Lately I’ve been feeling a desire to return to talking about the basics. The question of how I personally began thinking about wellness, prevention and nutrition is as basic a place to start as any. And while it is very true that my own parents’ commitment to nourishing food, their common sense approach to life, and the fact that they lived their values for almost 45 years on their farm in the New Jersey’s Watchung Mountains set a sure foundation for my interest in fresh food and good health, today’s post is the story of how I made these passions my own.

It all started around 2000, near the beginning of my medical career, after I had been practicing for a couple of years. I was beginning to get the hang of it. My practice was stabilizing, and I had gotten to the point where at least as many of my patients were established as new. And I was beginning to notice a few unusual things. Like most of America, at least half of my patients were overweight, and many of those were diabetic, with more coming in every day. It came to me one day that not only had I recently diagnosed more than the usual number of cases of type 2 diabetes, but that this new group of diabetic patients happened to belong to a very special group: Almost all the members of this select group of new patients were spouses of established diabetic patients of mine. 

Now I had learned in medical school that the tendency to develop diabetes is genetic, meaning that you were more likely to become diabetic if one — or especially both — of your parents was. But none of my professors had said anything about spouses. Spouses are not generally related to one another. But here it was. One after another, the spouses of my diabetic patients were arriving at the office with diabetes. What was going on? What did these husbands and wives have in common? If it wasn’t their genes, then what was it? It was their eating patterns.

So I started to look at how, what, and when they ate. They agreed to keep food logs for me, and they collected nutrition labels. They checked their blood sugars before meals, after meals, even in the middle of the night on occasion. Then we worked together to make sense of them, and after that I began to develop the recommendations that I created expressly for improving my patients’ blood sugars, not to mention their overall health. And then they began to make changes, big and small.

I noticed something else, too. As my patients began to incorporate the recommendations we discussed, they began to share that they weren’t the only ones whose health seemed to be improving. Their little ones seemed to be benefitting, too. There used to be a pediatrics office right across the hall from the internal medicine office in which I practiced, and patients would often come with children or grandchildren in tow, fresh from their own appointments a little while earlier. I saw it with my own eyes. Eating peanut butter instead of pop tarts, sweet potatoes in place of breakfast cereal, and orange slices instead of orange juice, was making a difference not just for big ones, but for the little ones as well.  

There is more to this story. Back in 2005, I, like the rest of America, watched the people of New Orleans struggle to survive in the aftermath of Hurricane Katrina. I remember staring, horrified, at one particular news photograph of a blanket-covered, wheelchair-bound body, flattened over itself as if tying its orthopedic shoes for eternity. My physician’s eye was seeing a second, deeper layer of tragedy below the surface, but what? I continued to stare at the photograph as I realized that it symbolized to me the awful consequences of uncontrolled diabetes and chronic disease.

For the individual in that photograph, Katrina was likely the last in a long series of humiliations. The disease’s destructive course speeded up by the storm, there was no alternative ending. Diabetes stole her ability to regulate her fluids, to monitor her sugars, to stand and walk. Diabetes destroyed her ability to adapt to the environment. Then came the hurricane. Unable to survive the heat, dehydration, starvation and immobility in that inhospitable place from which there was no escape, she died.

The twin tragedies of climate disaster and diabetes became linked in my mind. As harsh a blow as that storm was to the people of New Orleans, diabetes made it even more difficult to survive. Type 2 diabetes (and chronic disease in general) does that. No matter what your circumstances, this chronic illness makes it that much harder to survive. Katrina didn’t make diabetes more destructive, but it did show how profound that destructiveness is — and how urgent the need to prevent it. After Katrina, I became more committed than ever to preventing and reversing diabetes and related chronic diseases.

Annual diabetes costs in the U.S. are expected to rise to $336 billion by 2034. Diabetes alone is devouring our healthcare dollars, felling our workforce, and exhausting the resources of millions of families. Diabetes affects almost 21 million Americans, an estimated 6 million of whom have not yet been diagnosed. It is the number one cause of acquired blindness, non-traumatic leg amputation, and kidney disease leading to dialysis. Two-thirds of diabetic individuals die from cardiovascular disease, the number one cause of death in this country. Diabetics are two to four times more likely to suffer a heart attack or stroke than non-diabetics.

To optimize our overall health as a nation, to direct public health resources most effectively, and to be in the best possible shape to prepare for emergencies when they do occur, we must learn to differentiate between real food and manufactured calories.

By 2009, I had a blog, and not long after that, it had a name: Your health is on your plate. 

Thanks for reading!