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On Paula Deen and Diabetes

UPDATE (1/17): Paula Deen has announced she has been living with Type 2 diabetes for 3 years. Oh, and she’s endorsing Novo Nordisk.

UPDATE 2 (1/17): Dear members of the media: dietary fat has nothing to do with diabetes. Please stop trying to connect it with butter, lard, and deep-frying.

Rumors have circulated since last Spring, but according to multiple reports, Paula Deen is apparently days away from announcing that she has been diagnosed with Type 2 diabetes (and living with it for a while?).

Allegedly, the decision to publicize her condition is financially motivated, as several sources report that she has signed a multimillion-dollar deal with the makers of a diabetes medication (Novartis, according to reports not Novartis, which has denied bringing Ms. Deen on as a spokesperson).

I know — and in other news, water is wet (take a look at Ms. Deen’s “ultimate fantasy deep fried cheesecake” and Krispy Kreme burger). The ‘big news’ to me isn’t Ms. Deen’s medical condition, but rather that her “coming out party” will essentially be a drug company’s latest press release. It’s a worrisome message.

Many people on Twitter and Facebook have reacted to this news story by asking if (and, from what I perceive, hoping that) Ms. Deen’s diagnosis will serve as a “wake-up” call to the public that a steady diet of her style of cooking — which isn’t uncommon for many Americans — is a health risk.

Alas, I don’t think this will ring any alarms, especially since Ms. Deen’s public announcement is supposed to be intertwined with her endorsement of medication.

It would be different if she used her immense public platform to reflect on the pitiful state of the “Standard American Diet”. I’m not referring to a “diet” or “guiltless” recipes with sugar-free whipped cream and whole wheat cupcakes, but rather to creating a dialogue. Ms. Deen has a journey ahead of her, and she could really use this as an opportunity to take people on it.

How Ms. Deen chooses to manage her condition is her own business, but by signing an endorsement deal with Big Pharma, she makes a very clear public statement and recommendation to anyone else living with Type 2 diabetes: “take your medication!”.

That is precisely the message the pharmaceutical industry loves to hear (the underlying message being: “Medication matters more than eating habits”). It does not like to hear that nutritional management of Type 2 diabetes is realistic, sustainable, affordable, practical, and scientifically proven. After all, they can’t make a profit off of that. No one can trademark almonds. Note that “nutritional management” can refer to needing no medication at all or a lower dosages of medication.

It’s my hope that we in the nutrition and public health field will stories like this one not to blame people for their choices or trot out the same tired messages about just having smaller, “moderate” portions of processed food, but rather as an opportunity to showcase how Type 2 diabetes can be managed solely with and through whole, real food.

While we’re at it, let’s also challenge the notion that Ms. Deen’s cooking is the epitome of a cultural mainstay (how many times have we heard this style of cooking described as “all-American”?) or that it is somehow “of the people” (there is nothing elitist about a homemade batch of lentil and vegetable soup; if anything, it is the epitome of affordable cuisine).

Think the National Institutes of Health’s Children’s Inn regrets naming their kitchen after Ms. Deen a few months back?

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26 Comments

  1. Norma said on January 13th, 2012

    Bourdain was right.

  2. Em said on January 14th, 2012

    Being a southerner myself who wasn’t raised on Paula Dean’s brand of southern cuisine, I can’t help but watch her show. I once watched her deep fry a ham. It was surreal. For me, it’s akin to watching something shockingly lurid and taboo, like a snuff film.

    Truthfully, I always assumed that she was somewhat a healthy woman who just cooked these foods to shock and sensationalize southern diets.

  3. yulaffin said on January 14th, 2012

    I would love to see her switch to low carb foods and recipes to help her manage her diabetes. I have been able to get my BG numbers stable and near normal (5.7) since I eliminated most sugar and starchy carbs from my diet.

  4. Leah McGrath, RD LDN said on January 14th, 2012

    Can we perhaps take another look at this? Ms. Deen is much loved and admired in many areas of the South/Southeast and beyond. Having met her personally I know that the public persona you see is only 1/2 the story. She is hardworking, kind, gracious and much loved by her family and friends. Many celebrities have had the courage to come out in public when they have diseases with or without the endorsement of “big pharma”. In many cases this has served to draw attention to those diseases and increased the number of people getting diagnosed and seeking treatment. Ms. Deen will be 65 years old on January 19th. If she was your mother/aunt would you eviscerate her for taking medication? For all we know she could have been managing her diabetes with diet and exercise for years. There are many who ignore the very real complications of diabetes and refuse to take meds or follow a healthy diet to help control their blood sugar. Though Ms. Deen is not a health care professional; if she is able to reach even one person to convince them to get diagnosed and to keep their blood sugar under control that’s a good thing.

  5. Dr. Ayala said on January 14th, 2012

    Enjoyed this balanced post, and agree that this can be a good opportunity to educate about the connection between nutrition, weight and type 2 diabetes

    Indeed, lifestyle choices have a huge effect on our general health – especially on diseases like type 2 diabetes.

    Nevertheless, the media blame party around Paula Deen’s rumored announcement is over the top.
    It suggests that diabetes patients brought it on themselves, or that somehow, living a virtuous life is a warranty against diabetes and that all type 2 patients can reverse their disease by lifestyle changes.

    In fact type 2 diabetes develops as a result of both genetic and environmental factors…and who knows what else. And not all type 2 patients can reverse their disease by lifestyle changes

    So enough finger pointing. Blaming the patient is just plain silly, and so very judgmental.

  6. Andy Bellatti said on January 14th, 2012

    Leah,

    This post has to do with Paula Deen’s alleged endorsement deal with a pharmaceutical company and, on a broader scale and more importantly, examines how society tends to look at Type 2 diabetes as a condition that is managed with medication, rather than food. The fact that Ms. Deen is “hardworking, kind, loved by fans, and gracious” is irrelevant. I am not stating she is nasty, mean, or ungrateful. This is not a blog post on her character traits.

    My point is — if this is all about awareness and getting people to get diagnosed (which it isn’t), then why not just state she has Type 2 diabetes and end it there? Public figures’ public decisions are up for public scrutiny. As I wrote, how she chooses to manage her condition is her own business, but not when public endorsements are signed. No one forced Ms. Deen to be a spokesperson for a diabetes drug (nor, I am sure, does she *need* that money).

    I am not eviscerating her for taking medication — it is the profiting off of her disease and using her public platform to align herself with Big Pharma that I find troublesome.

  7. Michele said on January 14th, 2012

    I don’t think anyone is “eviscerating” Ms. Deen, or any diabetic patient, for that matter, for “taking their medication;” rather it is her years of demonstrating the WORST possible “home cooking” and promoting the “food is love,” gluttonous gorging with total disregard for health tack that her shows revolve around, and now using her alleged diagnosis as an apparent opportunistic move to make $$$ and give her viewers that Big Pharma message of “you can still eat crap if you take your pills!” I’ve watched her several times over the years and, as someone commented above, it’s a train wreck: you can’t believe she’s actually cooking things the way she does and people are, I guess, eating that way. Her current health problem, if the reports are true, is not something she “deserves” or that I’d wish upon her or anyone, but if she is using her condition as a marketing occasion, that’s deplorable; particularly if she continues to espouse the indulgent style of cooking and overeating she has in the past.

  8. Andy Bellatti said on January 14th, 2012

    Michele,

    I completely agree with you. We have to look at the context and history Paula Deen has given this country (and, let’s not forget, the rants about how it is “all-American cooking for busy families”, as if it cooking quick and healthy meals were an impossibility if one is pressed for time). She has every right to cook whatever she wants on her show, but it is the persona she sells around it that, to many people, is obnoxious.

  9. TAnya said on January 14th, 2012

    It is always interesting to me that celebrity chefs go on and on about how you have to use loads of butter and cream, etc. so that food tastes good. Once they have a heart attack or some other health problem then they jump on the healthier food bandwagon. I just wish we could convince more of them to showcase how easy it is to make tasty food that is good for you in the first place. Andy, you need your own cooking show!

  10. Andy Bellatti said on January 14th, 2012

    Thanks, Tanya. And, yes, I think the true hallmark of a good chef is making fresh food tasty. Deep frying and adding globs of sugar and butter are very easy “outs”.

  11. Tands said on January 14th, 2012

    Say what you will about Big Pharma, but medication saves lives. If Deen’s message is “Take your medication!” then she is not in the wrong. That is not to say, lifestyle changes should not be encouraged. But demonizing medication is misguided. As Leah McGrath pointed out, there are MANY diabetics who refuse to take their medication (and don’t make lifestyle changes either). There are many reasons why they do this, but I personally believe the pervading holier-than-thou message that taking drugs means you can’t take control of your life is at least partially behind it.

    You say that, “It does not like to hear that nutritional management of Type 2 diabetes is realistic, sustainable, affordable, practical, and scientifically proven.” I beg to differ. Nutritional management of type 2 diabetes is NOT realistic/sustainable. Nutritional intervention is exceedingly difficult. I recently read of an endocrinologist who operates a clinic that treats diabetics. Only 10% of his patients were able to sustain their lifestyle changes and they had very, very modest success. Most people cannot stick to these interventions.

    It would be nice if all of us could eat real, whole, organic, locally grown/produced foods and exercise every day, but this is not the case for most people. We do not all live in an ivory tower. Medication is at least a partial solution for this population.

  12. Andy Bellatti said on January 14th, 2012

    Tands,

    Of course there are situations where medication is necessary and saves lives, but in many instances, they are more about business and profit than a real need.

    This is not about being holier-than-thou or living in an ivory tower — it is about helping people realize they don’t have to depend on medications to feel well. Unpleasant side effects aside, medications are also a financial burden. Those who I have worked with on nutritional management of their condition are elated and grateful when they see they not only feel a lot better, but are able to cut back on medications. Talk about a money saver!

    I have never heard anyone who I’ve worked with tell me: “You know, after 6 months of eating better, I’d rather go back to the way I was eating before when I didn’t really give that much thought and just took my medications.” They are particularly excited when they realize that as a result of eating better, their cholesterol is improving, their blood pressure is closer to normal values, and they are able to be more physically active without being out of breath so quickly.

    Is it a shift? Absolutely. Is it a change that can be challenging at times? You bet. That is why RDs are part of a diabetes patients’ *team* (it’s about working *with* patients and having frequent interactions, not just telling them “what to do” and then leaving them to their own devices)

    Nutritional management does not require organic or local foods (that is a hyperbolic argument that is somehow meant to show “no one can eat perfectly”). It does not require expensive supplements, exotic “superfoods” or anything out of the ordinary. Starting one’s day with oatmeal that has peanut butter added to it, for example, is affordable, easy, practical, and realistic. I should point out that I have never heard a patient treating their diabetes through nutritional management say they could never sustain the proposed changes. There may be some tweaking necessary throughout the journey, but healthful eating patterns are absolutely sustainable.

    I have worked with and counseled many individuals living with Type 2 diabetes, from various age groups and ethnicities, and I can tell you that many of them were unaware of the connection between food and their prior to working on their diet. This is because, sadly, a lot of doctors don’t discuss that aspect with their patients, especially when patients are already on medication.

    As for the statistic you mention of an endocrinologist who mentioned that only 10% of his patients were able to sustain lifestyle changes: consider the source. Endocrinologists don’t counsel diabetes patients on nutritional matters.

    I can tell you that many RDs I have worked with would say success rates of their patients are at least in the high 70s. This is because lifestyle changes require commitment over time, support from professionals, solid education, and someone who is willing to work with you and customize a way of eating that fits within your means and likes. Picking up a “diabetic diet guide” is useless; what is needed is the human connection and interaction that turns dietary guidelines into something tangible for the patient.

  13. Leah McGrath, RD LDN said on January 14th, 2012

    Tands – agree… and to both Andy & Michelle since Ms. Deen (the correct spelling – not Dean) has not yet made any sort of public announcement regarding her condition it is totally premature to make any assumptions of what she is going to say, advocate or endorse. Why don’t you give her a chance? She’s never portrayed herself as a chef, health professional or dietitian but a woman who has conquered many adversities to create a successful brand and business. I also don’t make assumptions about her financial status.
    As a dietitian I’ve worked with diabetics since 1995 and there have been many cases that dietary modification and exercise were not sufficient to keep their blood sugar within desirable ranges. I think it is safe to say most people with diabetes would prefer not to have it and if they have it, not to be on medication or insulin, but this is not always possible.

  14. Andy Bellatti said on January 14th, 2012

    Leah,

    Public figure, public actions, public knowledge. No one is making assumptions about her financial status; it has been well-documented over the years: http://www.seriouseats.com/2008/08/top-10-celebrity-chef-earners-salary.html

  15. Tands said on January 14th, 2012

    Hi Andy,

    Thank you for your thoughtful response. I better understand what your ideas are from your reply. I definitely think nutritional intervention should be available to those who desire it and I agree that the link between food and health should be explained to the unknowing. I just feel that medication is often poo-pooed and chalked up as Big Pharma’s greed, when there is a real need for more and better drugs. I am a clinical researcher (not sponsored by the pharmaceutical industry) and have come across patients who are able to manage their disease with lifestyle intervention and many patients who cannot. That is why I am an advocate of drug use when necessary. We actually both want the same thing – options. You desire that the option of nutritional intervention be offered, while I desire that medicinal intervention be offered.

    Some endocrinologists (and other physician specialties) can and do, in fact, counsel diabetics on nutritional matters. Yes, most of the time patients are referred to RDs, but there are physicians who do treat patients directly with nutritional intervention. The physician I mentioned was involved in nutritional intervention. Yes, one could argue the whole physicians don’t know about nutrition (although many do have a solid background through education or clinical training), but that is a whole different matter.

  16. Michele said on January 14th, 2012

    I didn’t misspell her name, nor make assumptions about her financial status. I stand by my statement, however, that she has made a career demonstrating extremely unhealthy, over-the-top, indulgent recipes and cooking techniques and promoted them as just fine for everyday eating. If Deen does indeed become a celebrity spokesperson for a big pharmaceutical company’s diabetes drug whilst still deep frying anything she can get her hands on, I will be utterly disgusted. I also happen to be the daughter in law of an endocrinologist, and while he does not do extensive nutrition counseling with his Type 2 diabetic patients personally, he does discuss it with them as needed and requires them to meet with his staff RDs…and guess what? There are dozens who flatly refuse to change their diets (I can’t!), become more active (I don’t have time!) and, on top of that, are not compliant with their meds (too many pills! too confusing!).

  17. Andy Bellatti said on January 14th, 2012

    Michele,

    There are definitely obstacles. I can recall a good number of patients who came to one appointment and then never showed up again. For some, nutritional management can be challenging and intimidating. And, sadly, I think some people are under the assumption that a small setback or some self-doubt are dealbreakers when, in reality, they aren’t. They are part of the process.

    Nutritional management takes time, and it is also crucial to have support and encouragement (not only from health providers, but from friends and family). This is where, in many cases, an RD’s counseling skills are key. All the information in the world is meaningless if one can’t help a patient feel encouraged, at ease, motivated, and confident. And, many times, it also means giving the patient the space they need to make mistakes and challenge their own assumptions.

  18. Fleur said on January 15th, 2012

    I’d agree that is is troublesome to have any celebrity endorse a drug.

    Regarding medication use and Type 2 diabetes, I sort of walked a tightrope for a very long time with managing my diabetes only by diet and exercise, and it became increasingly difficult over time. If I wanted to, I probably could reduce my medication use if I chose to eat a diet of mostly animal proteins and vegetables…but even though such a diet was healthy to my blood sugars, it certainly wasn’t sustainable over time, and was probably unhealthy in other ways.

  19. Kyith said on January 15th, 2012

    Hi Andy,

    perhaps i can share something. over here we have to subscribe to cable tv to be able to watch shows on Food Network and 3 months ago decide to suscribe so that my parents can watch something they are interested in.

    now we have 2 channels one food network and one asia food channel. there is some distinct difference between the 2. the food channel cooks or chefs are very very extravagant with the level of sugar, salt, cheese and milk. The asia ones, well they are alot but still within acceptable range.

    but the one that caught my attention was Paula Deen’s. I could have sworn the though going through my head is “does she really cook like that all the time?” because everything she cooks just look so big of a health issue.

    i just don’t like the idea if she goes out and says cook like her but take your meds

  20. Andy Bellatti said on January 15th, 2012

    Kyith,

    Thanks for commenting. Where do you live? I find your comparisons between the “American” (US) food channel and Asian one (which country?) fascinating.

    The worst part is that Paula Deen’s cooking is revered by some as “home-style, All-American grub”, and any criticism of it immediately makes you a “snob” or an “elitist”. Her fans can be rather rabid.

    True talent lies in making food taste delicious without covering it in butter, sugar, and salt.

    Thanks again for your perspective.

  21. Alyse said on January 16th, 2012

    The fact that eating healthy is considered “elitist” or only something that “ivory tower” people can afford is crazy. I make $8.50/hr and only have about $35 to spend on groceries on a good week and live in a food desert and I manage to eat pretty damn well. Let’s not pretend that eating well is something no one can afford. It makes me want to scream when I hear that.

    Medicines do help but food is the best medicine we can give our bodies. Paula Deen is also a very heavy smoker so it’s not like she’s super concerned with her health in the first place. I think celebrity endorsements of some things can be great, but we also have to focus on nutrition and the things that real food can cure.

  22. Kat said on January 16th, 2012

    Such an important message. Thanks for writing this, Andy!

  23. Erica said on January 18th, 2012

    I’ve always been repulsed by Paula Deen. Whether or not the actions of public figures like her have a significant effect on the behaviour of the public, I think the lifestyle she promotes is unnecessarily extremist and dangerous.

  24. HJ Ralston said on January 18th, 2012

    Paula Deen criticizes Anthony Bourdain: “You know, not everybody can afford to pay $58 for prime rib or $650 for a bottle of wine. My friends and I cook for regular families who worry about feeding their kids and paying the bills.” Well apparently she feels everyone can afford $500 a month for diabetes medication, which is the cost of the drug Paula Deen is pushing, now that she has deceived God knows how many people into developing diabetes by not sharing advice she undoubtedly received to lay off the kind of food she cooks, when she was diagnosed three years ago. “But don’t worry” she assured us today. “She’ll be right there to help guide us to live with diabetes” that she helped us get. Awful. She should give back every dollar she earned pushing carb loaded dishes since her diagnosis.

  25. Fleur said on January 19th, 2012

    To HJ…I’m sure the only people using the new drug are people who have generous insurance plans. Then people wonder why health care costs keep going up. It isn’t clear to me that the drug she is endorsing is any better than any other diabetes drug.

    I think celebrities endorsing prescription medications should be considered unethical. However I can’t say that I agree with you that she alone has deceived people into developing diabetes.

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