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Investigating the science of body weight regulation

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Diabetes or Diarrhea – Take Your Pick*

Posted by Miriam Gordon on September 18, 2008

Metformin, otherwise known as glucophage, is a medication that works to lower elevated blood sugar and help the body process the excess sugar more efficiently. However, if you have the unmitigated gall to eat sweets while taking this medication, you will be punished by having copious diarrhea. I found this out first hand. I guess this is the price I pay for feeding my addiction.    

We all know that in this life, there is a price to pay for everything. Supposedly, the metformin I’m taking is helping to lower my blood sugar. So either I get diabetes or I get diarrhea, or I attempt to deprive myself to the point where I am physiologically compelled to binge. This “most appropriate” punishment for those who “dare” to be obese applies also to those taking Xenical, or it’s over the counter version, Alli. If you eat food with excessive fat content while taking these drugs, you will either be sitting on the toilet all day or forced to wear a diaper. So either deprive yourself of the food your brain is screaming at you for, or suffer those consequences. Either way, we are punished for doing what feels natural for us.    

Another version of punishment reserved for the fatties amongst us, compliments of the medical establishment, is weight loss surgery. Having your stomach stapled or a lap band put around your stomach internally to restrict the amount of food you can ingest is tantamount to punishing yourself for eating too much. Do you know how violently ill you become if you try to eat more than a few spoonfuls of food after you’ve had this surgery? Bad, bad fattie!! You deserve to be punished for your gluttony and sloth!    

The same woman who prescribed the metformin for me gave me a scientific paper to read, by a prominent childhood obesity expert, who questions whether the obesity “epidemic” is based on gluttony and sloth! His take is that children are not at all in control of their nutritional environment, so they are innocent of these cardinal sins. However, what is he saying about the adults? I wonder if the woman who prescribed the metformin for me and gave me this article to read is attempting on a subconscious level to tell me that I am gluttonous and slothful.    

If one searches PubMed for articles with the word “obesity” in the title and “gluttony” in the Title or Abstract, 12 papers come up! This proves that there is as much anti-obesity bias amongst the most prominent academic obesity researchers as there is in the general public. Most of these articles attempt to convey that the popular view of fat people as gluttonous and slothful is wrong, and that scientific progress is providing more and more evidence to combat this hideous notion. However, I believe they need to use these words because they are trying very hard to convince themselves of this. After all, from the moment they were born, they were immersed in the same western culture which has held absolute contempt for fat individuals, and it is therefore an intractable part of their consciousness.    

There is no need to include incite-ful (no pun intended) words, such as gluttony and sloth, in any publication written to present scientific data in an objective manner. These words are included in scientific publications in order to attract the attention of those (read: everyone in western society, including fat people) who have a strong, unfavorable gut reaction (again, no pun intended) to fat people and obesity.    

*Note added in proof, March 21, 2010: I originally wrote this post over a year and a half ago, and as with my other original posts, have decided to add notes in proof rather than delete the posts. I’ve decided on this course of action despite the fact that some of the language I originally used may be offensive to those in the fat rights-acceptance and health at every size (HAES) communities, because it reflects the overwhelming bias against fatness that everyone in modern western society has internalized. Tragically, it  is internalized by those who, like me, have naturally larger body sizes, and feel the constant need to beat themselves up for it.     

I only became aware of the fat rights-acceptance and HAES movements in August 2008, and I remember being absolutely blown away by the idea that there are people out there who actually support fat people, our rights, our health, and improving the quality of our lives.  At the time that I wrote this post, I was angry and confused, because I was in the process of transforming fundamental beliefs about my body and my value as a human being. I feel incredibly fortunate for having undergone this transformation and thank everyone who has ever worked toward the goals of civil rights for fat people, and has advocated for love and acceptance of fat people, along with promoting HAES. However, the recognition of just how difficult it is to make this mental leap of faith is critical to the advancement of these movements. We must not condemn those who can’t yet accept our views, but instead show them patience and understanding. In the end, I believe the fat rights-acceptance and HAES movements will prevail, despite tremendous odds, out of sheer common sense.    

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10 Responses to “Diabetes or Diarrhea – Take Your Pick*”

  1. Paula Jean said

    Dear Ms Gordon,
    Thank you for your thoughtful essay concerning the diabetes or diarrhea matter and the use of metformin. I have recently been “diagnosed” as diabetic and prescribed metformin, even though my blood glucose figure is the same as it was a year ago and I have none of the symptoms listed in everything I can find on diabetes. I don’t believe gluttony and/or sloth has much to do with it. I am guilty of neither of those sins; I simply have always enjoyed food. Maybe my Jewish grandmother (herself obese and probably diabetic) had more to do with my love of delicious and often rich foods. In any event, I agree wholeheartedly with your opinion of the use of those negative words in papers of a scientific or medical nature. Shame on those writers who cannot better express the causes of obesity in childhood or adulthood. More to the point would be the widespread use of High Fructose Corn Syrup and similar additives to our manufactured foods. I’m sure you know that story…. Good health to you – Paula Shapiro Colgrove

  2. Dear Paula Jean,

    I am so glad you found this post informative and greatly appreciate your support. Fighting anti-obesity bias within the medical-scientific establishment is one of the biggest civil rights challenges that face us today. I will continue to assess the scientific literature on the science of obesity, and do my best to address the civil rights issues as well. I hope you will continue to check in with my blog. Thank you very much for taking the time to share your thoughts. I do believe there are many physicians and other health professionals that are becoming more sophisticated in their understanding of obese patients, and good information on how to eat healthier and exercise sensibly are out there. Despite culturally based anti-obesity bias on the part of obesity researchers, particularly those who have a financial interest in keeping everyone feeling terrible about being overweight, there is a growing database of excellent scientific evidence for the intractability of what is defined in our society as “excess” weight. All we can do is keep learning.

    I wish you also the best of health. Thanks very much again for your comment.

    Best, Miriam

  3. nutrprofe said

    Metformin works to reduce glucose production in the liver by mimicking AMP. While it has no side effects for most people, some people cannot tolerate metformin and have severe diarrhea. There is no known connection to dietary simple sugars.

  4. Thank you Nutrprofe, for your response and for the enlightenment. Clearly, I didn’t do my homework sufficiently on this topic before writing about it.

    I believe this information is very illustrative in light of the fact that the woman who prescribed the metformin to me actually implied that I would have more diarrhea from the medication if I ate a lot of refined sugars. I know that to some extent, I’m imposing my own prejudices on to this woman by assuming that she was subconsciously driven to make me feel like a villain for eating refined sugars. However, I don’t think its much of a stretch.

  5. nutrprofe said

    Good to talk to you today, Miriam. Metformin is a beneficial drug if you can tolerate it. Hope you keep at it.

  6. diana said

    Interesting that I was told metformin tends to react with *fats* and people who avoid those when taking it do better. This kind of fits with my experience, and so I tend to eat less fat especially around the beginning of any met-preceded meal. Sometimes is seems to help, meaning there could be lots of other causes. Mystery drug, but my BGs are better on it, or I would be off it ASAP, as I don’t like drugs. Also interesting — met gave me weirdly intense dreams, and I’m narcoleptic already. So I cut the dose and don’t take it before dinner, only lunch. And it helps a lot. I also have to take B vites with met (but not at the same time) because met depletes these vitamins. If I don’t take a stress-plus B once a week, I get weak, tired, feeling rundown and out of energy. And I normally have LOTS of energy! Take care, and hope met is kind to you. –diana

    • Dear Diana, Thank you for sharing your knowledge and personal experiences with this drug. I really appreciate this feedback on personal experiences with metformin, and thanks also for the support. I’ve heard a bit about the B vitamins but I appreciate you bringing it up – I’m going to look into this, I could always use more energy.

  7. Natalie Sera said

    This is off-topic for this thread, but I’m posting it anyway. I’m not obese — just a little overweight (BMI currently 25.9). I have diabetes, and I have all my fat in my belly — so my new endocrinologist suggested Metformin. I refused it because I already have fecal incontinence, and can’t deal with what Metformin might cause.
    My issue is that I’m EMOTIONALLY obese. I was called fat during my whole childhood (I wasn’t — I was just rounder than my bony skinny sister). I have tremendous feelings of guilt for being fat, and therefore causing my diabetes, even though it doesn’t seem to be weight related. I’m really encouraged by the idea of HAES, and hope it catches on!

    • Dear Natalie,

      I’m glad you posted this comment and am sorry for the delay in responding. Thank you for your candor and for sharing your experiences. I encourage you to visit the links I posted – they will provide you with a great deal of moral support, which I believe is critical for good health, no matter what size you are. That’s a major tenet of HAES(SM).

      Your comment that you are “emotionally obese” is very insightful, and I think it’s great that you have this insight. This alone will help you deal with your illness. This society uses the word “fat” as an insult, which is just completely wrong. But this prejudice is so ingrained that most people will not even question discrimination against fat people. The fat acceptance movement is striving to take the sting out of the word “fat,” by using it as an objective description like tall or short. I’m so sorry you had to deal with that prejudice during your childhood. The standards that body size are judged by in this society are ridiculously skewed. There are people out there who can look at an anorectic person and still think that person is fat.

      Just a word about metformin – I am still on it, and the diarrhea has completely subsided. I am tolerating it well, and it’s a good medicine for diabetes. It is unusual for someone with your BMI to have diabetes – does anyone in your family have it? There is a genetic component to predisposition. Then again, BMI has proven to be a terrible indicator of overall health. You say you are “a little overweight” – over what weight? You might be just where you need to be. I share your hope that HAES(SM) catches on. It will definitely be an uphill battle, but I am hoping that little by little, people will finally accept the obvious – “weight loss” is temporary at best, and attempts at weight loss often lead to either more weight or other conditions. A health focused rather than weight focused approach is the only way to move forward, until science really begins to understand obesity, and perhaps come up with novel and safe medications which mitigate diseases like diabetes. Right now, science doesn’t yet have any good answers.

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