The Diabetes Epidemic

The CDC just released its latest estimate of diabetes prevalence in the US (1):

Diabetes affects 8.3 percent of Americans of all ages, and 11.3 percent of adults aged 20 and older, according to the National Diabetes Fact Sheet for 2011. About 27 percent of those with diabetes—7 million Americans—do not know they have the disease. Prediabetes affects 35 percent of adults aged 20 and older.

Wow-- this is a massive problem. The prevalence of diabetes has been increasing over time, due to more people developing the disorder, improvements in diabetes care leading to longer survival time, and changes in the way diabetes is diagnosed. Here's a graph I put together based on CDC data, showing the trend of diabetes prevalence (percent) from 1980 to 2008 in different age categories (2):

These data are self-reported, and do not correct for differences in diagnosis methods, so they should be viewed with caution-- but they still serve to illustrate the trend. There was an increase in diabetes incidence that began in the early 1990s. More than 90 percent of cases are type 2 diabetics. Disturbingly, the trend does not show any signs of slowing.

The diabetes epidemic has followed on the heels of the obesity epidemic with 10-20 years of lag time. Excess body fat is the number one risk factor for diabetes*. As far as I can tell, type 2 diabetes is caused by insulin resistance, which is probably due to energy intake exceeding energy needs (overnutrition), causing a state of cellular insulin resistance as a defense mechanism to protect against the damaging effects of too much glucose and fatty acids (3). In addition, type 2 diabetes requires a predisposition that prevents the pancreatic beta cells from keeping up with the greatly increased insulin needs of an insulin resistant person**. Both factors are required, and not all insulin resistant people will develop diabetes as some people's beta cells are able to compensate by hypersecreting insulin.

Why does energy intake exceed energy needs in modern America and in most affluent countries? Why has the typical person's calorie intake increased by 250 calories per day since 1970 (4)? I believe it's because the fat mass "setpoint" has been increased, typically but not always by industrial food. I've been developing some new thoughts on this lately, and potentially new solutions, which I'll reveal when they're ready.


* In other words, it's the best predictor of future diabetes risk.

** Most of the common gene variants (of known function) linked with type 2 diabetes are thought to impact beta cell function (5).

Two Wheat Challenge Ideas from Commenters

Some people have remarked that the blinded challenge method I posted is cumbersome.

Reader "Me" suggested:

You can buy wheat gluten in a grocery store. Why not simply have your friend add some wheat gluten to your normal protein shake.

Reader David suggested:

They sell empty gelatin capsules with carob content to opacify them. Why not fill a few capsules with whole wheat flour, and then a whole bunch with rice starch or other placebo. For two weeks take a set of, say, three capsules every day, with the set of wheat capsules in line to be taken on a random day selected by your friend. This would further reduce the chances that you would see through the blind, and it prevent the risk of not being able to choke the "smoothie" down. It would also keep it to wheat and nothing but wheat (except for the placebo starch).

The reason I chose the method in the last post is that it directly tests wheat in a form that a person would be likely to eat: bread. The limitation of the gluten shake method is that it would miss a sensitivity to components in wheat other than gluten. The limitation of the pill method is that raw flour is difficult to digest, so it would be difficult to extrapolate a sensitivity to cooked flour foods. You might be able to get around that by filling the pills with powdered bread crumbs. Those are two alternative ideas to consider if the one I posted seems too involved.

Ermmm... just stuff

Lost a little bit more. Very peculiar. Weighed in yesterday at 119kgs, so that's pretty good.

Found that this week it's not been that hard to cook every day and leave all the shite out of my diet. If I am basically happy and not too tired I can manage to cook every day, get inspiration to cook and also, most importantly, not snack/end up puking.

Relaxing when I eat has had a big job to play into being ABLE to eat and essentially my emotional well being.

Contrary to practically every other bandster on earth, I seem to do better when I have my dinner on a plate, late at night, in front of the telly, take 3 hours to eat it and drink whilst doing it.

Yep. this is TOTALLY the 'wrong' way to do it apparently but its been brilliant. I think I have found that this is actually the right way for me.

Every day this week I have had soup for late breakfast and lunch then in the evening made dinner with the family. I give myself a plate of dinner too and sit down with them with it in front of me. I have eaten about 3 mouthfuls by the time they have all finished, so I just shove it in the microwave and then wash up, tidy up, get DS to bed, get a big pot of green tea on the brew and prepare myself.

I put a dining chair next to the sofa, put the pot of green tea on it, a cup and my dinner. Then I switch to my favorite programme with DH and we sit and veg. I slowly enjoy my meal, enjoy my tea, and then its time for bed.

This is absolutely freaking PERFECT for me.

It totally cures the "nibble at nightime" thing I used to have going on.
It totally cures the "I can't eat/ *retch*" situation if I try and eat with the family
It totally cures the "they have nice things to eat and I am deprived" emotional turmoil in my head
It makes me relax, take things slow, wind down, spend quality time with DH(ok that can be debated as it is just TV) and also end the day contented and satiated with a minimal amount of calories.

When I was trying to eat my protein first, trying to eat three meals a day etc... it just didn't work and I would puke and then feel shit and then eat a slider/chocolate that made me feel happy, full but also fatter.

I have never felt that sweet spot in all the 4 years I have had the band, but I think I've wasted a lot of time looking and to be honest I know I have good restriction. I don't feel hungry. Period. If I ate a bite of bread straight off I would vomit. If I eat too quick/don't chew things to death, I have to either:
1.) Stop and wait
2.) continue above + real deep slow breathing for a minute or two (give a slight buzz!! LOL)
or 3.) Puke

I have been scared as a rabbit in the headlights about breaking my band. After it buggered the first time, I have been paranoia central worried about slips and breakage and port rupture etc. I have been so prissy with this thing but using it wrong all at the same time.

If anything it's only this last few weeks since we came back from holiday that I have felt normal. I kind of feel it's OK to be banded. It feels settled, not jerky or sore and I am not scared to eat like I was before in case something got stuck etc. Maybe the easy approach where I just get the fuck on with it is actually the best approach for me.

We shall see.

When we came back from  holiday I wanted to get a new bracelet. I had one that my dad found in the street. It was pearls and silver plated beads on elastic and it was really nice. The elastic was getting frayed after a few weeks so I asked for it to be put on wire. It came back from our jeweller on nylon with "this is just as strong" on the bag.

So I wore it, but I really wanted it on silver wire just because it would look better. Anyway after about 3 weeks the bracelet pinged off my arm and showered the car in beads! The little round silver plated beads were very very sharp at the centre as they were made from thin copper and had basically cut through the nylon!

So I gathered up as many as I could and sent them back with a note saying "Obviously not! Put it on WIRE!" on  the bag. 6 Weeks later I got it back on some metal wire, which made the whole thing smell like iron or hot pennies and the pattern was wack and some of the beads were even back to front. I think our dog would have made a better pattern match to be honest!

Anyway, although it wasn't the same, I wore it and it was OK I guess, but the ring like clasp they had put on it originally just kept catching on my clothes and whilst we were on holiday it pulled again and the ring clasp pulled all out of shape like a bent paper clip.

I was so disappointed. I had worn it for about 8 weeks out of the 6 months I had had it because of the time it had taken to get it mended (i.e.being for me and not a 'real' customer) so I just took it off and threw it in the wash bag. I said to DH that when we got back I would make a new one from his Pandora style bead supplier Chrysalis.

So I found all my beads and spacers that I wanted:

And they all of together to make this:

The double chin was of course optional!!

I know it's not a typical Pandora style design that I have chosen but its very close to the original bracelet that my dad found only solid silver and larger. I love all those colourful pretty beads but they just don't look right on me. I nearly had one when we first got the Chrysalis in stock, but it just looked wrong. I also don't like the fact that when you have a few beads on they fall to the bottom of your wrist so you can't really see it. I like them all completely filled up with beads so I can enjoy it too not just the table top!

So I am absolutely thrilled with it. They must have thought we were mental when I said I wanted 9 pearl beads, 7 barrel spacers, 16 Swarovsky Chrystal spacers and a just 1 locket charm!

It's so great having our own shop cos there is NO WAY on this earth I would spend £450 on this bracelet. It cost me £125 trade which I did feel a bit sick at but then it is solid silver and pearl. it will last forever unlike the one my dad found on the street by the playing fields at the back of his house.

The old one was so lovely too, but no one claimed it. It wouldn't have cost that much but it was really nice. they took it to the police and put a card in the shop window but no one claimed it after 3 months so it was theirs. I loved it to bits, literally!! I will keep hold of it as I cant bear to just chuck it, and maybe one day if DS has a little girl she can have it to play dress up with me!

Veggie Guacamole

(makes 3½ cups)

Ingredients:

• 2 ripe avocados, peeled and pitted
  
  


• Juice of 1 lemon
  
  


• 1 large tomato, seeded and diced
  
  


• 1 cup canned black beans, drained
  
  


• ½ tsp minced garlic
  
  


• 1 tbsp green onion, chopped
  
  


• 1 cup cooked corn (canned, fresh, or frozen)
  
  


• 1 tsp jalapeño peppers, chopped (optional)
  
  

Preparation:

• Mash avocados in a bowl. Add lemon juice and salt, then mix in the remaining ingredients.
  
  

Make 14 Servings:

Weight loss recipes Amount Per Serving (1/4 cup (70 g)): 77 Calories, 2 g Protein, 8 g carbohydrates, 3 g Dietary Fiber, 5 g fat, 1 g saturated fat, 8 mg cholesterol, 34 mg sodium

26/365 - Easy Lunch Idea

Sometimes I get so intensely focused on what I'm doing I forget to eat. No, it doesn't happen often, but occasionally, it does. For instance, yesterday was the last day of my kids' semester.  My middle school aged son had a few things due that weren't done and we were cramming to finish. It was two o'clock and I noticed my stomach felt off.

I searched the refrigerator, no left overs were found. The cupboards didn't have anything either. (At this point in my search, I realized I needed to go shopping) So I went to the pantry.  You can always find something in the pantry. I saw a can of soup and grabbed it. 

This soup is my go to lunch when I don't have much time but need to be filled. It's certainly not a pretty soup, it's actually quite ugly.  But shredded cheese and a dollop of sour cream can change that. 

Here is a link to a tasty line of soups: http://www.amys.com/ 

555

Tonight I watched the new A&E show, Heavy. Most of the reviews I've read by other bloggers weren't very positive, but I liked it. I wouldn't call it entertainment because it was difficult to watch. It wasn't really educational either because I already know how to lose weight. Yet I was compelled to watch it.

There was a woman that weighed 278 pounds and a man that weighed 555 pounds. I identified with the man because of his weight. I'm positive I have the propensity to weigh 555 pounds. My husband, friends and relatives all tell me I'm crazy to say I could weigh over 500 pounds. They really don't know me. They can't grasp how I view food. They don't understand the ongoing battle in my head about eating.

This is a conversation I had last night with my husband, Jack.

Me:  Do you ever eat just because you're bored or lonely or sad, but not really hungry?
Jack:  No. I eat when I'm hungry. Why would I eat if I wasn't hungry?
Me:  To make yourself feel better?
Jack:  How would eating food when I'm not hungry make me feel better?
Me:  I don't know. I was just wondering if you've ever done that before.
Jack:  No. Never.

No one really knows me when it comes to food. Not even the man I've been married to for almost 23 years. Most people in my life don't understand that I often eat when I'm not hungry. It just doesn't make sense to the normal person. I use it as a way to deal with stress and unpleasantness in my life. If I actually ate when I wanted, I would most likely be eating non-stop. It's a scary thought that I could very easily lose control with food.

I just have to take this a day at a time and continue the fight. 555 is a scary number and it's one I hope I never see.

Tortilla Pinwheels

(makes 4 servings)

Ingredients:

• 4 whole wheat tortillas, 8” size
  
  


• ¼ cup light cream cheese or Neufchatel
  
  


• 12 slices turkey ham, sliced, fat-free
  
  


• 1 cup spinach, torn, fresh
  
  


• ½ cup grated carrots
  
  

Preparation:

• Let the cream cheese come to room temperature. Whip with a mixer, or by hand, to make it easier to spread.
  
  


• Spread about 1 tbsp cream cheese onto the tortilla, making sure to reach the edges.
  
  


• Place 3 slices of turkey ham onto tortilla.
  
  


• Put several spinach in the center of the tortilla and sprinkle with 2 tbsp of carrots.
  
  


• Roll tortilla tightly; secure with a toothpick.
  
  


• Cut the tortilla into pinwheels by cutting it in half first, then making bite-sized slices along the tortilla until you reach the end. Lay each piece cut-side down on a serving plate. Serve at once, or refrigerate, covered, until ready to serve.
  
  

Tip:

• Choose colorful vegetables such as avocado red, cucumber, or red peppers, in your pinwheel.
  
  


• Make a fruit pinwheel using peanut butter or jam as the spread, then top with thin banana slices and other soft fruit like strawberries, peaches, plums, nectarines or plums.
  
  

Make 12 Servings:

Weight loss recipes Amount Per Serving (1 pinwheel (174 g)): 285 Calories, 21 g Protein, 32 g carbohydrates, 3 g Dietary Fiber, 7 g fat, 3 g saturated fat, 34 mg cholesterol, 1223 mg sodium