Have you noticed how people gain weight nowadays? You've seen it but perhaps not recognized it: the "muffin top," the belly fat, the apple-shape with the skinny legs. Have you tried on pants recently? A lot of them are now cut to be roomier in the waist.Take a look around you; people are gaining weight the same way. Each year, practitioners deal with more and more overweight patients. You may have heard that belly fat is a risk factor for everything from heart disease to cancer. What you haven't heard is why it's happening and what to do about, both for yourself and for your patients.
Back in the early 1980's, a dietary shift occurred in the U.S., and the theory of low-fat-is-good and high-fat-causes-heart-disease started taking hold. An entire food industry was born, based on reducing the fat in foods and changing the USDA Food Pyramid from the Four Food Groups to the current model. The Snackwell Effect is named for Nabisco Snackwell Cookies, which were marketed as low fat. Because "low-fat" was considered healthier than its alternative, we ate more of them and felt less guilty.
Fast-forward 25 years. This link for the Centers for Disease Control and Prevention shows how obesity spread and increased across the U.S., year by year.1 When we present this in a lecture, people always ask us to repeat the slides because it is so shocking to see the transformation.
The low-fat theory? Not working. People will argue that they lost weight doing a low-fat diet, because of course you will lose weight if you restrict calories enough. However, it is not sustainable, and you risk being deficient in the fat-soluble vitamins A, D, E and K. Perhaps where we should be looking is at the bottom of the food pyramid. Those six to 11 servings of breads, cereals, grains and pasta that were recommended as the base of the food pyramid have wreaked havoc on people and not just in being overweight or obese. This problem is impacting nearly all your patients and you are probably not recognizing it.
All those spleen qi deficiency syndrome symptoms? The bloating, the gas, the craving of sweets, the fatigue, hard-to-wake-up in the morning? All related to carbohydrate intake. How about the kidney deficiency syndrome symptoms of fatigue in the afternoons? Same thing. Or the liver blood/gallbladder symptom of waking up at night? Still related. I would estimate that more than 90 percent of our patients are dealing with blood sugar imbalances. When we help them manage those, many of their OM diagnoses clear up. So let me explain what's going on.
In trying to follow the recommendations of the USDA, people would start the day with bowl of cereal (whole grain, if they were really trying to be healthy), some skim milk, maybe half a banana cut into it, and a glass of orange juice. For lunch, they might have a sandwich with low-fat turkey with some baked potato chips. People weren't supposed to snack between meals, so when they got home and were hungry for dinner, they might have a small handful of multi-grain crackers beforehand, and then pasta with sauce, a side salad, and maybe a roll.
Every time a carbohydrate gets digested in your small intestine, it breaks down into glucose and is transported to the cells with insulin, the hormone released from your pancreas. In a perfectly healthy person, the amount of insulin released is just the right amount for the amount of glucose in the blood stream and when most of the glucose is transported into the cells, the insulin level drops, and you burn fat until the next time you eat. The problem is, that's not happening anymore.
What's happening is that after years of eating high-carb diet, your body begins to predict your carbohydrate intake and releases too much insulin when you eat, for example, that piece of whole-grain toast. Now what happens is, after the glucose is delivered to the cells, there is still insulin left in the blood stream. That excess insulin drives your blood sugar below normal levels, called "hypoglycemia," but it could also be named "hyperinsulinemia." Hypoglycemia causes fatigue, difficulty thinking, irritability, sugar cravings, memory loss, poor concentration and many symptoms related to brain function. Thirty to 40 percent of that glucose is needed for your brain. The other problem caused by insulin in the blood stream is an inability to access your fat stores. So you can't burn fat for energy. So what do you do? You eat a carb because it will raise your blood sugar faster than anything else, and then you often feel better.
But as time marches on, the constant presence of insulin in the blood stream causes problems. At a certain point, the cells and tissues get tired of being bathed in insulin and start to become resistant, refusing to allow insulin to deliver glucose. This doesn't happen all at once, but as the glucose starts to back up in the bloodstream, the body turns it first into a triglyceride (which is why whenever I see high triglycerides on a blood test, I know it's almost always from a high-carbohydrate diet) and then into a fat. Then the weight gain begins.
Another problem is that insulin resistance causes metabolic syndrome and severe hormonal imbalances like low testosterone and high estrogen in men (Those manboobs? That's estrogen.) and high estrogen and high testosterone in women (That thinning hair in women? Probably male-pattern baldness from high testosterone).2 Polycystic ovarian syndrome, caused by insulin resistance, is the number one cause of infertility in women. High blood pressure? That fatty bump at C7 in women? Caused by insulin resistance. As the blood sugar levels start to climb, the body churns out more and more insulin, in an effort to force the glucose into the cells, and, over time, as the pancreas overworks, it begins to fail, and then Type 2 diabetes results.
When I explain this to patients, I hold my hands apart and explain: "We were given this many points for carbohydrates in our lifetime, and you've used all yours up before the age of 35." They sometimes argue that grains have been around for thousands of years. However, our DNA has been around a lot longer and it is not designed to deal with this overload of carbohydrates. We got away with it for a long time because we were much more active than we are today, but between the carbohydrate overload and the computer age, this progression will not reverse itself easily.
It is not an underestimation for me to say that more than 90 percent of our patients are in one of these stages and often it's a combination. We see hypoglycemia and mild insulin-resistance together when the patient is struggling with fatigue and sugar/carb cravings, and also gaining weight around the middle. To support patients in changing their diets, we developed a package for learning how to eat low-carb, and incorporated the herb gymnema, which has been shown to reverse insulin resistance, and which patients love because it reduces their sugar/carb cravings.
When we're talking to patients about this, I explain to them that in this model, where I'm trying to prevent the surging of insulin, anything that triggers insulin is a problem. So there's no "good-carb/bad-carb" option like brown rice versus white rice; anything that triggers insulin is a problem. Ditto for artificial or alternative sweeteners (with the exception of stevia). From aspartame to sucrolose, to agave syrup, they will all trigger an insulin surge. That's why multiple studies have shown that diet sodas increase insulin resistance. Vegetarians are often struggling with blood sugar disorders because it's easy to eat too many carbohydrates, even "healthy" ones disguised as whole grains. And "fruits and vegetables" is not one word. Fruits are not a substitute for vegetables. For people who love sugar and carbs, it's easy to rationalize fruit as a healthier option, and not eat enough vegetables.
What I'm not saying here is that the oatmeal itself is unhealthy. Or that piece of fruit or the brown rice. But when you add that to the overload of carbohydrates we have all day, all they do is contribute to the progression that, over time, ultimately ends in diabetes. It's not a mistake that the International Diabetes Federation states that 81 percent of adults over the age of 55 are diabetic or pre-diabetic. That's four out of five older Americans.
So how do you help your patients? I'll address details in the second half. But the first step would be to start measuring the grams of carbohydrates eaten during a typical day, and start noticing how far that is from the number 72.3 That's the number of grams of carbs recommended a typical person ingest during a day. See how often you can get vegetables in your diet, from the spinach in scrambled eggs to an extra serving at dinner and skip the rice. And in the next article I will explain specifically, and in detail, how to address this epidemic.
- www.mayoclinic.com/health/metabolic syndrome/DS00522
- Lutz W. Life Without Bread. New York: McGraw Hill, 2000.
Click here for previous articles by Marlene Merritt, DOM, LAc, ACN.