Monday, August 15, 2011

Book review: Sugar Nation

Jeff O’Connell is the Editor-in-Chief for, a former executive writer for Men’s Health, and former Editor-in-Chief of Muscle & Fitness. He is also the author of a few bestselling books on fitness.


It is obvious that Jeff is someone who can write, and this comes across very clearly in his new book, Sugar Nation.

Now, with a title like this, Sugar Nation, I was expecting a book discussing trends of sugar consumption in the USA, and the related trends in various degenerative diseases. So when I started reading the book I was slightly put off by what seemed to be a book about a very personal journey, written in the first person by the author.

Yet, after reading it for a while I was hooked, and literally could not put the book down. Jeff has managed to write something of a page-turner, combining a harrowing personal account with carefully researched scientific information, about a relatively rare form of type 2 diabetes.

Jeff has a genetic propensity to insulin resistance, just like his father did. What makes Jeff’s case a little unusual is that Jeff is thin, and apparently has difficulty gaining weight. The most common type of diabetes is type 2, and most of those who develop type 2 diabetes do so via the metabolic syndrome. Typically this involves becoming obese or overweight before getting diagnosed as a diabetic.

In fact, in a thin person who is insulin resistant it seems that body fat cells become resistant to the normal actions of insulin much sooner than in the obese. This essentially means that they start rejecting fat. This is a problem, because fat should either be stored in fat cells (adipocytes) or used for energy; as opposed to being deposited in other tissues or remaining in circulation. Apparently this makes it even more difficult for them to control glucose levels once insulin resistance sets in; there is no “cushion”, so to speak.

Still, Jeff appears to believe that his case was that of a skinny-fat person, where body fat percentage is a lot higher than expected based on a low body mass index, and where excess visceral fat is a main culprit. In fact, Jeff seems to think that most cases of thin folks who developed type 2 diabetes are like this, as they follow the metabolic syndrome progression pattern. Fasting triglycerides go up and HDL cholesterol goes down, among other things, but in a skinny-fat body.

Somewhat predictably, what Jeff found out is that, in his case, adopting a low carbohydrate diet made an enormous difference. In fact, it made the difference between having a fairly normal life versus constantly suffering through hypoglycemic episodes. And, at the stage in which Jeff caught the problem, he did not have to avoid all natural carbohydrate-rich foods, not even things like apples. (He had to control portions though.) It is the refined carbohydrate-rich foods that were the problem for him.

I must say that I disagree with a few of the statements in the book. For example, the author seems to believe that excess saturated fat and salt may be quite unhealthy. I think that foods rich in refined carbohydrates and sugars are much more of a problem; cut them out and often excess saturated fat and salt either cease to be a problem, or become healthy. Jeff doesn’t seem to think that excess omega-6 fats can also cause diabetes; I believe the opposite to be true, via a pro-inflammatory path.

Still, this is a great book on so many levels. Jeff meticulously records his experience dealing with doctors, most of whom seem to be clueless as to what to do to prevent the damage that is caused by abnormally high glucose levels. This happens even though diabetes is those doctors’ main area of expertise. He talks about himself with complete abandon, and manages to mix that up with quite a lot of relevant research on diabetes. He gives us an insider’s view of the professional bodybuilding culture, including its use of insulin injections. His description of the Amish is very interesting and somewhat surprising.

For these reasons and a few others, I think this is a great book, and highly recommend it!


js290 said...

Ned, my uneducated guess lately has been that perhaps obesity is simply one possible phenotypic expression of insulin resistance.

The pro-carb folks like to point to the skinny Asian population, but they fail to realize skinny Asians also develop insulin resistance, too.

Ned Kock said...

Jeff seems to think that body fat accumulation comes first, before IR, but that in some people the amount of body fat needed to cause problems is relatively low. He talks about some compelling evidence in support of this view. His own case seems to support it.

David Isaak said...

Okay, we all know that excess body fat causes all manner of problems.

The thing I've wondered about is adipocyte number versus absolute quantity of fat storage. That is, A and B might have the same bodyfat percentage and the same bodyfat mass, but A and B might have a very different number of adipocytes.

Which is healthier given the same amount of bodyfat--many smaller cells, or fewer larger cells?

Ned Kock said...

Hi David. Body fat cells seem to be somewhat fixed in number. As body fat cells become saturated with fat, they become insulin resistant and start rejecting fat, which is a problem because fat is supposed to either be store in adipocytes or used for energy. The body then creates new body fat cells, and that tends to ameliorate the problem a bit.

This appears to happen with folks who are obese. Whether this is good or not I guess depends. If the person remains obese, this is probably good, but obesity itself has its own host of problems. But if the person loses a lot of body fat, becoming lean, maybe those extra body fat cells play a positive role, or maybe they do not.

It is possible that we evolved adaptations to deal with this, but I think it is somehow unlikely that too many of our ancestor went that route – from lean to obese and then back to lean.

js290 said...

Ned, since the body is capable of catabolizing lean muscle tissue it doesn't think it needs, it stands to reason it would do the same with adipocyte.

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The thing that makes Sugar Nation such an incredible read is that it is not just a documentary about sugar, diabetes and obesity. It’s a personal story of Jeff’s own search for answers.

Ned Kock said...

Hi js290. The number of various types of cells (e.g., adipocytes, muscle cells, nerve cells) is somewhat fixed. When we talk about catabolism of cells, we usually refer to loss of cell content, not destruction of the entire cell.

I find it fascinating that our bodies seem to have mechanisms that are hard at work all the time to prevent multiplication of cells outside the developmental growth period. And this applies to cells of almost any kind.

When those mechanisms don’t work, we have things like tumors and cancer.

David Isaak said...

Interesting, Ned.

I agree that few of our ancestors probably made a journey from lean to obese and back again. On the other hand, I suspect that at least in high latitudes they packed on pounds seasonally. I seem to have a tendency to gain weight, or at least hold it, in the summer and fall, and lose it in the winter and spring. I wonder if it is day-length mediated?

It seems that a good deal could be learned by studying liposuction, where both the number of adipocytes and their total mass is dramatically changed. But the literature has all kinds of conflicting results (from improvement in metabolic syndrome to no effect whatever. The studies don't seem to be easily comparable.)

There also seems to be some differentiation into calsses or breeds of adipocytes:

Given the public-health focus on obesity, it's surprsing how little we know about fat cells and fat as an organ!

Ned Kock said...

Thanks for the link David, and good points. Something that caught my eye right in the abstract:

“A 13% weight loss was accompanied by 46% improvement in insulin sensitivity …”

js290 said...

I wonder if losing weight led to increased insulin sensitivity, or did increased insulin sensitivity lead to weight loss?

Ned Kock said...

Hi js290. The authors mention an increase in adiponectin levels as caused by weight loss, and this increase acting as a mediator of the effect of weight loss on insulin sensitivity. This makes sense.

I’ve long been interested in adiponectin, way before it started receiving some attention in health blogs:

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Primal Plan be walking in familiar territory here - insulin sensitivity and resistance, eliminating sugar and grains, increased protein and healthy fats, increasing exercise. But where the Primal plan focuses on all the benefits of a primitive life and leaves you thinking, "Hey, this sounds like a great plan to follow," Nation zero sugar specifically on the epidemic of type 2 diabetes and leaves you wondering explodes "I slowly kill me for not following the plan."

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