by Marion Nestle
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).

Comments

  • MargaretRC
  • January 19, 2012
  • 5:11 pm

You’re welcome, Debra. I’ve got a lot more where they came from. I’ve been at this for nigh on 7 years and the amount of material keeps growing. Have you read Zoe Harcomb’s “The Obesity epidemic”? She does an amazing job of crushing the mainstream dogma of the past 40 years or so with data from scientific studies (some are the same ones that have been used to promote the current dogma) and irrefutable logic. It’s a great read.

  • Daniel L
  • January 19, 2012
  • 5:14 pm

Great text, it’s refreshing to see someone still has some sense.

  • murph
  • January 19, 2012
  • 5:21 pm

The author misinterprets the quote they’re bashing on:

“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.”

The author follows this up with “Wrong. You most definitely can eat your way to type 2 diabetes.”

But that’s not what ADA’s Spollett said.

Spollett said eating poorly doesn’t make people who aren’t predisposed to Type 2 diabetes into diabetics. There has to be some heredity in play.

Yes, you can hasten the onset of your Type 2 diabetes with poor diet and health habits, but if the other factors aren’t present – you won’t become diabetic.

Doesn’t mean people shouldn’t eat better and stay fit. But it does mean that authors should read what they are quoting.

You always have a way of informing people in such an enlightened way. You sift though all the rhetoric and give us the real “skinny”
THank you. I will be passing this on especially to my Diabetes Wellness clients.

  • Karl
  • January 19, 2012
  • 5:45 pm

In your third paragraph you say the American Diabetes Association is “wrong.” With what proof? Because there’s a link, a correlation between weight and diabetes (in some but not all individuals), you jump to the conclusion that one causes the other and not vice versa? Or that both could be caused by a third factor? What proof do you have (that isn’t also based on a study that similarly confuses correlation with causation)?

Type II diabetes is insulin resistance, that the cells in your body are chemically less able or unable to utilize the hormone insulin to absorb glucose. It’s a chemical thing. (And it can be caused or sped up by 40 years by hepatitis C.) How is that caused by weight? Are you assuming that the body can only produce small amounts of insulin and that the insulin runs out due to the extra cells in a fat person? That just doesn’t make sense, and it isn’t insulin resistance, it’s not how it is known to work. If that was the case, it would be called insulin deficiency.

We know that insulin deficient and diabetic people gain weight differently, it is distributed around their waist in a pear shape. Why is that? That specific distribution of fat can’t possibly be caused by their eating choices. There clearly seems to be some other factor involved that is medical / chemical, and who knows what other effects that may be having.

We also know that insulin resistant people go through years where their body overproduces excess insulin to compensate, likely before they are significantly fat. Insulin is a hormone that impacts reproduction, sleep, weight and a whole host of other things.

@MargaretRC

You’re the second person who has recommended Harcombe’s book to me, so I will be picking it up post haste. I spend a lot of time with my nutritional therapy clients trying to dispel the dietary myths that have been perpetrated on us by government and industry (Big Food and Big Pharm) so any clearly written, well-referenced resources are a godsend.

Thank you.

  • Brandon
  • January 19, 2012
  • 7:27 pm

@Karl

Adipose tissue (fat) releases cytokines (inflammatory agents) such as TNF-alpha and IL-6, that do a few things, one of which is to tell muscle cells to not respond to insulin. The more adipose tissue you have, the more of those cytokines get released, the more your muscles become resistant to insulin. That is how weight/fat is related to insulin resistance and the development of Type II Diabetes.

Do we know that diabetics are typically pears or gain weight in pear form? Also, above the waist = apple, below the waist = pear.

  • MargaretRC
  • January 19, 2012
  • 7:33 pm

@Murph, if you have to be hereditarily predisposed to develop T2 diabetes, how do you explain the run away epidemic taking place world wide now? The human genome doesn’t change that quickly. It takes more than 40 years to significantly change the gene pool to that extent. True, genetics plays a part in some people’s development of the disease, but I don’t think everyone that has it has a genetic predisposition. I think there are those who have literally eaten their way to type 2 diabetes–not that it’s their fault! As a population, we have dramatically (and understandably) increased our consumption of sugar and refined flours in place of the fats we’ve been told not to eat. Evolutionarily, we just haven’t had time to evolve the ability to manage that kind of an onslaught of glucose (and fructose) to our systems.

  • fiona
  • January 19, 2012
  • 7:33 pm

Fabulous article. Well said that Paula Deen can adjust her food just a little, keep the high fat, take out the carbs, change to great oils and bingo.. reverse her and millions of others’s diabetes. This is what Dr. Rosedale has done for 20 years.

  • Margeretrc
  • January 19, 2012
  • 7:57 pm

@fiona, “Well said that Paula Deen can adjust her food just a little, keep the high fat, take out the carbs, change to great oils and bingo.. reverse her and millions of others’s diabetes. ” I’m not sure where that appears in the article, but it’s true enough. If Paula Deen kept the fat (but switched out the vegetable oils for healthier sources of fat), and replaced the flour and sugar with lower carb alternatives, she could reverse her symptoms without expensive medication. But then she wouldn’t get the sponsorship dollars from the drug company….

  • Jennifer
  • January 19, 2012
  • 8:19 pm

Americans have the highest number if type 2 diabetes than any other country. Majority of cases are due to our what us now typical western diet of too much corn,industrial corn fed meat, dairy, fast food, high fat low nutritional food and THAT my friends is the link in most, not all, cases. So those of you arguing about this are making mute points. The fact that big pharma companies would rather treat the symptom and not prevent the disease is also proof that they’re only looking at their profits through people being sick. She is paid by the pharma company not to lead with diet and exercise, it’s an after thought. That’s the spin. Geez, did you guys read how aggressive this treatment is?? Injected only and a gazillion side effects. She’s pushing drugs for money, bottom line.

  • Peggy Holloway
  • January 19, 2012
  • 9:58 pm

Ah, but, you are confusing association with cause and effect. Yes, most people with “diabetes” are overweight. But it is not being overweight that causes “diabetes.” I refuse to even call chronic high blood sugar (or chronic hyperglycemia) “diabetes,” because I do not consider it a “disease” to be treated medically. The reality is, both obesity (or being overweight) and chronic high blood sugar are symptoms of an underlying condition, insulin-resistance, that does not allow the body to process the high carbohydrate load of the modern diet. The solution is simple: cut out the foods that cause high blood sugar, that is, sugar, starch, and grains. Pretty much all carbohydrates with the exception of non-starchy vegetables. Eat a high fat, moderate protein diet of whole foods, get plenty of exercise, engage in stress-relief practices, and despite your genetics (and most of us are genetically insulin-resistant to some degree), blood sugar and weight will normalize.
In case some readers want to chastise me for not “taking this “disease” seriously, I say “au contraire.” I am a crusader for proper treatment of insulin resistance because it has wreaked havoc on my entire family. I watched my father and grandfather suffer horrendous consequences of poor management of their “Type II Diabetes” and spent 30 years of my life trying to avoid their fate. I was marching straight for the same diagnosis in the late 1990′s, following a very low-calorie, low-fat diet and exercising so I wouldn’t “give my self diabetes.” In 1999 I learned about the work of Dr. Atkins, Dr. Bernstein, and others who understood the insulin-blood sugar-obesity connections. I went adopted a low-carbohydrate lifestyle and my health issues all reversed immediately, my blood sugar has remained normal, and my weight is healthy. I am 59 and in better health than most people half my age. My entire family has seen incredible benefits from a low-carb/paleo lifestyle. The symptoms of insulin-resistance that manifest themselves with a high-carb diet include mood disorders, eating disorders, and ADHD. My children and siblings have improved all of the above by adopting a well-regulated low-carbohydrate lifestyle. I wish the same for all here. Paula Deen could do such a service for her audiences by eschewing the sponsorship of Novartis (pushing medications to treat a non-medical condition) and cooking up some great low-carb, whole food meals like we eat at my house. Lots of full-fat meats and dairy, eggs, green veggies, and plenty of butter, coconut oil and cream. 12 years and counting….

  • Megan
  • January 19, 2012
  • 11:00 pm

I don’t get why it is so hard for people to face the facts and admit that diet is the issue. Drugs will not help the issue in the long run when the cause is diet.

  • Ilana
  • January 19, 2012
  • 11:51 pm

Important things,the diet have to be right,low-carb,
green veggies, olive oil, avokado.

It’s obviously very unfortunate and sad news to hear that anyone has been diagnosed with a health condition, but I’m disappointed that Paula doesn’t appear to be choosing to use her position and influence to highlight the difference that diet can make.

Just think of the impact she could have by publicly changing the way she cooks and eats?

Marion you are a breathe of fresh air – thank you for this post!

  • RIVA ROSENFIELD
  • January 20, 2012
  • 7:57 am

Losing weight and being more active following a diagnosis of pre-diabetes 2 has helped me to control blood glucose levels without medication for the past 2 years. This is harder to do since the ADA and drug companies seem to expect that medicine is a forgone conclusion. Hospitals also profit from the stomach stapling surgery which are very common now.

  • Long-time_diabetic
  • January 20, 2012
  • 9:36 am

I just wanted to point out a couple of things regards your comments on Paula Deen and diabetes.

Diet and exercise does not work for all diabetics, and diabetes is a progressive disease so that while diet and exercise may work well initially, some years later that may not be the case. So if diet and exercise is not working then endos usually recommend drugs.

If Paula Deen has been diagnosed with diabetes for three years (she may have had it longer than that), than this may not be the first diabetes drug she has tried. So if you don’t know for certain, it is better not to assume one way or the other.

Diabetes treatment is very personal and what works for one person may not work for another, and what works for one person at one time may not work at another time. Even when things are working, the effectivenes may vary from day to day. Even on medications or insulin, variations in the amounts of carbs with meals from day to day or even small time differences in meals can make a difference. Lots of things can make a difference: changes in schedule, stress, travel, amount of activity, and so on.

It is not logical to criticize anyone’s choices for how they treat diabetes. Unless you are that person you cannot know what things work and don’t work for them!

[...] cheesecake anyone?) in spite of having type 2 diabetes for THREE YEARS. For more opinions check out Marion Nestle; Yoni Freedhoff; and Andy [...]

  • Margeretrc
  • January 20, 2012
  • 12:07 pm

@Long_time_diabetic, what you say is true enough. However, it would be a mistake to (ever) discount the role that diet and exercise can play if you let it. As you know better than anyone, diabetes (types 1 and 2) are diseases whereby the body has difficulty managing blood sugar (glucose), so the less glucose you dump into your blood, the better off you are, and the sources of glucose are grains, starchy vegetables, and sugar–all of which produce a rise in blood glucose. Even if you need insulin/medication, restricting those carbohydrates can reduce the amount you need and improve your control and for type 2, at least, restricting them beginning as soon as you are diagnosed reduces the likelihood that you’ll ever need meds or insulin. My son is type 1 and will forever need to inject insulin. However, eliminating sugar and starch (he rarely eats bread, pasta, etc., or anything sweet) from his daily diet has reduced the amount of insulin he needs and improved his BG control. Hopefully, that will help him avoid the complications of his disease down the road. And exercise increases sensitivity to insulin, so is important for both types of diabetics as it, too, reduces the need for insulin/medication. Here are two doctors who live with diabetes themselves and know whereof they speak: http://www.carbohydratescankill.com/blog
http://www.diabetes-book.com/ Both their stories are fascinating and the information they have to impart to other diabetics is invaluable. Dr. Su is type 2, Dr. Bernstein type 1, so they’ve got it all covered!

  • Margeretrc
  • January 20, 2012
  • 12:14 pm

One more link: http://www.hlntv.com/video/2012/01/18/vinnie-politan-diabetes-demo It’s not the butter in Paula’s recipes!

  • murph
  • January 20, 2012
  • 1:29 pm

@Margeretrc

“…if you have to be hereditarily predisposed to develop T2 diabetes, how do you explain the run away epidemic taking place world wide now? ”

I have no idea why diabetes rates are increasing at the rates they are. But the increase in diabetes diagnosis is not inconsistent with heredity playing a part the the occurrence of the disease.

As has been explained to me repeatedly, the insulin producing cells of the pancreas wear out and are not replaced over time. A person can genetically possess more than enough beta cells for their lifetime, or just barely enough – or less than enough.

Their diet and lifestyle can speed the decline of their beta cells to the point where they are diabetic – but if their genetics provide them with the capacity to deal with their diet they will not become diabetic.

Which is not to pretend to be a scientist, or medical expert. While I have T2 diabetes, it does not make me expert.

I am, however, perfectly capable of calling out Ms. Nestle for being over-broad in her condemnation of what the ADA actually said.

There are many overweight people who eat terrible diets and do not develop diabetes – It is not just your diet.

In my own case, my diet did not make me a diabetic. It made my diabetes happen now, as opposed to years from now.

  • Emma
  • January 20, 2012
  • 1:53 pm

It’s totally my $650 wine habit that’s making me thin and healthy and elitist.

  • KB
  • January 20, 2012
  • 1:56 pm

This is an interesting debate. Many (though not all) who are predisposed to T2 diabetes can prevent diabetes through diet and exercise, but that requires a huge commitment and access to the necessary resources (a good preventative cardiologist, fresh fruits and vegetables, etc.).

An unaddressed question that continues to baffle me: why are nutrition and medical treatment so frequently separated? Why do we calculate the costs of medical care and groceries separately? There is an amazing lack of discourse about these issues throughout the medical and education communities (although fortunately there are people working to change that). It’s absurd that many health insurance plans don’t cover visits with a dietician until a patient has been diagnosed with diabetes.

This is not to discount previous comments: absolutely care varies by person. That is exactly why there needs to be more open discussion about all prevention and treatment options, including how to feed one’s family nutritionally appropriate food, even on a budget (which can be done). Hopefully then we can gather support to dedicate resources to better education and awareness programs.

  • Kelsi
  • January 20, 2012
  • 2:27 pm

As evidenced by the enormous range of opinions – people are very confused about diabetes, insulin resistance, whatever you want to call it.

I am insulin resistant. I do two workouts a day (with the blessing of my doctors) and work really hard to eat right for my own body.

That said: I am still very confused about what carbohydrates I should and shouldn’t be eating. I’ve read countless books, talked to many doctors, nutritionists. And yet, I still feel overwhelmed by carbohydrates. The information regarding them is contradictory.

I feel like an idiot for admitting that.

I have a graduate degree, I run marathons, I read books, I SEEK answers (not a pill or injection).

And I can’t find any solid, agenda-free answers.
But, perhaps, my experience highlights the fact that there is just so much misinformation out there.

Thank you Marion for that great article. Health care reform needs to start with our food, being sick in America is a trillion dollar industry. Let’s all take responsibility for ourselves and eat more veggies, get more exercise.

  • Margeretrc
  • January 20, 2012
  • 4:11 pm

@Murph, “There are many overweight people who eat terrible diets and do not develop diabetes – It is not just your diet.” Very true and I have no problem with you “calling out Ms. Nestle for being over-broad in her condemnation of what the ADA actually said.” There are indeed many for whom genetics does play a big part in determining if/when one gets diabetes. I only posed the question because, the way I see it, there are far more cases of diabetes developing around the world than can be accounted for by a heredity predisposition alone–though in the broader sense of heredity (evolution), I suppose one could argue that heredity plays an integral part in all of them in that most of us have not evolved the ability to handle the huge burden that a diet high in carbohydrates puts on it. At any rate, I totally sympathize and wish you well. If you haven’t already, I highly recommend the information available from Dr. Su at Carbohydrates can Kill (and in the book of the same name), Dr. Bernstein, and other links I have posted above. I’m not diabetic, but I am a scientist and the principals they put forth are invaluable and grounded in solid science.
@Kelsi, You are right. There is a lot of misinformation out there, most of it provided by people/organizations with an agenda. Even the ADA is not exempt. I believe you’ll find the various links I have provided in various comments in this thread are as free of such constraints as possible and grounded in solid science. Check them out. You won’t be sorry. And I have zero ties to them–I have nothing to gain by you checking them out, but you have a lot.

  • Cathy Richards
  • January 20, 2012
  • 5:29 pm

It seems to me there are a lot of comments about the trees in the forest, and not the forest itself. Irregardless of where the stored calories come from, or why, enlarged fat cells have a tougher time using insulin. Improving the body’s ability to reduce blood glucose is the key. In most type 2 diabetics whose pancreases are still producing insulin in normally-sufficient quantities, this can be done through activity, through food choices, or through decreasing the size of fat cells (weight loss) so that the insulin receptors can work better. Take your pick.

What we don’t know about Paula Deen’s Type 2 Diabetes is whether she is insulin resistant, insulin insufficient, or a combination. If insulin insufficiency is part of the picture (genetic or virally caused), drugs are definitely in order. But lifestyle is still crucial: activity, food choices, and weight loss still are crucial.

  • Margeretrc
  • January 20, 2012
  • 8:47 pm

@Karl, Good article. Glad to see someone in the media is not jumping on the “it’s the fat” bandwagon. However, I need to raise a couple of (minor) points–he says diabetes is a disease of affluence and age. Well, I don’t know if India is considered an affluent country, but diabetes is rampant there–among at least some of the poor as well as the affluent. Meanwhile, France, an affluent country, does not have the screaming rates of diabetes that we have. But then again, as he says, they eat a lot of fat and comparatively less sugar and starch. So you see, I buy that some people do have a hereditary predisposition, but I also don’t think the gene pool in France is that different than here. So one has to explain why diabetes is rampant here and not in France, and it’s reasonable to think that has more to do with their diet than their genes.
Also the study he cited is important, but I would like to see the results of a similar study comparing a low carbohydrate, high fat diet with a low fat, high carbohydrate diet. I’m betting the low fat diet would have a higher rate of diabetes. Because people are proving over and over again that you can short circuit your heredity with a low carbohydrate diet, which minimizes the amount of glucose hitting the blood stream. It’s how diabetes was treated before the discovery and subsequent use of insulin.

Leave a comment