Goliath was a giant. Eight feet tall. Goliath’s eyesight was poor. His brother and three sons were giants too. The Bible records how Goliath died, struck on the forehead by a stone thrown by David.
A giant can look fearsome but may not have the agility to match their perceived strength. They have the power but react slowly to events. Power in Goliath’s case came from his size. For David, a much smaller, younger person, his power came from speed. In both cases, physical power was projected as a force that led their respective tribes to choose each individual to represent the community.
The human body is made up of organs like the brain, the liver and big muscles like the thigh. Each organ in turn is made up of cells. Within the body, power is generated in the cell. In most cells, there is an organelle called the mitochondria. The mitochondria generate energy by breaking down glucose. That is why each cell must have a blood supply.
To thrive, your blood must have a certain level of sugar available for cells to take in and generate energy. Thinking and digesting food require considerable amounts of glucose. When sugar levels are low, you feel faint and powered down. If you cut your finger and start to bleed, there is pain. A signal that some cells are not getting enough glucose. But too much sugar in the blood presents a problem too. A problem of chemistry.
The process of breaking down glucose to generate energy is a chemical one. What is required is the glucose, oxygen and enzymes to catalyse the process. The body can break down glucose for energy without oxygen for short periods of time, but the yield is low.
Furthermore, the by-product of producing energy from glucose without oxygen is lactate. If too much lactate accumulates in the body, it is poisonous. Which is why big leg muscles can cramp when exercising. The brain does not cramp. It has very high standards and always requires oxygen to generate power to think.
Too much glucose in the blood encourages the cells to make more fuel, but the oxygen may not be enough, so the body begins to poison itself with too much lactate. To prevent that the pancreas releases more insulin, a hormone, to instruct cells to stop being so responsive to the glucose to give time for the liver to mop up the excess glucose eventually into fat.
The fat can, in theory, be used another day. From a small person, the fat accumulates, and we have a big person. The problem with having high blood sugar, followed by high insulin levels is that eventually the cells get used to these conditions and become less responsive. This is the condition called diabetes mellitus.
Two immediate problems arise. Blood is mainly water. Glucose in the blood is therefore a sugar solution. If the concentration of sugars is higher in the blood than in the cells, then they become dehydrated, and more water moves into the blood. This is why people with diabetes pass a lot of urine but at the same time are thirsty.
Secondly, the body now needs more insulin to do the same job. It may not have the capacity to make more insulin so, the doctor prescribes either medicine to reduce the blood sugar or additional insulin. So instead of a finely tuned system, where the power needs of the body are organised without much active thought, diabetes management is quite clumsy.
The person with diabetes must think about what they are eating, the type of food, the amount, the time they are eating and measure it against the medicine they have to take. At that point, the body has lost the power to control the blood sugar.
As a society, we look up to ‘big people’. We want them to do everything for us. In our daily lives, this translates into corruption. To make our people big, we set up decisive battles that will be pivotal. That we can talk about and analyse. Much like the story of David and Goliath.
When it comes to the development of society, we should not tell big people stories. Biology tells us that good systems, with feedback mechanisms achieve much more.
Medicine tells us the consequences when we ignore good health practices. Public health gives us the tools and knowledge to build a society that achieves its potential. A giant of any kind is unlikely to do more than give us a good story.
Senior lecturer, health systems, UoN
