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SUGAR NATION PDF

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Wavne Rikkers: ua. This article has been corrected. This article has been cited by other articles in PMC. Abstract Background High consumption of refined carbohydrate, in particular sugar, has been identified as a possible contributory factor in greater risk of excess weight gain. Methods Foods high in sugar were identified. Data relating to sugar supply and consumption from to were obtained from multiple sources. Results Australia produces and exports sugar from sugar cane and the sugar in imported foods has received little attention.

For those wanting a low-carb diet that's easy to follow, see this: I'll admit that the first few weeks on this diet were a bit challenging in terms of figuring out what to eat, but now that I've been on it for a few months, it's so easy.

It's easy and good, and I never feel deprived, which is the key to sticking with this lifestyle. I don't feel hungry much either. View 1 comment. Oct 11, Jenny rated it it was ok. I really hate to give bad reviews, and I know this author spent a great amount of time and research on his book. For me the biggest problem is that the book is mistitled -- it's really a book about Diabetes in America -- how to spot it, prevent it, and how pervasive it is becoming. Every chapter focused on another aspect of the disease.

While I understand that this is a major outcome of America's sugar addiction, I found myself wanting more content that was directly applicable to my life -- or e I really hate to give bad reviews, and I know this author spent a great amount of time and research on his book. While I understand that this is a major outcome of America's sugar addiction, I found myself wanting more content that was directly applicable to my life -- or even just more about the over-production and consumption of sugar in general.

This book does have some important messages, but I don't think you need to read the whole thing to absorb them -- best to check out the author's Men's Health piece that was the inspiration for the book instead: Thin Man's Diabetes - http: View 2 comments.

Nov 19, Carmen rated it liked it Recommends it for: This book was a little too technical for me. It was also disjointed But it is very informative about diabetes. It talks about how even thin people can have Type 2 Diabetes. It talks a lot about how Type 2 Diabetes is reversible, and how diet and exercise can cure it.

It talks about how the drug industry makes tons of money off diabetics. It supports a low-carbohydrate diet. And, b Who can I trust to help me? O'Connell's best advice seems to be "trust no one". Not the health bodies, not your GP, not the other amateur metabolic sleuth he connects with late in the book. Never have a baked potato without sour cream and bacon, for example that I was left with the conclusion that the only way to beat this thing is to undertake my own complicated investigation across a myriad of tests and doctors, to uncover the unique and personalised means to my own salvation.

And if it ends up being similar to O'Connell's - mini-meals every 2 hours, an extreme low-carb approach which most medical bodies would describe, apparently, as 'unhealthy', BUT with a couple of glasses of red wine allowable, somehow - then god help me. I don't know, I kinda felt like O'Connell's approach was often Grab hold of the research that suits your conclusions, ignore the rest. I will be eating less carbs from now on Feb 12, Martha Smith rated it did not like it Shelves: The author takes the reader on his personal health journey.

He takes you inside his visits with his "medical" doctors and the medications they prescribe to him. He indicates how difficult it is to find accurate information. The drug industry has saturated most of the literature in the doctor's office.

Doctors in general do not teach prevention or reversal. They pedal pills. Sadly, the author did not find the "cure" for his diabetes or answer he was looking for. He did not know that John McDougal The author takes the reader on his personal health journey. Barnard MD have been reversing diabetes for over 30 years with exercise and a plant-based whole foods diet. I highly recommend Dr. McDougall's and Dr. Barnard's books. I recommend the documentary, Forks Over Knives.

I think it is important for people to understand how sugar acts in the body. Below is my favorite college lecture on diabetes and sugar. The Bitter Truth by Robert H. He argues that fructose too much and fiber not enough appear to be cornerstones of the obesity epidemic through their effects on insulin. Feb 03, Lisa rated it it was ok. I expected this book to be more about what you could do about this Sugar Nation of ours -- not an expose on the author's personal experiences and other than saying that what he does to control it only specifically works for him because he has a unique type of situation, he doesn't go any further than that in terms of how others in this sugar nation world can deal with it.

It was also severely bogged down in facts, studies, blah blah blah, that was just way over my head in terms of what I could I expected this book to be more about what you could do about this Sugar Nation of ours -- not an expose on the author's personal experiences and other than saying that what he does to control it only specifically works for him because he has a unique type of situation, he doesn't go any further than that in terms of how others in this sugar nation world can deal with it.

It was also severely bogged down in facts, studies, blah blah blah, that was just way over my head in terms of what I could even grasp. And the author is highly critical of the medical establishment and the ADA and anything really that is being done for diabetics in our Sugar Nation -- and it was weird that that didn't appeal to me because I agreed with it. But I guess it was the lack of well, do this, or at the very least try this. I am not sure what the message was at all! Ummm, I read the book cover to cover and I still don't know how!

Aug 05, Krenner1 rated it it was amazing. Outstanding book on the discrepancies in diabetes self-care. The person who is thin, fit, yet with prediabetic numbers may not concern a physician; a referral to a dietician may still result in a lack of correct information.

There are cofusing, differing verdicts on diabetes treatment, and a tendency toward little intervention until the disease is full-blown and in control. The author, a thin, fit prediabetic, has researched this in-depth, and suggests his own physical salvation through a diet t Outstanding book on the discrepancies in diabetes self-care. The author, a thin, fit prediabetic, has researched this in-depth, and suggests his own physical salvation through a diet that goes beyond what many in the field suggest.

Superbly written. Not too technical and easy to read. Sugar Nation is Jeff O'Connell's personal journey, but his health issues, I now realize, are my health issues, and this book has ripped the scales from my eyes. I suppose to really explain my reaction to this book, there has to be a little background about me. Last month, right after Thanksgiving, I saw my doctor who asked why I had put on so much weight since the last time I saw her.

The answer was stress and junk food, and she said, "Well then, you know what to do there, but you may also want t Sugar Nation is Jeff O'Connell's personal journey, but his health issues, I now realize, are my health issues, and this book has ripped the scales from my eyes.

The answer was stress and junk food, and she said, "Well then, you know what to do there, but you may also want to look at quitting starchy carbs bread, rice, pasta, potatoes and sugar. I cut them from my diet and dropped 7 pounds in the first 3 weeks and even more shocking found that my near daily headaches disappeared.

Moreover, I wasn't having any more hypoglycemic episodes. I was starting to think that maybe sugar is evil, and so I picked up this book hoping to find some reasons to justify and reinforce my new commitment to a sugar-free lifestyle.

What I got, however, was a face-first dive into the specter of diabetes. So, yeah, I knew the hypoglycemia wasn't great, but I always just figured it was the opposite of diabetes, not the other side of the same coin. It's the precipitous drop that follows the spike; it's the reason that two donuts can put me down for an involuntary nap two hours later.

Maybe willfully, I had never made the connection that my reaction to sugar was a symptom of insulin resistance. This is particularly ridiculous because my mom was diagnosed as a Type II Diabetic at I just figured that her health problem didn't apply to me because her worst weight was still lbs greater than my worst weight.

If there's anything that this book taught me, it's that while obesity is an indicator for diabetes, it's not the only one, and being in a mostly normal weight range isn't the protection from insulin resistance that you might think that it is.

My whole maternal family is hypoglycemic--my grandmother, mom, aunt, cousin, sister, all. I've had episodes of it since elementary school and always have to remember to not go too long between meals, or else fight grogginess, shakes, anger, etc. Moreover, I've always treated it with a quick dose of sugar, which I now know is about the worst thing you can do. So when I say that this book has changed my entire perspective on having a good diet and regular exercise, I'm not joking.

I'd always felt that those things were good but somewhat voluntary. I'm now treating them as if they're as necessary as my feet, which by the way, I have no interest in losing. I think the most horrific thing I learned in this book is that every nasty sugar-induced spike was causing small vessel damage. That's why diabetics have issues with their kidneys and vision and feeling in their feet.

Think about that, you do not have to be diabetic to damage yourself with a spike in your blood sugar. Some of what O'Connell explores is also how insidious drug prescriptions for diabetes can be, and now sometimes the side effects are worse than what they're curing. I don't think that I made the same connection about my mom as he did about his dad for a pretty simple reason. My mom died two years later at 54, so I never had to watch diabetes tear her apart, but the way she died has taken on new significance for me.

She died of an accidental overdose, a bad drug interaction from her diabetes meds. They determined that it was accidental because she hadn't exceeded the daily recommended dosage for either drug. So yay, go diabetes drugs. So, perhaps it's a tad dramatic, but Jeff O'Connell has changed my life. He's made me realize that diet and exercise are something that I need to work on every day and that sugar is not a harmless pleasure. He's also made me very grateful that I have a doctor willing to take the time to give me not only dietary advice, but good dietary advice.

I'm seriously writing her a thank you note for putting in that extra bit of effort. I'm also giving a copy of this book to all the hypoglycemics I know and love. I don't agree with everything he does. For instance, I wouldn't touch processed food like diet soda and soy protein with a ten-foot pole. Additionally, he takes time to ridicule housework as aerobic exercise. I very much suspect that dude doesn't do his own cleaning. Even if he does, I don't think that a single man who travels extensively for work and doesn't cook can even conceive of the kind of destruction that my sister's four kids can wreak in a couple of hours.

He specifically conjures up the image of "your great-grandmother Anyhoo, I've read a lot about HIIT training outside of this book, and I think that he was just making a poor argument for how much more effective it is, but seriously, don't knock how much work maintaining a home is if you've never done it.

If you want to say that interval training is more effective, fine, I agree. If you want to say that five hours of cleaning is the same thing as five hours of sitting on the couch? You can go screw yourself. Sep 26, Shauna rated it really liked it. More fuel to add to the "you better watch what you eat" fire. It's rather alarming just how much sugar and simple carbs the average American eats, and how devastating this can be on a person's body. Reading this book has made me look at my own diet a little more closely, though I have yet to do anything about it.

Also alarming is the way Jeff O'Connell portrays much of the U. I d More fuel to add to the "you better watch what you eat" fire. I do wish he'd included a little more guidance as to what to eat and in what proportions, but I suppose a little research on my end won't kill me. Sep 19, Marguerite MacLean rated it it was amazing Shelves: This is one of those books you would call life changing.

Jeff O'Connell shares his journey from being diagnosed with pre-diabities to learning to control it through diet and exercise. His explanations make a lot of sense and he actually put his money where his mouth was in the sense he actually did the advise he gives others.

I knew a lot of what was in the book, but to read about his own life style changes it inspired to me to make a few myself. Here's hoping Nov 19, Christa Harmon rated it did not like it Shelves: I lost interest in this after listening for a few minutes.

The title of it was the most interesting part of what I made it through. Nov 20, Socraticgadfly rated it really liked it. Some of this book is very common sense, and shows that the American Diabetes Association isn't. O'Connell pushes, rather, a high-fat and high-protein diet. He's careful to say, though, that he doesn't endorse a full-blown Atkins diet, and to note that it often doesn't work so well as a diet tool in general, let alone an anti-diabetes tool.

And, O'Connell also pushes exercise, with Some of this book is very common sense, and shows that the American Diabetes Association isn't. And, O'Connell also pushes exercise, with some specific ideas.

That said, at times, he veers into the fringes of nutritional science, when he references people like Gary Taubes, and when he hits hard the hypoglycemia theory. Read with a grain of salt Dec 27, Karen rated it it was amazing. An excellent look at why type 2 diabetes has become a runaway epidemic in our society, and how most of the medical community and the American Diabetes Association have basically let it happen.

This is a must-read for anyone who has been diagnosed with the disease, or with prediabetes, or has a family history of it.

Sep 18, Spook Harrison rated it it was amazing Recommends it for: Basically everyone. At first the tone of the book, definitely written by a magazine writer! Extremely well-researched and examining the issue from multiple angles, this is an excellent text. Also, I'll be able to recommend it to my friends who don't like slogging through academic literature! Jan 09, Cynthia Egbert rated it it was ok. I actually only got through about 65 pages of this book before I had to walk away.

There is good material here if one is struggling with metabolic syndrome or diabetes but I needed something more for me and my situation and this one just didn't seem to offer it and the book also began to seem redundant. Sep 10, MJ Samuel rated it liked it. I believe his scare-tactic approach was too extreme because my love for sugar no matter how sluggish it makes me feel still took precedence over living the extreme diet and exercise regimen that he proposes.

Oct 27, Heather rated it liked it Shelves: I appreciate the heavy research and unflinching dedication that this author has put into managing his diabetes with diet and exercise. It is a feat to commit to this degree of self study and discipline in the interest of your own health. I have done a fraction of this kind of research to investigate and manage my son's ADHD and it is not easy.

That said, my feeling on this book is that it is perhaps mis-titled and perhaps mis-marketed by the publisher's synopsis. To suggest that he provides a simple solution is misleading. In addition, the title doesn't help the reader to see that the book is very specifically about one person's approach to managing his prediabetes and not about helping people in general wean themselves from sugar.

In fact, diabetes is not even in the title and that is what the whole book is about. I do not have pre-diabetes and was looking for a title about sugar in general. The book is mostly a telling of the author's journey specific to his own experience and the reader has to ferret out from this tale which pieces of dietary advice may or may not help with their own unique blood sugar situation. In addition, the author's really diligent work to arrive at his own balance required repeatedly going against medical advice and the advice of our country's supposed diabetes "experts", including the American Diabetes Association.

Unlike the author, most people are a dependent on insurance and therefore their insurance-approved physician and whatever advice said physician recommends b not magazine editors with connections, research experience and a job that pays you to investigate your health journey and c afraid of venturing off on their own in conflict what ALL of the experts recommend.

That is not to say that the book does not have merit. It is important that we learn that our "experts" are a misleading us, b ignorant of important dietary considerations and c in the clutches of big pharma. This book is pretty dry and academic, but has good stuff in it. Jan 31, Monica Gokey rated it it was ok. If fighting diabetes was a varsity sport, Jeff O'Connell would be the coach screaming at you at his players to "lay off the goddamn baked potato, you pussies!

While it's unclear what evidence he taps for his personal diabetes-mitigation plan, it's clear he thinks highly of it. An unpalatable tone of smugness underlies the whole book I found myself skimming several chapters. That said, the author's sample-size-of-one story was still somewhat useful to me. I, too, have a strong family history of diabetes I checked this out as a library book and thus it was free. If you're interested in a sugar book, I'd opt for one of the better researched tomes out there Skip "Sugar Nation" unless it's all you've got.

Jul 30, Stephanie Jackson rated it really liked it. Interesting book. The author is a journalist so there was lots of research involved.

He is also telling the story about himself and his treatment. I was interested as my husband is type 2 diabetic and the future complications we might expect are pretty horrifying.

He never outright states "The trick to beating diabetes is carb control before you're diabetic and for sure afterwards. I appreciate that he "doesn't have a dog in the fight". He'd not selling an herba Interesting book. He'd not selling an herbal supplement with his name on it. He's not advocating a specific diet that you have to download the book or their meals. The last part of the book is really about what he does to control his own blood sugar and his process of getting to that point.

My husband and I have felt some details are a worthy take away to implement and just in a few days, we've seen a big improvement in his glucose numbers. I start by asking Dr. His moth- er was a linguistics professor and his father a stockbroker in India, his nat- ive land. So without knowing a soul down in the delta, he moved there in , becoming the first physician to work at Mallory, in a health clinic being started by an MIT-trained nutrition specialist with the aid of a federal grant.

Doshi was assigned chronic disease management, which in an area like this is akin to learning surgery in a war zone. Fifteen years later, long after he could have left the region for an easier practice and Friday afternoons on the links, he remains here, a proud U. If I reflect on my own life, what good did I do? If I can say that I have crossed the barrier to love the people, and care for them, without realizing who they are or not, focusing on their minds, bodies, spirits, then I have lived my life.

He appreciates me coming to this place and finding him, but he also challenges my motivations. That is a question that you must ask yourself: Can I be so sensit- ive as to understand the suffering of other human beings?

I thought back to my skepticism regarding the motives of philanthropists who would donate some princely sum to build a new hospital wing in their name, dedicated to curing whatever disease had stricken them or a loved one. That disease was there before you ever got it, I would think. Now, standing in their shoes, in a sense, I wondered if my motives were any less conflicted and impure.

For a writer like me, maybe a byline was the equivalent of a name stenciled on the facade of a building. Regardless, the problem needs solving. Few regions have hosted more human suffering than this one, and type 2 diabetes has joined poverty and obesity on a long list of slave masters. My Indian guide takes me from the Mallory clinic in Lexington to another one in nearby Tchula.

I follow a cloud of dust up an un- paved driveway filled with small craters; the next thing I know, Dr. Doshi is wrestling with his lab coat while hurrying inside. I interview him in between his meetings with patients, most of them diabetics.

Anytime he leaves his office for a consultation, the urgency of his lecture can be heard through the walls. After returning, he sits behind his desk, and his tone becomes more measured.

These are long-term situations. What Is Type 2 Diabetes? In simple language, it explains how something called insulin resistance leads to diabetes. There are even Flip- ping it over, I see diabetes treatments presented as a series of simple steps: One of them, Ruth Tolbert, is a sixty-six-year-old African-American who found out she was a type 2 dia- betic in One of fourteen children whose parents were also type 2s, she always felt that diabetes was her destiny.

Ruth thought she was eating healthfully most of her adult life until a book she read one day told her otherwise. She stayed active, walking not only to get from one place to another but also for its own sake. But she gladly would have changed other habits—including eliminating potatoes with her steak and vegetables, cutting out high-sugar desserts—had she only known that they were sabotaging her well-intentioned efforts in other areas.

It decommissions the foes capable of warding it off, one by one, until it can act unchecked. Outsmarting the disease means not only managing your blood sugar but also sidestepping complications such as heart The damage in- flicted by high blood sugar on blood vessels in the brain doubles the risk of having one of these attacks.

She has trouble boarding the boat because of stroke-related balance and strength challenges. She needs a cane, and her right foot is balky and prone to swelling. Now that she knows what to do, she goes the extra mile—fifty-five of them, in fact.

They give you two starches on your plate. After fifteen minutes of conversation, she confides a secret: Doshi, but I stopped taking the metformin about three months ago.

I take a blood sugar tea from the health food store every day instead. It keeps my blood sugar down and makes me feel better than the pill does. The metformin made me very hungry. But I drive to lunch with Dr.

I wonder how people could be chron- ically malnourished in what appears to be an agricultural Shangri-la. Worrying about type 2 diabetes down the road often takes a backseat to feeding hungry mouths that night. Uwaifo, M. The urb- an and suburban poor are just as diabetes-prone as the rural poor. The bonds between the disease and poverty are interwoven at very fine scales of geographic resolution throughout the country.

Block by block, those conditions overlay poverty. If you took a hypo- thetical affluent neighborhood and placed it side by side with a poor one, diabetes rates in the poor neighborhood would predictably exceed rates on the affluent street by a widening margin.

Doshi and I are joined by his girlfriend, Julie, a Mississippi native whose wide body squishes his into one-third of their side of the booth. They met when she was working in housekeeping at one of the clinics; eleven years later, they remain together. Doshi after a few bites. Diabetes is only one manifestation of not only a medical problem but also a behavioral problem. Poor diet, lack of exercise, stress—so many things go hand in hand. You pay a greater price later on to the suffering of our own people than we can do by taking corrective measures ahead of time.

The key to solving this public health crisis lies with pre- vention, or, failing that, early detection and swift lifestyle change. Doshi strikes me as having the heart and soul of a modern-day Hip- pocrates. Like most doctors, probably like your Their alternative is a reli- ance on drug after drug to manage what becomes a long, painful, complications-riddled demise.

When they could just cure the disease. Sure, patients are handed a pamphlet with their prescriptions telling them that diet and exercise would, in fact, help. But the unspoken assumption is that the patient will never stick with the lifestyle program. Deeb, M. If only we invested as much effort honing message delivery as we do perfecting drug delivery. Hearing many physicians discuss lifestyle change as an alternative to dia- betes drugs reminds me of the Pledge of Allegiance or a religious hymn be- ing repeated only as a matter of habit.

How persuasive can any argument in favor of lifestyle change be when mo- ments later the same doctor is talking up prescription drugs, per the ADA guidelines? Back in early , the medical world was stunned when a combination of lifestyle changes dietary adjustments, exercise, and the resulting weight loss reduced diabetes incidence by 58 percent in the Diabetes Pre- vention Program, a major multicenter clinical research study.

The Problem solved, you might think. Blair, P. Lifestyle change is twice as effective and costs much less. This disease can be sent pack- ing using any number of strategies and techniques, none of which requires a drug prescription. People just need to be told what they are. On TV monitors hanging above the hallways, anchors—or actors playing anchors—bleat the latest diabetes breakthroughs, as if CNN were delivering a news flash.

In all, fifteen thousand people, thirteen thousand of them researchers and health care professionals, will attend. Experts are on hand to discuss the use of stem cells to grow new insulin- producing cells in the pancreas. In , , of the desperately overweight undertook such bariatric surgeries in the United States alone.

Epidemiological studies are reviewed, clinical trials updated, and panels convened to discuss everyone from the diabetic athlete to students with diabetes to pregnant women with The bar is crowded, and behind it, a line snakes past a long buffet. I aim to consume 80 or fewer grams of carbs excluding fiber a day to keep prediabetes at bay. Low-carb experts have convinced me this amount can keep my brain and body functional and healthy, especially since I choose whole food sources of mostly complex carbs with lots of fiber.

I might have half a cup of oatmeal with breakfast, some edamame with lunch, an apple, and broc- coli at dinner—not a Coke before bed. They claim even that amount is extremely low, and that anything below that threshold literally will starve the brain and central nervous system.

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But after four years eat- ing amounts well below their lower limit, my mind is sharp. My body feels great. I can power through forty-five-minute daily workouts. The only thing that seems helpless to function under these conditions, actually, is diabetes. The ingredient lists for the six dishes being served at the reception include reduced-fat or fat-free versions of dressings, broths, cream cheese, whipped topping, yogurt, and mayonnaise.

It strikes me as a strange fixa- tion, this fat phobia among mainstream weight-loss and diabetes experts. After all, fat has virtually no impact on blood sugar. The progression of diabetes pits the body against the brain, which must impose the discipline needed to control the disease: What, are you Those edicts are easy to ignore when floating in a stream of neon, incense, laughter, and blaring trumpets on a Friday night.

I could take my pick—temptations lurk everywhere here. And Bourbon Street could be renamed for the daiquiri, so freely do these spirits flow, sweetened with 2 grams of sugar per fluid ounce. A beer or daiquiri could help wash down the sandwich that is synonym- ous with this party town. French bread is cut in half, deep-fried, and then heaped with a filling such as fried shrimp. The problem is the French bread and the breading overlaying the shrimp.

All those carbs are harmful enough on the metabolic system, but they have an insidious cardiovascular effect as well when combined with all that saturated fat.

In , the Louisiana Public Health Institute conducted a phone survey to determine just how bad the diabetes problem in the city had become. Nine percent of those eighteen and older reported having been diagnosed with the disease. The actual number is surely higher. For now, anyway, my intellect presides over my lizard brain as I sit down by myself for dinner at La Bayou Restaurant and ask for a glass of cabernet sauvignon, my favorite.

I proceed to order a filet mignon, blackened and medium-rare. What does is the baked potato, so I skip that. The waitress offers to double the amount of vegetables, which seems pointless but not worth the effort of declining.

Beyond all the science being presented at the ADA conference, type 2 diabetes really boils down to the sum total of a very long trail of personal choices, made over a lifetime. Whether you worked the treadmill for twenty minutes or turned on the television. Whether you stuck with your diet or ordered that fudge brownie with vanilla ice cream, promising your- self that you would repent later.

That certainly was the case with me. Click Here had been thumbing through a magazine at a newsstand in West- wood, California, when something made me look to my left. Ten feet away, stepping from the street onto the sidewalk with his familiar gait, was my father, dressed in a suit.

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He had gained a few pounds and lost a lot of hair since I had last seen him. That had been sever- al years earlier. We were both startled. I know we exchanged phone numbers, but the reunion was as short- lived as it was random. I completed my degree and after that was busy carving out a career in publishing. Uninterested, even. He had become an entrepreneur. He had made a lot of money.

He had lost a lot of money. He had made it back again. He had remarried. He had a new family that included four children, none of whom knew that he had three sons from a prior marriage. Each report triggered only a glint of bewilderment, then indifference. Until September , that is. He said that my father lay in intensive care in a Los Angeles hospital. Two consecutive operations had removed most of his right leg.

This tragic news offered one more piece, perhaps the final piece, of a puzzle whose component parts had never seemed to form a coherent picture, even though I had inherited many of those same pieces. Not for me. In fact, the thought of making the trip from Pennsylvania to Los Angeles never entered my mind. And even then, I told myself I was going on business. As for him, I had neither received nor wanted one ounce of support since he and my mother divorced during my senior year in high school and I headed off to UCLA.

He owed me absolutely nothing, but for the first time—selfishly, perhaps—I wanted something from him: My flight touched down in L. Twenty minutes north of Chatsworth lay the Santa Clar- ita Valley, the destination for the last of the ten relocations my father had orchestrated during my childhood.

When I entered the hotel room, I slung my duffel bag onto the bed. No an- swer. I tried again twenty minutes later. I shot off a text to a friend of mine in New York City. After eating, I dialed the number again. This time, the rings stopped at two.

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After a few seconds, a faint voice emerged. It was my father. The two sentences he managed to utter were enough to let me know that we would meet. Forty-five minutes later, I was guiding my rental car onto the north- bound lanes of the San Diego Freeway, better known as the Or maybe when he reached the Pacific Ocean, he simply had no place left to run. Regardless, when my father arrived at what would become his final destination, he unpacked his family and started another.

Like him, I had always found L. His changes tended to be geographical; my rest- lessness took the form of personal transformation. This shaky, tentative reunion was past the point of no return, however, as I exited the , banked onto an overpass, and merged onto the Freeway, westbound. My father and my past were now minutes away. My stomach churned. After several wrong turns, I pulled up to the curb of the Chatsworth Park Care Center, a white, single-story complex. I strolled down the I knew my father would look starkly different—and much, much worse—than I remembered, but the person before me was unrecognizable.

Even though he was in a fetal curl and swaddled with blankets, I could tell this man was no more than six feet tall. She looked down at her paperwork. The one missing his leg, right? I knew this because the first thing I saw was a prosthetic leg propped against a wall. As I passed a curtain, the man I beheld looked nothing like the man who had raised me, and yet it was unmistakably him.

Two decades will change anyone, but he showed none of the grace or subtle shadings of aging; this was a human body in the process of cannibalizing itself. Then his eyes moved. From his hospital bed, my father struggled to size me up, angling his neck like a man peering hard into a foggy mirror. Where his right leg should have been was a brown corduroy pant leg, folded up and pinned together. Formerly six foot three, and pounds, he was now a pound collection of bones jutting against crinkled, discolored flesh.

My father extended his blood-splotched arm, his firm handshake now a feeble grasp. A small Phillies pennant was tacked above his bed. I saw a few photographs of children, no doubt his children, although they were strangers to me. I noticed a yellow balloon tethered to the bed frame. Shit, it was his birth- day last week. It was the sort of detail I had long since forgotten.

He showed me some of your articles and books. Twenty years leaves a lot of ground to cover. You have to start some- where. He wanted to know some basic information. Maybe the right time for that would never come. Some things never change between a father and son, I guess.

Baseball remained our default topic, just as it had been when I was seven years old.

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His alertness surprised me. Although it was turned off, a TV sat on the bureau across from his bed. He must have been following current events. I asked him the same question, knowing the answer. I knew that anyone in his current state would be nearing the end of a long and grueling battle with this disease.

I passed out one day. It felt like the sort of lie I might have told him as a teen- ager.

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I would later learn that he had neglected his diabetes for at least a decade. So did I. I had no desire to delve any deeper, under the cir- cumstances. Nor, I suspect, did he. After what he had been through, what mattered was making him feel as comfortable as possible. As I was preparing to leave, a pair of orderlies wheeled in a dinner of chicken, mashed potatoes, and fruit juice.

They pricked his finger and measured his blood sugar, but the key is what happens after a diabetic eats. Berkowitz, M. In addition to the dubious carbohydrate-laden meals served to him at his care facility, my father pointed out his root beer stash in a cabinet across the room.

Only the worse off he becomes, the lousier he feels, the more he craves the very thing that sentenced him to this hell on earth. The year was , and New Jersey had its own version of the story told in the movie Hoosiers. Be at practice on Monday morning. Even in the s, a six- foot-three pivot man was undersized, but he stood tallest on a team of runts representing Merchantville High School, the namesake of a small town nestled along the Jersey side of the Schuylkill, across from Philadelphia.

Personality-wise, my father was a study in highs and lows: In short, he was exactly the sort of human incendiary device capable of igniting a band of underdogs on a Cinderella run. This temperament would serve him less well later in life, however. The team wound up winning the South Jer- sey Championship. The end- ing to this storybook season was bittersweet, with Merchantville losing its final game.

The difference between victory and defeat turned on one er- rant bounce and a single point. All he really guarded were opposing players as a member of a barn- storming military squad stocked mostly with former collegiates from schools such as Vanderbilt and Kentucky.

The school was set to hand my father a schol- arship until officials reviewed his high school transcript. He was asked to spend a semester at a nearby junior college trying to improve his grades, but he be- came homesick and left, a decision he would regret.

Basketball was over, but life was about to tip off. As a player, my father thrived under the wing of a skilled high school basketball coach, a man by the name of Bob Elder. His real fathers offered no such constructive coaching, however.

Five years later, he was drafted to fight in World War II and disappeared for forty years, the beginning of a family tradition. The childhood memories I hold of my father are much better, except for his occasionally hair-trigger temper and the butt whippings it could pro- duce; and his wanderlust, which made me the new kid at school seemingly every year.

My father did fatherly things, such as playing sports with my two brothers and me, often and well. He coached our basketball teams. If the cancer my father beat when he was thirty-seven and I was nine had taken his life instead, to this day, my memories of him would have been af- fectionate, loving, and idealized: This was the best dad.

At moments, in his own way, he was. I had sought an assessment of my health. I was wondering if there was some way to make my body function a little better, some antidote to disparate symptoms that made me feel sluggish, particularly in the mornings, and particularly after I had had a pizza or a burger and fries for dinner the night before.

I made this crucial health decision with as much deliberation as one would give to choosing a garage for an oil change. When I entered the clinic for the first time, I met with Todd H. An extra fifty pounds or so settled around his waist. As part of our initial visit, he had the nurse draw some blood for routine lab work.

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Like all patients, I was weighed as a matter of course, and my height was measured for the umpteenth time. An in- dividual standing five foot ten might work out every day but weigh the same as someone of similar stature who sits around all day. The differ- ence: Even though they might have a matching BMI, it is misleading to lump together such disparate populations.

After some introductory banter, he opened a file folder and began scanning the results. Then he looked up. Not to say that this bad medical news came as a huge surprise. Both of my parents had survived cancer. My mother has had epileptic seizures as well. But I was tall and lean.

As life-threatening diseases go, leprosy and typhoid fever ranked higher on my things-that-might-kill-me list, even in light of the news I had learned about my father only a week earlier.

How the hell could I have missed the signs? I looked at my legs as I walked back to my car. Would I, too, lose one of them eventually? After sliding behind the wheel, I sat still for a moment and closed my eyes, trying to imagine the claustrophobia of a darkness that would never lift. Would impotence lie somewhere in my future as well? Adding up everything that diabetes could take away sobered me. I realized that in the end this disease could leave a man with nothing but regret.

Like many skinny people whose blood sugar regulation goes haywire, I had misinterpreted being thin for being healthy. I had never smoked. Recre- ational drugs and excessive drinking held no interest for me.

My lifestyle seemed comparatively healthy to me, a fact I thought would help stack the odds against premature sickness and dis- ease. Yet over those two decades, I had somehow acquired a disease of the overweight, or at least what I thought was a disease only for the over- weight. But they were un- healthy nonetheless. I knew enough to realize that aging alone would make my body less forgiv- ing of careless eating.

So I traded in some of the fast food I had relied on for years for healthier foods, or at least what I had always been told were healthy: Yet even those supposed upgrades, as it turns out, were roiling my blood sugar. The first combination contains 78 grams of carbs, 64 of them in the form of sugars. For the second combination—an Almond Joy and a Gatorade—the numbers are 61 and 55, respectively.

Unleashing those simple sugars in my bloodstream right before bed was wreaking hav- oc on my metabolic system. For all I know, diabetes was announcing its intention to strike me back when I was a pockmarked, cavity-riddled teen. In a study published in the American Journal of Clinical Nutrition, researchers divided a group of young pimpletons into two groups. The control was fed a diet heavy in processed carbs, what they probably favored before the study.

The latter group proved far more likely to see their blemishes vanish. The experiment reverse-engineered an anthropological observation—the absence of acne in traditional hunting societies, from South America to Australia and the Pacific Islands. That is, until they switch menus.

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Mann, Ph. Insulin and the other growth factors produced in response to carbs affect hormones in the skin, thickening pores. Once the pores seal off, they fill with oil and become infected. In hindsight, my metabolic system might have been burning through glucose so fast that my body could never store much of it for later use. Researchers at the Institute of En- docrinology in Prague analyzed the blood glucose levels of thirty men with hair loss predating their thirtieth birthday.

Those guys were more likely to be in the early stages of diabetes than men with thick hair. The researchers speculated that male-pattern baldness could be the male equivalent of polycystic ovary syndrome PCOS in women, with insulin resistance as the root cause of both.

A bigger study of men between the ages of forty and ninety-one—conducted by a pair of Taiwanese researchers and pub- lished online in spring —found a significant association between hair loss and the metabolic abnormalities that are synonymous with insulin resistance.

Other studies have found similar links. Warning signs had been flashing before I visited Dr. I thought it was stress. From the middle of the summer into fall and winter, stress was my shadow. One weekend morning in November, I woke up and drank a glass of wa- ter.

I felt as if I had consumed gallons before the weekend was out. In fact nearly a quarter century may have elapsed between the begin- ning of my insulin resistance and my prediabetes diagnosis. While the link between blood sugar ills and stress is harder to quantify than more easily measured triggers such as sugar or sloth, a link does ex- ist.

In stressful situations, your body releases another hormone, cortisol. Hormones deliver messages, and this one warns your body of trouble ahead. The secretion of cortisol sets off a chain reaction prompting the liv- er to ready glucose as fuel, and releasing fat energy for use by muscles.

Your body is ensuring that your brain and central nervous system have enough energy to handle whatever problem might arise.