What writing a book about America’s relationship with vitamins taught me about diabetes
After spending three years locked in a book-writing cave, I’m excited to say that my new book, VITAMANIA: Our Obsessive Quest for Nutritional Perfection is being published today by Penguin Press. It’s about the history of vitamins and how they’ve influenced the way we think about nutrition.
At first glance, these subjects might not seem to be related to diabetes – or at least they didn’t to me. But the more I discovered about vitamins, the more parallels I began to draw between their history and the daily experience of life with diabetes. Here are five of the most useful things I learned:
1. No one has all the answers
When I started researching the book, my first goal was to answer some basic questions about vitamins — like, for example, what the definition of a “vitamin” actually is. Imagine my surprise (and subsequent panic) when I found out that there actually isn’t a precise chemical definition – the word itself was coined by a Polish biochemist before any of the vitamins had even been chemically isolated. He originally called them “vitamines” – combining vita, the Latin word for life, with the chemical term “amine.” When it became clear that not all of the vitamins were actually amines, the final “e” got chopped off. The fact that we still use the word “vitamin” today has less to do with science than it does with the word’s marketing appeal.
After spending several weeks freaking out about how I was possibly supposed to write a book about vitamins if the word itself hasn’t been defined, I realized something that guided the rest of my research: there’s a lot about vitamins that is uncertain . . . and that’s okay. In fact, it’s not just okay; it can be empowering — because once you recognize how much about vitamins (and nutrition) is still unknown, you can stop tormenting yourself over the details.
Likewise, no one can predict how a particular piece of food is going to affect your blood sugar on a particular day – our bodies are simply too complex. It’s important, of course, to try our best to guess the proper dose of insulin and to keep our blood glucose levels in as normal a range as possible. But whereas I used to feel like there must be some “expert” diabetic out there who had all the answers, I now recognize that no one can perfectly predict diabetes. When my blood sugar ends up too high or too low I still feel frustrated – but I also recognize that it’s not my fault.
2. Nutrition is not a math problem – and neither is diabetes
It’s nice to think that there’s some formula out there for what constitutes a perfect diet. But the fact that the recommended dietary allowances for vitamins have changed so much since their creation – and are still evolving based on new science – proves that a “healthy diet” can’t be reduced to simple math. Likewise, while we can all work on fine-tuning our basal rates or trying to figure out approximate insulin doses for our favorite meals, the same dose of insulin is likely to work differently from one day to the next. Any doctor or diabetes educator who insists on treating diabetes purely as a math problem is refusing to admit how many other variables are at play.
3. Nutrition and Supplement Facts panels need to be taken with a large grain of salt
You know the “% Daily Value” column on Nutrition and Supplement Facts panels that supposedly tells you the percentage of your Recommended Dietary Allowance of a particular vitamin a serving contains? Turns out that those numbers are based on seriously outdated recommendations – namely, the ones from 1968. [i] (The FDA is in charge of regulating food and supplement labels, and when it comes to which version of the RDAs to use, it’s way behind on its updates.) This means that when your cereal or multivitamin tells you it provides 100% of your DV of a vitamin or mineral, that 100% is based on recommendations that are nearly 50 years old.
As for diabetes, I was dismayed to learn that the amount of carbohydrate listed on the label – a number that is clearly quite important for those of us who use carbohydrate information to gauge our potentially lethal insulin doses – allows for a disturbing amount of wiggle room. According to the FDA’s regulations, carbohydrate must be present in an amount “at least equal to 80 percent” of what’s shown on the Facts panels – and there’s no official upper limit. [ii] Instead, carbohydrate simply is not supposed to be present at amounts beyond a “reasonable excess,” but the term “reasonable excess” is not defined. Practically speaking, this means that a food that supposedly contains 50 grams of carb per serving could have as few as 40 grams, or as many as . . . well, I don’t know!
This emphasizes my previous point: it’s impossible to treat diabetes as a math problem when you don’t even know if you’re starting with the right numbers.
4. Beware of marketing claims
When vitamins were first discovered in the 1920s and 30s, it didn’t take long for marketers to start using them as a way to sell their products – I found old advertisements boasting of the vitamin content of canned pineapple, and even came across the seemingly brilliant — and inexplicably short-lived –Schlitz Vitamin D beer.[iii] These products might seem laughable, but if you think about it, they’re really no more ridiculous than Cocoa Puffs being marketed as an excellent source of vitamin D. The more I learned about the history of how marketers have used vitamins to manipulate us into buying their products, the easier it was for me to recognize the absurd marketing claims of today.
Likewise, some manufacturers are jumping on the low-carb diet trend and marketing products that, while superficially appealing, are actually no better than the versions that they’re replacing. (In fact, they’re sometimes worse – a lesson I learned this the hard way when I binged on sugar-free chocolate the night before an 80-mile JDRF bike ride in Death Valley.)
5. Diabetes and nutrition are not one-size-fits-all
We know that vitamins are essential for preventing specific deficiency diseases. Vitamin C prevents scurvy, for example; vitamin D prevents rickets. But we don’t know exactly how much of each vitamin our bodies require. In fact, according to a 2003 report from the Food and Nutrition Board – that’s the non-governmental organization responsible for updating the country’s RDAs — “it is almost impossible to know the true requirement of any one individual.”[iv]
The same is true for diabetes. As the saying goes, “your diabetes may vary” – which is why the American Diabetes Association’s official guidelines now explicitly recognize the need for individualized goals and treatment plans.[v]
By the time I’d finished writing the book, I’d realized that what seemed like separate subjects were more similar than they’d seemed. We want nutrition – and diabetes – to have black and white, simple answers. But thanks to the complexities of the human body, those answers will always come in shades of grey.
[ii] http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9 (search for 80 percent)
[iv] Committee on Use of Dietary Reference Intakes in Nutrition Labeling Food and Nutrition Board. Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification. Washington, DC: The National Academies Press, 2003. P. 91
[v] http://care.diabetesjournals.org/content/37/Supplement_1/S14.full (search for “treatment goals and plans should be individualized”)