The End of Diabetes (13 page)

 

Overall calories and weight loss results

Amount of fiber consumed per meal

Micronutrient diversity and completeness

Glycemic load of the meals

Antioxidant and phytochemical index

Satiety and removal of food cravings and addictions

A vegan diabetic study “A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals with Type 2 Diabetes” was published in
Diabetes Care.
14
The word
vegan
did not adequately describe the features of the diet that made it more favorable compared to the ADA diet. The researchers were careful to remove all vegetable oils and white flour products. If they'd called the diet a high-fiber, no-processed food, vegan diet, it would have been a more descriptive title indicating why it was somewhat more effective compared to the ADA diet. However, the results still did not compare in effectiveness with the program I am teaching here.

Typical vegan diets do not show the dramatic improvements in lipids, triglycerides, glucose, and even weight loss. One important design feature for better health and disease reversal is the reduction of high-starch vegetables and grains and the substitution of beans, nuts, and seeds instead. For example, another representative study showed that women on a low-fat vegan diet lowered LDL cholesterol by 16.9 percent.
15
In a similarly conducted study including nuts and seeds, participants dropped LDL cholesterol 33 percent.
16
For protection from all types of heart disease, a vegan diet with the inclusion of raw nuts and seeds is simply a healthier diet. However, the limitation of grains (especially flour) and the inclusion of green vegetables and low-starch vegetables in place of grains and starchy vegetables both play a role in the dramatic lipid-lowering benefits and weight loss.

When the diabetic diet is carefully designed around green vegetables and beans, with the addition of a small amount of fruit and a small amount of raw nuts and seeds, patients are able to stop insulin and sulfonylureas—the primary offenders that restrict weight loss—as soon as possible.

It is even more important for children, people who are thin, people who exercise a lot, and women who are pregnant and nursing to consume sufficient fat. The healthiest diet for all ages is one that includes some healthy fatty foods. This same diet will also prevent and reverse disease. There is no need for people with heart disease or diabetes to move to a special type of extremely low-fat vegan diet void of raw seeds and nuts, thinking this restriction is necessary or valuable for their cardiac health.

 

For an overweight diabetic, I recommend one ounce daily of raw, unsalted seeds or nuts, such as sesame seeds, sunflower seeds, flax seeds, chia seeds, hemp seeds, pumpkin seeds, walnuts, pistachio nuts, or almonds. Add them to a salad or blend them into dressings as an oil replacement.

We are beginning to get a clear picture of how we can prevent and reverse diabetes. As the weight comes off, it is important to remember that the main risk of weight loss is weight regain. Dietary improvements that are not maintained are of no long-term benefit, and rapid weight gain is, of course, unfavorable. When you really “Eat to Live” you enjoy the combination of dramatic results for your body weight and your health, and your tastebuds get healthier too. We marry great flavor with the emotional satisfaction of knowing you are doing the best thing for your health and it becomes the way you prefer to eat for your life.

The other risk from weight loss is the formation of gallstones, or cholelithiasis. My experience, however, is that people losing weight following my dietary recommendations have an extremely low rate of gallstone formation. Certainly, the formation of gallstones and the possibility of laparoscopic gallbladder removal may be a reasonable price to pay for losing 40 to 140 pounds of life-threatening body fat. Nevertheless, it is important to note that the inclusion of raw nuts and seeds in the diet, especially while losing weight, is crucial protection against gallstone formation. Nuts are rich in several compounds that protect against gallstone disease.

The
American Journal of Clinical Nutrition
reported that when 80,718 women from the Nurses' Health Study, age thirty to fifty-five years in 1980, were followed for twenty years, researchers found that the consumption of nuts and seeds offered dramatic protection against gallstone formation. Women who consumed five ounces of nuts per week had a dramatically lower risk than did women who rarely consumed them. Further adjustment for fat consumption (saturated, trans, polyunsaturated, and monounsaturated fats) did not alter the relation.
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These findings were also duplicated in a cohort of men.
18

Perhaps, then, the reason I have not observed a high rate of gallstone formation in spite of having thousands of clients and patients all over the country who've lost large amounts of weight is the inclusion of nuts and seeds in the program. Because it is difficult to determine who might be at a higher risk for gallstone formation, it is wise for every dieter to include at least one ounce of raw nuts and seeds per day in any weight-loss program to offset this real risk to healthy weight loss.

 

Fat Deficiency Can Cause a Failure to Thrive

For many people, the undue emphasis on extremely low-fat diets has resulted in health difficulties. I have encountered many individuals who have not thrived on vegan or flexitarian diets. They may have developed dry skin, thinning hair, muscle cramps, poor sleep, and poor exercise tolerance. Often they do not realize their real problem. They go back to eating large amounts of animal products, not knowing that they were fat deficient on their low-fat vegan diet. For most of these individuals, eating more healthy fats from nuts and seeds, taking a DHA supplement, and eating fewer starchy carbohydrates clears up the problem. This is not so uncommon. Some people simply require more essential fatty acids, both omega-6 and omega-3. DHA and EPA are those healthful, long-chain omega-3 fatty acids found in fatty fish and commonly known as fish oil. They are available from vegan sources today, mostly from algae or yeast.

A high-starch, low-fat diet—regardless of whether or not the dieter is eating meat—can derail weight loss and lead to high triglycerides, preventing lowered cholesterol levels. I have cared for some patients who came to me after they developed irregular heartbeats or cardiac arrhythmias. These conditions resolved when I added nuts and seeds back to their diet. Insufficient fat in the diet can also compromise the absorption of fat-soluble vitamins and healthful phytochemicals. When you eat a nut- or seed-based dressing on a salad, you absorb more of the carotenoids in the raw vegetables. More than ten times as much of certain nutrients are absorbed. A study detecting blood levels of alpha-carotene, beta-carotene, and lycopene found negligible levels after ingestion of salads with fat-free salad dressing but high levels after the same foods were eaten with fatty dressings.
19

Ultimately, the nut icing on the carrot cake was displayed in the Adventist Health Study-1, a twelve-year study of thirty-four thousand Adventists in California. This group is the longest-lived population that has ever been formally studied in depth. We knew that the vegan and near-vegan Adventists lived longer than other Californians, but what were the precise factors accounting for the years of life gained? Interestingly, this study found that the strongest effect of any food on promoting longevity was the consumption of nuts or seeds five or more times per week. The consumption of nuts added years of life, likely due to the antiarrythmic effect of nuts and seeds, compared to non–nut eaters, who suffered double the rate of fatal coronary events.
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For any population at risk of heart disease, especially diabetics, eating some seeds and nuts daily is imperative and maybe even lifesaving.

Let's take a look at a day's menu of equal calories both with and without nuts and seeds, to see some subtle but important nutritional differences.

 

Note: * indicates recipe included in this book.

 

You can see that the diet with nuts and seeds is higher in protein and much higher in the amino acid arginine. Arginine has special properties that benefit the heart, promoting vasodilatation (relaxation of the vessel wall) and preventing blood clotting. It also includes higher amounts of vitamin E and minerals, but that does not adequately reflect the major difference between these diets. The very low-fat diet greatly reduces the absorption of most of the carotenoids and other phytochemicals contained in a meal. They simply are not well absorbed in such a low-fat environment. The benefits of nuts and seeds are enhanced when they are eaten with a meal; they are not for snacking.

There is one more fascinating gem about nuts and seeds, and I do not want you to forget it: the calories are not all biologically available. They are similar to the resistant starch calories in beans. About 30 percent of the recorded calories from nuts and seeds are passed into the stool, not absorbed into the bloodstream.
21
Eating nuts and seeds increases stool fat, which means not all the fat is absorbed. Plus, the sterols, stanols, and other sponge-like fibers in nuts and seeds carry other calories from the diet into the stool as well. So in the calculated dietary menus above—one with nuts and seeds, one without—even though the calories recorded and eaten are about the same, the amount of absorbed calories from the diet plan with the nuts and seeds would be about 100 calories lower. Interestingly, however, the increase in fecal fat and fiber does not occur when the diet contains the oils instead of whole nuts and seeds. In other words, calories from oil are absorbed almost 100 percent. For example, eating whole peanuts versus peanut oil would have completely different biological effects.

Remember, it is best to eat nuts and seeds raw or only lightly toasted. When you roast nuts and seeds, you form carcinogenic acrylamides as the food is browned. You decrease the protein and create more ash from the roasting process. The more the nuts and seeds are cooked, the more their amino acids are destroyed. You also lower levels of calcium, iron, selenium, and other minerals in the roasting process.

With your growing awareness of the health properties of nuts and seeds, please take into consideration that they should be eaten in moderation. Should we sit in front of our TVs, eat an entire bag of nuts in an hour, and complain when we gain weight? Of course not. Healthy eaters avoid excessive calories and do not eat for recreation. Eat only one ounce a day if you are overweight. If you are thin, physically active, pregnant, or nursing, eat two to four ounces daily according to your caloric needs.

As we are beginning to see clearly, ideal health has very little to do with a precise ratio of carbs, fats, and proteins. To prevent and reverse diabetes, we must make certain that we are paying attention to our nutrient-per-calorie model. We need to eat foods with micronutrients and other proven health benefits to achieve our health goals.

It's time for action. It's time to eat the right foods that lead to long-lasting health.

CHAPTER EIGHT

The Nutritarian Diet in Action

I am one hundred pounds overweight. Three weeks ago, I had a physical and my blood sugar was 289. The doctor told me I was diabetic and would be on medication for the rest of my life. Instead of taking the medication the doctor prescribed, I started your program on Saturday, May 19. Three days later, my glucose was 90 points lower! Every day it is getting lower. My fasting glucose is now 117, and when I check at night before going to sleep it is 120 to 122. A drastic change from 289—in less than three weeks' time! I will continue this plan and my exercise regimen so that my numbers get even lower. I am losing about five pounds a week. Your advice has saved my life. Thank you, Dr. Fuhrman.

—Laverne Stone, age fifty

F
or diabetics, optimal health is not achieved by eating less to lose weight. Rather, diabetics have to make a big commitment not only to forming better eating habits but also to eating the
right foods
to help the body heal. This change includes making adjustments in their thinking as well as their diet. But it can be challenging to change your thinking when the doctors and the media are spewing misguided information.

A recent article published by the Associated Press quotes a former president of the ADA: “There is no special diet [for diabetics to lose weight]. You have to eat fewer calories than your body burns,” said Dr. Robert Rizza, a Mayo Clinic endocrinologist and former president of the American Diabetes Association.
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Nothing can be more untrue. A diabetic's life or death can most certainly depend on the quality and not just the quantity of what is eaten. It's essential to understand
what
to eat, not just how many calories are in the doughnut or large French fry order. A diabetic's life depends on it. All of us want a healthy life expectancy. Who would want to suffer needlessly in their later years?

Eating high-quality foods that are rich in micronutrients are your body's best friend. They fuel your body's self-repair mechanisms; they curtail your appetite; and they are the ticket to a slim, healthy body free of diabetes and heart disease. The right diet style can remove your addictive drive to overeat and enable you to control your chronic overeating for the first time. It can save your life.

When you eat a nutrient-rich diet, you are eating more food volume, more food by weight, and more high-water-content food, meaning you may feel more full after a meal even though you are eating fewer calories overall and less food that has a high caloric concentration.

 

High-Nutrient, High-Volume Foods to Fill Up On

I call high-nutrient, high-volume foods that fill you up the unlimited foods. They include:

 

1. All raw vegetables

2. All cooked green vegetables

3. Tomatoes, peppers, eggplant, mushrooms, onions, cauliflower

 

The goal is to eat large amounts of these three food categories to flood the body with micronutrients and fiber. Memorize them!

So these foods richest in nutrients per calorie are also naturally low in calories. You get more nutrients and fewer calories simultaneously. That is the real fountain of youth.

Fruit is not unlimited, but you can eat a few with breakfast and one with lunch and dinner if desired. Beans are not totally unlimited, but they are a recommended food that you should eat liberally each day. You can eat lots of them, up to a cup of beans with each lunch and dinner, two cups total a day. Nuts and seeds are an important and healthy food to include in your diet, but they should be limited to one ounce a day for overweight females or 1.5 ounces a day for overweight males. Obviously, these limits can be liberalized for people who are not overweight or diabetic and require more calories.

Remember, raw vegetables and all cooked green and non-starchy vegetables such as string beans, artichokes, zucchini, snow peas, eggplant, tomatoes, peppers, mushrooms, cauliflower, onions, and leeks do not have to be measured. Eat as much as you like of these dishes made with gentle spices, tomatoes, onion, and garlic.

 

The Salad Is the Main Dish

Raw vegetables should be eaten in large quantities at the beginning of each main meal. A sensible goal is to shoot for one pound of raw vegetables daily. I often say, “The salad is the main dish.” The word
salad
here means any uncooked vegetable. Think big when it comes to salad. The more raw vegetables you eat, the less you will desire of everything else. Raw vegetables are the healthiest, most weight-loss-promoting foods you can eat. Use a variety of raw vegetables in your salads. In addition to plenty of lettuce, include tomatoes, shredded beets, carrots, cucumbers, and peppers. You can also add any leftover steamed greens on top of a lettuce salad, some defrosted frozen peas, stewed mushrooms, or a handful of beans. Add a little fruit-flavored vinegar or one of my dips or dressings, and the salad can be the whole meal.

The increased production of the biologically active phytochemicals in raw vegetables is consistent with the studies that show a radically lower risk of cancer in people who consume more raw greens in their diet.
2
For those in the know, eating lots of raw greens is the most important nutritional intervention to prevent common human cancers.
3
Eat not only lots of raw greens every day but also big portions of cooked green vegetables. Remember, if it's a vegetable with the color green, it is rich in micronutrients and low in calories. It's a green light to eat more of it. The more greens you eat, the increased likelihood you will eat less of something else that is higher in calories. When you fill up with high-volume, high-nutrient foods that have a high micronutrient content, you will not feel the need to overeat foods that sabotage your health and weight. The added benefits include protection against heart attacks and cancer. Of course, green vegetables are the food that shows the most protection from diabetes too.
4
How great is that?

With the growing popularity of nutritional supplements, more and more Americans are looking for accurate information about nutrients that can make a real difference in their health and their lives. However, the reality is that the most powerful thing people can do to improve their health is eat more green vegetables. Americans eat a piddly amount of greens, but if they ate much more, disease rates of all types would plummet. Not only are vegetables rich in discovered vitamins and minerals, but as discussed, they also contain thousands of phytochemicals that are critically important to our health.

The more we get a better understanding of nutritional science, the more we learn that individual nutrients taken as supplements do not have the same healing and protective powers of high-nutrient, superfoods. Supplements can be used to supplement an area of potential suboptimal intake, such as B12, iodine, zinc, vitamin D, or DHA, but they never can take the place of eating healthfully. Not all vegetables are created equal, and one of the most fascinating areas of research in the last ten years has been the therapeutic value of cruciferous green vegetables.

 

The World's Healthiest Foods

Almost three hundred case-controlled studies show that vegetable consumption provides a protective effect against cancer and that cruciferous vegetables are the foods with the most powerful anticancer effects of all foods. Cruciferous vegetables are those in the broccoli and cabbage family and include such foods as bok choy, radishes, and watercress. While eating fresh fruits, beans, vegetables, seeds, and nuts have been all been shown in scientific studies to reduce the occurrence of cancer, cruciferous vegetables are different. Instead of a one-to-one relationship against cancer, they have a one-to-two relationship with a wide variety of human cancers. In other words, as plant food intake goes up 20 percent in a population, cancer rates typically drop 20 percent. But as cruciferous vegetable intake goes up 20 percent, cancer rates typically drop 40 percent.
5

Cruciferous vegetables contain phytochemicals that have a unique ability to modify human hormones, detoxify compounds, and prevent toxic compounds from binding to human DNA, thus limiting toxins from causing DNA damage that could lead to cancer. Sulforaphane, an extensively studied compound, is an isothiocyanate that has a unique mechanism of action. This compound blocks chemical-initiated tumor formation and induces cell cycle arrest in abnormal cells, meaning it inhibits growth and induces cell death in cells with early cancerous changes in a dose-dependent manner. Recent studies show that the amount of sulforaphane that can be obtained from eating a reasonable amount of broccoli can have dramatic effects to protect against colon cancer.
6

Most micronutrients that we read about (vitamin C, vitamin E, beta-carotene, lutein, lycopene) function as antioxidants in the body, meaning these compounds neutralize free radicals, rendering them harmless. But the phytochemicals in cruciferous vegetables do more. They enable the body's own antioxidant control system. When we take in direct antioxidants such as vitamin C and E, they fight a one-on-one war against free radicals but not much more. Their effects are gone in a few hours. Synthetic or isolated fractions of vitamin E, beta-carotene, or vitamin C can also cause pro-oxidant behavior, creating more free radicals. So instead of having a short-lived benefit that gets used up quickly, the unique compounds in cruciferous vegetables cycle over and over, protecting the body for three to five days after consumption. They fuel body systems already in place so that they function more effectively, but they also induce many different systems to defend against many different types of damage.

A study on prostate cancer shows that it takes twenty-eight servings of vegetables a week to decrease the risk of prostate cancer by 33 percent, but just three servings of cruciferous vegetables a week decreases the risk of prostate cancer by 41 percent.
8
The National Cancer Institute of the National Institutes for Health recommends nine servings of fruit and vegetables per day. I recommend eight servings of vegetables a day, with at least two of those being cruciferous vegetables, one raw and one cooked. Do you eat green cruciferous vegetables daily? Do you eat both raw and cooked green vegetables? Let's all make sure we do.

 

Greens and Heart Disease

Heart disease is caused by the buildup of fatty plaques in the arteries, known as atherosclerosis. However, arteries do not get clogged up with these plaques in a uniform way. Bends and branches of blood vessels—where blood flow is disrupted and can be sluggish—are much more prone to the buildup. A recent study shows that Nrf2, a protein that usually protects against plaque buildup, is inactive in areas of arteries that are prone to disease.
9
However, a phytochemical found in green vegetables activates Nrf2 in these disease-prone regions. Activation of Nrf2 is important for maximizing both prevention and removal of plaque. Ingestion of these beneficial compounds from cruciferous green vegetables had the strongest effect to activate the Nrf2 proteins, blocking atherosclerosis.

Vegetables have other powerful disease-fighting nutrients as well. Carotenoids are just one compound that is important for excellent health. Greens have high levels of carotenoids and other nutrients that prevent age-related diseases that diabetics are prone to. For example, the leading cause of age-related blindness in America is macular degeneration. If you eat these greens at least five times per week, your risk drops by more than 86 percent.
10
Lutein and zeaxanthin are carotenoids found in green vegetables with powerful disease-prevention properties. Researchers have found that people with the highest blood levels of lutein had the healthiest blood vessels, with little or no atherosclerosis.
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Of course, losing body fat, lowering glucose levels, and lowering blood pressure all play an important role in the prevention and reversal of heart disease. But the message here is that a diet rich in greens protects against diabetes, aids in weight loss, and fights cancer, in addition to enabling more targeted and effective reversal of high blood pressure and heart disease.