The big fat lie
How I came to embrace butter, and other dietary lessons learned from my being my daughter’s pancreas…
Sometimes you have to break something to fully understand how it works. Open a clock and examine its gears. Shoot a hole through someone’s gut and don’t let it to heal, so you can study the stomach and digestion. Or knock out the beta cells of a pancreas, to see how a Western diet wreaks havoc on blood sugar and insulin production — leading to weight gain, diabetes, and heart disease.
To understand why roughly half of Americans are now diabetic or prediabetic.
The answer: the Western carb-heavy diet is like a continual sweltering 120 degree summer— and our pancreases can’t take the heat.
Last March, my three-year-old daughter was diagnosed with Type 1 Diabetes. Her diagnosis upended our lives, utterly. But it also was the first time I truly understood how horrible a Western carb-heavy, fat-light diet is for our health.
Let me be clear at the outset: Type 1 Diabetes is not a disease of diet. My daughter did not develop Type 1 because she was not breastfed (she was), because she drank too much juice (we never gave her juice) or ate too many sweets (we avoided sweets then and now).
Type 1 is an autoimmune disease, in which the immune system attacks and destroys the insulin-producing cells of the pancreas.
But with her beta cells gone, I am my daughter’s pancreas.
She can’t produce insulin — the hormone our bodies need to turn carbohydrates into fuel — so I must give insulin to her, every time she eats, while she sleeps, and in small amounts all day long. Without insulin she would die.
Give her too much, though, and she could have a seizure, slip into a coma, suffer brain damage, and even die. Give her too little, and high blood sugars will slowly wreak havoc on her eyes, her kidneys, her nerves, and her heart.
My daughter and others like her with Type 1 walk a tightrope — minute by minute, day by day — between high blood sugar (too little insulin) and low blood sugar (too much insulin).
So all day and all night, I monitor her blood sugar with an amazing tool that syncs with my iphone, called a continuous glucose monitor. Whenever she snacks, swims, runs, climbs, rides in a car, or sleeps, I can watch it affect her blood sugar in real time.
What am I telling you? That my daughter’s diagnosis has been the best and worst crash course in the whole world on how food, exercise, sleep, and stress affect blood sugar.
And the upshot is that a diet bad for people with diabetes is only slightly less terrible for the rest of us.
How the Western Diet Stresses out the Pancreas
Rapid rises in blood sugar are bad for everyone, even for people without diabetes with perfectly normal, functioning pancreases. For everyone, high average blood sugars and post-meal spikes correlate with an increased risk of atherosclerosis, heart disease, stroke, cognitive decline, kidney failure, and overall mortality. Blood glucose after meals predicts the severity of heart disease in non-diabetic men.
For those with Type 2 Diabetes, higher post-meal blood sugar spikes predict a higher risk of a heart attack and death from all causes.
Unfortunately, doctors typically monitor average blood sugar over a period of 2–3 months using your HbA1c. Few doctors examine post-meal blood sugar, save when screening pregnant women for gestational diabetes.
And your HbA1c can provide false reassurance. Post-meal spikes in blood sugar are more predictive of heart disease and kidney disease than your average blood glucose. In other words, even if your body is managing your blood sugar okay most of the time, eating foods that spike your blood sugar still damages your arteries and kidneys.
Sound bad? It gets worse: high blood sugar is itself toxic to your insulin-producing cells. In the short term, high blood sugar impairs these cells’ ability to release insulin. In the long term, chronic high blood sugar destroys them. That’s right: blood sugar spikes destroy your body’s ability to handle sugar.
The toxicity of high blood sugar for insulin-producing cells is a major reason Type 2 Diabetes is a progressive disease. It is also why early aggressive treatment to normalize blood sugars in people with prediabetes or Type 2 can help preserve the insulin-producing cells and reverse or slow down disease progression.
How Can We Treat A Pancreas With Respect? Lessons From My Daughter’s Blood Sugar.
Rule #1: Have Some Fat With Your Carbs.
For years, we were all taught to demonize fat. Too much fat, we were told, causes heart disease, weight gain, and poor health.
Like most of us, I bought in. As a teenager, I would eat tasteless snacks like dry toast and jam to avoid extra fat. One of my friends recalls reminding her father to drink soda with his scrambled eggs to “thin out the fat”.
This advice turns out to be worse than useless, because fat slows down the digestion of carbohydrates, and slower carbohydrate digestion is easier on the pancreas.
Very high-fat meals are digested so slowly, many people with Type 1 have trouble figuring out how to deliver insulin for them. The carbohydrates in a high fat meal can raise blood sugar 4 or 5 hours after a meal is completed, as opposed to within 20–30 minutes for a low-fat meal. A popular Type 1 forum question: How the heck do I bolus (give pre-meal insulin) for pizza?
Avoiding fat in favor of carbohydrates leads to blood sugar spikes.
Plus, high-fat diets lead to greater weight loss than low-fat diets, according to a review of 53 randomized controlled trials (the medical gold standard).
And as for heart disease (the boogeyman of a high fat diet)… Doesn’t a high-fat diet lead to heart disease, as we have all had drummed into our heads? Nope.
Isn’t saturated fat, at least, the devil? It has its own nutrition label section, after all.
Again: Nope.
Saturated fat intake is unrelated heart disease, stroke, or death, according to a recent large meta-analysis (combined data analysis from multiple studies). Nor does replacing saturated fat with carbohydrates lower the risk of heart disease, according to another large recent meta-analysis, not even for people who have had a heart attack before.
Nor does swapping out saturated fats with carbohydrates improve markers of heart disease — like triglycerides and the ratio of good to bad cholesterol — according to yet another recent meta-analysis of randomized controlled trials.
For people with pre-diabetes or Type 2 Diabetes, high fat diets improve average blood sugar levels and blood pressure.
So what does increase the risk of heart disease? High blood sugar. Insulin resistance.
Note that the studies cited above were not cherry-picked to fuel some controversial point. They are top-tier reviews of all the best available evidence, and they all consistently show that high-fat is better than low-fat.
Rule #2: Eat Lower, Slower Carb.
Cut down on sugars. This one is pretty obvious, and hardly news. Still, daily carb counting teaches you, fast, how our shockingly enriched our diet is with sugar and high fructose corn syrup. Even foods that I once thought of as relatively healthy contain shocking amounts of added sugar: baby yogurt, popsicles, ketchup, barbeque sauce, granola, to name just a few. And these sugars add up: Americans eat a whopping 152 pounds of added sugar every year.
Sugar-containing foods send my daughter’s blood sugar through the roof, and fast. Faster than even the most rapid-acting insulin analogues available can keep up with. For this reason, we avoid them.
Expand your definition of sugar. When I say sugary foods spike my daughter’s blood sugar, it sounds like cookies and candies are off limits, but everything else is hunky-dory.
Not so. Refined carbohydrates are just as bad as sugar. Those sugar-free muffins have the exact same effect on your blood sugar as regular muffins.
Before my daughter’s diagnosis, I had of course heard refined carbohydrates were bad. But I didn’t really get it. But now, watching my daughter’s blood sugar spike from what I previously considered pretty normal, even reasonably healthy, meals of, say, Cheerios and skim milk or a bagel with jam, has radically altered my view on refined carbs.
From your pancreas’s perspective, eating refined carbs is like mainlining sugar. High glycemic index (GI), low fiber, refined carbohydrates — think fruit juice, soda, cold cereals, rice, muffins, bagels, and white bread — all spike blood sugar. In response to these spikes, the pancreas has to rapidly pump out high levels of insulin.
What about other types of carbohydrates? Does eating a diet that is not high in carbohydrates mean cutting out fruits, vegetables, legumes, nuts and seeds? After all, of of these foods contain carbohydrates, albeit in lower concentrations than sugars and grains.
But these foods do not lead to blood sugar spikes. These foods contain protein, fiber, and fat, which slow down carbohydrate digestion. They cause a slow and steady release of glucose, one that is easy on the pancreas, provides a sustained boost in energy, and keeps us feeling full for a long time. Moreover, these foods are nutrient dense, providing a lot of healthy vitamins and minerals.
Which carbohydrates are good and which are bad? A good place to start is their glycemic index (GI). When my daughter eats low GI foods, her blood sugar rises slowly and stays within the desired range. She is not alone. Studies on people with Type 1 Diabetes find that the rise in blood sugar after a high GI meals occurs sooner, faster, and is difficult to control.
Even a normal pancreas has hard time with high GI carbohydrates. In a study comparing low-GI and high-GI breakfasts, healthy kids randomly assigned to the high GI breakfast reported being hungrier and ate more for lunch than kids assigned to the low GI breakfast.
Why? Because high GI breakfasts set you up for an insulin rollercoaster of a day. They cause a rapid rise in blood sugar, which leads to a surge in insulin, which overshoots, dropping blood sugar, blocking satiety signals like leptin, worsening mood and cognitive performance, and leading to an increase in hunger.
Rule #3: Eat smaller, more frequent meals.
Why do we eat three big meals a day? This meal pattern is a holdover from our days of manual labor, when we needed to stock up on calories before heading to out to till the fields, hence a large breakfast, cease our labor only briefly in the midday heat, hence a large lunch, and then replace lost calories when we returned home, hence a large dinner. This meal pattern makes no sense for our office-working, desk-sitting, far more sedentary lifestyles.
Big meals, naturally, stress out the pancreas more than several smaller meals containing only a few carbs. You need more insulin to digest a large meal than a small one.
Rule #4: Know Your Insulin Resistance, And Eat Accordingly.
We can “see” my daughter’s insulin resistance, because when she is relatively insulin resistant, we have to up her insulin dose. Her times of high insulin resistance are not unique; most people have the same pattern.
We are most insulin resistant:
- In the morning. People with Type 1 Diabetes know this well; they often require 30–50% more insulin in the morning than they do later on in the day.
- When sitting for long periods of time. It’s no surprise that long periods of sitting, even in active people, is linked with a higher risk of disease. Sitting promotes insulin resistance. Don’t eat in the car. Go for a walk after a meal.
- When sleep-deprived. When my daughter sleeps poorly, she needs 25–50% more insulin the rest of the day.
- When stressed. Stress hormones prompt a sudden surge in blood sugar, a useful adaptation for a true fight or flight response, but terrible when we are stressed by snarled rush hour traffic or an infuriating work email.
Things that increase insulin sensitivity:
- Exercise. Exercise, even just walking, immediately increases insulin sensitivity and blood sugar, and these benefits last for up to 48 hours. Movement right after eating is especially helpful, as it moves glucose into the muscles and tempers the post-meal blood sugar rise.
- Getting enough sleep. Lack of sleep causes weight gain, insulin resistance, and heart disease.
- Reducing stress. Cortisol, the main stress hormone, raises blood sugar. This is great when you are running from a lion and need energy, but awful when you are stuck in traffic and fretting over lost time.
In Short…
The standard Western diet and lifestyle acts like a pressure cooker. We eat large high-carbohydrate, high-GI meals, that contain little fat, protein, or fiber (pancakes with syrup but hold the butter!).
We eat especially carb-dense meals in the morning (cereal with skim milk and orange juice), when we are most insulin resistant. Then we sit in our cars, stress over traffic, sit some more at our desks, and get too little sleep. We eat while sitting for long periods of time, at the movie-theater, in the car, in front of the TV.
We are hammering our pancreases all day long, and they were never built to withstand the abuse.
