Tell me what you eat and I will tell you what you are
– Anthelme Brilllat-Savarin (1755 – 1826)
Four weeks ago my father had a quadruple bypass heart surgery for seriously blocked coronary vessels. Through Dad’s hospitalisation and recuperation I have reflected on the health education surrounding wellbeing. My mother and father have spent over 30 years on a low fat, low cholesterol diet thinking they were doing the right thing in preventing heart disease. Unfortunately, what they didn’t realise was that the culprit is actually sugar rather than fat (see the Myth of Cholesterol at www.cholesterolcholestrol.com/cholesterolmyth.htm).
As we know, health and wellbeing is a combination of our physical health, our emotional health, our mental / cognitive wellbeing, social health and spiritual health. All of these areas need to be incorporated into our lifestyle. The difficulty is that we are often getting conflicting information and it can all seem overwhelming and too hard.
In this editorial I want to focus on sugar. Socrates said “We are what we eat”. 30 years of being told that we should eat a low fat diet with no regard to the sugar in our diet has created a generation obese people with the highest incidence of heart disease, diabetes and cancer in the history of the planet.
Certainly reducing our fat intake is important. What we are now becoming aware of is the role that sugar plays in our body and how large amounts of sugar and the associated link to insulin metabolism, are directly contributing to disease. Reducing the amount of sugar in our diet is to effectively metabolise insulin, and thus reduce the incidence of “lifestyle” diseases.
Insulin is part of our “feast and famine” metabolism. In times of feast we can store excess glycogen (from sugar metabolism) as fat and in times of famine we can draw on these reserves to sustain us. In a feast and famine society (such as the indigenous cultures such as traditional Aboriginal culture) greater survival advantage is conferred on those people who are the most energy efficient – that is those people who can store the greatest amount of “energy” in times of feast to tide them over in times of famine. When these cultures adopt a “feast life-style” like our western diet of highly processed foods, their systems automatically go into overdrive and we see the rapid onset of obesity, diabetes and cardiovascular disease.
In our Western society, over the past 50 years, we have adapted to the feast-only life-style. The first recorded death from heart disease was in 1912, now it is the leading cause of death. It is estimated that a staggering 48,000 people in Australia will die from cardiovascular disease this year (Gillespie, 2010).
In the last fifty years diabetes has risen from 0.002% (1 in 50,000) to 5% (1 in 20) and is still rising. The International Diabetes Federation estimated that in 2003 about 194 million people worldwide (5.1% of the adult population) had diabetes. The number of people worldwide with confirmed insulin resistance was estimated at 314 million (ibid). These are staggering statistics!
Kathryn Alexander (at http://www.getalife.net.au/mag/cholest_html) describes the insulin-cholesterol connection really well. “When we consume a diet high in refined carbohydrates (sugar and bakery products), its energy is released quickly and glucose floods the circulation instigating the release of insulin to counter this rise in blood sugar. Insulin is a storage hormone that “unlocks” the cells enabling glucose to enter. This brings the blood sugar levels down to within the normal range. Once inside the cell, glucose will either be used as fuel or stored as fat, which provides a good resource for energy when supplies are low.
However, when our body is continually overloaded by high-energy foods, the cells stop responding to insulin – in other words they won’t let insulin open the door to allow glucose in. This is known as insulin resistance and the upshot is elevated blood glucose and insulin levels. This starts a whole cascade of events as raised insulin levels trigger both cholesterol and triglyceride synthesis, and we see a new picture emerging.
The liver tries to keep abreast by removing the glucose (which is promptly converted to fats – triglycerides and very low density lipoproteins (vLDLs) – to be shipped out into the circulation) and degrading the excess cholesterol to bile acids for its elimination. If the insulin metabolism remains switched on, then cholesterol and triglyceride synthesis continues unabated. This increases the cholesterol, triglyceride and lipoprotein levels in our blood system, directly affecting our vessels and contributing to heart disease.
Excess glucose reacts with proteins in the blood vessel walls (glycation). This initiates a cycle of inflammation and oxidation (producing free radicals) which damages the blood vessel walls and adjacent nerves. The cross linking of protein-glucose complexes results in a build-up of inflammatory scar tissue that narrows the small capillaries reducing both blood flow and nerve transmission.
A similar process occurs with cholesterol. Cholesterol is a powerful anti-oxidant and in the absence of adequate anti-oxidant reserves (vitamins A, C, E and beta-carotene) will pick up free radicals and become oxidised. Once oxidised, specific immune cells take up the damaged cholesterol, but in the process become engorged and turn into “foam” cells. These are sequestered in the blood vessel walls and inflammation and oxidation is initiated. Scar tissue forms which leads to the hardening and narrowing of the arteries. So the end result of insulin resistance is elevated cholesterol and glucose, the narrowing of the major arteries and small capillaries, a reduction in blood supply to the tissues, raised blood pressure, all increasing the risk of heart disease and diabetes”.
Prevention is better than cure. The following things will contribute to our health and wellbeing:
- Maintain your ideal weight for height and a waist under 80 cm for women and 94 cm for men (CSIRO, 2008)
- Eat smaller portion meals (down size rather than upsize!)
- Reduce portion size and don’t overeat
- Eat 3 meals a day and reduce snacking – or snack on nuts or fruit
- Eat mainly fresh fruit and vegetables, reducing complex carbohydrates to a minimum depending on energy requirements
- Eat fresh whole fruit instead of juices as fresh fruit contains fibre
- Eliminate as much as possible sugary foods such as processed or sweet foods
- Reduce alcohol consumption to 1 glass of red wine a day
- Take antioxidants (Vitamin A, D, E, flax-seed oil, fish oil etc) to reduce the damage from free radicals which are the result of oxidation
- Drink lots of water
- Exercise daily to include weights, aerobic and flexibility exercises. This increases the efficiency of our glucose/insulin uptake
- Meditate daily to reduce stress and build resilience
- Get 8 hours quality sleep a night
- Keep thinking positive thoughts and focus on what you want (rather than what you don’t want!)
I have adopted a new eating regime to reduce my sugar intake – “trying” to maintain my daily input to 20g / day. This is almost impossible. If I have a 250mL flat white coffee that has 200mL low fat milk in it, I am having 10g sugar (I don’t have added sugar in my coffee!). That is 2 teaspoons in every cup! That is just the beginning! When we start to read food labels and add up the hidden sugar in what we eat we can be utterly shocked to see how much we actually ingest. I dropped over 3 kg in 3 weeks from just reducing sugar in my diet! It makes me wonder just how much hidden sugar I have been having. Being educated and conscious of our choices is vital in maintaining our wellbeing over time.
Good health to you!
– Orson Welles