diabetes

Sugar, Fat, and All of That

Mea culpa

I write today's post, fully aware that yesterday I ate four gingerbread cookies, two spritz cookies, one "Beurre and Sel Jammer" (Butter and Salt Jammer), one blueberry strudel cookie, part of a brownie, and part of a chocolate-covered Rice Krispy treat. In my defense, I had come from a Christmas party, but nevertheless, this post should probably be labeled Do-As-I-Say-Not-As-I-Do.

People magazine tweeted this morning that, for the first time, thirteen-year-olds will appear on the show The Biggest Loser. And why not? In the last thirty years, obesity and its attendant health ills have crept downward to become a problem of even the young. Nor are Americans the only people getting fatter. The Biggest Loser and its local spin-offs are hit shows in twenty-five countries worldwide and counting. Obesity is a big deal and big business. But what could be causing the worldwide weight gain?

If you're Dr. Robert Lustig, you think you've found the smoking gun. In his new book entitled Fat Chance (Penguin, coming December 27, 2012), he shares his alarming findings and provides plenty of evidence to back them up.

Lustig, a pediatric endocrinologist at UCSF whose "Sugar: The Bitter Truth" lecture video got lots of hits on YouTube, has been watching the rise of obesity and its attendant ills in his practice over the last umpteen years. While not every obese person is unhealthy (and many people with acceptable BMIs still suffer from metabolic syndrome), obesity frequently brings in train "the cluster of chronic metabolic diseases...which includes...type 2 diabetes, hypertension (high blood pressure), lipid (blood fat) disorders, and cardiovascular disease," along with "co-morbidities associated with obesity, such as orthopedic problems, sleep apnea, gallstones, and depression." Lustig even mentioned the increase of dementia as tied to this whole mess, as insulin resistance leads to dementia!

Consider some of his alarming statistics:

- 1/4 of U.S. children are now obese;

- Greater than 40% of death certificates now list diabetes as the cause of death, up from 13% 20 years ago;

- The percentage of obese humans GLOBALLY has doubled in the last 28 years; there are now 30% more overnourished (obese) people than undernourished, worldwide;

- Fructose (all the sugars you can think of, apart from the sugar in milk) is "inevitably metabolized to fat";

- Fructose consumption has doubled in the past 30 years and increased six-fold in the last century;

- The majority of humans, regardless of weight, release double the insulin today as we did 30 years ago for the same amount of glucose; this hyperinsulinemia leads to insulin resistance, the body thinking it's starving, and increased eating, especially for foods high in fat and sugar because our dopamine receptors aren't getting cleared--a vicious cycle;

- The processed food industry has turned to increased sugars of all kinds to improve flavor and shelf life; we eat lots of processed foods; therefore, 20-25% of all calories we consume on average come from sugars; in adolescents this number can approach 40% of daily calories.

Because I was blitzing through this, I didn't absorb the science as well as I might have, but Lustig helped me understand that how often, how much, and how unhealthily we eat can be a function not of choice but of our biochemistry. The feedback systems and processing systems which served humans so well for eons were not built to handle as much food as we eat nowadays, particularly the avalanche of empty sugar calories. Sweets and fats used to be hard for us to come by--if we hit a surplus, of course our bodies stored it up (as fat) for a rainy day! Unfortunately, there are no more rainy days, so we keep storing and storing and overloading the system.

Lustig's book is not about dieting or losing weight--in fact he says we have natural weights we gravitate toward, and there isn't a heckuva lot we can do about it, exercise or no exercise. But obesity is a new thing that is environmentally-aided, and that can be fought against.

His conclusion? You can probably guess. Lots of fruits and vegetables and fiber. The fiber in fruits requires enough work to digest that it effectively negates the fructose. Milk or water to drink (lactose is not processed like fructose). Meats (not corn-fed) and dairy (ditto) are fine, but don't skip the produce. Whole grains (all the brown in them--exactly how my son doesn't like them), but even then there's no need for tons of grain. And, if it has a nutrition label, it's a processed food. Use sparingly.

The low-hanging fruit Lustig tackles first is ridding your life of soda, smoothies, frappucinos, and fruit juice. (8 ozs of orange juice has more sugar than 8 ozs of Coke.) If you do alcohol, do just enough wine to get the resveratrol benefits and then lay off. (Another source of resveratrol? Peanuts!)

As Lustig points out, changing one's food environment is all but impossible for the poor. After all, corn and soy receive massive government subsidies, making the processed foods based on them cheap, cheap, cheap. Even if you have access to fresh produce, your money goes farther on the stuff in boxes, and food stamps cover soda. One of the more disheartening bits of the book was when he talked about meeting with Michelle Obama's personal chef Sam Kass, the point person for the White House Obesity Task Force. Kass admitted everyone in the White House (including the President) had read Lustig's NYTimes article "Is sugar toxic?" but they would do nothing to help. "Because they don't want the fight, this Administration has enough enemies." Sigh. Not that the Republicans mentioned fared any better. Basically, changing our food landscape is up to us. For those of us with the dollars, vote with our dollars! If we don't buy it, not all the food stamps in the world will make it profitable.

As I mentioned at the beginning of this post, it's kind of a bummer to read this going into Christmas-cookie season, but one of my New Year's Resolutions will be to improve the food environment for my kids. I'm already talking up the benefits of fiber and fruits and vegetables, and the juice boxes are history.  (How I wish I had a time machine! I would never have introduced our biggest consumption area for processed foods--breakfast cereal. I can only comfort myself that we don't eat any off of his "Ten Worst Children's Breakfast Cereals" list! In the meantime, I've converted my youngest to occasional oatmeal and have started making bran muffins for my oldest. The middle child's cereal tooth can only be tempered with homemade waffles, full of colon-busting whole grains and flaxseed.)

I highly, highly recommend this book. Pre-order it for your family as a Christmas gift that will keep on giving!

It's Good to Be Beige

For all you map-o-philes, the Center for Disease Control has released an interesting new one: County Level Estimates of Diagnosed Diabetes. This is the first time they've been able to break the data out on a county-by-county level, versus a state level. Leaving aside the newly-revealed "Diabetes Belt" in the nation's southeast, the data on Washington State are enlightening. Those burgundy counties (i.e., more than 10% of the population diagnosed diabetic) are Grays Harbor and Adams. King County clocks in nicely beige, with fewer than 7% of the population diabetic. One thing to note: these figures are only for people 20 years or older, so the rising rates of childhood diabetes are not represented. They probably demonstrate strong correspondences to the adult rates, however. For more information, check the Scientific American run-down. I wonder how many of their identified risk factors play a role in Grays Harbor or Adams, not to mention those deeper orange counties: (1) high obesity rates; (2) sedentary lifestyles; (3) lower education levels; and, (4) higher percentage of non-Hispanic blacks. Because the researchers are government-funded, there is much mention of encouraging people to live an "active lifestyle" and to watch the the number of calories, but no mention of the where those calories should come from. Well, it's a start.

Speaking of where calories should come from, eating fish gets another endorsement, this one from Science Digest. If you happen to carry the "bad" APOE gene, one found in 15% of the general population and 50% of those suffering from Alzheimer's Disease, "a diet high in Omega 3 oils and low in cholesterol appears to significantly reduce the negative effects of the APOE4 gene in mouse models." Around our house we refer to fish as "brain food." If your supplies of Loki Salmon are running low, remember they can be found online and at local Thriftway markets, as well as the year-round Ballard, U District and West Seattle Farmers Markets. As for the BFM's tuna supplier, Fishing Vessel St. Jude, find their cans at Whole Foods.

And then, in a final note that completely undermines all that has come before, I'm thrilled to have spotted the Molly Moon truck around Bellevue. Look for it Wed-Fri and again on Sunday, from 5-10 p.m. at All The Best Pet Care, 1048 116th Avenue Northeast and check the Molly Moon blog for updates!