Today, half of the US population has diabetes or is at risk of developing it. Even as recently as the 1950’s, type 2 diabetes was quite rare. Less than 1% of Americans at that time had symptoms. So how have our communities become such unhealthy places to live that 42% of Americans are obese, 34 million have diabetes (mostly type 2), and 88 million are at risk of getting diabetes?
These numbers are shocking, and this is a complex, challenging disease to live with. We need drastic action to reduce this trend. What to do? First, we must take a hard look in the mirror regarding our modern food culture.
Science shows that our environment and personal behaviors, along with family genetics and age, explain 90% of health. Type 2 diabetes comes from obesity, poor food quality, and ingrained, unhealthy habits that people don’t want to change or can’t change easily. But we are also heavily shaped by the options in front of us every day. When it comes to food, these choices are set by the companies that produce and distribute our food and drink options. The answer to our diabetes epidemic lies in improving these options and making better choices.
As a nation, we tackled the poorly regulated industries that led to polluted air and waterways in the 20th century. Now, we must shift our focus to the pollution in our food supply.
The disconnect between human biology and modern, highly processed foods
The basic biology of humans has not changed since the 1950s, but our modern lifestyle around eating and drinking would be unrecognizable to people living in the 1950s. Stop and reflect on this modern fact: the average American now drinks 44.7 gallons of soda every year. That’s 480+ cans of carbonated, high fructose corn syrup, tinted with chemical coloring and flavoring designed to make it palatable. Companies spend $1.04 billion annually to advertise junk drinks, even targeting the young and poor. Their business is not our health.
Today, cheap, unhealthy options (in large quantities) are pretty much the default –and sometimes the only— food and drink options available to us.
For example, doughnuts, bagels, and sweet pastries made of highly refined white flour, added sugars and salt, chemical preservatives, and synthetic colored dyes are now common options for breakfast. These “food” options have very little nutritional value for the human body, yet they are commonly consumed as part of the “most important meal of the day” by people on their way to work and school. Young people have no “cultural memory” of earlier, healthier ways of eating. Our waistlines are up against powerful companies that are not obligated to keep people healthy.
For Dunkin Donuts, as one example, these unhealthy options are the foundation of their business model. Dunkin has more than $1.37B in revenue, with 9,630 outlets. It sells 50 varieties of doughnuts alone, which in the 1950’s were traditionally much smaller and eaten as a treat. Dunkin has become an ingrained part of our modern food options and is one small example of how our food culture has changed to invite obesity and type 2 diabetes to reach epidemic levels.
As you can see, our daily living environment has been heavily distorted in just a few decades. These low-quality, low-nutrition foods and drinks now comprise most of our options in supermarkets, gas stations, airports, hospitals, highway truck stops, and cafeterias. Highly processed food choices and sugar-sweetened drinks have become “normalized” and hard for the average person to see as contributing to poor health.
This also affects doctors and clinicians. When treating a patient with type 2 diabetes, healthcare providers focus largely on a treatment plan of medications and medical treatments, rather than the urgent need to educate their patients about culture change and the connection between food-related lifestyle and health.
What we do understand about the effect of highly processed foods and drinks on our bodies?
There are many complex, interacting systems in the amazing human body. But these systems are not designed for and have had no experience handling the ingredients and chemicals in our modern foods or drinks. Nor are our bodies equipped to process the quantity of low-nutritional-value calories that the average American consumes. Today, our bodies also lack access to natural plant fiber and the healing properties of plants that were common in the diets of even our recent ancestors.
Here are some human systems damaged by highly processed foods and drinks:
- Hormones – The overstimulation of insulin production and promotion of fat storage in the pancreas, muscles, and liver, stress and weaken their ability to work correctly. Our bodies evolved to metabolize small amounts of slowly digested sugars, such as fructose in a piece of fruit.
- Innate and adaptive immune defense system – The enlargement of fat cells that then become stressed, kicks off an immune response (cytokines) that damages other heathy cells.
- Brain reward systems – Foods high in sweetness, salt, and fats had a high survival value in our ancestral past. But today, these manufactured foods are designed to hijack our natural brain reward pathways and create an unnatural drive to overeat.
- Gut bacteria – Along with a high intake of animal products (meat and dairy), highly processed foods can alter the delicate balance of healthy vs. unhealthy gut bacteria that impacts the brain, immune system, nutrition status, and overall physical and emotional well-being.
- Appetite and satiety system – Natural taste preferences for sugar, fat, and salt are distorted to create more demand. Humans are biologically adapted to food shortages but not the continuous intake of high calorie foods and sugar-filled drinks.
- Mental functioning – Chronic inflammation affects the brain, which promotes the development of dementia earlier in life; this is now being called, “type 3 diabetes”.
- Sexual functioning – Blood supply and nerve functioning are negatively impacted, particularly with type 2 diabetes, yet essential to normal sexual functioning and response.
- Blood vessels – Blood vessels become plaque filled and stiff and clots can form as a result of chronic inflammation from poor diet, smoking, stress, and physical inactivity. Inflammation is part of the body’s attempt to heal itself and fight our modern diet and other irritants that impact the delicate blood vessels that supply all our vital organs.
Breakfast can be healing, quick, affordable, and taste good
So far, we haven’t collectively given much of our national attention, human capital, or business savvy to creating healthy food and drink options for people living in our fast-moving culture – whether for breakfast or any other time of the day. We must teach people the skills to make over their favorite meals to be healthier, to be more discerning with restaurant menus, and to make more informed decisions when walking through supermarkets where highly processed foods and sugar-filled drinks are heavily promoted and misleadingly advertised.
There is a growing wisdom among some healthcare organizations such as the American College of Lifestyle Medicine, that we can do many simple things differently that will make a difference in our individual health. Blog #3 discussed the value of lifestyle medicine to effectively manage diabetes or even put it into remission by shifting to a mostly unprocessed, plant-based diet.
For example, here are some healthy breakfast options that are “plant heavy” but delicious and can be made free from highly processed food with portion sizes made to fit the person’s needs:
- Low-to-zero sugar oatmeal or with fruit and nuts or seeds
- Whole wheat toast with peanut butter and a side of fruit
- Overnight oats with banana slices or berries
- Cooked blueberries with plain yogurt and nuts
- A cooked egg with sauteed spinach and mushrooms
- Cooked tomatoes and black beans with salsa and whole grains
- Avocado or guacamole on whole wheat toast
- A green smoothie made of banana, frozen mango or peaches, and some added greens
- Coffee or teas and naturally flavored water without added sugars or flavored syrups
Our US healthcare system has not yet focused on this huge societal problem we face around our modern food culture and food supply, nor on stressing to patients as part of routine medical care the connection between unhealthy food and eating habits and poor health. It is time.
In our next blog, we focus on the tremendous changes happening now in the way we live as a result of COVID-19, including new telehealth and payment systems for healthcare providers that could provide a huge breakthrough in the way we treat chronic conditions and help patients.
Garry Welch, PhD is an expert in the area of behavior medicine for chronic disease care. He has extensive experience leading clinical research on behavior change strategies for people with diabetes and other chronic diseases. Dr. Welch’s 30+ years of clinical research led to co-founding Silver Fern Healthcare. He leads research and development at Silver Fern.