Run for Your Life

by Mark Cucuzzella

  The 2016 Dietary Guidelines emphasize, as they did in 1980, that fruits, veggies, beans/legumes, low-fat dairy, and whole grains form the foundation of a healthy diet. They correctly recommend that we reduce our sugar intake, and finally admit that, for healthy adults, dietary cholesterol and fat do not significantly elevate levels of blood cholesterol and fat, nor do they increase the risk of cardiovascular disease. And—finally, thankfully—eggs and coffee are off the “black” list.

  It’s true that this new, modified diet would, if followed carefully by the healthy and active 30 percent of the U.S. population that is insulin sensitive, result in maintenance of health. But the new guidelines still contain an abundance of carbohydrates, and again fail to address America’s epidemic of obesity, type 2 diabetes, and prediabetes. Fat isn’t even listed as a healthy nutrient, and the new guidelines ingrain the mistaken homily that dietary fat is a cause of obesity.

  And despite a caution about sugar, the new guidelines allow diabetics ten added teaspoons per day—disregarding the immediate and long-term toxicity this presents. Imagine allowing a few cigarettes a day to emphysema or lung cancer patients. Indeed, it wasn’t very long ago, before smoking was connected to cancer and lung disease, that doctors were endorsing cigarettes in television commercials. (Attend a medical conference, and at breaks watch the doctors head for the bagels, muffins, cookies, and sodas.)

  President Kennedy vowed in 1962 that America would land a man on the moon before the end of the decade. Seven years later, that milestone was reached. By contrast, it has taken four decades for nutritionists and medical experts to partly understand the components of a healthy diet, then grudgingly (and incompletely) agree on how to describe it and promote it. Meanwhile, the United States ranks fiftieth in the world in health indicators such as obesity, diabetes, inactivity, and poor health. Based on this stark evidence, any scientist (or casual observer) can conclude that the U.S. guidelines simply haven’t worked. It’s not likely that the new, lightly amended version will do us much better.

  How did this situation occur? To begin with, there’s an inherent conflict of interest in the Department of Agriculture’s dual mandates to advise the public about healthy food choices and to promote U.S. agricultural products (most of which end up in processed food). Looking further back, at human evolution, it was the agricultural revolution that domesticated us, not the other way around. When we turned from hunting and gathering to agriculture, we substituted a diverse menu of nutrient-rich foods for nutritionally depleted grains and seed oils, which tied us to cultivated land and crops.

  I’m a member of the Nutrition Coalition, a nonprofit that advocates for sensible, science-based national nutrition policy. We launched a petition to Congress that has triggered funding for a thorough, independent scientific review of the current guidelines, with results due out in 2020. None too soon.

  One small but positive development came with the demise, in 2015, of the Global Energy Balance Network, a “scientific” site funded by Coca-Cola that was designed to convince us that weight gain and loss was a matter of “energy balance.” We now know this is not the case. After public disclosure of the network’s funding streams to doctors and medical groups, Coke quietly and quickly closed the site.

  In our hospital, we have thrown out the concept of “energy balance” altogether, and encourage patients to eat salads, veggies, eggs, meat, cheese, and fish—real food—to satiety. It’s not their fault they have insulin resistance. It’s because of the food that’s heavily marketed and routinely placed in front of them. We initiated “Sugar Free JMC” (Jefferson Medical Center) in 2018, and are leading our state in getting sugar out of our health care environment.

  THE MAGIC OF FAT

  Contrary to what many assume, healthy dietary fat does not make us fat. Fat does not raise glucose or insulin levels. In fact, healthy fats have a remarkable ability to control weight—by satiating our hunger. When we eat foods in their natural (unprocessed) state, including healthy fats and protein, we become full sooner—and thereby stop eating. And we grow hungry later. Dietary fiber in veggies shares this hunger-satisfying effect, too.

  But this hunger-satiating effect doesn’t quite work when the fats travel with sugar and starch. When consumed with carbohydrates, dietary fat is metabolized and stored differently than when consumed in the absence of carbohydrates, and it affects our appetite in a different way. Bread and wraps, for instance, should be regarded as nothing more than vehicles to get the real food to your mouth. A better vehicle choice would be a utensil, or a large leafy green.

  A study led by Christopher Ramsden revisited the diet-heart hypothesis and concluded that replacement of saturated fat in the diet with linoleic acid (a major ingredient in safflower oil and margarine) does not lower risk of death from coronary heart disease.

  Healthy fats (those containing essential fatty acids and fat-soluble vitamins) are essential for maintaining a healthy body. Yet fat still doesn’t appear as a food category on the government’s widely disseminated “My Plate” nutritional health graphic.

  The “My Plate” health graphic replaced the “Food Pyramid,” yet it still pushes grains (carbohydrates) and fruits (largely simple sugars).

  The dairy they promote is low-fat. If you look at the foods typically consumed in America, more than 75 percent of this government-endorsed meal plate can be composed of sugar and carbs.

  CHARTING YOUR PATH TO PERSONAL HEALTH

  To determine whether you are glucose intolerant, you may want to check your post-meal glucose level on occasion, even if you’re not diabetic. This can be done with a simple device called a glucometer, available in generic brands for less than $20. Eat a customary meal, then check your blood glucose level two hours later. It should be under 140 mg/dl. A higher figure indicates that you are not regulating glucose optimally.

  As a prediabetic (but otherwise healthy) adult, if I ate a “healthy breakfast” consisting of a muffin, a big fruit bowl, sugar-sweetened yogurt, and juice—then skipped exercise and sat at a desk—my glucose level would easily go above 140 and stay there for some time. (The juice alone contains about 50 grams of carbohydrate.) When a diabetic person eats the same meal (as often happens, even in the hospital), they will consistently spike to over 200. This dangerously high post-meal glucose level might settle down and “reset” by the next morning (especially if insulin or other glucose-lowering meds are taken at night). But that imparts a false impression that all is well. Because many of these carb- and sugar-loaded foods are advertised as “natural” and may not contain “added sugar,” most people don’t realize that they are in fact consuming large amounts of sugar. Their “healthy breakfast” falls within the letter of the Dietary Guidelines, but is far from healthful.

  SLAYING THE SWEET (BUT DANGEROUS) DRAGON

  Diabetes and obesity are given lip service as life-threatening, yet they are more deadly and disabling than many cancers. It may sound hyperbolic (or for some, a tired refrain), but the sugar-sweetened drinks and highly processed, high-carb foods are dragons that must be slayed. This includes soft drinks, juices, sport drinks, sweetened milks, boost shakes, many types of smoothies, and most packaged yogurts—all of which are ubiquitous in our food system. If you are insulin resistant, the unique sugar in beer heads straight to the belly, too.

  Okay, but how about those uber-fit mountain bikers and trail runners who drink gallons of craft beer?

  These curves show insulin release over time, by food type consumed, beginning right after eating a meal.

  They can handle it—for a while. They are insulin sensitive, and likely young. Weight isn’t normally a problem for elite athletes, because after years of frequent and high-intensity exercise (I’m picturing myself during college), they have become carbohydrate tolerant and insulin sensitive. They exercise hard and often, work up an appetite, and satisfy their hunger with a starch-heavy meal. Their insulin kicks in and do
es its job of storing sugar in the energy-hungry muscles, where it is ready for the next day’s activity. Empty the tank, fill, and repeat.

  Young Kenyan marathoners can live this way, too. But for how long? The human pancreas wasn’t designed to handle the insulin demand from decades of processing 600 to 1,000 grams of carbs a day.

  We do respond individually to sugar, just as we do to exercise. But as we age, we predictably begin to join the greater population—expanding in numbers and in waist circumference—that is carbohydrate intolerant and insulin resistant. For most of us (and virtually all of us at advancing ages), the excessive carbs we consume make a beeline for our stores of belly fat, piling onto whatever’s already there.

  WEIGHT LOSS STARTS IN THE KITCHEN

  In something of a hopeful sign, people are just as active nowadays as they have been in the previous few decades. (This isn’t quite true for children, unfortunately.) But exercise alone won’t fix diabetes or prediabetes. In fact, vigorous physical activity, which is mainly a tool for building and maintaining muscle, is not associated with significant weight loss. For most of us, the composition of what we eat plays a far bigger role than exercise in maintaining body weight. As the saying goes: ounces are lost in the gym, pounds are lost in the kitchen and dining room.

  The shaded area above the midline in these graphs represents the magnitude of fat that is stockpiled (= weight gain), and the shaded area below the midline shows the burning of fat (= weight loss).

  For fat to oxidize efficiently, insulin levels need to be low.

  Thus frequent high-carb meals (and twenty-four-hour insulin injections, too) sabotage the process of burning fat.

  EASE IS THE DISEASE

  For millennia, humans have been on a constant search for sufficient food to eat. Harvard anthropologist Dan Lieberman describes this nutritional challenge, and how it has affected our evolution, in The Story of the Human Body. During the past century, and for the first time in human history, we have faced an unusual dilemma: food has become too abundant, cheap, convenient, easy to chew, and downright tasty for our own good. As a result, we eat large quantities of stuff that has lots of calories but tends to be of poor nutritional quality.

  For our ancestors, gathering, hunting, or growing food was tedious. Processing and cooking it took time and effort. Now this scenario has been replaced by convenience and low cost, which have become the biggest obstacles to a healthy diet. It’s too easy to dine at a restaurant or a fast-food joint, or grab inexpensive food to go. Many of us have abandoned the art and joy of preparing a healthful meal at home. As a fraction of total calories consumed, more than 62 percent of food in the American diet is highly processed. And less than 20 percent of the food America consumes requires cooking or preparation.

  Eating well doesn’t require shopping at health food stores or specialty markets. You can start with your chain supermarket and confine yourself, as best you can, to the display cases around the periphery. Focus on buying nonstarchy vegetables, meat, fish, nuts, olive oil, spices, lots of eggs, full-fat dairy, and unprocessed cheeses. If you aren’t insulin resistant, whole fruit (pitted and non-tropical, especially) and legumes can safely be added, along with small amounts of real, whole grains. Use these simple ingredients for virtually everything you prepare.

  THE VIEW FROM LAST PLACE

  Distressingly, most of America doesn’t eat this way. My home state of West Virginia leads the nation in obesity, physical inactivity, and their metabolic consequences. Arkansas and Mississippi share with West Virginia an adult obesity rate of close to 40 percent.

  Addressing this epidemic will require transformation of the way medical educators link the sciences of nutrition, biochemistry, and physiology to the clinical practice of primary care and community medicine. Hippocrates said, “Let food be thy medicine and medicine be thy food.” But medical school curricula have almost totally neglected food and nutrition.

  In response to this, in 2013 my colleagues and I developed a cooking, nutrition, and physical activity program for the West Virginia University School of Medicine called MedCHEFS—Medical Curriculum in Health, Exercise, and Food Science. Our goal is to teach medical students the scientific, clinical, and actionable aspects of healthy lifestyles, in a manner that will improve the health of our patients, our communities, and ourselves.

  Armed with the concepts in this book, our medical students enter the kitchen, prepare and cook healthful (mostly low-carb) meals, then participate in sessions on fitness, proper body movement, and lifelong, joyful activity. By the end, they see the importance of establishing a collaborative relationship with their patients in order to prevent disease and to cultivate overall health. Medical and health decisions are made with the patient, not for the patient, prescribing health and restoration.

  Some have questioned the relevance of learning about food and exercise in medical school. The response is simple: nearly every chronic disease is either driven or greatly affected by what we put in our mouths and what we do with our bodies. A program of disease prevention and healing, through modification of diet and lifestyle, is truly the best form of care we can offer.

  The great news that accompanies all of this is that healthy eating, which comes in countless forms, is remarkably nonrestrictive. Healthful meals include fresh, hearty, rich foods with plenty of fat. Add butter (from grass-fed cows, preferably) to anything you want. Then go out and exert at a comfortable level, on a routine basis. There’s no hurry. We are ready right now to begin dining sumptuously—for the rest of our healthy lives. Bon appétit!

  DRILLS

  The “exercises” in this chapter are presented as simple, sustainable dietary principles that attempt to answer the question “What should my family and I eat to be healthy?” The first, foundational exercise is straightforward: the next time you enter a distraction-crammed supermarket, shop with knowledge, awareness, and discipline. Make that every time you shop.

  Dr. Mark’s revised dietary guidelines for America

  Try these simplified shopping, cooking, and eating guidelines for a period of one month.

  Get rid of the sugar bowl, and cut out added sugar entirely. Eliminate sugared drinks, including juice and sports drinks. (This step alone, if you are a significant sugar consumer, will boost your health noticeably and significantly.)

  Upgrade all the components of your diet. Include lots of healthy fats and quality protein—eggs, nuts, seeds, olive oil, avocados, whole fat dairy, cold-water fish, nonprocessed meats. Eat from a rainbow: colorful vegetables should be integral to every meal.

  Go against the grains. Eliminate processed foods and refined grains and flour products such as bread and pastries, especially if you’re trying to reduce weight; learn your level of carbohydrate tolerance, and don’t exceed it. (Check by looking in the mirror for a “muffin top” over your belt.) Avoid “food products,” packaged meal replacements, and foods that list ingredients you can’t pronounce. As Dr. Harry Lodge says, “Don’t eat crap.”

  Remove all trans fats and vegetable seed oils (corn, vegetable, canola, and safflower oils, and margarines), which are known to exacerbate inflammation. Go for real butter, coconut oil, avocado oil, and first-press olive oil. If the fat tastes good in its natural state then it likely is good. Avoid all foods labeled “diet,” “low-fat,” or “low-calorie.” The fats in “low-fat” foods have almost certainly been replaced with carbs. Fat-soluble vitamins and minerals can’t be utilized by the body without the fat itself.

  Abandon all complicated, heavily prescriptive or overly restrictive diet regimens. Don’t go hungry! Eat until you are nearly full, not more.

  That’s how healthy eating works. The operative word is simplicity.

  Some recipes I can’t resist sharing

  Here are my favorite go-to dishes, well suited to those of us with busy lives and affordable for most
. The prep time for any of these, once the ingredients are gathered, should be no more than five minutes.

  The stinky omelet. That’s what my kids affectionately call it. Take three farm-fresh eggs and add any meat, cheese, or veggie you have. Top it with homemade guacamole: salsa, salt, a little lime juice, and a mashed avocado.

  Slow-cooked whatever meat is on sale. Your local market often has a big hunk of pork shoulder, brisket, rump roast, or whole chicken at a sale price because it’s a day past the sell-by date. That’s fine, because you will cook it in a slow cooker for eight hours. Add a simple seasoning rub. Use the extra for meals and salads later in the week.

  First-press olive oil on any leafy green. This brings out a remarkable depth of flavor to most bitter greens, and facilitates vitamin and mineral absorption. It’s no accident that cultures around the world add fat to vegetables. Simply pour some high-quality (dark green) olive oil over your uncooked greens, and add some salt. Massage it in with your hands for a couple of minutes. Top it off with high-quality balsamic vinegar (Kirkland brand, available at Costco and at a low cost, is a good one) and whatever else you like.

  Bone broth. This is magic for joints and fascia. From a butcher, get the bones (especially from grass-fed beef or free-range chickens), including all the cartilage and marrow. Place in a crock pot with water, celery, carrots, an onion, and salt. Let stew for twenty-four hours.