Sugar

Hail,
And in my idle hours, I see patients. I saw one today who had the worst diet I have seen this year. Innsmouth, where my clinic is, is in the worst part of the south, the south is the depressed part of the city, the city overall isn't doing well and the state seems to be settling comfortably into its handbasket. Correspondingly, it's not a lot of fresh chard and snow peas out here. It's chiko rolls and Coke.

But in an area where I have seen one case of scurvy, countless cases of insert-vitamin-here deficiency, and which will one day give the world the first death by fried chicken embolus, Barnaby Trudge stands out.

He stands out in a number of ways, actually. He presented with a cockatiel on one shoulder today. His tattoos were described by Dr No as "pugnacious", they look like his skin could get him into fights that his fists couldn't get him out of. He speaks softly and slowy, and it it is almost impossible to believe his documented gang history and significant prison time.

Today, however, he and the bird were here about his weight.
"I've put on a bit," he admitted. He sat in ballooning pants, with a white tee-shirt draped over his belly.
"How much do you reckon?"
"I'm not sure" he said.
We weighed him. He was up to one hundred and twenty kilos - that's well over two hundred fifty pounds. He is not much taller than I am.
"I might have to do some walking," he said.
"That's part of it," I said. "What do you eat?"
"It's not that good," he said.
We wrote it down. This is what we wrote.

One five hundred gram pack of cornflakes - about ten bowls.
Two heaped tablespoons of sugar on each bowl. It's normally three teaspoons per tablespoon.
Two coffees. Two heaped teaspoons of sugar in each.
Two litres of fizzy drink - each, for what I work out, with twenty four teaspoons of sugar.
Cordial - consumes a half litre a day (concentrate - he does add water). This comes out to another forty teaspoons.

I sat and stared.

''It's no good" he said. "Doctors can't work out why I'm so fat."

I looked at him. "Actually,"I said, "they can. I could be wrong, but it looks like you're eating about three quarters of a kilo of sugar a day."

"I do like it,"he said.

In one way, the solution is simple. He may well do astoundingly well with sugar substitutes. The thing is, it's more complicated than that. Long term opiates (whether for pain or to stabilise opiate dependence) alter the hedonic response to sugars - they affect how much pleasure you get out of them. People on opiates commonly crave high sugar and sometimes high fat foods. People on naloxone - an anti-opiate, it's narcan - eat less of these foods. It has something to do with pleasure, something to do with reward, it's not intimately connected to normal signals of satiety or hunger. It's not a big part of most people's eating, it's not everybody all the time, and from my understanding, it's hard to disentangle mood, energy expenditure, response to cues and all teh other squillion things that go into this kind of research.

And that's without even looking at the politics.

Anyway - Mr Trudge is off to the shops to change his diet and the dietician (almost certainly a slim young woman with meticulous self-control) to amaze her. The good thing about his diet is it is so easily fixed.

The rest of us, not so much.

Thanks for listening,
John