Stories & Interviews
Inspirational Stories and Interviews
“People have been sharing stories since the beginning of time, even before we had a spoken language,” – Paul Zak, PhD
Sharing your personal story can offer real health benefits. We once did this around open fires, and now we do it online. While social media has its downside, there are positive benefits: sharing stories has measurable health benefits for narrators and listeners alike.
Welcome to the Hypoglycemia Support Foundation (HSF) series of inspirational stories and interviews featuring everyday folks, distinguished experts, advocates, authors, practitioners, researchers and other distinguished leaders in the field of metabolic health and nutrition.
Why? These stories contain a wealth of information giving you insight into who’s supporting and leading the field of metabolic health and nutrition, and serving as champions for those who suffer from conditions such as hypoglycemia. Since the HSF is a patient advocacy organization, we value the many voices and stories that come from trenches. We don’t have to do this alone.
In an ideal world, upsetting experiences are transformed into stories that are shared with others.
This process helps us to understand the events and, at the same time, alerts our friends to our emotional and psychological state. Such storytelling ultimately helps us maintain a stable social and emotional life. In our less-than-ideal existence, however, we often keep important personal experiences to ourselves. Holding these secrets can be biologically taxing, can block the natural cognitive work of coming to terms with the secrets, and can distance the secret-keeper from friends and family. Translating personally upsetting experiences into language in a story format, even when the story is written rather than spoken, may accomplish for us what oral storytelling must have accomplished for our ancestors—improvements in physical and mental health as well as the development of closer social bonds.” -James Pennebaker, Telling Stories, the Health Benefits of Narrative
I first met Roberta in Miami and saw firsthand the helpful way in which she was trying to spread the word and offer information to those who might have hypoglycemia. I was very moved that she would spend selfless hours each day writing or calling others who needed help and who seemed not to have any idea what might be wrong with them. Roberta offered hope and possible answers.
Coincidentally, it was at the same time that close members of my own family realized that they too had hypoglycemia. Their ages ranged from sixteen to forty. Each symptom was different but debilitating for my cousins. The forty-year-old would feel faint and extremely grouchy. One of the teenagers became very angry when he had not eaten; the other had symptoms of depression. Her sleep was affected and her eating was erratic; actually I should say—not eating. The family took them to doctor after doctor with little results. Finally the older cousin had a diagnosis. As soon as he got control of his diet—for him, with protein and nuts—his mood swings left. He also was advised to reduce his sugar intake. Once the sixteen-year-old boy was told that diet was affecting his life, he was put on an eating regimen. He too needed protein. By altering his eating habits, his athletics improved and his anger disappeared. The female teenager had more difficulty at first since her symptoms were more severe. Again, once she started to acknowledge that what she was putting in her mouth directly affected her mood, her symptoms started to dissipate. Helpful answers were right in front of them—food. They were all given a copy of Roberta’s book, The Do’s and Don’ts of Hypoglycemia, and this became daily reading.
Since hypoglycemia appears to be in my family, I have become very aware of food choices as well. The remarkable changes in life as a result of Roberta’s dedication are very inspiring. Some of the stories break your heart—that people had to suffer so long when help was so close by—in some cases, in their own refrigerator. This work and book are important!
THANK YOU, THANK YOU, THANK YOU! The information you have been kind enough to share with me has been the key link enabling me to return to a normal life. Several months ago, I began growing faint and was, on about half a dozen occasions, taken to the emergency room of a local hospital. In every instance, I was told there was nothing wrong and that I was probably just hyperventilating. After consulting several doctors without any success at all, I was properly diagnosed by a local physician who recommended a glucose tolerance test. Once it was determined that I had hypoglycemia, I was referred to the Cleveland Clinic for dietary planning.
The staff at the Cleveland Clinic were enormously helpful but referred me to you and your organization for additional help. The materials you have supplied have helped me understand my problem and do what is necessary to return to a normal life. I am saddened by my own experience with the doctors who were unable to determine what was wrong with me. I am frightened for the many thousands of patients throughout the country with similar problems who are no doubt experiencing the same kind of difficulty with their diagnoses.
I hope for their sake that they will be as fortunate as I was to be directed to you and your wonderful, caring organization. Please let me know if there is anything I can ever do to repay the enormous debt I owe to you.
I was 16 and all I could think of was that I didn’t want to make it past my next birthday. I was scared and had no idea what was happening to me… I didn’t want to live anymore.
Instead of being out enjoying my friends and loving life, I was depressed and crying; I couldn’t eat or sleep. I was consumed with irrational fears, confusion, anxiety and paranoia. My health was failing and I remember praying to God to please help me or to just let me die because I certainly didn’t want to live my life being this sick. I remember thinking no one would ever want to marry me this way!
Fortunately, God had other plans for me.
My sister Theresa called her former high school psychology teacher and asked his opinion. During the conversation, he asked if I had ever had a GTT? She asked him what that was, and he told her it was a “glucose tolerance test.” He told my sister that his wife had something called hypoglycemia, and it can be the cause of some very severe symptoms like the ones I was experiencing. We immediately called the family physician and made an appointment. When the results came back positive for severe hypoglycemia and borderline diabetes, I remember crying with relief because I now knew the name of what I had and that I really wasn’t going crazy.
My body just overproduced insulin to a point that I never had enough blood sugar in my system for my entire nervous system to run correctly. Knowing that all I had to do was eat healthier foods, stay away from sugars and refined foods plus eat more often throughout each day was the answer to my prayers.
While it took some time to really get my health back to 100 percent, I was grateful and willing to follow through and help others who were going through the same thing.
I am so grateful to Roberta and the HSF for being there for me at a time when no one else understood. Through proper education and the support of my family and the Foundation, I came through one of the worst, most terrifying times of my life—and you will, too. Don’t give up!
Leslie Lee, Interviewed by Roberta Ruggiero, HSF Founder
Leslie Lee is on the Advisory Board of the HSF and talented Registered Dietitian at Swedish Hospital in Seattle, Washington. She was instrumental, with Wolfram Alderson and Roberta Ruggiero, in designing and implementing the current HSF Hypoglycemia Questionnaire and evaluated the results which are featured in the new 5th Edition of Roberta’s book, “The Do’s and Don’ts of Hypoglycemia: An Everyday guide to Low Blood Sugar” released September 12, 2017.
Leslie, I felt such a connection to you the first time we spoke. It felt like we were old friends just catching up. However, it was much deeper than that, we bonded, as Wolfram would say, on a soul level!! How did you feel after our first conversation?
Oh, I felt exactly the same way! We had an instant connection. I thought “this woman gets me.” One common theme among those of us who have struggled with hypoglycemia is feeling like we are not understood or taken seriously by the medical community. When you find someone who not only understands what you’ve been through, but has been through it herself, risen above it, and is helping others through it, it feels like a god-send!
I also can’t believe that after sharing our desire to educate and advocate for suffering hypoglycemic on a global level, we immediately started putting our ideas together about how we could join the “eliminate sugar revolution. Very slowly, and despite my time and energy being at an all-time low, our working and friendship relations blossomed. When I causally mentioned I would like to repeat the Hypoglycemia questionnaire from 1989, both you and Wolfram eagerly said, “Let’s do it!”
Both of you were responsible for taking our past Hypoglycemia Questionnaire to another level. You re-evaluated, designed and implemented a new version…more medical and technical.
Why were you so drawn (and eager) to join me and the HSF and then to take on the enormous task of the hypoglycemia questionnaire, it’s new design, evaluation and writing of the results?
I always felt like hypoglycemia was the rate-limiting factor on my quality of my life. It was something I had to understand better and overcome in order to live the life I wanted to live. When I was a young adult searching for information on why I might be experiencing hypoglycemia, how I should manage it, and, most importantly, how I could prevent it from happening, I found a literal void of information out there. Everything I read was basic and targeted to people with diabetes who were taking insulin. I was not that person, so their advice wasn’t useful. I didn’t find any answers in the doctors I saw either, so I decided to become a dietitian specifically to learn how to “fix” myself.
In nutrition graduate school, I saw another example of the void of information. Our community nutrition lab provided diet education to new diabetics, and nowhere in the curriculum was any mentioning of hypoglycemia. I told my advisor there was a hypoglycemia education need that our program wasn’t meeting, and she encouraged me to test it. So, I wrote a questionnaire (much like ours!), administered it to new diabetics enrolled in the program, and found a treasure trove of information. About 97% of our respondents had newly diagnosed type 2 diabetes, and two-thirds had serious concerns about their experience of hypoglycemia. When I realized that basically none were taking insulin, I realized hypoglycemia is happening in diabetics without being triggered by insulin administration. That’s when I realized that perhaps reactive hypoglycemia precedes the development of type 2 diabetes.
I hadn’t had many opportunities to explore this hunch further until our conversation. Thankfully, my boss at the time, Wolfram, was supportive of my spending time working on it, and the questionnaire was born.
What was the most startling conclusion of the new questionnaire?
There were many interesting conclusions. The most important result to me was what we learned about reactive hypoglycemia preceding the development of type 2 diabetes. Two-thirds of our respondents who have been diagnosed with type 2 diabetes or pre-diabetes reported they experienced hypoglycemia before their diabetes diagnosis. Most of them (85%) experienced hypoglycemia for two or more years before their diabetes diagnosis, which to me presents a very clear window of opportunity for education and diet improvement.
I believe the same metabolic dysfunction that presents as reactive hypoglycemia now can develop into insulin resistance and type 2 diabetes later, if diet is not modified. That was always my hunch and my greatest fear. It’s a simple observation, but I think it’s highly significant in that we can now interpret reactive hypoglycemia as a red flag or a call-to-action to intervene with diet modification and prevent diabetes from developing.
What would you like to see us (HSF) do with the results?
I’m a big believer in influencing the influencers. Physicians, nurses, dietitians need this information, because they are the touchstones to every patient. They need to know that it’s reckless to say “just eat more sugar” to a person on the verge of developing diabetes. Believe it or not, that’s common advice for the treatment of hypoglycemia! We need to stop the influx of misinformation out there, improve clinicians’ understanding, inform patients that what they’re experiencing could lead to diabetes, and then we need to empower them to change.
I’d love to see the HSF develop the gold standard in diet education for patients who experience reactive hypoglycemia. I think we can equip clinicians to better educate their patients on treating hypoglycemia strategically so that the treatment doesn’t trigger another episode of hypoglycemia, and, most importantly, eating in such a way that it’s prevented all together.
Do you think/believe the medical profession will accept and use our news/views and recommendations?
I do, but unfortunately, it’s going to require patient advocacy and the demand for better care. There’s nothing sexy about what we’re talking about. There’s little opportunity for a drug or medical device to fix the problem, so corporations will not be sending sales forces in to educate your physician. It will require a grassroots effort; both patient self-advocacy and the HSF will be critical.
Other than the medical profession and the HSF (hypoglycemia community), who will profit most from our results?
Those suffering from hypoglycemia, just like you and I, Roberta! That’s what we’re all here for—you, me, and every physician, nurse, and dietitian in practice today are striving to help those who are suffering. Fortunately, this isn’t a complicated matter—it’s simply a confused one. Opportunities to help abound, and I think that’s exactly what our questionnaire demonstrates.
Dr. Robert Lustig
Dr. Lustig’s latest book, The Hacking of the American Mind: The Science Behind the Corporate Takeover of Our Bodies and Minds, was released September 12, 2017.
Chantal: Dr. Lustig, congratulations are in order for your Sugar the Bitter Truth video available on YouTube uploaded in July 2009 which has received more than 7,000,000 views! For a science/medicine video, this a record! The average educational YouTube video gets less than 10,000 views. Did you ever imagine that it would go “viral”?
Dr. Lustig: I didn’t even think my mother would watch it, let alone 7 million.
Chantal: How do you get 7 million people to sit still for a 90-minute treatise on carbohydrate biochemistry? Since the lecture was posted online, has your practice changed as a neuroendocrinologist and the type of research you do at UCSF?
Dr. Lustig: Well, I certainly get more referrals now. I don’t know that it has changed my “practice” per se, but it has focused my research on the causes of metabolic syndrome, even more than just worrying about obesity. We’ve determined that metabolic dysfunction occurs due to insulin resistance, which is due at least in part to liver fat, which is due at least in part due to sugar metabolism. So we now have a direct path from what kind of food we eat, to how we get sick.
Chantal: You were among the first to debunk the dogma that ” A calorie is not a calorie”. I am a Kinesiologist with a master’s degree in metabolism. Your lectures changed my whole frame of thinking about metabolic health and how I counseled my clients. Do you find that healthcare providers and nutritionists still cling to the old “calories in, calories out” model?
Dr. Lustig: I am constantly attempting to debunk this dogma. Calories imply “energy balance”, which infers physics. But obesity is about “energy deposition”, which infers biochemistry. And metabolic syndrome occurs in normal weight individuals too. So it can’t be about energy balance.
Chantal: Is this fundamental misunderstanding something you still have to explain or receive criticism for? Why does it seem so hard to let that myth die? Are you “anti-sugar”… “the sugar police”?
Dr. Lustig: I am NOT the food police. But people can’t change their behavior unless they know the real story. My job is to educate, not to pass judgment. Are some sugars better than others? Gram for gram, it doesn’t matter. High-fructose corn syrup has been called out as being worse than sucrose. But the metabolic studies say they are both equally bad. The only reason HFCS is worse is because it’s cheaper. That made sugar cheaper because of market competition. And that’s what let it get into every food in the supermarket.
Chantal: What are some small steps we can take to reduce sugar in our households, workplaces, schools, etc.?
Dr. Lustig: EAT REAL FOOD! Real food is low-sugar, high-fiber. Processed food is high-sugar, low-fiber. Real food works. Processed food doesn’t. But processed food is cheaper. Because it’s subsidized. The problem is that diabetes is even more expensive. But you don’t pay for it today, you pay for it tomorrow.
Chantal: You wrote “Fat Chance” two years after your video lecture Sugar: The Bitter Truth. It was on the New York times best-seller list for a long time. Why was it necessary to write the book and what was the response to it?
Dr. Lustig: A medical journal won’t publish a long-form essay. And the public doesn’t read medical journals. It was necessary to get the information into the hands of the public. That means a book. You took a one-year sabbatical to earn a master’s degree in law at UC Hastings.
Chantal: Why did you think it was necessary to continue your education?
Dr. Lustig: Science should drive policy, but the politics get in the way. I needed to understand: 1) when does a personal health problem become a public health crisis, and what are the legal doctrines that bring society to that point; and 2) how did Big Tobacco circumvent the law for so long? This meant going to law school, where I focused on Public Health Law and Food and Drug Law.
Chantal: How has this law degree helped you?
Dr. Lustig: It helped me formulate what legal doctrines can be used to intervene. This has helped focus the argument and get academics and various public health officials on board to take this on.
Chantal: In 2013, you were a founder of the Institute for Responsible Nutrition (IRN) to help educate and advocate for the public. A big emphasis for the IRN was to encourage folks to eat “real food” rather than adopting specific diets or macronutrient ratios. Why take the approach to change food culture and lifestyle versus a more prescriptive approach?
Dr. Lustig: We’ve been trying the target-based approach (treating obesity) for 40 years, and it hasn’t worked. And we’re talking about hedonic substances. Education alone has never solved any substance of abuse. Did Nancy Reagan’s “Just Say No” work? We’ve got an opioid crisis! No, this is a public health problem, and requires a public health approach.
Chantal: What do you mean when you talk about “real food”?
Dr. Lustig: Food that came out of the ground, or animals that ate the food that came out of the ground. Then either it’s got the right kinds of fats (e.g. fish, avocados), or it doesn’t have much carbohydrate (e.g. meat), or whatever carbohydrate it’s got it balanced by its requisite fiber (e.g. grains, fruit). This is what humans ate for millennia, and didn’t get chronic disease.
Chantal: The IRN merged with United States Healthful Food Council (www.eatreal.org). What prompted the merger and how do you see this furthering your objectives? What is the mission of Eat REAL?
Dr. Lustig: IRN and USHFC had the same mission statements: “to eradicate childhood obesity and type 2 diabetes”. But IRN was focused on the food in the grocery store, and USHFC was focused on the food in restaurants. There is a tremendous amount of synergy there. IRN had the science, and USHFC had the business model. It was a symbiotic merger, with both sides contributing to common goals. UCSF Food Services was the first hospital system to receive the REAL Certified stamp of approval.
Chantal: Was this a complicated process and what is the effect on the patients and consumers who eat there?
Dr. Lustig: Hospitals need to model appropriate health behaviors for the public. Tobacco was first banned in hospitals. Dan Henroid, the Director of food services at UCSF, totally gets it. It wasn’t a hard sell. We also have the UCSF Healthy Beverage Initiative. You can’t buy a sugared soda at UCSF. When visitors first realize this, they scratch their heads. But then they get it.
Chantal: In terms of healthcare providers, where do you think the most change is still needed in terms of understanding and promoting metabolic health and nutrition?
Dr. Lustig: We have to re-educate an entire army of physicians on the “new nutrition”. Physicians frequently experience “cognitive dissonance”; they’re told one thing, but experience another. They are hungry for the truth. We’re starting to make inroads at many levels. Papers, books, magazines, infographics, PSA’s, are all starting to carry the new messages. And people are getting it.
Chantal: Metabolic disease is most preventable, yet is the biggest killer and has the largest burden on healthcare systems and economies in the world. Why is there still so little recognition of this fact?
Dr. Lustig: People have been told that these diseases are due to obesity, and that obesity due to two behaviors — gluttony and sloth. Therefore, if you get diabetes, it’s your fault. The problem is that India and China have 11% prevalence of diabetes, and they’re not fat. The U.S. is the fattest nation, and we only have 9.3% diabetes. So obesity and diabetes are not the same. People and governments have not yoked food processing to diabetes. And processed food is cheap. So the epidemics go on and on. Chantal: What are some of the most urgent changes needed to reverse the epidemic?
Dr. Robert Lustig: Stop food subsidies. We subsidize corn, wheat, soy, and sugar; four crops that are killing us. This is the basis of our entire processed food supply. Let the markets dictate the price. Even libertarians can get on board with that message.
Chantal: Does the myth of the “low fat diet” persist?
Dr. Robert Lustig: “Low-fat” tastes like cardboard. When we went low-fat in the 1980’s, the food industry started adding sugar to make the food palatable. Now we have a toxic food supply.
Chantal: What other fundamental misunderstandings drive metabolic disease?
Dr. Lustig: The three myths are: 1. It’s about obesity. No, it’s about metabolic disease. 2. A calorie is a calorie. No, because sugar is metabolized like alcohol, and so children are getting the diseases of alcohol (type 2 diabetes and fatty liver disease) without alcohol. 3. It’s about personal responsibility. No, it’s about public health, and remaking the food supply so that metabolic diseases like diabetes are reversed. That’s what we do in our clinic at UCSF every day.
Chantal: How can the food industry be part of the solution, instead of the problem?
Dr. Lustig: Right now, the industry is rewarded for doing the wrong thing. We have to reward them for doing the right thing. That means turning the business model on its head.
Chantal: Can the food industry make a profit selling real food?
Dr. Lustig: They could, but not with the current food business model. We have to change the food business model so that the industry “wants” to sell real food. As an example, you could tax soda, and use the tax to pay for water. Differential subsidization.
Chantal: To make the industry want to do the right thing. You are publishing a new book September 12, 2017, called “The Hacking of the American Mind”. Why did you feel another book needs to be written and can share any clues to the content?
Dr. Lustig: Dopamine is the “reward” neurotransmitter that tells our brains “this feels good, I want more.” Yet too much dopamine leads to addiction. Serotonin is the “contentment” neurotransmitter that tells our brains “this feels good, I have enough.” Yet too little serotonin leads to depression. Ideally, both are in optimal supply. But dopamine evolved to overwhelm serotonin (our ancestors were more likely to survive if they were continually motivated). The result is that constant desire can destroy our ability to perceive happiness, while sending us down the slippery slope to addiction. Since government legislation and subsidies in the last forty years have promoted ever-available temptation (sugar, drugs, social media, porn) combined with constant stress (work, home, money, Internet), we are now faced with an unprecedented epidemic of misery. But there are ways to recoup happiness even in the face of overwhelming adversity.
Look for Dr. Lustig’s new book release September 12, 2017. You can preorder now on Amazon and get a 35% discount.
Dr. Uma Pisharody
Uma Pisharody, MD, FAAP Interviewed by Roberta Ruggiero, Founder of the HSF
I read your bio several times, and was moved by the fact that at a very early age you knew you wanted to become an advocate for children’s health. Would you please explain the circumstances that led you to make such a decision?
As a child, I remember always wanting to be a pediatrician when I grew up. It was my own pediatrician that inspired me. I remember how gentle and kind he was, and how I would always look forward to seeing him. In school, I loved biology and chemistry which made choosing medicine an easy choice as I entered college. I figured that after medical school, if weren’t able to choose a career in pediatrics, I would actually consider teaching or another career path that would enable me to create a positive impact on children’s lives! I’ve always felt that being able to help children is the biggest honor of my life.
You are on the Board of Directors for the Institute for Responsible Nutrition; on the Advisory Board for the Northwest Chapter of the Crohn’s and Colitis Foundation of America and now for the Hypoglycemia Support Foundation. That’s not including being a member of the American Academy of Pediatrics, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, the American Gastroenterological Association, and the American Society for Parenteral and Enteral Nutrition.
What drives you to be involved with all these organizations? Do they have a common cause or interest?
I find that being part of these organizations allows me to become a better advocate for my patients and their families. By engaging with these organizations, I am able to keep abreast of the latest scientific breakthroughs in the fields of nutrition and gastroenterology. I am also able to better network and collaborate with other specialists. These organizations combine my interests of pediatrics, gastroenterology, and nutritional science. Those are the cornerstones of my day to day practice and the subjects about which I am most passionate.
When we first meet in January 2017, I felt an immediate connection to you. Do you have any idea why? You were the first doctor who not only accepted my work but praised it when you said… “You knew about hypoglycemia and metabolic disease before we did!” Not many doctors know about functional/reactive hypoglycemia let alone metabolic disease. Or if they do, I’ve seldom heard them use that phrase. Why do you suppose hypoglycemia is so poorly understood in the medical community?
I’m afraid nutritional science is still poorly understood by most doctors. We focus on disease and medications, but tend to forget the biochemistry of metabolism. Personally, I recall learning basic metabolic pathways in the 1st and 2nd year of medical school, but not really being forced to apply these once I got into my clinical years of training. Once I started seeing patients, I was being taught that ‘it’s all about calories” and that obesity and metabolic syndrome were from overeating, I didn’t even fully understand the toxicity of sugar and processed foods, until I read the work of Dr. Lustig. That’s why, when I read your book and saw how you had astutely described the relationship between processed food health decades ago, I was in awe. Kudos to you, Roberta, for understanding and exposing the truth about the quality of food being more important that the quantity, long before most doctors had started to realize this crucial fact.
The HSF is now in its 37th year. At first, adult women got in touch with us, typically in their fifties and sixties. Later, this was followed by a good share of men as well. Over the years, the age of those interested in hypoglycemia dropped to mid-thirties, then twenties and then we heard from increasing numbers of young adolescents and teenagers. It became especially worrisome when we started to hear from parents of very young children, one to three years of age, being diagnosed with hypoglycemia. The trend has increased alarmingly, and in response to the growing epidemic, we created the first ever website for children with hypoglycemia at www.hypoglycemiaKIDS.org.
I am so impressed that because of your education and advocacy efforts, Swedish Hospital is the first hospital in the country to ban juices on the pediatric menu. Please share what and how you managed to accomplish this – and why this issue is important for other hospital care systems to consider.
When I started working at Swedish Medical Center, fruit juice was being routinely offered and served to children following medical procedures and tests. One day, a patient of mine with metabolic syndrome was admitted for a liver biopsy. As was the protocol, he was automatically offered a glass of juice, as soon as he woke-up following his procedure. His mother was puzzled, as I had been advising him to strictly restrict juice (and sugar sweetened beverages), and asked me about it. The incident prompted me to write to hospital administrators about changing our hospital policy. I was asked to review the scientific literature and present my findings to our hospital’s pediatric quality improvement committee. I’m very grateful that this committee agreed with my recommendations and went on change the policy. I’m proud to say that the hospital no longer routinely offers juice to children who are admitted here. It is made available when medically necessary, or if the parents specifically request it, but it’s no longer the standard drink that they are served following medical procedures.
This is an example of a simple change that hospitals can make to educate families on the dangers of excessive intake of sugar. Hospitals should lead by example, serving healthy foods and beverages. This starts with educating families on why juice is not a healthy option for most kids.
In an article about your achievement of getting juice off the pediatric menu at Swedish Hospital, you stated “The most common liver disease in childhood is something called Non-Alcoholic Fatty Liver Disease (NAFLD). It’s the exact same fatty liver condition you see in alcoholics, but we call it ‘non’ because it’s in kids.” Dr. Robert Lustig talks about sugar being “the alcohol of the child.” It is my sense that few parents realize that fatty liver disease is one of the fastest growing chronic diseases on earth. Please explain why sugary beverages, including juice, make fat in the liver? Why is fat in the liver harmful? Also, since we can’t see fat in the liver, and this condition affects the non-obese as well as the obese, are there warning signs that parents can look out for – or is it a completely hidden threat, only preventable by proper diet?
Sugar (sucrose) is made up of two molecules; glucose and fructose. While glucose provides energy to every cell in the human body, only liver cells can metabolize fructose. This means that when consumed in large quantities, fructose can burden the liver. Overwhelmed by excessive intake of sugar, liver cells start to convert some of the fructose into fat. But over time, the increasing amount of fat overwhelms the system, and fat droplets get stuck within the liver, causing the cells to become swollen and sick. This can lead to cirrhosis and liver failure. Did you know that under the microscope, there is no way to distinguish the sick, swollen, and dying liver cells from a child who has been consuming too much sugar from the liver cells of an adult who has been a chronic alcoholic?! This is why Dr. Lustig calls sugar (including juice and sugary beverages) the “alcohol of the child!”
When children drink a glass of juice, the amount of fructose being absorbed into the liver far exceeds the amount they would get if they were to consume whole fruit instead. Remember that when ingested in naturally occurring, small quantities, especially in combination with fiber (as would be the case when fruits are eaten in their unprocessed form), fructose wouldn’t be toxic to the liver.
Roberta, you are correct. In U.S. children, NAFLD is now the leading cause of chronic liver disease. Unfortunately, many children aren’t diagnosed until the disease has progressed. This is because it’s hard to diagnose NAFLD, using routine tests. Once warning signs of liver disease and metabolic syndrome do show-up on a physical exam, or with medical tests, NAFLD has often already progressed! That’s why prevention is key. The only way to prevent the disease is by avoiding regular consumption of excessive amounts of sugar. And remember, too much fructose is toxic to the liver, whether it comes from 100% juice, sugar-sweetened beverages, or processed foods laden with sugar.
What can you say about these patients, and other early indicators of metabolic disorder that might be helpful to parents and the general public?
I have certainly been seeing more and more children referred to me for help managing their metabolic syndrome. As a pediatric gastroenterologist, I am alarmed by the growing number of kids with nonalcoholic fatty liver disease (NAFLD). Over the last two decades, children have become exposed to increasing amounts of sugar, especially because sugar is added to the vast majority of processed foods. As I have already mentioned, NAFLD is now considered the leading cause of chronic liver disease in children and adolescents in the United States. Whether it be the sugar found in infant/toddler formulas or baby foods, crackers, ketchup, and breads, sugar is sneaking into our diets in excessive amounts, compared to decades ago. Some of the earliest indicators of children developing metabolic syndrome are excessive weight gain, especially around the abdomen. This can be reversed by going back to eating foods that are less processed, with more fiber and less sugar.
What general advice can you give to parents whose child are diagnosed with blood sugar disorders? Do you do provide any education related to diet – if so, what kind of advice do you offer?
The dietary advice I give to my patients is pretty simple: “Just eat real food.” It’s called the “JERF” diet! We need to go back to the basics of cooking our own food, putting real ingredients together and enjoying the experiences and flavors of cooking with our families. The food we prepare should be food that our great-grandparents would have recognized! We can’t continue to rely on the food industry to decide what we eat. When we take control of the food we cook and eat, we avoid all the chemicals, additives, preservatives and sugar found in the vast majority of pre-packaged, processed foods. If there are two secrets to healthy eating, it would be more fiber and less sugar. If we teach our kids to be on the lookout for foods high in fiber and low in sugar, this will steer them clear of most of the unhealthier choices.
How important is the school environment or teachers, or even the extended family, to get involved in a child’s health, especially related to diet?
The importance of having a child feel supported on all fronts, as they pursue a life of healthy eating, cannot be understated. It’s imperative that the adults in a child’s life set healthy examples to follow. We can’t improve a child’s metabolic health just by telling them to eat healthy. We have to guide by example. Having healthy food at home is a great start, but since kids spend a large part of their lives outside of their houses, we also need to make sure that the food that they are eating at school is beneficial and nutritious. Support from cafeteria workers, teachers, having healthy food choices at friends’/relatives’ homes all plays a crucial role in ensuring children continue on a lifelong path to metabolic fitness.
As I mentioned, the HSF offers the only website dedicated to Children with Hypoglycemia. www.hypoglycemiaKIDS.org. Do you have any advice on how the HSF can enhance its educational work with children and families affected by hypoglycemia?
Since it’s so important to get education on healthy eating to schools, it would be great to see HSF start a classroom-based initiative, offering education to students, teachers and parents. Webinars or conferences could help educate about the dangers of processed food. The science of insulin resistance is complicated, but I think that the HSF has an amazing platform to put the science in an easy-to-understand, user-friendly format, and share this curriculum around the world!
Uma K. Pisharody, MD, FAAP
Dr. Pisharody currently practices in the Pediatric Gastroenterology department at Swedish Hospital in Seattle, Washington, where she helps children and families understand the connection between diet, nutrition, digestive health and well-being. In addition to being a Medical Advisor for the HSF, Dr. Pisharody serves as a member of the board of directors for the Institute for Responsible Nutrition and the medical advisory committee for the Northwest Chapter of the Crohn’s and Colitis Foundation of America. She is also a member of the American Academy of Pediatrics; the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; the American Gastroenterological Association; and the American Society for Parenteral and Enteral Nutrition.
Interview of the HSF’s Founder Roberta Ruggiero by Wolfram Alderson
What keeps Roberta Ruggiero going? Why devote almost four decades to the HSF? A brief but powerful look into her past, present and future will give you the answers! Don’t miss it!
Roberta, you founded the Hypoglycemia Support Foundation under some rather unusual circumstances. Please describe what happened.
The term “patient advocacy” hadn’t even been invented yet back then. Would you please tell the story? Please share the year and the setting. It may be hard for some to understand today how such events could transpire today.
The biggest and most exciting year of my life was 1960; I graduated from high school, got engaged, got married and then planned on having a baby! I was just eighteen years old, had attended a special novitiate high school to become a nun when very unexpectedly I met a tall, dark handsome man in an Air Force Uniform. He swept me off my feet and my plans changed drastically. Because I had no commercial or business training, just academic and religious, getting a job in the outside world was a challenge. Thus, starting a family seemed like the best answer for us. I became pregnant within a few months of us being married. I picked the name of a doctor out of the Yellow Pages, never knowing the difference between a doctor and a GYN or pregnancy expert. So, it was no surprise that every time I went to him and told him how much I was gaining, he said, don’t worry! I didn’t follow any diet and just ate what I always ate but doubled it! Lots of pasta, bread and my favorite: hot fudge Sundays. I gained over 50 pounds! I never dreamt that my actions during my pregnancy would haunt me for years to come!
My daughter was born in November of 1961. I was beyond excited and couldn’t wait for all of us to come home to the small apartment my husband and I had prepared. I believe it started slowly! My excitement began to fade and give way to sadness, then tears. The emotional roller-coaster that would soon follow began to escalate and was now combined with head pains. They started out inconspicuously and then were full blown pounding headaches, followed be severe fatigue insomnia and crying spells. I wasn’t sure if these symptoms were the result or the cause of my depression. In 1963, my son was born and every symptom I had intensified. By now I was already on Valium. My family physician said it had to be “after-baby blues” (postpartum depression). However, he did start a series of tests because my head pain had become unbearable. I had an electroencephalogram, spinal tap, and extensive blood work, and it all came back negative. More medication was prescribed. This scenario lasted 5 years. It was at this time that my physician said since there is nothing physically wrong, it had to be mental/emotional. He suggested I see a psychiatrist. Fearful and ashamed, I went to my first one, practically sneaking in to his office so that no one would see me. He said I probably got married too young, had children too soon, etc. He increased the doses of my medication and added more. After months of not feeling better and getting worse, I went to another psychiatrist. His diagnosis wasn’t any different. I don’t remember how or why but I got to a third. After sharing my story and the experience I had with all the medical specialists I was seeing, he looked over my case history. It was now 1968—my illness started in 1961. The new doctor had an answer. He said there were treatments that he felt could help me. I heard nothing he said after that. At this point I would do anything. I said yes, I’ll do it, take it. I was desperate! This all happened during a time when the patient believed in everything the doctor would say–we put them on a pedestal and asked no questions!
I remember the morning we left for the hospital like it was yesterday! We drove up to the hospital, got out, went up the stairs and into the entrance lobby. I kissed my husband Tony and said goodbye…see you soon! I remember going up an elevator, then seeing windows with bars on them. Then the voices, and screams! I was rushed into a room and told to strip down and take all my clothes off and put on a hospital gown. They also wanted my wedding ring and the Miraculous Medal of Mary that I always wore around my neck. This is when panic started to creep in. What’s going on?
I found out soon enough when I saw a long sitting bench and patients not only sitting there but leaning, crying and some screaming–they were writhing back and forth. Some patients were walking around, some trying to get the attention of the other nurses. Fear must have gotten to me because the next thing I remember is being put on a stretcher or hospital bed. Several nurses helped to get me on it and straighten out my body. They strapped down my arms, hands and feet. Then things moved fast. Something was being attached to my head. Lights, there were lights all around. Why? I felt and heard several people behind me, I couldn’t see them but assumed they were doctors or a doctor and a nurse. I saw a machine. What’s that for? They started putting something in my arm. Then the most frightening of it all, they reached for my tongue!! Then the lights went out. My life was never the same!
People don’t realize that electroconvulsive therapy is more firmly established than ever as a method of treating certain severe forms of depression. Why or why not is this a good thing? Has the technology become safer than the past? Most us are only familiar with the horror stories, like your own.
When I got home from the hospital I was full of shame, guilt, humiliation and the sense of degradation which accompanies electric shock treatments. It’s the erosion of the heart and soul, the body and above all, the mind. ECT is now administered more than ever. I wish that legislation would be passed to have a patient tested for nutritional and or chemical imbalances, including hypoglycemia, before such measures are taken. It’s time the food/mood connection is taken seriously. If ECT is good, safe and the horror stories are not as bad as people think…then why is there such secrecy surrounding it? Doctors and even patients don’t talk about it even though the number of patients receiving it is higher than ever!
Aside from the specific technology of shock treatment, a powerful lesson from your story appears to be that medicine has been hyper-focused on treating symptoms of disease with drugs, procedures, and devices. Dr. Robert Lustig says that while these strategies may serve some short term (tactical) purposes, they are not the cure – they don’t address the systemic cause. He emphatically states that the way to reverse or eliminate most metabolic disorders, such as hypoglycemia, is to fix the diet, starting with reducing or eliminating processed foods, added sugar, etc. How did you make the connection with food as being a source of your health and well-being and what have you done about it? What is your “secret sauce” as they say?
I didn’t on my own, not at first. After the last doctor I went to, the one that finally diagnosed me with a glucose tolerance test, the first thing he asked me is “What do you eat?” I had to think! Then I realized that I don’t eat! I had two small children, fifteen months apart, and I was sick since they were born. My husband Tony had to go to work, our medical bills were pilling high. I managed to feed my children but I skipped breakfast, most of the time I skipped lunch too. Then, around 3 pm my mom or mother–in-law would bring over some kind of pasta, loaves of bread and dessert…usually hot apple pie.
After telling me that I had a severe case of functional hypoglycemia, my doctor promised me that my symptoms would go away if I changed my diet! I thought he was crazy! He’s telling me that a simple diet change would cure my headaches, sever fatigue, depression, etc. No way, I thought!
I was given a sheet of paper with some foods to eat and some to avoid. That wasn’t enough for me. I then bought a few books on the subject, one by Dr. Robert Atkins and one by Dr. Carlton Fredericks–they saved me. But it was a long and challenging journey. While trying to figure out what to eat and not eat, the bigger challenge for me was getting off all the medications I was on. Then reading about the importance of vitamins and exercise to stabilize blood sugar, which confused me. I didn’t know where to start with vitamins other than a multi-vitamin I was taking. And as far as exercise went, raised in Brooklyn NY, all I did was skating, jump rope, hide and seek–nothing a mother of two would do. What I thought would take me months to conquer, took years. I longed for someone I could speak with, someone who understood my fears and frustrations. I wanted a support group for people with hypoglycemia!
You had no experience founding a nonprofit back in 1980. How did you pull it off, and then maintain the organization over the last four decades?
I was a make-up artist and volunteered my services to our local community theater for almost five years. The cast, directors and crew became family. I loved them. When it became clear that I was ready to start a support group for people with hypoglycemia, I turned to them. They helped me with bylaws, articles of incorporation, an accountant and a lawyer. And so, in June, 1980, we were incorporated as The Hypoglycemia Research Foundation, Inc. In December, 1991, we changed our name to The Hypoglycemia Support Foundation, Inc. and we just celebrated our 37th anniversary!
I started having support group meetings in my home town of Cooper City Florida–that lasted for almost fifteen years before we branched out to other areas of Broward County. I formed a Board of Directors and Advisors and sought out the direction and support of some of the best and renown doctors in the holistic health and medical fields. Dr. Emanual Cheraskin, author of the Vitamin C Connection, Dr. Harvey Ross, author of Hypoglycemia: The Disease Your Doctor Won’t Treat, Dr. Lenden Smith, Dr. Carlton Fredericks, Dr. Robert Atkins and of course Dr. Wayne Dyer!
I was also fortunate to have Dr. Doulas M. Baird and Dr. Lorna Walker, both experts in the field of hypoglycemia to join the HSF. They taught me everything I know about low blood sugar!
In 2000, I launched www.hypoglycemi.org and then used this avenue of communication to bring information, support and encouragement to those suffering from this insidious disease, hypoglycemia. Our education efforts eventually reached millions.
All of this work was not easy; there were times I wanted to quit. It took sheer determination, persistence and faith–this was something I had to do. I remember a very special someone in my life said “You didn’t choose it, IT chose you!” I couldn’t walk away!
The list of your accomplishments in the HSF Strategic Plan are impressive. What were some of your biggest challenges? Please highlight some of the accomplishments you are most proud of.
The biggest challenge was raising funds. We tried everything, carwashes, putting on a play/musical, raffles, campaign letters, seeking corporate funding. When I realized that could be a full-time job, I started funding the HSF myself. The fact that I kept my overhead low was in my favor.
I made a home office; I asked family and friends for help in reducing their services or donating them altogether. My husband Tony was in the printing business so we got a big discount on our printing needs. Every bit helped; and we survived. And, we did without! I remember going several times a week (and sometimes everyday) to our local 7/11 to make copies of important papers and documents I had to copy and send. We just couldn’t afford a copy machine! When we finally got one, I cried!
In 2010, the HSF was growing, and so were our financial obligations and responsibilities. At this time, we looked into professional fundraising. This resulted in putting on five HSF Fundraising Galas. In 2016, I had to put the Galas on hold brought the work of the HSF to a slow crawl in order to take care of my very sick husband. This was the most difficult time for me. My first love and responsibility was taking care of the man I had spent my entire life with–56 years! I was torn because I also did not want to give up the HSF. I stopped writing my monthly blogs, but was able to answer some e-mails and phone calls, especially when they pertained to children. I also kept up with HSF’s Facebook page, when I was able to. These were the darkest days of my life!
Little did I know that a miracle was brewing behind the scenes—and it included two amazing human beings, Wolfram Alderson and Leslie Lee Sutton! They were to save me and the HSF!
I am most proud of my book, The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar. I just finished the fifth edition and it will be available in September 2017. I have thousands of letters and e-mails that I’ve received over the years telling me how much the book helped them or saved their lives. This is what it’s all about: sharing my story, my book, my website…to give hope to everyone that is suffering from this most confusing, complicated, too often misdiagnosed and misunderstood disease! People must know they are not alone; that you can control hypoglycemia symptoms before they control you!
I want readers to know that YOU CAN DO IT!! No matter what obstacle comes your way, if you have faith, hope and trust in God, anything and everything is possible!
I could hardly write a sentence, let alone a paragraph on health and nutrition when I started writing my book back in 1985. However, I knew I had a story and a message that was compelling to share…that could save lives! Sheer persistence and determination overcame my 65 book rejections!!!
Then one day, I was invited to a party. While there I told the host, a friend of mine, about my rejections and asked: “Should I continue?” He immediately introduced me to Don Lessne, the publisher and owner of Frederick Fell Publishers in Hollywood, Florida. I casually told him my idea and he said: “That’s just what I need, send me your book!” The rest is history!
A typical response to a low blood sugar incident or acute hypoglycemia is to consume a food or beverage high in sugar. Isn’t this paradoxical to solving the problem? Why are so many confused about low blood sugar and how to treat it (cure it, versus just attacking acute symptoms)?
The patient is confused because they aren’t getting the appropriate information and instructions from their doctor on how to stabilize or control their hypoglycemia symptoms. If you’re lucky to get diagnosed, you may get one sheet of instructions. They don’t know any better because they are not told or taught about hypoglycemia in medical school. Exacerbating the problem is that only 30% of medical schools even require a course in nutrition! In 1960, the AMA did a turnabout and declared hypoglycemia a non-disease! Half of the correspondence I get is from frustrated patients who say their doctor doesn’t believe hypoglycemia exists! I’ve also been told, over and over again, “my doctor says just eat more sugar!”
I’m excited to say this is changing with functional medicine and holistic health care providers now recognizing and treating hypoglycemia. Chiropractors, nutritionists, doctors and other health care specialists are opening their minds to the food/mood/health connection. Dental disease and hypoglycemia are new being understood to be “canaries in the coal mine” of metabolic disease. Understanding hypoglycemia in the context of overall metabolic health is key.
You recently partnered with the Institute for Responsible Nutrition to conduct a national questionnaire on hypoglycemia. What have you learned? What insights have confirmed what you already knew, and what new understandings resulted from the questionnaire? Were there any surprises?
First of all, I felt very honored and privileged to have both The Hypoglycemia Support Foundation, Inc. and the Institute for Responsible Nutrition conduct an online questionnaire targeting individuals who experience hypoglycemia. Leslie Lee, who is now one our HSF Medical Advisors, played a major role in designing and evaluating this questionnaire, and I am very excited about the results and the conclusions that she helped us deduce from the questionnaire results.
The purpose of our questionnaire was to characterize experiences with hypoglycemia and the diagnostic process and to see if we could observe a connection between reactive hypoglycemia and the development of type 2 diabetes later on. Legitimizing the condition within the medical community is important, because so many people express to us that their health care providers do not understand or even believe what they’re going through.
We learned quite a few interesting things from our now 1500 respondents. First, about two-thirds of our respondents knowthey have experienced hypoglycemia, but only about half of respondents have been diagnosed by a physician and only about one-third have been diagnosed with an oral glucose tolerance test, the gold standard diagnostic tool. There’s a disconnect there—so many people know they experience it and yet they aren’t being diagnosed.
What’s going on there? Why do the patients seem to know that something is going on, but their physicians do not?
Maybe it’s difficult to diagnose, or maybe physicians just aren’t taking it seriously enough.
Second, about one-third of respondents’ experience hypoglycemia at least once a week while another one-third experience it at least once a day. That’s too frequently! Imagine the impact on their qualities of life! This is a clear indicate that people who experience hypoglycemia don’t know how to prevent it from happening! That’s a problem and an educational opportunity.
What foods trigger hypoglycemia?
We received mostly predictable answers—starches, sweets, soda, caffeinated beverages, alcohol, and so on. But what was most surprising was that 11% indicated that diet beverages—which provide no calories, no sugar, and no glucose—are a trigger of their hypoglycemia.
How could this be?
We know diet sweeteners are associated with increased risk of developing obesity, metabolic syndrome, and type 2 diabetes. Perhaps diet sweeteners can trigger hypoglycemia through the same mechanisms as their other metabolic implications? We need more research in this field. Diet sweeteners have historically been presumed to be metabolically inert, but it’s looking like they aren’t.
What do your respondents typically do when they experience hypoglycemia? How do they treat it?
Well, only 12% are “following the rule” and using the American Diabetes Association’s recommendation of eating 15 grams of fast-acting carbohydrate, resting for 15 minutes, then checking blood glucose and repeating if necessary. More than twice that many (27%) are eating indiscriminately—they’re eating whatever is handy in whatever quantity they want. About 30% are eating sweets like candy or dessert and another 30% are eating slow carbs, like nuts, seeds, and whole grains.
Why is this important?
There’s a fine line between treating hypoglycemia now and triggering another episode of reactive hypoglycemia later. If you treat hypoglycemia with rapidly-absorbing starch or sugar, and you eat a large quantity of it, because your body is desperate for energy, your blood glucose may spike too high in response. That blood glucose bolus may spike your insulin too high, which may result in hypoglycemia again shortly thereafter. It creates a vicious cycle! The treatment leads to the problem, and the problem necessitates the treatment! If people were more strategic with their treatment, they may be able to treat hypoglycemia without inducing another episode. Again, this elucidates another knowledge deficit and educational opportunity.
What did you learn about reactive hypoglycemia preceding the development of type 2 diabetes?
This is where it really gets interesting! Of those who took our questionnaire and who have been diagnosed with type 2 diabetes or pre-diabetes, 68%–a whopping two-thirds—experienced reactive hypoglycemia before their diagnosis!
Hypoglycemia is often thought of as “the opposite of diabetes,” and patients are often informed they do not need to worry about developing diabetes. “Just eat some sugar” is common dietary advice given to people who suffer from hypoglycemia.
Our questionnaire responses beg us to examine whether reactive hypoglycemia is an example of metabolic dysfunction that, if continued undiagnosed or and mis-diagnosed, could develop into insulin resistance and then type 2 diabetes over time. We need to be thinking of reactive hypoglycemia as a red flag that type 2 diabetes may develop if the diet isn’t modified now. Think how much damage the advice to “just eat more sugar” could do to someone on the verge of developing diabetes! That message alone could be the tipping point toward diabetes for that patient. Most people (85%) who experienced hypoglycemia prior to a diagnosis of type 2 diabetes or pre-diabetes, experienced it for an extended period of time—at least 2 years. Think of all the positive change they could have made in their diet during that period if they had only been informed.
I know from personal experience that it is often very challenging when presenting symptoms of metabolic disorder, like low blood sugar, to health care providers. Conditions like hypoglycemia are poorly understood and most doctors have little understanding of diet-related diseases. In fact, only 30% of medical schools in the U.S. even require doctors to take a nutrition course! How did respondents describe the patient experience?
We knew patients are frustrated, but we didn’t know the degree to which they are frustrated…until now! Only 40% feel as if they understand the condition well enough to satisfactorily manage their symptoms. And it’s amazing that that figure is as high as it is, because only 17% believe their health care team understands their condition! Further, only one in four feels like their condition is taken seriously by their health care team. That’s sad. We can and should do better for the patient.
Where this is misery, there is also opportunity. Did the questionnaire reveal any areas where the HSF can make a difference?
Opportunities abound. If clinicians understand hypoglycemia better, they can educate patients to think of it as a red flag that diabetes could develop. By providing a little information and diet education (and NOT providing counterproductive information), we have the potential to prevent type 2 diabetes in this population. What a blessing! An early red flag that, if we notice it, can inform our behavior and prevent disease! How empowering! The HSF is developing high quality educational programs for health care professionals that provide CME (Continuing Medical Education) credit.
Is the questionnaire still ongoing?
To continue this study for future references, the questionnaire remains open for responses. If you would like to participate, you can access it by visiting www.hypoglycemia.org and clicking on “Take our Hypoglycemia Questionnaire.” Questionnaire results are posted on the HSF website (https://hypoglycemia.org/learn-about-hypoglycemia/questionnaire/).
You wrote a book that is going to be re-released in September in a 5th (revised and updated) edition. What challenges did you have to overcome about writing a book about a complex medical issue? You don’t have a medical or science background. Please describe what education and experience prepared you to write the book, the challenges involved in writing it, what motivated you to write the book, etc.
Wolfram, you just hit a nerve! I was so frightened to write a book about a medical condition with no medical degree and writing about a condition the medical community labelled a non-disease. Even those who did recognize its existence, still called hypoglycemia the most confusing, complicated, too often misdiagnosed and misunderstood condition of the 20thcentury.
So, no, I didn’t have a degree but I lived my story and I wanted to share it. I couldn’t believe I went through hell for no apparent reason. If I could save just one life, it would be worth it!
And after going through thousands of letters and emails (currently more than 400 month), I realized that I had something to offer that no one else was providing. I knew from my personal experiences and from all these messages from people pouring their hearts out, that hypoglycemia is terribly misunderstood, misdiagnosed, and poorly treated. I knew what they needed and wanted–and that they were not getting it from the medical community. I had no choice but to write about it and do something about it!
What advice can you give to others who might be considering a role as a patient advocate? What gave/gives you the right or authority to stand up and to be heard? While today, it may be true that doctors are encouraged to listen to their patients, when you founded the HSF, this was not the case – quite the opposite. Please describe how this dynamic has changed over the years. For example, you are now recognized by some of the leading doctors and health professionals.
It is still mixed after all these years. Yes, the HSF and I have come a long way and I’m proud to say that we’re recognized, appreciated and accepted more than ever. But we still have such a long way to go. I get e-mails from doctors, endocrinologist who want my information, I send them free books, brochures, etc., and rarely get a thank you. I have to admit that sometimes makes me question what my work is worth! If I reach a low point, I count my blessings and look to our amazing group of HSF Medical Advisors, and my newest supporters, including world renown neuroendocrinologist Dr. Robert Lustig, U.K. Cardiologist Dr. Aseem Malhotra, Pediatric Gastroenterologist Dr. Uma Pisharody… and Registered Dietitian Leslie Lee Sutton. Each of these leaders are inspirations and have amazing stories – they are my champions!
In 2020, the HSF will be celebrating its 40th anniversary. What is the HSF planning in the next few years leading up to this big moment in your organizational history?
I’m feeling blessed to have you, Wolfram, as the HSF’s new CEO. Together we’ll take the HSF to heights we’ve only dreamed of! We’ve gotten the message out about our current focus and work to the hypoglycemia community, their family and friends. We have a new Strategic Plan that gives some clues to exciting developments in our future. In order to get the HSF message to where it can make a difference, we are developing some exciting programs that provide education to health professionals – for example, we’re involved in developing model CME (Continuing Medical Education) educational summits focusing on Metabolic Health and Nutrition Summits Swedish Hospital in Seattle. The next big thing will be Patient Medical Education – serious, science based education for patients that move beyond simply managing metabolic disorders like hypoglycemia, and focus on reversing and preventing metabolic dysfunction.
You were obviously decades ahead of others in gaining insight that this health issue is like a “canary in a coal mine?” Are you surprised that hypoglycemia is more of a problem today than it ever was?
No, sadly, I am not. I am so aware of the culprits that surround us—sugar and highly processed foods being the biggest and the most deadly! All I have to do is go to one of the malls in my community and I see what the kids are eating and drinking. One can’t really blame the parents or the children; they are surrounded by sugar and processed foods, and it’s hard to resist–once it has a hold on you, you’re in for the fight of your life!
That’s why I admire the work of Dr. Robert Lustig, he’s going right to the source to fight this battle…the food industry! His new book, coming out September 2017, called Hacking the American Mind, is going to expose the industry even more and explain the science of how the food industry designs foods in chemistry laboratories, specifically with intention of manipulating our bodies and minds.
Over 40 years ago, Dr. Seale Harris said “Low blood sugar is the diabetes of tomorrow.” As of the year 2000, one in three children will have diabetes. This news can be paralyzing. What is the good news? Why should we be hopeful that things are changing? What is the light at the end of the tunnel?
The good news is that you, Dr. Lustig, Dr. Pisharody, Leslie Lee and the incredible Board of Directors, Medical Advisors, Advisors, volunteers and the HSF community are coming together as a team like never before! The Strategic Plan we put together is really exciting! We’re establishing partnerships in Seattle, LA, NY and my home town in South Florida. We are reaching out to amazing health professionals and leaders at hospitals, universities, schools and drug and rehab centers around the U.S. and even other countries. Anytime we have a room full of people, and pose the question “how many have been affected by low-blood sugar incidents?” – most of the audience raises their hands. We know that hypoglycemia / low blood sugar/ metabolic disease is affecting millions! We are hopeful that our educational programs and partnerships will have powerful and lasting results. We can change the shocking statistics on diet-related disease!
In April 2018, Dr. Lustig will be speaking in my home town of Fort Lauderdale, Florida. I’m looking forward to seeing him and introducing him to some of our HSF supporters, family, friends, community leaders, sponsors and volunteers. If it weren’t for them we wouldn’t be here! Can you imagine where we’ll go when we all join forces!
I see a light at the end of the tunnel and it’s as bright as ever!
Richard Eckfield - Sustainable Santa
Interview with Richard Eckfield, Sustainable Santa© with Wolfram Alderson
Today, I’m interviewing Richard Eckfield, also known as Sustainable Santa.
Richard, please share a little about your “life before Santa.”
I spent more than 30 years in City Management and teaching my profession which is Public Administration at the college level. In 1967, I was appointed to a Deputy to the Assistant Secretary for Public Housing and Urban Renewal post at HUD by President Johnson where we significantly modernized and streamlined both Public Housing and Urban Renewal processes which helped turn around what was becoming the decline of our major cities. Taken together with local government innovations I have been privileged to be associated with, our cities are far stronger and more enjoyable than they have been in decades.
Where did the idea of Sustainable Santa come from? What led you down the slippery, snow laden, slope to Santa Land?
I am Swedish by decent with both parents born there. Everyone in my gene pool transitioned from blond to white haired at about 35 years of age. Back then I had a goatee and white hair and my students all constantly told me “you should be a Santa.” In our retirement years, we always had our granddaughters with us during Christmas Vacation as their parents all worked.
By 2012, however, they had grown up to the point where they would no longer be “camping out” with us for those weeks before Christmas. I applied to be a Mall Santa and was instantly hired. In that job, I learned first-hand the meaning of the words we all have said: “Childhood Obesity Crisis” as I lifted 60 pound 4 and 5 year-olds into my lap for that picture with Santa. Compounding that experience my employer had me passing our Candy Canes.
Clearly there was a disconnect between what Santa was promoting and the reality of what was needed to help kids learn to enjoy what we now call eating “Real Food” and enjoying being healthy, happy and fit for life. But back in 2012 the steps needed for Santa to take to help make that happen were blurred by the Fast and Processed Food promotions. America’s imagination of what Santa could or should do to promote kids eating and being healthy were unclear
Where does the “modern” idea of Santa come from (the big guy in a red and white suit, holding a bottle of Coke) – how is it different from the historical Santa?
The original Santa was Saint Nicholas – Bishop of the town of Myra which is in what we now call the country of Turkey. He lived to be 73 years of age, dying in 343AD – long before “modern medicine”. He lived that long because he ate what we now call a “Mediterranean Diet” of fish, goat, lots of veggies, olive oil, and he loved Greco-Roman wrestling. In short, he was a healthy fellow and he cared deeply about the citizens of his town, saving them from famine twice, and working other “miracles.” That is in addition to establishing the idea of “gift giving” Christmas eve which were originally small sacks of gold. Saint Nicholas is still a revered Saint in the Eastern Orthodox Catholic Church. And the image of the healthy Santa still prevails in most of Eastern and Western Europe.
In Colonial America, Father Christmas was also a healthy guy, often with a salt and pepper beard. It was not until the 1920s when Clement Moore memorialized the practice of the wealthy Americans of showing their wealth by being what they called “corpulent” in his 1924 poem “The Night Before Christmas” as the “jelly bellied” guy who smoked a pipe and blew smoke rings the shape of a wreath around his head, that the Fat Santa took center stage in our American culture. Back then, in the 1820s, the rest of the Americans, including the kids, were working hard on the farms and in the factories and were not “corpulent.”
That Santa image would have faded away. However, in 1931, at the beginning of the great depression, the Coca-Cola company launched the advertising campaign designed to boost their winter sales of their beverage, and voilà, we had the début of the Obese Santa in their newly invented Coke Colored outfit of the Red suit with the White Cuffs (Coke’s colors) and it worked. Coke is justifiably proud of the fact that they convinced America that Santa is supposed to be fat, and wears a Coke can colored outfit. That image continues to this day irrespective of the fact that there is nothing “Jolly” about being Obese nor is using that image to target kids to encourage them to drink sugary drinks.
How is Sustainable Santa different from other Santas? Do I still get a candy cane after I tell you what I want for Christmas?
It has only been 86 years since the debut of that first Coke Ad campaign featuring the Obese Santa promoting a sugar loaded drink. For the record, the Coca-Cola Company had used a different Santa image in previous years, but it was the 1931 guy who has since become the “modern” model. 86 years is just a flicker of a moment in the lifetime of a country.
This is now the 21st century and the need to address the ill-health throughout American (and due to our unhealthy eating practices of consuming Fast and Processed “foods” is spreading world-wide) the need to “rethink” our eating culture is obvious.
The Santa Icon still has influence with children and Santas and now Lady Santas (modeled after the Women Christmas Icons of Europe) are in a position to help concerned parents help their children learn the joy of Eating Real Food and living a Sustainable Lifestyle.
But making this transition will take time and persistent effort. Plus, the use of the older Santa image continues. Watch the current TV ads. They still have him still being a “cookie connoisseur” and refer to him as “big guy.” Be clear, this is NOT about being skinny. It is about being healthy, and promoting “healthful” practices.
That gets to the issue of the “reward” systems we employ. And NO, you do not get a candy cane for telling Santa what you want. In fact, the 21st Century Santa helps parents help their children understand the connection between our now excessive sugar consumption and their lack of enjoyment of a full and active life due to ill-health, even how this affects their academic performance in school. Eating healthy is far more fun and the 21st Century Santa helps parents and kids understand that with a series of games and activities we carry out, often in the Farmers’ Markets where “Real Food” is available.
Sugar and processed foods seem to be hallmarks of virtually all American holidays, including Christmas, and a fundamental way in which we “reward” ourselves and our children… birthdays, celebrations at work, everyday “treats” and “deserts” have become the norm. How do you carry your message beyond Christmas to the year round of challenge of maintaining a healthier diet?
First, we recognize that the Sugar and Snack industry has “captured” many American Holidays. We just completed a very successful effort in our local Farmers’ Markets where we promoted the sale of “Natures Candy” as the trick-or-treat handouts for Halloween. The Farmers’ were organized to make available items such as dehydrated oranges, apples and persimmons and honey-sticks as alternatives to the sugar loaded confections typically given out at Halloween. There can be healthy alternatives to Jelly Beans for Easter too, in addition to the healthy alternatives promoted at Christmas time.
The first two were adapted from the pioneering work of Michael Pollan.
Rule #1 addresses the sad fact that kids now eat just to have something to do. It has nothing to do with hunger. Thus Rule 1 is to tell the child: “If you are hungry, eat an Apple.” Then Santa says: “What? You say you don’t want an Apple? – well, if you are not hungry enough to eat an apple, then perhaps you are not really hungry… and the thought will pass.”
The goal here is not to promote apple-eating. It is to get them to think before they stuff something in their mouth just because it is there – and Junk Food, which is now marketed as “Snack” food is available virtually everywhere, at every checkout counter in America. Rule #1 it to make them think before they “snack.”
Rule #2 is simple: Treat Treats as Treats. Santa tell them there is absolutely nothing wrong with “special occasion foods.” Traditional Holiday cookies and a lovely cake on their birthday is perfectly OK. And the joy and happiness of making and baking them at holiday times should be cherished moments. But don’t make those “special occasion” treats a daily fare. Treat cookies, and cinnamon buns, even pizza as what they are = treats to be enjoyed only on special occasions.
Rule #3 has its roots in Europe where in most cultures Children get a “treat” on Saturday if they have done well in school and have done their chores all week. In Sweden – in the culture I was raised in – it is called Lördagsgodis which literally translates to “Saturday Candy.” However, it never was “candy” but rather some chocolate, or nuts, or a fresh orange to peel and eat. Thus Rule # 3 goes: No Sodas, No Snacks, No Second Helpings, No added Sugar or Salt and No Sweets, except possibly on days that start with the letter “S” = Saturday or Sunday.
All three rules are collectively intended to get the children to think about moving away from the Fast, Junk and Processed Foods. They are the “stop eating the bad stuff” rules.
In the farmers’ markets, we have two other activities which introduce them to the “good” Real Food. One is called: Try a Santa’s Garden Bite Here program where the farmers sample tastes of Real Food which they likely are not familiar with – introducing them to the cornucopia of wonderful new food flavors.
The second is the “Eat the Rainbow” game which teaches them the different nutritional values within the five (5) different color groups into which all fruits and veggies fall, and teaches them how to prepare and eat the veggies of their favorite colors. We encourage making a game of it: perhaps all Reds and Greens this week Yellow and Purple next week, with the kids participating in the preparation. Over time they learn to “Eat the Rainbow” of colors which yields a healthy life.
What is your mission, how are you trying to change Santa culture in the U.S.?
We are not trying to change “Santa culture” we are trying to change “America’s Eating Culture” and just like the Sugar and Sugary Drink industry used the Santa Icon to sell their products, we want to use the Santa Icon to “sell” the joy of “Eating Real Food and enjoying a Sustainable Lifestyle.”
Step 1 in that process is to influence the “message” to get Santas, irrespective of their current body mass index, to STOP promoting products which create ill-health. There is no “fat shaming” involved in passing out the Food Rule Cards and promoting trying Santa’s Garden Bites. These appeal to kids of all sizes and stimulate their natural inquisitiveness.
To the degree that the Santas themselves want to take this advice and improve their “healthfulness” image, that is fine but not essential. Time and national acceptance of the idea of a “Healthy looking” Santa will eventually dictate the alternation to the 1931 Coke creation.
However, companies and Santas who view being Santa as a business should avoid wearing a pillow to bring them into compliance with the now out-of-date obese Santa image. Professional Santas should also avoid the temptation of wearing gloves which can transmit germs and viruses between children visiting their lap. Our Santas go bare handed and use a hand sanitizer between each child when working with kids in the Farmers’ markets
What advice do you give to children while in your Santa role?
RICHARD In addition to “eating healthy” which I believe we have covered, we also urge them to be creative. One activity is to encourage them to “make that Holiday gift” for grandma or family and friends, not just buy it. We provide a Make a Christmas Gift Idea book which shows them how to make great gifts from items they can grow or gather from the Garden, the Forest, the Sea Shore or the Kitchen. That is all part of the Sustainable Lifestyle part of our mission.
Are you part of a larger movement? If yes, please describe who your collaborators are.
Organic Farmers, Sustainable Agriculture advocates, the host of groups concerned with the explosive growth of children’s ill-health with illnesses now showing up in elementary school at levels never seen there just a few decades ago. That is part of the reason why we started our efforts in Farmers’ Markets – not because those attending were already “health conscious”- which many are, but because in any movement to “change culture” you have to organize your base of support from which you can expand the recognition of the need for an eating culture change. The ability to launch such an effort is high among those participating in and attending farmers’ markets.
Are you familiar with the U.S. Dietary Guidelines? Why do you think dietary advice is so confusing and ineffective in the U.S.?
If you look at the current food label you will find that the DV – the daily recommended value for Sugar is not even listed. That is partly due to the “loophole” the sugar industry could take advantage of as there is no daily “recommended” about of Sugar. You do not need to eat ANY added sugar whatsoever. However, there are daily amounts over which you should not exceed. But these are not shown, and the proposed change in the Food Label showing whether the product contributes to more than 10% added Sugar to the daily calorie maximum have been “sidelined” by the new Administration and my not be implemented at all. That is very sad.
You have participated in a number of events with Dr. Robert Lustig – what do you find appealing about his message?
Our efforts owe a great deal to the guidance provided by Dr. Lusting and the research team he assembled at his Institute for Responsible Nutrition. We exhibit in our Santa Houses at the Farmers’ Markets a poster showing the finding of his studies in Oakland where in 10 days, by eliminating added sugar from the basically deplorable diet of children in what we call an “Urban food desert” there, they dramatically improved the children’s health as measured by improved glucose tolerance blood pressure, improved liver function, improved insulin sensitivity and decreased “bad” cholesterol.
Other “realizations” from Dr. Lustig which we share with parents is the fact that while we call our group the Real Santas to end Childhood Obesity – the fact is that the illnesses the Standard American Diet (SAD) creates are NOT limited to the overweight or obese kids. It damages all children on the inside, whether they show it or not on the outside.
Finally, that obesity is a symptom of illness, not a cause, has been very powerful realization we have learned from Dr. Lustig. When in serious conversions with patients, our Santas share the realization that: You don’t get sick because you’re FAT, you get FAT because you’re sick. The SAD diet is killing us all one spoonful at a time and with a team effort between Santa and parents we can help the children avoid that outcome.
As you know, I am CEO of the Hypoglycemia Support Foundation. We want people to pay attention to early signs of metabolic disorder, such as irregular blood sugar. Ironically, low blood sugar is often treated with consuming hefty amounts of sugar or starch, which is almost always the cause of functional low blood sugar or reactive low blood sugar. Overconsumption of added sugar and processed carbohydrates is at the center of the metabolical disease storm. These habits and conditions are often set into place early in childhood, enabled by parents who don’t know any better…and we have built a whole food culture that supports disease and disorder. After the year 2000, one in four children will have type 2 diabetes.
How do you address these issues in your educational work associated with Sustainable Santa?
Through the Food Rules, Garden Bites, and Eat the Rainbow programs previously discussed. We also make “SPARK” (Santas Promote American’s Right to Know) educational presentations where we show parents both how to read the food labels and point out what is missing on them.
MORE INFORMATION ABOUT SUSTAINABLE SANTA
Sustainable Santa Foundation
PO box 1225
Carlsbad, CA 92011