Eating for Diabetes Reversal: Part 2

A Spectrum Of Options

I have proposed that the "Modern Human Diet" has reached the nutritional breaking point, as a result of excess deviation from the "Natural Human Diet", an unintended consequence of modern technology.

The diabetes, obesity, and heart disease caused by modern food is a result of the way it has been altered by modern technology. Problems include high caloric density, excess unhealthy saturated fat in meat and dairy, low fiber, high glycemic load, high added sugar, trans fats, and the list goes on.

There is general agreement that we are NOT going back to eating mostly wild food like hunter-gatherers, but there has been considerable debate about how to eat in order to avoid the nutritional breaking point caused by the modern diet.

Put another way, the modern diet differs from the natural diet in many ways, and therefore there are many potential directions in which to backpedal away from the nutritional breaking point.

Anyone who has spent any time looking at the "Diet Books" section of the bookstore or library has noticed there are hundreds of different perspectives on how to eat for good health. Most, if not all, argue that the modern diet is problematic, and that their strategy will work well for disease prevention or recovery if followed. Sometimes the authors claim their strategy is best, and that other strategies are flawed. Some focus on diabetes, others focus on weight loss in general, and others focus on other conditions.

I refer to this phenomenon as the "Popular Diet Spectrum", because, with few exceptions, the eating strategies proposed by these popular diet books fall neatly along a nutritional spectrum ranging from very low in carbohydrate to very high in carbohydrate (or very low in fat to very high in fat). Also with few exceptions, authors provide "science-based" rationales for why their eating strategy will work well to reverse or prevent disease, and these rationales are reasonable and plausible. In a few cases, the rationales are clearly pseudoscientific meaning just plain incorrect (or incompatible with current knowledge), but even in these cases the eating strategy may work well, for reasons other than what the authors propose.

Although the diets fall along a continuous spectrum, I believe it is useful to categorize the popular diet strategies into 4 types. I call them low-carb, moderate carb, moderate fat, and low fat. Each has strengths and weaknesses, and each can work for diabetes reversal, in large part because they all reduce daily caloric intake and produce weight loss.

I'm happy to report that the past 5 years of scientific research has dramatically improved our medical knowledge of popular diets and various eating strategies.

In January 2005, my research group published a research study comparing the effects of four popular diets (Atkins, Zone, Weight Watchers, and Ornish vegetarian) on weight loss and heart disease risk factor reduction, and it is a privilege for me to share the results of this study with you.

Which eating strategies work best for diabetes reversal? Stay tuned for Part 3 of "Eating for Diabetes Reversal"

- 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 1

"Natural Food" versus "Modern Food"

What will be the top global threats during the next century? I nominate climate change, terrorism, and the diabetes/obesity epidemic caused largely by modern food.

Yes, modern food, the majority of the foods in our grocery stores, and most meals in our restaurants, are the top cause of skyrocketing diabetes and obesity rates, in my view. Reductions in exercise over the past century are also to blame, but the doubling, tripling, and quadrupling of type 2 diabetes rates we're seeing and anticipating around the world is mostly due to the radical change in what the human population eats. Human food has morphed so severely, due to food processing technology that caters to our love for sweet, starch, and fat, that our species is chronically ill everywhere modern food is found. We're eating ourselves to death!

Most of what we eat is so far removed from the natural wild food our prehistoric ancestors ate – so much lower in fiber content, so much higher in caloric density, so much higher in sugar and starch content, so much higher in saturated fat content, so much lower in omega 3 fats, and so different in so many other ways – that our bodies become chronically ill after decades of such nutritional abuse.

To put our species' current nutritional situation into context, consider the following perspective. For the first 99% of human existence, for 2 million years, humans have been eating a combination of lean protein and high-fiber fruits and vegetables derived from wild natural plants and animals. I'll refer to this as the "Natural Human Diet". We are genetically designed, through millions of years of evolution, to thrive on these foods. But when our eating became too different from the "natural human diet" KABOOM! Heart disease epidemic! Obesity epidemic! Diabetes epidemic!

For most of human existence, our beloved tastes (or cravings) for fat and sweet were crucial for survival. We've been genetically designed to conserve calories, store excess calories as body fat, and rest whenever possible, because we are genetically designed to survive in the wild, natural world. Our genes are the same as they were when we all lived outdoors and ate wild food. Ironically, these genetic traits that once favored our survival are the same traits that favor poor health in today's modern environment!

Our initial departure away from the "natural human diet" started about 10,000 years (500 generations) ago, with the advent of primitive farming. This period of time may seem long to some folks, but in terms of human genetic evolution, this is a very short time. Not long enough to produce major genetic changes in the human population, meaning we are the same, genetically speaking, as people who lived hundreds of thousands of years before farming was invented.

Interestingly, our gradually increasing departure away from the natural human diet (and toward a grain-based society afforded by the agricultural revolution) did not lead us to the nutritional breaking point until recent decades. This raises the question: "If we're genetically designed to eat like hunter-gatherers, why have hundreds of generations of humans been able to get away with eating a grain-based diet without the diabetes, obesity, and heart disease epidemics we've seen in the most recent generations?".

Until recent times, the absence of modernization has made a grain-based diet viable. The relative scarcity of food and calories, the less sophisticated grain processing methods, the hard physical work of daily life, and the relatively short human lifespan, all served to mask the cumulative effect of eating starch-based foods throughout life. In my view, modern technology is the culprit that has turned our grain-based diet into the fuel that propels the diabetes, obesity, and heart-disease epidemics. For example, I suspect the sharp rise in type 2 diabetes in China, affecting all age groups, is due to the difference between a rice-based diet in modern versus pre-modern times.

In contrast, human groups who eat primarily wild, natural food t o this day, members of hunter-gatherer societies, do not develop the high rates of heart disease, diabetes, and obesity seen in modern societies. When these people switch to a modern, grain-based diet, modern diseases come fast and furious, and these same diseases reverse in individuals who go back to their traditional hunter-gather routine.

So how should we eat in today's modern world? Stay tuned for Part 2 of "Eating for Diabetes Reversal".

- 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

A Diabetes Reversal Story (Part III)

Editor's Note: Don't miss parts 1 and 2 of Dr. Dansinger's series "A Diabetes Reversal Story."


Developing a new set of family meals proved very challenging. On the first day of the new eating plan, Tom came home from work hungry, but the family dinner his wife had prepared was not flavorful, delicious, or satisfying. He did not show his disappointment at the dinner table. Instead he remained positive and thanked his wife, in front of the children, for her hard work to make dinner for the family. Later, his wife acknowledged that her first attempt fell flat and they brainstormed about some favorite meals she could adapt.

The following night she hit a “homerun” with an outstanding healthy meal that everyone loved. Each week she had more and more hits, and less painful “misses”. She recorded her healthy recipes in20a personal “cookbook” and by 3 months she had 20 winning family meals. She used the cookbooks she already had to find and adapt new recipes and meals. She became faster and more efficient each time she repeated a winning recipe or meal. After 6 months she was comfortable improvising new meals at will. Soups, salads, entrees, and side dishes became second nature to prepare and the whole family came to enjoy the new menu.

In the meantime, Tom and I strategized together to devise a plan to increase his exercise time. He did not think it would be realistic to exercise before work on weekdays. We aimed for weeknights and weekends, 7 hours of exercise each week. He recognized his job was interfering with his availability to get the exercise he needed. We agreed he would leave work one hour earlier each day. He was working 45 hours per week including a 45 minute lunch break daily. He cut his lunch break time to 15 minutes, by bringing a light lunch from home instead of going to the food court at a nearby mall.

Also, as a manager, he recognized he could get his job done more efficiently in less time by managing his employees better and allocating more responsibility to them. By strengthening the leadership skills of his employees he improved the overall productivity of his office while leaving more time to take care of himself physically.

In addition, by leaving the office at 4pm instead of 5pm, he beat some of the evening rush hour traffic which saved an additional 15 minutes off his previous commute. Instead of getting home at 5:45, he was getting home at 4:30. He would join his wife in the kitchen and together they would hive dinner on the table by around 5:15. Tom specialized in soups and salads and his wife focused on the entrée and additional vegetable side dishes.

Each evening at 7:00 Tom would take one of his 3 children to the gym. They would play basketball or walk on the track. The older one became interested in tennis and took lessons one evening each week while Tom lifted weights. They would play tennis together one evening each week as well. By 9:00 Tom returned home with more energy than he left for the gym. He and his wife agreed to set aside the time from 9:30 pm to 10:30 pm as a “husband and wife time” free from errands, chores, or anything other than relaxation or romance. On weekends the whole family would go to the park, gym, or school athletic field to play together or practice sports like soccer, basketball, and softball. In short, Tom was spending more quality time with his family, doing a better job at work, eating much better, getting mu ch more exercise, improving his love life, and serving as a great role model for his family and friends.

At 3 months into the program he had lost 25 pounds, exceeding my prediction by 3 pounds. His A1c dropped from 7.3% to 6.3% by 3 months, and was down to 5.8% by 6 months. By that point he had lost 40 pounds. During the following 1.5 years he maintained a 45-50 pound weight loss and an A1c around 5.6% even after discontinuing the metformin.

His type 2 diabetes has been in remission for nearly two years.

A set routine, finely tuned over many months, has been a crucially important element of his successful maintenance. Maintaining this routine eventually became automatic or “second nature” for him. The main challenge became managing “threats” to his new routine.

Occasionally he did need to stay late at the office. Occasionally he went to parties or other social events with family or friends. Occasionally he would travel for work, or with his family for a vacation. Occasionally he succumbed to tempting unhealthy foods or skipping a workout because he was=2 0not diligent in his planning, or because he was simply tired, hungry, or upset.

I helped him navigate through various “threats” by reassuring him that all successful individuals have tough weeks and slip ups, and what makes them resilient is their ability to get back on the plan quickly and move on. After all, the aim isn’t to be perfect, the aim during the maintenance stage is to find a balance that allows one to live life to the fullest--staying healthy and enjoying what life has to offer without being excessive or overly indulgent.

Over time, with lots of practice, Tom became skilled at anticipating threats to his new lifestyle routine and minimizing the damage. He knew which restaurants were especially favorable for him and his family. He became accustomed to ordering healthy choices from nearly any menu from any cuisine, and consulting with the waiters as needed to get tasty healthy food every time he dined out. He had a stash of “backup meals and snacks” at work and at home, in case he forgot to bring his lunch or in case some other random occurrence or misstep interfered with his usual plan. When a social event with rich food was upcoming, he would eat even more conservatively prior to the event, and for days afterward, so that he could eat more liberally while celebrating and socializing. “Life’s special occasions are to be enjoyed, including indulging in rich food from time to time, but special occasions do not come every week” we reasoned.

I still see Tom monthly. We met weekly for the first 3 months, then every other week throughout the remainder of the first year, then monthly. He still keeps a daily food record and exercises 7 hours per week, including weight lifting 30 minutes 3 times per week. He asks me “why don’t other doctors and patients work together to reverse diabetes like this more often? Why is what I‘ve done so unusual?”

I tell him I’m working to change that and get the word out. Then, I tell him I’m proud of him and I thank him for making my own job such a pleasure.


-- Michael Dansinger, MD

A Diabetes Reversal Story (Part II)

Be sure to read Part 1 here.

Tom was eager to learn more about my approach to diabetes reversal. I explained that 15-20 percent weight loss was usually sufficient to achieve remission of type 2 diabetes, and a 10% weight loss was usually sufficient to reduce the A1c about three-quarters of the way toward remission. In his case a 20% weight loss would be 44 pounds, a reduction from 220 pounds down to 176. He agreed that would be an appealing weight. If he was fortunate, even a 30 pound loss might be enough for remission but we would not know until he got that far. To lose the weight he would obviously have to change his eating and exercise, and to find the right balance between effectiveness and sustainability. Too strict and he would not be able to sustain. Too lax and he would not achieve sufficient weight loss.

I described the approach that worked best for me – 90% dietary adherence plus 7 hours of exercise per week. Up to 10% of the amount of food he ate each week could be "treats" which I consider to be unhealthy food, and the remainder should come from the healthy food list. We went down the list of healthy foods together so I could get a good understanding of his food preferences, and so he could understand what I considered to be healthy. I explained I did not intend to push him to eat any foods he disliked, but wanted him to know all the foods I considered to be healthy and would help him achieve weight loss and diabetes reversal. We spent about 30 minutes discussing the food, and we brainstormed together to identify a few examples of breakfasts, lunches, dinners, and snacks that would probably work for him. He said his wife wanted to help him and was interested in finding new approaches to cooking for the whole family. He explained that 7 hours of exercise would be extremely challenging, given his other obligations and time constraints, and I asked him to spend the next week thinking it over. I also asked him to keep a food record, including food amounts and calories. I explained how to estimate food portions without using measuring cups or a food scale, by comparing the food volume to his palm diameter and thickness (6 ounces) or to his clenched fist (1 cup). I recommended getting a calorie counting book. I explained that patients who follow this plan typically reach weight losses of around 10% in 3 months, and in his case, I predicted such a weight loss of around 22 pounds would drop his A1c from 7.3% to 6.4%. Another 10-20 pounds beyond that, at the 6 to 9 month point, and he'd likely be in remission.

He left the office exuding an optimism that was sorely lacking when we first met. I had encouraged him to simply prepare, psychologically and logistically, during the 7 days until our next appointment. He discussed everything with his wife and she enthusiastically agreed to support his efforts. She read the diet materials I had given him, and she helped him think through some meals he could eat and she could make. She made arrangements to accompany Tom at the next visit.

They told their children about how important it was to keep their bodies healthy by eating the right foods and exercising. That weekend, instead of going to a restaurant for lunch, the family went on a half-hour walk together to the park and had a picnic lunch and walked home. They cleared the kitchen of as much unhealthy food as possible, and filled it with healthy food. Tom and his wife knew their children would complain about not having treats, such as ice cream, every night after dinner, but they both felt strongly that they had to be better role models and start teaching their children that treats that are unhealthy must be reserved for special occasions and not every meal is a special occasion. It would be hard, but they knew their united approach would stick if they remained focused on keeping themselves and their family healthy. They explained to their children that the doctor reminded them how important it is to keep healthy by eating right and exercising, and that everyone in the family would be expected to do their part to set a good example for the others. There would still be treats, but they would have to get used to eating unhealthy food only at special occasions. Most of what they would be eating would be healthy food. The children were not enthusiastic, but they did seem to respect the reasons why and the united front their parents projected.

Will Tom's efforts succeed? Will chaos ensue? Stay tuned next week for the final chapter of "A Diabetes Reversal Story".

—Michael Dansinger, MD

A Diabetes Reversal Story (Part I)

When I met "Tom" he was a 50 year old office manager who was diagnosed with type 2 diabetes two years previously. His diabetes was progressing. He was taking the oral medication metformin at the maximum dose, but his A1c had increased from 6.7% to 7.3% over the previous 6 months and his doctor encouraged him to see me about "lifestyle coaching" as an alternative to adding a second medicine for glucose control.

I wanted to know more about his lifestyle and circumstances and health goals. Tom is a family man. He is a husband and father of 3 school age children. He wanted to to set a good example for his family and he felt his gradually increasing weight was holding him back from being the role model he wanted to be. He was anxious about whether the next few decades would lead to insulin shots or diabetic complications. He didn't say so, but I suspected his expectations for a healthy retirement were very low due to his advancing disease. I learned that he liked most foods and enjoyed cooking. His wife did most of the cooking and grocery shopping, however. He was working 45 hours per week and was too tired after dinner with his family to think about exercise. He would usually watch television with his family until bedtime. On weekends he was involved in family activities. He was pleased that his children were involved in sports teams at school. The whole family would dine out at least twice on weekends, and would also usually gather for a family meal at his mother's on Sunday evenings. His father had died 25 years earlier of a heart attack at age 51. Tom was worried that he might follow in his father's footsteps with an early death due to a heart attack or other diabetes-related complication. He knew how devastating it can be to lose a father too early to a preventable disease, and he was determined to do all he could to avoid such a hardship for his own family. His mother had type 2 diabetes for the previous 10 years, was taking insulin shots, and was occasionally hospitalized with skin infections in her feet and legs as a complication of her diabetes. He worried about her ending up in a nursing home. His younger sister, who lived out of town, was 100 pounds overweight and had prediabetes.

He had been successful at all other aspects of his life. "Why is my health the one exception?" he wondered. He had gained 2 pounds a year since high school, and was now 220 pounds. At 5'10" he was carrying about 50 pounds of excess body fat. He had tried to lose weight a few times before, by eating smaller portions and jogging, but these efforts gave 10 pound weight losses that were hard-earned and unsustainable. He always felt hungry and the exercise seemed like a chore. It took time away from his wife and children and didn't seem worth the effort, for such a "small payoff". Nevertheless, he was more determined than ever to succeed. He explained that he felt "stuck between a rock and a hard place" between the sacrifices required by poor health, versus the sacrifices required to regain his health.

He made a conscious decision that doing whatever it took to achieve the necessary lifestyle changes was a better deal than letting his health deteriorate. He said he knew from past experience that hard work and persistent effort would be necessary, and that he would be faced with temptations to eat poorly and to skip the exercise, but he would work hard to overcome the logistical and psychological barriers that had interfered with past attempts to get healthy. "Tell me what to do and I will do it" he said.

I repeated back to him my understanding of his reasons for regaining his health. I told him I would do everything in my power to help him reverse the diabetes as much as possible, and that we should aim for a full remission of the diabetes, meaning normal blood sugar without medication. He was surprised that I was so optimistic about his chances for remission. He was mainly hoping to avoid a second medication for the diabetes, and the notion that he could get off the metformin was very appealing to him. He already knew that I have a "program" for diabetes reversal, and he wanted to know what was involved.

In the next posting I'll discuss my program for diabetes reversal. In the meantime, how is your own story similar and different from Tom's?

— Michael Dansinger, MD