Obesity is far more complex than you thought

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How can a six month old be obese? More and more are today.

My interest in obesity is decades long. Personally, I was overweight as a teen. I spent years dieting, shopping in the “chubby” section of A&S (Abraham & Strauss), being hungry and failing…Weight Watchers, Snackwell cookies, you know.

Somehow, luckily, through the years I managed to learn about food, wean myself off of my beloved scones and bagels, give up the junk and add more healthy foods and daily walking. I don’t quite know how I did it, but I imagine I was partly spurred on by the improvement I saw in my blood sugar management, and the ease. I remember reading Dr. Richard Bernstein’s book, The Diabetes Solution, it was eye-opening. I vacuumed a good portion of carbs out of my diet and never looked back. My blood sugars improved and the weight fell off.

As I began eating less sweets and salty foods, my tastebuds changed and the craving for these foods disappeared. My husband says I was able to change my diet because through the years I became happier. Maybe, but the truth is I’m a different person today with a different body, and for me food is no longer an addictive pleasure but nutrition.

Researching and writing three books on diabetes I had to learn a lot about food and how it works in the body. I came to understand being overweight, while a risk factor for type 2 diabetes, doesn’t cause it. In fact for most people being overweight is a consequence, not a cause, of type 2 diabetes.

Our SAD (yes, our diet is sad, but the acronym stands for “Standard American Diet”) drives insulin resistance which in turn causes type 2 diabetes. Huh? Our modern diet, full of processed foods, sugar and refined carbs, spikes our blood sugar. This causes the pancreas to produce extra insulin to lower blood sugar and ferry the excessive amounts of sugar in our bloodstream into our cells for energy. These excess carbs get stored in our cells as fat. After all, insulin is a fat storage hormone.

Eating an everyday diet of these foods causes the pancreas to overwork until it can no longer produce enough insulin for the SAD’s needs. Poor maligned fat all these decades; eating fat doesn’t make you fat, a high carbohydrate diet makes you fat. I get it, I have for many years.

Then I read this article on obesity recently in the HuffPost and found it thought-provoking. Everything You Know About Obesity Is Wrong. I sent it to some friends, including a friend of mine who’s a health professional.

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Image by Finlay MacKay

An email exchange occurred between us, and while we’ve been friends for almost four decades, and she’s since told me she basically agrees with everything I wrote, during our exchange she reflected the knowledge and attitude many health professionals hold – while the problem is not only calories in and calories out, most fat people do eat too much and move too little. And, that it’s up to them, “individual responsibility” for them to lose the weight. “Adding to the problem,” said my friend, “I wasn’t taught anything about obesity when I went to school.”

She also said which I hadn’t thought about, “as a medical person I don’t want to be blamed for people being fat. The system isn’t set up for me to treat people’s runny nose, cough, frequent urination, sprained ankle AND their obesity in one visit.”

Who thinks about the pressure on the shoulders of our health professionals in the midst of this obesity epidemic? Not just to treat the fallout of obesity – type 2 diabetes, hypertension, cancer, dementia, heart disease and fatty liver disease – but  that they’re also supposed to get people to lose weight. Which frankly is basically impossible within today’s society.

And our American view – just pull yourself up by your bootstraps – doesn’t work here. Obesity is not a matter of willpower, it’s largely biochemical and far more complex. Most individuals alone can’t solve the problem.

We need societal-efficacy as well as self-efficacy. We need governments and big food manufacturers to make healthy food and activity affordable and accessible. We need to feed our soil and our animals the proper diet and create an economic system that allows people to get back into the kitchen to cook.

We are living in the perfect storm for obesity – cheap, portable food available everywhere, labor-saving devices so we no longer move, industrial feedlots and food scientists who chemicalize food-like substances to release dopamine in your brain when you eat them, and hook you. And a diet of highly refined carbohydrate foods, sans fiber, that spike your insulin and for most people will lead to insulin resistance and weight gain.

I close with a great and easy explanation in the video below, according to Dr. Robert Lustig, what we can blame obesity on. Lustig, a pediatric endo and professor at SFUC, is relentlessly fighting against what he sees as the biggest cause of obesity – sugar and processed food, and perhaps the most frightening of all, if your mother was obese. That means during utero, when you were a fetus, her high insulin levels were being passed to you and you then become designed to be obese. Thus, the baby above.

Now you know, and now you know too, there’s no easy fix. This 8 minute video is one in a series produced by UCSF: The Skinny on Obesity (Ep. 3): Hunger and Hormones – A Vicious Cycle




Ending the fast: Day 3 & 4 at 2:53 pm


It’s mid-afternoon of day 4. I finished my fast last night.

I lost 4 pounds, that feels great, but I’m sure they’re racing back to me today as I re-introduce food. My blood sugar is still hovering low as it did during the fast, and I’m really sleepy. I think my body’s return to eating and digesting is taking a lot of energy.

Yesterday, day 3 of this bone broth, leafy greens and water fast, I was full of energy and not hungry. The only time I was hungry was immediately after I posted (my last post) about days 1 and 2 and said I hadn’t experienced any hunger!!! The hunger lasted from 4 PM to 9 PM when I dissolved it with a cup of decaf coffee with half & half.

Yesterday, all day I felt light, clear; like a younger version of my now Medicare self. I had an appointment with my ayurveda practitioner in NJ. I went with a friend. Afterward, we stopped at a diner on the road as she (we) hadn’t eaten lunch. I bolstered myself to be in a place with food and food aromas. It wasn’t necessary.

She ordered a spinach omelette and I ordered a cup of coffee. As the waitress put down my friend’s platter with egg, potatoes and toast, my eyes grew bigger, but still I wasn’t hungry. I did however reach over to pluck a piece of spinach out of her omelette. That’s when I thought hmmm…spinach is a leafy green, so I called the waitress back over and asked if they could make me a side of sautéed spinach. Sure enough, they could, and that and my coffee thoroughly satisfied me.

When I got home at 5 PM I made keto rolls. The husband can’t get enough of them and now friends I’ve shared them with say the same. Everyone I know broke their fast last night with whitefish, smoked salmon and rugelach (Yom Kippur). We broke our fast at 7 PM with the keto bread and what we usually eat for lunch – a vegetable soup that’s chock full of vegetables and aruvedic spices – cumin, coriander, fennel, digestive masala, turmeric, Indian sarsaparilla, ghee, salt and lime – they release toxins from the body.

Reaching for my Humalog before the meal it was other-worldly. I actually had to think again about my injection process and how much insulin to take. It’s amazing how quickly I forgot. The husband finished the meal with a piece of chocolate. For me, my second course was my I’d-take-this-with-me-to-a-desert-island-if-I-could-only-take-two-foods yogurt and almond butter.

At 11 PM my blood sugar was low, darn, so I ate a prune before going to sleep. I woke up at 69 mg/dl. I think I’m learning when you change something like this, the body takes some time to readjust.

Now day 4 I’m reflecting. I’m really glad I did a 3-day fast. I saw what it was, how it felt and if there’s a health benefit it’s nice to think I reaped it. I don’t, however, feel the need to do it again as I said at the end of day 2. Partly because my ayurveda practitioner said depriving the body of food heats the liver and most of our livers, including mine, is already too hot from years of ingesting things like vegetable oils, baked goods and refined carbs.

So, I expect to continue doing intermittent fasting a few days a week, and maybe a 24 hour fast every few months. All in all it was a great experience, even just to be able to say “I did it!.”

I know many people would like to try a fast but fear it will be too hard, how could they possibly not eat for a day much less three. I was one of those people. But it wasn’t hard. If you try it, you’ll know that.

I also really enjoyed discovering that I have more control over my hunger than I ever thought possible, and that is a really good thing. So when that voice comes, “eat, eat something now,” and half the time it comes out of boredom or habit, I have the choice to say, “thanks but no thanks,” and let it go to find someone else to mess with.


Vegetable soup and keto bread with ghee

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The dynamic duo


Day 2 of my 3-day fast. No, you didn’t miss day 1

I didn’t write about day 1, yesterday. But if you read me, you’ll know I’ve been doing a bit of intermittent fasting lately. About three days a week I don’t eat after dinner around 8 PM until lunch the next day at around 1 PM. I remarkably don’t find it hard to do, which I thought for sure I would. I thought I’d be ravenous skipping a late night snack, and since I like breakfast and wake up hungry, I thought no brekkie would be horrible.

Yet, here’s the truth. When you know there’s a rule to follow it’s much easier: I set my mind to the rule – no late night snacking and no food until lunch. I have a cup of coffee for breakfast either with a tbs of coconut oil or a bit of half & half. Amazingly, my morning craving for breakfast basically subsided. I did miss though the foods I had had for breakfast – Brown Cow whole milk plain yogurt, some berries and tahini or almond butter so some days I get it in during my eating window (lunch through 8 PM) for a snack. This is so much easier than a diet where you have to count calories, where you’re hungry all the time and mucking up your metabolism.

I have come to realize a few things, for me, as it may be different for you. Much of eating is a habit. Automatic, thoughtless. Since we eat every few hours our bodies are primed for the next meal. When you break the habit, your body sort of resets. And without blood sugar going up and down, your appetite falls away.

My intermittent fasting, about 3 days in a row out of a week, was going really good, so I decided to do a 3-day fast. Why? Two reasons: 1) as an experiment to see if I could do it, how I would feel, what I would notice? 2) buying into the idea that something called autophagy is happening, – your body switches over from burning glucose to burning fat, drawing energy from your stored fat as ketones, gobbling up damaged, junky cells and replenishing with healthier cells – I expect there are real health benefits.

I imagine I can’t really know if autophagy is happening without testing my ketone level, but from all I’ve read, I trust that it is. If you are concerned about ketones as in type 1 diabetic ketoacidosis, while they are the same ketones, you are not in danger of ketoacidosis. Your body is burning the ketones differently.

If you are thinking of doing this, many experts say work your way up to a 3-day fast. I have been on a low carb, high healthy fat diet for probably a decade. I was doing intermittent fasting for about two months, so I consider I had my warm up period. I’d also say do it with someone. The husband decided to do it with me which makes it sooo much easier. We know what the other is going through, and there’s almost no cooking or eating going on in this house to make the fasting person crazy. Even though I’m not hungry, I think the smells of food would start hunger hormones to activate and could be nearly impossible to resist.

I am also doing this fast with two type 1 friends, Karen and Denise, and I cannot tell you how much fun that is. We are emailing every few hours to check in, share feelings, what we’re doing, and I notice how we have all had lows fasting. We are all checking our continuous glucose monitors, which I would consider almost a necessity to do this, and we are smart cookies (sorry, guess my mind is food-rummaging) so we are being cautious.

We are all following the same basic eating plan. Bone broth at meals, Karen Rose Tank of course made her own from scratch. I bought the Culinary Treasures brand from Costco which Ginger Vieira, who was my first mate on this fasting adventure, recommended. At my house we grind up leafy greens like kale, arugula, spinach in a tiny food processor and put that in our soup. We add some of our ayurveda spices like cumin, coriander, fennel, masala, tumeric. I add salt and pepper and a drop of apple cider vinegar. Sometimes a dash of lemon or lime.

When we finish our “meal” we look at each other, “Delicious!” Either we’ve gone mad and haven’t noticed, or this brew we’ve concocted is really pretty good. Other than bone broth for lunch and dinner, we are drinking plenty of water. I have my morning coffee  and either late afternoon or evening I’ll have a cup of tea with half & half or decaf coffee with half & half. The husband has even relinquished his Starbuck’s cappuccino for plain coffee with a dash of half & half.

All that we’re eating is on the plan outlined by fasting doctor advocate, Dr. Jason Fung. Fung is a kidney specialist with a majority of patients with type 2 diabetes. In his practice he wondered why the typical diabetic meal plan had so many carbs on it and in return led patients to go on insulin and keep upping it. So he started putting his patients on intermittent fasting and longer supervised fasting protocols and saw that his patients were losing weight they hadn’t been able to lose before, reducing their insulin and getting off some of their meds. His two well-known books are The Obesity Code and The  Complete Guide to Fasting. 

So, what have I noticed? Again, even day 2 of this 3 day fast has not been hard. I’m now 41 hours in. My stomach has rumbled once this morning but that’s about it. I’m not hungry, although today I do notice I feel empty. I miss the ritual of food more than eating it: thinking about what I’ll eat, preparing a meal, sitting down to it with the husband for nourishment and conversation. I am not having food dreams, either waking or sleeping. I even realized this morning I haven’t thought of a glass of wine, it’s completely disappeared from my radar. My energy seems pretty similar to any other day. I haven’t experienced any of the symptoms of “keto flu” – lightheaded, headachy, nausea, cranky…I feel closer to my bones, have shed 4 pounds, and am at a weight I haven’t seen since I was probably 14. I’m also surprisingly clear and sharp on business calls.

As for titrating my meds being on MDI, I reduced my long-acting Tresiba by 1 unit two days before the fast, and today dropped it 1 more unit. So from 7 originally to 5 today. I take 2/3rds or 1 unit in the morning of my short-acting Humalog just for the Dawn Effect rise of my blood sugar. I don’t take any more short acting than that for the day. I am staying consistently level, trending toward low and here and there I have to raise my blood sugar which I’m doing with a teaspoon of honey. Am I breaking the fast? Maybe, but we’ve all had to treat lows and in my book, diabetes comes before fasting and it is what it is.

What else? 1) You can exercise while doing this. I’ve kept up my walking. 2) Don’t tell your friends who don’t understand. They’ll bring you down. 3) Schedule it for when you have no big plans, work or social. And 4) It helps to keep yourself busy and distracted. Beside working, I’ve been watching a slew of fountain pen videos and plan to watch clips from last night’s Emmy Award show tonight.

My parting words: do a lot of reading before you jump in. Start with a short fast, 8, 16 or 24 hours, to have a try. If you decide to do a few days fast, talk to your doctor if you’re on meds and/or friends who’ve done it. It’s getting so popular, I wouldn’t be surprised if one person within your spitting distance has done a fast. But not a juice fast where you’re taking in lots of sugar from juices, but a water and bone broth fast.

Funny, I’m much more a ‘classics’ girl than ‘trendy’ but I think this fasting is the real deal. This morning the husband said, “Let’s do this more often than we have.” I said, “Since we’ve never done it before that won’t be hard.” I imagine once or twice a year might just make it onto the calendar now. The fact that I’m ending my fast tomorrow night when everyone observing Yom Kippur will be ending their 24 hour fast is kinda funny and pure coincidence.



To pump or not to pump: reconsidered


Alyssa 1.jpgI heard the refrain from a Classic 1970’s Peter Allen/Carole Bayer song when my friend Alyssa called me last week,

Don’t throw the past away

You might need it some rainy day

Dreams can come true again

When everything old is new again

Because Alyssa, who’s had type 1 diabetes since the age of 10, and been on an insulin pump for the great majority of years, is wondering about switching to MDI (multiple daily injections). The “poor man’s pump” I was told years ago.

I have never used an insulin pump. People are always surprised, I’ve had type 1 46 years, I’m intelligent enough, super responsible, but MDI works for me. I’m accustomed to shots, I feel like I have control taking shots, my syringe won’t get occluded, and I don’t enjoy the idea of being tethered either through a foot or two of plastic tubing or just the weight of an Omnipod on me.

Alyssa’s query whether she should come off the pump and start MDI was a challenging consideration for her. She’s more or less run out of real estate on her slim body, and now, being so muscular from her latest hobby, acrobatics, the infusion sets, in her words, “… pop off and won’t go in,” and the whole device is in the way. Yet, she knows diabetes management from a pumper’s perspective.

So she came to me, the old hand using the old delivery system. Of course, for people who take a step “backward”, or take pump vacations as so many do, it’s not just re-learning injection techniques, it’s learning how to do the mental math a pump does for you every time you dose. It’s calculating carb ratios, carbs in food to consume and insulin on board.

I don’t really count carbs. Being on a low carb diet, most meals require about 1 unit of rapid acting insulin or a bit less, so I just eyeball food. Ah, that needs a half unit, that a quarter. And, since there’s so little rapid acting insulin in my body at any one time, I don’t give much thought to insulin on board. Talking with Alyssa I realized how we live in two different diabetes worlds.

Alyssa will make her choice. I think it’s a good thing if you pump to also have the dexterity to switch between pumping and injections. And she helped me realize just because something’s old, MDI, it doesn’t mean it’s any less or inferior. It’s all about what works for you and what you’re willing to sacrifice and gain.

Now of course I’m thinking this acrobatics looks pretty cool…hmmm…and I wouldn’t have to worry about my insulin pump.

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How doctor’s exam rooms make connecting with patients difficult

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This is one of my primary care physician’s exam rooms. The one I found myself in a week ago, just for an annual check-up. Ignore the book, that was mine. Notice the set up.

The nurse came in to take my weight and blood pressure. Then she sat in that chair with her back to me to take me a zillion questions to fill out a form on that computer.

I had difficulty hearing her, as she was talking to the computer screen. There was no connection between us as she hardly looked at me. Only when I asked her to repeat the question because I couldn’t hear her and then she had to turn around.

How does this make patients feel? I talk when I share the Flourishing Approach with health professionals about the importance of creating connection. It’s really hampered here based on the environment.

An office visit isn’t just about getting looked at and getting a script. It’s also about getting LOOKED at, seeing one another, connecting, collaborating, and feeling like you’ve got a partner there.

My doctor, bless his heart, when sitting in that chair, has me sit in the chair aside the computer. He never has his back to me. I think he knows instinctively the importance of seeing his patients and having them see him. But I can’t tell you how many nurses, physician assistants and lab technicians who never face the patient.

I already told my doctor I could redesign the office for him. He smiled wearily and revealed how much has to be fixed today in healthcare.