Episode Eight: Health Realities

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Our human bodies are complex machines that have evolved over hundreds of thousands of years, building on the work of millions of years of selecting what works best in the environment of our planet.

Our bodies work best when we eat and exercise in ways that are compatible with the result of this process. But so much of our world has changed, in such a short time, that we often find ourselves struggling against our nature. Food designed for taste and preservation is not as compatible with the health of our bodies as more natural foods. Our bodies work our entire lives to keep us well, despite all of the ways that we sometimes make this difficult. Smoking, drug use, bad food, bad stress, too much strain, not enough exercise, all present different challenges to our machines.

Many of those challenges are met with medical science. Most of us live longer, better, and healthier than many of our ancestors.

But we also struggle, personally and scientifically, trying to understand food, nutrition, healthy habits, and the best ways to apply our medical knowledge.

And because our health is so important to us, because our health is part of the foundation of everything that we do, and because feeding and healing our bodies is part of everyone's life every day, the reality of our health is tragically, deeply, and consistently hacked by forces that are willing to use our illness and our insecurities for their profit.

In July, 1967, the New England Journal of Medicine published an article titled, "Dietary Fats, Carbohydrates and Atherosclerotic Vascular Disease"

This article promoted the idea that saturated fats were responsible for coronary heart disease and downplayed the role of sugar. This encouraged food producers for decades to create low fat alternatives while less attention was paid to the risks of sugar.

What was not known at the time, and was not revealed until 2016 in an article in the Journal of the American Medical Association, was that the authors of the 1967 article were paid over six thousand dollars, which is about fifty thousand dollars today, as part of project 226 by the Sugar Research Foundation, which consists of members of the United States sugar industry.

Food is big business, and where there is big money there is advertising, lobbying, spin, and all forms of truth hacking.

Food today is plentiful and cheap, and the supermarket shelves are full of the results of marketing strategies and research to make everything both taste better and cost less to make.

It can be difficult deciding what to buy, what is best for us. If you don't know about project 226, a low fat product can seem like a better, healthier choice.

Not only do we have advertising for supermarket foods, fast foods, beer, restaurants, and the dairy, meat, and corn councils, we also see messages telling us that we should buy diet products and plans, because we're eating too much, and perhaps sometimes we don't even notice the irony.

Whatever our dreams, our shared realities, no matter what we do, or why we do it, we are biological machines. We breathe and we take in nourishment to fuel the cells of our bodies, which are complicated collections of organs and tissues, guided and controlled by chemical messengers and proteins.

Some people have food allergies. Some people can't process certain types of foods as easily as others.

People whose ancestors evolved where it is sunny and hot look different than people who adapted to frigid, darker regions. The chemistry and functions within our bodies are, in some ways, as varied as our outward appearance. And yet, we have this strange notion, that everyone should look about the same, that there is one standard for health, or one acceptable body shape and size.

When I think of our modern cultural realities about health, I imagine a cartoon panel of a bull dog running on a treadmill. In the thought bubble above his head is a greyhound, and the caption reads: "Just keep going!"

It's good to eat healthy, and to research and learn what that means, but all too often, when we begin trying to educate ourselves, we immediately find ourselves in a bustling carnival of reality bending pitchmen.

Many diet plans are based on actual science and studies, but the point of these plans is not our health. The point is to grab your interest long enough to sell you some pills, a book, a meal plan, or a membership of some kind.

Being someone's mark or advertising demographic is not the same as living a healthy lifestyle.

In the book, Health at Every Size, Lindo Bacon, doctor of physiology, challenges the simplistic idea that thin is healthy, and fat is unhealthy.

Lindo tells us:

"The healthy weight that your body aims for is called you set-point weight. Think of it as a preferred temperature on a fat thermostat. The system works tirelessly to do anything it can to bring your body into alignment with that point. This system only works if we let it, however. If you keep "jiggling" with the thermostat via diets, the mechanism breaks down. This jiggling is like a power struggle to wrest control away from you body's innate weight-regulation mechanism, and in the end, it only makes your body fight harder to retain control. The result: Your body forces you to not only regain any weight you've lost, but you may even pay a penalty with extra weight gain - and a set point now set higher to protect against future diets."

This is not a new or surprising revelation to the diet industries. Actually, they depend on it. Calorie restricting diets are intentionally designed to not work, but to keep you on the hook for the pills, another book, another meal plan, and they are designed to make you think that you have failed, so that you can be shamed, so that you will try harder, and you will keep buying diet products.

Diet fads are not new. Chapter three of Laura Fraser's book, Losing it , is titled "Ten Pounds in Ten Days: Diet Scams."

She writes about an early diet cure, Dinitrophenol, which is still used today as a powerful insecticide.

"During World War I, observers noted that fat men who worked in munitions plants lost a substantial amount of weight. After the war, physicians lost no time in prescribing it to dieters. In humans, it speeds up the metabolic rate until eventually the body burns itself up."

In the '40s, Amphetamines were used to control weight, but were found to be addictive.

In the 1980, a diet pill called fen-phen was pulled from the market after studies revealed that it could lead to heart valve damage.

In 2009, the FDA issued a warning that an herbal product, Hydroxycut, could lead to acute liver injury.

These and many more diet pills, supplements, and treatments were used with a genuine belief that they were scientifically proven to improve health, but it is important to consider why we were looking for these solutions in the first place.

Somehow we have built a strange cultural reality that anyone not shaped like a teenager on a track team has failed our collective expectations of health and needs to go on a diet.

We want our health, weight, and metabolism to have simple easy answers. We assume that it's as easy as calories in, calories out.

Imagine for one month you eat the best possible number of calories from vegetables, fruits, proteins, and grains. Then for the next month, every day you will have exactly the same level of exercise, and you will eat exactly the same number of calories, but this time you will get all of your calories only from granulated sugar.

The glycemic index rates different types of foods based on how they affect blood sugar levels. It's not just about calories. The type of calories that we eat matters as much or even more than the number of calories.

In his Ted Talk, Peter Attia tells the story of a night as a surgical resident in the emergency room when he treated a woman with advanced diabetes.

"Why did I hold her in such bitter contempt? This woman had type two diabetes. She was fat, and we all know that's from eating too much and not exercising enough, right? I mean, how hard can it be? As I looked down at her in the bed, I thought, if you just tried caring a little bit, you wouldn't be in this situation."

The entire video, which you can find at ted.com, is worth watching. Here are some excerpts of what he goes on to say.

"Three years later, I found out how wrong I was. Despite exercising three or four hours every day, and following the food pyramid to the letter, I gained a lot of weight and developed something called metabolic syndrome. I had become insulin resistant. How did it happen to me, if I was supposedly doing everything right? If the conventional wisdom about nutrition had failed me, was it possible it was failing someone else. Most researchers believe obesity is the cause of insulan resistance. But what if we have it backwards? Getting the cause and effect right makes all the difference in the world. Obesity may be just a proxy for what is going on. The answer is probably not too much food. It's more likely too much glucose."

In March, 2006 the Institute for Agriculture and Trade policy published "Food without Thought: How U.S. Farm Policy Contributes to Obesity."

The following is from the executive summary:

"For the past 50 years, U.S. farm policy has been increasingly directed toward driving down the price of a few farm commodities, including corn and soybeans. At the same time, prices for fruits and vegetables, grown with relatively little government support, have steadily increased. Low commodity prices have in turn deeply influenced private investment. The food industry invests in processes that can provide the greatest economic return, and as such it has focused on cheap commodities rather than on more expensive fruits and vegetables.

The problem with the extensive use of these cheap commodities in food products is that they fall into the very dietary categories that have been linked to obesity: added sugars and fats. U.S. farm policies driving down the price of these commodities make added sugars and fats some of the cheapest food substances to produce. High fructose corn syrup and hydrogenated vegetable oils -— products that did not even exist a few generations ago but now are hard to avoid —- have proliferated thanks to artificially cheap corn and soybeans."

How we think of our relationship with food, the realities that we accept and nurture for ourselves, and how we see others can lead us through a maze of pills, tricks, shame, surgeries, and desperation.

Maybe all we need to do is stop dieting for weight, and just eat for our health. It's really not that difficult. Michael Pollan, in his book, Food Rules, sums this up with seven simple words:

"Eat food. Not too much. Mostly plants"

It's not like we don't know that carrots, celery, apples, and grapes are better snacks than chips, crackers, and cookies. But even if we eat perfectly, there are still difficulties that we can encounter. The lack of some protein or enzyme might cause one person to have difficulties with digestion. Certain genetic traits might make someone more likely to have cancer than someone else living the exact same lifestyle.

Modern pharmaceuticals and treatments help when our bodies are deficient in these ways. Medicine is a modern marvel, but medicine is also money.

The title of Melody Petersen's book begins to tell the tale. The book is titled, "Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs"

She describes the benefit to the pharmaceutical manufacturers of blockbuster drugs, that bring in a billion dollars or more in a single year.

She writes:

"In this proifit-driven world of medicine, I did not often hear the executives talk of cures. The companies seemed to have little interest in getting to the bottom of what was actually causing cancer, heart failure, or diabetes. Instead, they focused like honeybees circling a picnic cake on products for what they called chronic disorders. These were drugs that did not cure but 'managed' diseases as patients took them once a day for the rest of their lives."

For some, this may simply lead to taking more pills because the prescription is medically justifiable, but sometimes this attitude can lead to intentional over-prescription or over-pricing with dangerous consequences.

In 2007, several Purdue Pharma executives pled guilty to charges of misbranding OxyContin and lying about the risk of addiction, which contributed to a major opioid crisis that began in the 1990s and is with us still today.

When Mylan pharmaceutical acquired the rights to the EpiPen, they hiked the price from fifty to three hundred dollars.

The medical choices and realities that we have chosen as a nation have led us to a situation where we are no longer the consumers of medical services. Rather, we are the product. Money is exchanged through the medium of our health and illnesses between our employers, and the pharmaceutical, insurance, and medical companies that define the standards and limits of our care.

We are profitable, not when we are healthy, or when we are gravely ill, but when we are perpetually just less than well, and in need of medicine that maintains our blood test result numbers within the ranges defined to be healthy.

In 2018, CVS, the drug store and pharmacy company merged with Aetna, the insurance company.

The American Medical Association filed an Amicus Brief that focused on how the merger would affect prescription drug programs and pharmacy benefit managers, which basically means that they felt the merger would increase drug prices decrease competition, and that this would ultimately be bad for patients.

After much review, the merger was approved. The AET stock symbol was cancelled, and trading continued under the CVS ticker symbol.

CVS is a publicly traded company. Anyone can buy CVS stock, and four times a year, since 2017, the company will pay a dividend of fifty cents for every share that someone owns. In 2020, the total dividend payout from this company was two billion, six hundred twenty four million dollars.

Over two billion dollars was paid by a pharmaceutical and insurance company, not to doctors, or for drug research, or to help pay for facilities, but to shareholders who had nothing to do with anyone's health. This is because we live in a profit based health care system.

Our modern medicine has often been a source of pride for our nation. One of the cultural values of our nation is economic freedom. We have become accustomed to the idea that companies and doctors have the incentive of the invisible hand of Adam Smith's market, and because of this, people would come from around the world to get the best treatment available.

But as with all incentives in a free market system, when building a better product or providing better service does not provide enough profit, the mechanisms of the free market can be manipulated, through monopolies, government mandates, exaggerated advertising, and other forms of truth hacking.

We decided long ago that health insurance would be tied to our employment, which makes our employers the customers of health insurance companies, and not individuals. We are just pools of bodies to be managed by companies that decide which doctors we can see, how much services will cost, and where and how we buy the medicines that pharmaceutical representatives have encouraged our doctors to prescribe to manage their cashflow. There are deals and negotiations about our health that we are not allowed to see, because we are not the customers. We are the product, bought sold, and drugged for the profit of the health industry.

Our food is mass-produced for flavor and cost and shelf life. Food science and production are manipulated for profit, leaving our metabolic systems in distress, and driving us into a profit-based health care industry designed to keep us just well enough to take our daily meds, while our choices are limited, the costs are hidden, and our deductibles are turned into dividends.

We have a sort of agra-medical industrial complex that is deeply entrenched, interconnected, overly complicated, and is in control of the realities that define our health.

The ways in which we feed and heal our bodies; the relationships that we have with our health, our doctors, and medical science; and the ways that we choose to pay for these services - are not limited to the systems and practices that put money into investor's pockets. We need only imagine new realities, where patients and doctors are in control, where insurance and medical companies operate as non-profit organizations for the benefit of our health, and we stop chasing the shadows of health through bad diets and bad pills.

The health of our bodies follows the health of our nation and the world. We can choose to embrace healthy realities filled with love, compassion, good science, good food, and laws devoted to the well being of our people. We might discover that health is not a puzzle to solve, but is as natural and simple as a flower turning toward the sun.