Sweet Teeth

Is the use of artificial sweeteners a healthy thing?  "The role of sweeteners on cancer risk has been widely debated over the last few decades," observes an article  in  Annals of Oncology (Oct. 16,2006, 2007; 18.1: 40-44).  According to the Mayo Clinic, artificial sweeteners are safe--with the exception of aspartame for those who have the rare, hereditary disease, phenylketonuria--they don't cause cancer, and they don't affect the metabolism ("Artificial Sweeteners: A Safe Alternative to Sugar?").  Indeed, it has even been most recently (again) argued, "Ways to promote the use of fat-modified foods and artificial sweeteners merits further research in both prevention--and treatment--controlled trials" (International Journal of Obesity, July 28, 2009; 33: 1183-1190).  And yet...

"Psychologists at Purdue University's Ingestive Behavior Research Center report that nine rats given yogurt sweetened with no-cal saccharin ended up eating more and gaining more weight and body fat than eight fellow rodents given yogurt containing plain old glucose (a simple sugar with about 15 calories per teaspoon, the same as table sugar)" (Scientific American, Feb. 11, 2008).  And Marcelle Pick (OB/BYN, NP) goes into great detail on the "potential danger" of sweeteners in her article, "Sugar Substitutes and the Poetential Danger of Splenda" --though this article is connected to a Women to Women cite that promotes its Core Balance Diet.   According to ABC News' Good Morning America's medical contributor, Dr. Marie Savard, who I think was commenting upon the same Purdue University study (mentioned above), "There's something about diet foods that changes your metabolic limit, your brain chemistry," (Feb. 11, 2008).

I think that moderation is the key--along with a constant reminder that substitution of sugar is not the same as permission to go crazy with ingestion of other kinds of sugars (carbohydrates in general).  For more information:

• "Are Artificial Sweeteners Safe?" (Denise Mann, WebMD)
• "Artificial Sweeteners" (MedicineNet.com)

Stress, Doctors, Sex, & Death

I have developed a significant distrust of most doctors.  (I once had a doctor tell me that I could live on a potato-a-day.  That was the start of my many years of bulimarexia.)  That distrust continues to grow.

Recently, I met with a doctor who I was considering switching to for a primary care physician (this doctor's specialty is internal medicine).  However, before I could fully discuss my concerns and explain my issues, he jumped down my throat, shouting, "C'mon, you're a smart girl!  Sugar levels in the blood stream mean that you are over-eating."  It was clear, from that moment on, that he had decided that I'm a liar.  Why would I lie?  I want to regain my former health!  After I told him off, explaining that he was passing judgment about me and my illnesses without nearly all of the facts, explaining that I am a smart WOMAN.  He backed off, saying, over and over, "You're the boss." Clearly, however, he was patronizing me.  He took in all data I could share, but his face showed that he did not believe me.  He even said that the only way he could work with me is if I accepted that I was in denial. I gave him several opportunities to change his attitude, but in the end I knew that this sexist, irrational bigot was not going to be my doctor.  

I was visiting this doctor, for the first time, because my current physician told me to go on the South Beach Diet.  I informed this doctor that I was done with diets, that I was trying other approaches, a combination of approaches, that would take me a long time to balance.  This doctor was very upset with my sassy reply (how dare I question the doctor!?) and told me that if I didn't lose weight quickly, then I would have to explore having my stomach stapled.  After explaining that I had researched this idea and, in consultation with my diabetes specialist, concluded that this was not a reasonable path, I told her that she needed to listen to me, to work with me.  She threw her hands up in the air in frustration, saying, "Well, we need to come to an agreement on SOMETHING because what you're doing or not doing right now isn't working."  I agreed, and I explained to her, again, my desire to strike a balance between foods, exercise, insulin and work.  And then she said, as if she hadn't heard a word I had just said, "So, South Beach or Atkins--which diet is it going to be?" 

To each doctor, recently, I've said that the major factor affecting me right now is stress.  I've been saying that a lot, lately: I'm stressed.  Or I've been saying that I'm tired.  Hell, I'm both!  What really stresses me out is prejudice. 


I just read an interesting essay in The New York Times today: "For Obese People, Prejudice in Plain Sight. (Harriet Brown).  "Stigma and prejudice are intensely stressful," explains Dr. Peter A. Muennig in this piece.  No shit?!  But what this Columbia professor next says is very ineresting: "Stress puts the body on full alert, which gets the blood pressure up, the sugar up, everything you need to fight or flee the predator."  Prejudice, in other words, can cause stress, which can then cause illness.  "Over time," explains Harriet Brown, "such chronic stress can lead to high blood pressure, diabetes and other medical ills, many of them (surprise!) associated with obesity."

No person can get rid of all stress in his/her life; in fact, a person needs a little stress.  "Because of the overabundance of stress in our modern lives, we usually think of stress as a negative experience, but from a biological point of view, stress can be a neutral, negative, or positive experience." (http://www.medicinenet.com/stress/article.htm#what)  

Therefore, we (those of us ill and/or otherwise overweight) might all need more positive stress in our lives.  For example, sex is a positive stress that can also cause other (negative) stresses to be released.  Have sex, or die?

Diets & Metabolism

A few months ago, my doctor and I were fighting about ways to control my metabolism.  I think that metabolism is one of the key factors in controlling obesity, Type II Diabetes, and other related health issues (such as blood pressure, liver diseases, heart diseases and perhaps even cancer).  Going on a diet, particularly a fad diet, however,  is not the answer.

A person's metabolism--my metabolism, your metabolism--has a rate and is affected by many factors.  Our metabolism can be fast/high and slow/low.  Some people burn fat and other calories at a higher rate, faster than others.  Some people burn fat and other calories more slowly, at a lower rate than others; they store it for later. Heredity is one of many factors to do with the rate of one's metabolism, but there are many, many other factors, too.  Writes Colette Bouchez of WebMD, "Your metabolism is influenced by your age (metabolism naturally slows about 5% per decade after age 40); your sex (men generally burn more calories at rest than women); and proportion of lean body mass (the more muscle you have, the higher your metabolic rate tends to be)."1   Stress is also a factor.  According to G. Seematter, C. Binnert and L. Tappy, "In obese patients, mental stress elicits responses which differ widely from those of healthy individuals. While mental stress enhances catecholamine-mediated energy expenditure in obese patients to the same extent as in lean subjects, it fails to decrease systemic vascular resistance due to endothelial dysfunction. This leads to enhanced blood pressure responses and the absence of stimulation of glucose disposal in obese subjects during mental stress."2 

However, obesity does not equate slow/low metabolism.  According to Molly Kimball, RD, "The simple fact is that the extra weight causes your body to work harder just to sustain itself at rest, so in most instances, the metabolism is always running a bit faster....When you are very overweight your metabolism is already running so high that any small cut in calories will result in an immediate loss."3 Thus, for a quick fix of losing just a few pounds, dieting is the answer.  But, in truth, you are starving yourself, and your body will eventually respond by slowing down  your metabolic rate, storing more fat (energy) and, ultimately, causing you to regain that weight lost, perhaps even gain additional weight (for the next time you starve yourself).

There is even a danger, I suspect, in the meal plans some companies put out for diabetes. (See the nutrition pages produced by the American Diabetes Association for quality advice on balancing carbohydrates with other foods.) Diets too low in carbohydrates can be very dangerous.  You need sugar, particularly glucose.  Your brain needs it.  (You acquire this glucose from carbohydrates contained in dairy products, a variety of grains, any legumes, as well as other vegetables, and fruits.) "Glucose is the only fuel normally used by brain cells. Because neurons cannot store glucose, they depend on the bloodstream to deliver a constant supply of this precious fuel."4 Your body needs glucose, too, particularly complex carbohydrates.


Just as there  slow/low and fast/high metabolisms, there are also complex (slowly metabolized) and simple (quickly metabolized) carbohydrates.  Simple carbohydrates include: most syrups, fruit juices, milk, and processed (table) sugar.  They are found in most processed/refined foods.  The body absorbs these very, very quickly, "as if delivered by a syringe."5  Complex carbohydrates include: bread, rice, pasta, cereals (which may also have simple carbohydrates), potatoes, fruits, legumes, carrots and corn.  To a lesser degree, complex carbohydrates may be found in green vegetables, such as green beans, broccoli, and spinach.  It is better to digest complex carbohydrates than simple carbohydrates.  "A sugary snack or soft drink that quickly raises your blood sugar level gives you a boost (and any caffeine adds to the lift), but it's short-lived. When you eat something with a high sugar content your pancreas starts to secrete insulin, responding to a kind of temporary hyperglycemia. Insulin triggers cells throughout your body to pull the excess glucose out of your bloodstream and store it for later use."6  Sometimes the insulin pulls too much out, and you suffer from a temporary glucose deficiency: your thinking slows down, you feel nervous/edgy, and your body feels weak (a kind of temporary form of hypoclycemia).


I believe that people with slow/low metabolisms might feel a drive to get "quick fixes" of simple sugars.  I'll research this for another entry.  Meanwhile, I think it is important to note that having a slow/low metabolism is not a curse, not a disability.


There are advantages and disadvantages to each extreme. Someone who is able to burn calories quickly is able to function in "sprints" and to use energy in daily activities at an intense rate.  Someone who is able to burn calories slowly is able to function at "marathon" levels and to use energy in daily activities at a steady, moderate rate.  This does not at all mean, however, that you need less food!   What it does mean, I think, is that the balance between exercise (both aerobic and muscle development) and eating is different than for those with high/fast metabolic rates.  According to Robert Yanagisawa, MD,"If two people both weigh 250 pounds, and one got there by dieting down from 350 and the other one was always at 250, the one who got there by cutting calories is going to have a slower metabolism.  That means they will require fewer calories to maintain their weight than the person who never went beyond 250 pounds." 7

Imagine that!  Dieting slows your metabolism.  I'll end this entry on that thought.....

Metabolism Working for You?

Let's start with a general understanding of how metabolism works.  According to Charles E. Ophardt (Elmhurst College), in "Overview of Carbohydrate Metabolism,"  glucose (blood sugar, which comes from other sugars and other carbohydrate foods) is "controlled by three hormones: insulin, glucagon, and epinephrine."  The first hormone, insuline, serves to transfer the sugar from the blood stream into cells, particularly liver and muscle, where it is converted into glycogen for storage.  When sugar levels are low, then the body secretes the other two hormones, equinephrine and glucogon, to convert the glycogen back into glucose.  Ophardt provides a lovely diagram for how this energy is then either used or put back into storage (for later use).

 

For a larger image, see: http://www.elmhurst.edu/~chm/vchembook/images/590metabolism.gif

It is (apparently) important for a constant and steady provision of glucose to various parts of the body (including the brain, which does not itself store glycogen); I suppose that this is somewhat  like gas to an automobile engine: you have to keep the pedal steady to maintain a particular speed.  For more details on this process, see "Introductory Metabolism Module" (Histology and Physiology 101; University of South Australia) and/or "Carbohydrate Metabolism" (General, Organic and Biochemistry, James K. Hardy, University of Akron).

We all need sugars to survive.  The trouble for those with type 2 diabetes is the regulation of that sugar.

Personal Opinion Based on Experience--Anecdotal

This topic is a touchy one for me, a topic closely tied to years of confusion, frustration, and ultimately, anger.  I read somewhere that my generation of women, the generation of yo-yo dieters, has suffered tremendously from poor dieting advice and the pressures of advertising and news media to conform to a particular size in an particular way.  Since I was 12, when my doctor found that I was "two pounds over the normal weight" for my size and age, I have been placed on or placed myself on diets.  Two pounds.  More recently, I had a doctor suggest that I go on the South Beach Diet (the latest fad) or else consider stapling my stomach (another recent trend in medicine).  There will be other blog entries on how fatness is a social (feminist, masculinist, experimentalist, whatever) issue; however, my point here is that many members of the medical profession (not all, but many) have misled both themselves and their patients.  The general impression that I have gotten from doctors over the years is that I should simply reduce either the amount of sugar (from chocolates to breads, dairy products, fruits, and starchy vegetables) and/or the amount of calories.   But I firmly believe that this is the central reason that I have become increasingly heavier and heavier.  My latest nutritionist and diabetes doctor (both of whom are excellent), when she found out how few calories I was ingesting each day (about 1300-1500, the latter on days of exercise), she exclaimed, "You're starving yourself!"  I knew it was true: my stomach kept me up at night with grumblings, and I was having a hard time thinking in my work--but I had been told to ignore these symptoms!

So, back to the topic: we all need sugars (and calories) to survive.  This is not the debate, I believe.  I believe the debate is quality of sugars, as well as a balance of types of sugars.  For example, according to Janet Jankowiak, MD, if you have diabetes (the inability to regulate sugars at a constant level), you "are more likely to have a heart attack or stroke at a younger age" and you may also "be at a greater risk for a decline in mental function--brain decay--or dementia" ("Too Much Sugar May Cause 'Brain Decay', Neurology, 2004).    According to Dr. Nicholas Bello, reporting on a Johns Hopkins University School of Medicine animal research project:

Dr. Bello and colleagues report that either continuous eating or binge eating a high fat, high sugar diet alters opioid receptor levels in an area of the brain that controls food intake. Opioids are a family of chemicals with actions similar to those of morphine; however, opioids exist naturally in the brain and have been linked to feelings of pleasure and euphoria. “These results are interesting because we saw changes in opioid receptor gene expression in a brain area that controls how much we eat during a meal”, said Bello. (ScienceDaily, Aug. 6, 2009)

So, the questions seem to be:

1. How much is too much?
2. How much is enough?
3. What kind(s) of sugars should be digested (and how much)?

Okay, so this is where the illusion of control becomes a vital issue. I don't want to tell you what to do, for several reasons.  I'm not a medical doctor, and I suspect that we all have damaged metabolisms of various degrees: what I find works for my body may not work for yours.  You are in charge!  Take charge!  You should find the answers for yourself--though not by yourself.  Consult a good diabetes specialist and nutritionist.  Do research of your own.  For example, I suggest you take a look at International Journal of Diabetes & Metabolism.