Let's forget about moderation

The Fray-Our Last Days

For quite some time now the buzz word for diet decisions has been "moderation." Suggest to others that you want to eliminate something and you'll get the usual scoff and token (unsolicited and unverified) comment that "everything's ok in moderation." Everything is most certainly not acceptable in moderation.

One should never tolerate in moderation or at all things like cigarette smoking, heroin, cocaine, abusive boyfriends, drinking and driving. The aforementioned examples are extremes, however, let's wax inquisitive about moderation when it comes to things like alcohol, fat, and sugar consumption. For those who experience addiction with alcohol and sugar, consumption in moderation is not plausible. The more we find out about sugar's negative effects the more we recognize the truth in this. I've posted these articles/studies before on how sugar is just as addictive as cocaine. Thus, there needs to be a sound basis for the suggestion of moderation when longitudinal studies are dictating otherwise. We would never suggest moderation to former drug addicts, so why are sugar and alcohol treated differently?

Addiction medicine is still relatively an undiscovered field. More research is required to understand why and how some people are just not able to moderate certain things. If the use of cocaine was as prevalent as sugar consumption we would most likely find the same story that addiction affects certain populations disproportionately. We find it so easy to judge sugar abstinence (and even alcohol abstinence) because these are both legal substances and also because the problems they cause are not immediately apparent (diabetes progression is slow, but it does directly correlate with sugar consumption) or are deemed as lack of impulse control. Addiction, like cancer, is a disease.

There's a lack of understanding and a lack of publicity of the findings that substantiate a person's aversion to sugar/alcohol. More introspectively, we may feel secretly judged/morally inferior to the individuals who have found, read, and utilize the hard evidence of science and correlate their own bodies' responses to these toxic substances and choose to alter their lifestyle. Thus, we may feel guilty for not doing the same, but their choice is a physiological one rather than a moral one. Let's just start by showing them support for making the choice.

Not too long back I used to be one of those individuals who thought dieters were weird; the practice seemed unnatural and I was under the veil of ignorance where I never questioned the world, my food habits, the food industry, the (very little and highly misinformed) food education, or even the FDA regulations. As I'm more embedded in academic medicine I realize that what we know now should always be subject to scrutiny. What I'm really asking for is a shift from the mindset that we have been conditioned to accept what is "general knowledge" without question. Instead, empower yourself by taking control of seeking answers and the truth through all the amazing resources that the technological age has offered at our fingertips, truly making informed decisions for yourself, and celebrating and learning from those who already do!
Let's hop to it!

The Sugar Series: Daily intake

Greetings fare readers! I drafted this a while back, but thought it important to post as we enter swimsuit season and seek to get our summer bods back in business. Here's some info on sugar intake. This is a subject I find important since the use of sugar in food products is virtually unregulated. I'll preface this post by re-posting an important Times article that summarize some of the issues with sugar.

http://opinionator.blogs.nytimes.com/2013/02/27/its-the-sugar-folks/


(1) Here are some answers to FAQs regarding sugar from the AHA
I was curious what the recommended upper limit for sugar intake was and it appears to be about 6tsp for women which equates to about 24g. Looks like my choco nut butter I sometimes consumes take up a good portion of that so I must be ware!

(2) I reverted back to my old research lab days where I used to play with chemicals and I recall how much a few 6 of something used to be and it seemed like quite a lot. Thus I found this as a comparison of how much 10g of sugar looks like. Just think about how much sugar is in stuff like soda!

(3) Buyer's beware! there really is sugar in everything! Well added sugar is what we are worried about, so check out this list to see if things you buy might contain sugar you're not aware of!
 -if making my own spaghetti sauce wasn't so time consuming I wouldn't be opting for the bottled version. Luckily Arabiatta sauce from Mezzetta's has only 3g or try Rao's Arabitatta which only has 4g- I assume the sugar is from the tomatoes since sugar is not listed in the ingredients.

There was a time in the past when I used to drink tons of vitamin water, eat those yummy flavored yoplaits in the morning, supplement with hot cocoa in the afternoons, snack on lucky charms and pudding cups and snack packs and make wonderful prepared muffins. I can't say I will never eat any of those things any more...once in a blue moon (I'd say ~every 8 months or so) I'll crave something I used to eat in the past and of course seasonally I'll pick up a hot cocoa. But I'll only buy one and not stock up. Once I'm done I no longer feel compelled to replenish and make that item a staple on my grocery list...I've moved on to much better! 

(4) I found this website on daily intake of all hot ticket items to watch (salt, sugar, fat,) very informative! I think the best rule of thumb for grocery shopping is stick to the perimeter. Most everything in the aisles that make up a good 70% of the area of a grocery store is filled with packaged foods. Typically fresh fruits, veggies, and meats and dairy are located in the perimeter and these grocery stores are designed to force you to go through aisles and grab a bunch of nonsense when all you might really need is milk which is almost always located in the far back.

(5) Here's info on the USDA sugar intake guidelines.

http://well.blogs.nytimes.com/2014/02/19/learning-to-cut-the-sugar/?src=me&module=ArrowsNav&contentCollection=Health&action=click&region=FixedRight&pgtype=Blogs

Medical Musings from this week!

Lana Del Ray-Summertime Sadness Remix

First off, GO TEAM USA at Sochi!!!  Getting excited for the Olympics--beautiful opening ceremony per usual...let the games begin! I love the Olympics. For some reason I'm always extra motivated when they come around. Plus Iove watching the fanfare of the opening ceremony. How wonderful for the world to unite on one stage!

(1) Another reason sugar is awful: it increases risk of cardiovascular disease. The numbers are truly astounding.
-A word about the article's comments section. Yes, one can do everything right and still drop dead before 50. There is obviously a genetic component when it comes to health that predisposes individuals to certain diseases such as diabetes, hypertension, and CV disease; however, there are still many aspects of our health that we have control over. Even if we one has all the genes that cause diseases, they can make sure they don't develop the diseases faster than their normal progression. These include not smoking, limiting sugar intake, and the most important being exercise and diet. Articles like these are not meant to generate paranoia, but rather serve to inspire and empower us to take whatever control over our health we can in order to be responsible for ourselves.

(2) On that note, I am thrilled to see that CVS will no longer be selling tobacco products. What a beautiful example of a corporation playing its part for the greater good of our communities.

(3) Once again the Supreme Court will be deciding on a number cases that directly affect womens' health.
(also a very interesting article.)

(4) Misinformed: Many news outlets have been decrying the Affordable Care Act as a recent report was released indicating decreases in labor. Please read this to really understand the difference between unemployment and the willful step-back in hours.

(5) All hail Netter! (for making very pretty anatomy pictures so the rest of us know where things are in color.)

(6) Very interesting quiz on twins where one smoked and the other didn't as long or didn't at all. Who looks older?

(7) Sometimes (rarely) metal on metal implants can cause Cobalt toxicity due to implant erosion. This is not something that is common but can cause severe complications in patients. I love these papers (here and here) mainly since both papers figured out what was wrong with the patient. Something to consider as a physician is that sometimes it's not the most obvious. Medicine is sometimes about good detective work and thinking outside the box. (Apparently watching medical dramas helps too.) 

Food For Thought: Letting Go of Sugar. The Sugar Series

Celeste Buckingham-Run Run Run

http://youtu.be/V8CQjV8vXJE

First off, Punxutawney Phil has let me down. Apparently there will be 6 more weeks of winter.

I wonder if I'm the only one who prefers to watch Downton Abbey over the Super Bowl? Nevertheless, in honor of Superbowl Sunday this post will be about sugar.

(1) Very interesting interview from a physician proponent for banning sugar. This interview dives into the history a bit behind the economics of sugar.
Bottom line: Production/consumption of sugar, like any other commodity, is a profitable business. There is fear of "the nanny state" but it is the government's duty is to serve the people and take concern in our welfare. Government action will be required eventually down the road (whether it be an extra tax of some sort on sugar or the ban from sugar much like the recent ban on trans fats) as more and more of us are killed from diabetes. Diabetes and obesity are already epidemics and are major public health concerns.
Here's more stuff from Lustig's group including a study published in Nature.

(2) Finding a proper sugar substitute (if one exists)

It's really not a matter of whether there's evidence about artificial sweeteners causing obesity or diabetes. Many of the companies that manufacture these sugars have a much more powerful lobbying arm in congress to prevent FDA regulation revisions and curtail NIH/government-funded studies that would further substantiate the evidence that is already out there against sugar. Common sense should be employed to recognize that as humans we ought to consume things that allow us to survive and thrive. Sugar (namely the artificial fructose kind added in nearly everything) deceives us into thinking we are thriving, but it in fact does the opposite. Your body does not need fructose or these additives to survive. Don't wait for the evidence to pour in to quit or limit your sugar intake. It took over 60 years between the time cigarettes became mass marketed in the early 20th century in the US and the first report from the surgeon general was released with evidence and warning of cigarettes' health effects. Let's not wait around for bad evidence or the regulations from the FDA against sugar for us to take control of our own health. When those start to come in there will be extreme and heavy resistance from the food industry because for them it means less profits.  What we know to be bad or addictive should be consumed in rations only (if at all.) (on a different note, the rat sitting on the oreo was the kind of rats I used to do animal surgery on in our study. I'll never not be afraid of them.)

This is all biological evolution, we are a surviving species because our ancestors consumed natural sugars from fruits and did not die. Thus we are not wired to avoid sugar or even consider it as a toxin. With the advent of artificial/processed sugars the story is entirely different. We consume it because we don't have immediate negative biological/physiological consequences, but overtime those sugars are related to increasing rates of diabetes and they will eventually kill us.

(3) Another article describing the toxicity of sugar.
Here's the highlights:
 -The study found "medical inference of causation by linking dose (the more sugar that’s available, the more occurrences of diabetes); duration (if sugar is available longer, the prevalence of diabetes increases); directionality (not only does diabetes increase with more sugar, it decreases with less sugar); and precedence (diabetics don’t start consuming more sugar; people who consume more sugar are more likely to become diabetics)." This is an incredibly sound study that put into check as many controls as possible (basically the best laid out study aside from some longitudinal randomized controlled double-blind study performed in-house.)
-"for every 12 ounces of sugar-sweetened beverage introduced per person per day into a country’s food system, the rate of diabetes goes up 1 percent"
-"all calories are not created equal...calories give off the same amount of energy when burned, but your body treats sugar calories differently, and that difference is damaging."
-"Metabolic syndrome is a result of insulin resistance, which appears to be a direct result of consumption of added sugars."

Bottom line: sugar alone can cause diabetes regardless of whether you are obese or not (obesity also causes diabetes but that's a different story.) The question for many readers now might be "how do I deal with this?" I'll dive deeper into this again, but as with any highly addictive substance there are many ways two of which are:

(1) the best is to cut out added sugar from your diet entirely. The more you consume it the more you will want it (it even trumps fat.) It is as addictive as cocaine (if not more.)
Here's more evidence of that
And another
This is all because "sugar more effectively recruits reward and gustatory regions, suggesting that policy, prevention, and treatment interventions should prioritize reductions in sugar intake."
The longer you keep consuming it the longer you will want it. This is tricky so read your labels. There's even sugar in things like salsa and hamburger/hot dog buns since the food industry already figured out (A) it's a great way to preserve the shelf life of products so things can be mass-produced and save companies money and maximize their profit and (B) they understand that artificial sugar is addictive so they add it into products that have no business needing it in order to compel consumers to keep buying more. The basic and easy ways to remove it from your life is replacing things like soda with green tea or water, reading your labels, avoiding packaged foods that have added sugar. Even just drinking less soda will decrease your rate of developing diabetes. A way to cut cravings is to add some healthier carbohydrates into your actual meal (ie carrots, radishes, beets, squash, yams etc...see this list for more) This will effectually trick your brain into thinking that you already consumed carbs so you will not crave dessert as much. Another way is to eat more natural carbohydrates also high in fiber such as brown rice (NOT WHITE RICE!) and other similar items like bulgar wheat. At least this way if you do eat some sugar the fiber will slow the absorption.

(2) The more plausible approach is wean yourself off sugar by taking small steps to replace even 1 sugar item one week with something healthier and then build up until you remove it entirely.

I know this is hard and unconventional and goes against the grain (pun intended!) I am a big Cookie Monster but let's try this together!