Sugar Nation

by HEAB on August 22, 2011

Does Type 2 Diabetes run in your family? If not, I bet you at least know someone who has it. For me, it’s both, and that’s fairly common these days as one in three American adults has Type 2 diabetes or is prediabetic. Scary, huh? We’re eating too much and not moving enough. Sounds easy enough to fix, right? So, what’s the problem? Well, I read a book about it, and I’d like to share it with you.


In his book, Sugar Nation, Jeff O’Connell shares his own personal battle with diabetes, the very same disease that ultimately took his father’s life. Jeff, editor-in-chief at and former editor-in-chief at Muscle & Fitness and executive writer at Men’s Health, was told he was prediabetic in the fall of 2006. As a tall, lean, and physically fit young man, the diagnosis came as a surprise even though the symptoms had been present a while, and since then, Jeff has has discovered the importance of questioning conventional wisdom, especially when it comes to your health. In fact, by following some unconventional dietary advice and staying active, Jeff is beating the hereditary hand he was dealt.

After reading Sugar Nation, my mind was filled with questions, and Jeff kindly took the time to answer them. Following is our Q & A, and I believe it will give you a glimpse into what Jeff’s book is all about.

Heather: It shocks me that for the most part, today’s doctors do not 
promote a low carb lifestyle to combat theType 2 diabetes epidemic.
 In Sugar Nation, you mention the lack of long-term research regarding 
low-carb diets. Why do you think funding for low carb dietary
 projects has been so low since health care practitioners like Dr.
Elliott Proctor Joslin were using them to prevent the progression of 
diabetes almost a century ago?

Jeff: An assumption has persisted for half a century that low-fat diets are the healthy kind. That’s wrong, I believe, and particularly inappropriate for diabetics, but what’s happened is that every major diabetes clinical trial involving lifestyle changes—exercise, dietary change, and weight loss—has defaulted to a low-fat diet. Results from exercising and at least paying attention to diet inevitably surpass results from drug treatments or doing nothing, creating this false reinforcement of the wrong diet for diabetics.

I always found it maddening to attend diabetes conferences and listen to presentations on these clinical trials. I thought: Did you even debate or consider using a different dietary approach–especially the one, low carb, that seems inherently logical for those intolerant of carbs? I’m pretty sure the answer has always been no.

Much of the funding for diabetes research flows through the American Diabetes Association, an organization that seems particularly unwilling to question what I perceive to be a flawed paradigm for effective anti-diabetes diets. When I asked the ADA (the American Diabetes Association), they told me that of the approximately 4,000 research projects they’ve funded since 1970, about 26 have focused on carbohydrates. As I say in Sugar Nation, I’d be curious to know if slightly more than ½ half of 1 percent of the American Cancer Society’s research has focused on smoking cessation.

Heather: I have a hard time understanding why insurance companies refuse to
 pay for preventative medical treatments – like gym memberships, 
nutrition counseling, etc. when in the long run it would save them so 
much money. Do you think the prevalence of Type 2 diabetes will
 change this in the near future?

Jeff: It should, and I hope it will, although it hasn’t yet, so…. Diabetes develops over years, even decades, so there may be a sense that somebody else will be picking up the tab down the road. That’s penny-wise and pound-foolish, to be sure, but companies, especially public ones, measure their financial performance in quarterly increments.

I suspect this tendency to under-serve prevention also reflects the reality that the overwhelming power of lifestyle change isn’t fully understood or recognized by the ADA and other organizations. I’m sure this orientation influences the reimbursement practices and other decision-making of insurance companies.

Heather: Since no one can dispute the fact that physical activity can
 protect against Type 2 diabetes, why aren’t doctors and the ADA using
 exercise as their first line of defense?

Jeff: There isn’t a full appreciation for the power of exercise to beat back diabetes, and there’s an assumption that diabetics won’t exercise anyway. So instead of doing what’s called step therapy—giving lifestyle change, such as exercise, a chance to work before taking a more invasive approach with drugs—the ADA has, since 2006, recommended that metformin be introduced simultaneously with lifestyle change at the time of a diabetes diagnosis. The implicit message: You won’t exercise, and/or you need drugs.

Many doctors say they’ll remove the drug treatment if lifestyle change works, but if it does work, they often assume the drug is part of the solution, even if it may not be doing a damn thing. And so they don’t remove it. From success through failure, the place of drugs in the diabetic’s regimen is assured.

Heather: With your reactive hypoglycemia, you are able to keep your blood 
sugar at more optimal levels by eating small frequent meals. Would 
you recommend this way of eating for everyone or only for those 
individuals with blood sugar issues? I ask because I know fans of the
 Primal or Paleo lifestyle promote intermittent fasting to keep insulin
 levels low. From what I understand, the premise is that chronic food 
intake causes spikes in insulin and to avoid this, it’s better not to 
eat as often, but for someone like you, a calorie laden meal only once
 or twice a day could cause a huge spike in your insulin levels 
followed by a low blood sugar crash.

Jeff: I think my approach is good not only for those with reactive hypoglycemia but also for those who are overweight, which is a pretty broad swath of the population. For those who are normal weight and have healthy glucose metabolism, I’d be loath to recommend that they do anything differently, since they’re healthy.

Remember, too, that while I’m eating frequently, I’m eating few carbs, and complex ones at that. So my hunch is that my insulin levels are chronically low despite these frequent small feedings. And if my insulin levels do rise in response to small, protein/fat-based meals, the rise is incremental rather than extraordinary. The research suggests that the latter is what causes arterial damage and other harmful consequences.

Heather: I often receive emails from girls who have been diagnosed with
 Polycystic Ovary Syndrome, and I feel like it’s become a blanket 
diagnosis for doctors who cannot figure out why so many young women 
are suffering from amenorrhea and infertility issues. In Sugar
 Nation, you state that PCOS may offer clues to reactive hypoglycemia’s
 prevalence. Do you believe a high percentage of these women are
 simply pre-diabetic and might be able to reverse some of their PCOS 
symptoms with changes in diet and more physical activity?

Jeff: I think that’s very plausible. Those health practitioners I interviewed who seemed tuned in to insulin resistance and its effects almost all viewed PCOS at least in part as another manifestation of insulin resistance or hyperinsulinemia. The assumption might be that strategies I use to deal effectively with reactive hypoglycemia could help women with their PCOS. Certainly seems like it would be worth a try if other approaches have failed.

Heather: According to Sugar Nation, you say that Type 2 Diabetes is on the
 rise because of 2 factors: decline in physical activity over the past 
century and an increase in the consumption of calories, particularly
 carbs. The lack of physical activity is obvious. We drive
 everywhere, we sit in front of computers, all day, etc. However, I’ve 
read different hypothesis regarding carb consumption. On my blog, I 
promote a low-sugar/whole foods approach to eating, but not 
necessarily low-carb. What about people with a healthy metabolism 
and normal insulin activity? How would you recommend they eat? Do
 you think everyone should keep carb intake to a minimum?

Jeff: I alluded to this before, but I would never suggest dietary changes to anyone with a healthy metabolism and normal insulin action. That would seem foolish and presumptuous. I do think that consuming a bunch of junk food and a ton of added sugars is almost always a bad idea, and that if you do that for long enough, that healthy glucose metabolism might turn on you. Otherwise, the dietary strategies outlined in my book are for those with insulin resistance and impaired glucose tolerance or at a high risk of developing them (e.g., those having family members with type-2 diabetes).

Heather: As I type this, I’m watching my 9-month old crawl around on the 
floor. I don’t want to be the parent banning birthday cake or pizza
 night and would prefer a more balanced approached to raising my 
daughter. What would be your advice to parents today regarding 
dietary choices for their kids, in an age where junk food is so 
readily available?

Jeff: I have no children, let alone kids clamoring to go to McDonald’s, so I’m not sure how much real-world cred I have on this subject. But it seems to me that you might compete with junk food by offering healthier alternatives that also taste great and have appealing textures. Edamame, for example, is like healthy popcorn, full of protein, fiber, and phytochemicals. Celery is boring alone but yummy when holding all-natural peanut butter or tuna fish. Those sorts of healthy snacks might keep kids from becoming ravenously hungry and overindulging in junk as well.

Sugar Nation definitely put things in perspective for me when it comes to sugar intake and activity level. Thankfully, I love being active, fitting in walks whenever I can and practicing yoga, and I’ve been anti-sugar ever since I lost weight. Yes, I do enjoy sugar on occasion, but I feel so much better when I avoid it. Plus, sugar and excess insulin in the body are my family’s enemies. We could all benefit from learning how to control our blood sugar, especially those of you that have family members with Type-2 diabetes, or if you have insulin sensitivity issues of your own. Let’s think positive about beating diabetes. Just like Jeff says, beating back diabetes isn’t about deprivation; it’s about enrichment. In truth, you’re asked to give up nothing that matters in life. So true Jeff. Thanks for sharing your story and wisdom with us and for for inspiring this morning’s breakfast…


Jeff’s Cinnamon Frambled Eggs (1/2 fried, 1/2 scrambled)

For the recipe, you’ll have to read the book OR for a chance to win a copy, simply leave a comment below telling me your favorite sugar-free snack. Mine? Baker’s unsweetened chocolate or a spoonful of nut butter. :)

Edited to Add: The giveaway is over, and the winner is Courtney.  Courtney, I will email you for your address. Thanks to all of those who entered, and if you’d like to order a copy of Sugar Nation, I’ve added it to my Amazon Store.

Disclaimer: Although I did receive a free PDF copy of Sugar Nation, I was in no way reimbursed financially for this review.