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This week celebrity chef Paula Deen announced that she has had Type II diabetes for the past 3 years. Ms. Deen is noted for her "comfort food" recipes that are rich in butter and sugar and are consequently high in calories. Many have chided the 65-year old cook promoting an unhealthy diet... but is this fair? Diabetes is a multi-factorial disease with diet as one component and Ms. Deen promotes homemade foods rather than the convenience or preservative laden entrees so detested by health conscious foodies. So is the problem really with her food choices or is it with something else?
A lot has been said about the modern American's dietary habits: too many calories, too many convenience foods, too many preservatives. It's true that the Western diet is loaded with calorie-rich choices but is this anything new? The 1950s American diet regularly consisted of comfort foods like casseroles, mac and cheese and dessert; however these dishes were usually made at home from "natural" ingredients like butter, milk, sugar and flour. Despite consuming more sugar and fat children and adults of the ‘50s were not as overweight..why? Diets back then focused on portion sizes; dinner plates were 2 inches smaller than they are today and so they consumed fewer calories. Meals were made from scratch and cooked using conventional methods with convenience junk food not yet in existence. Not to mention the fact that physical activity was higher then..no video games, computers or cable TV. The typical mid-century adult walked more and did their own calorie-burning yard and house work. The 1950s weren't perfect...people had a lower life expectancy and half of all deaths in that decade were due to heart disease. Despite today's modern medicine, heart disease still remains the number one cause of death, nevertheless people with cardiovascular disease live longer today thanks to medical advances and lifestyle changes.
Getting back to Paula Deen. Her comfort dishes are made from scratch using real ingredients and requiring some "home cooking." Meals made at home encourage family dining which in turn helps reduce overweight and obesity in children ("family mealtime). These are positive aspects. However, the trouble may come with portion sizes. Large, calorically dense portions can pack on the pounds especially in older adults who have slower metabolic rates. Those individuals at risk for developing diabetes need to focus on portion sizes, frequency of consumption and physical activity. It's interesting that no one has really addressed the other factors that lead to diabetes like physical activity. Moreover, pundits have suggested that the food itself caused Ms. Deen's diabetes. This is a common myth... Eating sugary foods per se does not "cause" diabetes, however, eating sugary, high calorie foods in excess coupled with sedentary lifestyle and weight gain are contributors to diabetes because people become obese. Obesity is the number one risk factor for developing type II diabetes.
Some Facts About Diabetes:
There is no doubt that the incidence of diabetes in the United States has skyrocketed in recent years. Type II Diabetes, also known as "insulin resistant" or "non insulin dependent" or "adult onset" diabetes accounts for 90-95% of all diagnosed cases of diabetes
When the Deen headline was splashed all over the newswire, the comments and tweets flooded in. Common remarks were "She makes food that makes you sick!" or "Her foods cause diabetes." Time to set the record straight about diabetes and it's causes:
•Obesity, age, gender, genetics, ethnicity and lack of physical activity are all risk factors for developing type II diabetes. Older adults are at risk for developing insulin resistance, as are women with a history of cigarette smoking and women who experienced gestational diabetes. Use of cholesterol lowering statin drugs may raise diabetes risk in older women, too. However, obesity by far is the greatest risk factor. Genetic predispostion is also a strong risk factor.
•Diabetes is associated with is NOT CAUSED by particular foods. Eating high fat, high sugar foods does not cause diabetes, but can cause obesity which is the number 1 risk factor for developing diabetes and/or insulin resistance.
•High sugar foods CAN exacerbate diabetes in persons who are diabetic. Diabetic individuals need to limit their portion sizes of certain foods in order to control blood sugar levels.
•Smaller, high-quality meals are required to maintain stable blood sugar levels. Regularly scheduled meals, eaten at the home dinner table may lessen snacking and weight gain.
•Weight loss can reverse Type II (non insulin dependent diabetes) in some cases.
•Diet and exercise should be tried before instituting drug therapy. Physical activity, not just diet, is a key component to diminishing Type II diabetes risk and managing the disease.
•Drugs used to lower blood glucose in Type II diabetes do not "cure" it; diet and exercise are still required for proper diabetes management.
According to the Diabetes Prevention Program (DPP), the most effective way to reduce the development of type II diabetes is weight loss and increased physical activity. The drug metaformin may be effective in reducing risk in younger adults at risk for developing the disease. (http://diabetes.niddk.nih.gov/DM/PUBS/statistics/)
Speaking of drugs, a lot of people are peeved at Ms. Deen for accepting the position as a spokesperson for a new diabetes drug. I don't know if Ms. Deen tried diet and exercise modifications before pursuing the "drug" route, but if not, it is disappointing. She is a well-known person who could use her celebrity and skills to help others. If she were one of my clients, I would challenge her to focus on reducing portion sizes, modify her cooking methods and increase her exercise before starting a drug regimen. Drugs are adjuncts to therapy, not the cure or the answer. So the question remains, is it the food choices of Ms. Deen that people are upset about or is it something more?
Diabetes is a multi-factorial disease. I really don't have an issue with the ingredients Ms. Deen uses however, I do take issue with the portion sizes, cooking methods and lack of balance. Smaller portions and less frequent consumption of homemade comfort foods can fit into a healthful diet. The real issue relates to Paula's credibility and ethics. Her choice to delay announcing her diabetes coupled with her decision to be a spokesperson for a new drug is hard to swallow, however it is her choice. The savvy public and her fans will decide if Paula's personal decisions will affect their image of her, and if so, her "brand" and income may falter.
Many in the media have chastised Ms. Deen's promotion of fatty food, with some suggesting that food choices need to be "regulated" for the good of public health or that more education about dietary selections is needed. Research and 20 years of personal experience has shown time and again that the majority of people know that eating too much fatty, high calorie food isn't healthy and can lead to obesity...but many people just don't care.... nor are many truly motivated to change their health habits unless something dire happens, like being diagnosed with a particular disease. While I don't advocate high consumption of rich foods, I'm not a fan of regulation because it doesn't empower the individual to make thoughtful choices. People tend to learn by example... seeing the consequences of personal decisions, including dietary choices, is more of a motivator for change than mandating new laws, chastising or instituting prohibition.
As far as Ms. Deen and her diabetes, her personal choices will have consequences for her health, her family and her business. One way or another, her story will serve as an example...of what, remains to be seen. People will decide for themselves if Ms. Deen's way of life is something that is desirable or something to be avoided.
The lesson may be that individual choice has consequences. Offering education while allowing the individual to decide how to use this knowledge is a hallmark of a personal freedom. Choosing to eat well most of the time while maintaining regular physical activity, coupled with knowing one's family disease history and possibily shutting off the Paula Deen show, are all personal choices an individual can make to empower themselves to seek a healthier lifestyle.
