So, I was thinking yesterday about one of my patients who is hell-bent on managing her pre-diabetes without medicine. It would be SO easy for her to start drugs and plan to take them forever but that's not her style and she's ready to do "whatever it takes!" (These are my favorite people to work with.) I reflected on my standard "rap" about managing carbohydrate metabolism with lifestyle. Many people who have a strong family history of diabetes, think that
they are at the mercy of their genetics and there's nothing they can do to keep from getting it. Let me tell you it just ain't true. (I love to tell you that things you think aren't true, don't I? I hope that's okay.)
There's a saying in integrative medicine "Genes load the gun, but lifestyle pulls the trigger." Most chronic diseases result from cells following instructions from genes inside them. Your lifestyle (food habits, activity pattern, stress level, chemical exposure, etc) translate in your body into instructions to your genes to make your cells do, or not do, various things. Some of those things make you sick, quickly or eventually; others keep you healthy. So to
stay healthy, you want to provide the correct instructions to your genes so they, in turn, send the healthy instructions to your cells. Hope that makes sense. The science of this is mind-numbingly complex but I like to give you news you can use.
So anyway people who have risk for carbohydrate metabolism problems (diabetes, overweight/obesity, insulin resistance) have what are often called "thrifty genes." This does not mean that they shop at the Dollar Store it means that as their ancestors evolved, they developed an exquisite and important talent they can release large quantities of the hormone insulin when food is abundant, which permits them to store fat efficiently for when food is scarce.
This is a definite survival advantage, no? You will want to be able to do this if the world food crisis gets worse. When I counsel people in my office I often say something like, "So, you have these thrifty genes as a gift from your ancestors, and they helped your people survive famine and scarcity. But imagine if you took those genes to the Old Country Buffet? Lots of food, lots of insulin, lots of fat storage, pants that don't fit, tears and gnashing of teeth,
bigger risk for diabetes, bada bing." And then we put together a lifestyle plan that is more appropriate for people with thrifty genes than whatever landed them in my office in the first place, and both of us are happier.
Thinking about this woman and our conversation earlier in the day, I realized with alarm that I had never actually BEEN to the Old Country Buffet. Maybe I was being prejudiced! I should really check it out! I stand for authenticity and truth so I went there for dinner last night to see just exactly was going on.
First off, I'll tell you that there were a lot of seniors there, and lots of kids. The place was packed. On a rainy Friday night, evidently I wasn't the only one who didn't want to cook. I think it was around 11 bucks for all you can eat and drink, and the staff people were really nice. I was seated in a spot where I could see most of the action at the food stations: salads, "vegetables", desserts, entrees, drinks, and condiments. I would guess that about half
the patrons were overweight or obese it was not possible to execute a scientific count.
What else? As expected, it was challenging, but not impossible, to get a good thrifty-gene-person meal here. You could make a chicken Caesar salad and there were good prunes (AKA for the trendy, "dried plums") -- but also lots of stuff with mayonnaise. Though the "vegetable" station had green beans, they were mixed with bacon; the other wells contained various shapes of pasta, I guess from the noodle plant. I imagine it's hard to keep green vegetables from
going totally gray and limp when they have to sit out like that, but surely if we can sample the dirt on Mars we have the technology to overcome this problem. Maybe they tried green veggies but people didn't eat them so they went to waste. I wonder if they might get away with spinach, or stewed tomatoes, or broccoli or sugar snap peas or some variant of ratatouille. Maybe it was just the night I went that this was the assortment, but I was troubled by this. The other veggie
choices were corn, carrots, potatoes, and lima beans. (Maybe I missed something.) A good thrifty gene program is pretty heavy on non-starchy vegetables, so that was a problem.
Though there were fried things and an abundance of pasta and pizza, there were also nicely roasted chicken pieces and a couple different kinds of fish, and what looked like a turkey breast on the carver's table, along with ham and roast beef. So you could go big salad, chicken or fish, a starchy veggie, and maybe some of those green beans. The salsa was good, by the way, so I put some of that with the chicken breast (salsa is a vegetable in my world as is
cole slaw, in a pinch.) Anyway, you could get by, if you were careful.
Fruit? Not so much. But whoa, there was an abundant assortment of other sweet things: brownies, cookies, lemon bars, pudding, ice cream, "dessert pizza," cheesecake, fudge, a couple kinds of "cobbler," and Rice Krispie bars (for starters.) If you have a sweet tooth along with your thrifty genes, this is Totally Not a Good Idea. I had a taste of brownie (following my three-bites-of anything-probably-won't-kill-me rule) and beat feet.
So now, no more mystery about the Old Country Buffet. (But have you grilled peaches yet? Now there's a great thrifty-genes dessert!)