight and having diabetes exists. We do know that being overweight doesn't cause diabetes, because two-thirds of American are overweight and about one-tenth of us have diabetes. But as our weight has gone up so too has the proportion of people with diabetes. Those two conditions have to have some association.

The Korean paradox is that this quite thin country has about the same incidence of diabetes as we do. Something else  has to be  at work here.

What is at work may well be work itself.

The Koreans have wrought an economic miracle. I don't know of any other country that has developed so rapidly. Just four decades ago,  gross domestic product  per capita was comparable with levels in the poorer countries of Africa and Asia. My Korean friends say that Korea was poorer than Ethiopia then.

When the Korean War ended in 1953 -- less than 60 years ago -- this country was completely destroyed. Now, people talk about  the "Miracle on the Han River," which refers to Korea's transformation from the ashes of the Korean War to becoming the 13th largest economy in the world, according to an article that I read in this morning's Korea Herald.  It now surpasses Mexico, which has more than twice as many people.

The miracle owes a lot to this country's indomitable quest for education and willingness  of its people  to pull themselves up by their bootstraps. That quest in turn owns much to the Confucian work ethic.

These people really do work hard. And long.

My friend Alex Leesong, the general counsel of i-SENS, a leading international manufacturer of blood glucose meters and test strips, told me that the Korean work week was the longest in the world. I was impressed, but had to check it out. In fact, what he told me was an understatement, according to what I read on Wikipedia.

"By far, workers in South Korea have the longest work hours among OECD countries," the international organization of the 33  developed economies.  "The average South Korean works 2,390 hours each year. This is over 400 hours longer than the next longest-working country and 34 percent  more hours than the average in the United States."

The hard work of the Korean people is the platform for the country's economic miracle. But it doesn't come without a cost. That cost is directly related to the epidemic of diabetes that Korea is now suffering.

A few days ago I visited one of Korea's most famous national parks with my friend Alex Leesong and with another friend, Cheol Jean, who calls himself Charlie Jean to make it easier for Westerners. Charlie is the CEO of Argos Publishers Inc. in Seoul and a writer about diabetes. He leads an active life. After learning in 1981 that he had type 1 diabetes, Charlie has continued to maintain an A1C level of around 6 percent without hypoglycemia. He also  enjoys many activities including Taekwon-do, judo, rock climbing, Taek-kyun, cycling, hiking, weight training, and yoga. And yesterday Alex and I went hiking and rock climbing with him.

Charlie Jean on top of Mount Seorag in Seoraksan National Park

On our drive to the park Charlie told me that less than 10 percent of Koreans are overweight in terms of the BMI standard. He said that only 0.4 percent of Koreans have type 1 diabetes, but that 10 percent of Koreans have diabetes of all types.  I thought that he didn't understand my question or that I didn't hear him right.

But, yes, he was saying that the people in this thin country have essentially the same incidence of diabetes as we do in the U.S.

Indeed, the official statistics bear him out.    In 2005  an analysis of the Korea National Health and Nutrition Examination Survey determined that 9.1 percent of Korean adults have diabetes. That proportion may well have increased in the last five years.

I wondered how this was  possible. Charlie says that the problem is largely work related -- and how the workers deal with the stress of their busy lives.

The sudden change in the typical diet from vegetarian to eating lots of junk food, meat, and dairy certainly played a role in the Korean diabetes explosion, he says.

"But this is not the only problem," Charlie added. "The problem is stress and lack of exercise, because the work week is so long." This is indeed the dark side of the Korean economic miracle.

"Korean men relieve the stress of their work by drinking." They go out on the town with their buddies from work rather than going home to their families in the evening or getting the physical activity they need. Drinking seems to be the way that they think they can deal with their stressful jobs.

This leads me to reach an inescapable conclusion that diabetes is indeed a lifestyle disease, as our critics often hurtle at us. But it is not one of sloth, but rather one of making less than optimal choices in dealing with the stress in our lives. Just like our brothers and sisters in Korea, all of us in America need to get a lot of physical activity, just like our ancestors who weren't "blessed" by all the labor-saving devices that we now have at our fingertips.