[Diabetes-Talk] Speech at Convention

[Gary Wunder]

This is a speech I gave on July 3 at the meeting of the DAN.

Heretic or Lunatic
By Gary Wunder

I come before you both as a diabetic and a man with an inquisitive mind. These shape my perspective on the perplexing controversies within the realm of science and nutrition. My purpose is not to prescribe a one-size-fits-all solution but to spark a dialogue, challenging us to evaluate established notions and consider differing perspectives. I chose the title "Heretic or Lunatic," not because I claim to be either, but because these are often the labels assigned to those who dare to question and investigate, and indeed, that is what I aim to do today and ask you to do tomorrow.

Our journey through the treacherous terrain of health and diet is fraught with contradictions. Eggs, once a breakfast staple, are now a contentious food item — good one day, bad the next. Milk, glorified as the builder of strong bodies, is now scrutinized for its appropriateness in adult meals, when it is clearly created for turning young calves into big fat cows. Bread, long revered as the staple of a good meal, has become the poster child for unhealthy processed food. And the debate rages on: Does eating fat make you fat? It sounds so right, but is it? Should balance be our guiding principle when we fix our plate? If it is, did you ever wonder how our ancestors, who supposedly ate so much better than we,  got that balance without trains, trucks, and refrigeration? 

These conflicts leave us in a quandary, wavering between fear and frustration, and often too paralyzed to make confident dietary decisions. As if this weren't bad enough, our experts do not always convey a consistent message for us to follow, and sometimes it just doesn't seem to work when they do and we do.

Let me share an unsettling anecdote. During my time working with a university, I came across a lecture advertised, ironically, about popular or "fad" diets. The presenter was a dietitian, and she agreed to record her lecture given that I was going to be away representing a very special organization you and I share. In addition to giving her my recorder, she asked if she might borrow the books she was going to lecture about. The ones I remember are The Atkins New Diet Revolution, Sugar Busters, The Zone, and a book about carbohydrate addiction. She admitted she had not read them herself. I was shocked, angered, and though I admired the kindness of this expert, her pedestal was not nearly as high as it had been before. She was prepared to criticize these theories and books without firsthand knowledge of their content. She already had her thesis, her rock, the knowledge she was so certain about that reading any criticism of it wasn't a priority and wasn't necessary in the formation of her already advertised presentation.

This is the manifestation of a broader problem within our scientific and healthcare communities—an unwavering adherence to established beliefs, this to the exclusion of fresh perspectives backed up by peer reviewed scientific studies. 

My doctor at the time of this lecture was an ardent advocate of the high carb, low-fat diet paradigm. I told her about my reading, but she was not impressed. She admired my sense of adventure, but rules were rules, even in a world she knew to be changing so fast she couldn't keep up with her journals. As we continue to uncover new scientific evidence, even the most entrenched conventional wisdom is liable to be challenged and found wanting. The one-size-fits-all approach to nutrition is becoming increasingly obsolete as we acknowledge the effect of our individual genetic makeup on our health.

The simplicity of certain age-old truths is being debunked. But inertia, momentum, and ego get in the way. Think for a moment about doing a study that makes you famous, getting something you have written in published in prestigious medical journals, writing a book that puts you on the New York Times best-seller list. Like many other people in business, religion, academia, and nutrition, think how hard it would be to give all that up and say that I was slightly off target, my study had flaws, we misinterpreted the results; shame on us: we found what we were looking for, rather than what was really there. We just never envisioned we could be so wrong.

So what are the age-old concepts being challenged, rightly or wrongly. "A calorie is a calorie, regardless of its source," they told us. "Body weight is a simple matter of calories in versus calories out," they insisted. "Never let yourself go hungry," they advised. However, these generalizations falter when confronted with reality: Why do starving people die fat, if you get fat by eating too much? Why do individuals following high-fat diets seldom suffer from early deaths due to heart disease?  What about the people who, because of their religion, participate in fasting? What about our ancestors who had no choice but to eat what they could get when they could get it, often going for long periods without anything except water? And perhaps, most importantly, why has our stubborn adherence to a high-carb, low-fat diet failed to deliver the expected health benefits that were promised, yet the eating advice still retains vocal advocates far more than you would think? 

I believe this demands a call to re-evaluate our traditional understandings and to explore what were once unthinkable propositions. I invite you to explore books such as "Good Calories, Bad Calories," Why we Get Fat and What to do about it and "The Big Fat Lie" by Gary Taubes, or The Big Fat Surprise by Nina Teicholz. Delve into The Case Against Sugar by the same Mr. Taubes, and consider whether, if there is a culprit in our dietary woes, sugar may be the villain. It has given the lower and middle classes what used to be known as the King's diseases because only the rich could get sugar in any significant quantity.

Knowledge is indeed power, and even though it sometimes confuses us, it pushes us to question, explore, and ultimately grow. It is a given among experts in any field that the more you know, the more you know you don't know. It sounds trite, but it demands courage, especially when certainty brings fame, the appearance of stability, and the illusion of strength. Our egos must give way to some level of uncertainty, and we uncomfortably conclude that live and learn is not a statement of the way it is; not a testament to knowledge through aging; instead it is a commitment we make to ourselves and to advancing our world.

Although the emphasis here has been on diet, let us not forget the value of exercise. Exercise helps us retain flexibility, reduces our age-related decline in balance, and helps us retain body mass. Many of us think we want to reduce our mass, but if body mass reduction comes at the price of muscle, we are losing rather than winning the contest in which we strive not only for longevity but for the quality those longer years should promise. Muscle is increased by exercise, and muscle burns calories at a much greater rate than body fat does. This goes well beyond the calories expended when doing the exercise itself. You will remember that in an address by Dr. Natalie Shaheen, she warned that we are "Sitting Ourselves to Death." Some people are too frail to exercise, but if you aren't one of those people, realize you can easily become one. The person who claims they have no time for exercise has a poor sense of time management, and the result is that they will likely have less time on earth, and less of it will be quality time because they did not give their body a substantial challenge most days of the week.

So my reaction when in the audience and listening to a presentation like this is to tell myself that I can do that. That was the reaction when my doctor told me I was prediabetic and could avoid becoming one if I did what she suggested "I can do that" was my confident response. But for me, "I can do that" misses the whole point. It is the wrong verb in the wrong sentence. What I really need to say and should have said then is that I will do that, that I promise myself to do that, and that I will make it important enough that it becomes a part of my daily behavior. Old behaviors are hard to eradicate, and new behaviors are hard to establish. Luckily the old ones are most likely to decline when replaced by the new, and the new is most likely to persist if replacing an existing behavior.

So I urge you not to cower in the face of conflicting information but to embrace the complexity of our bodies and the science that seeks to understand them. Challenge the status quo, question the known, realize that you too have a mind to bring to these issues, and, most importantly, explore what works for you. We are all genetically different, and our approach to nutrition and exercise should reflect this. Respecting science and those who are experts should remain part of our mindset, but so too should the knowledge that, with sufficient work and energy, we can develop some expertise of our own. For the Star Trek fans among us, "live long and prosper" should not just be the wish we extend to someone else; it should be one of the creeds we live by. It should be the promise we make to the person we know best and over whose life we have the most control. So live long and prosper.