What I Learned About Metabolic Syndrome in Paraguay
Tara Gignac BSc, ND
Last winter, my family and I had the good fortune to spend five months in beautiful Paraguay, South America, where we worked with homeless children near the little town of Carapegua.
My husband became a “farmer,” working on sustainable agricultural projects so that the children’s home would not be dependent on donations. Our five-year-old daughter spent her time playing in the guyava grove with the kids from the home, and I helped with the daily care of the kids and became the resident doctor, dealing with scrapes and cuts, fevers and coughs.
Before long, the entire community began to visit my little clinic under the mango tree, and I had the pleasure of helping these shy but happy people with complaints ranging from pneumonia and menstrual troubles to back pain and grief. It was a remarkable experience, one that I would recommend to any ND.
Dietary Ties to Metabolic Syndrome
As I was preparing to write this article, my husband asked me, “What’s metabolic syndrome?” My answer, of course, was one we all learned in medical school – it’s a constellation of signs and symptoms, including fasting hyperglycemia, dyslipidemia, hypertension and abdominal obesity.
“What causes it?” he asked.
My answer: [Among other things, risk factors include] poor diet, sedentary lifestyle, smoking and lots of stress.
“Sounds like they should call it Crappy Lifestyle Syndrome.”
He’s right, and we discussed the topic in more depth, focusing in particular on the diet associated with this constellation of symptoms, and how the typical North American diet, high in saturated fat and sugar and low in vegetables and fiber, is a key problem.
The next question my husband asked was more provocative. “Don’t you think it’s interesting,” he asked, “that when we were in Paraguay, we ate what most naturopathic physicians would consider to be an atrocious diet?”
It’s true. We ate a salad perhaps five times in five months, beef multiple times a week, and fried foods multiple times a week, often twice a day. The rest of our meals were made up of carbs in the form of potatoes, white flour pasta, white rice and sugar by the kilo. (Paraguayans love sweet foods; our home of 15-20 – mostly kids – used more than 110 pounds of sugar a month.) The surprising part, however, was not our diet. The surprising part is how incredibly healthy we were. We lost weight and felt fantastic eating what I normally would say was an extraordinarily poor diet. For months!
And we weren’t alone. We met many thin, fit, happy Paraguayans who spoke of having grandparents who lived well into their 90s. I saw hundreds of patients in Paraguay, and although I didn’t have the luxury of ordering lab tests (all I had were my senses, blood pressure cuff, stethoscope, a small flashlight and very little Spanish), I can tell you that of those people, I could count on one hand how many had high blood pressure or were obese. Furthermore, not one person told me they were depressed. They were very happy people, even in the face of having plenty to be depressed about.
Typical Paraguayan Diet
As NDs, we frequently see our nutritional job as one of getting patients to eat more green vegetables and more vegetarian protein choices, to reduce “white death” in all its forms, and to limit saturated and trans fats in the diet. But is it really that simple?
The typical Paraguayan diet consists of loads of white carbs, very few vegetables and fiber, and a lot of red meat that is often fried. On the surface, it looks very much like the North American diet that takes its share of blame for our poor health. Yet from some clinical (and a lot of anecdotal) evidence, Paraguayans seem to be a healthy bunch.
But let’s look a little closer at this diet. Eighty percent of what we ate in Paraguay was grown and/or produced within 20 miles of our home. The “milkman” delivered milk straight from the cow. The store down the road sold cheese that was handmade. The bread, baked at the local bakery, would go bad in a matter of days, sometimes even if put in the freezer. The beef was grown in the pasture outside our door, and the fruit and vegetables were grown in our own gardens and orchards, often picked fresh just before consumption. Even the sugar was raw, produced from the sugar cane that grew just down the road. There were very few packaged, canned, frozen or prepared foods. There were no fast-food restaurants, take-outs or drive-thrus. It was all made from scratch every day. Basically, most of what we ate was food as nature intended it to be.
One day while we were preparing juice for lunch, which involved blending fresh lemons (skins and all) for a short time, straining off the liquid and adding this beautiful brown-hued, raw sugar to make a juice unlike any I’ve tasted, one of the missionaries asked me if there was any nutritional content to raw sugar. I didn’t know.
What I did know was what I was taught: that sugar suppresses the immune system and can lead to the signs and symptoms of metabolic syndrome – i.e., it’s not good for you.
So I looked into it. I researched the nutritional content of raw sugar, and indeed it is full of minerals. In fact, raw sugar contains chromium, the trace mineral we all use regularly to help people better regulate their blood sugar.
What about fat? In the book The Omnivore’s Dilemma, Michael Pollan writes about the fat profiles of grass-fed beef vs. grain-fed beef. The meat from grass-fed cattle has a 2:1 ratio of omega-6 to omega-3 fats. Meat from grain- or corn-fed cattle has a 10:1 ratio of omega-6 to omega-3.
As NDs, we know that the imbalance of essential fatty acids in the North American diet is a contributor to metabolic syndrome. The assumption is that the saturated fat in beef is the problem, but perhaps it has more to do with the unnatural way that our beef is being fed. It‘s not the way that nature intended, and leads to unhealthy body biochemistry.
The American Heart Association states that the primary therapy for reducing the metabolic risk factors, including heart disease, is weight control and increased physical activity. Physical activity is the core lifestyle factor that the Paraguayans have in spades. Our entire daily routine centered on constant movement. It started with a long walk to school – there are no buses for children in rural Paraguay. So off we went at 6:30a.m. with our five-year-old walking the 1.25 miles to school … and she loved it!
The rest of the day was filled with work that was physical in nature – building, gardening, cleaning and cooking. We were in constant motion, usually outside, and we all felt energetic and healthy. It’s no wonder we became leaner and more fit. And every North American who came to visit lost weight and felt fit and content as well.
With all the activity, there was very little time during the “work day” to sit down and relax, but the work day is defined a little differently in Paraguay. All Paraguayans stop what they are doing mid-morning and mid-afternoon and have a terere break. This involves sharing a cold, refreshing herbal tea while resting, talking and laughing. It’s truly a joyous part of the day that everyone looks forward to – a wonderful time for the group to connect.
Lunch is the biggest meal of the day, after which the entire town takes a rest. Very little is open and everything is quiet until 2p.m., when work resumes until just before dusk, when the community meets to play soccer or volleyball, ending the day with some fun and laughs with friends.
It’s no wonder these people are so happy. Their lives are balanced, despite the stress and struggle to meet daily physical needs. They work and have fun. They have stress, but are connected to and deeply involved with the people around them. They are supported by their communities, and they all take the time to keep those connections open and healthy.
I can’t tell you conclusively that rural Paraguayans have optimal rates of blood sugar and cholesterol (I’m not sure anyone can – the healthcare system is a user-pay system, and most rural Paraguayans literally live hand to mouth. Money for a lab test would rarely, if ever, be in the budget.) Nor will I tell you that diet isn’t important. Upon arriving home in Canada, our whole family was happy to eat the beautiful, fresh greens we have so regularly here.
What I can say is that my experience in Paraguay has shifted my focus somewhat. I no longer throw out sweeping, generalized statements about sugar, fat, meat or flour, but focus on foods that nature, not science, made – even the fatty, sugary ones.
I’ve also seen first-hand the level of impact that activity and stress reduction can have on some symptoms of metabolic syndrome, and I know that diet can only take people so far. Metabolic syndrome, I now realize, is a complex cultural condition that needs a cultural solution, and culture is far more than just diet.
I will be changing my practice accordingly.
Tara Gignac, ND is in private practice in Collingwood, Ont. She is the author of two books to be published this fall: Escape101: How to Take a Career Break without Losing Your Money or Your Mind, and Healthy Profits: The 5 Keys to Wealth and Work Life Balance in Your Complementary or Alternative Health Practice.