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Conference Highlights: The Diabetes Pandemic

Hi there!

From the early 1800's until today, our per capita consumption of sugar has skyrocketed, as has the incidence of diabetes. Today we explore this global epidemic.

Some of this weeks episode highlights are:
7:05 Diabetes is the greatest global health crises of the 21st century.
11:35 We have gone from 5 pounds of sugar consumption per year per person in the 1800's to over 90 pounds per person today!
16:50 We have clear evidence that sugar consumption causes insulin resistance. Insulin resistance paves the way for diabetes, heart disease, and cancer.

--- Full Raw Transcription of Podcast Below ---

Introduction (00:00):
You are listening to the, keep the weight off podcast with Dr. Angela episode. Number 13,

New Speaker (00:07):
Welcome to The Keep The Weight Off podcast, where we bust all the dieting myths and discover not just how to lose weight, but more importantly, how to keep it off. We go way beyond the food and we use science and psychology to give you strategies that work. And now your host, Dr. Angela Zechmann.

Dr Angela (00:28):
Hello friends. It is so good to be with you today. I wanted to give you guys all an update because I spent my whole weekend on the computer watching presentations. I was actually at the obesity medicine association conference. If you don't know, I'm board certified in obesity medicine, and I absolutely love attending these conferences. And, you know, usually they're in a pretty cool city and we get to have a lot of fun with colleagues and all that. Well, these days it's all virtual and online and so it's different, but it's still really good. And, you know, it's interesting because I love going to these conferences, but my staff doesn't really like it so much because I get so excited about what I'm learning that I come back and I'm telling my patients all this cool stuff. And then I end up running long in the office visits and my staff is politely knocking on the door.

Marchelle (01:31):
You're not speaking for me because I love it when you come back from the conferences because we have all new stuff to tell people.

Dr Angela (01:40):
Oh, okay. Well oftentimes it gets to be a problem because I just talk too much. So anyway, I guess podcasting is going to be fun for me cause I do love to talk. So anyway, I wanted to tell you about what I learned this weekend. I'm only gonna share what I learned in two of the, I don't know, maybe 20 talks that I attended over the weekend. And these, these were the two that were most fascinating to me. We had a great talk by a gentleman named Gary Taubes. Now, I don't know if you've ever heard of him before. He is an investigative science and health journalist and he is co-founder of the nonprofit group, the Nutrition Science Initiative.

Dr Angela (02:31):
And he's actually like a New York times bestselling author. He's written three bestsellers. The first was called ""Good Calories, Bad Calories"" that came out in 2007. And then he wrote ""Why We Get Fat and What To Do About It"" that came out in 2011, and then his most recent one is called ""The Case Against Sugar,"" and that came out in 2016. So Gary Taubes is also in the documentary that I recommended that all of my patients watch. And if you have not watched it, those of you who are listening to this podcast, it's called ""Fed Up"" and he's a prominent person that's interviewed in that podcast. He just knows a lot about the science of how we end up gaining weight. And in this talk, it was fascinating because he took us through a brief history of diabetes in the United States. And he started out with this research paper that was written in the late 19th century. And so we're talking the late 1800's and there were two authors to this paper. One of them was the famous Elliot Joslin. I don't know. Have you ever heard of the Joslin Diabetes Center Marchelle? It's one of the preeminent institutions in the country that assists with diabetes, education and treatment.

Marchelle (04:00):
I had never been affiliated with anything that had to do with diabetes until I started getting insulin resistance. And when I started working for you, because I had never really planned on getting diabetes. Now, I know a lot more about it.

Dr Angela (04:12):
Well, so now you know about Joslin Diabetes Center and what Elliot Joslin and his colleagues did was they come through all the records of mass general hospital in Boston between 1824 and 1898. So think about this, you know, like the mid 1800's, and this was 74 years worth of inpatient hospital records. And they had 48,000 records that they combed through. So, I'm just imagining grad students or somebody helping them go through all of it. And they were all handwritten, you know, obviously. So they were just looking to find out what was the prevalence of diabetes and how many cases of diabetes do you suppose they found in 48,000 records over 74 years? How many cases of diabetes do you suppose they found take a wild guess. Four? Oh, no. They found 172, just 172 cases in 48,000 records. So that's one in every 280 patients back in the 1800's. Okay.

Marchelle (05:31):
So like things have changed a lot over time.

Dr Angela (05:36):
Well, and then, but what they noticed is that if they looked at different decades, starting in 1824, each decade, the diabetes rates and prevalence got higher. And then Mr. Taubes showed us more research noting that as time progressed throughout the 1900's, the rates of diabetes got even higher. So every decade, just more and more and more diabetes. And then in the last 40 years, the diabetes rates have just absolutely skyrocketed. And today there are like 30 million Americans living with diabetes. That's one in 11. So we went from a prevalence rate of one in every 280 patients in a hospital to one in every 11 people!

Marchelle (06:28):
I'm wondering much diabetes has spiked during the quarantine and during COVID, because I know that there was like a huge amount of weight gain and we're seeing like a lot, a lot more of new patients. And I think that, I think about what I read was even in juvenile diabetes, that during quarantine, it spiked like 30%.

Dr Angela (06:56):
Oh, wow. I wouldn't be surprised. I would not be surprised at that. Huh. Well, I don't know the answer to that question. That's a good question. Going back to Gary Taubes talk. He quoted Margaret Chan, who was the director of the World Health Organization in 2016. And she said that this isn't just going on in the United States. Diabetes is one of the biggest global health crises of the 21st century and the World Health Organization estimates that the number of adults living with diabetes has almost quadrupled since 1980. So this is how rapidly this has happened. There were 108 million in 1980. Now there's 422 million by 2014. And I'm sure that number's way higher now.

Marchelle (07:47):
I wonder what's causing that because I think that's probably around the time when a lot of fast food chains started to open up. Like Pepsi, Coke, all of that kind of stuff. Probably. Yeah.

Dr Angela (08:00):
Yeah. I don't know. That's that's the question, you know, like, so she says, this is a slow motion disaster. She said the probability of keeping a bad situation from getting much worse is virtually zero. So she was pretty negative in her in her ideas of what could be done to prevent this from getting worse. And so, you know, this disease is devastating and it's getting more and more prevalent all over the years and now it is just explosively prevalent. And so the question Gary Taubes asked is, and this is an obvious question, ""what's causing this pandemic of diabetes ... what's causing it?""

Marchelle (08:43):
Restaurants is what I would say.

Dr. Angela (08:45):
That's what you think. Well, they used to think in the old days that diabetes was caused by obesity and that obesity was caused by over consumption of food that we just eat too much and we don't move enough.

Dr Angela (09:02):
And that's why we gain weight. And that's why we get fat. And that's what causes diabetes. And as a matter of fact, you know, in 2016, the American Beverage Association (hint hint) testified in the US District court in San Francisco. And here's what they said. Obesity arises as a result of an energy imbalance between calories consumed and calories, expended creating an energy surplus and a state of positive energy balance, which in turn results in excess body weight over time. So Gary Taubes is just, I mean, he's just brilliant intellectual, and he points out the fallacy in this reasoning by comparing it with wealth. So he says, imagine if you think about wealth in the same way that the food and beverage administration or food and beverage association is thinking about obesity. So for example, wealth arises as the result of a money in balance between dollars earned and dollar spent creating a money surplus and a state of positive money balance, which in turn results in excess wealth over time, like how ridiculous is that right? He also compared it with climate change, he said, climate change arises as a result of a heat imbalance between energy entering the atmosphere and energy, leaving it, creating a heat surplus in a state of positive heat balance, which in turn results in excess heat and climate change over time. So, I mean, it's just, it just goes to show you how totally absurd this whole calories in calories out thinking is.

Marchelle (10:52):
I just wanted to add like when you're growing up, you know, especially like me growing up in the eighties and nineties and all that, we were just simply taught. It didn't matter like what you ate. It was just general calories. So you just look at your calories and then, you know, less calories, less weight. Right. So we weren't really taught, like, not even in health class, that there is a different, you know, two different kinds of fuel either you're going to fill your body with protein or you're going to fill it with carbs. I mean, we, we just didn't have the details. And so I think that's just a huge part of this problem is there's not enough.

Dr Angela (11:28):
Yeah, absolutely. The information out. Yeah. Yeah. So what is the real cause of this obesity and diabetes epidemic we're witnessing? Well, then he started showing us data on sugar consumption, which was fascinating. So he went all the way back to 1800. And at that point in time, Americans ate about five pounds of sugar per year. That's it? And then in the 1840s, when the industrial revolution got started, candy and ice cream started being manufactured. And then in the 1880s, sodas were developed. And so the consumption of sugar gradually increased over time and they got better at manufacturing, sugar cane and getting sugar out of beets. And, you know, it's like, and now it's high fructose corn syrup.

Marchelle (12:23):
Don't get me started on that!

Dr Angela (12:28):
Well, we want to guess how many pounds of sugar we consume now? Well actually not now in 1986, guess how many pounds of sugar we consume per year on average? Five pounds in 1800. Well, it's 75 pounds of sugar in 1986 per year per person. Now days it's 90 pounds per person per year now.

Marchelle (12:56):
That's like, Coca-Cola's getting richer. And we're getting sicker.

Dr Angela (13:00):
So, you know, it would appear, there might be a correlation between high sugar intake and the Americans, and even in the global industrialized diet, and higher prevalence of diabetes, there might be a correlation there, right. But I'm an epidemiologist and I've got a master's in public health. And I worked as an epidemiologist at the Washington state health department for many years. And what I always told people is that correlation does not mean causation. And so what I mean by that is just because two things seem to go along together.

Dr Angela (13:39):
That doesn't mean that one thing causes the other. Okay. So this does not prove that our excess sugar intake is causing diabetes. It's just correlated with it. And so this is what the food and beverage industries are constantly using to defend themselves. It's just really hard to prove that sugar causes diabetes, but something is happening. Yeah. Something is happening for sure. But we do know the metabolic effects of sugar consumption. There's been a lot of research. We do know that the body responds very, very differently to the intake of sugar versus fat versus protein. So we do know that a calorie is not a calorie that when you're eating fats and you're eating carbs and you're eating proteins and you're eating sugar and fructose in particular gets processed in liver, it gets processed very differently. And so there's definitely enough evidence to say, Hey, you know, maybe this stuff, isn't all that good for us.

Dr Angela (14:53):
And so in March, 2021, there was a study that was done. And they they investigated the metabolic effects of daily sugar-sweetened beverage consumption. So sodas and energy drinks for several weeks in healthy lean men. So they you know, they did physical exams on them ahead of time, made sure they were healthy and made sure they didn't have diabetes or any other issues. And then they gave them various amounts of sugar sweetened beverages. And what they found is that beverages sweetened with the sugars, fructose and sucrose. Now sucrose is table sugar, and it has both glucose and fructose together. Okay. But beverages that were sweetened, they were different than beverages that were sweetened with just glucose alone. And that anything that had fructose or sucrose table sugar in it, it caused the liver to produce fat.

Marchelle (15:57):
The reason why they use the high fructose corn syrup, I did some research on this. It's just because it's cheaper to make, for sure, because in the U S we grow a lot of corn and not much sugar. So we have an abundant amount of corn. So that's one of the reasons why we use so much of the high fructose corn syrup - its extremely bad for you!

Dr Angela (16:25):
Yeah. So it goes straight to the liver and it causes the liver to produce fat. And then these resarchers said, this change may pave the way for further unfavorable effects on metabolic health. So that's like scientific lingo that says, we think that there might be something going on here. It was so interesting the way, the way you have to develop your conclusions in scientific papers. So, but we have very, very clear evidence that sugar consumption causes insulin resistance and that insulin resistance paves the way for diabetes and heart disease and cancer. Okay.

Marchelle (17:03):
You know, so another thing that I read was it's because it's been shown to drive inflammation, starting this, starting them, all of it, exactly that's associated with, you know, the risk of obesity and diabetes and heart disease and cancers. So inflammation is where it starts and with nuts because of the sugar and the high fructose corn syrup.

Dr Angela (17:27):
So the conclusion is that sugar, and particularly fructose, may well be the fundamental cause of obesity, diabetes, and heart disease because of its effect on insulin resistance and saying that there's a lack of scientific agreement, or that it's controversial. That's true, but it's not reassuring. And of course the industry is going to be all over that to try to say, Hey, you know what? You can't prove that these things aren't safe. What Gary Taubes ended up saying is that there's plenty of evidence to indict sugar as a cause of diabetes, but it's, it's very hard to actually convict sugar of this. So you just have to like, keep your ears peeled to the ground and just know that the food industry is going to keep up their shenanigans, telling us that candy and sugar-sweetened beverages and high fructose corn syrup can be part of a balanced diet. But remember everybody, this is a crock of crap. Don't fall for it.

Marchelle (18:29):
Like when it says, you know, the study shows, then you have to pay some attention. And I mean, I even read that loss of memory is associated with the high fructose corn syrup. Oh yeah. You know, basic cognitive abilities are linked to the sugar. I mean, the high fructose corn syrup I think is like a really deadly problem. I mean, sugar is as well, but I don't know the high fructose corn syrup when I started reading about that got me super pissed!

Dr Angela (19:01):
Yeah. Yeah. And they banned it in Europe. So I mean like,

Marchelle (19:05):
Yeah, exactly.

Dr Angela (19:07):
Gatorade. It's banned in Europe,

Dr Angela (19:13):
Really. Man... it needs to be banned here too. And all of these, like, you know, these, these crazy, Oh, you know, these caffeinated beverages that all the kids are drinking these days, we could do a whole nother podcast just on sugar-sweetened beverages. Oh, it's horrible. So that was that awesome. Talk by Gary Taubes, which I just learned so much from him. We had another talk by a gal on the treatment of diabetes. So we went from like, where's this coming from to, how do you treat it now that you've got somebody in front of you? It was a talk on type two diabetes or adult onset diabetes. So there's type one diabetes, which is generally diagnosed in children and people less than 20 or 25. Although there's now another form of diabetes, which is latent onset adult diabetes, adult type one diabetes. So there is a, there is that being recognized.

Dr Angela (20:08):
But when I talk about type two diabetes, these are not people who need to take insulin. There are people whose blood sugars run high and they may end up eventually needing insulin, but they generally don't have to take insulin from the very beginning. And the issue is just really severe insulin resistance. So we learned about, I mean, there are just so many new diabetes drugs that have come out. And basically those of us who specialize in obesity medicine these days really need to know how to treat diabetes because essentially it's, diabesity, diabesity diabetes and obesity. They just go together. And I noticed that I'm diagnosing adult onset diabetes at younger and younger ages all the time. I mean, you know, we have 30 year olds, 20 year olds that I'm diagnosing with diabetes. And it just kills me, you know, to be diagnosing someone that young with adult onset diabetes.

Dr Angela (21:07):
We, we used to never see it in people that young we'd see it in 50 and 60 and 70 year olds. You know, and this is like, like when I'm really tempted to just throw charts across the room and yell and scream at the food industry, because you know, they're doing this to people, this is what they're doing to people. And this is what they're doing to our kids is they're setting them up for a lifetime of hell. So when I diagnose someone with diabetes, you know, I know that education is key. Now, many people don't really understand that diabetes is fundamentally a disease of the blood vessels. So if you think about it, if any of you podcast listeners have diabetes, that's what I want you to understand. It's a disease of the blood vessels. And if the blood vessels don't function properly, then they get clogged up.

Dr Angela (21:55):
Then the body's cells start to die off. And that's why we end up seeing all of the complications that we see of diabetes. So the tiny blood vessels in the nerves are generally the first ones that get blocked off. And so people will end up with what's called neuropathy, which basically just means that there's numbness and tingling and pain, usually in the legs and feet. And this can be prevented though, by keeping the blood sugars down and keeping the blood sugars in more normal ranges. So I always try to explain to people that this is our goal. Our goal is to think about keeping the blood vessels open and keeping the blood flowing. And in order to do that, we keep what's called the A1C. This is this is a measure of your average blood sugar. Over three months, we keep it less than seven.

Dr Angela (22:46):
If we can. And we do this with a three-pronged approach, keeping carb and sugar intake, low regular exercise, and using medications and medications, maybe in pill form. They may be in shot form. Sometimes we end up needing to use insulin, although I always wanted to prolong that need as long as possible. It's entirely possible to live life without, with diabetes without ever having to take insulin. I see it all the time. So it's really super important to take a diagnosed diabetes diagnosis seriously and get on it quickly. Research shows that like the sooner you get it under control, the better the long-term outcomes are. And some people, you know, I can tell just by talking to them that they're in denial. They're not hearing me, they hear that they've got diabetes, but they're just, aren't able to take it in. And so they deny it and ignore it. And then there are others who, you know, they're not diabetic, but they're headed in that direction. And they're already really super, super scared and anxious about it because they've seen somebody in their life. Who's had diabetes and they're like, I don't want that.

Marchelle (24:00):
Yeah, that's kind of your, I was out like when I first started working for you, like, I really didn't have any idea, like what I was getting into. And then you know, I was overweight and so I did the blood work panel and then found out that I had some insulin resistance and it really kind of scared me because I had no idea that, you know, I was at that point, yeah. By no means do I want to have to put, take shots in my belly every day? And I'm sure like most of us don't, but that's why the awareness of all this is so important because I'm sure if I was aware of what that Big Mac was going to do to me, you know, in 20 years I would have probably made different decisions. So yeah.

Dr Angela (24:48):
Well, everyone handles this diagnosis differently. And what I can say is that you can live a perfectly normal life with diabetes if you do what it takes to keep it under good control. So there's just a lot of hope these days. And especially with these newer classes of medications that are so awesome, that we're oftentimes able to delay the need for insulin shots for many years, and many patients never need to take insulin at all, which is awesome. So if you're a podcast listener with diabetes, just make sure that you've got a good obesity medicine doctor in your corner. And depending on the severity of your diabetes, you may also need an endocrinologist on your team. Certainly a good family practice person or a internist. I just can't emphasize enough how important it is to take this diagnosis very seriously. Okay. So do you have any thoughts, any other thoughts about this?

Marchelle (25:46):
Oh, my mind is just like all over the place because it's just really just a really scary thing to have to deal with. I mean, I know that a lot of our patients come in and, you know, they want to lose some weight and they get their blood work done and they find out that things are going in a pretty bad direction. And I don't know, I just have a lot of empathy for this situation.

Dr Angela (26:11):
Yeah, yeah. You know, those morning frappes at Starbucks and the daily run through the McDonald's drive through and you know, the pizza and beer on Friday and all of this stuff, everybody does it. And everybody thinks that is also normal.

Marchelle (26:29):
That's just like the American way. I mean, Starbucks is the thing it's on beer on a Friday night. It's just so normal. And you just don't know. I mean, not, you just don't know. I think a lot of people just understand what that's going to do to them in the future. I sure as hell didn't I had no idea. I mean, I thought I was invincible and then got that blood work back in.

Marchelle (26:56):
Yeah. I'm scared straight.

Dr Angela (27:00):
Well, I just, I want our listeners to know that there's plenty of hope and that we've got all kinds of resources to help support you in getting healthy again. One of the things that we have is the Journey Beyond Weight Loss membership. And I'm actually opening that membership up again. It's going to be open from May 1st to May 7th. 2021. We're gonna do our kickstart for the course, the Journey Beyond Weight Loss course on May 11th. So keep your eyes on your email or if you want to join the Journey Beyond Weight Loss membership, you can always go to, and read all about the program and see if that's something that you might be interested in signing up for. It's a really, really supportive environment. This is the best way to get the holistic whole person support that you need. And we've got such an awesome community of people there too. And everybody understands how much of a struggle this disease is to keep under control, but you need, you know, you need support. You can't just do it all on your own.

Marchelle (28:13):
So if you're interested in actually making like a long-term change and not just buying into another diet program where they're going to feed you your meals, hint, hint, Jenny Craig, Weight Watchers thing. I mean, if you're like interested in actually really finding out the information and becoming a part of a community, that's going to make a lifelong difference. This is the program.

Dr Angela (28:36):
That's what we are. We're really we're very nurturing and we're just giving you all kinds of scientific information, all kinds of understanding about how your brain works and how you can make these changes that will last a lifetime so that you can be healthy and vibrant for the rest of your life. So that's our goal. So right there is knowledge. Remember that power is knowledge and knowledge is power. So and again, I'm learning new stuff all the time at these conferences and I'm doing all kinds of other stuff. I'm always trying to keep up with with anything that I can think of that will help my peeps to stay healthy. I'm on it. So, all right. So I think we're good to go for this week. We will see you all next week. We're going to have a very special episode next week, so I'm super excited. So keep your keep your eyes on your podcasts for the next download next week. Okay. Take care everybody.

Conclusion (29:39):
Hey, if you really want to lose weight and keep it off for good, your next step is to sign up for Dr. Angela's free weight loss course, where you're going to learn everything you need to get started on your weight loss journey, the right way, just head over to to sign up. Also, it would be awesome if you could take a few moments and write a review on iTunes. Thanks. And we'll see you in Journey Beyond Weight Loss.

- Dr. Angela


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