A Big Bowl of Sugar

Hard work is generally motivated by the reward of the end goal (bonus, promotion, recognition, etc). As I have alluded to repeatedly in these blog entries, remaining healthy is hard work (especially these days). The majority of us probably enjoy eating fatty, salty and sugary food while lying on the couch but unfortunately the end point for this lifestyle is likely far from a reward.

The last few weeks I have been the senior resident on an inpatient general medicine service. It is always an interesting transition from outpatient medicine to inpatient medicine since there are often different goals. The acuity of a hospitalized patient requires a standard work-up (usually featuring many tests and blood work, anyone who has been hospitalized can attest to this) and establishing a discharge plan once stabilized. The most common hospital admissions on our service are pneumonia secondary to underlying lung disease (COPD), heart failure, chest pain, and uncontrolled diabetes. One common link exists between the majority of these patients and their ailments, lifestyle choices have negatively effected their health (smoking/poor nutrition).

On rounds the last couple of days, I have become focused on the breakfast trays of our various patients, specifically the types of carbohydrates the hospital was feeding these people. My focus was heightened since earlier in the week I heard an outstanding lecture by a leading physician in the field of obesity, Dr. David Ludwig from Children's hospital in Boston. The lecture focused primarily on obesity, specifically in children, and the toxic environment that in large part has perpetuated this decline in health in this country and across the globe. A large focus of the talk was on the benefit of the glycemic index, something we have continued to hear a lot about through various diets (South beach, nutrisystem, etc.).

The Glycemic index was created in the early 1980's by Dr. David Jenkins in order to determine the best foods for diabetics. The concept was to determine a score for carbohydrates based on their effects on blood glucose. Foods that are digested quickly, and thus lead to a rapid elevation in blood glucose, are given a higher score on the glycemic index. The standard foods used as a reference number are 50 grams of pure glucose (sugar) or 50 grams of white bread and these equal a score of 100. While this tool was initially created with diabetics in mind, studies have indicated that this approach to nutrition may help prevent cardiovascular disease and cancer.

After attending this lecture, I was extremely distraught that our patients were basically consuming trays full of high glycemic index foods. There has been a large movement over the last decade to control patients blood sugar levels while they are in the hospital because studies have shown better overall outcomes (specifically post-surgery) so there are protocols to use insulin for inpatients. The rationale for elevated sugars in the hospital is many times explained by a stress response based on illness, steroids, etc. but a large component may be that we are feeding this captive audience products instead of food.

Food politics continues to be an uphill battle for the public in this fight against obesity. It is hard to know what is good for us and what is not. As I have said previously, read the labels and if you don't know what some of the ingredients are then don't eat it. Are Cheerios good for me since on the box the cereal is in a bowl depicted as a heart or if it says low fat is it good for me? I plan to start using the glycemic index as a guide for myself and my patients to provide more meaningful information on carbohydrate choices since they are unavoidable (nor do I want to avoid them, as stated by my one of my entry titles "To carbs, I love you).

Here are some examples:(low GI <55, medium GI 55-69, high GI 70 and above)

Bakery products: pound cake (54), croissant (67), Doughnut (76)
Beverages: apple juice (41), grapefruit juice (48), orange juice (52)
Breads: multi grain (48), rye bread (64), baguette (95)
Breakfast cereal: Muesli (56), puffed wheat (74), rice crispies (82), corn flakes
(83)

Here is a link with a complete list: http://www.lowglycemicdiet.com/gifoodlist.html

By the way, the breakfast trays for many of my pre-diabetics/diabetics in the hospital on the pre-ordered diabetic diet was comprised of corn flakes/rice crispies (both high GI), a white roll (also high GI), a banana and orange juice (also both high GI). There has been a movement, rightly so, to prevent hospital re admissions through better discharge planning and follow up with physicians. Nutrition is a necessary entity in these patients health that needs to be prioritized and taught while they are in the hospital.

I plan on finding a way to address this with the people making the food choices for the patients in the hospital. Let us all begin to think about the glycemic index when we are making food choices so we can maintain the right direction or reverse a potentially dangerous course.

Thank you all for reading. Please continue to provide feedback and pass this on to those who may find it useful. Until next time...