Reprinted from the Wall Street Journal Book Review Section, 12-29-2016
In 2012, New York Mayor Michael Bloomberg announced the Sugary Drinks Portion Cap Rule (aka the Soda Ban) prohibiting the sale of sugary beverages of greater than 16 ounces. His administration had successfully curtailed smoking in restaurants and bars, a move that inspired similar ordinances nationwide, and supporters of the Soda Ban considered the new measure a concrete proposal to respond to the epidemics of obesity and diabetes that have afflicted the country. (Diabetes is the seventh leading cause of death in the U.S.) New York courts tanked the rule, saying that the Board of Health had exceeded its regulatory authority, but not before soda companies had undertaken a counterattack, hiring canvassers to solicit signatures on the street and even launching a perverse television ad campaign claiming that the rule would adversely affect lower-income families.
THE CASE AGAINST SUGAR
By Gary Taubes
Knopf, 365 pages, $26.95
One wonders whether the debate might have been different if everyone involved had been able to read Gary Taubes’s blitz of a book, “The Case Against Sugar.” In his 2010 best seller, “Why We Get Fat,” Mr. Taubes argued that carbohydrates like grains and starchy vegetables were behind the obesity epidemic. “In a world without cigarettes, lung cancer would be a rare disease, as it once was,” he wrote. “In a world without carbohydrate-rich diets, obesity would be a rare condition as well.” This time around, he focuses on the “unique physiological, metabolic, and endocrinological effects” that sugars have on the human body, how they trigger obesity and diabetes, and the role that the food industry has played in covering up sugar’s contributions to our national health crisis.
Mr. Taubes’s argument is so persuasive that, after reading “The Case Against Sugar,” this functioning chocoholic cut out the Snacking Bark and stopped eating cakes and white bread. It was easier than I expected: Within a week, I was so sensitive to sugar that I could taste it in the weirdest places; in a restaurant salad, for instance, and in my organic yogurt. When I ate a piece of Thanksgiving squash pie, it made my head buzz. I felt like I’d just taken a hit off a tank of nitrous oxide.
For me, getting off sugar was a health tweak, but for many Americans, it may be a matter of life or death. More than 35% of Americans are considered obese, and the health risks of obesity include Type 2 diabetes and heart disease. Almost 50% of Americans have diabetes or pre-diabetes, a condition that features higher than normal sugar levels in the blood—sometimes much higher. Diabetes has long been considered the penalty of obesity, and obesity, reports Mr. Taubes, has long been blamed on a couple of deadly sins—gluttony and sloth—and the consumption of “all calories together, rather than sugar by itself.” The idea that we get obese because we take in more calories than we expend is a notion so ingrained in public-health conversations that “arguments to the contrary have typically been treated as quackery.”
“The Case Against Sugar” builds upon the case he made in “Why We Get Fat,” carefully laying out the science to show that a sugar calorie is not like a spinach calorie but “triggers the progression to obesity, diabetes and the diseases that associate with them.” Here’s how. Sugar is a simple carbohydrate. Carbohydrates in your food are the source of glucose in your blood, and glucose powers your cells. Insulin is a hormone that transports glucose from your bloodstream into your cells and, as Mr. Taubes puts it, “signals the fat cells to take up fat and hold onto it.” Under normal conditions a cell has abundant receptors for insulin and has no problem processing the glucose. But if you consume high, constant volumes of maple syrup, corn syrup, agave, honey, raw or refined sugar, your pancreas responds by producing more insulin, and cells adapt by reducing their responsiveness to it. (The same thing can occur when you eat refined starches like white bread, white rice and potatoes; they are digested so rapidly they flood your bloodstream with glucose.)
What happens next? Basically, the cell stops listening to the insulin knocking at the door. This is insulin resistance. When the cell starts refusing to take glucose from the blood, glucose builds up in the bloodstream, causing the pancreas to make even more insulin, which (you will recall) tells the cells to hold onto your fat. It’s a feedback loop that causes obesity and culminates in Type 2 diabetes. (Type 1 diabetes, which is less common, derives from insulin deficiency.) The link between obesity and Type 2 diabetes is one of such interdependence that the term “diabesity” has been coined.
Methodically, relentlessly, Mr. Taubes argues that “bad science” over the course of many years primarily blamed obesity, diabetes and other “Western diseases” on overeating or lack of exercise or both. This mistake, made by clinicians starting in 1907, became institutionalized because the medical field tends to be obedient to “a small number of influential authorities.” But as the evidence against sugar built, and more researchers reported the correlation between sugar calories, obesity and diabetes, the food industry moved in to protect its turf. Mr. Taubes cites one 1953 ad in which Domino Sugar claimed “3 Teaspoons of Pure Domino Sugar Contain Fewer Calories than One Medium Apple.” That’s a little like saying a cubic meter of methane gas costs less to produce than a cubic meter of sunshine.
“The Case Against Sugar” is a history of the food industry and the medical science that has both supported and denied the role of sugar in disease. It explores the addictive aspect of sugar (which anyone with a toddler is familiar with); the “peculiar evil” of marketing sweets and sweetened cereals to children; and the industry’s 60-year effort to shift the blame for obesity and diabetes to saturated fats and behavior. In the 1960s, for example, the Sugar Association, a trade group, became concerned about the emerging evidence linking sugar to diabetes and heart disease. It worked hard, Mr. Taubes claims, to “combat the accumulating evidence from researchers,” by financing industry-friendly research and besmirching the credibility of scientists whose research suggested that sugar was unhealthy. These efforts were successful enough to influence the language of FDA reports on sugar in 1977 and 1986, as well as the first government-compiled Dietary Guidelines, released in 1980, which unsurprisingly declared that fat caused disease.
Opinions began to change in 2007 when the “Sugar Papers,” a trove of internal documents detailing the relationship between the sugar industry and medical researchers in the 1960s and 1970s, was discovered by Cristin Kearns, the general manager of a large group of dental practices. The trove—which she found by (wait for it . . . ) googling—revealed that the sugar industry had worked with the National Institutes of Health to create a federal program to combat tooth decay in kids that did not recommend limiting sugar consumption. Mr. Taubes convinced me that these food companies deliberately set out to manipulate research on American health to their favor and to the detriment of the American public.
As the author’s own account shows, he is hardly the first to warn of the toxicity of sugar. But busting sugar is tough: In the early ’80s, high-fructose corn syrup replaced sugar in sodas and other products in part because refined sugar had developed a reputation as generally noxious, and corn was a vegetable, for God’s sake. This is a bait and switch. All sugars produce the same biological results if you consume enough. Soda is a particularly pernicious way to overdose on sugar because it’s just sweetened water—drinking a can of Pepsi® doesn’t seem analogous to eating cheesecake.
This year, San Francisco became the first American city to require health warnings that say: “Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay” on public advertisements after the beverage industry failed to get a court order to stop it. Starting on Jan. 1, Philadelphia will be the first major city to institute a 1.5 cent per ounce tax on sodas and other sugary drinks. But the battle goes on. Between 2009 and 2015, soda companies spent $106 million opposing local and federal public-health initiatives, according to Mr. Taubes. Just last year this paper ran an article about the Global Energy Balance Network, a nonprofit funded by Coca-Cola® that “suggested Americans were overly fixated on calories and not paying enough attention to exercise.” The story will sound familiar to any reader of Mr. Taubes’s book.
“The Case Against Sugar” should be a powerful weapon against future misinformation. In 2015 the New York Times’s health columnist Jane Brody reported that she’d heard people saying: “Let me know when the nutrition gurus make up their minds and maybe then I’ll change my diet.” Well, there is a lack of agreement about the amount of sugar that can be consumed in a healthy diet. But “ultimately and obviously,” writes Mr. Taubes, “the question of how much is too much becomes a personal decision, just as we all decide as adults what level of alcohol, caffeine, or cigarettes we’ll ingest.” Consider the evidence. Decide for yourself.
Plastic surgery offers the promise of improving dimensions of life for many. Procedures are not risk free however. Sometimes, the expected result doesn’t materialize, and your investment offers little or no real return. Sometimes, even worse, your result becomes a liability. You avoid being seen. You cover, camouflage, or hide the area. You’re unable to return to activities and/or situations you enjoy, fearful that a bad result will stigmatize you. You’re not alone. While most procedures offer good results when performed by qualified specialists, problems occasionally arise even in expert hands. Preventing and managing a disappointing outcome is critical. My recommendations follow:
1. Research your surgeon. The surgeon who has the highest standards for his or her own performance, members of the American Society of Aesthetic Plastic Surgeons, will hold the highest standards for your result. View “before and after” photos (unretouched) on his or her web gallery. The quantity and quality of results should be the type of outcome you desire for yourself. In consultation, you must feel comfortable with your surgeon, and must have inner trust that he or she truly cares about the quality of your outcome. Is your doctor a professional, or a businessperson?
2. Clearly communicate your desired result to the surgeon. Find out if your requested change is safe and reasonable. If your surgeon is trying to tell you, for example, the breast implants you want will be too large for your body, listen to that recommendation. If you feel strongly in your desire and the surgeon seems to disagree, get an additional opinion from another qualified surgeon. Has your chosen surgeon achieved your desired result with others? Are you a good candidate? Are your anatomic features conducive to the surgical change you want? Plastic surgical techniques have limitations. Tummy tuck can only narrow the waist so much, and facelift cannot make you look like you are twenty two again.
3. Follow post surgical instructions. Don’t resume normal activities before recommended. If certain garments and/or skin tape are recommended, these often prevent complications and/or improve the final result. Although inconvenient, post-surgical burdens are temporary. Once a problem develops, fixing it can be costly, painful, and/or very inconvenient. Complications are best avoided. Post-surgical routines usually facilitate healing and improved outcomes.
4. Be patient: Healing and resolution of swelling take time. If an undesirable feature of your result becomes apparent, ask your surgeon about it. Soft tissues are distorted by swelling, and amazing improvements in your result often develop as local changes related to surgery slowly dissipate. In general, if a bothersome area at the surgical site seems to be improving from month to month, surgical revision is NOT indicated. Only when the outcome is stable, often one year or longer following the initial procedure, should surgical revision be considered. The exception to this is a feature of your result that you and/or the surgeon do not see improving, do not believe will improve, and is unacceptable in your personal, social, or professional appearance.
5. Be prepared for revision(s) if necessary, either by your initial surgeon or another one. Sometimes, even when the operating team, the surgeon, your expectations, your anatomy, the equipment used, and all other variables seem to be in your favor, nature and fate interfere with your desired outcome, and you end up disappointed with one or more aspects of your result. In this case, your surgeon can and usually will be able to revise the result and improve it by another procedure, most often smaller and less costly than your initial operation. If the bothersome feature is worth changing, go for the revision. Your result will last for many years, and daily dissatisfaction can often be avoided by these smaller follow up improvements.
You want the best result, and the best surgeon. How can you tell? Truthfully, the surgeon with the highest standards for his or her own performance reliably holds the highest standards across the board. The best surgeon will have the highest level of training and certification, and will offer you the best care, and likely the best result.
So how can you know? Plastic surgeon or cosmetic surgeon? The differences may surprise you. Because of common misconceptions surrounding cosmetic plastic surgery, you should understand what’s behind the scrubs and the white coat.
Operations that improve the human body are called Plastic Surgery after the Latin plasticus: that may be molded. The two types of plastic surgery are reconstructive surgery, after injuries, and aesthetic (cosmetic) surgery, to improve appearance. Cosmetic surgery is only a part of plastic surgery, but to perform it well, the physician must be fully trained in the entire specialty.
1. All plastic surgeons are cosmetic surgeons but not all cosmetic surgeons are plastic surgeons.
Board Certified Plastic Surgeons have more training and ARE qualified to perform both reconstructive and aesthetic/cosmetic surgery.
A Cosmetic Surgeon is NOT certified to perform plastic/reconstructive surgery.
2. The American Board of Plastic Surgery (ABPS) is the ONLY board approved by the American Board of Medical Specialties (ABMS), which accredits surgical training programs.
Plastic Surgeons ARE certified by the American Board of Plastic Surgery (ABPS).
The American board of Plastic Surgery does NOT acknowledge Cosmetic Surgeons.
3. Don’t all certifying boards have high standards? My surgeon said he’s board certified.
Confirm not only that that your doctor is “Board Certified,” but that he/she is certified by the American Board of Plastic Surgery (ABPS).
Cosmetic Surgeons who claim to be board-certified may have received their certificate from the American Board of Cosmetic Surgery; the American Board of Medical Specialties (ABMS) does NOT recognize this board.
4. Is my surgeon trained to perform my surgery?
After graduating medical school, a Board Certified Plastic Surgeon must be selected among many applicants for residency training in Plastic Surgery. If chosen, the physician learns how to be a surgeon for three to five years, then trains for at least three more years in plastic surgery. Training involves closely supervised continuous evaluation and management of many complex clinical situations, and matures the surgeon personally and professionally. Successful completion of the post-graduate residency years qualifies the surgeon for written and oral examinations administered by the American Board of Plastic Surgery. Surgeons must submit an entire year of his or her surgical accomplishments for the exam. Surgeons are not eligible for the exam until they have been practicing plastic surgery independently for two years or longer.
There are no such requirements for Cosmetic Surgeons. Cosmetic surgeons are doctors who merely decide to perform cosmetic surgery in their practice. The may be certified in any medical specialty such as a gynecology, dermatology, family physician, ear,-nose-throat, etc. Their training may consist of several short weekend courses to a one-year cosmetic surgery fellowship.
5. Why do hospitals and surgery centers only allow doctors certified by the American Board of Plastic Surgery(ABPS) to perform cosmetic procedures?
Because they know the difference! Board Certified Plastic Surgeons CAN perform both reconstructive and aesthetic/cosmetic surgery in hospital or outpatient surgery centers.
Cosmetic Surgeons are NOT privileged for cosmetic surgery at these facilities and are not allowed to perform reconstructive plastic surgery. For this reason, cosmetic surgeons usually perform surgery in office based operating rooms.
6. The American Society of Plastic Surgeons (ASPS) embraces excellence in plastic surgery. Education, research, intellectual exchange and promoting unity are core values.
Only doctors certified by the American Board of Plastic Surgery(ABPS) can become a member of the American Society of Plastic Surgeons (ASPS)
7. The American Society for Aesthetic Plastic Surgery (ASAPS) is an exclusive privilege and requires proven excellence in aesthetic/cosmetic plastic surgery.
- Members MUST be certified by the American Board of Plastic Surgery(ABPS).
- Participate in accredited Continuing Medical Education (CME) programs.
- Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate a wide range of experience
- Be sponsored by two ASAPS-members to ensure that the applicant’s professional reputation meets the high standards required by The Aesthetic Society.
- Abide by ethical standards for professional conduct outlined by the Society’s Bylaws, Code of Ethics, and Conflict of Interest Policy observed by all ASAPS members.
ASAPS does not offer membership to doctors who are trained in specialties other than plastic surgery; therefore Cosmetic Surgeons do NOT meet these requirements.
For cosmetic surgery, your safest choice is a surgeon certified by the American Board of Plastic Surgery who is also a member of the American Society of Plastic Surgeons and/or the American Society of Aesthetic Plastic Surgeons. Quality is the difference.
Research proves those who are successful place themselves in situations making success easier to achieve. Conversely, efforts culminating in failure first involve a conscious decision putting one into situations subject to temptation. The first rule for reducing your body weight: Don’t be tempted.
Pleasure enjoyed in the circumstance of temptation must be found elsewhere. The easy decision to avoid happy hour avoids a stronger temptation of cocktails. The easy decision to avoid Las Vegas avoids a stronger temptation of gaming tables. If you enjoy happy hour tremendously but have an alcohol problem, finding alternative enjoyment is critical. If you enjoy Las Vegas but have a gambling problem, learning to love a non-gambling venue is important. Find alternatives, lots of them. The best alternatives will offer strong allure to you. The more healthy and powerfully enjoyable alternatives you find, the more likely will be your success.
The easy decision to avoid calorie heavy environments prevents overeating. Control your exposure and location. Make it easy for yourself rather than setting yourself up for failure by irresistible temptation. For weight loss, avoiding restaurants altogether is good policy. Avoid neighborhoods and streets those restaurants are on. If you must go, know in advance what you will consume, and stick to it. If healthy isn’t on the menu, ask for it. Grilled or steamed, not breaded or fried. Vegetables or salad instead of potatoes, corn, or rice. Balsamic vinegar on the side instead of Ranch, Thousand Island, or Balsamic Vinaigrette. If it’s not on your plate, you won’t eat it.
In the supermarket or grocery, don’t walk your aisles of weakness. Bypass them altogether. Ignore them. They don’t exist. Pick up your pace to defeat demons lurking within. Don’t give them a shot at you.
If a certain club, social group, or regular sales-business-professional meeting includes heavy hors d’oeuvres, avoid the events entirely. Find another way to get benefits you need from the group. If you must go, change their menu. You’ll be helping others in the organization.
A new book by Tamarin Lindenberg entitled “Female Cancer; The Vital Role of Self Perceived Beauty in the Healing Process,” explores the relationship between quality of life of breast cancer survivors and the actual and perceived appearance of their post treatment breasts. Ms. Lindenberg finds that improved appearance of women’s breasts correlates with improved “body confidence, sexuality, and the ability to move forward” after mastectomy with or without chemotherapy, radiation, and other cancer treatments. Her research included women from several areas of the United States. Tamarin, a cancer survivor herself, interviewed many women to understand in more detail the impact that quality of care, most specifically the quality of their breast reconstruction, has upon their self-image and feminine identity.
An important part of Lindenberg’s investigation was her selection of women from various income and ethnic backgrounds, and her collection of the most intimate thoughts and impressions of her female subjects. Although her work continues as Tamarin resumes graduate work following her life changing cancer ordeal, she has already confirmed by revelations from others what she knew from her own experience: The powerful impact of self perceived beauty upon the life of a woman. Ms. Lindenberg has assembled a team of professionals to further help in her work, and is documenting her efforts at CALIEB (Care and Love In Every Blessing).
Better understanding of aging anatomy is heralding a NEW era of smaller, safer, easy recovery plastic surgical procedures with long lasting changes that essentially prevent an aged appearance for your entire adult life. Even in your sixties, seventies, and eighties, with annual, bi-annual, or semi-annual maintenance and attention to smaller procedures, men and women can manifest youthful vibrance and allure. You’ll NEVER lie about your age, your appearance will do it for you.
Gravitational settling of facial soft tissue is managed by segmental (minor) lifts rather than a full face and neck lift. Cheek lift, temporal brow-lift, eyelid-lift, ear-lobe lift are all office procedures. Even minor face and neck lift operations can be performed safely and comfortably in the office while you’re awake and relaxed. Some skin sagging is corrected by removal and re-arrangement of descending tissue. Examples of this are jowl removal ,lip-lift, and “anguloplasty” (corner of lip lift) procedures. Skin wrinkling can be treated by laser or by filling with fat or off-the-shelf products. Hollows on the aging face create shadows that send a signal of darkness, depression, and sadness. Others interpret this as hostility and avoid you. The face should reflect light, and be bright. Small implants, fat grafting, minor surgical lifts, and off the shelf fillers re-shape surface contours to reflect light in a youthful way.
Subtle improvements offer the added advantage that others notice you look good, but don’t really know that something was done. You still look like yourself, but younger. Although major rejuvenation still requires a trip to the operating room for general anesthesia, Dr. Steve Laverson, a San Diego Plastic Surgeon, performs many improvements in the office under local anesthesia. Among these minor enhancements, he includes brow-lift, upper and lower eyelid lifts, cheek-lift, minor nose re-shaping, lip shaping and lip lifting, facial fat transfer or filler, neck liposculpture, jowl removal, laser skin smoothing and wrinkle removal, laser skin tightening, and others.
Procedures to maintain youth are secondary to healthy lifestyle, especially moderate diet and regular exercise. Cosmetic and plastic surgery are most effective in the context of ideal body weight and overall fitness.
Choosing minor procedures doesn’t mean they can be performed well by a “minor” cosmetic surgeon. Certification by the American Board of Plastic Surgery means your plastic surgeon has met the highest standard for his or her own performance, which increases the chance that he or she will hold himself or herself to the highest standard for your care and your result.
Dr. Steve Laverson is certified by the American Board of Plastic Surgery, is a member of the American Society of Aesthetic Plastic Surgeons, the American Society of Plastic Surgeons, a fellow of the American College of Surgeons, and has been in practice in North San Diego County since 1993. For consultation, call his Encinitas office at 858-295-4001 or visit feelbeautiful.com.