Email a Friend
Print Article
Eating For Diabetes Reversal: Part 6
Dr. Dansinger's Eating Strategy for Diabetes Reversal
So far we've discussed the following principles:
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
Foods to minimize or avoid
Next time I will discuss general approaches to breakfast, lunch, dinner, and snacks.
- Michael Dansinger, MD
Read the entire series:
Related Topics:
So far we've discussed the following principles:
- The natural human diet has been distorted beyond the nutritional breaking point by modern technology.
- 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..
- There are many ways to backpedal away from the modern human diet.
- 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.
- Glycemic load reduction helps reduce hunger resulting in decreased caloric intake and weight loss.
- Caloric density reduction helps reduce caloric intake resulting in weight loss.
- Saturated fat reduction helps reduce insulin resistance and the duration of glucose spikes.
- Loss of excess body fat is a potent tool for combating type 2 diabetes.
- I define type 2 diabetes remission as hemoglobin A1c of 6.0 or less without diabetes medication for at least 2 months.
- 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:
- "Natural Food" versus "Modern Food"
- A Spectrum Of Options
- The Tufts Popular Diet Trial
- Dating the Diets
- Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal
- Dr. Dansinger's Eating Strategy for Diabetes Reversal
- Sample Meals
Related Topics:
17 Comments:
your articles are always informative.It educates me about different vistas of life.I always wait for an articlefrom you sir.Thanx for providing us such information.Thank u again.
Thank you for sendind such an informative message.
please tell me more about type 2 diabetes.
I'll look forward for your feedback.
thanks again
Great article on diabetes. Not many physicians speak about diabetic remission. My personal condition with adult onset diabetes has gone from a worrisome problem to one that is manageable.This was realized in about 18 months through healthy diet choices and an exercise regime very much similar to the recommendations the doctor suggests. I am male, 55 years old and my most recent A1C was 5.5 after losing 30 lbs. The doctor's adherence level strategy is "right on".
However, on diet, I include whole grains and high-fiber cereals as recommended by a diabetic nutritionalist. Right or wrong?
Further comments on that would be appreciated. It is not at all easy to conquer diabetes but the more knowledge, the better.
Thanks! you articlesare very informative and suggestions are easy to follow. i keep waiting for your informative articles.
Thank you for reading my blog and posting your comments and questions.
Regarding whole grains, I realize my criticisms of whole grains go "against the grain" of the standard advice, however this has been a very successful approach for those patients who adhere to this method. Once a patient reaches the target weight or A1c level, we often add small amounts of whole grains to see how much they can "get away with" before the weight or A1c climbs too much. Many can eat one serving of whole grains daily after reaching the maintenance stage.
Michael Dansinger, MD
I was diagnosed as pre-diabetic about 1.5 years ago. I restricted they types of food I was eating, and restricted my calories, a lot. I went from 220 pounds, to 128 pounds in about a year. I began having issues with my blood sugar again about 4 months ago, and was diagnosed with type 2. I can't seem to get it back under complete controll even with meds. I am going to go by your guidelines as much as is possible for me, I am weak from time to time. What about dreamfield pasta? What are your recomendations on it? I have eaten it some, and had favorable results. I love pasta so that part is especially difficult for me. Thank you, Yours in health, A. Walker
Good response.
I have been staying with the whole grains and now have gained unwanted weight and suspect the next A1C will be up. I am going to reduce that portion of my diet. Finding what works and adhereing to that method takes work but, it is all about our health so it is worth the effort.
On exercise, I stick to a strict program and would welcome the doctor's comments on the combination of diet and exercise.
What about the effects of this diet and ketosis? I am newly diagnosed (my tests show somewhere between pre and the real thing T2) and am following a very low carb diet using the recommendations here. My fasting blood glucose is around 100and I checked myself after dinner last night - I was 106. I do have some ketostix and I have been runing in the middle to high range. Should I just not worry about ketosis or add some carbs in?
Please Dr Dansinger help me out.
Am I damaging something else for the sake of the blood glucose?
I have lost 1 1/2 pounds already. Is the goal of the diet to lose weight or to control sugars now?
The goal should be to remove insulin resistance and leptin resistance, and the blood sugar and weight would automatically fall in place.
Eliminate nutritional deficiency, reduce inflammation, create a low sugar and low insulin environment in your body (by eating food that have low glycemic load), and exercise a lot (balance of aerobic, flexibility and weights). Building muscle is crucial. One hour per day of exercise is mandatory, and you should be sweating profusely at the end of the exercise session. There are no alternatives of substitutes to exercise if you want to reverse type 2 diabetes.
Use extra-virgin olive oil, or canola oil, or groundnut oil for cooking. Include steamed broccoli or spinach with 2 tablespoons of extra-virgin olive oil in your breakfast. Drink raw vegetable juices, especially of brussels sprout.
A daily supplement of Chromium Picolinate 200 mcg is mandatory to make the existing insulin work better.
Take supplements of Vitamins B, C & D. Drink lots of low fat milk or alternatively take Calcium supplements.
Snack a lot of walnuts, almonds, flaxseeds, dried figs and dried apricots.
Eat 4 different fruits a day (apple has to be one of them). Avocados are beneficial.
If you have developed peripheral neuropathy or any eye or kidney ailment due to the high blood sugar levels, take Ginkgo biloba supplements (40 mg daily), to open up the small capillaries.
Type 2 diabetes is conquerable. It is not a disease, but just a self inflicted condition due to an unhealthy lifestyle and lack of knowledge. Diabetic medications make the condition worst and must be weaned off by changing eating habits, nutritional supplements and exercise.
Twitter realtime Diabetes + Diabetic search feed for real people http://diabetics.tk DIABETICS.TK
I have read that buckwheat lowers the blood sugar. Is this grain acceptable for use in your diet regimen for type 2? Is it an exception to the ruleof no grains?
I came across this enlightening article about the engineering science perspective on type 2 diabetes, at this blog:
http://www.deathtodiabetes.blogspot.com/
Engineering Science Perspective
Now, in engineering, we take a slightly different view of "disease" in machines -- we focus on what's actually causing the machine failure, and we use various engineering methodologies to analyze and determine the root causes.
Also, from an engineering perspective, we frame "the problem" a little differently than medical science. Why? Because we realize that the first critical step in solving a problem is to carefully define the problem. If you do not define the problem, you cannot solve the problem -- end of story.
So, from an engineering perspective, the problem is "a human body is defective, it's broken, it has a disease called "Type 2 diabetes".
From an engineering perspective, we "see" the disease a little differently. Instead of characterizing Type 2 diabetes as a "blood sugar" disease, we see it as a disease of cellular damage -- defective cells. So, from our viewpoint, the question is very simple: "Can the cellular damage be repaired? Can the defective cells be fixed?"
Because we love detail, we took a deeper look at the cellular damage, and discovered (from all the excellent medical research and clinical studies) that a specific portion of the cells were damaged -- namely, the insulin cell receptors that recognize insulin and allow glucose to be pulled into the cells from the bloodstream.
Because these receptors are damaged, the cells can't pull in glucose from the bloodstream. So, how do we repair these receptors?
Well, since cells are made up of water, protein, fat, and saccharides, what if we provided these cells better raw materials? What if we provided these damaged cells the best proteins? the best fats? the best water? the best saccharides? Would that help? Well, it couldn't hurt!
We also took a look at the blood, and discovered that most if not all Type 2 diabetics are deficient in several key nutrients, e.g. Omega-3s, magnesium, Vitamin C, Vitamin E, CoQ10, water, amino acids, etc. In other words, the cells are suffering from a nutritional starvation.
There are thousands of studies that demonstrate the healing powers of food such as vegetables, greens, fish, legumes and plant oils, and filtered water. Interestingly, a diabetic's body is fighting inflammation, oxidative stress, and toxicity. Drugs actually cause more inflammation, oxidative stress, and toxicity, so it's clear why most diabetics can't improve their health. The good news is that certain whole foods such as broccoli, red peppers, garlic, onion and extra virgin olive oil actually fight and prevent inflammation, oxidative stress, and toxicity!
So ... if you provide the diabetic's body with these missing nutrients, is it possible that he/she can get well?
It depends upon how many years the diabetic's body has been breaking down and rotting from the inside and the overall health state of the diabetic's body. More important is the attitude of the diabetic -- if the diabetic is willing to make changes, he/she has a fighting chance.
So, how do you know the diabetic's health is improving?
From an engineering perspective, we look at a comprehensive set of data, not just blood glucose levels. We believe that the diabetic's body must improve in several critical areas, including fasting blood glucose, post-meal blood glucose, stress-test blood glucose, insulin level, blood pressure, hemoglobin A1C, weight/waist line, body composition, lipid profile (blood cholesterol), energy level, and emotional stability.
The goal in diabetes, (I have been a type one for close to 35 years),is to get excess sugar off the red blood cells. The other goal is to avoid starch if at all possible.
The old rule was that we used to need starch to offset the protein
when metabolising because you also
have to be careful of to much protien in the urine. The kidneys
play a huge role in diabetes. I would say for all type 1 Diabetics to ask if the Dr. can help you with a carb counting diet and get
the formula you need to match the
fast acting insulin with the number
of carbs per meal which allows you to factor in a very moderate amount of the right carbs with the protein and adjust the insulin with what you plan to eat rather than letting the diabetes control you, you will control the diabetis and keep your sugars down around 90-100. If you can also add in exercise for at least a half hour a day you may be able to reduce the insulin dose by up to 2 units per meal depending on the formula
that has been set by the Dr. Everybody is different but for me, 1 hour on the treadmill takes off
at least 2 units of humalog at the next meal. It is amazing how the body reacts to the exercise. For me, for example, if I have 60 carbs
in a meal, 1 unit of Humalog = 20 carbs and 20 goes into 60 3times,that would be 3 units. If I chose to get on the treadmill or other major activity, for each half hour, my units of insulin can be reduced by 1 which means 1 hour would reduce my mealtime insulin to 1 unit. 1 unit is a very low number but it does have an affect.These are the reasons I think carbs have a purpose because they are needed, just eat the right ones and have some protein
in moderation for sure. I like the list of food provided in the article. Diabetes is a challange
every single day and yes the body can go in a bad direction if the Diabetes is ignored. Make sure and test the sugar often and see the Dr. every 3 months to get the A1C
and if it is difficult to grip it,
get a referal to see an endocrine Dr. if the primary Dr. has not sent you to a specialist yet. For
the type 2s out there, keep the diets and exercise going and if the
Dr. decides to start you on insulin, do not worry because when
on insulin, you are the one in control and I have heard from other type 2s that when they started on insulin they felt tons better than when they had sugars
up over 180-240 most of the time.
Everybodys case is different,just thought I would share my story.
please check with your Dr.to get the best recommendations for your
individual situations. Good luck everybody!
Through trial & error during the first year after I was diagnosed as T2, I ended up eating low glycemic and low fat as these foods did not spike my blood sugar. All my numbers are excellent and my last A1C was 5.8 I'm never hungry but I just don't lose weight. I have a circulation problem that keeps me from exercising and that seems to be the problem. I stick with it even though I've only lost 10 lbs in 7 months as it's very satisfying and I've never felt better in my life. Thanks for the information.
please dr is bread made from wheat and no suggar good for T1diabetes.
please dr, is bread made from whaet and no sugar good for diabetes patiant
I have read and thoroughly enjoyed your series of articles. You mention, however, that there will be a "Part 7" regarding sample menus for breakfast, lunch and dinner. That would be very helpful. I find that non-egg based breakfasts are my most difficult challenge (I know we can eat eggs/whites, I am just tired of them right now). Any imaginitive menu ideas would be welcome indeed!
Post a Comment