Summer 2006, I had just got back from spending a year abroad in Spain, so of course, there were people to catch up with and stories to tell. My first night back out in London with friends ended up with John – an old friend of mine – disappearing on us (a usual occurrence to which we were not surprised); but the next morning saw us around a hospital bed where John was receiving urgent medical care.
Over the years we’d known him he’d always been ‘thoroughly lazy’ (lethargic, to be fair), and would often “hibernate” for long portions of the day… turns out, these were severe symptoms of diabetes. John may well have been diabetic for as many as three to four years before we were in the hospital unit with him at that moment, and we’d all notched his behaviour up to simply being… well, a bit of a “bum”. Perhaps if we’d been better informed, we might have recognized the signs and he could have sought help sooner.
It’s estimated that over 400 million adults between the age of 20 and 70 around the world are diabetic, and this figure is expected to rise to over 600 million in the next 20 years. In the UK alone there are over 4 million people suffering with diabetes, and it is thought that there may be half a million more who are undiagnosed. John’s case surely highlights the fact that our awareness of the condition [as a society] needs to improve to help prevent more cases from developing.
Roll on March 2009… I had just embarked on my latest adventure – having worked in the Fitness Industry (in a sedentary role: Sales) for a couple of years after graduating – I decided to fly halfway around the world to discover a new culture, and delve into a new chapter in my life [teaching English as a Foreign Language]. What happened within the first week of being there was far from expected…
Although I’d had to get a myriad of shots and jabs before arriving to South Korea, upon arrival I was required to undergo a thorough Medical Exam, the results of which were that I discovered that I [too] had become Type II Diabetic.
Whilst not entirely *shocked* by the news, it still threw me off, and I couldn’t help but think about how churlish I had been towards my friend John [in the past], in assuming him to simply be akin to a human sloth; alas, here I was – having spent the previous couple of years in the *Fitness Industry* (irony of all ironies) – and it turns out that, well, anyone can become diabetic. Granted, there is a complex interplay of genetic and environmental factors when it comes to Type 2 diabetes, as it tends to cluster in families. People with diabetes in the family are two to six times more likely to have diabetes than people without diabetes in the family. And in my case, my Dad had been diabetic, so it “made sense”.
In a way, John’s case from years before had helped with regards to my awareness of the condition, and I had done some research into it, and remembered having read that *Type 2* was, in fact, reversible. That was all the motivation I needed – the mere opportunity to be able to turn things around; a second chance, if you will.
I went back to researching everything I could, but the first “real world” problem I encountered was one of culture and gastronomy… Of course, now I’m living in Asia, and carbohydrates are everywhere! The first thing you learn about Diabetes is: ‘Carbs are the Enemy’… Of course, that’s not true – you just have to figure out how best to consume them so as to avoid problems. However, going from typical Western eating to “noodle and rice heaven”, threw a bit of a curve ball my way. It was at this point that I discovered the Paleo Diet, and one type of Korean food that absolutely worked perfectly with it: Korean BBQ! High in protein & fat, and [relatively] low carb – ideal. For those of you who are unfamiliar, Korean BBQ is effectively barbecued meat (usually pork, but could be chicken or beef) paired with lettuce leaves and tons of little accompaniments that are almost all vegetal in nature; rice and noodles are very much considered an optional extra. I also turned to Martial Arts in a bid to hone my discipline and stay active, as well as an incredible way to immerse myself in their culture.
My time in Korea went smoothly, and my symptoms of diabetes were seemingly in check. But a year on, and it was time to uproot and move again, this time relocating [back] to Spain. Now, I had two new problems: yet another new culture and gastronomy to adapt to; Spanish cuisine [a.k.a. the “Mediterranean Diet”] – although touted for being one of the healthiest in the world – wasn’t created equally in all parts of the country. The more central regions eat far less fish, and far more red meat, so instead of plenty of super health Omega-3s, you get tons more saturated fat. Now again, we can’t go demonizing entire food groups or macronutrients; but this brings me to my first major revelation towards better understanding Diabetes: Moderation.
See, the second issue I had was that I no longer had Martial Arts to keep me distracted. Distracted from going out and drinking. Distracted from my one long-standing addiction: candy! Distracted from real life, basically. I quickly discovered a candy shop that I loved, and I would binge on massive bags of Pick ‘n’ Mix at the weekends. I started to notice that I was feeling really lethargic, and another cultural aspect that wasn’t helping either was the *siesta* – they wound up being an excuse to “crash” from a sugar high, which was a horrendous way to be treating my body. Worse still, I started to put on weight; the biggest misconception about Diabetes is that people assume that you have to be either severely overweight or even obese to have it. I forgot to mention, but John, was 5’ 7” and barely 150lbs, and I was 5’ 11” and around 165lbs (steadily gaining 20-30lbs over the course of a few years) … but neither one of us were exactly “tipping the scales” in a big way.
I decided that I had to make some changes before I risked letting things get worse, so I joined a bodybuilder’s gym, and gave the Paleo Diet another go. Resisting the daily temptations was still difficult, but I found that if I simply exercised a little more self-discipline with my choices but still allowed myself small “treats”, then I could enjoy occasional bouts of naughtiness, but strictly in moderation. This proved to be the best way of preserving my sanity while trying to lead a healthy lifestyle. The thing is, we’re not lab mice, so we can’t have our environment controlled for us; we must consider that certain human behaviour is simply normal, but try to make more informed decisions regarding what we eat.
The next thing I had to do was better understand what was going on internally. It was all good and well to have sussed out the food and to be getting back in the flow with keeping active, but I had always been slightly flummoxed by all the “biochemistry” of it all. This was the point at which I realized that I had to go about learning in a different way. Nutrition was always interesting to me, so I’d happily read up on it for fun. Endocrine systems, insulin, human physiology, and the like were interesting in some cases, but just mind-numbing to read about. So, I started to watch videos on them. As I better understood things, I developed analogies to better understand what goes on inside a diabetic – what was going on inside me at the time.
The first analogy I worked on was a different way of viewing carbs. Now, public perception of fat is generally that it is bad, and this notion is deeply engrained, so much so that most people won’t even question it. But then, just look at what the UK and U.S. governments have been telling us for the past 40 years: “eat less, exercise more… oh also, don’t eat fat, and carbs aren’t the problem”; and this was all based on outdated information, and poor science. Fortunately, there has been more recognition in recent years as to how *sugar* is the main issue when it comes to diabetes and obesity. But we can see how confirmation bias has reinforced itself over more than a generation.
So, if carbs are okay, but sugar is bad, but carbs are made up of sugar… how can we better understand something that is already terribly obscure at its most basic level?
Well, I want you to imagine you have a wallet [or a purse] in your hand (you can go ahead and grab one if you wish). This wallet should be empty to start. Now, if you take a single dollar bill/note and put it inside, it won’t take up much space, right? (This example works best with dollars!). However, if you were to go ahead and try putting ten dimes in there, it would feel a lot heavier. Let’s consider GBP for a moment: it would be the equivalent of having a fiver in your wallet versus ten fifty pence coins. So, the wallet represents your body. The paper money would be carbohydrates. And the coins would be *sugar*. Let’s give a more complex example: say you have three dollar bills and twelve quarters – the value of the coins is equal to that of the paper money, and you have a total of $6. Half as paper, half in coins. So, if we say that those $6 represent six grams of carbohydrates in total, we could say that 3 grams of it is sugar. It would clearly be easier on the wallet to have six single notes because the coins take up a huge amount of space in comparison. So, when we look at carbs and sugar in relation to the body, just think of how overstuffed your bloodstream and cells become when you have too much sugar, whereas if you had carbohydrates (of which little to none was sugar), the impact would be far less.
That’s how I now look at sugar – if something I pick up at the shops says (for example), ‘20g Carbs, Of Which 12g is Sugar’, that’s a rather large percentage of it that is going to reap havoc internally (over half); but if it said ‘20g Carbs, and 1.4g Sugar’, that is going to have far less impact on your blood sugar levels.
The second analogy looks at the dreaded hormone: insulin (and its buddy – glucagon). I use the motorway as a metaphor in this instance. If we look at sugar as being a rowdy bunch of bikers, it is safe to say that one rowdy biker is manageable for the police (played by *insulin* in this analogy). So, one gram of sugar (one biker) isn’t going to cause too big a problem. But a whole gang of twenty or so… well, that’s going to call for more police on the road. And this is where things start to get messy. Having one police patrol on the motorway to monitor things is good for everyone’s safety. But having an entire squadron in pursuit of a whole gang is just chaos. So, if the motorway represents your veins and arteries, and we’ve just taken up all the lanes with police and bikers, a crash is somewhat inevitable. The job of the police (insulin) is to get those bikers off the road (out of your bloodstream) and into… well, cells (works perfectly, no?). So, insulin has done its job and cleared the way of all the sugar, but the carnage was akin to a Die Hard movie, and you’re the one left feeling the aftermath. Then we have glucagon – we can consider this hormone as the delightful “parole officer”. It is glucagon’s job to escort sugar out of the cells and back into the bloodstream, but in a way that ensures that the sugar behaves and goes right to where it’s needed with no rowdiness along the way. The biker – “sugar” – is now “reformed” and duly entering the bloodstream in a controlled manner headed to wherever it is required to perform “community service” (i.e. be put to use by our muscles).
Understanding the impact of sugar on the body, the role of insulin, and the fact that moderation is vital are the three things that helped me reverse Type 2 Diabetes. It took a couple of years, but when I went to get tested by doctors (both in Spain, and again a couple of years later in the UK), I was diabetes-free [each time].
In Spain and Korea I worked as a teacher. Now – back here in the UK – I have re-entered the Fitness Industry under a more meaningful role, and am one of the highest qualified Personal Trainers specializing in Diabetes & Obesity. I believe it was C.S. Lewis who wrote, ‘The Task of the Modern Educator is not to Cut Down Jungles, but to Irrigate Deserts’, and I believe this to be true and of paramount importance on the subject of Diabetes. There is so, so much information out there, and it can be very contradicting depending on whose opinion you read or hear. In working with my Personal Training clients and seeing members everyday who come to have a program written, it has been eye-opening to see just how under-informed we are as a society (due to the lacklustre eating decisions so many people are making – and thinking they’re healthy), and more worryingly, just how few Trainers actually take the leap to become a Specialist; so really, the modes of attaining enlightenment on the subject mostly derive from the Chinese whispers of whatever one Googles these days, thus giving rise to the futility of attempting to single-handedly cut through the proverbial jungle.
My insights have helped the people I work with to make positive lifestyle changes, but more importantly, in a way that they better understand the effects of these changes and why they’re so crucial to implement. Understanding that “eat less, exercise more” is an antiquated approach with extremely poor likelihood of adherence and/or success is a turning point that we as a society must reach.
Since the mid-90’s the number or cases of diabetes has more than doubled, and figures suggest that we’ll see a further 20% increase in the next 5-10 years. Therefore, it is fundamental that people receive better information that is more readily “absorbed”, and I hope that with even just the couple of simple analogies I’ve provided, that maybe someone reading this who may have been recently diagnosed, or perhaps knows someone close to them with Diabetes may have something of an epiphany or a “eureka moment” like I did. Then they can implement the necessary changes, and who knows, maybe instead of an increase in the number of diabetes cases, we may just see an increase in the number of people reversing the condition and living a healthier, more normal life. Once those deserts become irrigated, the change of environment can be unrecognizable in the most splendid of ways.
Yours in Training,
Chris Atkinson | Master Personal Trainer, SDO