October 22, 2010
Smoke, Fire, Inferno: Are You STILL in the building?
by Barbara Berkeley, MD
Picture this. It's a grey fall morning in Northeast Ohio, the kind of morning when the nip in the air prompts people to get out the mittens and the knitted hats. There's a peek of sun now and then; a few moments of lucent optimism. Each time the light glows, the leaves flash irridescent orange and red. But it doesn't last long. The clouds quickly reassemble and cover the sun. Unlike the leaves that still cling to the branches, the leaves that litter the ground are brown, wet, and dead. Winter is just a moment away.
From the corner seat in our local coffee shop, I'm blogging and watching life go by. The first guy who comes in from the street has a prominent belly that's hanging way over his belt. He orders a coffee, a doughnut and a blueberry muffin. He pours sugar liberally into his cup of joe.
The pastry case looks tempting. There are five different types of muffins, multiple slices of pound cake, rice crispy treats, cookies and scones. If you ask for coffee, the smiling staff has been trained to ask, "Anything else for you today?". They appear to be slightly offended--mildly shocked--- if you don't get something sweet.
I flash back to a story from Don's medical school days. He was assigned to take an eating history from a very overweight patient. She reported that she usually ate cake for breakfast. He came home and told me this and we were so shocked that the story was repeated for years. That was 1980. Now I sit and watch as the majority of people in our town leave this coffee shop with a bag full of cake for breakfast. Actually, they've probably already had breakfast, because it's now 10 am.
A vertical rack offers a selection of newspapers with their front pages tilted forward attractively. Bold headline, above the crease on USA Today: DIABETES CASES MAY DOUBLE BY 2050.
The pace of our sugary dissolution is apocalyptic, frightening. Why are we all becoming diabetic and why doesn't anyone care? Smoke in our house, flames licking at our feet. Sometimes I feel like I'm a lone voice shouting FIRE. It's like a bad dream. The one in which you try to call someone with an urgent message, but your feet stick in the sand, your fingers turn to rubber when you try to dial the phone, the line is dead. Over and over.
Last night we held our second Refuse to Regain Group. Eleven maintainers showed up, all so anxious to learn from each other. Many in our group have lost over 100 pounds and one person has lost over 250 pounds, but the tasks of maintenance remain the same. In order to maintain, in order to beat off the world of illness, fat and diabetes, we must find a way to live outside the sugar and starchy American norm. How we do this was the subject of heated debate. Can we eat whatever we want, but just have three bites? The National Enquirer reports that Kim Kardashian eats a bite of dessert and pours champagne over the rest to ruin it, perhaps the ultimate demonstration of our wasteful, profligate society and our search for ways to have our cake and avoid it too.
At the meeting, there was a clear division between those who had maintained weight for years and those who were just getting started. The newbies were still wrestling with the Kardashian solution. Surely there was a way to continue to "play" with pasta, potatoes, grains, bread, cereal and sweets. Maybe on the weekends? Maybe with steely self control? Maybe by keeping a food diary? Please, please let there be a way!
The more experienced maintainers had long since made their peace with the elimination of sugars and starches. They ate by consistent rules and had discovered certain non-triggering treats (NTTs) that worked for them. Their diets relied on large amounts of fruits and vegetables, lean proteins like poultry, fish and low fat dairy and some nuts. When their weight went up a bit, they eliminated their NTTs temporarily.
What is causing our obesity and diabetes? The honest answer is that no one knows. Perhaps we've simply exceeded the amount of stress our insulin systems can tolerate. Perhaps epigenetic changes that occurred in utero, in wombs that were exposed to much higher levels of sugar than earlier generations, have left us vulnerable to these foods. Or, there may be new obesogens in our environment, chemicals that disrupt the normal ability of our insulin to choose whether sugars should be burned or stored. We store everything and become fat and increasingly sugar intolerant. (And please remember that all starches are sugar too, including whole grains).
It doesn't much matter, because the short term answer is clear. Eat a diet that is consistent with your ancient genes and one that avoids as much starch and sugar as possible. This removes the stress from an insulin system that is busted...either by overexposure or by some unknown obesogenic cause.
The tsunami is gathering. The fire is already raging. We are facing an untold epidemic of overweight, diabetic, atherosclerotic Americans. You are in the line of fire. I'm telling you the answer. I'm shouting that the roof's about to cave in. But so far, there aren't many people running for the exits. They are still staring, glassy eyed, at the pastry case and pondering the Kardashian compromise.
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