Jan 19 2012

Weighing in on Paula Deen

The huge fuss over Paula Deen’s type 2 diabetes is understandable.   She is, after all, the queen of high-calorie Southern cooking.  And diabetes rates are especially high in the South.

Perhaps less understandable is the reaction of the American Diabetes Association.  As reported in the New York Times,

Heredity, according to the American Diabetes Association, always plays some part. “You can’t just eat your way to Type 2 diabetes,” said Geralyn Spollett, the group’s director of education.

Wrong.  You most definitely can eat your way to type 2 diabetes.

Type 2 diabetes is closely linked to overweight and obesity.  No, not everyone who is overweight develops type 2 diabetes.  But most people who have type 2 diabetes are overweight.

The first line of defense?  Lose a few pounds.  Even a relatively small reversal of calorie balance can make symptoms of type 2 diabetes disappear and reduce or eliminate the need for drugs.

Mrs. Deen does not mention weight as a factor in her disease, or losing weight as an effective treatment.

Instead, she is now a spokesperson for the drug Victoza.

According to the Times’ account, Mrs. Dean says that it is elitist to criticize her food:

You know, not everybody can afford to pay $58 for prime rib or $650 for a bottle of wine. My friends and I cook for regular families who worry about feeding their kids and paying the bills.

Really?  Does Mrs. Deen think those families can afford to pay the $500 a month drug companies charge for Victoza?

Victoza costs in other ways too.  It has to be injected and is not exactly benign.

Victoza® is not recommended as the first medication to treat diabetes. Victoza® is not insulin and has not been studied in combination with insulin…It is not known if Victoza® is safe and effective in children. Victoza® is not recommended for use in children

In animal studies, Victoza® caused thyroid tumors—including thyroid cancer—in some rats and mice.  It is not known whether Victoza® causes thyroid tumors or a type of thyroid cancer called medullary thyroid cancer (MTC) in people which may be fatal if not detected and treated early…Inflammation of the pancreas (pancreatitis) may be severe and lead to death.

The company also advises:

Victoza® is an injectable prescription medicine that may improve blood sugar (glucose) in adults with type 2 diabetes when used along with diet and exercise.

Diet and exercise?  Why not just do that in the first place?

As for the American Diabetes Association: its disinterest in promoting diet and exercise is easily explained.  It is funded by drug companies.

I gave a talk at an annual meeting of the Association a few years ago and was astounded by the number of drug companies giving things—writing pads, pens, and tape holders, but also lab coats and stethoscopes—at the trade exhibit.  Much of the scientific meeting was devoted to drug studies.  I spoke at the only session that year on dietary issues.  And Coca-Cola sponsored a session on sugars in diabetes.

Mrs. Deen’s food is best eaten in moderation.  She would do more for her own health and that of her fans if she used her television presence to promote healthier lifestyles.

Update, January 30: Brad Jacobson interviews drug reps on AlterNet (I’m quoted).

  • Joe

    What a hot topic though I am not surprised to see that so many have opinions on what Paula is or is not and what she should or should not do.

    Though I know that some think I am a troll and post under various aliases I am a real person and a read RD. As such I see first hand that people make choices regarding their diet based on foods that taste good first and health consequeences third or fourth. It is just human nature to act in our own self interest despite the opinion of others. Ms Deen is only a high profile example of what is going on.

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  • http://www.thedailybeast.com/articles/2012/01/17/no-proof-paula-deen-s-high-fat-southern-cooking-caused-her-diabetes.html Karl

    I totally agree that a low-carb diet can help at least some people lose weight (more than paleo, which has more carbs) and/or put their diabetes into temporary remission (remission is not a “cure,” there is no cure yet). I’m surprised there are people here saying this, because I feel we are in the minority and still considered dangerous and debunked crackpots (like Dr. Atkins) by the medical and general communities.

    Most diabetes doctors still advise their patients that they “need” to eat some carbs every day, that fruit and juice is good for you and fat and calories are bad, that a calorie is a calorie is a calorie, that weight is a simple equation of calories eaten minus burned, that it’s OK for diabetics to have agave and fruit sugars even though both of those are often 40% glucose.

    Most “lite” and diet products and diet companies also are still low fat and fairly high in carb. (Eff you, WeightWatchers!). I’m not aware of a major diet company that offers low carb, and grocery stores have divested themselves of most of their Atkins and low-carb specialty products, as the general population have lost interest in low-carb, based on advice that it’s “dangerous.”

    Because of all this, I have a hard time blaming the patient / victim / fatty. How the hell are they supposed to magically know that low-carb could help them and their diabetes, when their doctors and friends and the public and the weight loss industry and the media are all telling them to avoid it and eat carbs? Answer, they can’t really.

    But the bottom line people need to realize is that EVERYONE IS DIFFERENT. Low carb works great for some people, others have a different issue. These diet studies people quote mostly do not take these things into account, and instead blindly study a mixed batch of people with different dietary needs, and try to apply the resulting advice and findings to everyone indiscriminately. Hence you have people here saying, “see, the French do it, so that proves you/we/everyone can do it too.” Or “My cousin lost 30 pounds just by cutting out all the lard sandwiches, so therefore everyone who’s fat is a pig.”

  • Margeretrc

    @Karl, “But the bottom line people need to realize is that EVERYONE IS DIFFERENT. Low carb works great for some people, others have a different issue.” True, sort of, but the issue here is diabetes. Everyone who has diabetes, whether it is type 1 or type 2, has one thing in common: an inability to manage (or difficulty managing) blood glucose. So for them, not eating things that significantly raise their blood glucose levels makes the most sense, and that is a low carb diet. That’s biology–not based on what the French or anyone else do. And a low carb diet, by definition, has to be a high fat diet, since too much protein can be dangerous. I agree with you that it is pointless to blame the victim, for all the reasons you said, and I hope I didn’t come off looking like I was. I’m not. I’m merely trying to counter the people who are jumping up and down saying this proves that the fat phobes were right all along and that eating butter and lard (like Paula Deen does on her show) is going to give you diabetes. It doesn’t prove anything of the sort and it won’t–not without being combined with a load of starch and sugar, anyway. I do agree with Dr. Nestle that Ms Deen is wrong to focus on an expensive drug that has some nasty side effects, while ignoring the role that diet and exercise can play in treating this disease that afflicts so many people in this country and the world. And while I agree with the ADA that heredity plays a significant role in the development of diabetes, I disagree that one’s diet plays no part in that development–on that point, Dr. Nestle and I are in agreement, though I don’t agree with the rest of her tenet. It’s anecdotal, but my husband was prediabetic–there is no history of the disease in his family, by the way–and removing most of the sugar and starch from his diet (while significantly increasing the fat) has helped him lose weight and prevent the disease from progressing to full blown diabetes. I have no doubt that, had we continued to eat the way we were eating–or, worse, eat the way his doctor recommended (a low fat, high carbohydrate “heart smart” diet), he would be diabetic by now. And I know at least one other with no family history of diabetes who developed the disease by following a low fat, high carbohydrate diet prescribed by his doctor. Do I blame the diabetic? Heck no, even though he literally “ate his way to type 2 diabetes.” (And he is not nor ever was overweight.) I blame the doctor, just as I blame all the doctors, health professionals, and government officials who have promoted a low fat, high carbohydrate diet for the past 40 years for the epidemic of obesity and type 2 diabetes raging now. Sure, some of them would have become diabetic without such recommendations because of a strong genetic predisposition, but all of them? Highly unlikely.

  • Harold Roth

    Something I’d like to point out about the connection between diabetes and obesity. According to figures often quoted, most people with diabetes are overweight. “Most” is 80%.. That means 20% of them are NOT overweight, but further:.

    Two-thirds of the general population of the US is overweight. So slightly more people with diabetes are overweight than the general population.

    According to what I have read, people who are overweight and lose the weight can indeed drop their blood sugar, but often it returns even at the lower weight. So that’s not a panacea either.

    Maybe we ought to start looking at other possible sources of the problem. Like GMO foods (and feeds for meat animals), dyes, synthetic flavorings, preservatives, pesticides that concentrate in fats, synthetic musks in the water, and so forth.

  • Michael

    I don’t think that anyone really disagrees with that, Joe (with the exception that eating the way Ms. Deen’s show encourages one to, or the way she evidently did granted her weight and diagnosis, is properly called ‘self-interest’). The reason a lot of people are outraged, I think, is not the reasons why she took up eating the way she did, but the reasons why she pursued the course she did in her TV and marketing actions in the public spherey. Ms. Deen has known she was diabetic for three years, and has at no time made a disclosure of this to her viewers while she profited from continuing to serve up her deep-fried cheesecake and doughnut hamburgers. She had an obligation to disclose, and also a particularly powerful opportunity to help move the needle on the health of her viewers had she done so, and chose to remain silent — finally revealing her diabetic state only upon inking a deal to promote a dangerous diabetes drug.

  • Kat

    Wow, 67 comments! I suppose, like it or not, Paula Deen has a real effect on the American public’s diet.

    She gave up sugar-sweetened beverages and is walking every day. If her fans could follow that advice, it would be a huge step forward for the health movement.

    As always, I love reading your posts on hot topics and the comments.

  • Peggy Holloway

    Kelsi:
    For excellence science on weight, insulin-resistance, and “diabetes,” read anything by Gary Taubes, of course, but I especially recommend “The Art and Science of Low-Carbohydrate Living” by Phinney and Volek. Real science by real researchers.

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  • http://www.nedcon.ro/ Thomas G

    You are right. I totally agree with you, Karl.

  • http://fourmeals.com Sarah S

    This is, easily, the most sensible write up I’ve seen on the subject. For that, thanks!

    One part of this that I’ve noticed not many people talking about is the ridiculousness of her comments defending her style of cooking. I can agree fatty southern fare has its time and place, but am bothered by the suggestion that our choice is between expensive red meat and more affordable butter.

    There is no reason to believe we can’t eat healthful food on a budget, or that just because you have a limited income, you’re somehow limited to flavoring your food with fats and sugars. Obviously, there are a range of barriers between many low-income households and healthy diets (education, accessibility…), but I would argue that affordability is not the main issue here. Going on the defensive in the name of butter is not helping anybody.

  • Kelsi

    Peggy: Thank you for the resources. I will check them out ASAP.

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  • http://consciouslyfrugal.blogspot.com ConsciouslyFrugal

    Oh, how I have long loved Ms. Nestle’s work, but this entry is truly disappointing. I could give a crap about Paula Dean, but there are some serious accusations being lodged against a nonprofit organization here and I question their factual basis. (On a side note, a shout out to all the folks noting the complicated nature of diabetes. Did you know the leading researcher in the field of PCOS thinks it’s another type of diabetes? And that some researchers are advocating for a new definition for a type 1.5? On and on. Hmmm, is it just the twinkies? Endocrine disruptors? Oh me oh my!)

    Do you (the author) have a citation for your claim that the American Diabetes Association (ADA) is funded by drug companies? Other than your personal experience of speaking at at one conference of the ADA’s Research Foundation? I ask, because I used to work for the ADA as a fundraiser, and my life would have been a helluva lot easier if the drug companies were funding them in a substantial way. Our office did receive funds from drug companies, but it amounted to less than 10% (perhaps the Research Foundation receives more? Would be interesting to actually research that, eh?) of total revenue. The majority of funds for my former office (major metro area) came from fundraising walks. (Please note: This is not an endorsement of the ADA. Hugely jacked up organization with major issues, but I do prefer facts over hyperbole or speculation based on free pens.)

    Also, the ADA most certainly does advocate weight loss, although not of the extreme variety that those who moralize obesity so love. Virtually all of the free information given to the public advocates weight loss of 5-10% of total weight, just as you noted that research has found to be most beneficial (which was a finding, by the way, that was largely ADA-sponsored research). The ADA has multiple programs dedicated entirely to teaching people healthier habits and moderate weight loss. In two years, I did not witness one program dedicated to drug therapy.

    Basically–we don’t need to attend the hyber bowl to address critical social issues or assume a nonprofit organization is inherently evil because they accept corporate monies from organizations we loathe. Far too many worthy organizations would have to close their doors. Although I wouldn’t work for the ADA again for all the money in the world, I find your summary of the organization patently false. (I can’t believe I just defended the ADA, but c’mon people! Facts, for the love!)

  • mary

    ”buttery goodness???” Butter doesn’t really have a taste!

  • greg

    marion you cannot just eat your way to type 2 diabetes. in every case there was a relative who also had it. do you mean to tell me that you know more than the ada. i doubt it.

  • Charles D. Hord

    As the linked paper states there is a very strong genetic component to Type 2 Diabetes, http://edrv.endojournals.org/content/19/4/491.full.
    Whatever the ADA is really about is irrelevant; bad diet + genetic predisposition to Type 2 Diabetes = expressed phenotype Type 2 Diabetes. Since not all the genes involved in diabetes are known, nor is a clinical genetic test for Type 2 diabetes available, it is definitely prudent to adhere to a healthy diet and exercise, ABSOLUTELY in the case of family history of diabetes! I’m not a nutritionist, but I am a Type 2 Diabetic, child of a Type 2 diabetic, and a molecular biologist, and can attest to the living hell that is being diabetic. Understand the medical reality, and that you don’t know whether or not you have a genetic predisposition to diabetes, so it’s best to err on the side of diet and exercise. Consider it Dean’s Bet: What’s the harm in diet and exercise? You might even prevent diabetes!