40% With Diabetes
According to the new CDC estimates, 40% of adults will develop diabetes in their lifetimes. That’s two out of every five Americans! Are you kidding me? This is not an infection, people. It is not contagious. This is a behavioral/dietary issue and we have lost the battle. What we are doing is not working. Please don’t be fooled about the quality metrics forcing doctors to get these people’s glycohemoglobins under 8 either. That may help some but the real issue is how to get these patients to eat better (lower carb) and exercise more and we are no where close to doing that.
Lower carb is not the answer. The problem has nothing to do with individual nutrients. We don’t eat vegetables any more. It is the most fundamental change to our diet over the last half century, which is the same period of time in which lifestyle diseases started to reach epidemic proportions.
Telling people to avoid anything is problematic. The “can’t have” syndrome is a powerful antagonist. Even worse, an attitude of denial and avoidance puts people in a position of trying to manage their diet using negative emotions (shame, guilt, maybe a little bit of angry defiance).
Educating people about nutrition is definitely not the answer. As a society we know more about nutrition than ever before. So why are we the fattest, sickest society in the history of the world? Nutritional science has no practical value for the average person. And since doctors were largely not taught about nutrition in medical school their information is not much better than a layperson’s. So how good can their advice be?
Keep it simple and concentrate on changes with leverage. Changing certain key behaviors will naturally lead to changes in other behaviors. Here are the best pieces of advice on improving lifestyle that doctors should be giving to every patient they see every time they see them:
Eat more vegetables.
Watch less TV.
“I eat good” is what I hear patients tell me all the time. “I eat lots of veggies now”. They are obese and diabetic but good thing, they are eating their veggies plus every other carb in the world. Please, Tom, not buying your advice. And yes, I have been in the field for 20 years and have sat in front of patients directly over 100,000 times in my career. And yes, I have a Master’s in Exercise Science and know a ton about nutrition. Telling them to eat more veggies and watch less TV would fall on deaf ears. The fat theory has been debunked. The calorie theory (calories in vs. calories out) has been debunked. Protein restriction has never been a diet. So, what is left? Carbs. The only success I have ever had was to get them closer to a Paleo diet (and I am not saying that is the end all diet, either, but I think it is pretty close)
Doug, I don’t think there is much question that a whole food vegan diet is the healthiest possible diet for human beings. A non-vegan diet based on the way humans ate in a natural environment is probably nearly as healthy for most people. But the “Paleo” diet does not meet that criterion – primarily because it includes WAY more animal than you could reasonably hunt.
But I think your point is that compliance is lacking. In that respect the whole food vegan diet is pretty drastic in today’s society and therefore not very good advice.
Trying to get patients to follow any “diet” is problematic. I fail to see why you think it is easier to get patients “closer” to a Paleo diet with its many rules and restrictions than to follow two simple suggestions. The trick is in how to present the advice. Here’s one way:
From a very broad perspective a healthy lifestyle includes healthy eating, active living, healthy relationships and healthy habits. Each one of those could be broken down into a dozen or more subcategories (healthy eating = less red meat, less refined sugar, more vegetables, etc.). In other words, adopting a healthy lifestyle is a daunting proposition.
But there is a magic combination. If you focus just on eating more vegetables and watching less TV you will have change cascade throughout your lifestyle. Eating more vegetables leads to less red meat and refined sugar. Watching less TV leads to more movement and healthier relationships. Both lead to healthier habits. That’s a Cliff’s Notes version, but you get the idea.
Agree to disagree. And I was a vegetarian for 20 years. Saturated fat (red meat)as evil has also been debunked.
Doug, I will agree to disagree, if I can just figure out what you disagree with. It seems like you are opposed to the idea that vegetables are good for you. I know you know better but “carb” is not synonymous with plants anymore than “protein” is synonymous with animals. And because there is a broad misconception about those things, the advice of “eat less carbs” is not particularly helpful. People need actionable advice, not more “knowledge”.
As for saturated fat – public health officials determined after World War 2 that people were eating way more meat than before. They looked deeper and discovered this meant drastically higher saturated fat intake. Seemed logical to assume the increased fat was causing the rising rates of heart disease. So on advice people switched to chicken and saturated fat intake went way down. But nothing happened to heart disease rates. So I agree with you – the evils of saturated fat have been debunked. But what exactly does that mean? Just that we don’t know what the problem is – NOT that there is no problem. The evils of red meat exist and they are more of a mystery now than ever.
They should at all the veggies they want. 🙂 Cutting out processed food (pasta, rice, bread) is also important. Read Paleo Solution, Primal Blueprint, etc. Not that they are the end all or be all but it’s a start. So, once again, it’s the carbs.
Diabetes may have nothing to do with medicine, what doctors do or the new guidelines…rather it may be a problem with the FDA, USDA and the industries that flood the market with foods loaded with corn syrup and other horrible stuff.
Good health starts with good agriculture and how food is being handled from educating people to cook, taste and appreciate healthy meal to the use of food for physical and mental fueling and enjoyable activities.
It is certainly more than HbA1c.
There’s got to be some way we can blame doctors for this . . .