Paula Deen ~ A Classic Case of Type II Diabetes

Was anyone surprised by the revelation that Paula Deen has type 2 diabetes?   See here and here, for example.  Full disclosure here.  I'm a NorthEast girl and was raised pretty agnostic in terms of regional foods/cuisines.  Still, as an adult I've enjoyed learning different cooking styles, flavors and ways of preparing foods and I'm an admitted Food Network junkie.  But Paula?  She was not one I ever watched much (unless she was judging on a competition show).  Sure, I love some Southern foods -- chicken fried steak w/gravy anyone?? -- but most of those foods are reserved for traveling to where they are local fare (although Chili's does make a pretty good version of the aforementioned steak).  And I find her accent and delivery just a wee bit over the top.  But I think every time I've ever seen the woman cook, I've seen her put half sticks of butter in a pan while saying jokingly that she's adding "a little".  Butter and Paula are synonymous in my mind -- if someone said Paula Deen in a word association game, butter would be the word that popped out of my mouth.

Now I'm not sure if Deen has the genetic predisposition towards T2, but aside from that, she's got all the lifestyle risk factors:  She's 64 or 65 depending on the source, which means she was over 60 when diagnosed -- IOW she's your classic example of why T2 used to be called Adult-onset diabetes.  She's overweight and was admittedly inactive.  She also consumes a very high fat diet and a considerable amount of sugar (she says she used to drink a lot of sweet tea).  

I can see the low carbers now screaming how it wasn't the butter and all that fat that made her diabetic.  Carbohydrates did that!  I remember someone on Jimmy's forum trying to tell people that Deen's cuisine was great except for the carbs and Julia Child basically cooked low carb.  Advocates from all corners of the health sphere have had their knives out for Deen and her diet.  Folks, her cuisine has a demonized macro or food for everyone.  There's the sat fat, the whole fat, the meat, the cholesterol, the wheat, the carbs, the sugar.  Did I miss anything?

It's funny, though, nobody seems to have a problem looking at the overweight Paula and blaming that she eats "fattening foods".  The TWICHOOBS are predictably clinging to the "it was the carbs" chant, absolving the hundreds of calories of butter she put into every dish she made.  No offense to Southerners, but few cuisines I can think of have succeeded in making even vegetables fattening.  Grok didn't smother his greens with rendered wild boar fat.  

So Paula Deen is a classic T2.  Perhaps she had the genetic susceptibility, but she overate and was either in caloric excess or caloric balance at a weight exceeding the ability of her fat stores to properly buffer lipid levels in circulation.  In the next week or so I'm going to flesh this out with some research.  But as it turns out , our current knowledge points mostly to the fat in her diet that put her over the edge, as her fat cells were no longer able to efficiently clear the fatty acids from her high fat meals from her bloodstream.   I have no doubt that if she's had the scans, she has considerable ectopic fat deposition in muscles, liver and pancreas.  Drinking sweet tea throughout the day probably compounded her liver fat and hepatic insulin resistance.  

If she were my mom, I would find a way to encourage her to lose weight fast.  I'd probably (gasp!)  advocate a low carb diet (a sane one where she's cutting back on that butter too).  The reason being I think that for the short run she could probably eat similarly foodwise to how she does now and achieve the dramatic caloric deficit that seems to do well to drop pounds fast, but more importantly, drain the ectopic fat swamps.  She's already doing the other thing I would suggest -- being more active.  Once insulin sensitivity is improved, it's time for some dietary changes to a more balanced macro ratio.  That's if she were my Mom ... because otherwise Paula would become an amalgamation of two well known low carbers making sugar free cakes and pies and loading down veggies and meats with butter and such.   And long term VLCHF does not have a good track record in populations outside the Inuit either for weight maintenance or glycemic control.

The predictable reactions amongst LC'ers to Paula are evidence that much needs to be done to educate people on what IS known about the causes of diabetes.   The scientists don't have all the answers yet, but where diet is concerned, they have provided us with knowledge of the diets that promote diabetes in susceptible populations.  Here is where Taubes has done the most damage with his lies about the Pima.  Yes, lies.  In Taubes' version of history, the traditional Pima diet was relatively low carb, although in his lectures he tends to slip in the truth that agriculture was integral to their culture.  As Gary tells us, after they assisted white settlers, those settlers returned the favor by diverting the Pima's river and hunting their game to extinction, thereby impoverishing them.  The Pima experienced a period of famine and were essentially converted to eating a diet of government rations.  The human part of this history lesson is true.  The dietary part?  Pure figment of Taubes' cherry-pickin' imagination.  The traditional Pima diet :  " although seasonably variable, was [estimated] ∼ 70–80% carbohydrate, 8–12% fat, and 12–18% protein. "

The story of the Pima has been repeated  with cultures around the globe as these formerly isolated cultures were exposed to Western foods.  This continues today on a different level as more developed yet somewhat traditional cultures are now exposed to the more modern processed/refined/convenience foods permeating the West.  The story for the Pima was NOT, as our intrepid science journalist concocted, a poisoning by carbohydrate.  It was eating a more SAD-like diet.  And while I'm on the subject of misrepresentations and outright lies, the obese Pima, and the obese in general in this country, do NOT eat the USDA Food Pyramid or anywhere near something resembling a low fat diet.  Most of these cultures ate far less fat than what we consider "deprivingly" low fat at 20%.  The dietary recs are for 30% -- hardly low fat -- but the obese tend to eat closer to 40% fat.  Interestingly enough, two regulars here at the asylum have each lost like 20 lbs this past year eating ... SAD macronutrient proportions!  30-40% fat, 15-20% protein, 45-55% carb.  But that's just FYI anecdotes.

It wasn't increasing carbs, and the supposed postprandial insulin spikes they elicited that spurned the obesity and diabetes epidemics in the Pima.  IF we're going to blame a macro, it is the fat.  A return to traditional diets is almost invariably cutting fat from the modern diet, with that one exception of the Inuit we know we all really descended from.   Even if the Pima tale were true, Taubes' insistence that anything that increases postprandial insulin leads to IR is just simply NOT supported by the peer review literature.  There is support for the notion that the 65% high carb diet advocated by the ADA may not be high enough in carbs!  Carbophobic TWICHOOB's can't wrap their heads around this.  All I can say to those people is to KEEP reading and keep an open mind when doing so.  In researching some of the Rosedale safe starches posts, I darned near converted to a low fat diet in a fit of panic!   Some historical posts here on this notion of carbs causing insulin resistance.

GCBC Reference Check ~ Part V of ? ~ Insulin Resistance: Taubes v. McGarry 

 Insulin Resistance ~ Taubes v. McGarry ~ Speaking of Banting ...

You might recognize the first commenter on that second post (from March 2011) - one Dr. Stephan Guyenet.  He's taken quite a beating on many blogs for going insane, changing his mind, etc.  Oddly enough from some of the very same people who decry intransigence in scientists for failing to "think outside the box".  That's not the way I see it.  Stephan is a good scientist and offers his interpretations based on the evidence available.  The role of free fatty acids in the etiology of diabetes is unmistakable, but there are gaps in the knowledge as to exactly how.  Also, acknowledging this role does not compete with the known detriments of hyperglycemic glucotoxicity.  But the notion that glycemic control is all there is too it is oversimplified.  Hyperglycemia -- aka what is diagnosed as diabetes -- is the end result of the pathologic progression.  It may well be that when one is at the cusp of beta cell malfunction, excessive postprandial glucose excursions put you over the edge, but they are not what "wore your beta cells out" or even what caused the basal hyperinsulinemia that is exhibited by the "classic" T2's and existed for some time prior to progression to frank diabetes.

EDIT 10/10/13:  Since this article was written in Jan. 2011, I have continued to read and research on diabetes.  The aforementioned beta cell dysfunction does appear to occur much earlier on than previously thought.  These posts may be of interest:  

β-Cell dysfunction vs insulin resistance in type 2 diabetes: the eternal “chicken and egg” question

Insulin/Proinsulin/etc. in Normal, IGT and T2 Diabetics 

What is Diabetes?       /END EDIT

This is the sort of thing that I was saying when I said that, in the end redux, "science" as put forth by Taubes will ultimately undermine the forward path of good science.  Too many have been misled into believing that eating carbs causes hyperinsulinemia, insulin resistance and basal hyperglycemia (e.g. elevated fasting glucose).   There are sooooooo many research groups working on this problem.  Public and private monies spent by public and private entities to find answers.  We are to believe that Hope Warshaw and the ADA, in cahootz with Big Pharma just want to keep us all fat and diabetic so we need to buy their books, services and drugs.  Only Paula Deen wasn't listening ... and worse, she was teaching untold numbers of fans how to cook like she does.  And so now Paula reveals she's diabetic and low carbers everywhere are screaming about how it's sooooo unfair that they are blaming their beloved butter so many appear addicted to.  (Yes, I said addicted.  If someone wants to presume anyone who binges on carbs from time to time -- heck, even the many who simply consume them in normal portions on a daily basis! --  is carb addicted, I'm going to call all the fat bingers  addicts too.)   It was the sweet tea and flour can't they all just see that?  Dang the government My Plate -- Low fat made Paula fat!  Oh wait ....

A few closing comments on the circumstances surrounding Paula's disclosure and endorsement of the diabetes drug Victoza.  First, for those not aware, Victoza is a GLP-1 mimetic, like Byetta.  GLP-1 is an incretin -- secreted in the gut primarily in response to fatty acids.  It slows gastric emptying, stimulates insulin secretion, reduces glucagon secretion and may have insulin sensitizing effects.  Oh ... and in the case of Byetta, many experience weight loss (so much for insulin = fat accumulation).   I have no idea if the scenario I'm about to propose is even remotely true, but starting with the facts, let's use some TWICHOO logic and see where that gets us with fat intake and GLP-1.   GLP-1 is secreted by intestinal cells in response to fat, therefore, a high fat diet should result in GLP-1 spikes, and hyperGLP-1-emia which would lead to GLP-1 resistance and decreased action of GLP-1.  Eventually we would burn out the GLP-1 secreting capabilities of the intestinal cells.  The "cure" here would be a low fat diet ...  To be clear, I'm just doing some Metabolic Mad Libs.  Think about this for a minute ... she's not taking insulin to "cover" her carb intake, she's taking GLP-1 to "cover" her fat intake.  

So I've seen two criticisms of Paula on the disclosure/endorsement front:

• Timing of the disclosure, coming some 3 years after diagnosis:  Look, at what point does being a TV celebrity chef require disclosure of medical records?  She need never have disclosed this information, in my opinion.  Unless perhaps she were promoting "Healthy Southern Living".   Nobody would ever be under the delusion that Deen's cooking was intended for those looking to improve the healthfulness of their diet.  Nobody buys her books or even the Smithfield hams she endorses because of any sort of schtick.  I'm sure if Dana Carpender's upcoming LC cooking gig comes to pass, that she'll be hawking her recipes for health and weight loss/management.  After all, Dana owes her fame to her weight loss, something she no doubt considered as she scrambled to lose weight for TV.
• Endorsing Victoza:  Well, presuming that the drug is helping her manage her diabetes, along with lifestyle changes including dropping the sweet tea, eating lower fat foods, and exercising (yikes!!), what's the problem?  Or are only folks like Robb Wolff, Jimmy Moore and Mark Sisson allowed to cash in on their "brand".  Isn't it ironic that Carpender herself took Victoza for some time?  Should she disclose that as she creates "healthy" 75% fat low carb meals for her new show? 

In the end, Paula is a classic T2.  If her diet didn't cause her diabetes, it's a good bet it contributed to it's progression.  She was counseled by conventional medicine to enact lifestyle changes.  No doubt those were part of the original advice, and we don't know if they were tried first prior to the Victoza.  If Victoza was started right away, perhaps her diabetes was severe enough to require immediate treatment to maintain glycemic control.  Presumably it is working for her.  You know, Jenny Ruhl of Diabetes 101 takes metformin and Prandin, an insulin secretagogue (I'm not aware that this caused weight gain for her either).  For all the wonderful glories heaped on Westman for his study in which we're told 95% of the VLC diet group "reduced or eliminated medications".  Had someone other than a LC darling Atkins author Doc like Westman made that claim, they would have been criticized for exaggerating the efficacy of their intervention, because this is exactly what he did.  See:  Diabetes "Crash" Cures: VLCal vs. VLCarb.  Most of the reductions were in insulin, duh eat less carbs need less pp insulin, while oral medications often remained at pre-intervention levels.  This is only a big hoorah if one considers insulin an evil hormone, rather than a life sustaining one.  A thought process that is inconsistent with acceptance that thyroid supplementation is appropriate for an underactive thyroid ... insulin therapy is merely the same for a malfunctioning pancreas!

In conclusion, I'm rooting for Paula.  I think just giving up the constant sweet tea should produce some weight loss.  Coupled with reducing some fat (calories!!) and moving more, perhaps this weight loss may be more significant.  Perhaps Victoza has the weight loss effect as well.  In a year, it would be great to read of Paula's cure!  Eh ... But I'm a realist and I don't see this happening.  Why?  Paula is known for her over the top use of butter in those foods she's been making for a decade on TV.  Either she needs to do a major 180 and supreme transformation, or she'll need to maintain at least some of her persona/brand moving forward.  Given that she took 3 years to divulge her disease and is taking Victoza now, and presumably for some time.  So it seems to me that the mid-60's Deen is likely stuck in her ways and not interested in reinventing a Lean Mean Nondiabetic PaDeen.  Will her "celebrity chef" brand suffer?  Eh ... only because it took so long to divulge her condition, if at all.  It's not the "crime", it's the coverup.  As I said at the outset, it is doubtful that any of her fans were looking to her for advice on cooking healthy meals for the family anyway.  Her persona was always authentic in that regard.  So it will depend on whether or not keeping this from her fans offends them.  I'm thinking not, but in the end I really don't care much as I'm not a fan.  Make room for another Adam Gertler show, I find him far more entertaining.  And please, they are just too darned cute, so I don't want to hear of any diabetes diagnoses for the Neely's. 

UPDATE 10/10/13:  I saw some footage from Paula Deen's recent "comeback" appearance.  She appears to have maintained her weight loss and perhaps lost even more.  It would also appear that the stressors of basically losing her career/franchise are taking a huge toll.   It would be interesting from an anecdotal angle to get an update on her diabetes, but I doubt that will be forthcoming.