In my mind, doctor visits came in two flavors. The first was the kind where the nurse puts you into the room (after your mandatory half hour wait in the waiting room) for another 20 minute wait, perched atop those cold, metal examining room tables in one of those nightgowns, and then the doctor finally arrives, only to give you a long speech. Your stats are all good, you are basically as healthy as the proverbial horse, but – BUT! – just you wait, your good luck won’t last forever. You’re significantly overweight, and though none of your tests reflect that fact (yet), someday something is going to give. The second flavor also involves all the waiting and sitting almost nekid on the cold , metal examining table, but ends with the doctor telling you that you have some rare, deadly tropical disease, and only two weeks to live.

Every year I go for my check up, I expected to hear one of those two results. Admittedly, the second option always had me on edge, and I would be extremely relieved when the doctor got to the “Your tests are all fine, but you know…” part. After your fortieth birthday, when it occurs to you that you are not immortal, every little ache, every little sharp pain in your gut becomes in your mind some deadly cancer that is going to cut you down in the prime of your life — when in reality, it’s just the chili you had for dinner.

Well, as it turns out, there is a third flavor, a third, middle option between “complete clean bill of health” and “certain death.” Despite a terrible diet and being significantly — let’s be honest; morbidly — overweight, the diabetes diagnosis came out of left field for me. My body has always been so resilient and so easy to maintain, that I just never paid attention. And I felt fine, good even. There were subtle symptoms, but I didn’t catch them: going to the bathroom more often, for instance, as my body (in desperation) tried to use my kidneys to dump the extra sugar piling up in my bloodstream. I just dismissed it as a symptom of my body’s mileage meter clicking up to the half century mark.

But there it was: my body has lost the ability to manage the sugar levels in my blood, and if left untreated will lead to damage to my eyes, my cardiovascular system, and my kidneys. The one that popped out at me when the doctor spouted that list was the eyes: I have rooms full of books, and I make a living by writing. I need all that stuff, but I especially can’t live without my eyes.

How did I get here? To begin with, I’m from a Great Lakes rust belt city. where everybody (including my parents and siblings) worked in the steel mills. I grew up in a world of ridiculous plenty, between the local farms and the regional immigrant-shaped diet.  And given that so many in the region (including us) where relatively recent immigrants, opulent meals were a sign of success — we’ve made it, and the proof is our tables are overflowing with food! Everybody ate as much as they wanted — restaurant portions were huge — and yet fat people were unusual. Everyone worked physically demanding jobs and could process massive amounts of carbs with no problem. My wife and I recognized that kind of diet was not sustainable and we added lots of veggies to our meals, but clearly, not enough.

There is another part of the story, however, one that I was already vaguely aware of, but am only now beginning to fully appreciate. For anyone who has lived some years abroad, one of the oddities one notices is that foods outside the U.S. tend to taste harsher — saltier, more sour, more savory. It requires a palette adjustment to enjoy those foreign foods. The problem is that American food is riddled — to an astonishing degree — with sugar. It comes in so many insidious forms: cane sugar, corn syrup, concentrates, and so many compounds whose names end in “-ose.” Americans have an extreme sweet tooth, and everything, from their beer, their bread, their sauces, their everything is laced with some form of sugar. Human bodies are not able to process all that sugar; diabetes is the fastest growing disease in the US (with the world, which loves American foods, catching up); almost 10% of the U.S. population was diagnosed with diabetes in 2015, and by some estimates the number of undiagnosed cases may double that figure. (National Center for Chronic Disease Prevention and Health Promotion, 2017)

My doctor went on a long rant to the effect that if the Federal government simply evaluated cane sugar (and its sibling products such as corn syrup) based on its health impact, it would quickly become a heavily regulated commodity, but a host of sugar-related lobbies in Congress ensure that will never happen. Another professional dietitian countered that sugar cane isn’t such a problem, so long as eaten in moderation. But that’s the problem, as I’m learning now that whole sections of the average American super market are off limits to someone like me who must avoid sugars. Really, read your food labels; it’s in everything.

So where does this leave me? I now must manage my diet. In truth, as my dietitian is showing me, this isn’t a diet but a lifestyle — the kind of food types and portions I should have been eating all along, and which all adults should be eating. My diabetes is reversible and that is my goal, but this disease is really a lifestyle wake up call. I don’t have to completely give up home-made macaroni and cheese or ice cream, just limit them, and eat a lot more veggies. This is the plan for getting this 1968 model mortal coil to last into its 70s or 80s.

So changes abound for me. But I will leave you with a glucose warning: Ask not for whom the bell tolls….