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

Eating for Diabetes Reversal: Part 3

The Tufts Popular Diet Trial

About 10 years ago, during the summer of 1999, the Atkins diet was starting to catch on like wild fire. I first learned about it from another doctor. We were out to dinner with friends, and he ordered a bacon cheeseburger without the bun and a side dish of buttered vegetables. I was flabbergasted by such an odd choice, and dumbfounded when he explained he was eating this way to lose weight! "You can't lose weight on a high fat diet" I insisted, but his wife backed up his ludicrous claim that the pounds were melting off week by week on this crazy diet. This doctor friend encouraged me to read Dr. Atkins' New Diet Revolution so I could understand the scientific rationale, and I came to understand Dr. Atkins' hypothesis: in the absence of carbohydrates, the body is forced to use its own fat for fuel, resulting in weight loss and reduction in heart disease and diabetes risk factors. The Atkins diet is the prototype for an entire category of popular diets I refer to as "Low-Carb" diets.

At the same time, the Zone diet, by Barry Sears PhD., was also becoming increasingly popular. He too hypothesized that the modern diet was too high in refined carbohydrates, and should be more like the natural human diet. He proposed using food like a powerful drug to keep insulin levels in the optimal range – or zone – by eating 40% of calories as carbohydrate, 30% as fat, and 30% as protein. Like Atkins, he too cited many scientific studies supporting his hypothesis. There were many spin-offs of the Zone diet that became bestsellers, including Sugarbusters! and the Suzanne Somers diet book series. The Zone diet is the prototype for an entire category of popular diets I refer to as "Moderate Carb" diets.

Low carb and moderate carb diets flew in the face of conventional wisdom. The nutrition experts had reached a consensus that fat, especially animal fat, was a major problem in the Western diet. Discouraging excess fat and meat consumption has been (and remains) an important public health goal, and likewise for encouraging whole grain consumption, and these new and unproven "fad diets" were running counter to the public health message. Such diets were mainly viewed as pseudoscientific and largely dismissed and criticized by the authorities. A few scientific papers projected such diets would be harmful, and such diets became easy targets for nutritionists who were eager to bash them in the popular press. Moderation, balance, and variety are the keys to healthy eating and weight control, according to popular wisdom, and the Weight Watchers diet is a prototype for this type of "Moderate Fat" diet.

In addition to the classical moderate fat dietary approach embraced by the mainstream, there has also been a school of thought dedicated to pushing dietary fat very low. In theory it makes a lot of sense to follow a very low fat diet – the food is low in calories, and minimizes artery-clogging saturated fat. Most non-Westernized cultures follow a very low fat diet high in complex carbohydrates and fiber, and their rates of heart disease, obesity, and diabetes have been much lower than in Western cultures. Dean Ornish MD has been the most outspoken expert to advocate for this dietary approach, and his popular diet books on this topic are the prototype for the "Low Fat" cate gory of diets.

So, in late 1999, while I was starting a fellowship training program in medical research at Tufts University and Medical Center in Boston, I sought out the opportunity to work with USDA nutrition scientists to compare the health effects of various eating strategies. I was intrigued and bothered by the large gap between the enormous growing public interest in popular diets, and the absent body of scientific research directly comparing them to one another. As popular press articles about the "Diet Wars" drew the nation deeper into the debate, the importance of conducting a comprehensive research study seemed to grow exponentially, and it was a thrilling opportunity for me to actually design and conduct a research study that some might call a popular diet "smack down".

With the help of my research mentors Ernst Schaefer MD, and Harry Selker MD of Tufts University/Tufts Medical Center, and USDA research dietitian Joi Gleason RD, I was able to recruit 160 overweight or obese men and women to follow either the Atkins, Zone, Weight Watchers, or Ornish diets for a year. We needed to randomly a ssign participants to their study diet, in order to ensure that each diet group was evenly matched at the start. Participants agreed to attend diet training classes during the first 2 months, and to follow their assigned diet to the best of their ability during that time. Participants were then encouraged to follow their diets to whatever extent they wanted during the following 10 months, because we wanted to determine how well these diets would work under "real-world" conditions where people only follow the diets voluntarily, rather than being pushed to do so for "study purposes". We measured their dietary intake according to diet records, as well as their weight, blood pressure, cholesterol levels, glucose, insulin, hemoglobin A1c, and C-reactive protein (a measure of artery inflammation) at 0, 2, 6, and 12 months, thus enabling a scientifically valid comparison between the 4 diets at various time points. The study was paid for by the National Institutes of Health, Tufts Medical Center, and the USDA Human Nutrition Research Center at Tufts. No diet book authors were involved in the funding, design, or conduct of the study.

The study took 5 years from conception to publication, and was the lead article in the highly respected Journal of the American Medical As sociation (JAMA) on January 5th, 2005. It received a large amount of media coverage, and was one of the most highly read scientific research articles of the year. See these links for WebMD coverage of the study:

4 Popular Diets Heart Healthy Whether it's Atkins, Ornish, Weight Watchers or Zone, it's the pounds that matter

4 Diets Face Off: Which Is the Winner? The Best Diet: The One You Stick With

In my view, the study results provided the scientific data to support a new way of thinking about "which diet is best?"

In short, it was a 4-way tie between the diets. There was no winner! All 4 diets produced weight loss by reducing daily caloric intake, but most people found it difficult to stick closely to their diets as time went on. Those people who consistently stuck to their assigned diet ate less calories than they did prior to starting the study. They lost weight, and the weight loss produced improvements in their risk factors for heart disease and diabetes. Adherence level, rather than diet type, was the key determinant of weight loss and risk factor reduction. The best diet turns out to be the one you can stick to! This is a whole different mindset and viewpoint than the previous view, that the classical approach should be best for everyone. In the 5 years since I published the Tufts Popular Diet Trial, many other studies have been published that confirm and strengthen the validity of our findings and this new viewpoint.

I'm eager to hear your comments about the findings I describe above. Stay tuned for the implications and applications of these findings to the field of 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