Book Review: Pancreatic Oath – A secret quantified self sort of book

I call it secret because you have to read about a third of the book before you realize that the cornerstone of the health advice is using glucometer to figure out what meals you eat are a kick to the pancreas for *you personally*. For diabetics, this is old hat. The difference here is that the advice is aimed at non-diabetics. Also, since the advice is aimed at non-diabetics. In a nutshell, you check your blood sugar levels on wake up, before eating, 2 hours after eating and record everything in a diary. If pie doesn’t spike your blood sugar levels above 100, you can eat it. Otherwise, you have to drop it, shrink the portion or change the recipe until you get your blood sugar levels back between 70 and 100. [n.b. if you are diabetic, the advice is different and diabetics often aim for slightly higher numbers because the consequences of being low are severe, e.g. coma, vs the consequences of being high, e.g. a slow life long decline and early death]

This fits in very nicely with anyone who has been exposed the the Quantified Self movement (fad? geeky hobby?) Unlike the fitbit, my withings scale, my withings blood pressure cuff and my nintendo DS pace counter, glucometers hurt and involve drawing blood– unless you do your research. Old fashioned glucometers and measuring on the finger tip (instead of the side or arm) seem to be correlated with pain, the latest state of the art ones are supposed to be significantly less painful (or not painful at all).

The first third of the book is preachy. I’m mostly already sold, but I understand why the book has to be written this way. Dietary habits are incredibly stable. Normally, threat of imminent death is not enough to change dietary habits. I think it is because humans as a species have *never* lived in an environment with an abundance of food, so even 100-200 years ago, it was always less risky to eat more than less because of the risk of future famine or food shortage. It takes a near religious conversion to get people to change.

The middle third is about the mechanics of blood sugar, insulin and how the spikes that non-diabetics experience in blood sugar and insulin damage our blood vessels, eyes, kidneys… you name it. [This contrasts with diabetics who don't just deal with spikes, but all day highs or wildly fluctuating levels because it isn't just a overworking pancreas but one that is broken] After reading this, I got a distinct impression that the pancreas is a keystone organ. When it is broken, the rest of the body begins to fail, like a big slow motion house of cards. This is a bit different from lung or heart failure, since if you can’t breath or pump blood you die in five minutes. So our body has over engineered those, they put up with a lot of abuse– just look at how much abuse smokers get away with before it kill them. Another way to look at it is that your brain (stroke), lungs (drowning), heart (heart attack) is about life and death health issues. The pancreas is the organ that is relevant to health (that and the liver, but I get the impression that the liver is more durable than the pancreas, although the liver will show signs of distress the same as the pancreas when blood sugar levels spike). But the rest of the organs work as long as they aren’t abused. The author uses the phrase “get your pancreas into idle” It’s a good metaphor. The non-diabetic doesn’t want to make the pancreas run at full tilt most or even some of the time.

Finally, we get to the advice on measuring.

At the end are a bunch of recommended recipes. This book made a valuable observations about the glycemic index approach– which is a closely related diet/heath advice. Glycimic index charts promise to tell you if a given food will cause your blood sugar levels to spike after you eat it. But in practice, the same foods affect different people differently. So the glycemic index needs individual measurements to account for individual differences. In which case you can ditch the glycimic index chart and just use the actual glucometer readings.

The author has a detectable left slant, pro-organic, pro-farmers market, pro-yoga and mediation. The author interestingly had a pragmatic approach to exercise– a lot of people who have let their health go have gotten themselves into a position where exercise isn’t an significant option– the knees are shot, so they have to focus on improved health by look on the energy intake side and not the energy usage side. The author is also pro-vitamins. I like micronutrients, but other than the bit about cinnamon and other blood sugar linked micronutrients, I thought the vitamin advice was unnecessary. I say, a book should fight one battle at a time and the case for using a glucometer among non-diabetics was made, but the case for vitamins wasn’t really well supported.

The author’s website is here with links to get the book. Also available on Kindle, which is how I read it.

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