The End of Diabetes (16 page)

In spite of the huge volume of solid information documenting the deleterious effects of beta-carotene, vitamin A, and folic acid, it is still almost impossible to find a multiple vitamin that does not contain these substances.

 

Iron, Copper, and Selenium

Although iron is crucial for oxygen transport and other physiological processes, in excess iron is an oxidant that may contribute to cardiovascular disease and cognitive decline in older adults.
21
Iron should be taken as a supplement only when a deficiency or increased need exists, such as during heavy menstrual bleeding or pregnancy.

Recent studies have also shown that excess copper could be associated with reduced immune function, lower antioxidant status, atherosclerosis, and accelerated mental decline.
22
For these reasons, I also exclude copper from my supplements and those I recommend. A healthy diet gives us enough copper.

Selenium, of course, is essential, but a healthful diet gives us enough. There is some evidence that high selenium levels may contribute to diabetes, hyperlipidemia, prostate cancer, cardiovascular disease, and impaired immune and thyroid function. Therefore, supplementation beyond what is present in natural foods is likely not beneficial and may result in overexposure.
23

Some people, even when consuming an ideal diet, may need more of certain nutrients. Individual absorption and utilization of nutrients varies from person to person, and some people simply require more to maximize their health. For example, B
12
is always low on a near vegan or vegan diet, and some individuals require iodine or more vitamin D due to differences in absorption and utilization. Likewise, some people may also require more minerals such as zinc for maximizing their health and longevity.
24
I have designed a few supplements that conveniently supply the micronutrients of value, leaving out any potentially risky or controversial elements. These are available at www.drfuhrman.com.

I do recommend taking a high-quality multiple vitamin/mineral supplement to supply extra vitamins D and B
12
, zinc, and iodine because ideal amounts of these are hard to acquire even in an excellent diet. As discussed above, the main issue here is making sure you do not ingest supplemental ingredients that are potentially harmful in your quest to optimize your levels of these valuable micronutrients. Most vitamins and minerals have a window of optimal intake, so the goal is to take the right amount, not too much or too little.

 

Vitamin D and Calcium

Even though most people are deficient in Vitamin D, too much can also be suboptimal, so blood tests are often recommended to assure the proper level of supplementation. The multivitamin/mineral I make available at www.drfuhrman.com contains 2,000 IU of vitamin D
3
, an appropriate amount for the majority of individuals, even though some people could require more. Vitamin D is a critical nutrient, not just for your bones but also for general protection against heart disease, cancer, autoimmune disease, and many other health problems. Taking this higher level of Vitamin D has been shown to offer benefits to diabetics.
25
The ideal amount of vitamin D supplementation is best determined by blood work. The 25-hydroxy vitamin D level ideally should be between 30 and 50 ng/ml. I do not recommend high-dose calcium supplementation under the false pretense that it is good for the bones. In fact, too much calcium can weaken bones and can even contribute to calcifications in the vascular system.
26
Extra calcium is not required for people following my nutritional guidance because the diet has adequate calcium already.

 

Long-Chain Omega-3 (EPA and DHA)

I also recommend a supplement supplying the long-chain omega-3 fatty acids EPA and DHA. DHA is essential for optimal brain and eye function, and EPA is particularly protective and therapeutic for depression.
27
Deficiency poses increased risks to diabetics.
28
Conversely, adequate intake of long-chain omega-3 has been shown to benefit diabetics.
29
This can pose a challenge, however, because most DHA and EPA are derived from fish oil, and fish has been demonstrated to actually worsen diabetes.
30
In fact, fish intake showed a 22 percent higher risk for diabetes when comparing five or more servings per week with less than one serving per week.
31
Therefore, I recommend fish only in limited quantities, which are sufficient to assure adequacy in these fats. Though the body can make some EPA and DHA from walnuts, flaxseeds, and greens, the conversion is variable from person to person and the levels in most vegans are suboptimal. Besides, few people consume enough walnuts and flaxseeds every day to assure adequate DHA production. Supplemental DHA and EPA is a good idea for nutritional assurance, especially for diabetics.

However, I do not recommend fish oil capsules regularly because each capsule contains about 1,000 milligrams of oil, and this high dose of fish fat may have a negative effect on diabetes. The goal is to prevent deficiency, not supply excess. Instead, 150 to 300 milligrams a day is sufficient. Consider the algae-sourced DHA supplements available or DHA/EPA Purity, which provides a clean and effective source of these omega-3s without harvesting fish and without overdosing on fatty acids. I do not recommend the pharmacologic use of high-dose fish oil to lower cholesterol and triglycerides, because those dosages are not without risks.

 

Thiamine (Vitamin B
1
)

Another supplement to consider taking if you have diabetes is thiamine (Vitamin B
1
). Studies indicate thiamine deficiency often accompanies diabetes.
32
The higher the glucose levels, the more likely you are thiamine deficient, as thiamine is lost as glucose is excreted. Furthermore, even a mild deficiency of thiamine can promote complications of diabetes.
33

Supplemental thiamine can help protect the kidney in the diabetic. Thiamine deficiency in diabetics is linked to increased oxidative stress and damage to kidney and nerves.
34
Studies have demonstrated that diabetics benefit from taking extra thiamine.
35
Diabetic nephropathy, neuropathy, and possibly retinopathy have been shown to improve with thiamine supplementation.
36

I typically recommend that people with active diabetes in the process of reversal ingest about 10 to 20 milligrams a day of extra thiamine, that is about ten times the normal recommended daily intake. However, once the diabetic issues are resolved, this need not continue. Many health professionals use a much higher dose, which would only make sense if the glucose was very high and uncontrolled even with medications, but this is not the case with people following my nutritional guidelines.

 

Alpha Lipoic Acid

Even though alpha lipoic acid is commonly touted as an important supplement for diabetics, its use is questionable. When given intravenously, it has been shown to have some benefit to diabetic neuropathy, but its usefulness orally is not proven. Alpha lipoic acid is already available among the hundreds of beneficial compounds in green vegetables. The bottom line is that if you are following this program to reverse diabetes, it is unlikely that adding an alpha lipoic acid supplement will offer additional protection. However, people with neurological problems from their diabetes, especially if they are eating a diabetes-promoting diet, would be reasonable candidates for this type of therapy.

 

Glucose-Lowering Plants and Herbs

Supplementing your diet with herbs and plants to lower glucose is reasonable, both in capsule form and added into dishes. A few grams of cinnamon have demonstrated benefits at lowering blood glucose and improving lipid parameters without apparent side effects.
37
Gymnema sylvestre is also mildly effective.
38
Powdered fenugreek seeds require too large a dose to be effective so are more difficult to utilize.
39
There are other plants and plant extracts that have little side effects and have been shown to mildly lower blood sugar. They include green tea, acacia extract, hops, bitter melon, and nopales cactus.
40

Though these plant extracts are not as strong as blood-glucose- lowering medications are, the advantage of using natural agents is that, by themselves, they do not cause hypoglycemia. On the other hand, they do not address the main cause of diabetes. I find that most of my patients do not need these aids to adequately control their blood sugar because the diet and exercise program is so effective. However, in cases where extra help is needed, a combination of natural plant extracts can be added to the protocol, which can further reduce or eliminate the need for medications and their significant side-effect profile.

 

Plant Sterols and Pomegranate Extracts

Plant sterols and pomegranate extracts may also be considered for their lipid-lowering and cardio-protective properties in diabetics. Plant sterols are naturally present in plant foods (especially nuts and soybeans), are structurally similar to cholesterol, and are components of plant cell membranes, similar to cholesterol in animal cell membranes. Plant sterols have long been recognized, and are FDA approved, for their capacity to reduce LDL cholesterol.
41
More than forty human studies have been published confirming their LDL-lowering properties. Plant sterol supplements can produce a decrease of approximately 15 percent in LDL levels.
42
This LDL lowering occurs in the digestive system, where plant sterols inhibit cholesterol absorption. This blocks not only absorption of dietary cholesterol but also reabsorption of the cholesterol produced by the body.
43
An interesting recent finding is that plant sterols have additionally been shown to offer protection against several cancers.
44

Pomegranates are a delicious and unique fruit that contain a wealth of beneficial phytochemicals. Their potent antioxidative compounds have been shown in medical studies to reverse atherosclerosis and lower cholesterol and blood pressure.
45
Among the antioxidant substances in pomegranates are anthocyanins, catechins, quercetins, and distinctive ellagitannins called punicalagins—punicalagins make up the bulk of the pomegranate's antioxidant load.
46
These potent antioxidative compounds are believed to be responsible for the pomegranate's numerous health benefits. In diabetics and nondiabetics alike, pomegranate reduces cholesterol, oxidative stress, and inflammation. In addition, pomegranate acts similarly to ACE-inhibiting drugs, naturally lowering blood pressure.
47
In one study of patients with severe carotid artery blockages, after taking one ounce of pomegranate juice daily for one year, on average these patients experienced a 12 percent reduction in blood pressure and a 30 percent reduction in atherosclerotic plaque. In striking contrast, the participants who did not take the pomegranate juice experienced a 9 percent increase in atherosclerotic plaque.
48
Also look for pomegranates in season, and if you can, freeze some of the seeds for use later in the year.

 

Chromium

Chromium is another nutrient commonly recommended to diabetics because those with diabetes are typically overweight and have been eating diabetic-promoting diets low in chromium. In other words, eating refined grains, sweets, and processed foods leads to chromium deficiency and worsens diabetes. A meta-analysis identified forty-one trials that evaluated the effects of various chromium formulations and dosages and found mild benefits, especially among patients whose diabetes was poorly controlled.
49

Of course, when you eat a nutritarian diet with tomatoes, onions, and greens—foods that are very high in chromium—you protect yourself from chromium deficiency and diabetes. So even though clinical trials show a modest improvement in markers of insulin resistance and glucose levels in patients who supplement with chromium, I am not certain this supplement will be of value for people following my high-micronutrient approach, as they are now receiving adequate chromium and have already curtailed foods that cause chromium deficiency.

Remember, this is not a calorie-counting plan. You can eat as much as you desire of the recommended unlimited foods. You can eat limited amounts of several other foods too. Let hunger be your guide. Do not eat until you're full. Just eat so your hunger is satisfied. You do not have to eat all the foods in the suggested guidelines and menus, and you can switch around the meals if that's what works best for you. The most favorable way to eat is to learn from experience so you know the right amount of food that will allow you to be hungry in time for the next meal. If you are not hungry before the next meal, then you have eaten too much at the prior meal. Remember, hunger is felt mostly in the throat and increases your ability to enjoy food. If you are not hungry, do not eat. You will not die if you skip a meal or two or three. Err on the side of undereating so you can make sure you are eating only when you're hungry. You will enjoy eating more when you feel you have emptied your tank before refueling. As they say, hunger is the best sauce.

CHAPTER NINE

The Six Steps to Achieving Our Health Goals

I was diagnosed late November 2006 with diabetes at the age of fifty-two. My fasting blood sugar level at the time was 160. My weight was 218 pounds. I had been prediabetic for some time, along with a strong family history of the disease.

I took this news as a personal death wish. Being a pharmacist, I know the long-term complications and risks that diabetes carries. I became determined not to let this diagnosis doom me to a life of medication and routine insulin shots.

My wife found Dr. Fuhrman's book when she was browsing through the health section at our local bookstore. It was a godsend. While I have never been a big red meat eater, the thought of evolving my diet from a chicken and fish diet to the ultimate goal of a primarily plant-based diet seemed like a huge challenge. However, I was determined to beat diabetes at any cost.

I am proud to say that Dr. Fuhrman saved my life with his eating program. And I enjoy it. My latest test results speak for themselves: Cholesterol (total) 139, LDL 79, HDL 49; blood pressure 110/75; weight 172; A1C 5.3.

The only downside (if you call it that) to this experience was my need to buy a new wardrobe. My waist size dropped from thirty-eight inches to thirty-three inches. My large shirts now hang on me like a trash bag! I have lost the fat face that you see in my before photo. Thank you so much for giving me the means to change my life and become healthy. I am a new man!

—Steve D.

Y
ou have now read lots of science and logic. Hopefully, I have motivated you to make a change. The problem for some of us is that our behavior is not controlled by logic or science; it is controlled by feelings and emotions.

Change can be very difficult for some people and easier for others. Knowledge is clearly the key that can set us free from the vicious cycle of food addiction and self-destructive eating practices. If you are one of those people who finds change difficult, then let's work together to lose the emotional baggage that could be interfering with achieving excellent health. You have to lose the fear of change and the fear of giving up the comfort foods that fuel your food addictions. Replace them with excitement about a more pleasurable and comfortable life driven by the results you will see as your body is transformed.

We must look to the big picture and focus on long-term results, not short-term recreational eating. Together, we can get rid of the on-a-diet mentality and move to becoming an expert in nutritional excellence. Part of gaining this expertise is learning some great-tasting recipes that you will love. You also have to accept that it takes time to allow your taste buds to adapt to this new way of eating. Be patient with yourself. It could take a few months to prefer this way of eating and for your taste buds to sensitize themselves to lower levels of salt, sugar, and oil in natural foods. Over time, though, you will find that you enjoy this style of eating every bit as much, and even more, than your prior diet. This becomes especially true when you see the physical results of eating food that is so good for you.

It is a good idea to have a meeting with your family members or other people you live with to explain your new diet direction and to ask for their support. Do not try to change their eating habits, but ask them if they can help you by understanding what you are doing and why. Perhaps they can read this book to help you stay focused on your new diet style and new health goals. If your loved ones feel that you aren't trying to change them but are just asking them to respect, understand, and support you in your new diet plan, they may choose to make important changes toward better health for themselves.

Support is important. If you don't have supportive family or friends, or a supportive local network, join my website membership at www.drfuhrman.com to help you interact with others who eat the same way. The connection with others is valuable. You will find you are not alone. Thousands of others are on the same path to good health and want to support you and share your life's challenges.

Lastly, please don't forget the personal rewards and sense of achievement you will receive from earning back your excellent health. This is a reward that continues year after year, a reward that multiplies over and over again when other people are positively influenced to earn back their health because of your example. You do not live alone on an island. Your health and well-being, and the positive message you radiate to those around you, affect your family, friends, fellow workers, and community, even your nation. Destructive eating may give you a momentary high, but the most pleasure in life comes from more meaningful achievements. Make the commitment to earn back excellent health, and soon you will find that healthy eating can be just as pleasurable. Every day on this program places you closer to improved health and a more rewarding and pleasurable life.

 

Six Essential Steps to Help You Reach Your Health Goals

 

Step #1: Make the Commitment and Write It Down

Keep track of your progress in a notebook. Start by writing down at least five reasons why you eat the foods you now do. Think of reasons why you should continue on your current course that has made you diabetic and is keeping you diabetic. This may sound like a silly exercise, but it is helpful for closure and clarity as you examine how you got to this point and how you plan to move toward health.

Then on the next page, write down the advantages of making a complete, firm, and irrevocable commitment to eating the way I am suggesting for the next twelve weeks. This means if you have diabetes, stay with the phase one dietary guidelines for the full twelve weeks. Allow time for your taste preferences to change, for your weight to drop, and for you to reduce serious health risks. Then, after the first twelve weeks, you can choose if it is the right time to make some small modifications to the program (moving to phase two) or to stay with phase one to maximize more gains. If the advantages are not immediately clear, take a moment and reflect on how your dietary habits are affecting you and everyone around you. What are the long-term dangers and consequences? This section will include why what you were eating was slowly killing you and what you hope to gain from this great change in food preferences and eating style.

Some people prefer to rationalize and protect their addictions. The desire to maintain these addictions has taken over their life despite the long-term health consequences. My guess is that these individuals did not get very far into this book. But the fact that you are still reading tells me you are ready. This step is very important because the rest of society eating the SAD will surely attempt to convince you otherwise. This notebook will prepare you for any internal conversations with yourself or any external conversations that may arise about your choices. It is the ultimate shield that protects you and enables you to confidently move toward health and a life that is not ruled by disease, medications, doctor visits, and fear.

The reason I chose twelve weeks for this firm commitment is because it takes us that long to change our taste preferences, learn new favorite recipes, and get in a rhythm of eating and enjoying this plan. Twelve weeks gets us past the stage of experimentation and into the realm of real everyday living. After twelve weeks, the health turnaround will be in full swing, and you will be seeing powerful results daily. Then it will be easy for you to feel and understand that this is a lifetime commitment to excellent health because this becomes the way we all prefer to eat and enjoy most.

After you have listed the advantages and disadvantages of your new diet style in your notebook, write down your commitment:

A commitment means that an excuse is not an excuse. There can be no excuses to break this commitment. Addicts always have excuses. They always have a reason or rationalization to explain why their lifestyle change did not work or was too difficult.

“It is too difficult a time right now”; “I had to travel on my job”; “I am invited to a wedding”; “My son smashed up the car”; “I am having trouble at work” are all common excuses. The reality, however, is that life is stressful and change is difficult, but a commitment means you do it no matter what. Do not
try
to do this because trying means you will accept an excuse not to do it. Instead, commit no matter what life throws your way and no matter how much effort it takes. Things that have huge value require effort. Giving it a
try
is the formula for failure. Moderation means failure. Great success means a significant effort is usually required. Doing it
no matter what
is the formula for success. It is the formula that all successful individuals use to achieve great results.

 

Step #2: Draw Up a “Business Plan”

Regardless of the scale of any venture, a business plan is an invaluable asset. It is a map of how you plan to achieve your goals. I believe a plan is essential for success. Let's start by creating a weekly schedule. First work on the plan on scrap paper, and then write it in your notebook. The plan should consist of determining your food shopping days, what to buy and where, which days to do your cooking, what you cook, and what you plan to save as leftovers for the days you are not cooking. It should also include what days you exercise and what exercises you do on those days. All of these details need be part of your weekly planner. The more precise you are with the plan, the easier the follow-through as your days unfold. This step is essential for creating the important balance between your job, your diet, your exercise, and other details in your life. This plan will make sure this program is accessible no matter how busy you are.

Most people use weekends to do a big food shopping trip as well as their major weekly cooking. It's a good idea to make a big pot of veggie-bean soup, a salad dressing, and a cooked vegetable. Then you have food to use as leftovers for the main part of the week. You may also consider doing another small shopping trip and a food preparation session on a smaller scale, perhaps on an evening you take off from going to the gym. Sometimes frozen vegetables or canned beans can be used so you can exercise instead of cooking one night. When writing your business plan, choose which recipes you are going to make and the foods you have to buy to prepare them. Now you have your diet plan for the week.

Write your business plan in the form of a weekly calendar so you can see when you shop, cook, exercise, and do other errands and recreational activities. Planning is essential for success. You have to plan to make sure this program fits into your life. You don't always have to cook, but you always have to plan.

 

Step #3: Track Your Progress

Next, make a section in your notebook to track your medications, your weight, your blood pressure, your blood sugar, and your lab tests. Add an entry at least twice weekly documenting your progress, and include how many pounds away you are from your goal weight. Also write down the exercises you do and the length and vigor of the exercise so you can record your increases in exercise tolerance. This all will make it easy to reduce your medications at the appropriate rate and time.

It has been shown in medical studies that keeping a diet diary to record everything you eat helps with staying on a diet. This is not necessary for everyone, but I believe it is valuable to have the stats and details at your fingertips. Tracking progress can be a powerful motivator. Not only are you feeling better, more energetic, and losing weight, but also you have all the data to prove it.

 

Step #4: Make It Public

Now make your commitment public. Tell at least six people that you are making a radical change in your diet and your health. Tell them about this book, why you are making this commitment, and what you hope to achieve. Putting your commitment out in public makes it harder to turn back. Voicing your commitment to others makes it more established in your mind and makes it easier to resist the temptation of just eating your old way. It is common to receive a skeptical and discouraging response in return, sometimes even from your physician. That should only harden your desire and ability to prove them wrong. You are now in control of your life and your health. It is not up to your physician, friends, or family. Doing what everyone else does got you into this mess to begin with. Now it is up to you. You now know more than they do about getting healthy. You can do whatever it takes to earn back your health. Thousands of people have succeeded, and so can you. There is no turning back.

 

Step #5: Make Your Kitchen Healthy

Start by ridding your home of all unhealthy foods that you no longer intend to eat. Stocking your refrigerator and cupboards with the right ingredients for your diet and discarding the diabetes unfavorable foods is a major step. If you are living with people who cannot go along with excellent nutrition, separate the storage areas for your food. Use a different refrigerator for the unhealthy food or use a separate area of the main refrigerator. Get rid of or separate other food items as well. Put a big label on that section that says your name and
Don't Touch.
Give your spouse or others you live with permission to offer you help if you need it. They have to be instructed, “Don't let me eat the food that you are saving for yourself.” Don't forget that if you are having problems committing to this program, it helps to talk with others who have done it and are doing it. You can find a support group on my website, www .drfuhrman.com.

Stock up on plenty of fresh and frozen fruits and vegetables. Buy many varieties of dried beans. Also buy some canned beans. Look for brands without salt, usually available in health food stores. The kitchen should become health central. It is vital to have it stocked and ready to help you help yourself. Roll up your sleeves, and let's get to work.