Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health (15 page)

This disease is not just about being fat and having to take medications; it leads to serious complications, such as kidney failure (40 percent of all kidney failure is caused by diabetes) and limb amputation (more limb amputations are performed for diabetes than any other nontraumatic disease). We’re talking
real
serious.

It’s a frightening modern phenomenon, the widespread democratization of a formerly uncommon disease. The widely broadcast advice to put a stop to it? Exercise more, snack less … and eat more “healthy whole grains.”

The explosion of diabetes and prediabetes has been paralleled by an increase in people who are overweight and obese.

Actually, it would be more accurate to say that the explosion of diabetes and prediabetes has been in large part
caused
by the explosion in overweight and obesity, since weight gain leads to impaired insulin sensitivity and greater likelihood that excess visceral fat accumulates, the fundamental conditions required to create diabetes.
¹⁰
The fatter Americans become, the greater the number that
develop prediabetes and diabetes. In 2009, 26.7 percent of American adults, or seventy-five million people, met criteria for obesity—i.e., a body mass index (BMI) of 30 or greater—with an even greater number falling into the overweight (BMI 25 to 29.9) category.
¹¹
No state has yet met, nor is any approaching, the 15 percent goal for obesity set by the US Surgeon General’s
Call to Action to Prevent and Decrease Overweight and Obesity.
(As a result, the Surgeon General’s office has repeatedly emphasized that Americans need to increase their level of physical activity, eat more reduced-fat foods, and, yes, increase consumption of whole grains.)

Weight gain is predictably accompanied by diabetes and pre-diabetes, though the precise weight point at which they develop can vary from individual to individual, a genetic component of risk. One 5-foot-5 woman might develop diabetes at a weight of 240 pounds, while another 5-foot-5 woman might show diabetes at 140 pounds. Such variation is determined genetically.

Trends in obesity and overweight in Americans, 1960-2008. Overweight is defined as BMI of 25–30; obese BMI ≥ 30; extremely obese BMI ≥ 35. While the percentage of overweight Americans has remained flat, that of obese Americans has ballooned, and the extremely obese have also increased at an alarming rate.
Source: Centers for Disease Control and Prevention

The economic costs of such trends are staggering. Gaining weight is exceptionally costly, both in terms of health care costs and the personal toll on health.
¹²
Some estimates show that, over
the next twenty years, an incredible 16 to 18 percent of all health care costs will be consumed by health issues arising from excessive weight: not genetic misfortune, birth defects, psychiatric illness, burns, or post-traumatic stress disorder from the horrors of war—no, just getting fat. The cost of Americans becoming obese dwarfs the sum spent on cancer. More money will be spent on health consequences of obesity than education.

Yet another factor parallels the trends in diabetes, prediabetes, and weight gain. You guessed it: wheat consumption. Whether it’s for convenience, taste, or in the name of “health,” Americans have become helpless wheataholics, with per capita annual consumption of wheat products (white and wheat bread, durum pasta) having increased by twenty-six pounds since 1970.
¹³
If national wheat consumption is averaged across all Americans—babies, children, teenagers, adults, the elderly—the average American consumes 133 pounds of wheat per year. (Note that 133 pounds of wheat flour is equal to approximately 200 loaves of bread, or a bit more than half a loaf of bread per day.) Of course, this means that many adults eat far more than that amount, since no baby or young child included in the averaging process eats 133 pounds of wheat per year.

That said, babies eat wheat, children eat wheat, teenagers eat wheat, adults eat wheat, the elderly eat wheat. Each group has its own preferred forms—baby food and animal crackers, cookies and peanut butter sandwiches, pizza and Oreos, whole wheat pasta and whole grain bread, dry toast and Ritz crackers—but, in the end, it’s all the same. In parallel with increased consumption, we also have the silent replacement of wheat from four-foot-tall
Triticum aestivum
with high-yield dwarf strains and new gluten structures not previously consumed by humans.

Physiologically, the relationship of wheat to diabetes makes perfect sense. Products made with wheat dominate our diet and push blood sugar higher than virtually all other foods. This sends measures such as HbA1c (reflecting the average preceding sixty to ninety days’ blood glucose) higher. The cycle of glucose-insulin reaching high levels several times every day provokes growth of
visceral fat. Visceral fat—wheat belly—is closely aligned with resistance to insulin that, in turn, leads to even higher levels of glucose and insulin.
¹⁴

The early phase of growing visceral fat and diabetes is accompanied by a 50 percent
increase
in pancreatic beta cells responsible for producing insulin, a physiologic adaptation to meet the enormous demands of a body that is resistant to insulin. But beta cell adaptation has limits.

High blood sugars, such as those occurring after a nice cranberry muffin consumed on the car ride to work, provoke the phenomenon of “glucotoxicity,” actual damage to pancreatic insulin-producing beta cells that results from high blood sugars.
¹⁵
The higher the blood sugar, the more damage to beta cells. The effect is progressive and starts at a glucose level of 100 mg/dl, a value many doctors call normal. After two slices of whole wheat bread with low-fat turkey breast, a typical blood glucose would be 140 to 180 mg/dl in a nondiabetic adult, more than sufficient to do away with a few precious beta cells—which are never replaced.

Your poor, vulnerable pancreatic beta cells are also damaged by the process of lipotoxicity, loss of beta cells due to increased triglycerides and fatty acids, such as those developing from repeated carbohydrate ingestion. Recall that a diet weighted toward carbohydrates results in increased VLDL particles and triglycerides that persist in both the after-meal and between-meal periods, conditions that further exacerbate lipotoxic attrition of pancreatic beta cells.

Pancreatic injury is further worsened by inflammatory phenomena, such as oxidative injury, leptin, various interleukins, and tumor necrosis factor, all resulting from the visceral fat hotbed of inflammation, all characteristic of prediabetic and diabetic states.
¹⁶

Over time and repeated sucker punches from glucotoxicity, lipotoxicity, and inflammatory destruction, beta cells wither and die, gradually reducing the number of beta cells to less than 50 percent of the normal starting number.
¹⁷
That’s when diabetes is irreversibly established.

In short, carbohydrates, especially those such as wheat products that increase blood sugar and insulin most dramatically, initiate a series of metabolic phenomena that ultimately lead to irreversible loss of the pancreas’s ability to manufacture insulin: diabetes.

A Paleolithic or Neolithic human breakfast might consist of wild fish, reptiles, birds or other game (not always cooked), leaves, roots, berries, or insects. Today it will more likely be a bowl of breakfast cereal consisting of wheat flour, cornstarch, oats, high-fructose corn syrup, and sucrose. It won’t be called “wheat flour, cornstarch, oats, high-fructose corn syrup, and sucrose,” of course, but something more catchy such as Crunchy Health Clusters or Fruity Munchy Squares. Or it might be waffles and pancakes with maple syrup. Or a toasted English muffin spread with preserves or a pumpernickel bagel with low-fat cream cheese. For most Americans, extreme carbohydrate indulgence starts early and continues throughout the day.

We shouldn’t be one bit shocked that, as our physical lives have become less demanding—when’s the last time you skinned a nanimal, butchered it, chopped wood to last the winter, or washed your loincloth in the river by hand?—and rapidly metabolized foods of convenience and indulgence proliferate, diseases of excess will result.

Nobody becomes diabetic by gorging on too much wild boar they’ve hunted, or wild garlic and wild berries they’ve gathered … or too many veggie omelets, too much salmon, or too much kale, pepper slices, and cucumber dip. But plenty of people develop diabetes because of too many muffins, bagels, breakfast cereals, pancakes, waffles, pretzels, crackers, cakes, cupcakes, croissants, donuts, and pies.

As we’ve discussed, foods that increase blood sugar the most also cause diabetes. The sequence is simple: Carbohydrates trigger insulin release from the pancreas, causing growth of visceral fat; visceral fat causes insulin resistance and inflammation. High blood sugars, triglycerides, and fatty acids damage the pancreas. After years of overwork, the pancreas succumbs to the thrashing it has taken from glucotoxicity, lipotoxicity, and inflammation, essentially “burning out,” leaving a deficiency of insulin and an increase in blood glucose—diabetes.

Treatments for diabetes reflect this progression. Medications such as pioglitazone (Actos) to reduce insulin resistance are prescribed in the early phase of diabetes. The drug metformin, also prescribed in the early phase, reduces glucose production by the liver. Once the pancreas is exhausted from years of glucotoxic, lipotoxic, and inflammatory pummeling, it is no longer able to make insulin, and insulin injections are prescribed.

Part of the prevailing standard of care to prevent and treat diabetes, a disease caused in large part by carbohydrate consumption … is to advise increased consumption of carbohydrates.

Years ago, I used the ADA diet in diabetic patients. Following the carbohydrate intake advice of the ADA, I watched patients gain weight, experience deteriorating blood glucose control and increased need for medication, and develop diabetic complications such as kidney disease and neuropathy. Just as Ignaz Semmelweis caused the incidence of childbed fever in his practice to nearly vanish just by washing his hands,
ignoring
ADA diet advice and cutting carbohydrate intake leads to improved blood sugar control, reduced HbAlc, dramatic weight loss, and improvement in all the metabolic messiness of diabetes such as high blood pressure and triglycerides.

The ADA advises diabetics to cut fat, reduce saturated fat, and include 45 to 60 grams of carbohydrate—preferably “healthy whole grains”—in each meal, or 135 to 180 grams of carbohydrates per day, not including snacks. It is, in essence, a fat-phobic, carbohydrate
centered diet, with 55 to 65 percent of calories from carbohydrates. If I were to sum up the views of the ADA toward diet, it would be: Go ahead and eat sugar and foods that increase blood sugar, just be sure to adjust your medication to compensate.

But while “fighting fire with fire” may work with pest control and passive-aggressive neighbors, you can’t charge your way out of credit card debt and you can’t carbohydrate-stuff your way out of diabetes.

The ADA exerts heavy influence in crafting national attitudes toward nutrition. When someone is diagnosed with diabetes, they are sent to a diabetes educator or nurse who counsels them in the ADA diet principles. If a patient enters the hospital and has diabetes, the doctor orders an “ADA diet.” Such dietary “guidelines” can, in effect, be enacted into health “law.” I’ve seen smart diabetes nurses and educators who, coming to understand that carbohydrates cause diabetes, buck ADA advice and counsel patients to curtail carbohydrate consumption. Because such advice flies in the face of ADA guidelines, the medical establishment demonstrates its incredulity by firing these rogue employees. Never underestimate the convictions of the conventional, particularly in medicine.

The list of ADA-recommended foods includes:

• whole grain breads, such as whole wheat or rye
  
• whole grain, high-fiber cereal
  
• cooked cereal such as oatmeal, grits, hominy, or cream of wheat
  
• rice, pasta, tortillas
  
• cooked beans and peas, such as pinto beans or black-eyed peas
  
• potatoes, green peas, corn, lima beans, sweet potatoes, winter squash
  
• low-fat crackers and snack chips, pretzels, and fat-free popcorn
  

In short, eat wheat, wheat, corn, rice, and wheat.