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P h y s i c i a n s c o m m i t t e e f o r r e s P o n s i b l e m e d i c i n e
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Diabetes Basics
I
n the past ew years, much o what we thought weknew about diabetes has been turned on its head. Newunderstanding o the nutritional causes o diabetes givesus the power to keep it rom occurring or to turn it around.Here is what is supposed to happen: Our bodies turn starchy and sweet oods into glucose or our muscle cells to use or uel.Insulin, a hormone made in the pancreas, ushers glucose intothe cells. People with type 2 diabetes, the most common type,
Diet and Diabetes:
Recipes or Success
generally have enough insulin. However, their cells becomeresistant to it, leaving too much glucose in the bloodstream,where it can cause problemsOver the short run, people with uncontrolled diabetes may eel tired, thirsty, urinate requently, and notice blurred vision.In the long run, they are at risk or heart disease, kidney problems, vision loss, nerve damage, and other diculties.
Dietary Approaches to Diabetes
Diabetes diets typically call or portion control, carbohydratelimits and, or those who are overweight, calorie restrictions.Fortunately, there is another way.
Low-at, plant-based dietsare ideal or diabetes
and the conditions associated withit, such as heart disease, weight gain, high cholesterol, andhigh blood pressure. And, they oer the nice advantage o not requiring any weighing or measuring o portions. Goinghungry is not necessary!Te old approach had us cutting down on carbohydrates. It’strue that overly processed carbohydrates—those made withsugar or white our, or example—are poor choices. However,delicious unprocessed or minimally-processed oods, suchas potatoes, rice, oats, beans, pasta, ruit, and vegetables,were the main part o the diet in countries where peoplewere traditionally t and trim and where diabetes wasrare. Unortunately, highly processed carbohydrates andaordable meat and cheese dishes have moved in, and nowwe have a worldwide type 2 diabetes epidemic.A low-at vegetarian approach recognizes that whole-oodcarbohydrates are ne; it’s the at in our diets that is the problem.New inormation suggests that at in animal products and oilsintereres with insulin’s ability to move glucose into the cells.
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Eating less at reduces body at. Less body at allows insulin todo its job.
However, choosing skinless chicken, skim milk and baked fsh is not enough o a change or most people tobeat diabetes.
Te new approach eliminates atty oods and animal protein,such as meats, dairy products, and oils, and oers unlimitedgrains, legumes, ruits, and vegetables. One study ound that
 
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21 o 23 patients on oral medications and 13 o 17 patients oninsulin were able to get o o their medications afer 26 days ona near-vegetarian diet and exercise program.
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During two- andthree-year ollow-ups, most people with diabetes treated withthis regimen have retained their gains.
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Te dietary changes aresimple, but proound, and they work.A 2006 study, conducted by the Physicians Committee orResponsible Medicine with the George Washington University and the University o oronto, looked at the health benets o a low-at, unrened, vegan diet (excluding all animal products)in people with type 2 diabetes.
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Portions o vegetables, grains,ruits, and legumes were unlimited. he vegan diet groupwas compared with a group ollowing a portion-controlled,higher-at diet based on American Diabetes Association (ADA)guidelines. Te results o this 22-week study were astounding:
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Forty-three percent o the vegan group and 26 percent o the ADA group reduced their diabetes medications. Amongthose whose medications remained constant, the vegangroup lowered hemoglobin A1C, an index o long-termblood glucose control, by 1.2 points, three times the changein the ADA group.
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he vegan group lost an average o about 13 pounds,compared with about 9 pounds in the ADA group.
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Among those participants who didn’t change their lipid-lowering medications, the vegan group also had moresubstantial decreases in their total and LDL cholesterollevels compared to the ADA group.
his study illustrates that a plant-based diet candramatically improve the health o people with diabetes.It also shows that people ound this way o eating highly acceptable and easy to ollow.
ype 1 Diabetes and Diet
While people with type 2 diabetes can ofen reduce, andsometimes eliminate, medications when they lose weight andood and exercise are better controlled, those with type 1 diabeteswill always need insulin. Even so, a good diet can minimize theamount o insulin required. ype 1 diabetes, ormerly called“childhood onset diabetes,” occurs when the pancreas stopsproducing insulin. Te cause o type 1 diabetes remains elusive.Several studies have implicated cow’s milk consumption as apossible contributor.
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When milk consumption patterns wereexamined across various nations, there was a strong correlationwith the incidence o type 1 diabetes. It may be that milk proteins cause an autoimmune reaction in which the body mistakenly attacks its own insulin-producing cells. For thisreason, among others, the American Academy o Pediatricsno longer recommends unmodied cow’s milk or inants.When breast-eeding women ingest dairy products, the cow’smilk proteins end up in their own breast milk. For this reason,breasteeding mothers may do well to avoid cow’s milk untilmore research is completed
Te Remarkably-Simple New Dietary Approachto Diabetes:
Give It a 3-Week Trial. What HaveYou Got to Lose?
1. Begin a Vegan Diet: Avoid Animal Products.
A
vegan
diet has no animal products at all: No red meat,poultry, pork, sh, dairy products, and eggs. Why? Animalproducts contain
saturated 
at, which is linked to heart disease,insulin resistance, and certain orms o cancer. Tey also containcholesterol and, o course, animal protein. It may surprise youto learn that diets high in animal protein can aggravate kidney problems and calcium losses. All the protein you need can beound in whole grains, legumes, and even vegetables: that’swhere strong horses, bulls, and elephants get their protein.
2. Avoid Added Vegetable Oils and Other High-Fat Foods.
 Although vegetable oils are healthier than animal ats, youwill still want to keep them to a minimum. All ats and oils arehighly concentrated in calories. A gram o any at or oil containsnine calories, compared with only our calories or a gram o carbohydrate. Te amount o at we really need each day is quitesmall and readily available by eating whole oods.Avoid oily toppings and oods ried in oil. Limit olives,avocados, nuts, and peanut butter. Read labels, and choose oodswith no more than 2–3 grams o at per serving.
3. Favor Foods with a Low Glycemic Index.
Te glycemic index identies oods that increase blood sugarrapidly. Tis handy tool allows you to avor oods that havemuch less eect on blood sugar.
Quick Glycemic Guide
High-GI 
(avoid)
Low-GI 
(enjoy)White or wheat breadMost cold cerealsWatermelon, pineappleBaking potatoesSugar Pumpernickel, rye,multigrain, or sourdough breadOld-ashioned oatmeal,bran cerealsMost ruitsSweet potatoesPastaRice, barley, couscous,quinoaBeans, peas, lentilsMost vegetables 
4. Go High-Fiber.
Aim or at least 40 grams o ber each day. Choose beans, vegetables, ruits, and whole grains (e.g., whole wheat pasta,barley, oats, quinoa). Aim or at least 3 grams/ber perserving on labels and 10 to 15 grams per meal. Start slowly.Expect a change in bowel habits (usually or the better).
 
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Gassiness rom beans can be minimized with small servingsand thorough cooking.
5. Focus on the “New Four Food Groups.”
Enjoy unlimited whole grains, legumes (beans, lentils, peas),ruits and vegetables. Modest amounts o nonat condiments,salad dressings, nuts, and seeds also ne. See the resourcesbelow or more inormation.
A note on vitamin B12:
Tose ollowing a diet ree o animalproducts should take a B12 supplement o 5 micrograms per day.Any common daily multiple vitamin will provide this amount.
Additional Resources
For more inormation, visit these Web sites or pcrm.org/shop
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www.NutritionMD.org 
(ry the Meal Planner ool)
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www.FoodForLieV.org 
(Weekly Web-casts, with our coreclasses on type 2 diabetes)
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www.pcrm.org/diabetes
(Message Board and otherresources)
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Dr. Neal Barnard’s Program or Reversing Diabetes: TeScientically Proven System or Reversing Diabetes Without Drugs
by Neal D. Barnard, M.D.
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A New Approach to Nutrition or Diabetes
(DVD)
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Breaking the Food Seduction: Te Hidden Reasons Behind Food Cravings—and Seven Steps to End Tem Naturally
by Neal D. Barnard, M.D.
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Te McDougall Quick & Easy Cookbook: Over 300 DeliciousLow-Fat Recipes You Can Prepare in Fifeen Minutes or Less
 by John A. McDougall, M.D., and Mary McDougall
Pasta with Lentil Marinara Sauce
1 pound pasta o choice1 jar (26 ounces) at-ree, low-sodium, tomato-based pastasauce1 can (15 ounces) lentils, rinsed and drained1/2 cup dry red wine (can be nonalcoholic) or low-sodium vegetarian brothSalt to tasteFreshly ground black pepperCook the pasta according to package directions.Meanwhile, combine the pasta sauce, lentils, and wine or brothin a medium saucepan. Heat gently and season with the saltand pepper. Serve over the drained pasta.Makes 5 servings
Per serving: 470 calories, 19 g protein, 91 g carbohydrates, 9 g sugar, 2 g totalat, 3% calories rom at, 0 mg cholesterol, 8 g ber, 173 mg sodium.
Cherry omato and Brown Rice Salad withArtichoke Hearts
Tis delicious salad is a complete meal and is a great picnic orpotluck dish. Because neither tomatoes nor rice benet romrerigeration, it should served at room temperature.3 cups warm brown basmati rice6 ounces marinated artichoke hearts, rinsed in hot water,drained, and sliced1 cup chopped scallions1 1/2 pounds red, yellow, or mixed cherry tomatoes, halved1/2 cup chopped resh basil1/2 cup at-ree Italian dressing3 tablespoons lemon juice2 cloves garlic, crushed1/4 teaspoon saltFreshly ground black pepper to taste1 head crisp lettucePlace the rice in a large salad bowl and add the artichokehearts, scallions, tomatoes, and basil. Mix gently.Combine the Italian dressing, lemon juice, garlic, salt, andpepper in a small bowl or jar. Whisk or shake until wellblended. Pour over the salad and mix gently. Serve on beds o lettuce on individual plates.Makes 6 servings
Per serving: 153 calories, 4 g protein, 32 g carbohydrates, 3 g sugar, 1 g totalat, 6% calories rom at, 0 mg cholesterol, 4 g ber, 376 mg sodium
Berry Mousse
Tis is so easy that it’s hardly a recipe! Your blender does mosto the work. Tis can be eaten as a pudding or used as a top-ping or ruit.1 package (12.3 ounces) reduced-at extra-rm silken tou,crumbled2 3/4 cups thawed rozen unsweetened berries o choice3 tablespoons sugar or 2 tablespoons agave nectar1 tablespoon berry liqueur (optional)Blend the tou, berries, sugar or agave nectar, and liqueur, i using, in a blender or ood processor until smooth. Spoon into4 pudding dishes and rerigerate until chilled.Makes 4 servings
Per serving: 123 calories, 7 g protein, 24 g carbohydrates, 17 g sugar, 1 g totalat, 5% calories rom at, 0 mg cholesterol, 3 g ber, 89 mg sodium
Recipes rom
Dr. Neal Barnard’s Program or Reversing Diabetes: heScientically Proven System or Reversing Diabetes Without Drugs
by NealD. Barnard, M.D. Recipes by Bryanna Clark Grogan.
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