Overweight, Obesity and Diabetes: the other rising tide

Global warming has been in the news a lot lately and yes, the potential of the rising oceans is a major concern for our generation and beyond. However, the bigger threat to our immediate health and that of our healthcare system is the dramatic increase in health issues related to overweight and obesity in developed and developing countries alike. At current rates, the healthcare costs associated with the sequelae related to dysfunctional metabolism will stress to bursting our current systems of heath insurance and health care.

Pharmaceutical companies are already finding their supplies of insulin in demand at a greater rate than they can supply it and, of course, costs are increasing (to the thrill of shareholders, but not those who are insulin dependent). Drugs used to treat diabetes, including insulin and metformin, have become a $34 billion annual business (up 12% since only last year). Huge companies such as Novo Nordisk are making half of their profits on insulin alone. For Novo Nordisk that amounts to half of their $11.1 billion in sales. There are 366 million diabetes sufferers worldwide of which 1 dies every 7 seconds from issues that develop from the disease. The total health care costs related to diabetes is $465 billing according to the International Diabetes Federation.*

The maddening thing is that nearly all of these cases could have been avoided, and those that got started could have been reversed if people had only been given adequate information on how to take care of themselves. Probably THE most damaging information perpetuated in the last 40 years has been the nearly ubiquitous advice to ditch dietary fats in favor of high-glycemic carbohydrates. By dramatically increasing highly processed grains and sugars and taking out the traditional healthy fats that the body needs to maintain the endocrine system, brain, nervous system, and immunity, we have stomped on the accelerator driving our collective pancreases to the brink of destruction by forcing our bodies to process far more sugars than ever before in the history of the human food supply. Time and time again I have seen people struggle with weight, blood lipids, and blood sugar who are trying valiantly to follow low-fat diets and still seeing no positive change in their health or weight.

Finally, we are beginning to hear the voices of reason from scientists and biochemists and even journalists like Gary Taubes (see his new book "Why We Get Fat") and Nina Planck (check out her book "Real Food") who point out that we have been on the wrong track for decades. We MUST turn this ship around before our healthcare system is flooded. The incidence of type 2 diabetes has been increasing dramatically in younger and younger patients. What used to be considered "adult-onset" diabetes, is now showing up in children as young as 8 and 10 years old. To me this is even more ominous and immediately threatening than the polar ice caps melting...

Wake Up. Take Charge. Get Healthy. Get REAL.



(*as referenced in Bloomburg Business Week Oct 3-9/11 p. 30-31)

On Your Mark... Get Set...

In my preparations to put together a workshop series on the proper combination of nutrition and exercise, I have spoken with numerous friends and clients about what sorts of topics might interest them. In the process I have been regaled with some very funny tales of competition and training woes that were related to poor food choices pre or post exertion. One of the ones that had the biggest impact on me was about a guy who had arrived at the starting line for a bike race without properly fueling up in the pre-dawn pre-race hours and now was starving. In a last minute effort to get some sort of fuel in before the starting gun, he inhaled a hot dog with all the fixings from a nearby vendor. You can probably already guess where this story ends up... The interesting thing is this person is a semi-pro rider but never got any guidance about eating to win.

It should be pretty obvious that even if you didn't know about all the chemistry behind digestion and absorption, you might listen to your body when it cringes at the thought of a pre-race hot dog. The brain gets us into trouble in so many ways when it thinks it knows best and over-rides the needs of the body (hence all the various addictions to sugar and caffeine and other potential nutritional pitfalls). What you want immediately prior to a hard workout or competition sporting event is something that the body won't have to work hard to breakdown into fuel. This is why companies like Cliff Bar have developed products like "Gu" which is pretty much straight glucose and some maltodextrin which is a loosely held together starch that the body can work on while the glucose goes straight to the blood stream. That hot dog is a digestive time bomb that first starts out as a barely chewed up lump sitting in the stomach. Once that starting gun fires, the signals from the body are to forget about anything except the adrenaline pumped task at hand: RIDE FAST! A few miles into this endeavor, that hot dog has been jostling around in the stomach waiting to be digested with acid building up by the minute. The time bomb explodes into either vomiting or diarrhea because the body needs to get rid of it in order to continue to push hard in the race. Now, the rider is doubled over, exhausted, and drained of reserves because the last little bit of fuel left from dinner the night before has been used up.

Let's help this poor rider rewind and replay his morning in a way that sets him up to win. Three hours prior to competition (yes, often in the wee hours of the dark), let's be sure to give our rider a well balanced breakfast complete with easy to digest foods like pancakes with bananas and a little almond butter. Two hours prior to the race start, let's be sure our rider has 16 ounces of electrolyte replacement drink (I'll post a recipe for one you can make at home). One hour prior to race start he's warming up his muscles by jogging lightly or riding short distances pushing a little and then backing off. During this warm up, he is drinking about 8 more ounces of water. In the 15 minutes prior to start, nothing should be going into the stomach. Now when the starting gun blasts, our rider doesn't have a lump of undigested food to contend with, and his muscles are bathed in ready glucose with more on the way. The enzyme systems needed to produce this ready supply of fuel are already on line and working at near full capacity.

On your mark.... Get set....

The Disconnect

Something I see on a daily basis that still confounds me is the radical disconnect between health and the things we do (or don't do) every day. It still amazes me that the vast majority of those in conventional health care don't understand that what their patients eat and drink makes a difference in health trajectories and disease outcomes.

One of the most startling examples is in the field of oncology. There is a scan that is performed using radioactive sugar injected into the bloodstream so that areas of high metabolic activity "light up" on the screen. The reason these areas show up is because highly metabolic tissues suck up sugar at a much more rapid rate than surrounding cells and tissues in order to keep up their activity or growth. This is one way to find tumors which are rapidly growing self-cells that have lost their brakes. Sugar can therefore be clearly seen as cancer's favorite food, right? So why then do so many of my cancer patients come to me with instructions from their oncologists to "have milkshakes and any high calorie foods to be sure to keep weight on"? It boggles, really. Let's throw gasoline on the flame and then sit back scratching our heads as to why the cancer cells happily step up production!

Another brain bender is the recommendation for diabetics to eat a high-carb, low-fat diet. The pancreas is already stressed out and can't keep up production of insulin to deal with the carbohydrate that is already coming in! And yet, the idea is to reduce caloric intake rather than look at what those calories actually represent to the system as a whole. To control blood sugar, one needs dietary fats and proteins and fiber and minerals and vitamins and enzymes and MOVEMENT... It's basic biochemistry.

As consumers without degrees in biochem, we are bombarded at the grocery store checkout with magazine covers that exhort us to lose those pesky 15 pounds plastered over the top of a background picture of a 4 layer death-by-chocolate cake. We are told by food product manufacturers that we can have their "non-fat, sugar-free, low-carb, no cholesterol" food product and it will be just as good as the real thing. But our bodies know the difference even if the marketing agents can fool our brains. Bodies don't understand artificial sweeteners, artificial colors, artificial fats, gums, and fake proteins. Our bodies understand real food. The fake stuff has far more health consequences than the real stuff. Don't kid yourself into believing that we are smart enough to fool Mother Nature quite yet...