Type II diabetes Decreased glucose tolerance Hyperinsulinemia Mechanistic plausibility
	Endometriosis Hormone disruption and immune suppression Animal models
	Cancer ???

Below is a TRW diabetes update (not part of Birnbaum presentation)

Michigans Midland County incidence of diabetes is higher than Michigan and National averages

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	The Midland County Health Director, Mike Krecek, stated in the Cities May 26th Midland meeting [more] Midland county residents have a higher incidence of Diabetes than State and National averages Ironically, he also stated that the citizens of Midland County overall health is better than most. Extensive research exists which documents the link between diabetes and dioxin.  Summary of 66 studies linking PCB's and Dioxins to diabetes (about half are specific to dioxin) Abstracts of studies 1-33 Abstracts of studies 34-66 References NAS Institute of Medicine 2000: Veterans & Agent Orange Dioxin exposure and type 2 diabetes Strength of Evidence in Epidemiologic Studies Based on material presented in the papers and reports reviewed here, as well as the cumulative findings of research reviewed in Veterans and Agent Orange (1994), Veterans and Agent Orange: Update 1996, and Veterans and Agent Orange:Update 1998, the committee finds that there is limited/suggestive evidence of an association between exposure to the herbicides used in Vietnam or the contaminant dioxinand Type 2 diabetes. No one paper or study was determinative in reaching this decision. Instead, the committee found that the information accumulated over years of research now meets the definition established for limited/suggestive evidence—that is, evidence is suggestive of an association between herbicides and the outcome, but limited because chance, bias, and confounding could not be ruled out with confidence. Federal Register: 2001 VA 38 CFR part 3: Disease associated with exposure to certain herbicide agents: Type 2 diabetes Dioxin in the City of Midland soils and the flood plain downstream are higher than any other city in the State of Michigan. So, if a County of people with excellent health habits have the highest rate if diabetes in the nation, what could be the cause? Common sense indicates a possibility dioxin is causing the diabetes and the National Academy of Sciences agrees. Mr. Krecek noted the elevated levels of diabetes back in 2002 when he 1st was hired.  To date, if a study is in progress, it's behind closed doors.
	June 2003: Dioxin Linked To Diabetes The Department of Veterans Affairs (VA) has proposed adding type 2 diabetes to the list of diseases positively associated with exposure to Agent Orange and other herbicides used in Vietnam during the war. Dioxin is found in Agent Orange and other similar herbicides. If approved by the VA, veterans who served in Vietnam who develop adult-onset diabetes will be able to file claims for compensation without having to prove that their diabetes was specifically caused by exposure to herbicides sprayed in Vietnam. The proposal follows a review by the Institute of Medicine of the National Academy of Sciences that evaluated mounting evidence supporting the possibility of a link between Agent Orange/dioxin and type 2 diabetes. The review found new "limited or suggestive" evidence of an association, though this evidence was not conclusive. For more information see Veterans and Agent Orange: Herbicide/Dioxin Exposure and Diabetes, available from the National Academy Press, Washington, DC for $18. Call 202-334- 3313 or 1-800-624-6242.
	Diabetes is increasing The finding that an endocrine-disrupting chemical like dioxin may be able to promote diabetes opens up new avenues for thought about this rapidly-increasing disease. Perhaps it isn't fat itself that causes diabetes --perhaps it is the toxic chemicals stored in our fat that cause disease. It has been known for a long time that human fat accumulates toxic chemicals. For example, the U.S. Public Health Service has been collecting samples of fat from humans for 20 years and analyzing them for halogenated hydrocarbons, including dioxin, beta-hexachlorocyclohexane, heptachlor, DDT, DDD, DDE, PCBs, trichloroethylene, perchloroethylene, 2,4-D, methyl chloride, vinyl chloride, polyvinyl chloride (PVC), and chloroform, among others. We each carry literally hundreds of exotic toxic chemicals in our body fat. For any particular chemical, our fat often has a concentration 100 times as high as the concentration in our blood serum. It is also known that chemicals can be released from fat to re-circulate in the blood stream during times of pregnancy, stress, illness or fasting. Many fat-stored organohalogens are known to interfere with our endocrine systems by mimicking or blocking natural hormones.

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