Conquering Diabetes

Recipe of the Week: Vietnamese Chicken Salad

2009-11-19T13:30:00.006-05:00

Eating for diabetes reversal is all about learning how to make the most of healthy ingredients. I love ethnic recipes, like this one below, because of the exciting flavors and the opportunity to gain familiarity with foreign ingredients.

Find this recipe and hundreds of healthy recipes here.

Vietnamese Chicken Salad

Photo Credit: Michelle Howard

Ingredients:

1 pound boneless chicken breast, or 2 cups cooked, shredded chicken
3 tablespoons freshly squeezed lime juice
2 tablespoons fish sauce
1 tablespoon white vinegar, cider vinegar, or freshly squeezed lime juice
1 tablespoon sugar
1/2 teaspoon black pepper
3/4 cup very thinly sliced onion
2 cups finely shredded green, savoy, or Napa cabbage
3/4 cup shredded carrots
1/2 cup fresh mint leaves, cilantro, or basil leaves
1/2 cup rau ram leaves (available at Asian markets; optional)
3 tablespoons coarsely chopped roasted and salted peanuts (optional)

Preparation:

Put chicken in a medium saucepan and add 2 to 3 cups of water, enough to cover chicken by about 1/2 inch. Bring to rolling boil over medium-high heat, then reduce heat to maintain a lively simmer. Cook until done, 10 to 15 minutes.
Meanwhile, combine lime juice, fish sauce, vinegar, sugar, and pepper in a medium bowl. Stir to dissolve the sugar and mix everything well. Add sliced onion and toss to coat. Set aside for 20 to 30 minutes, until you are ready to complete the dish.
Transfer the meat to a plate to cool, reserving the broth for another use, such as making soup or cooking rice. When the chicken is cool, tear it into long, thin shreds. Coarsely chop the mint and/or herbs. Add the shredded chicken, cabbage, carrots, mint, and herbs to the bowl of onions and seasonings, and toss to coat everything well. Mound the salad on a serving plate, and top with chopped peanuts, if using. Serve at room temperature or chilled.

Yield: 4 to 6 servings

Nutritional Information:
Per serving: (if 4 servings): 206 calories, 29 g protein, 14 g carbohydrate, 3.5 g fat, 1 g saturated fat, 78 mg cholesterol, 2 g fiber, 760 mg sodium. Calories from fat: 15%

Enjoy!

- Michael Dansinger, MD

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Research Study of the Week

2009-11-17T11:00:00.001-05:00

Doctors and scientists know that obesity and type 2 diabetes are strongly related, and we know that losing excess body fat dramatically improves diabetes, but we don't have a confident understanding about how, exactly, obesity causes or promotes type 2 diabetes. Here's some new research evidence that helps me understand a bit more about how excess body fat promotes type 2 diabetes. The bottom line always comes back to "eat right and exercise", but many will find that understanding why that's true can help them stick to it!

- Michael Dansinger, MD

Critical Link Between Obesity And Diabetes Discovered

ScienceDaily (July 9, 2009) - A Monash University study has proven a critical link between obesity and the onset of Type 2 diabetes, a discovery which could lead to the design of a drug to prevent the disease.

The findings were published July 8 in the journal Cell Metabolism.

The team, led by Associate Professor Matthew Watt, discovered that fat cells release a novel protein called PEDF (pigment epithelium-derived factor), which triggers a chain of events and interactions that lead to development of Type 2 diabetes.

"When PEDF is released into the bloodstream, it causes the muscle and liver to become desensitised to insulin. The pancreas then produces more insulin to counteract these negative effects, " Associate Professor Watt said.

This insulin release causes the pancreas to become overworked, eventually slowing or stopping insulin release from the pancreas, leading to Type 2 diabetes."

"It appears that the more fat tissue a person has the less sensitive they become to insulin. Therefore a greater amount of insulin is required to maintain the body's regulation of blood-glucose," Associate Professor Watt said.

"Our research was able to show that increasing PEDF not only causes Type 2 diabetes like complications but that blocking PEDF reverses these effects. The body again returned to being insulin-sensitive and therefore did not need excess insulin to remain regulated."

Associate Professor Watt said identifying the link is a significant breakthrough in explaining the reasons why obesity triggers the onset of Type 2 Diabetes.

"Until now scientists knew there was a very clear pattern and had strong suspicions that a link existed between the two conditions, but our understanding of the chain of events that are caused by the release of PEDF shows a causal link," Associate Professor Watt said.

"Type 2 diabetes patients will benefit knowing the two conditions are linked. We already know that weight-loss generally improves the management of blood glucose levels in diabetes patients. Researchers can now move forward knowing this link exists and we can begin to design new drugs to improve the treatment of Type 2 diabetes," Associate Professor Watt said.

________________________________________

Adapted from materials provided by Monash University.

Monash University (2009, July 9). "Critical Link Between Obesity And Diabetes Discovered." ScienceDaily.

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Mindset of the Week: Things Work Out

2009-11-12T16:27:00.000-05:00

Diabetes reversal is all about living life to the fullest by doing the best we can with what we've got, which is true about all life's challenges and imperfections. Please let me know what you think the poem below has to do with conquering diabetes.

Things Work Out
By Edgar A. Guest

Because it rains when we wish it wouldn't,
Because men do what they often shouldn't,
Because crops fail, and plans go wrong
Some of us grumble all day long.
But somehow, in spite of the care and doubt,
It seems at last that things work out.
Because we lose where we hoped to gain,
Because we suffer a little pain,
Because we must work when we'd like to play
Some of us whimper along life's way.
But somehow, as day always follows the night,
Most of our troubles work out all right.
Because we cannot forever smile,
Because we must trudge in the dust awhile,
Because we think that the way is long
Some of us whimper that life's all wrong.
But somehow we live and our sky grows bright,
And everything seems to work out all right.
So bend to your trouble and meet your care,
For the clouds must break, and the sky grow fair.
Let the rain come down, as it must and will,
But keep on working and hoping still.
For in spite of the grumblers who stand about,
Somehow, it seems, all things work out.

What do you think this has to do with conquering diabetes?

-Michael Dansinger, MD

This poem and others can be found at Motivational-Well-Being.com.

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Personality of the Week: Christina Pirello MFN, CCN

2009-11-11T06:27:00.004-05:00

If you don’t know about Christina Pirello, you might want to check her out. I caught her great article in the Huffington Post this week, titled It’s American Diabetes Month.

Here’s an excerpt:

As November approaches, we leave Halloween and breast cancer awareness behind for the next holiday in our yearly calendar of illnesses. Seems each month has its signature malady. Type 2 diabetes is such an American epidemic that we can skip giving kids bikes for Christmas and move right to the wheelchairs they'll be needing later in life. Forget the basketballs, baseball gloves and bats. Before you know it, all our video games, phones, Blackberries and other wireless devices will come with their own built-in glucose meters. They already come in designer colors; why not become a part of the rest of our overly connected lives?...

This lady is on fire! Here’s her bio:

Christina Pirello, MFN, CCN is one of America’s preeminent authorities on natural and whole foods with a radiant personality that only serves to make her message more powerful. At age 26, she was diagnosed with terminal leukemia. By the time her illness was identified, the cancer had already advanced to an acute stage. Her doctors gave her little reason to have hope for the effectiveness of conventional medical therapies and told her she had only months to live. Then a co-worker introduced her to Robert Pirello, a whole foods advocate who helped her adapt her lifestyle and diet based on whole, unprocessed food. With love, dedication and death-defying discipline, Christina overcame the odds, and in the process developed an expertise in cooking with whole foods. After just two months of eating beans, grains and vegetables, her doctors noticed a significant improvement in her condition. In fourteen months, her cancer was gone.

From that time, she was utterly convinced of the close relationship between diet and health. She knew her life’s calling was to help others discover the importance of this relationship in their own lives. To that end, she studied and became an expert in traditional Chinese medicine, ayurveda, acupuncture and earned a Masters Degree in Nutrition. Today, almost 26 years later, Christina is a glowing example and inspiration on the power that our food choices have on our overall health and well-being and has been teaching whole foods cooking classes, conducting lifestyle seminars and lecturing all over the United States.

Christina is the Emmy Award-winning host of the television series Christina Cooks!, which airs weekly on over 200 national public television stations nationwide. She has written five cookbooks, the bestselling Cooking the Whole Foods Way; Your Way to the Life You Want; Glow, A Prescription for Radiant Health and Beauty; and Christina Cooks: Everything You Always Wanted to Know About Whole Foods, But Were Afraid to Ask. Her latest book, This Crazy Vegan Life was published in January, 2009 and she is currently at work on her sixth book.

In 2008, Christina founded The Christina Pirello Health Education Initiative, a non-profit organization dedicated to changing America’s relationship with food, with community outreach, media programs and several in-school programs designed to teach our kids to make healthier choices before it’s too late. She works closely with the city of Philadelphia on various school and farm market programs under the umbrella of The Initiative.

Christina holds a faculty position at Drexel University, where she lectures as a professor of culinary arts. She also serves on the board of The Farm Market Trust, The Green Council of Philadelphia, The Green City Youth Council of Philadelphia, The Chefs for Humanity Chef’s Council and is a member of IACP (International Association of Culinary Professionals) and Women Chefs and Restaurateurs. Christina earned both her Bachelors and Masters Degrees in Fine Arts from the University of Miami, and was awarded a Masters Degree in Nutrition from Philadelphia’s Drexel University in 2003.

Christina, we need more leaders like you. Keep up the great work!

~ Michael Dansinger, MD

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Modern Food

2009-10-13T14:27:00.002-04:00

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

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

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

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

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

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

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

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

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

~ Michael Dansinger, MD

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Eating for Diabetes Reversal: Part 7

2009-10-13T14:26:00.032-04:00

Sample Meals

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

Eating Program For Healthy Weight

Overview

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

The Formula

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

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

Jazz it up and add variety with flavorful condiments

The Rationale

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

Step 1: Chose from the 4 Protein Categories

Eggs/Dairy - Egg whites and dairy protein are healthy; fat in egg yolks and dairy is not healthy. By limiting or avoiding the unhealthy fats, eggs and dairy can form an important and versatile base for a wide variety of meals and are a favorite for breakfast.

Recommended items include cartons of egg whites, egg-beaters, whole eggs that have increased omega-3, non-fat cottage cheese, non-fat ricotta cheese, Designer Whey protein powder (dairy protein for smoothies), "light" artificially sweetened yogurt, and non-fat plain yogurt. A serving is: 2 whole eggs/6 egg whites/6 ounces non-fat cottage or ricotta cheese/protein power according to canister directions/8 ounces light or plain yogurt.

Nuts/Soy - Soy foods and nuts can be used as the base for a wide variety of meals, with a few caveats. Major advantages include the absence of unhealthy animal fats and excess starch or sugar, their versatility, and the importance of this protein group for vegetarians. However, soy foods can contain excess salt while nuts contain excess calories if eaten in excess, therefore these protein choices are eaten in combination with other healthy ingredients.

Frozen or refrigerated soy-based meat substitutes (Morningstar Farms, Boca, Gardenburger), and Quorn (similar to mushroom protein), can stand in for burgers, sausages, diced chicken, and ground meat, while firm tofu can also be used to provide variety and interest to meals. One serving is approximately 6 ounces.

Fish/Shellfish - Fish and shellfish are top choices for healthy protein. I recommend eating from this category once per day. They contain healthy fat or minimal unhealthy fat, taste great, and come in many varieties. Especially convenient are canned and frozen fish and shellfish.Frozen fish can be rapidly thawed in hot water, and like fresh fish, tastes great lightly seasoned or can be marinated quickly for added flavor. Fish is now often frozen right on the boat and does not develop a fishy smell if cooked the same day it is thawed.

Few fish have unacceptable levels of mercury; limit swordfish to twice per month and limit "solid" albacore tuna in cans or fillets to twice per week. Chunk or light tuna, salmon, and other commonly eaten fish and shellfish have low or minimal mercury levels that do not negate the powerful health benefits of fish. One serving is approximately 6 ounces.

Poultry Breast - the breast meat from chicken and turkey is high in protein with low levels of unhealthy fat. There is too much unhealthy fat in the dark meat and skin, so only eat the white/breast meat. Ground poultry should also be avoided, unless it contains only white/breast meat.

Chicken and turkey breast are available cooked or uncooked at all supermarkets, and can easily form the base of a wide variety of soups, salads, or main dishes. Turkey breast slices, thin or thick (try half-inch thick slices), are especially convenient and are available at any deli counter. Salt/sodium in prepared poultry breast can be high, but when paired with other low-sodium ingredients, overall salt intake remains low. One serving is approximately 6 ounces.

Step 2: Chose the vegetables/fruits

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

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

Step 3: Add flavorful condiments

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

Sample Meals

Egg/Dairy Meals

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

Soy/Nut Meals

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

Fish/Shellfish Meals

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

Turkey/Chicken Breast Meals

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

Grocery List

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

- Michael Dansinger, MD

Read the entire series:

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Eating For Diabetes Reversal: Part 6

2009-08-25T11:03:00.009-04:00

Dr. Dansinger's Eating Strategy for Diabetes Reversal

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

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Eating for Diabetes Reversal: Part 5

2009-08-19T12:19:00.006-04:00

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

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Eating for Diabetes Reversal: Part 4

2009-08-11T10:20:00.007-04:00

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

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Eating for Diabetes Reversal: Part 3

2009-08-07T10:25:00.005-04:00

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

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Eating for Diabetes Reversal: Part 2

2009-07-28T14:25:00.006-04:00

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

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Eating for Diabetes Reversal: Part 1

2009-07-21T11:23:00.006-04:00

"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:

Related Topics:

A Diabetes Reversal Story (Part III)

2009-07-16T10:50:00.003-04:00

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)

2009-07-09T21:57:00.002-04:00

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)

2009-07-07T06:28:00.000-04:00

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

What Is Diabetes Reversal? (Part II)

2009-06-30T19:28:00.000-04:00

To fully understand the concept of diabetes reversal, it is important to understand how diabetes is detected, measured and monitored.

Measuring Diabetes
People with insulin resistance can eventually develop prediabetes which typically progresses to type 2 diabetes. In many cases people do not know they have prediabetes or early diabetes, until symptoms of diabetes occur, leading to medical attention and correct diagnosis. It is important to know that screening blood tests can detect the early stages of diabetes, or prediabetes, or insulin excess.

By measuring the levels of insulin, and glucose (sugar) in the blood, we can know whether someone has excess insulin levels, prediabetes, or diabetes. Eating a meal changes these levels, making them difficult to interpret, therefore clinicians often prefer to measure them while a patient has been fasting overnight or for 8 to 12 hours. The fasting levels of blood glucose may fluctuate widely from day to day, and no single measurement of blood glucose is a reliable indicator of the overall average blood sugar level.

Fortunately, we have a blood test that indicates the average blood sugar level, called the HEMOGLOBIN A1c. We often just shorten the name to "A1c". This test measures how "sugar-coated" the blood cells are, and is an excellent reflection of the overall or average blood glucose control. The higher the A1c, the higher the average blood sugar, and the greater the risk of future diabetes complications. Knowing your A1c means knowing your risk of diabetes or diabetes complications. Normal healthy people have an A1c of less than 6%, meaning less than 6% "sugar coated". In fact, at our hospital laboratory, normal is 5.8% or less, so greater than 5.8% means prediabetes or diabetes. Diabetes experts throughout the world are working together to achieve a consensus about how to use the A1c to define the official cutoff points for prediabetes versus diabetes. Obviously it is one continuum and the definitions or cutoff points are arbitrary. Lacking official cutoff points at this time, I believe it is fair to say that PREDIABETES is roughly an A1c of 5.9% to 6.4%, and DIABETES is roughly an A1c of 6.5% or higher. An A1c over 7% is considered insufficient control of the diabetes, and clinicians often consider increasing the intensity of the diabetes treatment when the A1c surpasses 7%. A1c's in the 8%-10% range are considered poorly controlled diabetes, and A1c's over 10% indicate very poor control, and if such levels are sustained over many years, there is especially high risk for diabetes complications, such as heart attack, stroke, sudden death, blindness or eye damage, foot infections or amputation, or kidney damage possibly leading to chronic dialysis.

Controlling Diabetes
We all recognize that healthy eating, exercise, and weight control are important for controlling diabetes. Doctors, dietitians, diabetes educators, nurses, and other health professionals agree that such lifestyle measures are crucially important. Nevertheless, medications are often used to help control the blood sugar levels. Some medications help reduce the insulin resistance, others stimulate the pancreas to make more insulin, some have a combination of effects.

Recent research studies have suggested that using multiple medications to reduce the A1c much lower than 7% may have little or no substantial advantage over just leaving the A1c at 7%. Unfortunately, there is risk of diabetes complications in all people with diabetes, despite A1c's at or below 7%. In general, people with prediabetes progress to diabetes with gradually increasing A1c's, despite a gradual increase in medication. Eventually, insulin delivered as injections or via a small "insulin pump" is used to replace or augment oral diabetes medications. All diabetes medications have side effects.

Reversing Diabetes With Surgery
Obesity surgery often reverses type 2 diabetes. Gastric bypass surgery, typically performed using the "minimally invasive" approach with a few small incisions, usually normalizes blood sugar within a few hours or days, allowing the elimination of diabetes medications for many years and possibly for one's full life. The rapid rate of diabetes remission indicates that the weight loss is not the initial cause of the diabetes reversal. Rather, the change in the intestinal anatomy causes changes to the digestive process and hormonal balance that, combined with the change in food intake, result in diabetes reversal. The dramatic weight losses, often well over 80 pounds, clearly help sustain the long-lasting remissions. Alternatively, lap-band surgery, involving "minimally invasive" laparascopic placement of an adjustable band that constricts the stomach, results in more moderate weight losses, often in the 40-60 pound range, thereby leading to diabetes remission once a sufficiently low body weight has been reached. Most people with recently diagnosed type 2 diabetes can achieve remission with lap-band. More studies are needed to clarify the duration of remission and reversal rates according to age group, degree of obesity, duration of diabetes, and other factors that might influence the effectiveness of such surgery. Surgery for diabetes reversal or control seems like an extreme measure, however, as surgical techniques and post-surgical management of patients continue to improve, the attractiveness of such measures continues to increase, in my opinion. Still, it just seems "unnatural" to use surgery to reverse or control diabetes, and it is clearly not an ideal solution or anybody's first choice. Personally, I favor it over medication, as a long-term solution for many people who simply can't control their type 2 diabetes through diet and exercise.

Reversing Diabetes With Diet and Exercise
We know that weight loss, via healthy diet and exercise, can delay or possibly prevent the onset of type 2 diabetes in people with prediabetes. We also know that many people with prediabetes or type 2 diabetes have been able to restore normal blood sugar levels by improving their diet and/or exercising more. Unfortunately, such people are the exceptions, and most people do not achieve or sustain sufficient lifestyle changes to avoid progression of diabetes, once diagnosed. There are no published research studies that convincingly demonstrate the value of lifestyle change for achieving durable diabetes remissions in typical patients, at least not yet. Researchers around the world are working together to evaluate the effects of weight loss through diet and exercise, on diabetes control, and once those results are published, we will gain a better understanding of the relationship between weight loss and risk of diabetes progression and complications.

Meanwhile, I am convinced that reversing prediabetes and type 2 diabetes, as much as possible, through diet, exercise, and weight loss, is the best approach. Health care providers and patients have not done all they can to work together to use lifestyle methods to beat diabetes. Unhealthy lifestyle habits are the root cause of type 2 diabetes and reversing the underlying cause is the principal way to reverse diabetes. I do not use the word "cure" because the diabetes will re-emerge if the lifestyle changes are not sustained, and can even relapse despite ongoing adherence and weight loss. Whether patients can sustain remissions for decades remains to be seen.

Defining Diabetes Remission
There is no official definition for type 2 diabetes remission. The general concept is normal blood sugar levels without diabetes medication. However, if a person stops diabetes medication and has a few normal blood sugar readings, that is clearly not sufficient. Diabetes is officially defined as fasting glucose over125 mg/dL. Prediabetes involves fasting glucose levels in the 105-125 mg/dL range and A1c9s in the 5.9-6.4% range. Is getting into the prediabetes range considered remission? There is no official answer and therefore the topic is up for debate.

Lacking an official definition, I arbitrarily define DIABETES REMISSION as an A1c of 6.0% or less with no diabetes medications for at least 2 months, in a person formerly diagnosed with type 2 diabetes. One could use a different definition, but this one is mine. If someone has been diagnosed with type 2 diabetes, I do not use the term prediabetes to describe an improvement. I define DIABETES RELAPSE as an A1c of 6.5% or higher in someone who was previously in diabetes remission. I define PREDIABETES as an A1c of 5.9-6.4% in someone who has not met the definition of diabetes. I define REMISSION of PREDIABETES as an A1c of 5.8% or less in someone who has met criteria for prediabetes but not diabetes. RELAPSE of PREDIABETES is a return to A1c in the 5.9-6.4% range.

— Michael Dansinger, MD

What Is Diabetes Reversal? (Part I)

2009-06-26T12:22:00.000-04:00

When I discuss "diabetes reversal" this is what I'm talking about:

First, I'm talking about Type 2 Diabetes, the kind that is associated with being overweight or obese. Type 1 diabetes, also known as autoimmune diabetes, which usually develops in childhood or early adulthood, is not what I'm talking about. Around 80-90% of diabetes is type 2.

Second, when I talk about "Diabetes Reversal" I'm talking about trying to put the diabetes into REMISSION, meaning that the blood sugar levels are normal without diabetes medication. In other words, the disease is undetectable.

Third, if the diabetes is too far advanced or if you have been on diabetes medication for too long, the diabetes might not be fully reversible, or may quickly relapse.

Fourth, it takes hard work and sacrifice to master the eating and exercise strategies that reverse the diabetes. I can show you the way, but I can't make you do it. You have to want it badly enough to make it happen.

I suspect that 75-80% of people with type 2 diabetes can potentially reverse their disease to the point of full remission. These remissions can last for years. Perhaps lifelong remissions are possible!

In the coming weeks and months I'll discuss more about how diabetes reversal works and how to do it. Remember, you know you'll succeed once you decide you'll never give up trying.

How Type 2 Diabetes Develops

To really understand diabetes reversal, it is important to first understand how type 2 diabetes develops.

Type 2 diabetes is traditionally considered to be a progressive disease. It works like this. As we all know, we must eat food for energy. Unfortunately, people with diabetes have a problem getting the energy from food into the muscles and organs that depend on that energy to work properly. In all people, with or without diabetes, the food we eat is digested and absorbed into the blood stream, causing the blood sugar level to rise. The cells of our body tissues, especially cells in muscles and organs, are designed to use that sugar for energy, and our cells have a specific way to let that sugar in. The cells of our bodies require INSULIN, a hormone made by the pancreas organ and secreted into the blood stream, to get the sugar from the blood stream through the cell surface membrane, to the inside of the cells where the sugar can be used for energy. In normal healthy people, the insulin hormone attaches to the surface of cells in a manner that is analogous to a key unlocking a door to let the sugar into the cell. In contrast, in people with type 2 diabetes, the cells do not recognize the insulin properly, and the sugar doesn't get into the cells very efficiently, like a door with a blocked up keyhole. The sugar can't get into the cells very efficiently, resulting in high blood sugar levels.

Why is the keyhole blocked up? In other words, why don't the cells recognize the insulin? This is what we call INSULIN RESISTANCE, which results from a combination of unhealthy eating, excess body fat, lack of exercise, and genetic predisposition. For example, being overweight or obese leads to excess fat levels in the blood and in the muscles and organs, that "jams the keyholes" or causes the cell surfaces to recognize insulin less efficiently.

In the face of insulin resistance, the body makes MORE insulin hormone. The pancreas organ makes twice as much insulin as normal, in order to get the sugar from the blood into the cells. Many overweight people live their full lives with high insulin levels and do not develop type 2 diabetes. Others may seem healthy for 10 or 20 or even 50 years with increased insulin levels before developing diabetes. In fact, a person does not develop type 2 diabetes unless the pancreas becomes so overworked, that it cannot continue to do "double duty", and can no longer make so much extra insulin. Only then does the blood sugar level start to rise abnormally, in which case we recognize this as PREDIABETES. Over time, as the insulin-producing cells of the pancreas continue to wear out, the blood sugar levels rise further and we recognize this as type 2 diabetes. Therefore it is the COMBINATION of insulin resistance PLUS the weakened ability to make excess insulin that leads to type 2 diabetes.

Why does the pancreas, or the insulin-producing cells of the pancreas, weaken in some people faster than in others? Scientists are working hard to learn more about this, but in fact we don't have a good enough understanding for me to propose a satisfactory answer. The simplistic answer is that some people just have better luck than others. It is common to see individual differences in the way an organ or body part responds to overuse. For example, some people exposed to lots of noise eventually need hearing aids, others never do. Some joggers eventually get bad knees, others do not. Excess alcohol over many years sometimes causes severe liver disease, sometimes it doesn't. These differences are often genetic, but may also depend on the presence or absence of other environmental factors that we often just don't recognize.

DIABETES REVERSAL is about reversing the underlying insulin resistance and strengthening the insulin-producing cells of the pancreas, aiming to normalize the blood sugar levels without diabetes medication. In future postings I'll explain more about this.

— Michael Dansinger, MD

The Diabetes Reversal Equation

2009-06-24T13:09:00.000-04:00

Thank you, WebMD! I'm especially grateful for the opportunity to connect with the type 2 diabetes (and prediabetes) community. I'm excited to share what I've learned about weight loss, nutrition, popular diets, exercise, obesity, diabetes, medical research, and medical practice.

The aim of this blog, "Conquering Diabetes" is to discuss all topics related to overcoming and reversing type 2 diabetes. Together we'll share our insights and experiences in all things relevant to reversal of type 2 diabetes. Much more than eating right and exercise, we need to explore the way doctors, nurses, dietitians, chefs, personal trainers, politicians, health insurance companies, hospitals and clinics, patients, parents, and children all have a role or potential role in reversing the diabetes epidemic. We'll explore various eating strategies, exercise, our love/hate relationship with unhealthy food, share our own stories, and create our vision for a healthier future.

My mission, my passion, my calling, is to coach patients with type 2 diabetes in the eating and exercise strategies that normalize blood sugar, and to train other health professionals and the general public in the methods I use to reverse diabetes.

In the weeks and months to come I'm looking forward working together. Together we can and must overcome type 2 diabetes for the sake of ourselves and our children and their children. Join me now. We can't afford to leave this work to the next generation. We can only do this if we build momentum and grow together. Together let's learn how to reverse diabetes as individuals and eventually as a nation, and solve the "Diabetes Reversal Equation".

Click here for video version of my poem below

A Diabetes Drama for President Obama

Dear President Obama, I'm calling for you! You've inspired the nation, we're long overdue.

We need a strong leader in this time of trouble, who can help us see that our own strength can double.

The healthcare system is in severe crisis! The costs are astounding, with spiraling prices.

For excessive tests and costly machines, we're stuck in a rut, with the same old routines.

The annual cost of a common disease, is more than the wars that we fight overseas!

One-seventy billion a year for diabetes?!! That is the enemy that might just defeat us!

Twenty percent of all healthcare expenses, on patients who have this--a shock to the senses!

One in three children may contract this illness, as adults or teens due to our stillness!

Here is a war that we should have engaged, millions have died and you bet I'm enraged!!!

Most of these patients get complications, even though we treat them with many medications.

Blindness and limb loss and chronic dialysis, result from our failure to heed the analysis.

You need not be an economist or scholar, we can reverse this for pennies on the dollar!

Diabetes type 2, which is ninety percent, is due to the life style habits doctors lament.

Until we overcome the underlying cause, we remain paralyzed in the enemy's jaws.

We know what it takes to get there in theory, but previous leaders have been too leery,

To make it happen on a national scale, to invest the resources to ensure we prevail.

We now know the weight loss it takes to reverse the majority of cases of this diabetes curse.

Coaching for weight loss of forty pounds initially seems like its way out of bounds.

But I've learned how to do this on a routine basis, for men and women of all ages and races.

A caloric reduction of twenty-five percent, is enough to achieve this glorious ascent

Out of the grips of this terrible killer, transforming sorrow into a thriller.

The key isn't diet type, it's all about adherence, and removing the obstacles that cause interference.

Weekly coaching by an authority, can normalize glucose for the majority,

Who sufficiently fear blindness or amputation, or stroke or dementia, or loss of sensation.

But doctors need training in the methods I've learned, to reverse diabetes, in those sufficiently concerned.

And we need a president who can leap into action, who knows what it takes to get enough traction.

Inspiring doctors to learn to achieve, reversal rates that initially seem hard to believe

Is the way to wage war on this foe we must beat, so we don't have to endure the burden of defeat.

A wealth of huge savings awaits in the confines, of Americans' increasingly expanding waistlines.

To tap it we must be clever and inventive, and carefully craft the right incentive.

Sharing a portion of the recovered wealth will stimulate people to recover their health.

Every sustained diabetes remission, annually documented by a qualified clinician,

Could reward the patient with a nice tax break, while all Americans share in the take.

Success on a national scale will save dollars in billions, eyes, kidneys, limbs, and lives by the millions!

The first country to achieve diabetes domination, will be the great envy of every other nation!

When great presidents propose with conviction, an American challenge to crush an affliction,

It brings out the best in our glorious nation, in these times when we desperately crave inspiration!

Believe with me now, that we can rise to the occasion, and solve the diabetes reversal equation!

—Michael Dansinger, MD