Monday, June 27, 2011

Thoughts about insulin resistance.


(Not me, thankfully, though I'm not far behind this dude.)

I continue my long tradition here of breaking all the rules of good blogging, this time with a diversion into... medicine! (To paraphrase Mark Twain, never let a lack of knowledge stand in the way of a perfectly good post.)

***

I vowed from Day One at the JW that I would not devote any time here to dieting issues. Not because this isn't a perfectly legitimate thing to write about, and not because no one would be interested--indeed, weight struggles are something with which many of us are familiar. My rationale has been that I find blogs that concentrate on a person's life rather tiring, especially on their interior life (unless you're just a hell of a lot more interesting than I am... internally). I'm much more interested in reading about ideas and issues than I am about a particular person. (Granted, with a blog it's all personal at some point, but I still think it best to stick to ideas.)

So what to do then when one's personal life brings one into contact with ideas? Well, we just stretch the rules a bit.

So. I've been fat my whole life, really. I remember seeing 202 lbs. on the scale when I was in 8th grade (a time when I should have been what? 120 lbs?) and I was probably 220 when I finished high school. By my 30s I was in the 250 lb. range, and now, nearing the ripe age of 50, I'm around 270. By most calculations that puts me around 100 lbs. overweight. I don't think of myself that way, and I think I carry my weight in such a way that I'm perceived as being stocky but not 100-extra-pounds obese. But I am. I used to be a runner in my 20s and 30s, a tactic for trying to keep my weight under control. But I had only limited success with this, and like many people my weight has been an up-and-down-and-mostly-up-again struggle.

In addition to my attempts at exercise I--like much of America--have spent much of my life trying to diet. I rarely followed a specific program, mostly concentrating on calories-in / calories-out. But that gets harder the older one gets. A few years back I tried the Atkins diet, and I was particularly taken with it, both because I found it worked and because the concepts behind the diet were aimed precisely at me (one of my first clues that calories-in / calories-out may not really be enough). America is suffering a growing epidemic of obesity and diabetes, and Atkins was the first source I'd come across that made any real sense of this epidemic. I lost around 50 lbs. on Atkins, but I learned that a life entirely without carbs was not really sustainable for me.

But, again, the takeaway here was that Atkins' philosophy had me directly in its crosshairs; I am the poster child for the phenomena that prompted him to concoct his regimen. (There are a lot of people, I know, for whom his diet regimen is not workable, or even applicable.) I also tried Weight Watchers, which I think is a truly great program and one which IS applicable to many people. But while good-sense advice and meal planning are surely beneficial to me, I've come to see that I suffer from a particular and specific metabolic problem, and any real fix for my weight is going to have to grapple with this. (And I think ultimately WW will need to grapple with these issues as well.)

A friend was recently put on the South Beach Diet by his doctor, and that led to us discussing dietary matters. Susan has a copy of the South Beach Diet book, and my perusal of the book and my discussions with my friend reinforced my impression that Drs. Agatston and Atkins are pursuing in pretty similar fashion the same demons (and both are singing my song). Agatston's attempt to differentiate his thinking from Atkins' feels more marketing than substance to me, though I acknowledge his emphasis that fat consumption should be reigned in and specified. But in the final stage of Atkins one is consuming quite a number of fruits and veggies. (So often Atkins is characterized for the first phase of his diet, a shocking plan which runs contrary to just about everything we adults have been told for 40 years; but his "maintenance phase"--my phrase--looks about like what most of us think of as a healthy diet.)

But the South Beach Diet: I read the book--and began the plan--and it all has me chewing specifically on the topic of insulin resistance (or type-2 diabetes or metabolic syndrome or even syndrome X). These terms all address the same phenomenon, or at least stages of it. For my purposes, insulin resistance refers to a dietary condition where insulin loses its effectiveness in metabolizing carbohydrates. The condition appears to arise from excessive carbohydrates in the diet over a prolonged period; all these carbs require the body to produce lots of insulin to metabolize, and over time (for a number of reasons I have not internalized) the insulin loses its effectiveness. As the insulin becomes less effective, the body produces more and more of it to compensate; meanwhile these high levels of insulin contribute to storing these excess carbs away as fat, a condition which exacerbates the whole situation. A vicious cycle develops where the carb addict consumes more and more carbs (because the ones he's already eaten aren't turning into energy), which further increases the need for insulin. The result is the body essentially losing its ability to metabolize carbs adequately--diabetes.

As I say, I'm really a poster child for this problem (while thankfully avoiding diabetes thus far): I've been overweight all my life, and I've eaten over 90% of my meals out for 30 years. This means that a huge preponderance of my diet consists of processed food. I'm also regrettably a product of the food-industry culture, with my almost laughable Diet Coke addiction and my love of candy and chips and all the junk that exactly brings insulin resistance about. Food has long ago been dissociated from hunger and nutritional maintenance for me; it's all about wants and desires. At my twice-yearly medical checkup last week, I learned that my blood sugar is slightly elevated--not enough to be a problem yet, but it's trending where I don't want it to go, and this is on top of my already being on medication for blood pressure and high cholesterol.

This is just a stupid situation all around; I'm gradually killing myself with food.

The American diet has become very heavily weighted toward the foods which cause this metabolic disaster (the exploding epidemic of diabetes in America is proof positive): our convenience stores and drive-thrus and even our supermarkets are stocked with an overwhelming preponderance of processed quasi-foods that are triumphs of marketing and profitability but disastrous to our bodies as sustenance. I know this because these are precisely the foods I have spent my life eating--and much of my adult life fighting against the effects of (as any overweight person can tell you, being fat is a low-grade 24/7 preoccupation).

I'm at risk of sidestepping a crucial fact here: none of us is overweight--let alone trending toward diabetes--except by way of food we've placed voluntarily in our own mouths. We don't get fat without complicity. But that argument adds up to shit when we are being walked doe-eyed into an epidemic. Ongoing appeals to will power and self-control have brought us steadily backward until our present catastrophic state.

It hasn't just happened. Whether we are complicit or not, this is something that has been systematically done to us--and for one simple reason: it makes a shitload of money for big corporations. And it is being increasingly done to the citizens of other nations. Like the tobacco industry or the gambling houses of Las Vegas, the food industry has found the secret button--found, carefully nurtured and cultivated it--that gets us, zombie-like, to pursue a path that is very decidedly NOT in our best interest, and they are hiding with all the other industries behind the tree of individual free will as a means of escaping responsibility for the damage being wrought (it's a very crowded space behind that tree).

Cigarettes and gambling are perhaps instructive analogs. Cigarettes are now universally acknowledged as unquestionably dangerous to our health. They are ONLY deleterious; there is no possible upside to smoking--except, significantly, the relentlessly-marketed "social benefits" (a whole-cloth invention of the tobacco companies). And with the health questions firmly decided, society has in consequence moved consistently in the last 30 years to discouraging smoking, with warning labels and heavy taxes. (My point is not to debate whether this is the correct way to approach the problem of smoking, but simply to note that as a society we are taking active steps against a thing now universally acknowledged as harmful.) With gambling, things are fuzzier. It's possible to gamble without vice or ruin, and one's gambling does not necessarily hurt other people. For millions of folks it's fun to save up a couple grand and live it up for a few days in Vegas; no harm done. But we don't let minors do it, because it's easy for our sense of risk and reward to be misled--indeed, the entire industry is based on a predictable mis-firing of our risk/reward instinct.

Food strikes me as more like gambling. But it differs from gambling or smoking in that everyone HAS TO eat. You can steer clear of Vegas if you feel unable to control yourself at the craps table, but steering clear of food is a non-starter. And what a leg up for industrial food producers! The process of getting people hooked on an obscene proliferation of bad foods--our supermarkets are now about 80% junk--has been a gradual one, but it piggybacks on our inexorable need to eat something. A company need only find a way to make THEIR something THAT something and the profits that are the be-all and end-all of industry will come rolling in: caffeine (in the case of Coca-Cola, it was cocaine originally--the ultimate way to addict your patrons to your product); sugar--LOTS and lots of sugar; intense, lab-crafted artificial flavors.

And billions of dollars spent yearly on marketing, especially to kids.

So all this to get to this question: At what point do these companies bear responsibility when their relentless drive for profit causes them to take actions which they know and we know will cause many people to bypass their common sense and best interests toward an outcome that's disastrous for us (but not for them)? At what point do we hold McDonald's--maybe the largest food vendor in the country--accountable for marketing and selling products which they know to be deleterious to our health--more than this, they know to be actively contributing to a medical epidemic? To say they bear no responsibility is, IMO, bullshit.

(This seems an especially germane question as I look around China and see a new generation of fat, American-looking Chinese. These have never been seen in China! This is like discovering a pristine land and quickly destroying it to get to the precious metals underneath, except the pristine land is 1.3 billion human beings. Convenience stores in China are much smaller than ours and have very little of our standard junk food, but the phenomenon is clearly growing. I generally see only young folks in the 7-11s, and mostly kids in the McDonalds, but there is a huge effort underway by McDonalds and Subway and Burger King and KFC and many other American brands to turn China into an immense new source of revenue. As the population in China ages, hundreds of millions of consumers of American junk food are being created--and, predictably, millions of people who will suffer from insulin resistance and eventually type-2 diabetes.)

So what to do? Good socialist that I am, I propose that what appears to be working for the tobacco industry should be applied to the junk food industry: we should tax the shit out of processed foods which cannot be demonstrated (scientifically, independently) to have some dietetic reason to exist--not marketability, not profitability; manufacturers should have to demonstrate dietary merit for any processed food or we should be required to pay something extra for the privilege of exercising our freedom of choice to eat what we know will hurt us and burden our health care system. Put that money in the health care fund.

I love me some jalapeno Cheetos, but I have to look myself in the mirror and acknowledge that they're killing me; them and peanut M&Ms and Double-Stuff Oreos.

This is not going to happen, guaranteed, because we are easily kept from speaking with one voice and in any case we're no longer in control of our government. But that's another post.

8 comments:

dbackdad said...

Wow, you are so thorough with your posts that it makes my head hurt. I didn't want to comment too soon until I had a chance to take it all in.

And before I address anything serious, it is worth noting that if I had two lovelies like those in the picture helping me up, life wouldn't be so bad. :-)

At different times in the last 5 years, I've done Atkins, with great success. I didn't have too much trouble sticking with it and saw quite a bit of weight loss. The only reason I really abandoned it was because I abandoned meat altogether about 15 months ago. As I may have mentioned before, this was not necessarily for the health benefits of doing so (though there are definite benefits) or because of an immediate concern for animals (though I certainly have some). It was out of environmental concerns and the disproportionate carbon cost of raising and transporting meat.

Now, in the first year of my vegetarianism, I didn't want to be too much of a stickler about trying to stay low carb because I wanted to make sure that I stuck with it. And I have with no issues, though I've probably gained 15 pounds in that time. But in the last 3 or so months, I've made a concerted effort to scale back the carbs while staying vegetarian. Difficult, but not impossible and I hope it will result in the losing of those 15 pounds and some more. Atkins, South Beach, and most major eating systems are preaching the same thing ... fruits and vegetables, lean or no meat, whole grains, minimize refined sugars. Nothing to argue with any of that.

I completely agree about processed foods. The biggest reason why we consume so much is because it is cheap and convenient. It's not just that this stuff should perhaps be taxed ... it's that we should stop subsidizing those that produce it. Small farm fresh foods are more expensive because those farms don't get the ridiculous subsidies that corporate corn, soy and wheat growers get. It's great to say that inner city people should eat better, but they don't even have access to the fresh foods that some of us are lucky to get and be able to afford.

If we were all given better access to fresh food and those producers were able to compete on a level playing field, all of us would eat better. And if we ate better, we'd be healthier and healthcare costs would go down. This is the crux of why all of this will not happen ... who has the power and the money? The ADM's of the world and insurance companies. They line the pockets of the government and write the legislation. Organic Bob with his small farm has no pull whatsoever. These large companies have a financial incentive to keep us fat, stupid, addicted to sugar and dependent on healthcare.

wunelle said...

I always appreciate that you take the time to wade thru my ramblings. I think your comment belongs verbatim in the body of the post, like the fingers in the glove. I have always felt vegetarianism is laudable for so many reasons (as you enumerate), and I'm only prevented from that path by my struggles to control my diet at all. Here's hoping I manage some permanent changes to build upon.

More and more I find the icy fingers of unrestrained capitalism to be the constriction on our throats; we need to regain human control of our government, which is looking like a tall order.

Currently reading Chris Hedges' Death of the Liberal Class, which is considerably blackening my mood. He's Taibbi without a sense of humor.

Jeffy said...

I've started my own battle to shed some excess weight. I've just done the count your calories method, and so far I've had at least a bit of success. I found a spiffy little app for my phone that has helped me quite a bit. It is from myfitnesspartner.com and it will look up the nutrition info on any food I eat, and then keep a running total for the day to see how I am meeting my target. It has been a real eye-opener to keep track of what I eat and see how little I need to eat in order to lose weight. I've had to cut back, but I can generally find meals that don't wreck my daily total. I just have to be somewhat careful, and be very stingy with the snacks.

I've heard very good things about the South Beach diet, so if you can follow the advice given by that book I think it can be pretty good for you. The main thing is that you need to eat fewer calories than you need to survive, but it is very helpful to do it in a way that makes sense in terms of how your body works, and that is where the South Beach diet can help. Plus, you need to be able to stick with it long-term, or the weight will just come right back, so you need to find ways to adjust your diet that you'll be able to continue indefinitely. So many diets are not realistic in that regard, and I think the SB does about as well as can be done.

Jeffy said...

I agree that the bulk of the food that is available in the US is not just not good for you, but is out-right bad for you. I don't think, though, that this sad situation is a result of food producers maximizing profits at all costs, rather it seems more likely due to their efforts to compete with each other in the marketplace. The result is pretty much the same, but I don't think that it is something as evil as the big bad corporations trying to get rich by getting us hooked on crack that we can't say no to. I think it is more the case that if I want to sell my food product, then I have to entice you to buy it instead of the other choices out there. Since most people decide what food to buy based primarily on taste and price those are the things that producers strive to improve on. This rather naturally leads to the current situation.

The problem stems from the way we are designed to gorge when food is available to be able to get by during those times when it is unavailable. We also crave foods that are necessary for survival, but often not abundantly available in nature, like salt. Now that food is always available we have to work against the programming that got us here in the first place.

It is clearly the case that the foods that are better for you are more work to produce and more expensive to deliver. Anything that can be processed mechanically can be done much more cheaply than those things that require manual labor, and processed foods that ship easily and have a longer shelf life are cheaper to handle. If the goal is to provide as minimum ration of calories to as many people as possible, then wheat wins out over produce such as tomatoes quite easily.

It would be interesting to see what would happen if we were able to impose a sin tax on unhealthy foods. I am not sure that doubling the cost of a Big Mac, Diet Coke and a bag of Peanut M&Ms would do much to deter you or I from buying and eating them, unless there was something else readily available that we thought we could stomach. I think that as is often the case, such a sin tax would be the greatest burden on those least able to afford it. Right now supper at McDonald's is quite likely more affordable than a healthy alternative, so unless that alternative can be made more cheaply we'll just make folks poorer faster, rather than making them healthier. We already get most of our produce picked and processed by underpaid immigrant laborers, so there isn't much we can do to make that cheaper.

So, while I am not convinced that this dilemma is the result of bad intentions, I do think that it is an example of how free market forces don't always work to produce the most desirable outcome. We get what we want - cheap, abundant tasty food (that happens to be pretty bad for you), but not what we know we need. Maybe if we could get our wants to match up with our needs we'd be set.

wunelle said...

As always, I'm grateful for a little tempering :-)

And I think there's a big chunk of truth in what you say--that the food companies are merely trying to out-compete each other for our dollars rather than actively seeking to degrade our nutrition.

And yet I wonder if there can be compatibility between these things, short of some government-run propaganda campaign which makes healthy choices a desirable option. Looking at China, again, I think of the billion people there for whom most of our supermarket options are of no interest whatsoever. I think their tastes are differently-attuned than ours, and it becomes a chicken-and-egg question to ask what came first: the taste for junk food or the heavily-marketed junk?

I suppose I've been running down a particular path for a while now, with Food, Inc. and Fast Food Nation and Eating Animals in the foreground of my thinking, and perhaps I'm running to paranoia. But even then I think it's kind of a dangerous combination, this survival mechanism you cite (quite correctly, I think) and the development of quick, cheap food that hits all of those triggers.

I agree that making McDonald's food more expensive by a junk food tax will disproportionately hit the poor, which is a negative consequence I didn't think thru. And yet, like Wal-Mart, this cheapness is ultimately killing us.

So I'm back to not knowing really how best to progress, but I think our current path is unsustainable. Worse than that, it's trending us toward bad places.

wunelle said...

(I hasten to add that a government-run propaganda campaign for healthy eating has roughly a 0% chance of being successful, FWIW.)

wunelle said...

AND YET...

I still can't help thinking that every interface between business and food results in problems for we consumers: soft drinks--food items of purely deleterious effects--are now everywhere in schools, even "sponsoring" lunch rooms and school sporting events; corn products are now absolutely everywhere, including places quite far-flung from ground-to-mouth consumption (think High Fructose Corn Syrup); it is quite difficult here to eat without avoiding meat (and I confess I love meat), even though our very meat-heavy diet is a disaster for the environment and very inefficient vis-a-vis nutritional resources.

I think I could feel more sanguine about business and food if there were more In N Out Burgers and fewer McDonald's (to say nothing of family farmers vs ADM).

Jeffy said...

I think you are right, that this is a situation where the benign interests of the big food production companies are at odds with the true needs of their customers. And you are right that mere propaganda will not change any behavior. It may well be the case that some government intervention for the good of the people is necessary. Somehow, someone has to be the parent and force us to do the right thing, because we are so keen on doing the wrong things.

I think you are also right in that folks for whom junk food is a foreign thing not only have no interest in it, but they generally dislike it, except for the 'American' factor. It is a learned taste, but it is not hard to learn.

This is one of those issues that affects us all, and that we don't really want to fix, for the consumers it seems too hard to fix and the producers don't want to mess with a system that is working for them. I'd much rather see our politicians trying to solve this problem (and some others like it - most of which you have mentioned before) than go after the easy issues that will get them donations from special interests. I don't think there is an easy solution, or even just one solution, but I do think that by giving folks the right incentives - either to make healthy choices or for producers to provide healthy choices (that people will actually buy) we can improve this situation.