Sugarless Tuesdays: A Teaching Moment for Type 1 Diabetics

Paula Deen doesn’t understand very much about diabetes.  That’s the feeling I was left with after interviewing her a few weeks ago.  She was delightful to talk to – warm, charming, and eager to share.  It’s no surprise she’s incredibly popular.  I could have listened to her for hours.  What made me sad, though, as I listened to Paula speak was the fact that she felt getting diabetes was an inevitable part of growing old.  Then at the end of our conversation Paula said something that made me more than just sad.  It made me cringe.  Paula said,”My goal at the end of my life…If you hear the name Paula Deen, what is the first thing you think of?  I hope it’s not butter. ”  Of course, I can understand that – who wants to be eternally associated with churned milk, right?  But what I wanted Paula to have said was not that she feared being remembered as the queen of butter.  I wanted her to say she feared an everlasting association with sugar. 

Paula Deen, don’t worry about the butter.  The problem with your recipes is the refined carbohydrates and sugar.

I’m not the first person to say this.  While there have been hundreds of articles written in the last month calling fat a culprit in Paula Deen’s diabetes, a few have also spoken up in fat’s defense.  David Mendosa, an avid low-carber said he doesn’t blame Paula for “the fat and salt in her recipes, but all the carbs.”  And a few days ago I read an article by Dr. Jonny Bowden, Paula Deen: The Lost Teaching Moment. This is his main point:

“Paula Deen is not diabetic because she eats too much butter. She’s not diabetic because she cooks with too much fat. She’s not diabetic because she eats “unhealthy” stuff like meat. She’s diabetic because her body can’t effectively process sugar.  Period.  In fact, if all she ate was fat and protein, we probably wouldn’t be having this discussion. (But of course, there would also be no Paula Deen show.)  Diabetes educators, the American Diabetes Association, and virtually everyone else in the mainstream is jumping on her high-fat cooking as the “cause” of her diabetes, but nothing could be further from the truth. Fat is NOT the enemy in the American diet. Fat doesn’t make you fat, and it most certainly doesn’t make you diabetic.  Let me explain.  Type 2 diabetes is a disease of carbohydrate intolerance. Not fat intolerance. Not protein intolerance. Carbohydrate intolerance. And the reason the “teaching moment” is being lost here is because everyone is parroting the same old, past-its-expiration-date garbage about the “dangers” of fat, while ignoring the simple fact that it is carbohydrates — especially sugar and processed carbs — that create the blood sugar havoc that ultimately results in diabetes.”

Now I know that Dr. Bowden is oversimplifying.  It’s not only a sugar-rich diet that leads to type 2 diabetes, however, it is certainly a major contributing factor in many cases.  Something I’ve thought about many times since I was diagnosed with type 1 diabetes is how much I’ve learned about carbohydrates and carbohydrate metabolism.  Even if you disagree with me that eating fat is okay, consider this point seriously for a moment: Who knows the effect of carbs on the human body better than a person with type 1 diabetes (or the caregiver of a person with type 1 diabetes)?  I believe the answer is no one.  We’re the world’s experts. Who among us does not know the effect of a cupcake on blood sugar levels versus the effect of a steak on blood sugar levels?  Doesn’t this knowledge make us natural teachers?  Is the teaching moment being lost not on Paula Deen but on us?

Not sure what needs to be taught? 

Like it or not (and believe me, I wish this weren’t true!), sugar is toxic to our bodies, and not just if you have diabetes.  In a recent article in Nature, Dr. Robert H. Lustig and his colleagues called for government regulation of “added sugar”, as there is with alcohol and tobacco.  Their argument is essentially that the metabolic effect of sugar, particularly fructose, is equal to that of ethanol (drinking alcohol).  Regulation, they suggest, “could include tax, limiting sales during school hours and placing age limits on purchase.”

I once argued for something along the same lines when I objected to a proposed soda tax on the basis that not just sodas, but all sugars, should be treated equally, as we treat all cigarette brands equally. I wrote, “Perhaps we can institute laws that require supermarkets to make a junk food section with a tollbooth at its entrance and charge $5 per person to enter. Such a draconian and expensive measure might really lead to a considerable reduction in the consumption of all junk food.”

But even the tollbooth is not enough.  None of it will work without education.  And don’t think those  little black and white nutritional labels on our junk food are meaningful education.  How many people look at those labels before purchasing a product?  My guess is very few.  The reason is because we don’t view our food products something dangerous, poisonous, or something that requires review.  We assume that what’s for sale in our supermarket is okay for us to eat. We also assume that if people were to read nutrition labels, they would understand them. Not true.  Moreover, how many people know that refined carbohydrates and sugar are the same to our bodies?  Do the people who drink six cans of soda a day have any idea what 28 grams of sugar per can means?  If we labeled soda cans with a skull and cross bones instead of “20 grams sugar,” maybe people would get it.

I’m not, however, really a fan of scare tactics.  I also find it hard to believe that the majority of our society will ever be able to “fear” sugar.  But we who truly know the effects of sugar in the body can begin the long and difficult process of educating people.  We can bring diabetes awareness to a whole new level.

I’m not suggesting we follow or promote one diet or another.  I’m not suggesting that we all treat our diabetes in the exact same way.  No two bodies are alike.  The one thing, however, that we do all have in common, is our inability to metabolize sugar. Then why do we boast that we can eat whatever we want?  Why do we get angry and defensive when someone asks “Should you be eating that cake?”  We should do the hard thing and say “No, I shouldn’t be eating this cake, and neither should you.”

It’s not easy.  It’s anything but easy.  I have been able to reduce my sugar intake to close to zero, though I have days when I fail.  What I haven’t been able to do is prevent my children from eating sugar.  Part of that is because I don’t want to make my sons “different.”  I don’t want them to feel deprived.  But another reason is that while I can stop myself from eating sweet food, I haven’t succeeded in changing in the way I think about it.  I can’t imagine a birthday party without a cake.  I can’t really imagine a world without dessert, if not for me, then for others.  I want to be able to change the way I think about food. 

So, facing my own weakness, I come back now to the “teaching moment.”  Do we who understand the effects of sugar on the human body in the most intimate way have a responsibility to speak up and help the dozens of millions of type 2 diabetics and pre-diabetics?  If we are real trailblazers who are going to make a difference in diabetes awareness, I think the answer is yes.

In November 2010, to mark Diabetes Awareness Month, I started a Facebook page called Eat Responsibly.  I hoped hundreds of thousands of people would support the campaign, however, fewer than 40 people “liked” it.  Perhaps this coming November we can raise the bar.  Awareness needs to be more than promoting a symbol or a color.  We need to take action. In the meantime, would you join me in Sugarless Tuesdays? (Note: In case of hypoglycemia, please do have sugar!)  One a day a week without sugar and junk food.  Can we do it?

 For more on the dangers of sugar (and the defense of fat) visit Peter Attia’s blog, War on Insulin.

Graph from Nature:  http://www.nature.com/nature/journal/v482/n7383/full/482027a.html

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

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Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)