Modern Food

Our world today - our civilization,
Progressively shaped by socialization,
Is a cultured modern derivative,
Of hunting tribes more primitive.
We lived in caves or somewhere outdoors,
We ate what we hunted and fished from the shores.

We foraged for berries and other fruits,
Leaves and mushrooms, stems and roots.
We evolved to seek meat, and fruit as a treat,
Thus our cravings for fat and for sweet.
The key to survival and fighting disease,
Had always been eating more calories.

For nearly all of human existence,
We lived this way with no assistance,
From complex tools or modern machines,
Survival depended on simple routines.
There were no farms, no tractors, no crops,
No mills or flour, or bakery shops.

Our natural diet did not contain,
Cereal, bread, pasta, or grain.
No hot dogs, pizza, or pepperoni,
Sausage, salami, cheese or bologna.
No cookies, pies, donuts or cake,
Or any kind of food that is fake.

Modern society has seriously faltered,
We've become addicted to the food we've altered.
The modern foods we love today -
We're just not designed to eat that way.
Once we see it the truth is so clear,
Our bodies can't handle the treats we hold dear.

The reason this problem remains unsolved,
Is due to the fact that we have not evolved,
A new set of genes to eat "modern" food,
Without getting sick, so we must conclude,
The natural way, the way that is best,
Is to eat the food we're designed to digest.

Fish and fowl, or very lean meat,
Are possible foods that we might eat.
Butternut squash, peppers and beans,
Corn, peas and beets, and all kinds of greens.
Carrots, zucchini, melons and berries,
Peaches and oranges, mangoes and cherries.

No human tribe or society,
Has ever had such a variety,
Of healthy food so easy to get,
We take it for granted we tend to forget,
Our good fortune for this cornucopia,
Some might call it a utopia.

The foods that can save us are found right beside,
The foods that will kill us and rot our inside.
We all face this challenge, we all face this choice,
We all have free will, we all have a voice.
Our future is bright, our potential is vast,
Once we learn this lesson from our distant past.

~ Michael Dansinger, MD

Related Topics:

• Type 2 Diabetes Message Board with Michael Dansinger, MD
• Get the Diabetes Newsletter in your inbox

Eating for Diabetes Reversal: Part 7

Sample Meals

Now that I have clarified the types of foods to focus on, you may be wondering how to assemble quick, easy meals from those foods. Below I describe the overall strategy for designing meals, and I provide specific examples of quick, easy meals. You will notice that these are not gourmet meals, because my patients are generally looking to avoid complicated recipes. We'll get into more elaborate dishes at a later time, but for now, use these sample meals as a starting point to create your own personalized approach to the "natural human diet".

Eating Program For Healthy Weight

Overview

Eat 3 meals daily, consisting of healthy protein (about 6 ounces) complemented by vegetables/fruits (1-2 cups) and condiments (up to 2 tablespoons).

The Formula

1. Start each meal by selecting one of 4 protein categories (eggs/dairy, nuts/soy, fish/shellfish, poultry breast)


2. Add vegetables/fruits (fresh, frozen, canned, or dried)


3. Jazz it up and add variety with flavorful condiments

The Rationale

This eating strategy takes advantage of modern conveniences to replicate the nutritional characteristics of the "Natural Human Diet". The human body has been genetically designed to eat low-fat protein and high-fiber vegetables and fruits. Our modern culture has radically changed the diet to consist largely of starch, added sugar, and unhealthy fats from meat and dairy, which together promote obesity, diabetes, and related health problems. Minimizing the starch, added sugar, and animal fat reduces hunger and appetite, increases will-power, and allows individuals to feel full and satisfied with dramatically fewer calories. Therefore, "special occasion foods" containing excess starch and/or animal fat should only be eaten at "special occasions" comprising less than 10% of all meals

Step 1: Chose from the 4 Protein Categories

1. Eggs/Dairy - Egg whites and dairy protein are healthy; fat in egg yolks and dairy is not healthy. By limiting or avoiding the unhealthy fats, eggs and dairy can form an important and versatile base for a wide variety of meals and are a favorite for breakfast.
   
   Recommended items include cartons of egg whites, egg-beaters, whole eggs that have increased omega-3, non-fat cottage cheese, non-fat ricotta cheese, Designer Whey protein powder (dairy protein for smoothies), "light" artificially sweetened yogurt, and non-fat plain yogurt. A serving is: 2 whole eggs/6 egg whites/6 ounces non-fat cottage or ricotta cheese/protein power according to canister directions/8 ounces light or plain yogurt.


2. Nuts/Soy - Soy foods and nuts can be used as the base for a wide variety of meals, with a few caveats. Major advantages include the absence of unhealthy animal fats and excess starch or sugar, their versatility, and the importance of this protein group for vegetarians. However, soy foods can contain excess salt while nuts contain excess calories if eaten in excess, therefore these protein choices are eaten in combination with other healthy ingredients.
   
   Frozen or refrigerated soy-based meat substitutes (Morningstar Farms, Boca, Gardenburger), and Quorn (similar to mushroom protein), can stand in for burgers, sausages, diced chicken, and ground meat, while firm tofu can also be used to provide variety and interest to meals. One serving is approximately 6 ounces.


3. Fish/Shellfish - Fish and shellfish are top choices for healthy protein. I recommend eating from this category once per day. They contain healthy fat or minimal unhealthy fat, taste great, and come in many varieties. Especially convenient are canned and frozen fish and shellfish.Frozen fish can be rapidly thawed in hot water, and like fresh fish, tastes great lightly seasoned or can be marinated quickly for added flavor. Fish is now often frozen right on the boat and does not develop a fishy smell if cooked the same day it is thawed.
   
   Few fish have unacceptable levels of mercury; limit swordfish to twice per month and limit "solid" albacore tuna in cans or fillets to twice per week. Chunk or light tuna, salmon, and other commonly eaten fish and shellfish have low or minimal mercury levels that do not negate the powerful health benefits of fish. One serving is approximately 6 ounces.


4. Poultry Breast - the breast meat from chicken and turkey is high in protein with low levels of unhealthy fat. There is too much unhealthy fat in the dark meat and skin, so only eat the white/breast meat. Ground poultry should also be avoided, unless it contains only white/breast meat.
   
   Chicken and turkey breast are available cooked or uncooked at all supermarkets, and can easily form the base of a wide variety of soups, salads, or main dishes. Turkey breast slices, thin or thick (try half-inch thick slices), are especially convenient and are available at any deli counter. Salt/sodium in prepared poultry breast can be high, but when paired with other low-sodium ingredients, overall salt intake remains low. One serving is approximately 6 ounces.

Step 2: Chose the vegetables/fruits

Much of the variety and interest for the meals come from the vegetables and/or fruits, rather than the relatively limited protein choices. Some meals will call for convenient, rapidly prepared vegetables/fruits while others benefit from preparations that require more time and effort. To maximize convenience, taste, and variety, becoming familiar with all the available varieties and preparations of vegetables and fruits is highly recommended. Fresh, frozen, canned, and dried produce each have advantages and disadvantages. An adventurous spirit and open-mindedness can be great assets when considering potential combinations of various produce and protein options. Do not dismiss combinations of savory and sweet in the same dish. Dried fruits can be used in moderation (1/4 cup per day) straight out of the bag, or rehydrated in water for a few hours or overnight.

Aside from white potatoes, starchy vegetables such as winter squash, sweet potatoes and other root vegetables, and beans/legumes can be used in moderation (3 one-cup servings per week). Avoid fruit juice, discard the juice from canned fruit, and avoid fruit canned in heavy syrup. Vegetables should not be deep fried or cooked with much oil/fat; they can be sautéed in spray oil or skimpy amounts of olive or canola oil. To keep produce fresh, make a weekly trip to the market. Pair a full serving of protein with about 1 cup fruit, 2 cups of cooked vegetables or soup, or up to 4 cups of salad/raw vegetables.

Step 3: Add flavorful condiments

Condiments are typically bottled or jarred sauces, dressings, relishes, jams, chutneys, spices, pickled vegetables, or other similar foods used in small quantities, that add great flavor to meals. They should be used regularly to provide the flavor and variety necessary to make this an exciting and interesting eating strategy. Most condiments are acceptable when no more than 2 tablespoons are added to a meal (up to 100 calories per 2 tablespoons), including salad dressings. Salt, fat, sugar, and starch are often present, but are best used in this context and in these limited amounts. The end result is the transformation of protein/vegetable/fruit combinations into exceptionally flavorful, pleasurable, and unique meals.

Sample Meals

Egg/Dairy Meals

PROTEIN	VEGETABLE/FRUIT	CONDIMENTS	INSTRUCTIONS
½ cup Egg Beaters - Southwestern style	½ cup diced peppers & onions	Spray oil ¼ cup salsa	Sauté the vegetables, set aside, cook the egg beaters omelet style, add veggies, then top with salsa.
6 oz cottage cheese - fat free	1 cup fruit such as pineapple, pear, banana, etc.	Any sweet spice or condiment, optional	Place cottage cheese in a bowl, add optional condiment/spice, and fruit.
6 oz ricotta cheese - fat free	1 cup thawed frozen berries	None	Place ricotta cheese in a bowl, add fruit.
2 fresh eggs	½ cup corn salsa (Trader Joes)	½ cup Pinjur (Trader Joes)	Add pinjur and corn salsa to a small pan, cover, cook over medium heat for 4 minutes, add eggs sunny-side up style, cover for 4 minutes and move to plate.
3 hard boiled eggs, minus 2 yolks	1 cup/piece any fresh fruit	2 T. pesto (Trader Joes)	Mash the eggs, add pesto and eat with fruit on the side.
4 hard boiled eggs, minus 2 yolks	1 cup/piece any fresh fruit	2 T. honey mustard	Cut eggs in half, mash 2 yolks with the honey mustard, and scoop into yolk cavity. Eat with fruit on the side.
½ cup Egg Beaters	½ cup spinach ½ clove garlic	2 T. feta - fat free	Sauté the spinach and garlic, then add egg beaters, cover on medium heat until cooked, frittata style.
Protein powder 1 scoop - Designer Whey Chocolate	1 banana	½ tsp. cinnamon 1 cup cold water	Place all ingredients in a blender. Blend until smooth.
Protein powder 1 scoop - Designer Whey Vanilla	½ cup frozen cherries	¼ tsp. almond extract 1 cup cold water	Place all ingredients in a blender. Blend until smooth.

Soy/Nut Meals

PROTEIN	VEGETABLE/FRUIT	CONDIMENTS	INSTRUCTIONS
1 T. spicy peanuts 1 T. plain peanuts	1 T. raisins 1 T. dried cranberries	None	Mix together to make trail mix (makes 1/4 cup).
2 T. peanut butter	1 cup apples, pears, carrots, celery, bell pepper and/or cucumber	None	Spread peanut butter on sliced vegetables/fruits.
Morningstar Farms Grillers - 1 veggie burger	1 cup sliced raw vegetables, pickles Nonfat cheese - Kraft singles	Mustard, ketchup, BBQ sauce	Cook the burger according to package directions. Add cheese, condiments and eat with a fork with side veggies.
2 Boca Italian Veggie Sausages	2 cups raw bell pepper and red or yellow onion	2 T. olive or canola oil 1/2 cup tomato sauce	Slice vegetables into strips and sauté in oil. Thaw sausages in microwave and slice into coins. Add to vegetables. When vegetables are soft, add tomato sauce until cooked through. Transfer to plate.
2 Boca Bratwurst Veggie Sausages	2 cups raw red cabbage and red or yellow onion	2 T. canola oil ¼ cup cider vinegar	Slice vegetables into strips and sauté in oil. Thaw sausages in microwave and slice into coins. Add to vegetables. When vegetables are soft, add cider vinegar until cooked through. Transfer to plate.
1 cup Quorn brand crumbles with ½ cup water	2 cups salad vegetables: lettuce, cilantro, scallions, tomatoes, cucumber, black beans	1/2 packet taco seasoning mix salsa, hot sauce, guacamole, nonfat sour cream	Thaw crumbles in microwave, and heat in skillet with water and taco seasoning. Prepare salad and top with up to 2 T. condiments.
½ block or 1 cup firm tofu 1 fresh egg	1 cup frozen peas	Spray oil 2 T. low sodium soy sauce	Dice tofu into ½ inch cubes. Add all ingredients to hot sprayed skillet and stir fry until hot, about 3-4 minutes. Transfer to plate.
1 cup Quorn brand crumbles with ½ cup water	½ cup black beans mashed 1 diced scallion ½ cup corn salsa (Trader Joes) 1 cup canned diced tomato	½ packet chili or taco seasoning mix	Mix all ingredients together and simmer for ½ hour. Double recipe to make 2 meals if desired.
½ block or 1 cup firm tofu	2 cups frozen Asian vegetables	Spray oil 2 T soy sauce, teriyaki sauce or similar	Thaw vegetables and stir-fry in sprayed skillet. Dice tofu into ½ inch cubes and add with Asian sauce until cooked.
Morningstar Farms breakfast sausage (4 links or 2 patties)	1 cup or 1 piece fresh fruit	None	Cook the sausages according to package directions and eat with fruit on the side.

Fish/Shellfish Meals

PROTEIN	VEGETABLE/FRUIT	CONDIMENTS	INSTRUCTIONS
6 oz. can boneless skinless pink salmon	3/4 cup canned beets ½ cup corn salsa (Trader Joes)	1 T. pesto (Trader Joes)	Drain salmon. Dice beets. Add all ingredients to a bowl, mix and eat.
6 oz can solid white tuna, drained	1 cup frozen green soybeans (edamame) ½ cup canned mushrooms, drained	2 T. teriyaki sauce	Thaw soybeans in microwave. Add all ingredients to a bowl, mix and eat.
Tuna in Thai curry sauce, 1 packet (Trader Joes)	2 cups diced salad vegetables: cherry tomatoes, cucumber, cilantro, mint, red bell pepper, red onion, carrot shavings	None	Add diced salad vegetables to a bowl, add curried tuna, mix and eat.
1 cup shrimp - raw or cooked	2 cups frozen stir-fry vegetables	Spray oil 2 T. teriyaki sauce	Thaw frozen shrimp and vegetables. Cook in sprayed skillet until cooked through. Add sauce and transfer to plate.
6 oz can solid white tuna, drained 1 boiled egg, chopped	½ cup cherry tomatoes, halved, ½ cup frozen green beans	2 T. balsamic vinegar salad dressing	Thaw green beans and add all ingredients to bowl, mix and eat.
6 oz fresh salmon or other fish fillet	1 cup fresh asparagus	2 T. sauce of choice; for example, apricot preserves blended with spicy mustard	Cook fish and asparagus on George Foreman grill, in skillet, or oven. Serve with sauce of choice.
1 cup frozen scallops	1 bag fresh spinach 1 box diced mushrooms	1 T. oil 1 T. diced garlic	Sauté the mushrooms in oil and garlic. Add spinach and transfer to a plate when cooked through. Saute the scallops until cooked through and eat with vegetable mixture on the side.
6 ounces frozen or fresh artificial crab legs, such as Louis Kemps	¼ cup finely diced red onion ¼ cup chopped scallion, 1 cup diced cucumber	2 T. light mayo	Thaw crab legs, then finely chop and mix in a bowl with other ingredients and eat.
Boneless skinless pink salmon - 6 oz. can, drained	2 cups vegetable soup, homemade or canned	2 T. sauce of choice	Heat the soup in a pot and mix in the salmon and any additional seasonings. Transfer to bowl and eat.
6 oz cooked tiny shrimp	2-3 cups diced combination of cucumber, cherry tomato, yellow bell pepper, cilantro, red onion, mango, avocado	2 T. mango chutney or curried mango sauce	Mix all ingredients in a bowl and eat. Tastes best if left to stand in refrigerator several hours or overnight
6 oz can solid white tuna, drained	Diced cucumber 1 cup	2 T. sweet rice vinegar 1 tsp. sesame seeds	Mix all ingredients together in a bowl and eat.

Turkey/Chicken Breast Meals

PROTEIN	VEGETABLE/FRUIT	CONDIMENTS	INSTRUCTIONS
6 oz cooked turkey breast, ½ inch cubes	½ cup diced cucumber, ½ cup diced red bell pepper, ½ cup quartered cherry tomatoes, ½ cup chopped fresh cilantro leaves	¼ cup peach salsa (Trader Joes)	Mix all ingredients together in a bowl and eat. Can use turkey from the deli counter sliced ½ inch thick at time of purchase, then diced when ready to use.
6 oz cooked turkey breast, finely diced in 2 cups soup broth	1 cup frozen peas/corn/carrots, 2 diced scallions, 1 tsp. minced jalapeño pepper, ¼ cup diced avocado	None	Simmer all ingredients in soup pot for 15-30 minutes, transfer to bowl and eat.
6 oz cooked turkey breast, ½ inch cubes	2/3 cup corn salsa (Trader Joes)	2 T. cranberry orange sauce (Trader Joes)	Mix all ingredients in a bowl and eat.
6 oz cooked chicken breast, sliced	1 cup sliced red or yellow onion, 1 cup sliced bell pepper	2 T. canola oil Fajita spices and/or 2 T. fajita sauce	Sauté peppers and onion in a pan until soft and browned. Add chicken slices and fajita seasonings. Transfer to a plate.
6 oz cooked chicken breast, diced	1 cup red cabbage, 3 scallions, ½ cup red bell pepper, ½ cup carrot	1 T. sweet rice vinegar, 1 T. soy sauce, 1 T. olive oil	Finely shred or chop the vegetables and place in a bowl with diced chicken. Mix dressing ingredients and toss all together.
6 oz cooked chicken breast, diced	½ cup diced red pepper, 3/4 cup diced orange, ½ cup diced avocado	¼ cup Mojito sauce (Trader Joes)	Add chicken and Mojito sauce to a skillet to warm, then mix in a bowl with other ingredients.
6 oz ground or diced turkey breast 1/2 cup water	1/2 cup black beans mashed, 1/2 cup corn salsa 9Trader Joes), 1 cup diced tomatoes, 1 scallion diced	Spray oil ½ packet chili or taco seasoning mix	In a soup pot, brown turkey in spray oil, add other ingredients and simmer ½ hour. Transfer to a bowl and eat.
6 oz cooked chicken breast, diced 1 cup chicken broth	½ cup diced yellow onion, 1 cup frozen corn/peas/carrots, ½ cup diced tomatoes in juice	1 T. oil, 2 T. peanut butter	In a soup pot sauté onion in oil, add vegetables until hot, add broth, chicken and peanut butter and simmer 15-30 minutes. Transfer to bowl and eat.
6 oz cooked chicken or turkey breast, diced	2 cups canned low-sodium soup	None	Heat soup and chicken/turkey in a pot until warmed. Transfer to a bowl and eat.

Grocery List

Chicken breast, raw or cooked
Turkey breast, cooked whole, deli slices, or raw
Canned salmon - boneless skinless, 6 oz
Canned tuna - solid white, 6 oz
Packaged tuna in red curry sauce - Trader Joes
Frozen shrimp
Frozen scallops
Frozen fish fillets
Frozen salmon burgers
Boca frozen vegetarian sausages - Italian/Bratwurst/Smoked
Morningstar Farms - frozen vegetarian breakfast sausages links or patties
Morningstar Farms - frozen vegetarian burgers, any flavor
Quorn - frozen vegetarian crumbles and chicken style cubes (tenders) and fillets
Designer Whey - protein powder chocolate or vanilla
Tofu - Extra firm
Eggs - with omega 3
Ricotta cheese - fat free
Cottage cheese - fat free
Feta cheese - fat free
Cream cheese - fat free
Sour cream - fat free
Milk - fat free
Yogurt - artificially sweetened 'light' or plain nonfat
Canned beans - black, pinto, etc
Peanut butter - natural (just peanuts and salt)
Pickles
Condiments - relishes, chutneys, sauces, dressings etc, up to 100 calories per 2 Tbsp.
Corn salsa - Trader Joes
Peach salsa - Trader Joes
Pinjur - Trader Joes
Mojito Sauce - Trader Joes
Canned Soup - low sodium, low fat, low calorie
Canned fruit - preferably 'light' or in light syrup, not heavy syrup
Canned vegetables
Frozen vegetables - peas, corn, mixed, stir-fry Asian, etc.
Frozen fruit - cherries, berries, pineapple, etc.
Dried fruit - raisins, apricots, dates, figs, etc. (eaten in moderation)
Nuts - eaten in moderation
Fresh vegetables - cucumbers, peppers, carrots, cilantro, mint, basil, parsley, red cabbage, red onion, yellow onion, scallions, broccoli, spinach or other greens, cauliflower, zucchini, mushrooms, etc.
Fresh fruit - apples, oranges, grapefruit, pears, bananas, grapes, pineapple, mango, melon, etc.

- Michael Dansinger, MD

Read the entire series:

1. "Natural Food" versus "Modern Food"
2. A Spectrum Of Options
3. The Tufts Popular Diet Trial
4. Dating the Diets
5. Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal
6. Dr. Dansinger's Eating Strategy for Diabetes Reversal
7. Sample Meals

Related Topics:

• Type 2 Diabetes Message Board with Michael Dansinger, MD
• Get the Diabetes Newsletter in your inbox

Eating For Diabetes Reversal: Part 6

Dr. Dansinger's Eating Strategy for Diabetes Reversal

So far we've discussed the following principles:

1. The natural human diet has been distorted beyond the nutritional breaking point by modern technology.


2. The modern human diet is too high in caloric density, glycemic load, saturated fat, added sugars, and trans fats, and too low in fiber, omega 3 fats, vitamins, minerals, etc..


3. There are many ways to backpedal away from the modern human diet.


4. Adherence level is the key determinant of weight loss and reduction of diabetes and heart disease risk factors, regardless of the type of eating strategy used.


5. Glycemic load reduction helps reduce hunger resulting in decreased caloric intake and weight loss.


6. Caloric density reduction helps reduce caloric intake resulting in weight loss.


7. Saturated fat reduction helps reduce insulin resistance and the duration of glucose spikes.


8. Loss of excess body fat is a potent tool for combating type 2 diabetes.


9. I define type 2 diabetes remission as hemoglobin A1c of 6.0 or less without diabetes medication for at least 2 months.


10. Many people can achieve type 2 diabetes remission with sufficient adherence to the right eating and exercise strategy.

For my Diabetes Reversal Program patients I have devised a specific eating strategy based on my cumulative knowledge and experience, aiming to find the right balance between effectiveness and feasibility. Too strict or extreme and the strategy will not be feasible, too liberal or compromising and the strategy will not be effective. There are many eating strategies that work well, but this is the one I have come to favor because it fits best with my personal preferences and philosophy. I use other strategies sometimes, but this is my main one.

My aim is to use modern food to approximate the nutritional characteristics of the Natural Human Diet. I'm aiming to substantially reduce caloric density, glycemic load, and saturated fat, in the most reasonably balanced manner possible. The eating strategy must have rules that are clear and simple. Most importantly, the strategy must work to reliably achieve caloric reductions, weight loss, and A1c reductions, in all who follow it, plus it must improve (or not worsen) any heart disease risk factor that needs correction.

People cannot be expected to follow the eating strategy at 100% adherence level. Nobody is perfect and everybody wants to eat unhealthy treats occasionally. Following the eating strategy at 90% adherence level, such that no more than 10% of the food eaten is outside the healthy food list, is the goal. Following the eating strategy at 70% level will not bring 70% of the health benefits, unfortunately. Furthermore, there is a major difference between 80% adherence and 90% adherence, when it comes to weight loss and health improvement. Ninety percent adherence is an ambitious goal, but that's what it takes to get it right. All the guesswork and complexity has been eliminated for the individual user--just learn to stick to the food list at the 90% level and everything else will fall into place.

A prominent feature of my favored eating strategy is that it is very critical of starchy foods. When I say starchy foods I'm referring to breads, rice, pasta, cereal, grains, white potatoes, foods made from flour, etc. The body turns starch to sugar, and this stimulates hunger and appetite, and spikes the blood sugar in people with diabetes or insulin resistance. Starchy foods usually have a high caloric density, and they often serve as a vehicle for fat (for example, a roll with butter, French fries, mashed potatoes with gravy, etc.).

Another prominent feature is that it aims to reduce saturated fat, which worsens insulin resistance. For this reason I encourage poultry breast instead of the dark meat, and discourage red meat unless it is 95% lean or leaner. Even 95% lean means about a third of the calories are coming from fat. Dairy products should be fat-free or 1% fat, and small amounts of low-fat cheese are allowed. Egg yolks can be eaten in moderation, aiming for more whites than yolks. Fish and shellfish are encouraged, since they contain healthy fat, and generally help with weight loss.

I am liberal with fruit, despite the fact that it has natural sugars. I have found that in the case of this particular eating strategy, fruit helps with weight loss and dietary adherence, and I rarely have to limit fruit to get excellent control of the blood sugar levels. If we're desperate to push the A1c lower after getting as much weight loss as possible, we sometimes limit the amounts or types of fruit, but even then it can be counterproductive or produce little marginal benefit. Fruit turns out to be crucially important.

"Borderline foods" have both starch and fiber, so they have mixed effects. Foods like sweet potatoes, corn, popcorn, oatmeal, whole grains, high-fiber cereals, bananas, and legumes (lentils, kidney beans, etc.) are moderate to high in glycemic load, but have other nutritional properties that are favorable, including fiber, therefore those of us aiming for a "moderate-carb" eating strategy usually have mixed feelings about these foods and there is lack of consensus about how to handle these foods. If we allow all the borderline foods it seems to be too liberal, but if we exclude all the borderline foods it seems to strict, therefore we draw some kind of arbitrary line that allows some but not others. My rule of thumb is if it is a vegetable or fruit, then I allow it, and if it is a grain then I do not. Bananas, sweet potatoes, corn (as a vegetable), and legumes are "in", while oatmeal, whole grains, corn (when ground for flour), popcorn, and high-fiber cereals are "out". Chemically and nutritionally these foods have fairly similar properties, but philosophically they differ because fruits and vegetables have always been mainstays of the natural human diet, while grains are relative newcomers. The line is fairly arbitrary, but that is how and why I draw the line as I do. Sticking to a clear rule is even more important than the specifics of the rule in this case.

I allow low-fat dairy products even though they are not part of the natural human diet for adults. The nutritional profile of fat-free or very low fat dairy products is favorable enough, given the low caloric density, glycemic load, low saturated fat, and high protein and calcium content.

The eating strategy is low in sodium. Most sodium is used to flavor starchy foods, and does not necessarily correspond to how "salty" a particular food tastes. Following this eating strategy automatically reduces sodium without having to pay special attention to sodium and salt.

I encourage people to use their appetites as a guide. I do not limit food portions (with a few exceptions) or meal timing. Foods that are on the approved list can generally be eaten in any reasonable amount at any time of day. Because the eating strategy minimizes appetite-stimulating foods, hunger goes way down, and because the food is low in caloric density the daily caloric intake goes way down as well. People eat much fewer calories without hunger, and that is the key to achieving substantial weight loss. Learning how to stick to it for the long-term is the key to maintaining substantial weight loss "forever".

Below is a list of food types that I usually encourage, and a list of food types that I consider unfavorable, and to be minimized (considered to be "treats").

Favorable Foods

• Vegetables (any vegetable except white potatoes). Fresh, frozen, canned are all fine.
• Legumes (lentils, kidney beans, etc.) Dried and canned are fine. Limit hummus to ¼ cup per day.
• Soups made from vegetables, legumes, and/or other foods on the favorable food list.
• Fruits (fresh, frozen, canned are all fine. Drain juice from canned fruit, limit dried fruit to ¼ cup/day).
• Fish and shellfish (not deep-fried)
• Poultry breast (avoid dark meat, ground poultry must be breast meat only)
• Eggs (eat more whites than yolks, omega 3 enriched yolks are best)
• Lean meats (95% lean or leaner)
• Soy foods (such as veggie burgers, tofu, etc., limit low-fat soy milk to 1 cup per day)
• Milk (skim or 1% only, limit up to 2 cups per day)
• Cottage cheese, fat free or 1%
• Yogurt, plain or "light" only (Greek style plain non-fat yogurt is preferable)
• Non-fat cheese, or low-fat cheese (limit to 1 ounce low-fat cheese per day)
• Non-caloric beverages (up to 10 calories per 8-ounces)
• "Diet desserts" with no added sugar, up to 100 calories per day (diet jello, diet pudding, etc.)
• Protein powder (example: Designer Whey)
• Condiments and salad dressings (up to 50 calories per tablespoon, limit 2 tablespoons)
• Vegetable oil, nuts, peanut butter, and seeds limit 2 tablespoons per day

Foods to minimize or avoid

• Starchy foods and grains (flour, bread, cereals, all rice, all pasta, all grains, pizza crust, popcorn, etc.)
• Full-fat cheese, cream, butter, and other dairy products
• Fatty meats (less than 95% lean)
• Foods with added sugar (canned fruit ok if juice is drained, condiments ok if less than 50 cal/tbsp.)
• Margarine, unless no trans fats or partially hydrogenated oil (limit 1 tablespoon per day)
• Juice
• Alcohol

Next time I will discuss general approaches to breakfast, lunch, dinner, and snacks.

- Michael Dansinger, MD

Read the entire series:

1. "Natural Food" versus "Modern Food"
2. A Spectrum Of Options
3. The Tufts Popular Diet Trial
4. Dating the Diets
5. Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal
6. Dr. Dansinger's Eating Strategy for Diabetes Reversal
7. Sample Meals

Related Topics:

• Type 2 Diabetes Message Board with Michael Dansinger, MD
• Get the Diabetes Newsletter in your inbox

Eating for Diabetes Reversal: Part 5

Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal

Ready to take your diabetes reversal nutrition knowledge to new heights of sophistication? Hold on to your hats, we're about to take off!!

Different eating strategies work for diabetes reversal by reducing "Caloric Density", "Glycemic Load" and/or "Saturated Fat". Let's see why these three concepts are so important to understanding diabetes reversal.

Caloric density, as many already know, refers to how many calories are packed into a given amount of food, and allows us to compare different foods. What has more calories--an ounce of carrots or an ounce of hot fudge? Obviously the hot fudge! The caloric density of hot fudge is greater than the caloric density of carrots. It doesn't matter whether we're comparing a tablespoon of each, or a pound of each, as long as the amount of food we're comparing is the same, the hot fudge will always have more calories because it has a high caloric density.

When considering whether a particular eating strategy will be good for achieving and maintaining a healthy body weight, it stands to reason that foods with a low caloric density, with few calories per ounce of food, should be favorable. Indeed, the average caloric density of any particular eating strategy is a very important consideration. There are charts and books that indicate and rank the caloric density of common foods. For example, Volumetrics by Dr. Barbara Rolls, provides such information and uses it as the basis for an entire eating strategy designed to minimize caloric density as a means to weight loss. The idea is to fill up on foods that are low in calories - vegetables, most fruits, low-fat proteins, low-fat dairy, soups, etc. Foods that are high in fat, high in sugar, and low in water content, tend to be higher in caloric density - fatty meats, oils, fried foods, nuts, olives, avocados, crackers, regular cheese, etc.

In fact, a major criticism against the modern human diet is that it is much too high in caloric density, and this has fueled the obesity and diabetes epidemics.

Almost all eating strategies aim to keep caloric density low, however that is not the only major consideration when it comes to effective eating strategies.

This is where glycemic load comes in. Glycemic load reflects the blood sugar raising effects of a given amount of food. Which food raises blood sugar levels more--an ounce of carrots or an ounce of hot fudge? Again, the hot fudge is the culprit! An ounce20of hot fudge raises blood sugar much more than an ounce of carrots does. The glycemic load mainly reflects the total amount of carbohydrate in a defined amount of food. It stands to reason that a good strategy for keeping the blood sugar low should be to keep the glycemic load of the eating strategy low. This generally means keeping the total number of carbohydrate grams low, but it also means choosing foods that are less processed, are higher in fiber, and do not have added sugar. For example, an ounce of white rice raises the blood sugar a bit more than an ounce of brown rice. When the fiber coating of grains, or the fibrous membranes of fruits and vegetables are disrupted or removed, the glycemic load of the food increases because the sugar and/or starch in the food is more rapidly digested and absorbed into the blood, causing a greater blood sugar elevation than when the food is digested more slowly.

Foods with high glycemic load not only raise blood sugar--they are appetite stimulants! The greater the glycemic load, the greater the appetite stimulation. This is not readily apparent to most people. After all, high carb foods like bagels, pasta, and rice seem filling when you eat them, but what many fail to realize is they can make you hungry later in the day or the next day.

Interestingly, some foods are high in caloric density, but low in glycemic load, while other foods are low in caloric density and high in glycemic load, and that's where things start to get complicated. For example, bacon and other fatty meats are typically high in caloric density, but low in glycemic load. Same story for cheese, vegetable oils, avocados, olives, and nuts. On the other hand, lentils, beans (kidney, garbanzo, etc.) bananas, pineapple, oatmeal, brown rice, etc. are low to moderate in caloric density, but high in glycemic load. Experts often have mixed opinions on the role for these foods in eating strategy design.

To make matters more complicated, the blood-sugar raising effects of a certain food is affected by the presence of saturated fat and trans fat. Saturated fat is found primarily in red meat, poultry, dairy, and tropical oils (coconut oil, palm oil, cocoa butter). These fats, especially from meat and dairy, worsen insulin resistance on the day they're eaten. Ice cream, cheese, whole milk, cream, hamburger, bacon, salami, etc. have enough saturated fat to significantly prolong the amount of time a high-glycemic food will raise the blood sugar.

When someone with type 2 diabetes or insulin resistance eats ice cream, the sugar in the ice cream causes the blood sugar (glucose) levels to soar, and the saturate fat in the ice cream exacerbates the pre-existing insulin resistance, thereby hindering the insulin from getting glucose into muscles and organs where it belongs. The glucose levels stay up even longer than usual! The combination of high glycemic load and saturated fat is especially unfavorable for diabetes and blood sugar control. A double whammy!

In principle, an eating strategy that is low in caloric density can work well for weight loss and diabetes reversal, but the effectiveness might be limited if the food is high in glycemic load. Appetite might be stimulated, but the food is so low in calories, and so high in fiber, that appetite stimulation does not result in a significant problem. Similarly, high glycemic load can increase blood sugar levels in the short-term, but the weight loss offsets any short-term worsening in glucose levels. The Ornish diet works this way.

On the other hand, in theory an eating strategy that is very low in glycemic load can work well for weight loss and diabetes reversal, but the effectiveness might be limited if the food is high in caloric density and saturated fat. The foods might be high in calories, but there is little appetite stimulation or excess hunger, and the total daily caloric intake can go down, leading to weight loss. Saturated fat intake might be high, but there is little opportunity for prolonged glucose spikes, with such low glycemic load. In theory, the weight loss can offset any ill effects that saturated fat would cause under more typical situations with a higher carbohydrate intake.

So, in theory, the ideal eating strategy for good health would be low in caloric density, low in glycemic load, high in fiber, and low in saturated fat. These differences characterize the differences between the "Natural Human Diet" and "Modern Human Diet" I discussed in Part 1 of "Eating for Diabetes Reversal"

Unfortunately, the theoretically ideal eating strategy does not usually work in actual practice because it is too strict for most people. They just can't stick to it and figure out how to make it work under real world conditions. Again, the problem comes down to adherence. The more ambitious the eating strategy, the lower the adherence level, and the less effective it becomes!

My job is to help motivated people to master an eating and exercise strategy that will help them achieve and maintain diabetes remission, or get as close to it as possible. Not just in theory, but in actual practice!

How do I do it? I'm excited to share the specifics of my basic eating strategy next time!

- Michael Dansinger, MD

Read the entire series:

1. "Natural Food" versus "Modern Food"
2. A Spectrum Of Options
3. The Tufts Popular Diet Trial
4. Dating the Diets
5. Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal
6. Dr. Dansinger's Eating Strategy for Diabetes Reversal
7. Sample Meals

Related Topics:

• Type 2 Diabetes Message Board with Michael Dansinger, MD
• Get the Diabetes Newsletter in your inbox

Eating for Diabetes Reversal: Part 4

Dating the Diets

Reversing diabetes is all about backpedaling away from modern human diet and getting enough exercise. There is a whole spectrum of options for backing away from the modern human diet, and the scientific evidence that has accumulated over the past 5 years demonstrates that dietary adherence level, rather than diet type, is the key predictor of the amount of weight loss and improvements in heart disease and diabetes risk factors.

All the diets we compared in the Tufts Popular Diet Trial (see Eating for Diabetes Reversal Part 3) reduced caloric intake, and that appears to be the main determinant of weight loss. The Atkins diet is not all about eating low calorie food however. Butter, mayonnaise, cheese, fatty meats, and many other high-calorie foods are allowed and were eaten by study participants, with no direct focus on reducing food amounts or daily caloric intake. How did they lose weight? Food records indicated they lost weigh by eating fewer calories (indirect calorie reduction). Our study was not designed to verify or exclude the possibility of a "metabolic advantage" (increased metabolism) caused by eliminating carbohydrates, however as best as I can tell, the Atkins diet results in a reduced caloric intake by reducing hunger and appetite. Fat and protein reduce hunger, while starch and sugar increase hunger, due to the effects of these foods on hormones and other signals to the appetite center of the brain. Furthermore, the foods are high in saturated fat and cholesterol, yet the expected worsening of cholesterol levels in the blood is offset by the weight loss that occurs. In fact, the Atkins diet improved cholesterol ratios as well as any other eating strategy, mainly by increasing good (HDL) cholesterol without increasing bad (LDL) cholesterol. In people with high blood pressure, prediabetes, or diabetes, the Atkins diet did a nice job improving those problems too. Unfortunately, we were unable to assess the effect of any of the diets on heart attack rates, so it is possible that the Atkins diet worsens the risk of heart attacks, even though all the blood tests and other measurements suggest otherwise.

On the other hand, the Ornish low-fat vegetarian diet reduced caloric intake directly because the food people were eating was low in calories. They ate plenty of food, but the daily caloric intake was low. Again, the more closely someone followed the Ornish diet, the lower the daily calorie intake, and the greater the weight loss. The greater the weight loss, the greater the reduction in heart disease and diabetes risk factors. Even though the Ornish diet is high in whole grains and therefore starch, the weight loss offsets any rise in blood sugar or insulin that might have been expected. The cholesterol ratios improved, mainly by decreasing the bad (LDL) cholesterol without increasing the good (HDL) cholesterol. Dr. Ornish has demonstrated that high adherence to his diet can reduce blockages in the heart arteries, and reduce heart attack rates. This does not prove that his diet would reduce heart attacks better than other diets in a fair head-to-head trial in which all participants were highly adherent to the diets.

The other diets, like Zone and Weight Watchers appear to benefit from both the direct, and indirect approach to calorie reduction. They reduce starch and sugar, resulting in less hunger, and they reduce the caloric density of the food, thus resulting in direct caloric reduction. Similarly, they improve body weight and risk factors for diabetes and heart disease in parallel to dietary adherence level.

To those who say one diet is best for everyone, I say that is like saying one color of the rainbow is best, or one type of music is best. Individuals may have favorites, but that is different from saying one is best for everyone. Similarly, those who say a particular diet is bad (or worst) for people, are not being open-minded or basing their opinions on the scientific evidence we have to date. Sadly, the Atkins diet was unfairly dismissed many decades ago, and had the authorities been open to testing this diet in the 1970’s, we could have known then what we know now.

I welcomed the news that there are many options available. Some might say this adds confusion and "too many choices" but I reject that concern. I know many people who have failed the classical mainstream approach to weight loss, but found long-term success on less mainstream approaches.

"How do I find the right eating strategy for me?" My answer is "Dating the Diets". There are hundreds of diet books out there, each a little different from the others. Many fish in the sea. A cover for every pot. Go find yours! I have often said looking for the right eating strategy is like looking for a life partner. You might have to kiss a few frogs along the way, but that is a small price to pay for finding your soul mate – your long-term match. Your true love to which you can remain faithful forever. Some may prefer to play the field and just switch from plan to plan, which also works. They all cut calories, so as long as you switch plans without any significant time spent "off plan" you can maintain or extend your weight loss or health goals.

In an attempt to take advantage of these new insights (about 6 years ago), I directed a medical program devoted to offering about a dozen different eating strategies to my patients. After getting to know each patient’s medical situation, lifestyle, and food preferences, I would help them choose from a "menu" of eating plan options ranging from very low carb to very low fat, and everything in between. We had small groups available for each eating plan, and it was a lot of fun for me to lead so many kinds of groups. Some patients did switch between groups sometimes, although most preferred to remain devoted to their one particular favorite.

So to sum up so far, there are many eating strategies that work, but only if you can find one you can stick to. For too may people, that challenge remains unmet.

I wish there was some kind of pill I could prescribe that caused high adherence levels – because that pill would produce diabetes reversal!

Talk with others about Taking Your Diet on a Date on Dr Dansinger's message board.

- Michael Dansinger, MD

Read the entire series:

1. "Natural Food" versus "Modern Food"
2. A Spectrum Of Options
3. The Tufts Popular Diet Trial
4. Dating the Diets
5. Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal
6. Dr. Dansinger's Eating Strategy for Diabetes Reversal
7. Sample Meals

Related Topics:

• Type 2 Diabetes Message Board with Michael Dansinger, MD
• Get the Diabetes Newsletter in your inbox