So that evening I had five enemas to try to clean out my system. I had never had one before. It was embarrassing. I felt completely humiliated, but at the same time, I was willing to do whatever it took to get me back home.
They put me on a liquid diet. I spent two, almost three weeks keeping myself alive with soup broth and Ensure shakes that old people drink. That was all I could handle. I couldn’t eat real food. That would hurt too much. I remembered when I used to do marketing for the hospital, and I interviewed a cancer patient one time who had throat cancer and couldn’t eat solid food. His wife said she had researched how many Ensure shakes he would need to drink each day in order to have enough calories and nutrients to stay alive, and that is what she did. This guy survived for a year drinking Ensure shakes. I thought to myself, no big deal. I can drink Ensure shakes and keep myself alive.
I went to a gastroenterologist and had more tests that basically said the same thing. They thought for sure that I had Crohn’s disease, and the entire conversation centered on verifying that I had Crohn’s disease. They did a colonoscopy of my lower intestine and bowel, and they found no evidence of Crohn’s. There were no lesions. There was no scarring. Nothing. All they found was severe inflammation, which they said was not an issue.
My dad drove me to the appointment, and as I was coming out of the anesthesia, the doctor came in and said, “Good news. You don’t have Crohn’s disease,” as if he had saved the day. At this point, I think I’d been almost two months on the Ensure shakes and eating lots of smoothies and soft foods like mashed potatoes, noodles, and rice. My dad said to this man, “She still can’t eat real food.” The doctor said, “Well, if that works, okay for her. She should just keep doing that.” My dad said, “No, I don’t think you understand. She can’t handle eating regular food; it hurts.” He said, “Well, if she can eat the potatoes, then she can just eat the potatoes.” Then he walked out of the room.
I remember one morning, I woke up, and I was shaking because I needed to eat. I grabbed some leftover cooked chicken out of the Tupperware in the fridge. I sat on that kitchen floor because that was as far as I could get, and my daughter sat next to me. That was our breakfast. We shared a piece of chicken that we ate with our fingers out of the Tupperware dish. I sat there until it digested a little bit, and I stopped shaking, and I thought, this is ridiculous. I can’t even get her a proper breakfast, let alone make myself anything. What is wrong with me?
I don’t know what the turning point was. Maybe it was lying on the couch for two weeks and not being able to eat normal food, and drinking soup broth, and not being able to take care of my daughter. I finally decided: I am not ninety-five. These are things that happen to someone who is at the end of her life. What is happening to me? Am I slowly dying off? I remember, growing up on the farm, we had a pony. His name was Peanut, and he was getting old. Ponies live longer than horses. If they live to be thirty, they have lived a good life. This one was thirty-six, and he was starting to get sick. I remember the vet came over. The pony had one problem here, another problem there. Things were just one on top of the other. The vet said, “Well, he is old, and his systems were structured to shut down. That is what happens when you get old.”
I thought, my systems are starting to shut down.
Mary Beth Stutzman’s systems were not shutting down. Something more fundamental was in play, a disease of civilization that each of us suffers from in one way or another. What ailed her was a specific condition brought on by the way we eat and live. But knowing some basics helps us understand how she got better (she did get better—dramatically better) and what this story means for each of us. We’ll come back to her story soon enough.
CARBS TO SUGAR
The diseases that ail us, that list of burdens on our health and the leading causes of premature death and debilitation worldwide, can appear like a tangle of threads suggesting complexity. But if one simply recalls two fundamental and crucial facts—that these are diseases of civilization and that civilization is by definition the domestication and resulting dependence on grain agriculture—then the tangle is really a Gordian knot, ready to be cut with one big satisfying whack of the sword. There is actually a better name for the Gordian knot, and it is metabolic syndrome. This is medicine’s name for a series of problems that run together like type 2 diabetes, heart disease, and obesity, all related to the metabolism of sugar.
If one reads the succession of diet books, one might come away with the incorrect impression that much of this problem remains unsettled. There are a couple of reasons for this confusion. First, over the course of researching evolutionary nutrition, science’s ideas and assumptions about what our ancestors actually ate, the diet that made them so healthy, have changed, and some of that change is interesting. We have always looked to the past with a set of cultural blinders that allowed us to see what we wanted to see. This is unavoidable and only partially correctable, over time, by doing more science: picking through bones, sorting DNA and arrowheads. But the thing is, we will never know for sure; there will be blanks, and our cultural preconceptions, prejudices, and imaginations will fill in those blanks.
But there is a more unsettling factor in much of the disagreement and confusion. The dirty little secret of the whole business is that diet books sell well, and so it is often in the best interests of authors to argue that their prescription is very different—new and improved, to borrow a phrase from marketers—from preceding prescriptions. Interests of commerce dictate an emphasis on differences and disagreements. We think a better approach here is to cut back to fundamentals and begin on the common ground, and the common ground is the indisputable fact that for millions of years, our ancestors thrived on a diet that did not include dense packages of carbohydrates. They had a low-carb diet for the very simple reason (and also indisputable fact) that dense packages of carbohydrates for the most part did not exist. When you consider that these very same foods constitute something like 80 percent of all human nutrition today, you get some idea of the significance of this revolution. This is the correlation that counts: high consumption of carbohydrates with high incidence of disease related to carbohydrates. But we have more than a coincidence here. We can explain the mechanism by which it works.
The world of carbohydrates subdivides pretty endlessly, but the first cut is two classifications: complex and simple carbohydrates. The complex carbohydrates are more intricate molecules better known as starches, and this is the stuff of our main agricultural crops: corn, rice, wheat, and all grains, as well as potatoes. Fruits and vegetables do indeed contain carbohydrates, but in far smaller amounts, meaning they’re far less concentrated. Starch from grains and potatoes is to spinach what a glass of 180 proof rum is to beer—and that’s more than an analogy, because the same substance is in play. Alcohol comes from fermented, broken-down carbohydrates.
So where does sugar figure in? Simple. Sugars are the simple carbohydrates. You eat both complex and simple carbohydrates, but your digestion breaks both complex and simple into simple and simpler. The process of digestion of carbohydrates is a disassembly of the larger, complex molecules of starches to yield sugars, and this elemental and straightforward process begins in your mouth. So simple is the process that some starches are rendered into sugars through chewing and saliva even before they hit your throat. The result is a long list of sugars, but these in turn reduce to two in the main: glucose and fructose. For instance, table sugar or cane sugar, known as sucrose, is really about half glucose and half fructose, the latter so named because it is the dominant sugar in fruits. (And it’s present in most fruits in laughably small amounts, compared with the sugar in, say, a glass of Coke, or even apple juice. That’s the issue.)
The dominant industrial food process of our day is, in fact, simply a replication of this reduction, breaking down the starches of corn into sugars as high-fructose corn syrup. And even high-fructose corn syrup is, like sucrose, a combination of glucose and fructose: it’s about 55 percent fructose, which is wh
at the manufacturers mean by “high.” Next time you hear an argument that somehow cane sugar is better than high-fructose corn syrup, bear in mind you are arguing about 50 percent versus 55 percent fructose.
But like one big, long funnel, this whole process, both natural digestion and factory manufacture, aims at a single point, which is glucose. Glucose is a fuel, the dominant fuel of our muscles and especially our brain, especially in today’s sugar-saturated world. The glucose you eat as glucose goes straightaway to the bloodstream and, in theory, at least, goes to work. Fructose goes to your digestive system, and a couple of hours later, enzymes have converted it into glucose and sent it to your bloodstream.
But here is the dark little secret in all of this, and it sounds very odd to say it: glucose is toxic. It is poison, and the body regards it just that way. We have spent generations now in a search for toxins that sponsor the diseases that ail us, the industrial chemicals, pesticides, and pollutants that may kill us, and yes, these may be killing us. But the supreme irony in all of this is that the obvious toxin hides in plain sight. It’s difficult to accuse the very substance on which all of civilization depends. People who consider these matters often refer to the “omnivore’s dilemma,” but it gets more and more difficult to claim to be omnivores, creatures that eat both plants and animals. The prima facie case is we have become carbovores as a result of our domestication by grain. This is the carbovore’s dilemma: we exist for the most part on a substance that our bloodstream treats as a toxin.
Now wait a minute. Carbohydrates in food are nothing new, and hunter-gatherers ate them all along, even fairly dense packages as one might find in the tubers that were the precursors of domestic potatoes or in the wild grass seeds that were precursors of grain. Further, haven’t we argued that the hallmark of the species is our adaptability, our nimbleness, our bodies’ ability to adjust to novel conditions and balance its systems through homeostasis? So what if we are eating more concentrated forms of carbohydrates? That hardly qualifies as turning what was a basic food group for millions of years—and not just for humans but for the whole animal kingdom—into something we call toxic. Why don’t our bodies simply adjust and head right back for homeostasis? The answer is, our bodies do.
Glucose is a very specific toxin, toxic in large doses in the bloodstream. This is precisely why the more extreme carbovores among us make a big deal about blood sugar level, the highs and lows that come with the balancing act—because it is a balancing act. And our bodies are highly adapted to execute this balancing act with a series of reactions all regulated by the hormone insulin. When glucose arrives in the bloodstream, it immediately and reliably (in everyone but those with type 1 diabetes) triggers the pancreas to secrete insulin, which sends a series of signals through the body, all with the central purpose of removing glucose from our bloodstream. Fast. Insulin oversees the body’s response to toxicity. Glucose is a three-alarm fire that demands immediate reaction, which is why your brain pays so much attention to it—the blood sugar rush.
The body has basically two choices for getting glucose out of the bloodstream. The first and best answer is to send it off to muscles and organs, where it converts into a derivative called glycogen, a readily burnable fuel for our muscles. The catch is, the body has a very limited capacity for storing glycogen in muscle fibers—maybe enough energy to keep a marathon runner going for an hour or so, the quantity of glycogen from a few ounces of sugar. Further, unless you are a marathon runner, the majority of this storage space in muscles is already pretty full most of the time. So the body deals by going straight for plan B, which is to convert the glucose into fat and store it in ever broader bands around the stomach, butt, and thighs, depending on gender. (Gender determines which other hormones are present and where they are in the body to interact with insulin and guide the process of storing fat.)
There’s a side chain to this process of fat conversion, again related to the fact that the body considers glucose to be toxic in the bloodstream and so makes its removal a priority. It is this: muscles burn glycogen to do work, but they are also capable of burning fat in parallel, both what we eat and what is stored. No need to convert back into glucose; fat itself burns very well to fuel muscles. We are told over and over again, especially in the world of athletics, that carbohydrates are your fuel. But the fine print, even in mainstream advice on this issue, reveals that fat is your fuel, too. And for endurance athletes especially, but even in day-to-day movement, fat is the most important fuel, or it is unless you have a surplus of glucose from eating too many carbohydrates. Back to insulin: remember, it is a hormone and so sends a variety of signals designed to remove glucose from your bloodstream. One of the strongest and clearest of those messages is to tell your body to stop burning fat and burn glucose instead as a priority. Coincident to this is a signal to stop moving fat from storage. The priority is to remove the glucose from the bloodstream.
None of this is a real problem, as long as one eats carbohydrates at levels at which we were evolved to eat them—that is, few and mixed with a variety of foods. This is our adaptability: the system is designed to return our bodies to homeostasis, a built-in regulator that makes glucose useful and keeps it out of the bloodstream at toxic levels. The problem arises when we overwhelm that system, when we deliver far more glucose and deliver it far more directly than our bodies were designed for.
Mode of delivery is as relevant as quantity. Remember that through most of human evolution, the majority of our carbohydrates came as the complex variety embedded in a matrix of fiber, which is to say foods. The digestion of this food took time, and so our bodies metered out the glucose in dribs and drabs through the course of a day. Now, though, we deliver many of our carbohydrates in the simple form, much of it as glucose, and sometimes not even in food at all but dissolved in water, a practice that completely bypasses the leveling effect of the digestive system. Sugar dissolved in water is the worst-case scenario, which is why soft drinks are so insidious and loom so large in the problem of childhood obesity around the world. But this is equally true of more socially accepted forms of dissolved sugar, such as fruit juices. That all-organic, all-natural fizzy fruit drink from the health-food store (no high-fructose corn syrup, only natural cane sugar) is every bit as damaging as a Coke, at least with respect to glucose. If you come away from this book with one rule and one rule only, it is this: don’t drink sugar water. In any form. Not a Big Gulp Coke. Not a Knudsen’s 100 percent natural and organic fruit juice.
But even in food and even in the form of complex carbohydrates such as the bagel you picked up this morning at Starbucks, the effect is only slightly less corrosive and sets you up for the crash, which is a condition called insulin resistance. It means that like those who repeatedly heard the boy who cried wolf, your body slowly becomes calloused to the constant ringing of the three-bell alarm of insulin. Your signals become crossed and this sends you eventually into the full-on crisis that is metabolic syndrome. This is the Gordian knot, the cluster of nasty little maladies that run together: obesity, heart disease, high blood pressure, type 2 diabetes, and stroke—and, less directly, cancer. Each of these is rooted in metabolic syndrome. This is the core of the emerging argument that sugar is toxic and sugar is responsible for what ails us. Carbs are responsible, too, because—as we’ve just shown—carbohydrates reduce to sugar.
The argument remains controversial, especially among nutritionists, or at least in the public pronouncements of nutritionists, and there is an issue embedded here that has more to do with the sociology of science than with the science itself. We have heard nutritionists acknowledge in private that fat is not the problem but turn around in public and say it is, simply because they are reluctant to abandon a fifty-year-old message. Doing so, they say, might confuse the public. The result, though, is a mixed set of messages, made even more mixed by the big-money politics of food and sugar and industrial agriculture—some of which is sinister, and some of which is simply wound up in bureaucratic inertia and human
nature. The problem is, we have been told for a couple of generations that we are fat because we eat too much fat, and that’s a much more direct argument and easier sell than saying—as we have here—that we are fat because we eat too much sugar and complex carbohydrates. Some of us do indeed eat too much fat, and we’ll get to that in a moment, but first let’s challenge the fat-o-phobes straight on. Fat is good for you, and we ought to stop saying otherwise.
THE RISE OF FAT-O-PHOBIA
The history of blaming fat for the cluster of diseases around metabolic syndrome, it turns out, is short and focused. Science has been thinking about obesity for at least a couple of centuries, but for only about fifty years have the arguments focused on fat. We can blame Ancel Keys and Dwight Eisenhower for this. Keys was a researcher at the University of Minnesota who was first known for a series of intriguing studies during World War II on the effects of starvation. He used conscientious objectors as the volunteers in his experiments and demonstrated that the psychological effects of starvation were extreme and included lifelong psychological debilitation, even after full nutrition returned. But he was better known for focusing on fat in general and cholesterol in particular. Keys is the reason most of us now know our cholesterol numbers.
Eisenhower’s contribution to all of this was the heart attack he had while still serving as president, which greatly drew national attention to what was then, as now, a widespread health problem. And true enough, Eisenhower had by then given up his four-pack-a-day Camel habit, but he also had a high cholesterol number at about the time Keys, a messianic character, was trumpeting the evils of cholesterol to public health officials.
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