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Conquering Diabetes

with Michael Dansinger, MD

Michael Dansinger, MD is here to provide hope, inspiration, and knowledge for people with type 2 diabetes or prediabetes who want to conquer their disease and reclaim their health.

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Tuesday, August 25, 2009

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

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Posted by: Michael Dansinger, MD at 11:03 am

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