The October issue of Today’s Dietitian reported that we Americans eat 153 pound of sugar a year. That’s about 30 teaspoons per day.

“How could that be?” You say, munching on the last of the Halloween candy. I don’t add 30 teaspoons of sugar to my food everyday.”

You don’t have to. We’ve all heard about High Fructose Corn Syrup, HFCS. Sometimes we even try to avoid it. But what is it anyway?

Well, first of all, it’s not actually pure fructose (the sugar found in fruits) It’s about 50/50 fructose and glucose. The composition is similar to table sugar. So what’s the problem with that?

Experts will tell us we are consuming a lot of empty calories. That is calories without nutrition. Do we they agree that that is the problem?

Not exactly.

The Dietary Guidelines for Americans, the ones that brought us the plate that replaced the pyramid, report that added sugars offer little nutritional payback. However, their guidelines state that foods with added sugars are no more likely to contribute to weight gain than any other source of calories in an eating pattern that’s within calorie limits.

Calories. Remember those? The word is derived from the French word for heat. It used to measure the energy value of food. The truth is that our foods now have more calories. HFCS in our foods has increased by more than 1000% between 1970 and 1990, and that means more calories in. It’s dangerous, because we humans like the taste of sweet, and it’s way more available than when we used to have to battle bees for it. And when so many foods have sweeteners, we may not even taste the difference. Unless we read the labels, we don’t even know they’re there.

So, if we just cut out all sugar, would we all be lean and mean?

Kelly Brown, PhD, a professor at Yale University and director of the Yale Rudd Center for Food Policy & Obesity says that “…sugar is an important culprit in the obesity problem, but it’s not the only one. Sugar is important for several reasons: It’s added to the diet in large amounts; it makes things more palatable so that it pushes people to over consume it; and it’s a major source of calories, especially from sugars added to beverages.” Now, I’m picturing one of those gigantic sodas that doesn’t fit into your car’s cup container.

A lot of what we do is based on what we believe. So what do we believe.

The Food Information Council Foundation 2012 Food & Health Survey revealed consumers’ attitudes about sugar and health. Of those surveyed.

•   20% believe that calories for sugars are responsible for weight gain.
•  62% believed a moderate amount can be part of a healthful diet.
•  61% said it’s not necessary to completely eliminate sugar to lose weight.            
• Only 28% believed all sugars are similar and used by the body in the same way. 
• 51% are trying to avoid sugars when choosing foods and beverages.
• 35% pay not attention to sugar content.

I received a Tweet recently about a publication that was looking for stories that will send health messages. So here’s a story I’d like to share.

A number of years ago I was working as an inpatient diabetes educator. The patients I saw had been admitted because they were already having some complication from their diabetes, frequently infections. Many were learning for the first time that they had the disease. As hospital stays are often short, I often had only one or two chances to have an impact before the person went home. (Remember 90% of health care decisions take place out of the influence of medical providers.)

Before I counseled someone, I needed to know about their lifestyle, their habits, so I listened more than I talked. As I said goodbye, I’d say, “I hope I never see you again.” Meaning, I hope you do what you need to do to stay well. “But if I do, we’ll just go over this again.”

One person comes to mind, as I write this. A very overweight man in his mid-twenties, who I did see again. The second time, he was a visitor sitting at his mother’s bedside. She now had diabetes, and the doctor had written an order for me to see her.

When I walked in, I noticed that the room was strewn with fast food wrappers and soda cups. I introduced myself to the patient and then to the family. Then I saw him.

“I know you,” I said to her son. “Weren’t you here a few months ago?”

I often say that I have eyes trained to notice weight loss. I can see a five or ten pound difference.  This guy had lost weight – a lot. But how? He was clearly still eating fast food. He hadn’t obviously taken everything I’d said to heart. But he was thinner, significantly.

“You look great,” I said, even though he had a ways to go. Progress is progress.

“Yes,” he said. “I’ve been losing weight.

I looked at the bag and the huge soda next to him. “How?” I asked.

“Well, I still don’t do everything I’m supposed to, but I did change one thing.”

The magic bullet? The thing that everyone has been looking for?
“Tell me,” I said.

He took a sip of his soda, “I don’t drink regular sodas anymore. I switched to diet.”

“That’s all?” I asked.

“That’s all,” he answered.

When a doctor makes the choice to prescribe insulin for your diabetes, you may feel like a failure, as if you are being punished. You are shocked at the prospect of self-injection and try to negotiate your way out of the process. “Can’t I try another pill? I promise to lose weight, exercise, give up sweets forever?”

When the doctor or Diabetes Educator says, “Insulin is your friend,” it sounds like a bad joke.

November 14th is the birthday of Frederick Banting, and also the day we celebrate World Diabetes Day. Most of us have forgotten or are unaware of how it was not so long ago, before the discovery of insulin. In 1922, Dr. Banting, along with his 22 year-old assistant, Charles Best, a medical student, first conceived of the idea that led to the discovery of insulin.  Let us consider what life was like before the magic extract.

In those days, children dying from diabetes were kept in large wards, often with 50 or more. Most were comatose. Families grieved and waited for their deaths.

On January 11, 1922, one of those children, 14 year-old Leonard Thompson, lay dying at Toronto General Hospital. That day, Leonard was the first human to be given an injection of insulin. Further injections were canceled, because the extract was so impure that the boy suffered a severe allergic reaction. But during the next ten days James Collip, a biochemist, worked night and day to improve and purify the ox-pancreas extract. A second dose was given on the 23rd. This was completely successful. The boy woke up.

Later, in one of the medicine’s most dramatic moments, Banting, Best and Collip, went from bed to bed in an entire diabetic ward injecting each patient with the new purified extract. Before they had reached the last dying child, the first few were awakening from their comas, to the joy of their families. Insulin was hardly a punishment. It restored life.

Over the years, insulin, which originally came from cows and pigs was purified and zinc was added to it to lengthen its effect. In 1978, Genentech produced synthetic insulin using recombinant DNA techniques.

As a Diabetes Educator, I seldom found anyone enthusiastic about the prospect of taking the miracle potent. The truth is, I would have found it distinctly odd if a client enthusiastically embraced the prospect as, “The best news ever.”  

Diabetes management is a complicated endeavor, which involves many lifestyle changes. Banting’s and Best’s discovery is only part of the management equation. But insulin is our friend and on this month we might consider the miracle of its discovery and the lives that are still being saved.

The theme of the World Diabetes Day campaign from 2009-2013 is Diabetes Education and Prevention. It’s a call worldwide for the public to understand the impact of diabetes and know how to prevent it from happening, and if it does, how to delay the complications.

www.worlddiabetesday.org.

November is also American Diabetes Month, Considering how common the diagnosis of diabetes is the symptoms are not as well-recognized as they should be. Individuals who would be alarmed at a change in a mole or a lump in a breast, often overlook the dramatic Warning Signs of diabetes in themselves and their children. They include:

·      Frequent urination

·      Excessive thirst

·      Increased hunger

·      Weight loss

·      Tiredness

·      Lack of interest of concentration

·      Blurred vision

·      Vomiting and stomach pain, which is often mistaken for the     flu.

 All is not lost. You might need to hold on a little more tightly, but just as surely as that jury duty summons, you saw this coming. It’s CHEAT SEASON.

The truth is, we all kind of look forward to temptation, the Latin origin of which means to test, to try, to handle.

 You will be tested. It will be trying. You will cheat, but you can handle it. So, even if your Thanksgiving dinner plate weighs more than your Labrador Retriever, even if after dinner you lie next to the table in a tryptophan stupor; you can still hold onto your good intentions.

 Enjoy the day. It is one of my favorites, because I’m sentimental. The smell of turkey conjures up cold, Connecticut mornings, watching the Macy’s parade on a black and white TV and loved ones long gone. If you get nostalgic on this fourth Thursday in November, you are not alone. Traditional dishes connect us to our past. That’s one of the functions of food.

 Many years ago, shortly after moving to California, my roommate and I hosted a Thanksgiving dinner party for the unfortunate interns, residents and nurses who would be without kin on this family-oriented day.

My roommate’s family had Southern roots. We prepared two turkeys, one with her traditional, corn bread stuffing and one with my authentic, sausage stuffing. Our guests could have chosen a variety of political, social or medical topics to discuss over dinner, but one topic dominated. Which stuffing was the real thing?

Since then, whenever I invite someone to my Thanksgiving table, I always ask ahead of time, “What single item needs to be on our menu for this to truly be Thanksgiving for you?”

What can’t you live without? For me it’s mashed potatoes, fluffy, buttery. The gravy is nice, but it’s the potatoes. Deprivation, like guilt, is the enemy of change. My advice to you is to enjoy that memory-laden food.

It makes no sense though to decide that if you overdo you have to continue to overdo. Treat yourself, but remember to savor the pleasure. The first Thanksgiving was a celebration of a healthy arrival after a long voyage. Honor your individual journey. Stay on the path.  

A few years ago, I was giving a talk to a women’s service club and had barely mentioned Cheat Season, when a member in her 80s called out, “pumpkin pie.” I could tell by the look on her face that she loved it.

While doing pumpkin research I ran across an interesting fact. For the pilgrims, the round orange thing became a stewed vegetable, side dish. Are you tempted? The pilgrims didn’t have sugar, so the pie variety did not show up on the original menu? Nor did cranberry sauce. The bogs of Cape Cod were filled with sour, low-calorie cranberries. Yum! The pilgrims hadn’t thought to put cows on the Mayflower, so there was no cream or butter either. Potatoes, both sweet and regular were rare, as were, I guess, the marshmallows that frequently top the latter.

 When you sit down next to your favorite Aunt Esperanza, be thankful that dinner table protocol has changed since that first feast. Then, the choicest food was placed next to the most socially prominent person. The rest of the guests ate what happened to be next to them. Imagine if you were really into eagle or swan, and you were sitting by the serving plate with seal on it. Yes, those were actual items at the original table!

The pilgrims didn’t use forks either. They ate with spoons, knives and their fingers and wiped their hands on large cloth napkins, which they also used to pick up hot morsels. Those conventions might make it easier not to overeat. The finger thing would definitely slow green pea and gravy consumption.

 At the first Thanksgiving there were no hors d’oeuvre or dessert courses either. All the food was put out at the same time.

Research also tells us that the Wampanoags who shared the harvest had different eating habits than the colonists, whose set pattern was breakfast, dinner and supper. (Incidentally, breakfast was leftovers from supper, which was leftovers from the noonday dinner.) The Native Americans tended to eat only when they were hungry!

Did you know that on this one day about 690 million pounds of turkey finds its way to our tables? That’s about two pounds per person. A lot of people don’t even like turkey. So if the gobbler is your obsession, have at it. Things could have been different if Benjamin Franklin had had his way.

 In a letter to his daughter in 1784, Mr. Franklin suggested that the wild turkey would be a more appropriate national symbol for the newly independent United States than the bald eagle. The turkey is “a much more respectable bird, a true original Native of America, and though a little vain and silly, a Bird of Courage.”

As you approach this holiday table, here’s more of my sage advice:

·      Sage is good in stuffing.

·      Make sure you sit close by your favorite dish.

·      Savor every bite.

·      In honor of the Wampanoags, try to get a bit hungry before you start, and consider if not the dancing that they engaged in, a post-feast stroll around the block, before the non-traditional pie course.

·      Unlike the pilgrim’s event, our Thanksgiving doesn’t go on for three days. Thanksgiving dinner is one meal, one chance to cheat.

·      Being a little vain isn’t silly. You do want to fit into your outfit for the upcoming Holiday parties.

·      Savor your time with family and friends.

·       Celebrate your healthful voyage.

·      Your struggles to change are respectable.  Be a Bird of Courage.

Scientists keeps finding things out and sharing them with us. 
Such was the case with the report in Thursday's New England Journal of Medicine. 

Sometimes the media picks up these scientific ah-ha moments and turns them into OH NO moments!
This is what the article said

"Statin use in patients with cancer is associated with reduced cancer-related mortality. This suggests a need for trials of statins in patients with cancer."
http://www.nejm.org/doi/full/10.1056/NEJMoa1201735?query=featured_home

Now, does that mean that statins prevent cancer? Maybe it says that people who use statins have increased health awareness, and might pick up their cancers earlier? Or does it just say that scientists found something positive and more study is needed?

I'm reposting a portion of the blog Thanks For The Memory
to remind us that our health decisions are between us and our doctor, not us and the news media.

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Human brains are wired to react to stress. The amagdyla, an almond shaped mass located deep within the temporal lobe of our brain, is involved with emotions related to survival. It evolved as a sort of alarm to prevent our prehistoric ancestors from being eaten by tigers. I was guessing that the statin heads-up was stimulating more than one amagdyla to go into overactive mode. 

Later, I watch TV coverage. A perky woman with a concerned look reports, “Today the FDA had a big warning.” On another channel, a male reporter adds,  “This is a big deal for those who are taking statins.”  

Is it?  Soon, bespectacled expert, Dr. Steven Nissen, chairman of the department of Cardiovascular Medicine at the Cleveland Clinic speaks to the camera.  With his first words he warns about “overreacting.” 

Too late! In order to draw in viewers, the language had already been ratcheted up to terror level. At that point, whatever the doctor says will be filtered through fear. The other filter, cynicism, is activated as statistics about statins and how much the drug companies benefit monetarily are flashed on the screen. Nissan’s message is not getting through. His attempts to reassure the public that only “a few people will cross over the threshold to diabetes, and that memory loss is rare and reversible” is being lost.

Then, an attractive, fit newsman enters sharing that he was on statins. “I called my cardiologist and said, ‘Hey, how about if I take a six-month break and have my blood checked twice over the six month period and see what happens?’” Mr. Newsman looks pretty happy about his decision. I notice that nowhere in the conversation does he indicate what his doctor has replied.

Now, Dr. Nissen, who is also a cardiologist, feels some responsibility to point out that if this guy was on statins, there was a reason. As he sees it, Mr. Newsman is at risk. If he stops his statins, he could have a heart attack. 

“But what’s the harm of seeing how you feel?” Mr. Newsman asks.  Feel? Since when do you feel your cholesterol levels rising? He brags that his numbers are good now, that he exercises and has a good diet. I believe him, and I think the doctor does too. He explains that diet and exercise are recommended for everyone, but those interventions can only lower your levels by 10-15%. He states unequivocally that Mr. Newsman’s cholesterol levels are going to go right back up. Then he delivers his zinger! Dr. Nissen stresses that these drugs reduce the risk of death from heart and stroke by 30%! That’s great news, but it’s lost to a commercial break.

In Your Medical Mind, a book about how we make health related decisions, the authors caution against the old paternalistic way of doing medicine.  They suggest that we don’t have to do what doctors say, that our health care specialists might actually have to explain and negotiate. As I listen to the anxious discourse, I wonder how many people have had a satisfying conversation with their practitioner. How many know what their individual risk factors are? Does anyone negotiate?

It’s just a matter of time before a new, scary news report makes you question something that is working to prolong your life. Terrifying tigers are always going to be out there, and we will always react to them. We should. Paying attention is good. So is asking questions. This is about survival, isn’t it? Or, maybe it’s about time – to talk to your doctor about what the real threats are for you. Write yourself a note, so you won’t forget.