Preventable, yet “Encouraged”

Stunning statistics from a study published in the December issue of Diabetes Care, as reported by Health Day News:

The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.

That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.

At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.

The increase is from adult onset, or type II diabetes. Health Day attributes the increase to obesity:

Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don’t use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.

The problem is that the official stance towards this problem has little hope of solving the underlying issue: our addiction to carbohydrates. While the general consensus is that people would not be diabetic if they lost weight, telling people to lose weight has proven to be a dismal failure. The reason is that very few people will starve themselves voluntarily.

The standard American diet is one rich in refined, processed foods (i.e., carbs). The “optimum” diet recommended by nutritionists is one that is low in dietary fat and eschews refined, processed foods in favor of “complex carbohydrates, such as whole grains, cereal, rice, pasta, potatoes, dry beans, carrots and corn”, with calorie reduction necessary to lose weight. It doesn’t work because you are always hungry on that diet.

Hungry people eat. And if they eat “complex carbs” that are “low in fat” they never feel sated, and will never stop eating.

Try this experiment … go to the sugar bowl and spoon out a scoop of sugar onto the counter. Then another. And another. Keep going, and when you have 22 spoonfuls of sugar on the counter, you have the average American’s intake of sugar. But what if you cut out all the added sugar found in soft drinks, cookies, candy and other snacks (even low fat ones)?

If you follow the various guidelines by the USDA, American Heart Association, et. al., you’ll limit fat to 20% of your dietary intake, and get adequate protein, making up the rest of your diet with those complex carbohydrates. Let’s take an example of a 2,000 calorie diet, and see how that works out in grams of each micro nutrient:

  • Fat, 44g at 9 calories each = 20% of calories
  • Protein, 100g at 4 calories each = 20% of calories
  • Carbohydrates, 300g at 4 calories each = 60% of calories

Carbohydrates turn to sugar (glucose) in your gut in a very short time, within 2 to 4 hours. Even “complex carbs” turn to sugar.

Spoon out another 75 teaspoons of sugar onto your counter. That is the amount you are asking your body to metabolize when you eat 300g of carbohydrates per day.

Here’s a layman’s explanation of what is happening: The body needs sugar to run, but if it can’t use it in a very short time, it is stored as fat. Blood sugar spikes in 2 to 4 hours after eating carbs, and the body reacts by releasing insulin to drive the sugar into the cells so they can use it for energy. If the cells have enough, they refuse insulin’s prompting, and the sugar is stored as fat. As you abuse this system by overloading it with sugar, the cells become more and more resistant to insulin, and the body sends out more and more. When the sugar is pushed into fat cells, your blood sugar level drops, and hunger returns even though you ate only a few hours ago. So you eat again, and start the process all over again (if you eat a diet “rich in complex carbohydrates”). Sound familiar?

The emphasis on low fat, high carbohydrate diets has caused our expanding waistlines, and emphasizing that people should continue to eat this way but reduce calorie intake is counter intuitive. Survival depends on getting enough to eat, and your body will betray you if it thinks it is starving.

A better approach is to limit carbohydrates to about 1/3 of all calories if you are at your goal weight and otherwise healthy. For a 2,000 calorie diet, that’s about 167 grams of carbs. The rest of your calories can come from fat and protein. It is best to calculate your minimum protein requirement, usually calculated at about a half gram per pound of lean body weight. “Lean body weight” is your weight minus your fat (take your body fat percentage times your weight, and deduct that from your total weight to get your “lean body weight”). The book The Protein Power Lifeplan has this approach as a “maintenance diet”, and people can tolerate it for life … because you don’t get hungry.

And if you need to get to your goal weight, the first phase of the diet can help you do that without getting hungry. You can short-circuit the vicious cycle of carb intake, insulin response, fat storage and premature hunger by eating a diet that is tuned to your needs.

BMI and the “Obesity Epidemic”

Tom Naughton deconstructs the “obesity epidemic” at his blog Fat Head:

But what I found most interesting was the data on who’s “overweight” and by how much. Here are the numbers:

  • More than 50 pounds overweight: 6%
  • 21-50 pounds overweight: 17%
  • 11-20 pounds overweight: 15%
  • 1-10 pounds overweight: 24%
  • At ideal weight: 18%
  • 1-10 pounds underweight: 7%
  • 11-20 pounds underweight: 3%
  • More than 20 pounds underweight: 1%
  • Undesignated: 9%

As we noted in our post Does Being Overweight Harm Your Health, all-cause mortality studies show that you have a 17% less chance of dying if you are in the “overweight” BMI (as compared to being “normal weight”). Even being “obese” was statistically even with being “normal weight” in these studies. The absolute worse thing you can do is be “underweight”, with a stunning 73% greater risk of dying than a “normal” weight person.

We have also noted our belief that individuals have to assess their own health needs and identify their individual risk factors, rather than focusing on a “society wide goal”. If your risk factors lean more towards developing diabetes II, then controlling blood sugar levels may be more important than being within 10 pounds of some goal weight. And as McNaughton notes, adult onset diabetes is at epidemic levels:

A different Gallup poll underscores another point I made in the film: there is a genuine epidemic out there, and it’s called diabetes. More than 11% percent of Americans adults have diabetes now, and more than 90% of those have type 2 diabetes, which is mostly preventable. The rate has more than doubled in the last decade alone. Among senior citizens, the numbers are even more harrowing: nearly one-quarter have diabetes. Just think of all the physical damage that’s causing. And even those numbers don’t count the pre-diabetics.

Nutritionists tend to focus on the weight end of the scale (so to speak), but they are missing the point. You can’t push a string. People are overweight because of their blood sugar levels (i.e., hyperinsulinemia, insulin resistance and related disorders leading to diabetes). They are not suffering from high blood sugar levels because of their weight. As Naughton sums it up:

The constant drumbeat about the obesity epidemic and the emphasis on losing weight is sending the wrong message. We need to tell people to get their blood sugar checked and keep it under control with the proper diet. If we do that, the 10 pounds will take care of itself. And if it doesn’t, well … so what? A bit of belly won’t kill you if it’s not the result of high blood sugar.

If your blood sugar is elevated, the way to get it under control is by adopting a low carb eating lifestyle. You will lose weight, but the most important thing is that you will live longer. And living longer is the goal.

Vytorin: Lowers LDL, but so what?

Statins are a class of drugs that lower cholesterol levels, and, the reasoning goes, should reduce the risk of heart attack. But the reality has been less illuminating than the promise. This morning word of another study showing that the popular statins containing ezetemibe, Vytorin and Zetia, do not lower the risk of heart disease. As the LA Times reports:

For the second time in as many years, a large clinical trial has found that the key ingredient in the heavily advertised drug Vytorin provides little or no benefit in preventing heart disease compared to a competing product. The ingredient is ezetemibe, which blocks the absorption of cholesterol in the intestines. It is sold alone under the brand name Zetia or in combination with the cholesterol-lowering drug simvastatin under the brand name Vytorin. The combination of drugs has been shown to reduce cholesterol more than simvastatin alone, but that apparently does not translate into a lower risk of heart disease.

Statins are often credited with a number of unpleasant side effects, including uncomfortable muscle aches. And evidence is mounting that while they may lower LDL cholesterol numbers, they aren’t providing the reduction in heart attacks that “should” result.

Low Carb Pie Crust

You can find several variations on the low carb pumpkin pie recipe, most often without a crust. One recipe uses crushed pecans, but they are expensive now. I found an old recipe for “Nut Brown Crust” in the American Home All Purpose Cookbook, published in 1966.

Nut Brown Crust

1 1/2 Cup finely ground almonds, walnuts, Brazil nuts or pecans
3 Tbls Sugar (or sugar substitute, like Splenda)
2 Tbls soft butter

Blend finely ground nuts, butter and sweetener together with fingers. Press firmly into a lightly buttered 9-inch pie plate. Bake at 400°F for 6 – 8 minutes. Cool before filling.

Using almond meal (sometimes called almond “flour”), I found I could make a very good crust that acts a bit like a graham cracker crust. This crust works well with pumpkin pie filling.

The almond meal has a total of 30 grams of carbohydrates, with 18 of them fiber. The net carb count is therefore 12 grams for the entire pie. Many of the low carb pumpkin pie fillings come in at about 12 grams for the entire pie also. Slice that pie into 8 slices and each is only 3 grams of carbs.