You’re SORRY? Oh fuck you.

Dr. Peter Attia thinks about his former patient often, the woman who came to him in the emergency room at Johns Hopkins Hospital one night seven years ago.

She was obese and suffering from a severe complication of Type 2 diabetes, a foot ulcer, which required an urgent amputation. At the time, Dr. Attia admits, he silently judged her. If she had only taken better care of her health, maybe exercised more and eaten less, he thought to himself, this never would have happened to her.

But a few months ago, in a TED talk, Dr. Attia stepped onto a stage and offered a few words to his former patient: “I hope you can forgive me.”

WHAT THE FUCK?  Why should she forgive you?  You’re just another judgmental asshole in a nice long line of judgmental assholes.  Is it really such a stain on your self-image that someone might not worship you as the all-perfect person you want to be?  Why should she spend any pity or compassion on you?

“As a doctor, I delivered the best clinical care I could, but as a human being, I let you down,” Dr. Attia, his voice breaking, said in his talk. “You didn’t need my judgment and my contempt. You needed my empathy and compassion.”

Wow.   Just … wow.   He thinks his “judgment and contempt” did not prevent him from delivering the best clinical care?  Or is he admitting that the “best clinical care I could” might not be the best clinical care?

I still don’t see why he thinks an apology from just one doctor might MATTER at this point.  Maybe it would.  Maybe pigs would fly, I don’t know.

Apparently Attia’s now looking into research on whether “the precursors to diabetes cause obesity, and not the other way around“.  Interesting.  Did he read some genetic research on type 2 diabetes?

Dr. Attia’s insight was informed, in part, by the startling discovery a few years ago that despite paying close attention to his diet and exercising frequently, often for hours at a time, he had developed metabolic syndrome, a precursor to Type 2 diabetes. He had made all the right lifestyle choices, he thought, and yet he was overweight and on a fast track toward obesity and diabetes.

Oh for fuck’s sake.   Dr Perfect is SHOCKED, SHOCKED to discover his body is not 100% under his control at all times.  OMG, this is a REVELATION.

Sources:

NY Times article on Dr Attia, where I pulled most of the quotes from.

Dr Attia’s TED talk.

Interesting Results, or, Fat Not Fatal

Not so interesting in terms of finding that being fat, alone, doesn’t make you die sooner.  But the data on how fat interacts with other conditions is interesting.

Results: In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories.

Source: U of California, Davis

Big Fat Sleep

No, it’s not news that lack of sleep is tied to fat.

What sleep researcher Dr. Orfeu Buxton found is more information on how this occurs.

The resting metabolic rate of the volunteers by the end of the five weeks was 8% lower than where they had started. […]  That could explain why night shift workers tend to gain more weight and have a higher likelihood of obesity than day workers; such weight gain is linked to an increased risk of diabetes and heart disease.

Wow, it’s like the number of calories burned isn’t standard across all bodies at all times!  Or not just affected by exercise!

The scientists learned something else interesting about another mechanism that put the disrupted sleepers at higher risk of diabetes: the combination of having their circadian clocks reversed (sleeping during the day and waking at night) and the poorer sleep they got as a result had an effect on their insulin levels. After three weeks in the lab, the participants produced about a third less insulin from the pancreas in response to meals; with less insulin available to break down glucose, blood glucose levels started to rise and three of the 21 volunteers showed high enough levels to qualify them as pre-diabetic.

Two things struck me about this.  First is that it occurred after 3 weeks.  Second is that only 3 of the 21 volunteers reached the pre-diabetic range, even though they were all living in the same lab undergoing the same regimen.  Again, it’s like they’re individuals or something.

Not News

The website Fark makes fun of news stories that are not, actually, news.

Example:  Students Discover Desks Have More Germs Than Toilets

Why isn’t it news?  Well, it’s a common story that pops up once a year or two, and relies on people not thinking about which is more likely to get janitorial attention.

Today my Google Health section looked a bit like Fark.

First: Paula Deen has diabetes.  Because she’s fat and publishes “unhealthy” recipes, she’s being blamed for “bringing it on herself” with unhealthy food.  Fat people being blamed for their health problems, gee, where have I heard that before.

( Never mind that Ms Deen is 64 and the American Diabetes Association states that the risk of type 2 diabetes goes up with age —  26.9% of people over 65 have it.   Or that the American Diabetes Association states that “Most overweight people never develop type 2 diabetes” and that eating sugar doesn’t cause diabetes.)

Second:  obesity rates?  Were leveling off in 2010.  And 2007.  Lots of stories about it in the last 4 years.   Um….

 

 

Poverty’s Link to Diabetes

[C]onventional wisdom about Type 2 diabetes would suggest that once obesity, lack of physical activity and other lifestyle risk factors were taken into account, diabetes incidence rates would even out between lower- and higher-income groups….

[A recent study found that] for men, being in the lowest-income category (earning less than $15,000 per year), doubles the risk of developing Type 2 diabetes compared to being in one of the highest-income brackets (earning more than $80,000 per year). The risk remains the same when other risk factors are taken into account, such as education, body mass index and physical activity levels.

The findings are even more striking for women in the lowest-income category. For them, the risk of developing type 2 diabetes is more than triple the risk of women in the highest-income category. When education, body mass index and physical activity levels are taken into account, the risk is still well more than double. — CTV

Like other discussion of diabetes risk factors, this is looking at correlation. In looking at other risk factors, a family history of the disease doubles the risk as well.  Other diabetes risk factors that dovetail in with “not enough money” include: stress/cortisol; depression; inadequate sleep; lack of exercise (and while some living in poverty have very physical jobs, they may not get the relaxation and stress-relief benefits that tend to go with leisure-time exercise) and while it’s probably not an official risk factor I doubt that food insecurity would help prevent diabetes.

Coffee at Lunch?

The “coffee drinkers are less likely to have diabetes” idea has popped up again, this time focused on those who have coffee with lunch.  From the abstract,

[T]he hazard ratio in the highest category of coffee consumption [≥3 cups (375 mL)/d] was 0.73 … in comparison with no coffee consumption. This inverse association was restricted to coffee consumed at lunchtime (hazard ratio: 0.66 …) when comparing >1.1 cup (125 mL)/meal with no intake.

.73 or .66 on an observational study doesn’t seem all that huge.  What struck me was how the lower chance of diabetes was associated with women who drank coffee at lunch.  Generally when I have coffee with lunch, it’s actually at the end of the lunch — a sign that I have time to de-stress a bit more and relax.  Stress is known to influence blood glucose levels in non-diabetics as well as diabetics….

But is my experience (coffee with lunch meaning de-stress time) what most people experience?  Or is it really something in coffee?  Right now, there’s no way to know — and I doubt this is going to be double-blind tested anytime soon ;)

Search Trends: Diabetes

A trend I’ve recently noticed in the search terms (WordPress’s handy table of phrases Google says people searched on to get to my site):  fat people who don’t have diabetes.

Specific examples:

why not all obese people get diabetes
do all overweight people get diabetes
i’m obese; will i get diabetes?
why obese people get diabetes
how many obese people have diabetes
how to fat people get diabetes
do all overweight people have diabetes 2
what percentage of obese people get diab
do all overweight people develop diabete

Since there is evidently some confusion out there, I’m going to make it nice and clear in this corner of the net:

No, not all fat people have diabetes.

From the American Diabetes Association – which is not exactly the most fat-accepting group in the world:

Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Why not?  Other major risk factors for diabetes are genetics, race, and age — even sleep patterns have been implicated.   But weight is seen as being something people can control, and weight gain has traditionally been a precursor to type 2 diabetes, so “control your weight” has been the drumbeat of the public health sector.

By the way, research shows that regular exercise alone decreases diabetes risk.  It’s often lumped in with “lose weight”, but in fact, exercise improves your health whether you lose weight or not.

More:

One might even surmise from this that weight gain alone doesn’t cause diabetes, or that diabetes isn’t completely avoidable….

Drink Coffee, Avoid Diabetes?

This was one headline I was grateful to read this morning. For one thing, the laugh was very welcome!

Coffee, Tea Might Stave Off Diabetes

More Evidence Coffee, Tea Could Prevent Diabetes

From the abstract, this looks to be a review-lots-of-observational-studies study, looking at correlations.  The general result?  People who drink more coffee, decaf coffee, or tea* had “an inverse relationship” with people who get diabetes.

Naturally, since drinking coffee/tea isn’t seen as something all Right People Should Do Anyway[TM] (unlike, oh, being thin?) this isn’t being reported as “Of course you should drink coffee/tea anyway, this is just another reason.”   In fact, there’s even statements like Reuter’s “Clinical trials are needed to investigate whether these beverages do indeed help prevent diabetes, the researchers say.”

But whether or not anything actually comes of this, I got a good giggle out of it.

*I assume they mean actual tea leaves, not herbal infusions.

ADA: Not all fat people get diabetes

From the American Diabetes Association:

In a recent survey conducted by Harris Interactive on behalf of the American Diabetes Association, 2,081 Americans were asked questions to test their diabetes knowledge.  The results showed that several diabetes myths and misconceptions are common and diabetes remains a misunderstood disease.

[…]

Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.

According the survey, approximately three in five respondents (59%) did not know that this is a false statement.  In addition, more than half (53%) of respondents did not know that risk for developing type 2 diabetes increases with age.

Fact: Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes.  Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Yes, I’ve posted this before, but it bears repeating: Not all fat people get diabetes.  Thin people should still get blood sugar checks every so many years  — especially if they have a family history of the disease.   It’s not contagious, either.

Most Fat People Don’t Get Diabetes?

I’ve had it banged over my head for decades that “OMG you’re going to get diabetes!!!!”, so when I read this I was a bit flummoxed:

Roughly 20% of the people with Type 2 diabetes are thin, and 75% of obese people never get it.

All those years of worry, of dieting to try to avoid diabetes, of being told that I ABSOLUTELY would get diabetes if I didn’t lose weight permanently, and … 75% of obese people never get it?

Yes, if 25% of obese people get diabetes in their lifetime, that is a large precentage.  But the impression I’d been given was that it was closer to 80% or 90%.   Was I just totally misunderstanding all these years, or just listening to too many scare tactics?

Edited to add: This CDC report from 2004 includes more information on the number of diabetics who are overweight or obese across various ages and ethnicities.  It notes that it did not include people living in nursing homes.

Edited to add: This Gallup poll reports that 11% of Americans overall have diabetes, which would put the rate of diabetics who are fat higher than those who are officially “normal weight”.  Considering diabetes causes insulin resistance and weight gain, this is not suprising.