CHAPTER 14

D IS FOR DIABESITY

KILL THE SUGAR BEFORE IT KILLS YOU

Don’t dig your grave with your own knife and fork.

ENGLISH PROVERB

Both my wife, Tana, and I know what it is like to have loved ones die of “diabesity,” the double-barreled threat of diabetes and obesity. It robbed Tana of one of the most important people in her life: her grandmother Abla. From a young age, I also observed the devastating toll these conditions took on family members and friends. For that reason, rather than beginning with a case study from the Amen Clinics, I want to go further back and introduce you to two people affected by diabesity, both of whom helped steer Tana and me toward careers in the health profession.

GRANDMOTHER ABLA: THE DEVASTATION OF DIABETES

One of Tana’s first —and fondest —memories of her grandmother was of her large, soft belly. When she cuddled with her grandmother, Abla’s ample lap and infectious giggles gave Tana a sense of comfort and security. Everything on Abla’s four-foot-eleven, 200-pound body was round and soft. As a child, Tana found Abla’s plumpness endearing.

Tana also loved the comfort foods her grandmother prepared for the two of them. She savored the warm Syrian bread smothered in butter and dripping with honey. (In a pinch, they’d substitute tortillas slathered with butter and sugar.) In this way, her grandmother passed along her unhealthy attachment to food. As a lonely latchkey child, Tana learned to comfort herself with the same warm, sugary foods her grandmother ate.

As a girl growing up in what is now Lebanon, Abla had been terrorized by Turkish soldiers. The emotional trauma caused her lasting pain, and sugar was one of the ways she medicated herself. Sugar and other simple carbohydrates increase serotonin in the brain and help people feel happier and more relaxed. Unfortunately, they also predispose people to diabetes and obesity and can cause serious mental health crises; Tana’s grandmother had several.

Abla had been diagnosed with type 2 diabetes before Tana was born. At the age of 11, Tana started administering Abla’s insulin shots because diabetes had compromised her grandmother’s eyesight, so she could no longer be trusted to give herself the correct dose. The responsibility fell to Tana because her mother was working three jobs.

By the time Tana was 12, Abla spent her days staring at the television set in her bedroom, even though she could barely see it. She was legally blind and had heart disease as well as significant neuropathy (pain, numbness, tingling, and ulcerations) in her hands, feet, and eyes. Neuropathy made it a struggle for her to walk, even just from her bed to the bathroom. She finally gave in to using a bedside commode, a humiliation for this proud, modest woman. The tips of her toes turned black, sores oozed on her legs, and she sometimes cried from the pain. Had she not died of heart disease, Abla’s toes would have had to be amputated.

Tana mourned not only the loss of this sweet woman, but all that diabetes had stolen from her grandmother. Her experience helping administer Abla’s insulin shots and caring for her physical needs was part of the reason Tana became a nurse —and became serious about guarding her own health.

Sam: addicted to sweets

Sam was the father of one of my best friends when I was a teenager. I knew him for more than 30 years. Sam struggled with alcoholism, temper problems, and his weight, and at age 55, he was diagnosed with type 2 diabetes. When I was in medical school, Sam confided in me that if his doctor told him he’d have to take insulin shots, he would kill himself. Thankfully, when he learned he had to get the injections, he didn’t commit suicide, but over the next 20 years, his uncontrolled diabetes killed him, slowly and painfully, organ by organ. Even though he was repeatedly counseled to stop eating sugar, Sam was addicted. He would sneak out for doughnuts, sugary pastries, ice cream, and candy. Even though his wife and children were furious with him, he just couldn’t stop himself. Sam was able to give up alcohol, but not sugar. Over time, he lost his eyesight and both his legs, and he died with dementia. It was tragic to watch, especially because it didn’t have to be that way.

FROM THE BRAIN WARRIOR’S WAY LIVE CLASS

“It is very interesting when I go to the grocery store. There are whole sections of the store I don’t even go through anymore because they no longer apply to my life. At the checkout stand there is always a variety of junk food to tempt people on the way out. It’s funny that my eyes see the candy bars, but I am not tempted to eat them because they register in my head as nonfood items. It’s like [I’m] looking at a candy bar, but it registers in my head is if it were tape or razor blades or something. I am not tempted on a whim to buy tape or razor blades and run home and eat them in the closet. . . . The candy no longer calls my name! Mr. Snickers and I are officially divorced. Yeah!”

“My husband looks great! And he is no longer prediabetic! Thank you.”

“My husband’s A1c went from 9.4 to 6.2 since we started The Brain Warrior’s Way. How’s that for success! I realize that so many of the things you’ve taught us are now part of my regular routine and my mind-set. My cabinets have only good-for-us foods. My comfort food recipes have changed. Even things you and Tana have said keep popping into my head. . . . A friend was complaining about loving a food that bothers her. I said to her, ‘Why would you eat something that doesn’t love you back?’ Oh, my goodness! I am a Brain Warrior!”

Both diabetes and obesity are independent risk factors for memory problems and several forms of dementia. In this chapter, we will explore these two risk factors, why they cause problems, and what you can do about them.

Insulin: The Blood Sugar Hormone

Think of the hormone insulin as a fuel regulator that unlocks cell membranes so they can absorb glucose (sugar) and other nutrients from the bloodstream. The pancreas secretes insulin whenever you eat carbohydrates. Simple sugars and highly processed carbohydrates, such as baked goods, candy, bread, pasta, and crackers demand a large release of insulin and can cause significant blood sugar highs and lows. One consequence of high insulin levels is that the body switches from breaking down dietary fat to storing it, which, over time, can lead to weight problems.

One of the biggest consequences of aging is a loss of insulin sensitivity in the muscles and a decrease in insulin’s ability to regulate blood sugar, leading to prediabetes and diabetes. Eliminating sugar and other simple carbohydrates from your diet can help regulate your body’s production of insulin; allow fat to be broken down for energy; and prevent the depletion of chromium, a mineral required by insulin receptors.

DIABETES: BLOOD SUGAR BLUES

Diabetes develops when insulin, the hormone that regulates blood sugar levels, becomes deficient or ineffective. The illness has two forms: Type 1 diabetes occurs when the body refuses to make insulin, and type 2 develops when the body mismanages it. (Prediabetes is a precursor of full-blown type 2 diabetes.) In both types, the body is subjected to chronically high blood sugar levels, which damage blood vessels, causing them to become brittle, inflexible, and more likely to break. Damaged blood vessels cannot supply nutrients or take away toxins, which ultimately leads to problems with every organ in the body, including the brain. Recently, scientists reported new evidence linking abnormal insulin levels to Alzheimer’s disease and cognitive decline.[510] The correlation is so strong that some researchers have labeled Alzheimer’s “type 3” diabetes.[511]

Risk factors for diabetes include aging, a family history of the disease, excessive consumption of sugar and high-glycemic foods, obesity, alcohol abuse, exposure to toxins discussed in chapter 10, and a sedentary lifestyle. Watch for these warning signs: increased urination, excessive thirst, increased appetite, and delayed wound healing.

The negative effects of diabetes include increased inflammation, depression, Alzheimer’s disease and vascular dementia, strokes, heart disease, hypertension, and accelerated aging.[512] Diabetes has been linked to decreased blood flow to the brain (the number one predictor of future memory problems), apparent on SPECT imaging,[513] and a smaller hippocampus.

Scientists have been studying whether medications for diabetes might help people with Alzheimer’s, and the answer seems to be yes. Medical data from more than 145,000 diabetics treated with two common medications to lower blood sugar —Actos (pioglitazone) and Glucophage (metformin) —revealed that they also lowered the risk of dementia.[514] Another study found that dementia-related changes in the brain could lead to diabetes, instead of the other way around.[515] This is contrary to what had been previously thought —that diabetes begins with trouble in the pancreas or a high-fat and/or high-sugar diet.

Even mildly elevated blood sugar levels and prediabetes are significant problems and are associated with brain atrophy, memory problems, and dementia.[516] In people who didn’t have diabetes, for example, the risk for dementia was 18 percent higher for those with an average blood glucose level of 115 milligrams per deciliter compared to those with an average glucose level of 100 mg/dL. (See “Checkup for Diabesity Issues” for information on healthy blood sugar numbers.) And every incrementally higher glucose level was associated with a higher risk of dementia. “High-normal” blood sugar levels have also been associated with shrinkage in the hippocampus (leading to memory problems).[517] The dementia risk was even worse for people who had diabetes, because their blood sugar levels were generally higher: It was 40 percent higher for people with an average glucose level of 190 mg/dL compared to those with an average glucose level of 160 mg/dL. That’s a lot of numbers, but the bottom line is that the higher your blood sugar level, the higher your odds of getting dementia.

Here is the scariest part of this story: Diabetes and prediabetes now affect a horrifying 50 percent of the US population.[518] Blood sugar problems have dramatically escalated in the last 30 years. One of every 100 people in the United States had type 2 diabetes in 1960; that percentage has increased tenfold to 1 in 10 people today. The rate of type 2 diabetes has increased 700 percent just since the 1980s.[519]

Our sedentary lifestyles and standard American diet (SAD), along with increased toxins, are likely to blame. The great news is that a majority of these cases are preventable. Lifestyle changes have actually been shown to reverse the disease. People of faith may also find motivation in the fact that making better dietary choices honors their Creator, who designed foods that in their natural state can perfectly meet our bodies’ needs: “Whether you eat or drink, or whatever you do, do it all for the glory of God” (1 Corinthians 10:31).

OBESITY: THE RISK OF THE “DINOSAUR SYNDROME”

In 2010, my friend Cyrus Raji, MD, PhD, and his colleagues at the University of Pittsburgh (Dr. Raji is now at the University of California, San Francisco) published a study on elderly adults that looked at the relationship between brain volume and body mass index (BMI),[520] a measure of body fat based on weight and height. They found that compared to people who were at a healthy BMI (18.5–25), those who were overweight (with a BMI of 25–30) had 4 percent less brain volume on MRI and their brains looked eight years older; people who were obese (with a BMI greater than 30) had 8 percent less brain volume and their scans looked 16 years older. After I read Dr. Raji’s study, our team at Amen Clinics published research that looked at our brain SPECT scan database and found the same trend in our overweight and obese patients.[521] Following the publication of these papers, dozens more have been published with the same finding.

Shortly after we published the paper on obesity, I was flying from Chicago to Des Moines on a small plane to do a public television appearance for my program Change Your Brain, Change Your Body. The woman who sat in the seat next to me was extremely obese. Part of her body was in my seat, which made things a bit uncomfortable for both of us. About halfway through the short flight, this thought came to mind: You should tell her she wants to avoid the “dinosaur syndrome” —big body, little brain —so she doesn’t become extinct.

My next thought was Shut your mouth! That is so rude.

Did you have a mother like mine, who used to say, “If you don’t have anything good to say, don’t say anything at all”?

When I got off the plane in Des Moines, I called my wife, Tana, and told her about the dinosaur syndrome and my crazy thought. She said, “Don’t ever say that out loud. That is so rude!” We think alike.

Two weeks later, Tana and I were visiting a health-care company about possibly working together. The marketing director —I’ll call him Will —was morbidly obese, which frustrated me. I believe if you don’t live the message of your work (his was health), you cannot be a good messenger. But I didn’t say anything until that night, when we were out at a restaurant with his marketing group. Whenever I go out to dinner, I try to be thoughtful about what I put in my body. I love my brain and try to protect it. I ordered a salad with blackened wild salmon and grilled asparagus. After Will ordered clam chowder and chicken-fried steak with mashed potatoes, along with wine and two chocolate soufflés for dessert (one for the table), I couldn’t take it anymore. I said, “Will, you might want to avoid the dinosaur syndrome.” At that point Tana kicked me under the table and gave me the look that only your wife can give you, the one that says, “What’s the matter with you?”

But Will was curious. “What do you mean?” he asked. That prompted a long discussion about his goals, weight, brain size, and health.

“How old are you?” I asked.

“Forty-two,” he said.

“Are you done with your career? Have you achieved your goals?” I queried.

“Not even close,” he said.

“Then you need your brain to be healthy to progress even more,” I said, stating what was obvious to me, but unfortunately is not to most people.

He said his cholesterol had been fine and his doctor didn’t seem “that concerned” about his weight. He asked why I thought there was a connection between weight and brain size.

I replied, “The fat on your body is not innocuous. It produces inflammatory chemicals that can damage every organ in your body. Depression and dementia are associated with inflammation. Plus, fat stores toxins, so the more fat on your body, the higher your toxic load; and belly fat turns healthy forms of testosterone into unhealthy, cancer-promoting forms of estrogen.”

After our conversation, Will vowed to get serious about his health. A month later he wrote to tell me that he was down 17 pounds, and after a year he had lost 80. He has since been promoted multiple times.

With two-thirds of Americans overweight and more than one-third obese, we are seeing the biggest brain drain in the history of our country. It has even become a national security crisis: The military rejects 70 percent of potential new recruits because of health reasons, with weight issues being the most common cause. Obesity has also recently been associated with 11 different types of cancer.[522]

It is critical to get your weight under control because excess pounds can damage your brain. (And if you are also diabetic, the harm may be even worse.[523]) In a study that followed more than 10,000 people for 36 years, being overweight or obese in midlife was shown to be strongly associated with memory problems and dementia in later life.[524] In another study of 408 healthy adults, as BMI went up, cognitive scores went down, especially in decision making (executive function).[525] In yet another, overweight people were less responsive to memory training.[526] With all of this new information, our team at Amen Clinics looked at our NFL player data and found the same correlation: When we paired players by position, the function of their prefrontal cortex went down (as well as their scores for reasoning and memory) as their weight went up.[527]

This information got my attention, too, as I was once overweight myself. Over the course of a year or so, I lost more than 25 pounds, and I have kept it off for the past 10 years. I never want to knowingly do anything that harms my brain. I use all the principles in this book because, like you, I need to live the message. 

Metabolic Syndrome (MetS)

Five common risk factors raise the odds of heart disease, diabetes, and stroke. When you have at least three, you have a health problem known as metabolic syndrome, which is closely related to insulin resistance. The five risk factors are:

Watch out for any combination of these symptoms; MetS increases your overall risk of memory problems and dementia by a whopping 300 percent.[529] It is also associated with low blood flow throughout the brain.[530] If you have or suspect you have MetS, take it as a sign that you need to make a number of lifestyle changes to keep your brain working for you. The good news? You can do something about it if you are serious about rescuing your memory. Losing as little as 10 percent of your belly fat can decrease your cardiovascular risk by 75 percent.

CHECKUP FOR DIABESITY ISSUES

To make sure your weight doesn’t become a health issue, you should always know how you stack up on these health numbers.

Body mass index (BMI)

Your BMI is a measure of weight compared to height. An optimal BMI is between 18.5 and 25; the overweight category falls between 25 and 30; over 30 indicates obesity, and over 40 indicates morbid obesity. If you take our free Brain Health Assessment on www.amenclinics.com, we will calculate your BMI.

Waist to height ratio (WHtR)

Another way to measure whether your weight falls in a healthy range is to calculate your waist to height ratio. Some researchers believe this number is even more accurate than BMI because the most dangerous place to carry weight is in the abdomen. Abdominal fat, which is associated with a larger waist, is metabolically active and produces various hormones that can cause harmful health effects, such as elevated blood pressure, high cholesterol and triglyceride levels, and diabetes.

WHtR is calculated by dividing your waist size by your height. A woman with a 32-inch waist who is 5’10” (70 inches) would divide 32 by 70 to get a WHtR of 45.7 percent. Generally speaking, it’s healthy to stay under 50 percent —in other words, your waist size should be less than half your height in inches. When measuring your waist size, use a tape measure! Don’t hazard a guess or rely on your pants size, which can vary among manufacturers. In my experience, 90 percent of people underestimate their waist circumference.

Lab tests

Get blood tests for your fasting blood sugar, insulin, and hemoglobin every year. If they are abnormal, think of it as a health crisis to be taken very seriously.

The Strategies

The exciting news about diabesity is that, with a targeted plan, you can significantly decrease your odds of diabetes and related illness.[531] As with all the BRIGHT MINDS risk factors, it is important to take the long view and develop a lifestyle you can live with and feel happy about. Even though you will feel better quickly on the Memory Rescue plan, you need to stay with it for a year to get the long-term benefit for your brain. This recommendation is consistent with the findings of others’ research as well.[532]

  1. 1. Follow the Memory Rescue Diet. It’s especially important to limit high-glycemic, low-fiber foods (sugar and foods that turn to sugar), wheat (including whole wheat), and processed foods, and to eat a diet high in smart carbohydrates, which are high in fiber and low on the glycemic index. This diet will give the pancreas a break from constantly having to secrete high levels of insulin and will make your cells more insulin-sensitive. A Swedish study compared the effects on blood sugar of a grain-free diet (Paleo) and a Mediterranean diet, which relies, in part, on whole grains. After 12 weeks, the blood sugar levels were markedly lower in the Paleo group (down 26 percent) than in the Mediterranean group (down 7 percent). At the end of the study, all patients in the Paleo group had normal blood glucose, which was not true for those in the Mediterranean group.

    Grains may impact weight and insulin resistance because they contain proteins called lectins, which some researchers suspect can promote inflammation and halt weight loss efforts. Aside from promoting weight loss and improving blood sugar regulation, avoiding grains is very beneficial for overall intestinal health. Anti-inflammatory in nature, the Memory Rescue Diet promotes a favorable balance of good to bad bacteria in the gut. In addition, many patients feel relief from minor digestive discomforts such as bloating, gas, and indigestion when following a low-sugar, no-dairy, no-grain plan.

Bright Minds Tip icon

A daily glass of fruit juice has been linked to signs of preclinical Alzheimer’s disease. Choose whole fruit instead.[533]
  1. 2. Lose weight slowly (if you need to lose). It’s the healthiest way to drop pounds and keep them off. A good, safe rule of thumb is one to two pounds a week. Here are more weight-loss tips:
  2. 3. Exercise! It’s known to improve blood sugar levels and reduce weight, and it also helps with detoxification. Strength training has been shown to be particularly effective. Compared with women who reported no strength training, women engaging in any strength training reduced the incidence of type 2 diabetes by 30 percent.[536] All movement matters, even just walking, but walk as if you are late[537] (see chapter 5, page 67).
  3. 4. Check with your physician to see if other treatment is necessary. Depending on your personal numbers and your genetic risks, you may be able to improve your health without resorting to taking medication.

The Nutraceuticals

Bright Minds Tip icon

Cinnamon can help your blood sugar levels and spice up your love life.

The Foods

AVOID (OR LIMIT):

CONSIDER ADDING:

PICK ONE HEALTHY BRIGHT MINDS HABIT TO START TODAY

  1. Know your BMI now and check it monthly.
  2. Measure your waist-to-height ratio.
  3. Don’t drink your calories.
  4. Start the Memory Rescue Diet.
  5. Eat protein and fat at each meal to stabilize blood sugar and reduce cravings.
  6. Lose weight slowly if you are overweight, and develop lifelong healthy eating habits.
  7. Supplement with chromium picolinate.
  8. Take alpha-lipoic acid.
  9. Use cinnamon and nutmeg in your cooking.
  10. Weigh yourself daily —it will keep you honest and motivated.[555]