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Publisher Little, Brown and Company
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In The Blood Sugar Solution, Dr. Mark Hyman reveals that the secret solution to losing weight and preventing not just diabetes but also heart disease, stroke, dementia, and cancer is balanced insulin levels. Dr. Hyman describes the seven keys to achieving wellness: nutrition, hormones, inflammation, digestion, detoxification, energy metabolism, and a calm mind - and explains his revolutionary six-week healthy-living program.
With advice on diet, green living, supplements and medication, exercise, and personalizing the plan for optimal results, the audiobook also teaches listeners how to maintain lifelong health. Groundbreaking and timely, The Blood Sugar Solution is the fastest way to lose weight, prevent disease, and feel better than ever.
UNDERSTANDING THE MODERN PLAGUE
For this we must make automatic and habitual, as early as possible, as many useful actions as we can, and guard against the growing into ways that are likely to be disadvantageous to us, as we should guard against the plague.
—William James, “The Laws of Habit,” The Popular Science Monthly (February 1887)
It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.
A Hidden Epidemic: The United States of Diabetes
Diabesity, the continuum of health problems ranging from mild insulin resistance and overweight to obesity and diabetes, is the single biggest global health epidemic of our time. It is one of the leading causes of heart disease, dementia, cancer, and premature death in the world and is almost entirely caused by environmental and lifestyle factors. This means that it is almost 100 percent preventable and curable.
Diabesity affects over 1.7 billion people worldwide. Scientists conservatively estimate it will affect 1 in 2 Americans by 2020, 90 percent of whom will not be diagnosed. I believe it already affects more than 1 in 2 Americans and up to 70–80 percent of some populations.
Obesity (almost always related to diabesity) is the leading cause of preventable death in the United States and around the world. Gaining just 11–16 pounds doubles the risk of type 2 diabetes, while gaining 17–24 pounds triples the risk. Despite this, there are no national recommendations from government or key organizations advising screening or treatment for pre-diabetes. We are becoming the United States of Diabetes.
The prevalence of type 2 diabetes in America has tripled since the 1980s. In 2010 there were 27 million Americans with diabetes (25 percent of whom were not diagnosed) and 67 million with pre-diabetes (90 percent of whom were not diagnosed). African-Americans, Latin Americans, and Asians have dramatically higher rates of diabesity than Caucasians do. By 2015, 2.3 billion people worldwide will be overweight and 700 million will be obese. The number of diabetics will increase from 1 in 10 Americans today to 1 in 3 by the middle of this century.
A CHILDHOOD PROBLEM
Perhaps most disturbing, our children are increasingly affected by this epidemic. We are raising the first generation of Americans to live sicker and die younger than their parents. Life expectancy is actually declining for the first time in human history.
Here are some startling statistics:
One in three children is overweight in America.
Childhood obesity has tripled from 1980 to 2010.
There are now more than 2 million morbidly obese children above the 99th percentile in weight.
In New York City, 40 percent of the children are overweight or obese.
One in three children born today will have diabetes in their lifetime.
Childhood obesity will have more impact on the life expectancy of children than all childhood cancers combined.
Special Note: Childhood Obesity and Diabetes—The Blood Sugar Solution for Children
The biggest tragedy is the global spread of childhood obesity and “adult”-onset or type 2 diabetes in little children. We are now seeing eight-year-old children with diabetes, fifteen-year-olds with strokes, and twenty-five-year-olds who need cardiac bypass. While The Blood Sugar Solution is a program mostly for adults, it is also powerful and effective for children. The whole family must be part of the solution, and we have to make our homes, communities, and schools safe for our children.
The Blood Sugar Solution includes many child-friendly recipes. And when it comes to supplements, there is something for everyone, even infants and children. In fact, any child over twelve years of age with diabesity can follow the basic Blood Sugar Solution plan. Children younger than twelve or those who qualify for the Advanced Plan should work with an experienced functional medicine practitioner. See www.bloodsugarsolution.com for how best to support your children’s health if they are overweight or have type 2 diabetes.
A GLOBAL PROBLEM
Diabetes is just as widespread in other parts of the world: In 2007, it was estimated that 240 million people worldwide had diabetes. It is projected to affect 380 million by the year 2030, about 10 times the number of people affected by HIV/AIDS. Sadly this is a gross underestimate. Estimates in 2011 put the worldwide total at 350 million. In China alone, rates of diabetes were almost zero 25 years ago. In 2007, there were 24 million diabetics in China, and scientists projected that by 2030 there would be 42 million diabetics in China. However, by 2010, there were 93 million diabetics and 148 million pre-diabetics in China, almost all of whom were previously undiagnosed. Imagine if we had 148 million new cases of AIDS overnight in one country.
Sixty percent of the world’s diabetics will eventually come from Asia because it is the world’s most populous region. The number of individuals with impaired glucose tolerance or pre-diabetes will increase substantially because of increased genetic susceptibility to the harmful effects of sugar and processed foods. Interestingly, people in this Asian population (who are uniquely susceptible to diabetes even though they may not be obese) are increasingly affected as they adopt a more Western diet. Weaker environmental laws and regulations also expose them to increasing levels of toxins, which, as we will see later, are a significant cause of diabesity.
Ponder this: From 1983 to 2008, the number of people in the world with diabetes increased sevenfold, from 35 to 240 million. In just three years, from 2008 to 2011, we added another 110 million diabetics to our global population. Shouldn’t the main question we ask be why is this happening? instead of what new drug can we find to treat it? Our approach must be novel, innovative, and widely applicable at low cost across all borders. Billions and billions have been wasted trying to find the “drug cure,” while the solution lies right under our nose. This is a lifestyle and environmental disease and won’t be cured by a medication.
DIABESITY: THE MAJOR CAUSE OF CHRONIC DISEASE AND DECREASED LIFE EXPECTANCY
Diabesity is one of the leading causes of chronic disease in the twenty-first century, including heart disease, stroke, dementia, and cancer.
Consider the following:
One-third of all diabetics have documented heart disease.
It is estimated that nearly everyone else with type 2 diabetes has undiagnosed cardiovascular disease.
People with diabetes are four times more likely to die from heart disease, and the rate of stroke is three to four times higher in this population.
Those with pre-diabetes are also four times more likely to die of heart disease. So having pre-diabetes isn’t really “pre” anything in terms of risk.
There is a fourfold increased risk for dementia in diabetics. And pre-diabetes is a leading cause of “pre-dementia,” also known as mild cognitive impairment.
The link between obesity and cancer is well documented and is driven by insulin resistance.
Diabesity is the leading cause of high blood pressure in our society. Seventy-five percent of those with diabetes have high blood pressure.
Diabesity is also the leading cause of liver failure from NASH (nonalcoholic steatohepatitis), also known as fatty liver. It affects 30 percent of our general population (about 90 million) and 70–90 percent of those who have diabesity. Those with fatty liver are at much greater risk of heart attack and death.
Diabesity is an important cause of depression and mood disorders. Women with diabetes are 29 percent more likely to develop depression, and women who took insulin are 53 percent more likely to develop depression.
Nervous system damage affects 60–70 percent of people with diabetes, leading to a loss of sensation in the hands and feet, slow digestion, carpal tunnel syndrome, sexual dysfunction, and other problems. Almost 30 percent of people age forty or older with diabetes have impaired sensation in their feet, and this frequently leads to amputations.
Diabesity is also the leading cause of blindness among people ages twenty to seventy-four.
Diabesity is the leading cause of kidney failure—accounting for 44 percent of new cases each year.
People with poorly controlled diabetes are three times more likely to have periodontal or severe gum disease.
A recent remarkable study published in the New England Journal of Medicine examining 123,205 deaths in 820,900 people found that diabetics died an average of six years earlier than nondiabetics and 40 percent of those did not die from heart disease or the usual diabetes-related causes. They died from other complications not obviously related to diabetes, complications most wouldn’t necessarily correlate with the disease. Yet it makes perfect sense given that diabesity is the underlying cause that drives most chronic illnesses.
DIABESITY: A MAJOR GLOBAL THREAT TO ECONOMIC DEVELOPMENT
Direct health care costs in the United States over the next decade attributable to diabetes and pre-diabetes will be $3.4 trillion, or one in every ten health care dollars spent. Obese citizens cost the U.S. health care system 40 percent more than normal-weight citizens. In a sample of 10 million commercial health plan members, those without diabetes cost $4,000 a year compared to $11,700 for those with diabetes, and $20,700 for those with complications from diabetes.
Diabesity places a large economic burden on our society. The direct and indirect costs of diabetes in America in 2007 amounted to $174 billion. The cost of obesity is also significant, and amounts to $113 billion every year. From 2000 to 2010, these two conditions have already cost us a total of $3 trillion. That’s three times the estimated cost of fixing our entire health care system!
Are we getting our money’s worth? Is our current approach winning the battle against these completely preventable and curable diseases? Clearly the answer is no!
The Impact of Diabesity on Developing Nations
Diabetes is not just a problem for rich countries with too much food; it is also a disease of poverty that is increasing in developing countries as well. In India, diabetes carries a greater risk of death than infectious disease. In the Middle East, nearly 20–25 percent of the population is diabetic. When I helped in Haiti (the poorest country in the Western hemisphere) after the earthquake in 2010, I asked the director of Haiti’s main public hospital what the major medical problems were prior to the earthquake. His answer surprised me: heart disease, high blood pressure, and diabetes—all caused by diabesity.
By 2020, there will be fewer than 20 million deaths worldwide from infectious disease, but more than 50 million deaths from chronic preventable lifestyle diseases—heart disease, diabetes, and cancer. These are all fueled by the same preventable risk factors: high blood pressure, overweight, physical inactivity, high blood sugar, high cholesterol, and smoking. But strikingly, 95 percent of private and public efforts and funding focus almost exclusively on combating communicable or infectious disease.
THE SOLUTION: TAKE BACK OUR HEALTH
There is a solution available, one that is accessible and scalable, one that is available to everyone and prevents, treats, and reverses diabesity at a fraction of the cost. This book provides that solution for individuals, communities, and nations. It will require significant change at all levels, but each of us has the power to transform this problem.
In addition to curing diabesity on an individual level, we need a movement. I call it Take Back Our Health, and in Part V, I explain how we can all join this movement so we can get healthy together. It starts with the individual, but moves into families, communities, workplaces, schools, and faith-based organizations and filters through us to government and corporations.
In the next chapter, we will look at the true causes of diabesity, and why current treatments aren’t working.
The Real Causes of Diabesity
As a former emergency room doctor, I know that for acute illness and trauma, there is nothing better than conventional medicine’s current tools and knowledge. However, when it comes to chronic disease and to the diabesity epidemic, we clearly have a massive global problem on our hands. We know that our current approach to prevention and treatment is not working because millions more are affected every year. Treating diabetes with medications or insulin is like mopping up the floor while the faucet continues to overflow. That is exactly how my patient, Jane, a fifty-three-year-old African-American corporate executive was being treated until she came to see me.
Reversing Diabetes: A Patient’s Story
Being smart and accomplished, Jane had the time and resources to fix her out-of-control diabetes, except for one thing. No one gave her the knowledge and tools necessary to avoid going on insulin (which was the next step her doctor recommended), or to actually reverse her problems. In fact, when diabetics start taking insulin shots, they usually gain weight and their blood pressure and cholesterol begin to rise and they get more depressed. That is because too much insulin is the problem, not the solution. It will help the blood sugar come down, but the real causes of diabetes are never addressed.
Jane developed a whole list of conditions, including high blood pressure, low HDL (good) cholesterol, high triglycerides, and sleep apnea. By the time I saw her, Jane had had diabetes for ten years, and despite taking maximum doses of diabetes medication such as metformin and glyburide, her blood sugar was over 300 mg/dl (normal is less than 90 mg/dl), and her hemoglobin A1c, which measures the average blood sugar over the last six–eight weeks, was 10.3 (ideal is less than 5.5; diabetes is over 6.0).
She did her best to eat well. She had oatmeal for breakfast, and chicken and salads for lunch and dinner. By nighttime, however, her appetite was out of control and she craved sugar, candy, and ice cream. Most nights, she came home from work too tired to cook or exercise. In fact, she was so exhausted, she was going to take early retirement because she couldn’t focus or keep up with her work.
Doctors prescribed a beta-blocker for high blood pressure and Lipitor for high cholesterol (both of which make diabetes and insulin resistance worse). Of course, she had some predisposing factors for diabetes—her father had died at fifty-five from a stroke (and most likely had pre-diabetes), and her mother and aunts all had type 2 diabetes.
Jane was obese; she was 5-foot-2, weighed 190 pounds, and had a BMI of 34. Her blood pressure was very high—164/104—despite the fact that she was on blood pressure medication.
She had a fatty liver from diabetes. Her cholesterol looked normal on Lipitor, with an LDL of 100 mg/dl, but no one checked what was most important about her cholesterol—the size of her cholesterol particles. Small particles are caused by insulin resistance, are very harmful, and don’t improve with statin drugs. A good number is fewer than 600 small particles; Jane had 1,320. Her vitamin D was also very low at 17 ng/dl (normal > 45 ng/dl), which also contributes to diabesity, because she worked inside, had dark skin, and lived in the Northeast.
She also had many problems with her mitochondria, the factories that produce energy in the cells. This is a major factor in insulin resistance (see Chapter 13), indicating the need for coenzyme Q10, alpha lipoic acid, and B vitamins including biotin. She had low levels of minerals, including magnesium and chromium, which are important in blood sugar control. She also had oxidative stress and high levels of lipid peroxides, indicating rancid fats in her blood—all linked to diabetes.
The first thing we had her do was get her appetite under control and her energy back by teaching her to eat only real, whole food (nothing packaged or processed) and to eliminate all flour and sugar. To curb her cravings and reduce her appetite, we had her eat protein with every meal (including breakfast), have a protein snack in the morning and afternoon, and not eat three hours or less before bed. Jane’s diet became primarily organic with cleaner sources of protein (lean meats, fish, eggs, and protein powder), low-glycemic (low sugar) snack bars, nuts, seeds, legumes, fresh fruit, vegetables, and some whole grains. When she started the program, she was inspired to clean out her kitchen cabinets of all unhealthy foods. She then stocked up at the natural foods market, buying a greater variety of foods.
Jane admitted that she followed the diet perfectly for one week, and then began to cheat. When she did, she noticed that certain foods caused symptoms. In particular, she thought that dairy and sugary foods significantly worsened her afternoon fatigue.
She went back on The Blood Sugar Solution food plan and very quickly started feeling better. She finally felt she could start to exercise. Eventually I had her do interval and resistance strength training, which also helps reverse diabetes.
We corrected her nutritional deficiencies of B vitamins, vitamin D, chromium, and magnesium, and added fish oil. And we gave her support for her energy and calorie burning in her cells with alpha lipoic acid and coenzyme Q10. We also gave her a special super fiber known as PGX before every meal, which slows absorption of sugar and fat and makes you feel full so you eat less. Instead of sugary oatmeal to start the day, she had a medicinal protein shake. All these things have been shown to improve blood sugar control and correct insulin resistance.
We had her start high-dose niacin (vitamin B3) to increase her cholesterol particle size and took her off the beta-blocker and the diabetes drug glyberide, which pushes insulin higher. This type of drug, called an oral hypoglycemic, actually makes things worse over time by pushing the pancreas to pump out more insulin. The drug even has a black box warning that it increases the risk of heart attacks, which is exactly what you are trying to prevent by taking the drug to lower blood sugar.
After four months, Jane’s energy was dramatically increased. Her blood sugar decreased from over 300 mg/dl to about 90 mg/dl. Her blood pressure went from 164/104 to 127/79. Her skin was clearer, and her cravings were gone. She had exercised every day, lost 20 pounds, and her sleep apnea went away.
After a few more months she lost a total of 30 pounds. Her blood sugar, hemoglobin A1c, liver, cholesterol, and vitamin D tests all returned to normal. Even her small dense cholesterol particles got light and big and fluffy and went from 1,320 to 615, and her mitochondrial and calorie burning increased to normal. She went from being so sick she almost had to retire to feeling empowered in life and health and “at a magical point, happy and enjoying life.”
GETTING TO THE ROOT OF THE PROBLEM
Jane didn’t need insulin. She needed the right knowledge and plan. As physicians, we are trained to offer medication or surgery to solve diabetes (and disease in general), when the real causes include poor-quality diet, nutritional deficiencies, hormonal imbalances, allergens, microbes, digestive imbalances, toxins, cellular energy problems, and stress. We think that treating the risk factors, such as high blood sugar, cholesterol, and blood pressure, with medications will help. But we don’t learn how to identify and treat the real causes of disease.
Doctors (and patients) never ask the most important question: Why is your blood sugar, blood pressure, or blood cholesterol too high, and why is your blood too sticky and likely to clot?
In truth, diabetes and elevated blood sugar, blood pressure, and cholesterol are simply symptoms that result from problems with diet, lifestyle, and environmental toxins interacting with our unique genetic susceptibilities.
WHY LOWERING YOUR BLOOD SUGAR CAN KILL YOU
Shocking new findings should make us question our outdated approach to treating diabetes by simply lowering blood sugar with medication or insulin. The ACCORD study published in the New England Journal of Medicine in 2008 involved 10,000 patients with diabetes who were designated to receive intensive or regular therapy to lower blood sugar. These patients were monitored and their risks of heart attack, stroke, and death were evaluated.
Surprisingly, the patients who had their blood sugar lowered the most had a higher risk of death. In fact, the National Institutes of Health stopped the study after three and a half years, because it was evident that the aggressive blood sugar lowering led to more deaths and heart attacks.
How could this happen if, as we believe, elevated blood sugar is the cause of all the evils of diabetes? Why would lowering blood sugar lead to worse outcomes?
This may surprise you, but many of the methods used to lower blood sugar, such as insulin or oral hypoglycemic drugs, actually make the problem worse by increasing insulin levels. Contrary to what most people think, type 2 diabetes and diabesity are diseases of too much, not too little, insulin. Insulin is the real driver of problems with diabesity.
INSULIN RESISTANCE: THE REAL CAUSE OF DIABESITY
When your diet is full of empty calories and an abundance of quickly absorbed sugars, liquid calories (sodas, juices, sports drinks, or vitamin waters), and refined carbohydrates (bread, pasta, rice, and potatoes), your cells slowly become resistant or numb to the effects of insulin, and need more and more of it to keep your blood sugar levels balanced. This problem is known as insulin resistance. A high insulin level is the first sign of a problem. Unfortunately, most doctors never test this. The higher your insulin levels are, the worse your insulin resistance. As the problem worsens, your body starts to lose muscle, gain fat, become inflamed, and you rapidly age and deteriorate. In fact, insulin resistance is the single most important phenomenon that leads to rapid and premature aging and all its resultant diseases, including heart disease, stroke, dementia, and cancer.,
High levels of insulin tell your body to gain weight around the belly, and you become more apple-shaped over time. Insulin, the fat storage hormone, also drives more inflammation and oxidative stress, and myriad downstream effects including high blood pressure, high cholesterol, low HDL, high triglycerides, poor sex drive, infertility, thickening of the blood, and increased risk of cancer, Alzheimer’s, and depression.
Hypoglycemia (low blood sugar) is often an early symptom of insulin resistance. If you skip meals or eat too much sugar or refined carbs, you will experience swings in blood sugar that make you feel anxious, irritable, tired, and can even cause palpitations and panic attacks. Stuffing down a big cinnamon bun or swigging a 20-ounce soda will cause big spikes in sugar and insulin and a quick surge in energy, followed by the inevitable crash as your blood sugar plummets. Eventually your cells become so resistant to insulin that your blood sugar stays up and your pancreas can’t produce enough insulin to fight against the high blood sugar and your numb cells. That’s when you cross the line to diabetes.
Diabesity can be prevented, treated, and reversed. But new and better drugs or procedures are not the solution. Diabesity will not be cured by a pill or surgery. Blockbuster drugs such as Avandia fail in their promise and often cause harm. Gastric bypass surgery has increased from 10,000 to 200,000 per year in the last decade. But how many of the 1.7 billion overweight citizens of the world can undergo gastric bypass? And how many of those will gain back most of the weight they lost?
Our current problem-solving tools, methods of diagnosis, and way of treating patients are still based on nineteenth- and twentieth-century ideas about the origins of disease and overlook the complex web of biology as well as the social, political, and economic conditions at the root of our current chronic disease epidemic.
Chronic disease results from imbalances in our biology that occur as a result of the interactions between our genes and our environment. We first must focus on the causes (poor diet, stress, toxins, microbes, allergens) that disturb our whole system. We must understand and work with the network of our biological systems that become imbalanced because of the effects of the environment in which we live. We must use a new map to navigate chronic disease, one that is based on a new model of treating chronic illness. This map is called functional medicine (www.functionalmedicine.org). It is a way of treating the causes, not just the risk factors; of treating the whole system, not just the symptoms; of creating health, not just treating disease. In fact, if you focus on creating health rather than treating disease, the disease often takes care of itself. Disease goes away as a side effect of getting healthy.
Seven Myths About Obesity and Diabetes That Keep Us Sick
Many of the notions we hold to be true about disease are, in fact, misconceptions or falsehoods. This is especially true of diabetes and obesity. Before we can go beyond simply treating symptoms and risk factors, we must examine and give up the myths of diabetes.
MYTH 1: DIABETES IS GENETIC
We have been led to believe that diabetes is a genetic disorder, that if we have a family history of diabetes we are more likely to get it, and that diabetes is essentially a random genetic event over which we have no control.
The truth is quite different.
As I mentioned earlier, from 1983 to 2008 the number of people in the world with diabetes increased sevenfold, from 35 million to 240 million (and I believe this is actually a serious underestimate). Change of this magnitude could not happen with a purely genetic or inherited disorder in such a short time. The genetic code of the human population changes only 0.2 percent every 20,000 years. It is not altered from generation to generation. What many people don’t realize is that our genes are affected by our environment. Our genetic code itself may not change, but the way those genes are expressed is highly influenced by the world around us. And our environment has changed more in the last hundred years than in all of previous human history.
In truth, diabetes is almost entirely induced by environmental and lifestyle factors. While there are some predisposing genes, those genes get turned on (or “expressed”) only under conditions of poor diet, sedentary lifestyle, stress, and exposure to environmental toxins. Therefore, a search for the diabetes gene and the magic bullet drug or gene therapy to treat it will lead us nowhere. Scientists who have examined the human genome for the obesity and diabetes gene have been disappointed. While understanding our genes and the predispositions they give us can help us personalize our approach to metabolism and weight loss, they can shift our focus away from the most important target: the modifiable lifestyle and environmental factors that are driving this epidemic. How we eat, how much we exercise, how we manage stress, our exposure to environmental and food-based toxins, and the structural violence or “obesogenic environment” that influences these factors are what is truly driving our diabesity epidemic.
The collection of environmental, dietary, and lifestyle exposures we each experience has been called the “exposome.” The exposome, which affects our genetic expression, in the end may be much more important in determining health or disease than our actual genome. It is becoming increasingly clear that 90 percent of our disease risks are due to differences in environment, not genes. Looking at the things that wash over our genes from outside sources (air, water, diet, drugs, organic pollutants, heavy metals, radiation, and physical or psychological stressors) and from internal processes (inflammation, free radical production and oxidative stress, allergens, infections, and even gut flora) gives us insight into the origins of and the cure for our chronic disease epidemic. Changing your exposome is the foundation of The Blood Sugar Solution.
The exposome directly influences our genes, resulting in changes in gene function or expression that lead to the disordered biological state of diabesity. The genetic code itself doesn’t change, but which parts of this code are expressed does change. This is an important idea. We can’t change our genes, but we can change their function and expression. The collective experience of our lives—our intrauterine environment, diet, toxins, microbes, allergens, stresses, social connections, thoughts, and beliefs—controls which genes are turned on or off. It also controls the quality and type of proteins produced by our DNA, as well as what happens to those proteins and how they function once they are produced.
More striking is that if your DNA is tagged by an environmental factor, those alterations in genetic expression can be passed down through generations. The way in which our genes are tagged or turned on or off by our exposome is called “epigenetics.” The “epigenome” becomes inheritable. If your grandmother ate too much sugar, or smoked, or was exposed to mercury from too much sushi, she may have “turned on” genes that lead to diabesity. Her epigenome, which carries increased risk of disease, would then be passed down from generation to generation. This does mean your risk is increased, but it’s far from being a death sentence.
Your genes provide the instruction book for all the proteins in your body, which control your physiology and biology. You may have a genetic predisposition to diabetes or obesity, but you are not predestined. Every moment, you have the power to transform your gene expression and reverse disease by changing the messages and instructions you send to your DNA. You can “turn off” the genes your grandmother “turned on” generations ago.
For those who are still not convinced and believe that diabetes is genetic, let me tell you the story of the Pima Indians of Arizona. After living for centuries in a harsh desert environment, in the early 1900s they were plunged into a Western culture and food environment. Their traditional diet was essentially plant-based—whole grains, squash, melons, legumes, beans, and chilies—supplemented by gathered foods, including mesquite, acorns, cacti, chia, herbs, and fish. Although the diet was high in carbohydrates, they were low-glycemic carbs—which means they converted into sugar in their bodies relatively slowly and did not lead to high blood sugar levels. Within one generation, the Pimas switched to a diet rich in sugar, sodas, white flour, trans fats, and processed foods. This is a diet I call the “white menace”—white sugar, white flour, and white fat (shortening). They went from being thin and fit with no obesity, diabetes, or heart disease in their population to being the second most obese population in the world. Eighty percent of Arizona Pimas have diabetes by the time they are thirty years old, and they are lucky to live to age forty-six. Pima children as young as three or four are getting adult-onset diabetes and need cardiac bypass surgery by the time they are twenty.
The diabesity epidemic in the Pimas is not due to a recent genetic mutation. They sent their ancient, desert-dwelling genes a different set of instructions. Food is not just calories. It is information, and the typical American high-glycemic-load diet turned on the Pimas’ diabesity genes.
They didn’t have much of a choice about this. You do. This affects not only the poor or Native American populations, but all of us. Obesity takes nine years off the life of the average person, and obesity in adolescents creates the same risk of premature death as heavy smoking.
Have no doubt: Diabesity is not a genetic disorder in the strictest sense. While it’s true that the genes you inherited from your parents or grandparents may put you at greater risk, that doesn’t necessarily mean you must get diabesity. The condition is a direct outcome of dietary, lifestyle, and environmental factors turning on all the wrong genes. It is about a bad “exposome,” not bad genes. You can turn these genes off, and The Blood Sugar Solution will show you how.
MYTH 2: DIABETES IS NOT REVERSIBLE
Most of us are taught that diabetes is not reversible and that we are destined to suffer progressive decline in function, including heart disease, kidney failure, blindness, amputation, strokes, and dementia. We also believe that it is nearly impossible to treat obesity or to be able to maintain long-term weight loss. We think that the only treatment options are to limit the consequences and reduce the complications.
However, there is clear evidence from the scientific literature that diabetes is reversible, especially if it is caught in the early stages and treated aggressively through lifestyle intervention and nutritional support, and occasionally with medications. Even most later-stage diabetes can be reversed with very intensive lifestyle changes, medications, and supplements.
A groundbreaking study showed unequivocally that even people with advanced type 2 diabetes, when the pancreas has pooped out and the insulin-producing (beta) cells are damaged, can recover and diabetes can be reversed in just one week through dramatic changes in diet (a very low-glycemic, low-calorie, plant-based diet). In the study, patients’ blood sugars plummeted, triglyceride levels fell, and the pancreas recovered (measured by sophisticated MRI techniques). After just one week, they were taken off their medication, proving that diabetes is not a progressive, incurable condition. And the diet was more powerful than medication; yes, it may take a lot of work to reverse diabetes, but your body can heal given the right conditions. In The Blood Sugar Solution, I will show you how to do this.
But most doctors don’t catch diabetes in the early stages. Doctors typically measure a person’s fasting blood sugar—the level of glucose present in a blood sample drawn a minimum of eight hours after the last meal. A recent study showed that anyone with a fasting blood sugar of over 87 mg/dl was at increased risk of diabetes. Yet most doctors are not concerned until the blood sugar is over 110 mg/dl or, worse, 126 mg/dl, the level that technically signals diabetes. But diagnosing problems with insulin resistance and blood sugar control at this point occurs too late in the game. In fact, your blood sugar is the last thing to go up. Your insulin spikes first, and despite being the simplest way to detect problems early, doctors rarely order the two-hour glucose tolerance test, which measures not only glucose but also insulin levels at fasting and one and two hours after a sugar drink—a much more effective way to catch problems before the onset of disease. (See the online guide How to Work with Your Doctor to Get What You Need at www.bloodsugarsolution.com to learn what tests to ask for and how to interpret them.)
I recommend early testing for anyone who has a family history of type 2 diabetes, belly fat or increased waist size, or abnormal cholesterol. The blood sugar quiz at the beginning of the book, and the more detailed diabesity quiz in Part III, can help you understand your risk and act early. Don’t wait until your sugar is high. That would be too late.
If you have already reached the very late stage of type 2 diabetes when your pancreas has been damaged, you can still experience extraordinary gains in health and vitality if you treat the problem with a whole-systems approach like the one outlined in this book. Remember: Diabetes can be reversed.
MYTH 3: PRE-DIABETES ISN’T A PROBLEM UNTIL IT TURNS INTO FULL-BLOWN DIABETES
The most important idea in this book is that pre-diabetes is not “pre” anything. It is a deadly disease driving our biggest killers—heart attacks, strokes, cancer, dementia, and more.
A Heart Attack Is Not “Pre” Anything: A Patient’s Story
John learned the truth about pre-diabetes the hard way. He was a forty-nine-year-old salesman who had spent his career going from job site to job site. One day, after ten years of eating fast food on the run, John experienced that dreaded crushing chest and left arm pain. The heart attack got his attention, along with the angiogram and the need for two stents to open his clogged arteries. He came to me wondering what had happened. He thought he was healthy, albeit a little overweight. He didn’t have high blood pressure or diabetes and his cholesterol was normal at 173. What he didn’t know was that he had pre-diabetes, and his doctor had not picked it up in his yearly physical.
His diet was pretty typical for an American male—fast food, burgers, fries, sodas, and chips, and he drank at least two beers a day. The only green things he ate were green M&Ms. Over ten years, during which he suffered a stressful relationship and the death of his mother, he gained 50 pounds and his waist went from 32 to 36 inches. His blood tests showed normal blood sugar and cholesterol, but a very low good cholesterol, or HDL, of 34 mg/dl (ideal is greater than 60 mg/dl). He also had a fatty liver caused by his sugary processed diet. When we looked a little deeper, we found that after a sugar drink (which is the best way to test for pre-diabetes and diabetes), his insulin and blood sugar skyrocketed—a clear sign of pre-diabetes. We also found he had dangerous small, dense cholesterol particles, even on Lipitor, and high levels of mercury (he lived on the Gulf and ate a lot of fish). His omega-3 fats (EPA and DHA), which help normalize blood sugar, improve insulin sensitivity, and reduce the risk of heart disease, were low even though he ate fish.
By the time I saw him, he was on a cabinetful of medication, including a beta-blocker (which made him tired), and a whopping 80 mg, or eight times the starting dose, of Lipitor (which can cause more insulin resistance and increase the risk of diabetes). Statins such as Lipitor also lower coenzyme Q10, which is needed for cells to make energy and burn calories. He was put on a blood pressure pill (ACE inhibitor) and two blood thinners (Plavix and aspirin). He lost a few pounds right after his heart attack but still had a long way to go.
I put him on The Blood Sugar Solution. Over the course of a year, he went from a fast-food-eating, soda-drinking, pill-popping, big-bellied guy to a thin, fit, healthy man. He lost 62 pounds and gained 30 years of life. He took up running and got healthier and healthier. We gave him special nutrients to improve insulin sensitivity, including chromium, biotin, alpha lipoic acid, vitamin D3, PGX (a special fiber to lower blood sugar, insulin, and cholesterol levels), and fish oil. I also gave him high-dose niacin (vitamin B3) to raise his good cholesterol and turn his dangerous small, dense LDL particles into light, large, fluffy ones. I corrected the deficiency of coenzyme Q10. We boosted his liver detoxification with n-acetyl-cysteine and helped his body get rid of the mercury. We helped him thin his blood with natural blood thinners.
After a year, he was no longer on any of the medication he’d started on—no Lipitor, no blood pressure meds, no blood thinners—and all his numbers were better than when he was actually on the medication. His blood sugar was 93, his total cholesterol went from 173 mg/dl on the Lipitor to 137 mg/dl off the Lipitor, while his good cholesterol went from 34 mg/dl to 58 mg/dl and all his particles were light and fluffy. These are better results than any medication can achieve. His fatty liver was healed, and at fifty years old, he was healthier than ever.
John’s heart attack happened because of his pre-diabetes. In fact, one study found that about two-thirds of all patients admitted to the emergency room with heart attacks had pre-diabetes or undiagnosed diabetes. Another important study found that the risk of heart attack increases with any increase in average blood sugar, even for those who don’t have diabetes. Taking statins and beta-blockers, which actually cause insulin resistance, would not have corrected John’s pre-diabetes.
Many people believe that pre-diabetes isn’t a problem until it becomes full-blown diabetes, that it is just a warning sign. Nothing could be farther from the truth. It is an earlier stage of diabesity that carries with it nearly all the risks of diabetes. Pre-diabetes can kill you before you ever get to diabetes, through heart attacks, strokes, and even cancer.
Pre-diabetes can even cause “pre-dementia” or mild cognitive impairment—think of it as early Alzheimer’s. Recent studies have shown that diabetics have a fourfold increased risk of developing Alzheimer’s, and patients with pre-diabetes or metabolic syndrome have a dramatically increased risk of pre-dementia or mild cognitive impairment (MCI). You don’t even have to have diabetes to have brain damage and memory loss from high insulin levels and insulin resistance. Just having pre-diabetes can give you pre-dementia. Alzheimer’s disease is actually being called type 3 diabetes today. Recent studies have found that as your waist size goes up, the size of your brain goes down. Your brain function is also impaired. One extraordinary brain imaging study by Dr. Daniel Amen and his colleagues found that obesity was associated with decreased blood flow in your frontal cortex (the portion of your brain that controls executive decision making—“should I have that doughnut right now or not?”).
And if that isn’t bad enough, pre-diabetes can cause impotence in men and infertility in women (it can be related to polycystic ovarian syndrome).
So if your doctor has diagnosed you with pre-diabetes or metabolic syndrome, don’t think that you are only at risk for something “in the future,” such as diabetes or heart attack. The problems are happening right now.
MYTH 4: ONCE YOU START ON INSULIN, THERE IS NO GOING BACK
Insulin treatment in diabetes is a slippery slope, because increased insulin dosage often leads to increased weight gain, higher blood pressure, and elevated cholesterol. Remember, insulin is a fat storage hormone that also drives appetite and inflammation. Blood sugar improves, but overall risk of heart disease does not. That is why insulin should be the last resort in managing blood sugar and diabetes. And if you have to be on insulin, get on the lowest dose possible. Eating whole, real, fresh food and exercising vigorously will keep your blood sugar low and your insulin needs down.
The good news is that, with aggressive lifestyle intervention and dietary change, you can reverse diabetes and stop insulin therapy under your doctor’s supervision. Many of my patients and my colleagues’ patients have successfully gotten off insulin. By understanding and treating all the underlying causes of diabetes, the possibility exists of not only eliminating insulin treatment, but also reversing diabetes and insulin resistance.
This is not seen as much in conventional medical care, because the type of diet and lifestyle intervention advice is not adequate or properly designed to create a reversal of diabetes. It is possible with the right treatment approach, based on functional medicine, and new models of group care and community support that teach sustainable behavior change and nutritional life skills (including cooking, shopping, exercise, and mind-body skills).
MYTH 5: LOWERING BLOOD SUGAR WITH MEDICATION PREVENTS DEATH AND HEART ATTACKS IN DIABETICS
Avandia, the world’s number one blockbuster diabetes drug, contributed to the deaths of 47,000 people from heart disease in the first eleven years of its use (this data was hidden from the government and the public most of that time). We have to give up on the hope for the magic pill that will fix our problems.
Large drug trials have attempted to prove that targeting risk factors such as cholesterol or blood sugar levels with drugs reduces the risk of heart disease, diabetes, and death. Despite hundreds of millions of research dollars spent over many decades, aggressive risk factor treatment of the two most important targets—cholesterol and blood sugar—has consistently failed to show benefit in preventing disease (although treatment may be helpful if you have already had a heart attack).
Recent large trials published in the New England Journal of Medicine,,, have confirmed that by treating risk factors with drugs, not only may we be ineffective in preventing heart attacks, diabetes, and death, but we may also be creating harm by ignoring the root causes of disease. Chronic disease is not due to a drug deficiency. High cholesterol is not a Lipitor deficiency. High blood sugar is not an Avandia deficiency. Isolating one risk factor, or even separately treating multiple risk factors, will fail until it is done in the context of addressing the upstream drivers of disease.
Everyone loves the idea of popping a pill to fix the problem. Cardiologists advocate handing out statins at fast-food restaurants. Taking Lipitor at the same time you’re consuming a cheeseburger, fries, and soda misses the point. Those foods kill you in ways that have nothing to do with your cholesterol—they make you insulin resistant, and they don’t give you the fiber, vitamins, minerals, and antioxidants that real food does. What’s worse, new research shows that statins don’t work for prevention, even though over 75 percent of prescriptions are given to prevent heart disease. They do work to prevent a second heart attack, but not the first one. The independent Cochrane Collaboration performed a comprehensive review of the research using statins to prevent heart disease by examining fourteen major studies involving 34,000 patients at low risk for a heart attack. They found little or no benefit. If you haven’t already had a heart attack, these drugs won’t help you prevent one, despite misleading drug ads or doctors’ advice.
In addition to the Cochrane Review, many other studies also support this and point out the frequent and significant side effects that come with taking these drugs. In 10–15 percent of the patients who take them, they cause muscle damage, cramps, weakness, and aches; exercise intolerance (even in the absence of pain and elevated CPK, or muscle enzymes); sexual dysfunction; liver and nerve damage; and other problems. They also can cause significant cellular, muscle, and nerve injury and cell death in the absence of symptoms.
A study published in the Journal of the American Medical Association examined five major clinical trials on statins including 32,752 nondiabetics over 4.9 years. During the study period, 2,749 patients (or 8.4 percent) developed diabetes. Those on the highest doses of statins (which are increasingly prescribed by physicians) were at the highest risk of developing diabetes. If all doctors followed the latest cholesterol treatment guidelines, and all their patients took their prescribed statin medication, there would be 3.5 million more diabetics in America. Oops.
There is no lack of research calling into question the benefits of statins. Unfortunately, that research doesn’t get the benefit of the billions of dollars of marketing and advertising that statins do.
Should diabetics not try to control their blood sugar? Yes, they should. It is clear that elevated blood sugar causes small vessel injury leading to blindness, kidney damage, nerve damage, and cataracts. And the major causes of death in diabetics are heart disease, heart attacks, and strokes. But these problems are best addressed not through medication, but by treating the root causes.
It is the elevated levels of insulin that cause high blood pressure, abnormal cholesterol, and inflammation, not high blood sugars.
Lowering your blood sugar without addressing the underlying causes gives you a false sense of security and leads you to believe that you are doing something good to prevent heart attacks and early death. Unfortunately, the evidence shows otherwise.
Tragically, insurance doesn’t usually pay for the right treatment—intensive lifestyle therapy (although I believe this soon will change). No one profits from lifestyle medicine, so it is not part of medical education or practice. It should be the foundation of our health care system, but doctors ignore it because they get paid to dispense medication and perform surgery. They should be paid to develop and conduct practice-based and community programs in sustainable lifestyle change.
The future of medical care must be to transform general lifestyle guidance—the mandates to eat a healthy diet and get regular exercise that many physicians try to provide to their patients—into individually tailored lifestyle prescriptions for both the prevention and the treatment of chronic diseases.
And delivering lifestyle interventions through small groups is the most powerful way to create sustainable behavior change. Remember, it is easier to get healthy together. Lifestyle is often the best medicine when applied correctly, and it is the only thing that will get us started on the road to reversing this global health crisis.
MYTH 6: HEART SURGERY AND ANGIOPLASTY ARE GOOD TREATMENTS FOR DIABETICS WITH HEART DISEASE
A study in the New England Journal of Medicine showed that surgery and angioplasty for diabetics with heart disease work no better than medication in reducing heart attacks and death, and have higher risks.
How Unproven Treatments Can Kill: A Patient’s Story
Dan’s dad was diabetic. He had the best medical, pharmaceutical, and surgical care available. Nevertheless, he suffered from very poor health. He went to the emergency room with chest pain and was quickly shuttled into the cath lab for an angiogram. He was told he needed a cardiac bypass operation, even though research evidence has shown no reduced mortality for cardiac bypass or angioplasty in diabetics. Not providing effective treatment is one thing, but providing harmful, costly, and ineffective treatment like this is unethical.
After the bypass, Dan’s father developed a postoperative infection of MRSA (an antibiotic-resistant killer staph bacteria) in his sternum, which led to a month in the intensive care unit; plastic surgery to repair the chest defect left after surgeons removed his infected sternum; and “ministrokes,” which led to pre-dementia and a protracted recovery from hospitalization, requiring months of home care.
The surgery and subsequent therapy with blood thinners and cholesterol and blood-pressure-lowering medications did not enhance the quality of his health and life. In fact, he declined rapidly physically and mentally and died of a stroke.
Dan’s father was not offered the treatment that would have cost less than 2 percent of the $400,000 his care cost, and would have likely created an infinitely enhanced quality of life by actually reversing the underlying causes of his diabetes and heart disease. If he were simply provided the choice of a different treatment—an individual or group program for sustainable and comprehensive lifestyle change, based on the principles in The Blood Sugar Solution— perhaps he would still be alive and our national debt would have been reduced by $400,000. It should be our right to have access to proven treatments that provide better value for the individual and for the health care system.
MYTH 7: WEIGHT LOSS IS NECESSARY FOR THE REVERSAL OF DIABETES
At an American Diabetes Association convention in New York City, the main booth front and center in the convention hall presented a breakthrough “cure” for diabetes—the surgical treatment of diabetes with gastric bypass surgery. Unfortunately, I have seen many patients who gained back all the weight they lost, and more, after gastric bypass. My patient Alan, for instance, had been overweight since he was six years old and never experienced a day without ravenous hunger. At forty years old, he had a gastric bypass and went from 450 pounds to 250 pounds, but then gained back 100 pounds. At sixty years old, Alan was sick and tired, and he had to deal with all the complications of gastric bypass surgery.
Gastric bypass is touted as a solution for obesity; in fact, the number of gastric bypass surgeries performed each year has increased tenfold in 10 years to about 230,000 a year—at $30,000 a pop. While this approach works for some, clearly it’s not the answer for our epidemic of diabesity. It often fails, and it can cause many complications, including vomiting and nutritional deficiencies.
Shrinking someone’s stomach to the size of a walnut with surgery is one way to battle obesity and may be lifesaving for a few, but it doesn’t address the underlying causes. And many will regain the weight because they didn’t change their understanding of their bodies or relationship to food.
Clearly, weight loss is critical and important for obtaining optimal health. However, what we are finding in patients who have gastric bypass surgery is that even a dramatic change in diet in a short period of time creates dramatic metabolic changes. All the parameters that we thought were related to obesity, such as high blood sugar, high cholesterol, high blood pressure, inflammation, and clotting, are dramatically reduced even without significant weight loss because of the rapid effects of dietary changes that control which genes get turned on or off. This is called nutrigenomics— the way food talks to your genes. While weight loss is important, what’s more important is the quality of food you put in your body—food is information that quickly changes your metabolism and genes.
The converse is also true, as we learned in a study in the New England Journal of Medicine that discussed a woman who had 20 kilos (more than 40 pounds) of abdominal fat removed by liposuction. She showed no changes in any of her metabolic markers of obesity, including blood sugar, cholesterol, blood pressure, and inflammation. Despite losing 20 kilos, she was still sick.
The take-home message is that the quality of the food we put in our bodies drives our gene function, metabolism, and health. It is not simply a matter of your weight, or calories in/calories out. Eating powerful, gene-altering, whole, real, fresh food that you cook yourself can rapidly change your biology. You will lose weight, by getting your systems in balance, not by starving yourself. The Blood Sugar Solution is like getting a gastric bypass without the pain of surgery, vomiting, and malnutrition.
Food Addiction: Fixing Your Brain Chemistry
Whatever happened to old-fashioned willpower? Everybody knows that the obesity epidemic is a matter of personal responsibility. People should exercise more self-control. They should avoid overeating and reduce their intake of sugar-sweetened drinks and processed food. There are no good foods or bad foods; it’s everything in moderation. Right?
This sounds good in theory, except for one thing…
New discoveries in science prove that processed, sugar-, fat-, and salt-laden food—food that is made in a plant rather than grown on a plant (as Michael Pollan, author of In Defense of Food, would say)—is biologically addictive.
Remember the old potato chip commercial with the tag line “Bet you can’t eat just one”? Bet you can’t imagine that kind of commercial for broccoli or apples. No one binges on those foods. Yet it’s easy to imagine a mountain of potato chips, a whole bag of cookies, or a pint of ice cream vanishing quickly in an unconscious, reptilian-brain eating frenzy. Broccoli is not addictive, but chips, cookies, ice cream, and soda can become as addictive as any drug.
In the 1980s, First Lady Nancy Reagan championed the “just say no” approach to drug addiction. Unfortunately, that approach hasn’t fared too well—and it won’t work for our industrial food addiction either. There are specific biological mechanisms that drive addictive behavior. Nobody chooses to be a heroin addict, cokehead, or drunk. Nobody chooses to have a food addiction either. These behaviors arise from primitive neurochemical reward centers in the brain that override normal willpower and, in the case of food addictions, overwhelm the ordinary biological signals that control hunger.
Why is it so hard for obese people to lose weight despite the social stigma, despite the health consequences such as high blood pressure, diabetes, heart disease, arthritis, and even cancer, and despite their intense desire to lose weight? It is not because they want to be fat.
It is because in the vast majority of cases, certain types of food—processed foods made of sugar, fat, and salt combined in ways kept secret by the food industry—are addictive. We are biologically wired to crave these foods and eat as much of them as possible.
ARE YOU ADDICTED?
While some of us may be more genetically predisposed to the addictive properties of food (or heroin or alcohol), if you examine your own behavior and your relationship to sugar in particular, you will likely find that your behavior around sugar matches up perfectly with why you can’t control your diabesity. Use the scale below, developed by researchers from Yale’s Rudd Center for Food Policy and Obesity, to determine if you have a food addiction.
If you find yourself scoring 3 or higher, or answering yes to more than two of the questions, you may be suffering from food addiction.
Based on these psychological criteria and new neurological research, many of us, including most obese children, are “addicted” to industrial food.
Let’s review some of the scientific findings confirming that food can, indeed, be addictive:
Sugar stimulates the brain’s pleasure or reward centers through the neurotransmitter dopamine exactly like other addictive drugs.
Brain imaging (PET scans) shows that high-sugar and high-fat foods work just like heroin, opium, or morphine in the brain.
Brain imaging (PET scans) shows that obese people and drug addicts have lower numbers of dopamine receptors, making them more likely to crave things that boost dopamine. This is, in part, genetically determined.
Foods high in fat and sweets stimulate the release of the body’s own opioids (chemicals like morphine) in the brain.
Drugs we use to block the brain’s receptors for heroin and morphine (naltrexone) also reduce the consumption and preference for sweet and high-fat foods in both normal-weight and obese binge eaters.
People (and rats) develop a tolerance to sugar—they need more and more of the substance to satisfy themselves; this is true of drugs such as alcohol or heroin.
Obese individuals continue to eat large amounts of unhealthy foods despite severe social and personal negative consequences, just like addicts and alcoholics.
Animals and humans experience “withdrawal” when suddenly cut off from sugar, just like addicts detoxifying from drugs.
Just like drugs, after an initial period of “enjoyment” of the food, the user consumes it not to get high but to feel normal.
Circle the number that best matches the level of your behavior: 0 = never, 1 = once a month, 2 = two to four times a month, 3 = two to three times a week, and 4 = all the time.
1. I find that when I start eating certain foods, I end up eating much more than planned.
2. I find myself continuing to consume certain foods even though I am no longer hungry.
3. Not eating certain types of food or cutting down on certain types of food is something I worry about.
4. I find that when certain foods are not available, I will go out of my way to obtain them. For example, I will drive to the store to purchase certain foods even though I have other options available to me at home.
5. There have been times when I consumed certain foods so often or in such large quantities that I started to eat food instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities I enjoy.
6. I have had withdrawal symptoms such as agitation, anxiety, or other physical symptoms when I cut down or stopped eating certain foods. (Please do not include withdrawal symptoms caused by cutting down on caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)
7. I have consumed certain foods to prevent feelings of anxiety, agitation, or other physical symptoms that were developing. (Please do not include consumption of caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)
8. My behavior with respect to food and eating causes significant distress.
9. I experience significant problems in my ability to function effectively (daily routine, job/school, social activities, family activities, health difficulties) because of food and eating.
IN THE PAST 12 MONTHS
10. My food consumption has caused significant psychological problems such as depression, anxiety, self-loathing, or guilt.
11. My food consumption has caused significant physical problems or made a physical problem worse.
12. Over time, I have found that I need to eat more and more to get the feeling I want, such as reduced negative emotions or increased pleasure.
13. I have tried to cut down or stop eating certain kinds of food.
Remember the movie Super Size Me, in which Morgan Spurlock ate three meals from McDonald’s every day? What struck me about that film was not that he gained 24.5 pounds, or that his cholesterol went up, or even that he got a fatty liver. What was surprising was the portrait it painted of the addictive quality of the food. At the beginning of the movie, after he ate his first supersized meal, he threw it up, just like a teenager who drinks too much alcohol at his first party. By the end of the movie, he only felt “well” when he ate that junk food. The rest of the time he felt depressed, exhausted, anxious, and irritable and lost his sex drive, just like an addict or smoker withdrawing from his drug. The food was clearly addictive.
The problem of food addiction is compounded by the fact that food manufacturers refuse to release any internal data on how they put ingredients together to maximize consumption of their products, despite requests from researchers. In his book The End of Overeating, David Kessler, MD, the former head of the Food and Drug Administration, describes the science of how food is made into drugs—through the creation of hyperpalatable foods that lead to neurochemical addiction.
THE SPECIAL CASE OF LIQUID CALORIES
Liquid sugar calories are the most addictive “food” in our diet. Sugar-sweetened beverages are a unique category of food. Aside from being the single biggest source of added sugar in the diet, sugary drinks drive diabetes and obesity in ways that solid food (even solid junk food) doesn’t. And many of these beverages are also loaded with caffeine, which compounds their addictive properties.
Why are sugar-sweetened drinks so bad for us? Here are a few good reasons:
If you drink your calories in sweetened beverages, you don’t reduce your solid calories to compensate. So not only are these empty calories, but they’re extra calories you normally wouldn’t eat.
From 1977 to 2002, consumption of calories in sugar-sweetened beverages doubled and is the main source of added sugar calories to our diet.
During that time period, obesity rates doubled in children ages two to eleven and tripled in adolescents from ages twelve to nineteen.
More than 90 percent of American children and teenagers drink sodas every day. Liquid calories account for up to 10–15 percent of the total daily calorie consumption of the average teenager.
The average consumption of sugar-sweetened beverages is 175 calories a day. Since these calories are in addition to calories from solid food, this would add 18 pounds to the average person’s weight each year.
Each can of soda consumed by children per day increases their risk of being overweight by 60 percent. Soft drinks are the largest source of added sugar to children’s diets. Researchers from Harvard’s Children’s Hospital showed in a randomized trial that, if provided with easy access to alternatives to sugar-sweetened beverages, kids would reduce their intake of sugar-sweetened drinks by 82 percent and have significant weight loss.
In the Nurses’ Health Study of 91,249 women, those who had one sugar-sweetened soft drink had an 82 percent higher risk of having diabetes over 4 years. Those who drank fruit punch doubled their risk of developing diabetes.
Other studies also link sugar-sweetened drinks to pre-diabetes, diabetes (particularly in African-Americans), and heart disease.
A review of over 30 studies, published in the American Journal of Clinical Nutrition, found clear evidence that drinking sugar-sweetened beverages led to weight gain.
Bottom line: When you drink your calories, you don’t feel full, so you end up eating more overall.
A large study by Harvard scientists, funded by the Centers for Disease Control and the Robert Wood Johnson Foundation, found that if people drank water instead of sodas, they would consume 225 fewer calories a day (equivalent to about one soft drink). In a year, that is 82,123 fewer calories. That amounts to a weight loss of 24 pounds a year just by switching to non-sugar-sweetened drinks.
What should we be drinking? Water. Tap water. Filter it, chill it, squeeze a little lemon juice in it, and enjoy it. We have been brainwashed to think we can’t drink just water, but it is what we are made of and it will help you lose weight. In fact, researchers found that drinking water before meals increases weight loss by about 44 percent.
There is ample proof that sugar-sweetened drinks are harmful to our health. But even if they weren’t, shouldn’t manufacturers of these products have to prove that they are safe rather than expect underfunded scientists to prove they are harmful?
There have been some studies that found little or no association between weight gain and sugar-sweetened beverages. However, many of these studies were funded by the food industry, including the American Beverage Association (formerly known as the American Soft Drink Association). In fact, a 2007 review of more than 206 scientific studies found that if the food industry funded the study, there was up to an eightfold likelihood of the study findings proving favorable to the food industry.
A little-known fact is that many food industry goliaths banded together to form the Center for Consumer Freedom, which has created a media campaign stating that the obesity epidemic is a hoax. They tell us, “Don’t believe your eyes; believe us.” Owing to “privacy concerns,” the website won’t reveal its funders. Investigators discovered that Coca-Cola, PepsiCo, Kellogg, Kraft, and others were behind this but wanted to remain anonymous because, as reported on the website, they are afraid of food fascists—those vegetable-eating, organic-gardening militia groups. Oh my!
Diet Drinks: Helpful or Harmful?
If you are thinking that diet soft drinks are the answer, think again. Diet drink consumption has increased 400 percent since 1960. They may or may not cause cancer, but the evidence is mounting that they lead to weight gain rather than weight loss. Those who consume diet drinks regularly have a 200 percent increased risk of weight gain, a 36 percent increased risk of pre-diabetes or metabolic syndrome, and a 67 percent increased risk of diabetes. A study of over 400 people found that those who drank two diet sodas a day had five times the increase in waist circumference as those who did not drink soda.
Seems you can’t outsmart Mother Nature. Fooling your brain into thinking you are getting something sweet plays dirty tricks on your metabolism. Artificial sweeteners disrupt the normal hormonal and neurological signals that control hunger and satiety (feeling full). A study of rats that were fed artificially sweetened food found that their metabolism slowed down and they were triggered to consume more calories and gain more weight than rats fed sugar-sweetened food.
In another alarming study, rats offered the choice of cocaine or artificial sweeteners always picked the artificial sweetener, even if the rats were previously programmed to be cocaine addicts. The author of the study said that, “[t]he absolute preference for taste sweetness may lead to a re-ordering in the hierarchy of potentially addictive stimuli, with sweetened diets… taking precedence over cocaine and possibly other drugs of abuse.”
The use of artificial sweeteners, as well as “food porn,” the sexy experience of sweet, fat, and salt in your mouth, alters your food preferences. Your palate shifts from being able to enjoy fruits and vegetables and whole foods to liking only the sexy stuff.
My advice is to give up stevia, aspartame, sucralose, sugar alcohols such as xylitol and malitol, and all of the other heavily used and marketed sweeteners unless you want to slow down your metabolism, gain weight, and become an addict.
Under the food stamp program (SNAP), the U.S. Department of Agriculture spends $4 billion a year on soda for the poor. That buys almost 30 million servings a day or over 10 billion servings a year of corn-sugar-sweetened drinks. The government (our taxes) pays now and pays later through ballooning Medicaid and Medicare costs for obesity- and diabetes-driven disease. They won’t revise their policy because they say it’s discriminatory to prevent the purchase of soda. To whom: the poor or industrial food and agriculture?
THE “SODA TAX”
Thomas Frieden, director of the Centers for Disease Control, and Kelly Brownell of Yale University authored an article in the New England Journal of Medicine advocating for a penny-an-ounce tax on sugar-sweetened beverages, known around the country as the “soda tax.” Just as taxing cigarettes has reduced smoking, it is estimated this tax would reduce soda consumption by 23 percent a year. The 10-year savings in health care costs would be $50 billion. The increased revenue to strapped state governments would be $150 billion a year.
Now, taxing sugar-sweetened beverages would not eradicate obesity, but liquid calories are proving to be a clear target for public health intervention. Doing this could generate revenue for obesity prevention and treatment programs and reduce soda consumption. Funds from this initiative could be earmarked for community programs to address obesity in adults and children, especially for the poor.
This would cost nothing and have immediate impact. It could “supersize” the efforts of Michelle Obama, who only has $400 million to fight childhood obesity. The American Beverage Association, led by Coca-Cola and Pepsi, spent $1 million in lobbying against this idea in 2000. In 2009, they spent $20 million. If they didn’t think it would affect policy or consumption, they wouldn’t fight it. Their own internal studies show that when Coke increased prices by 12 percent, their sales dropped 14.6 percent.
We can alter the default conditions in the environment that foster and promote diabesity and addictive behavior. It’s simply a matter of public and political will. If we don’t, we will face an ongoing epidemic of obesity and illness across the nation and the globe.
If pushed, Big Farming can start growing healthy food to feed the nation, and Big Food can come up with innovative solutions that satisfy consumers and supply healthful, economical, convenient, and delicious foods for our world. However, these industries will not police themselves. And if the foods they market are addictive, what are the ethical, legal, and moral implications of allowing these food pushers unrestricted access to our children?
How Big Food, Big Farming, and Big Pharma Are Killing Us
What is the driving force behind all the cheap, low-quality foods that are little more than combinations of fat, sugar, and salt and, as we saw in the last chapter, have proven to be as addictive as any drug?
Junk food produced from and made cheap by government subsidies such as the 2010 Farm Bill are heavily marketed (to the tune of $30 billion a year) by mega–food corporations such as Altria (formerly known as Philip Morris–Kraft), ConAgra, Cargill, Tyson, Sara Lee, Unilever, General Mills, Kellogg, Coca-Cola, and PepsiCo. Government subsidization is how a Twinkie with thirty-nine different ingredients and a hefty marketing budget can cost less than a head of broccoli.
These processed foods are heartily consumed by our ever-widening population, driving obesity rates up to nearly three out of four Americans. The more they eat, the fatter they become. The fatter they become, the more they develop heart disease, diabetes, cancer, and a myriad of other chronic ailments. The sicker our population, the more medications are sold by Big Pharma for high cholesterol, diabetes, high blood pressure, depression, and many other lifestyle-driven diseases. One of the leading products of the American food industry has become patients for the American health care industry. The toxic triad of Big Farming, Big Food, and Big Pharma profits from a nation of sick and fat citizens. The government essentially stands in line next to you in fast-food chains helping you buy cheeseburgers, fries, and cola.
But in the produce aisle of your supermarket, you are on your own. The 2010 Farm bill provided $42 billion in subsidies to Big Farming to encourage the production of cheap sugar (from corn) and fats (from soy beans). It did not offer support for farmers to grow fruits, vegetables, or healthy whole foods. Aside from subsidies for corn, sugar, and wheat, the Farm bill does almost nothing to support the production of whole, fresh, local, seasonal, or organic produce.
That’s one reason why everywhere you look—in stores, schools, and government institutions and food programs—you find cheap, high-calorie, nutrient-poor processed foods (or “food-like substances”). It’s becoming increasingly difficult to avoid making food choices that drive obesity, especially when the price of fruits and vegetables has increased five times as fast as sugar-sweetened beverages.
It’s not a coincidence that the poorest states, such as Mississippi, in our country are also the fattest. Poverty makes it impossible to make the best food choices, and poverty rates are higher than they have been in a generation. Not only are healthier foods almost always more expensive, they are often not available in poorer neighborhoods. This combination of factors is a direct link to obesity and diabetes.
Our government has not been very helpful in these areas. Its focus has been on education (e.g., the food pyramid or the new “my plate” initiative) and on encouraging personal responsibility rather than on regulating Big Food. Government actions are at best anemic. In 2011, the Federal Trade Commission (FTC) and other government agencies announced new food marketing guidelines. The agencies would like Big Food to refrain from marketing foods to children with trans fats or more than 15 percent saturated fat, 210 milligrams of sodium, or 13 grams of added sugar per serving. But this was only a suggestion of guidelines that the FTC encouraged the food industry to consider implementing in five years. That’s like suggesting tobacco companies consider not marketing cigarettes to children in five years. We need tougher policies, not buckling to lobbying interests.
The food industry has decided to preempt any food-labeling regulations that would give consumers real, credible information about the disease-causing or health-promoting effects of their products. At the request of the Centers for Disease Control, the Institute of Medicine, an independent scientific body, came out with food-labeling recommendations in late 2011. That is why in early 2011, two major food-industry trade associations, the Grocery Manufacturers of America (GMA) and the Food Marketing Institute, announced a new and voluntary nutrition-labeling system. Major food and beverage companies will use it on the front of packages to “help busy consumers make informed choices.” Or to confuse the heck out of them. Their system lists the percents of various nutrients at their discretion. Most nutrition experts would have a hard time figuring out if the food was healthy or not, and that is the intent. In Europe, the red, yellow, and green labeling system provides consumers with an easy way to quickly assess their food choices. But the mantra of the food industry is that there are no bad foods. Nonsense. The science is clear—trans fats and high-fructose corn syrup are bad. So are pharmacological doses of sugar.
The general public, too, seems to prefer that government not regulate what we eat. We accept that the government mandates auto safety regulations and that the FDA oversees drug safety, so why are we so resistant to oversight for the food and farming industries? After all, poor diet causes many more deaths than auto accidents. We certainly can’t leave it to the Toxic Triad to police themselves. It didn’t work for Big Tobacco; why would it work for them?
THE CAUSES OF AN OBESOGENIC ENVIRONMENT
There is an element of blaming the victim in all of this that misses the environmental conditions that drive obesity and disease and lead to what is now being called an “obesogenic” environment. There are five main factors:
Industrial processed, fast food, and junk food are addictive. As we’ve seen, these foods are biologically addictive and drive excess calorie consumption.
Big Farming’s influence increases obesity around the world. Surplus crops from the United States are sold cheaply to poor countries, which in turn destroys local farming economies and displaces farmers, creating unemployment and making developing nations dependent on imported processed food and corn syrup.
Unethical, manipulative food marketing drives eating habits. There is very little government control over Big Food’s marketing practices, especially in marketing to children. The government licenses the airwaves but doesn’t police them.
Families are not eating home-cooked meals together. Family mealtime has disappeared in much of America. There are many reasons for this, but it’s been helped along largely by the proliferation of convenience or fast foods. This has led to a generation of Americans who have trouble recognizing vegetables and fruits in their original form and can’t cook except in a microwave.
Environmental toxins abound. These contribute to weight gain, obesity, and diabetes. We have to worry about not only what we eat but also the burden of plastics, metals, and pollutants that have been shown to poison and slow our metabolism and lead to weight gain.
To really change our obesogenic environment, we need to create healthier choices for everyone. We must focus on specific actions we can take personally, politically, and in our communities to alter our food landscape.
FOOD MARKETING PRACTICES: ARE THEY ETHICAL, MORAL, OR LEGAL?
Big Food takes advantage of the glut of processed food in our country to drive up profits through the use of mass media technologies. Other than drinking sugar-sweetened beverages, the number of hours of screen time is the single biggest factor correlating with obesity. The average American spends nine and a half hours a day in front of a screen, mostly television. In addition to the metabolism-slowing, hypnotic effect of watching television, relentless food marketing targeted to children is one of the major factors driving this problem. The average two-year-old can identify, by name, junk food brands in supermarkets, but many elementary school children can’t readily differentiate between a potato and a tomato (as Jamie Oliver demonstrated in his television program, Food Revolution).
Think about this: If processed and junk foods are addictive, and we are pushing our children to consume them, what are the moral, ethical, and legal implications?
The Robert Wood Johnson Foundation is the largest organization working to address the epidemic of childhood obesity. They spend $100 million a year on public education and programs. How long do you think it takes the food industry to spend that amount on marketing processed and junk food to children? Four days. By January fourth each year, the largest funder fighting the battle against obesity is out of cash, leaving the food industry the rest of the year to push their “drugs.”
The average child sees 10,000 ads for junk food on television a year. The food industry spends $13 billion a year marketing their products to children. Adding to the television onslaught, there are now product placements in toys, games, education materials, songs, and movies; celebrity endorsements; and stealth campaigns using word of mouth, text messaging, and the Internet. The food industry proudly uses terms such as “stealth,” “viral,” and “guerrilla” marketing to describe their practices on Facebook, YouTube, and Twitter, and in product placements in popular television shows such as American Idol, during which all the judges are drinking Coke, thanks to a multimillion-dollar deal with the show. The worse the food, the more companies spend on marketing.
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