In every minute taken to read this blog post, someone is dying from preventable diet-related disease.

More people have died from metabolic disease since 1980 than the [i]sum of all the world’s military conflicts combined. This is more than a burgeoning health issue – it is a [ii]national security issue with profound economic implications. The HSF seeks funding, support and partnership to develop much needed educational content and programs for medical professionals and their patients that focuses on metabolic health and nutrition – preventing, treating, and resolving diet-related issues. The urgency of this work has never been greater.

The HSF is a 39-year old nonprofit organization, founded by a patient advocate, dedicated to forging a healthier world empowered by science-based nutrition and the prevention, early detection, and management of metabolic disease. Hypoglycemia, also known as low blood sugar, is one of the earliest and most frequently experienced indicators of metabolic dysfunction by the general population. For decades, the HSF has been filling a critical gap in educating the public about a health issue recognized as a “canary in the coal mine” of metabolic disease. The HSF has forged a compelling new strategic vision and is poised to expand its impact at a critical moment in U.S. public health history.

Dr. Seale Harris, the [iii]pioneer researcher of hyperinsulinism, viewed hypoglycemia as a harbinger of more complex metabolic disease as early as 1924: “The low blood sugar of today is the diabetes of tomorrow.” Today, low blood sugar is an issue that affects the majority of the population in some form or another, and is a key indicator that metabolic dysfunction is at play. Patients, adequately informed by their doctors, can take action to address diet and lifestyle factors that are driving the condition before more advanced diet-related disorders progress. Unfortunately, many doctors are poorly prepared to diagnose and treat the condition within the context of metabolic (systemic) dysfunction.

In 1958, the year after Dr. Seale died, slightly more than 1.5 million people were diagnosed with diabetes each year. In 2015, the [iv]rate had increased to over 23 million per year. Since 1980, [v]rates of type 2 diabetes have quadrupled. [vi]More than half of Americans are now either pre-diabetic or diabetic. [vii]Nearly half of adult Americans are obese, a rate that has nearly doubled since 1980, while [viii]childhood obesity and diabetes diagnoses have tripled. [ix]One in two adults in the U.S. has a chronic disease. [x]One out three children born in 2000 will have diabetes.

Chronic disease rates have escalated, and now exceed communicable disease. While 80% of the obese population suffer from metabolic disease, it is important to know that 40% of the non-obese also suffer from metabolic disorders. Conditions such as non-alcoholic fatty liver disease (NAFLD) are not easy to detect and are [xi]increasing at alarming rates in adults and children. Metabolic disease erodes our health care system both directly (hypoglycemia, type 2 diabetes, NAFLD) and indirectly (heart attacks, strokes, cancer, dementia), while prevention programs are lacking funding and support.  

National [xii]health care expenditures are currently $3.2 trillion – 75% of this results from chronic disease, and 75% of this is preventable and diet-related. An estimated $1.8 trillion is being wasted. One study showed that a 10% reduction in mortality from heart disease would have a value of $5.5 trillion to current and future generations, while a 10% reduction in mortality from cancer would be worth $4.4 trillion. [xiii]Research suggests that a modest reduction in avoidable risk factors could lead to a gain of more than $1 trillion annually in labor supply and efficiency by 2023.

Wellness programs generally report high returns of investment (ROI), and preventive and early intervention measures targeted to those already identified to be at risk, result in significant ROIs. [xiv]Data show that public health interventions generate anywhere from four to twenty-seven dollars for every dollar invested. The good news is that we are resilient, and [xv]research shows that simple interventions, such as reducing consumption of added sugar within limits recommended by the World Health Organization (WHO), can result in dramatic improvements in child metabolic health, including a 22% reduction in liver fat, in as little as 10 days.

Defying the statistics on diet-related disease, and the ROI of preventive measures, less than 30% of medical schools require courses in nutrition, despite repeated calls from the U.S. government and medical authorities to do so. Research shows that most primary care doctors are unprepared to diagnose and advise patients with diet-related disorders, lacking the time, training, and tools to help patients, and, by default, focusing on management of disease versus actually addressing the root causes of metabolic dysfunction. Doctors have little confidence that patients can make the necessary lifestyle changes, and rely on drugs like Metformin and procedures like gastric bypass surgery.

One of the leading ways to provide training to doctors and health care professionals is a system called Continuing Medical Education (CME). CME education is supported by the national Accreditation Council for Continuing Medical Education, and consists of educational activities designed to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. CME content is widely respected and validated by respected institutions such as the American Medical Association, and provides a body of knowledge and skills recognized and accepted by medical professionals. CME keeps health care providers up to date with the most current knowledge needed to help their patients.

In contrast, patient medical education is unregulated, and health literacy among the patient population is hobbled by a lack of quality education, and inconsistent information that lacks standards aligned with current evidence-based medicine. Information about diet-related disorders is particularly inadequate, and many doctors prefer to avoid providing education about nutrition and diet and focus on treating patients with drugs or devices. Prevention of diet-related disease has little support within the mainstream health care system, and the protocols for sustaining optimal metabolic health and nutrition are woefully lacking.  While dietary interventions have been developed that can reverse type 2 diabetes and non-alcoholic fatty liver disease – few doctors are aware of the most current science.

HSF leadership have been involved in the development of the nation’s first Metabolic Health and Nutrition CME summits at Swedish Hospital in Seattle. The second summit is took place June 15-16, 2018.  The first summit focused on [xvi]Pediatric Metabolic Health & Nutrition and the second summit expands the focus to Metabolic Health & Nutrition for the Whole Life Span. HSF would like to foster the development of similar CME summits at other leading health care institutions in the U.S.

The HSF would also like to offer smaller CME programs focusing on specific sets of topics featured at the comprehensive metabolic health and nutrition summits. The development of these CME modules will build on the impressive network of contacts in the field that leadership of the HSF has assembled over decades of work. There is a distinguished and very impactful group of leaders in the metabolic health and nutrition field – but there is a lack of awareness about their work. HSF will tap their considerable expertise and knowledge (critical to developing high quality CME content featuring the most current research and practice) and bring their work to national audiences.

In conjunction with the development of the CME programs, HSF also proposes to develop Patient Medical Education (PME) programs that translate the content developed for professional health care providers into education that is relevant and applicable to the patient population acutely affected by metabolic health disorders. It is not unusual for patients visiting diabetes clinics to be handed one-size-fits-all diet guidelines like the “Food Pyramid” or “My Plate.” These diet plans, high in carbohydrates, are typically not what the patients need, but Registered Dietitians feel compelled to follow Academy of Nutrition and Dietetics (AND) guidelines that are woefully out of date. Drugs like Metformin (Glucophage) are routinely prescribed, designed to managed disease, not eliminate the causes of it.

If any of this sounds like something you might want to get involved with, please contact Wolfram Alderson, CEO, Hypoglycemia Support Foundation by email.

FOOTNOTES

[i] U.S. deaths since 1980 caused by: terrorism = < 4,000; warfare = <9,000; gun violence = <1,500,000; diet-related diseases = >45,000,000.

[ii] The Impact of Obesity on National and Homeland Security

[iii] https://en.wikipedia.org/wiki/Seale_Harris

[iv] https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

[v] Type 2 Diabetes Rates Quadruple Worldwide Since 1980.

[vi] Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012

[vii] Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults Aged 20 and Over: United States, 1960–1962 Through 2013–2014

[viii] Childhood Obesity Facts

[ix] As of 2012, about half of all adults—117 million people—had one or more chronic health conditions

[x] One in Three US Children Born in 2000 Will Develop Diabetes

[xi] Nonalcoholic fatty liver disease: A comprehensive review of a growing epidemic

[xii] National Health Expenditure Data, Centers for Medicaid and Medicare Services

[xiii] An Unhealthy America: The Economic Burden of Chronic Disease — Charting a New Course to Save Lives and Increase Productivity and Economic Growth

[xiv] Return on investment of public health interventions: a systematic review.

[xv] Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome

[xvi] Pediatric Metabolic Health and Nutrition Summit, Swedish Hospital, Seattle.

*Yes, Gift. Why?

“Because long before you get diabetes or heart disease, low blood sugar, also called Hypoglycemia, sends you insistent warnings, like a “canary in the coal mine,” while you still have time to spare yourself. The gift messages take many forms: anxiety, depression, physical and mental fatigue, brain fog and cravings  — all with the same greeting: ‘Change while there’s still time.’ Assuming you listen and act, it could save you a lifetime of unnecessary suffering.”
– Dorothy Mullen, Founder, The Suppers Programs

The food-mood connection is a vital one – listening to what blood sugar is telling you and taking appropriate actions can dramatically improve your metabolic and mental health. Mental health conditions are increasingly being evaluated within the context of metabolic health. Blood sugar dysregulation (high and low), often associated with insulin resistance and hypersecretion, is one of the “canaries in the coal mine” for many metabolic and mental health disorders, and is associated with many medical conditions.

“The low blood sugar of today is the diabetes of tomorrow.” – Dr. Seale Harris

Hypoglycemia is one of the most confusing, complicated, misunderstood, and too often misdiagnosed or undiagnosed conditions of modern medical history. A growing need/emphasis on patient self-advocacy and education is emerging, since, unfortunately, many healthcare professionals are poorly equipped to diagnose the issue, and often lack the training in nutrition science to prescribe a proper dietary response. Nutrition education in medical schools has actually declined in the last three decades. How do you listen to what blood sugar is telling you, and what actions can you take as a patient?

Background

Hypoglycemia is associated with a wide variety of diet-related disorders (metabolic syndrome, type 2 diabetes, fatty liver disease, etc.) and medical conditions (critical illness, drug side effects, organ failure, gastric bypass surgery, etc.). The most common form, functional / reactive hypoglycemia is diet-related and preventable. There are tools available to you that can help pinpoint why and where you might be on a blood sugar roller coaster, and simple solutions involving diet, stress, and lifestyle are accessible and affordable. New and old diagnostic tests and technology can help you pinpoint what the issues might be, and provide helpful data to your healthcare provider.

Resources

Some conventional methods such as keeping a diet/symptom diary and a variety of tests have been in place for decades. Now, new bio-monitoring devices have the potential to empower consumers to optimize their metabolic and mental health – matched with personalized nutrition built on the foundation of real food.

• Hypoglycemia – Blood Sugar Roller Coaster (Comprehensive Infographic)
• Hypoglycemia – Do’s and Don’ts (Book by Patient Advocate, Roberta Ruggiero)
• Sweet Revenge – Turning the Table on Processed Foods (Public Television Program – get a discount code here)
• https://hypoglycemia.org (Informational Website)

By Dr. Keith Berkowitz, M.D. Medical Director for The Center For Balanced Health and Medical Advisor for the Hypoglycemia Support Foundation

According to the American Diabetes Association, 21 million Americans have diabetes and another 54 million American are at risk with pre-diabetes or elevated blood glucose.

Because of this, our attention has been concentrated on treating high blood glucose while largely ignoring other blood sugar disorders. Poor eating habits, the addition of unhealthy ingredients, increased stress and poor sleeping habits has led to the increased incidence of this under-appreciated blood sugar disorder: hypoglycemia.

Hypoglycemia has been traditionally defined as a low blood glucose level (serum levels less than 70 mg/dl either taken fasting, randomly or after a glucose challenge). Unfortunately, most individuals I see in my practice do not present with these results but instead present with normal blood glucose levels, the ability to lose some weight but not the last 10 to 20 pounds or unexplained low energy levels.

One reason for this is that most individuals only have fasting blood glucose or an HgbA1c taken by their health professional. An HgbA1c level represents the average amount of glucose in the blood over a three month period. A level of 4.0% is equal to an average blood glucose level of 60 mg/dl while a level of 5.0% is equal to a blood glucose level of 90 mg/dl. HgbA1c levels between 4.8% and 5.9% are considered normal. Levels below 4.8% are usually consistent with hypoglycemia.

Individuals with hypoglycemia can often have symptoms that include: headaches, increased irritability, difficulty concentrating, palpitations, light-headedness, fatigue, anxiety, excessive sweating or urination, leg cramps, dizziness and clamminess. Other symptoms can be related to eating. Patients I see with this diagnosis often feel more tired after meals, feel “sick” when they either miss a meal or if a meal is delayed.

So, if you have significantly reduced calories or carbohydrates, are you still unable to lose weight?

Are you unable to lose that last 20 pounds no matter what you try?

Eating a low carbohydrate diet but still hungry and/or tired after meals?

I just may have a solution for you.

Traditionally treatment for hypoglycemia has been to give sugar. Unfortunately, this treatment only provides temporary relief and in very sensitive individuals causes an even greater reaction thirty minutes to two hours later. Although, a strict low carbohydrate diet is helpful, it does not always solve the problem by itself.

In my practice, the Center for Balanced Health, I see individuals with such pronounced hypoglycemia that their blood sugar drops almost immediately after a glucose challenge. It’s the equivalent of filling an automobile with gas only to find that the gas tank has a very large leak.

At the Center for Balanced Health, we help patients manage their hypoglycemia by telling them to:

• Eat five to six small meals a day about every three hours. Think of yourself as a fuel-efficient automobile. You want constant flow of energy (glucose) throughout the day.
• Avoid meals that are too small or too large especially at night. Meals that are too small will not provide enough energy to get you through the day. Meals that are too large place a larger burden on your metabolic system to process these nutrients and thus can trigger a hypoglycemic reaction.
• DON’T skip meals especially breakfast. Breakfast is the most important meal of the day because it sets the tone.
• Balanced eating. Always have some protein and fat at each meal or snack. Avoid and limit foods high in sugar or other refined carbohydrates especially on a empty stomach. Still utilize a controlled carbohydrate approach and get your carbohydrates from foods high in fiber (dark green leafy vegetables, non starchy vegetables, avocado, high fiber low carbohydrate crackers as examples)
• Get a good night’s sleep. Good sleep helps replenish your system so that your body works more efficiently.
• Use of a fiber supplement (make sure you take with enough water) or eating a high fiber food (without refined carbohydrates or sugar) before meals or snacks can help slow the absorption of carbohydrates and thus prevent rapid declines in blood sugar.
• Exercise regularly. Strength training can improve glucose metabolism
• Avoid alcohol, caffeine, tobacco use
• Avoid the use of stimulants

If you suspect hypoglycemia, the best diagnostic test is a glucose tolerance test with insulin levels and an HgbA1c. I usually do this test in my office because a glucose challenge can sometimes precipitate symptoms of low blood sugar. 

Along The Way To Food System Change

I am blessed to have been raised by a mother who loved food and who believed preparing meals for loved ones was a work of the soul – for the soul. Cooking together and eating together was sacred family time, and the kitchens where I grew up were always where the greatest conversations happened. Despite raising three children as a single working mother, my mother always made our meal-time special, and my siblings and I grew up with a sense that sharing good food together was an essential part of what it meant to be family.

I’m sure that it was no coincidence that my lifelong career in nonprofit service began when I was hired by the Los Angeles based Interfaith Hunger Coalition to start the first Certified Farmers’ Markets in California – back in 1979.  That work, which evolved into something called the Hunger Organizing Team, set a fire in me – something that I call “Food System Change”.

Decades later, I am still enamored with the idea that we the people can transform our food system. Along the way, I acquired decades of experience working to develop and support food system solutions like farmers’ markets, urban agriculture, horticulture therapy, school-based gardening. My current work at the Hypoglycemia Support Foundation focuses on education and community building that builds on cutting edge science and patient centered, grass roots advocacy.

I consider myself incredibly fortunate to have had made a living doing this work.  Along the way, some amazing men and women have shaped my thinking and practice in creating social and environmental change. Visionaries such as Mike Fonte, Pat Reif, and Gene Boutilier who led the ecumenical community in Los Angeles to embrace food security and access to healthy food to be primary matters of faith.  Exceptional organizers and change agents like Dolores Carlos, Nancy Berlin, and Vance Corum who, as my colleagues and mentors, helped to shape my thinking and practice of being a community based organizer and agent of real change. 

As I have passed a milestone of 40 years of service in the field, my list of such positive influences is now quite long, so I won’t belabor them here. Roberta Ruggerio, my colleague, Soul-Sister, and Founder of the Hypoglycemia Support Foundation, is now on the top of this list.

I am blessed to have Dr. Robert Lustig on the growing list, who is a pediatric endocrinologist at UCSF, a global champion for public health, and my distinguished co-founder of the Institute for Responsible Nutrition, where I served as Founding Executive Director. Dr. Lustig is well recognized around the world for his remarkable efforts to expose the processed food industry’s role in the global pandemic of metabolic disease, so I’m going to focus on two unsung heroes who are currently on the top of my list of influential people: Cindy Gershen and Dorothy Mullen.

Cindy has an amazing history as a chef and restaurateur. After coming to terms with some of her own diet related health issues, Cindy decided to commit her life to creating food system change from within the schools, founded a nonprofit called the Wellness City Challenge, and has forged an exceptional model that places high school students at the epicenter of creating positive changes in their community located in Contra Costa County, California. Her culinary teaching classroom is legendary, and she champions the idea that if you “change the food, you can change the future” of youth, families, school districts, and cities, even when resources are lacking. To witness Cindy and her small army of supporters is an inspiration, and you can’t help but get pulled into her vortex of food system change – not only because of her passion, but because she is presenting a highly effective model that can be scaled and replicated anywhere in the world.

Like Cindy, Dorothy Mullen is a force of nature with a heart of gold and seemingly unlimited energy for making transformational change possible. There are various models for creating food system change – business models, organizational models, academic models, etc.  Dorothy champions the community model – eschewing approaches that monetize change. Dorothy’s work in central New Jersey, known as the Suppers Programs, thrives on the currency of love and community, relationship building, powerful concepts such as “harm reduction,” and the idea that “logical miracles” are possible when your needs are met for nourishing food, social support, and having a safe place to experiment and self-observe (“how you feel is data”) while you change old habits. Dorothy and her co-founders have forged a powerful learn-by-doing approach for everyday folks who come together to cook, eat, taste, learn, and feel their way to vibrant health using whole, real food. No dietary dogma or bias – there are vegan, vegetarian and omnivore meetings.

Here is a photo of Cindy and Dorothy meeting in Cindy’s classroom at Mt. Diablo High School in Concord.  It is difficult to describe the power and energy of these two women without sounding a little mystical. The love in their hearts, passion for their work, and the intellectual force in their brains is so powerful that you can actually feel the energy. However, the true magic of their work is not ethereal but very real and rooted in years of hard work and practice in community settings, listening deeply, working, cooking, eating, and learning with thousands of everyday folks.

One of the key strategies of the Hypoglycemia Support Foundation is the simple idea to “find the good and praise it”. When it comes to food system change, we don’t need to recreate the wheel, just become part of it.  

We know that there are many more Cindys and Dorothys around the country. I invite you to share your own journey of food, health, and discovery and to highlight some of the influential people in your world of food system change.  

-Wolfram Alderson, CEO, Hypoglycemia Support Foundation