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More on the Right Attitude: Surviving the Holidays when You Have Diabetes: Top Ten Tips from LCA
One thing that’s certain in our society is that every year, right around the time we are most sedentary, the holiday season will come with all its attendant snacks, feasts, and stresses. As children, many of us looked forward to the holiday season of fun, gifts, and treats with eager anticipation. And even as adults it can still be a wonderful experience. But for some it can be a sad and lonely time of the year. A number of factors can contribute to such feelings, including increased financial stress, fatigue, recent personal loss, unrealistic expectations, inability to be with family, memories of past holiday celebrations, change in diet, and change in daily routines. These symptoms are almost identical to clinical depression: loss of interest in activities you usually find pleasurable; unintentional weight loss or weight gain; inability to sleep, or sleeping too much; feelings of worthlessness or inappropriate guilt; and a diminished ability to concentrate. Doesn’t sound like a very Merry Christmas, Happy Hanukkah or Good Kwanzaa. If you struggle with the holiday blues there are some things that you can do, and ways you can think, to alleviate some self-inflicted suffering: 1. Denial is not a river in Egypt. Try not to fall into thinking, “I’ll worry about my health goals after the holidays.” As we’ve all experienced, “the holidays” can easily run continuously from the Jewish holidays or Thanksgiving, through Christmas, Hanukkah and Kwanzaa, and on through New Years (and some go even further through the Superbowl! Why not just continue the season to St. Patrick’s Day while were’ at it?). If your goal is overcoming insulin resistance, weight loss, maintaining your healthy weight,
or keeping your blood sugars down, you’re going to have to continue to monitor your progress—and follow your program of eating right and staying physically active, even through the holidays. 2. Pencil it in. Stick to your usual schedule during the holidaysi. To the extent that you can, don’t mess up your usual routine (e.g. IT six days a week, etc.), which might allow you “permission” to stray from your goals. 3. Weigh to go. A recent study in the New England Journal of Medicineii found that daily weighing was the key to keeping weight off. The study found that those who weighed themselves every day were 82 percent less likely to regain weight they had lost. The main factor here is not the weighing alone – “Hey, look, I gained another five pounds! Pass the rum balls!” – but your willingness to make daily adjustments based on what the scale tells. We encourage you to weigh yourself daily, even over the holidays, and use this information to motivate you to go for an extra stroll, refrain from quite so much snacking, and limit your portion sizes, especially during the evening meal. If, like many people, you don’t believe in daily weighing, consider weighing yourself weekly, at least, and make adjustments accordingly. 4. Leave leftovers. We suggest you limit celebrations to one-day events—and whatever you do, don’t keep leftovers around! Give food away, send it home with someone else, and if you have to, don’t be afraid to dump it. Remember: all excess food goes to either to “waste” or to “waist.” You decide which. Studies show that the more side dishes and little bowls of leftovers you bring out of the refrigerator, the more you will eatiii. Your eating the extra food or keeping it temptingly around won’t help a starving child anywhere.
5. Set limits. Before the celebration, determine what you’re going to eat, and how much. A lot of problems come simply because we don’t think before we act. The day of the celebration, adjust your meals accordingly. For example, if you know you’re going to a house party at 4 p.m., eat a large, healthy, fiber-filled lunch at home at 2. That’s right: break your mother’s old rule and deliberately spoil your appetite—with good food. Whenever possible, try to eat your main meal at lunchtime instead of suppertime. A great way to ensure this happens at holiday time is to start hosting the parties yourself. This way you can control the kinds of foods you eat and the time you eat them, as well as introducing your loved ones to the wonders of the PBD. We’ll have some special holiday recipes in the upcoming LCA cookbook, “The 30 Day Diabetes Miracle Cookbook” coming out later this year from Perigee. You can also try keeping a journal of what you eat and how much. Monitoring your behavior is a proven way of changing your behavior positivelyiv v. If you’re planning to eat some sweets, make the portions as small as possible, and load up on the good stuff (Sid Lloyd, the CEO of LCA’s parent foundation likes to say, “That veggie platter at the end of the buffet is ALL FOR YOU!”) 6. Keep it real. Keep your expectations high, as we tend to rise to the level of our own expectations. But don’t expect that you must be perfect. Setting your specific expectations too high (saying on Christmas day, “I’m going to lose five pounds before New Year’s”) can cause undue stress and anxiety. 7. Walk it off. Go for a stroll before and after the celebration: keep up your physical Activity Program. Burn those calories you intend to eat or you’ve just eaten. 8. USA! USA! Don’t forget Unconditional Self-Acceptance. If you blow it, don’t get down on yourself. Acknowledge the mistake and move on. Get back on the scale the
next morning, continue to monitor your blood sugars, and make the necessary adjustments. As they say in the recovery business, don’t let a lapse turn into a relapse. 9. Change it up. Create new, healthful holiday traditions. Sometimes hanging onto the past can trigger memories that contribute to a depressive moodvi. Certainly hanging onto past holiday eating habits can sabotage your health plan. 10. Have fun. Remember the motivation triad? We are all motivated to seek pleasure and avoid pain, with as little energy output as possible. During the holidays, as ever, focus on pleasure rather than pain. Focus on what you are getting by your new lifestyle (health, vitality, strength, pride, longer life) and what gives you pleasure (gift-giving, family, home and hearth)—rather than on what you are “giving up” (pie, cookies, ham). If you feel like you have to “give something up,” you will feel deprived. If you focus on what you’re getting and what you’ve got, you will find pleasure.
Counseling Today, December, 2000. Wing RR, Tate DF, Gorin AA et al. “A Self-Regulation Program for Maintenance of Weight Loss.” NEJM. 2006, 33(15):1563-1571. iii Wansink, Brian. Mindless Eating. New York: Bantam Books, 2006, 76. This idea reminds us of an old “Lockhorns” comic strip by Bunny Hoest and John Reiner (King Features Syndicate): Leroy looks up from his dinner plate and asks Loretta, “This side dish – whose side is it on?” iv Klem ML, Wing RR, McGuire MT, et al. “A descriptive study of individuals successful at long‐term maintenance of substantial weight loss.” Am J Clin Nutr. 1997, 66:239‐246.
Bandini LG, Schoeller DA, Cyr HN, Dietz WH. “Validity of reported energy intake in obese and nonobese adolescents.” Am J Clin Nutr. 1990,52:421-425. vi Counseling Today Dec 2000.
A History of Vegetarianism
Notwithstanding all our doom-saying about the Standard American Diet (SAD), the majority of the world’s population is more vegetarian than not. Most indigenous cultures have historically based their diets on plant foods, and those that ate meat tended to use it either as a “condiment” (a very small “side dish”) or as a feast food for special celebrations, rather than a staple article of the daily diet. Of course, most of the world’s vegetarians are not doing so by choice alone. Meat is expensive, in more ways than one, especially for native peoples living off the land. In addition, there are various religious and cultural constraints against the daily consumption of meat. The majority of Americans, on the other hand, are omnivores. We eat animal- and plantbased foods. It’s interesting that there are probably far fewer strict carnivores than strict vegetarians in the world. Having said that, American omnivores’ orientation to food is very much animal-based. Consider the typical answer to a common question, “What’s for dinner?” The answer is usually something that had a face and a mother (“Brisket,” “Steak,” “Chicken,” “Pork chops,” or “Fish,” for example), and the plant food is considered the sad little side dish. A vegetarian, by contrast, finds it hard to give a one-word answer to the question, “What’s for dinner?” because dinner has a lot more variety. In the Western world, people tend to be vegetarians by choice. It would have to be a choice, so strong are the cultural and economic incentives to subscribe to the SAD. Just how many vegetarians are there out there? That’s harder to track than you might think.
First, a little bit of history. The Greek philosopher and mathematician Pythagoras (yeah, the triangle guy) is considered the granddaddy of vegetarianism. His cronies like Socrates, Plato, and Virgil, were similarly inclined. For thousands of years, health, ethics, and piety were all cited as rationales for deliberately not eating animal productsi. The vegetarian movement did not take hold in American until the 1800s, where at first it was largely church-related. Many Christians proposed that Adam and Eve were vegetarian; it was the diet God intended. The Seventh-Day Adventist Church (SDA), co-founded by Ellen G. White in the mid-19th Century, was a principle proponent of a plant-based diet, mainly for health reasons. Mrs. White writes, “Grains, fruits, nuts, and vegetables constitute the diet chosen for us by our Creator. These foods prepared in as simple and natural a manner as possible, are the most healthful and nourishingii.” About 40 percent of today’s SDA members are still vegetarian. As a result, their health and longevity have been studied in great detail. We’ll talk more about that later, but suffice to say, they’re in better shape than the general population. Toward the middle of the 20th Century, protein was all the rage (and protein meant “meat” to most people). Vitamins had recently been discovered, and they, too, were associated with animal foods. Despite all that, a 1943 Gallup poll showed somewhere between 2.5 and three million Americans, or two percent of the population, still identified themselves as vegetarianiii. In 1944, the word “vegan” (pronounced “vee-gun”) was coined in England by individuals who had become frustrated over the fact that vegetarians commonly consumed dairy products. “Vegan” is derived from the first three and last two letters of the word “vegetarian.” True vegans consume no animal products at all, whereas many people who call themselves vegetarians eat dairy, eggs, and sometimes fish.
The numbers of vegetarians steadily increased, especially during the health-conscious “counterculture” in the 1960s and 1970s. Then the number of vegetarians in the U.S. doubled between 1985 and 1992, when a Gallup polliv revealed that 12 million adults considered themselves vegetarianv. The Vegetarian Resource Group conducted its own poll in 2000, and discovered that about 4.8 million adults, or about 2.5 percent of the U.S. population, was vegetarianvi. In a 2002 Time/CNN Harris Interactive survey, four percent of Americans polled called themselves vegetariansvii. In 2003, another study showed that number of U.S. vegetarians at around 2.8 percentviii. It seems safe to say that somewhere about 3 percent of Americans generally don’t eat meat. It’s interesting to note, though, that upwards of 10 percent of Americans call themselves vegetarian. This indicates to us that a great number of people are leaning in a vegetarian direction. You can now order a Veggie Burger at Burger Kingix, and similar vegetarian and vegan items from most fast food and family style sit-down restaurants. Target, Wal-Mart, and nearly all major grocery chains carry multiple products targeted to vegetarians. Health food stores and natural markets are thriving. Soy milk has its own section in all the chain stores, and even Mom and Pop stores sell it now. You can get vegetarian meals at Camden Yards and Comiskey Park: in fact, more than half of all Major League ball parks now serve vegetarian burgers, veggie dogs, or other non-meat main course optionsx. College and university food service managers report that up to 40 percent of students request vegetarian food options. Many traditional Mexican restaurants – even those in the American heartland – now serve refried beans made without lard. On a recent visit to New York City, home of famous steak houses, eight-inch-high deli
sandwiches, and hot dog vendors, we found one of the city’s several vegan restaurantsxi packed at 9 p.m. on a Wednesday night. USA Today reported in 2004 that the vegetarian food industry was positively booming. Total U.S. retail sales of vegetarian foods, including soy milk and other dairy alternatives had been $730 million in 1998. By 2003, it had doubled to $1.6 billionxii. Despite the alarming statistics we quoted about the SAD in chapter 2, the tide is turning toward healthier, more natural foods. And that, as Martha Stewart would say, is a good thing. It’s not all whippersnappers embracing this vegetarian lifestyle, either. A 1992 pollxiii showed that vegetarianism is not restricted to the young. More than 55 percent of self-identified vegetarians in the U.S. were over age 40. This resurgence of interest since the 1980s and 90s is mainly health-related, surveys show (plus we think the association vegetarianism used to have with fringe and “hippie” cultures is largely gone – in fact, it is possible those “old hippies” are now CEOs of companies that are producing many vegetarian products!).
Why “Plant-Based” and Not “Vegan?” Because we’ve bandied a few words around in this chapter, we want to clarify here what we mean by “plant-based diet.” When we advocate a plant-based diet (PBD), we mean to say we believe the best chance you have to combat diabetes and other diseases is to base as much of your diet as possible on plant foods, and to eliminate or at least extremely restrict your intake of animal foods, including beef, poultry, pork, fish, eggs and dairy. While this is by and large what
many would consider a vegan diet, we don’t generally use the term “vegan” at LCA for a few reasons: • To some people, the term vegan means a total lifestyle of eliminating everything from life that is derived from an animal source. This not only includes animal products in the diet, but also animal products used for clothing or any other purpose. • Some also associate the word “vegan” with certain political and social movements that are considered by many as extreme in nature. • Our purpose for recommending a total plant-based diet is strictly to improve your health. Our philosophy is not based on any other ethical, political, or social reasons. • While we strongly recommend you follow a strict plant-based diet (in other words, vegan diet) to get the maximum health benefits, the term and concept of “plantbased” allows for occasional flexibility. As T. Colin Campbell puts it, you should try to avoid all animal products if you want to maximize your health—but you shouldn’t “obsessxiv.” Our intention in this book is to show you the evidence behind the benefits of a plant-based diet on conquering diabetes, but then let you decide the extent to which you want to follow that advice. If you really like a particular soup at your favorite Thai restaurant, but you find out there’s some fish in the stock—you don’t have to feel guilty for eating it. The amount of fish you’d be eating is nutritionally insignificant. Even though we don’t generally use the term “vegan” at LCA to describe ourselves, others are more likely to use the term “vegan” than “plant-based.” When you are seeking restaurants or menu items to order, shopping for various packaged foods and cooking
ingredients, looking for dietary supplements, or buying cookbooks, you’re nutritionally safe when you trust the word “vegan.”
Spencer, Colin. The Heretic’s Feast: A History of Vegetarianism. Havover, NH: University Press of New England, 1995 ii White EG. “Diet and Health.” In The Ministry of Healing. Altamont, TN: Harvestime Books, 1999, 194. iii Gallup poll #302 9/14/1943. iv Shelly Hankelovich and White/Clancy. “The American Vegetarian: Coming of Age in the 1990s. A Study of the Vegetarian Marketplace Conducted for the Vegetarian Times.” Shulman, Inc., 1992. v Virginia Messina, Reed Mangels and Mark Messina. The Dietician’s Guide to Vegetarian Diets Second Ed. Jones and Bartlett Publishers, 2004, 5. vi Vegetarian Resource Group (VRG) Zogby poll. vii “How Many Vegetarians Are There?” A 2003 National Harris Interactive Survey Question Sponsored by the Vegetarian Resource Group. Press Release July 1, 2003. viii Vegetarian Resource Group (VRG). ix “How Many Vegetarians Are There?” A 2003 National Harris Interactive Survey Question Sponsored by the Vegetarian Resource Group. Press Release July 1, 2003. x “Vegetarian and Vegan Foods at Major League Ball Parks”. The Vegetarian Resource Group. Press Release, June 1, 1999. xi Candle 79 on 79th Street and Lexington Ave. is the “upscale” second location of the longstanding Candle Café, a few blocks south. The food is fantastic at both. xii USA Today. February 2004. xiii Shelly Yankelovich and White/Clancy. “The American Vegetarian: Coming of Age in the 1990s. A Study of the Vegetarian Marketplace Conducted for the Vegetarian Times.” Shulman Inc., 1992, 242. xiv Campbell, T. Colin. The China Study. Dallas: BenBella Books, 2004, 242.
Lies, damn lies, and advertising
What’s driving our constant, restless quest to be driven? Look no further than Madison Avenue. Everything the advertising industry puts in front of us is deliberately “More” and “Better” that the stuff we presently have. It’s Better Homes & Gardens, after all—not So-so Homes & Gardens Kinda’ Like Yours. The goal is to make you feel less satisfied. Less privileged. Lesser. Sid Lloyd, the CEO of LCA’s parent foundation, puts it this way: Ever gone through a model home? There’s no punch list on those babies. Everything is immaculate, ergonomic, high-tech, and reeks of quality. In the big, beautiful kitchen, there’s the requisite massive stainless steel fridge and Sub-Zero freezer. There are two ovens in many new kitchens now. “Just one oven?” some prospective homebuyers must be saying, “But how will I cook two turkeys at once?” The gas grills are enormous. The skylight is gorgeous. But there’s what you’ve been waiting for, right in the middle: an island (cue the opera music and heavenly lights). Is that Dupont Corian in Winter Wheat? No. It’s Italian marble. Built-in vegetable sink. Oh, the things you could do with an island. You could really use an island. You need an island. You deserve an island. More. Better. Now.
Of course you don’t really need it. You’ve just been looking at something designed to make you feel unhappy with what you’ve already got. If you flip this process around and visit an average home on Haiti or in Micronesia, you’d probably be very thankful for the kitchen you’ve got, even without the marble island. When you’re wiping the scum off the pond to get your drinking water, a bottle of Perrier would look like gold. There are four basic lies that advertisers and marketers tell us about “More” and “Better,” and recognizing them is a key to overcoming the forces coercing us to poor health. • Big Lie Number One is You Can Have It All! Really? Where would you put it? You know, we have the largest houses in history, per capita, by square footagei. Yet one of the fastest growing industries is storage. So we’re working endless hours to get more stuff, or to pay off the stuff we’ve already got, and meantime, we have neither the time nor the space to enjoy or even use the stuff we’ve got. And ironically, the most important “stuff” we have, our bodies, our health, is usually the last thing on our list to take care of. • Big Lie Number Two is You Can Do It All! Yachting to Australia. Getting that big promotion.. Counseling the homeless. Working on that back swing. Spending more time with your kids. Losing weight. Granted, we’re much more productive than at any point in human history. But we must be intelligent, thoughtful, and balanced about where we spend the limited resource of time. Listen to time and motion expert, Brian Tracy, who reminds us that time is inelastic, inflexible, irreplaceable, perishable, and equitableii. How do you figure out how to spend your time? How do you choose from all those competing things
you could do? How can you find the time to take care of yourself amid all the rival obligations you have? Well, first, you must figure out what matters to you, what brings you a sense of peace, success, and fulfillment. In short, what you value. When it comes to your health, you must truly value it, or you will not “find the time” to give it any attention. Even in our hyper-busy culture, people who claim they have “no time” to get active (or to prepare healthful meals, check their blood sugar, go to the doctor regularly, food-shop more carefully, or read labels) are telling themselves and the world a big lie, or what social psychologists call a “fundamental attribution error.” It’s not that you don’t have enough time. You’re just spending that time on something else. We spend our time according to what we value. Bet you’d value your life and health more – and re-allocate your time correspondingly – if you had a massive heart attack, or went into a diabetic coma from high blood sugar ten minutes from now. Suddenly your health would rise up your list of priorities, wouldn’t it? Time management expert and inspirational speaker Stephen Covey calls this the difference between doing things that are truly “important” and things that are merely “urgentiii.” Important and urgent are not synonymous. Urgent simply means it seems like it must be done now. A ringing phone is urgent—but seldom is important. We spend most of our time on these urgent things, on “putting out fires.” And as a result, we ignore the important stuff, the stuff that really matters. Making time for meditation and inspiration. Eating right. Getting active.
Sleeping properly. Drinking lots of water. Getting enough sunlight. Sadly, such things seldom seem urgent—until it’s too late, that is, or at least almost too late. Instead you have to decide to concentrate on the important stuff. You have to decide today that your health matters. That feeling good again matters. Instead of staying late slumped at your desk tonight, eating greasy junk food because of an “urgent” issue at work, consider making a different choice. Concentrate on what really matters, what’s important, what you value. How about not dying of diabetes so you can stick around to spend time with and support your family? How about having fun and weathering the hard times together with good friends? Even we workaholics can adjust our thinking without giving up our devotion to the office. How about extending and expanding your career contribution by living longer with more energy, enthusiasm, and clarity? “No time,” you say? To take care of yourself? To feel good? To live? Don’t live the lie anymore. Choose differently. This principle is pretty obvious, of course, but the vast majority of people don’t practice it. • Big Lie Number Three is You Deserve it All! No, you don’t. None of us “deserves” a big screen TV and a stable of thoroughbreds any more than someone else. But if we don’t get those things, we feel like victims. If we don’t get them, we feel deprived, diminished. Look, that guy’s got a boat! Why shouldn’t I have a boat? And when we don’t get the boat, we settle for a large bowl of ice cream with sprinkles and chocolate syrup, until the “hunger” hits us again tomorrow.
Easterbrook, Gregg. The Progress Paraxox. New York: Random House, 2003, 18. Tracy, Brian. How to Master Your Time. Audio program. Nightingale-Conant, 2003. iii Covey, Stephen R. The 7 Habits of Highly Effective People. Free Press, 1990, 150.
More on Microorganisms: Microbial and Mooing Menaces
We wrote in The 30-Day Diabetes Miracle about the dawn of the domestication of animals beginning a new era in chronic diseases such as diabetes. But with this revolution came a whole other nightmare. Health psychologist Douglas Lisle uses a nasty little term for it: Micropredatorsi. If you think as many modern scientists do, you can extend the scenario and directly blame animal foods – mainly the fat, protein, and concentrated calories – for pretty much all of our most serious problems. For example, there are dozens of strong studies supporting the idea that early introduction of cow’s milk protein wreaks havoc on Baby Laypersonrry’s body: the pancreas treats the animal protein molecules as microscopic poison and calls on the immune system to shoot to kill, often destroying its own insulin-producing beta-cells along the way, and dramatically increasing Larry’s chance of developing Type-1 diabetes as a childii iii iv v vi. Who knows what further problems we’ll create in the future by genetically modifying food, and even by cloning food? Just after Christmas, 2006, the U.S. government declared that food from cloned animals is safe to eat, and probably won’t even require special labels by the Food and Drug Administration. Here’s a fun quote from the FDA that you can hang your health hat on: Cloned livestock “is virtually indistinguishable” from conventional livestockvii. You have to love that word “virtually.” Sounds like the beginning of a Michael Crichton sci-fi movie to us. Even if cloned animals are completely indistinguishable from conventional livestock, they would still not make for an ideal diet for people with diabetes. We have’ll addressed more dangers of eating animals in chapter 2.
Douglas Lisle and Alan Goldhamer. The Pleasure Trap. Summertown TN: Healthy Living Publications, 2003. 46. ii Gerstein HC. “Cow’s milk exposure and Type 1 diabetes mellitus: A critical overview of the clinical literature.” Diabetes Care. 1994, 17:13-19. iii Scott FW. “Cow milk and insulin-dependent diabetes mellitus: is there a relationship?” Am J Clin Nutr. 1990, 51;489-491. iv Karjalainen J, Martin JM, Knip M et al. “A bovine albumin peptide as a possible trigger of insulin-dependent Diabetes Mellitus.” NEJM. 1992, 327:302-307. v Akerblom HK and Knip M. “Putative environmental factors and Type 1 diabetes” Diabetes/Metabolism Revs. 1998, 14:31-67. vi Naik RG and Palmer JP. “Preservation of beta-cell function in Type 1 diabetes.” Diabetes Rev. 1999, 7: 154182. vii See: U.S. Food and Drug Administration Center for Veterinary Medicine. Food Consumption Risks 2007 and USFDA FDA News press release, “FDA Issues Draft Documents on the Safety of Animal Clones, Dec 28, 2006. The Associated Press stories about this report ran on Dec. 29, 2006.
More on Animal-Borne Diseases: Mad Cow
There’s another sinister disease transmissible to humans from animals—bovine spongiform encephalopathy (BSE), more commonly known as “mad cow disease.” This disease is 100 percent fatal. It is has been shown to be transmissible from cows to a number of different animal species, including humans. The incubation period for the disease ranges from two and a half to eight years in cows, during which time they will show no evidence of the diseasei. This is troublesome, because a typical beef cow is taken to market between 14 and 20 months of ageii. They may show no signs of illness, yet they could still harbor the disease and transmit it to the consumer. The agent responsible for the disease is not destroyed by temperatures used for cooking meat, so thorough cooking will not offer protection. And it’s not just beef that poses a risk. Mad cow-like illnesses have been observed in deer, elk, goats, and pigsiii. There’s a concern that fish, too, might be affectediv, especially farmed fish given feed made with contaminated meat and bone meal. It remains legal in the U.S. to place renderings from cows into the feed of chickens, pigs, fish, and household pets. Likewise, it is permissible to place renderings of these animals into cow feed. This can result in animals infecting each other in a roundabout fashion. Currently the U.S. tests for mad cow disease in only one in 2,000 cows that are slaughtered: in fact, as amazing as it sounds, the USDA has stopped private ranchers from testing their herds voluntarily and at their own expensev!
Bovine Spongioform Encephalopathy – “Mad Cow Disease” Fact Sheet, USDA Food Safety and Inspection Service. ii Ritchie HD, A review of applied beef cattle nutrition, Michigan State University Extension Beef Bulletins Jan 1, 1994. iii NeuroCenter, University of Bern, Switzerland. http://www.neurocenter-bern.ch/tse_e.shtml. iv “News in Brief.” The Lancet. 2003, 361. v McNeil, Donald G., Jr. “U.S. Won’t Let Company Test All Its Cattle for Mad Cow.” New York Times. April 10, 2004.
More on Caffeine and Diabetes-Could coffee be for you after all?
Everything we say about caffeine in The 30-Day Diabetes Miracle seems to imply that caffeine makes diabetes worse, right? That’s true, but only in the short-term, and only with high doses of caffeine. Other recent studies suggest that there might be other substances in coffee besides caffeine (trimethylxanthine, for one), which actually might help certain aspects of diabetesi ii. One large study in Finland (which has the highest per-capita coffee consumption in the worldiii) shows long-term caffeine consumption is actually associated with a statistically significant lower risk for Type-2 diabetesiv. But we don’t recommend using coffee as a way to moderate diabetes. Besides increasing blood pressure and cholesterol, caffeine has other adverse effects. Caffeine is an addictive substance, specifically a central nervous system stimulant in the same general family as cocaine and methamphetamine. It keeps nerve fibers firing when they would otherwise be quiet. This artificial overstimulation interrupts the natural sleep cycle, which is a bad thing, especially if you’re trying to lose weightv. Caffeine interferes with our ability to slow down when we do eventually have time for reflection and meditation. It’s been our clinical experience that the coffee “jitters” can increase appetite, causing you to snack more.
Salazar-Martinez E, Willett WC, et.al. “Coffee consumption and risk for type 2 diabetes mellitus” Ann Intern Med. 2004, 140(1):1-8. ii Van Dam RM, Reskens EF. “Coffee consumption and risk of type 2 diabetes mellitus.” The Lancet 2002, 360:1477-1478. iii World Resources Institute. Earth trends data tables: energy and resources. “Agriculture and Food – Resource Consumption: Coffee consumption per capita.” http://earthtrends.wri.org/text/pdfs/data_tables/ene4_2003.pdf. iv In this study, those who had seven or more cups of coffee a day were 34 percent less likely to develop diabetes than drinkers of two or fewer cups a day. See: Tuomilehto J, Hu G, Bidel S, et al. “Coffee Consumption and Risk of Type 2 Diabetes Mellitus Among Middle-aged Finnish Men and Women.” JAMA. 2004, 291(10):1213-1219. Other population studies show that drinking five to six cups of coffee a day reduces diabetes risk by 61 percent for women and 30 percent for men, and drinking 10 or more cups of coffee per day reduces diabetes risk by 79 percent in women and 55 percent in men, regardless of age, weight, alcohol, or tobacco use. See: Nuovo, Jim. “Type 2 Diabetes,” in Chronic Disease Management edited by Jim Nuovo. New York: Springer, 2007, 181 v Van Cauter E, et. al. “Impact of sleep and sleep loss on neuroendocrine and metabolic function. “ Horm Res. 2007, 67 Suppl 1:2-9.
More On How To Use Cognitive Behavior Strategies To Make and Maintain Major Life Style Change: (The Case Study of Nancy)
Our patient Nancy’s story provides just one simple example of how this kind of thinking can help you. Nancy came to LCA for much the same reason most people do. She was almost without hope, and she told us we were her “last shot.” It’s not infrequent that we hear this. Every three weeks, we pick people up at the airports in Oklahoma City or Dallas, and many are in bad shape: wheelchairs or walkers, some barely able to see us because of retinopathy caused by sustained high blood sugar. Well, it’s fair to say Nancy’s blood sugar was out of control. Her eyesight was failing fast. Her weight was way above where it should have been. She also suffered from painfully inflamed nerve endings in her feet because of long term high blood sugar. Like many of our patients, her diet at home was pretty typical of Americans— SAD. So one of the first things we did was put her on a fast (don’t try this yourself without talking to your doctor first, especially if you have diabetes). The three day complete fast was no sweat for Nancy—most people find it not only surprisingly tolerable after they get through the first day, but weirdly invigorating, too. Then the fourth day came, and Nancy came down to “break her fast” with breakfast, looked at her plate, and started sobbing. Her breakfast was the usual first meal we recommend after a fast: a lovely plate of steamed vegetables. Nancy literally wept. “I can’t stand vegetables,” she whined.
We consulted our behavior counselor, Lonnie Carbaugh. Lonnie thought, uh-oh, our diet here is plant-based, and Nancy hates vegetables. Of course the food we serve goes way beyond plates of plain, steamed vegetables. It’s prepared by gourmet chefs. But still, she claims she hates to eat veggies, so gourmet or not, there was a problem. Nancy was hungry, though, so she nibbled with a sour expression on her face. Then it came to light that Nancy had yet another problem, not uncommon in our land of plenty. As a child, she’d been taught by her mother to clean her plate (you remember the old chestnut, “There are starving kids in China”? Well, that has to be updated now to, “There are obese kids with diabetes in Chinai ii.”) In any case, it was clear as Nancy picked up a baby carrot and sniffed it, this was going to be a long day. Fortunately, there was a hero at Nancy’s table. One of our doctors had already cleaned his plate, so he switched plates with Nancy, giving her permission to leave the table, now that “her” plate was empty. Lonnie’s a very positive and open-minded guy, but even he came to the early conclusion that Nancy was going to have a hard road ahead if she was going to make it on our program. She was determined—that was for sure. She muddled through, and saw improvements in her diabetes and her overall health. After Nancy left LCA, Lonnie called her every month, collecting information on how many days a week she was sticking to the plant-based diet. Usually, even people who are doing well have a slip-up and snag a burger or a candy bar every once in a while. But after six months, Nancy still hadn’t “cheated.” She was totally sticking to our diet
and physical activity program. And after nine months, she was still going strong. But she sounded really depressed. “How are you feeling?” Lonnie asked her. “I never felt so good in my life,” she said. But she said it in a depressed way, like Eeyore the donkey in Winnie-the-Pooh. “It sounds like there’s some kind of disconnect here,” said Lonnie. Nancy said, “I still can’t stand vegetables.” “Tell me about how you’re planning your daily meals.” “Well, I eat all my vegetables in the morning so I can get them out of the way. At lunch, I have more of the things that I enjoy.” Lonnie had an idea: “So how many minutes do you spend eating vegetables every day?” “Maybe about fifteen.” “So you’re telling me that for fifteen minutes a day you’re miserable, but for the rest of the day you feel better than you ever have before?” “Hmm. I guess I am saying that.” Put that way, it didn’t sound so terrible. Lonnie called Nancy back a year later: “I’ve never felt so great in my life!” she proclaimed. She was sticking to the LCA plan. She had gone from a size 16 to a size 8. Her eyes were back to normal, and her diabetic neuropathy (nerve pain and numbness in the
feet and legs) was gone. She had tons more energy, too. Her life had changed dramatically. Nancy reminded herself that prior to coming to LCA, she’d felt quite a bit more “miserable,” and for much more than 15 minutes a day. There were three keys to Nancy’s success that you can learn from. 1. One was that she changed her beliefs. She had to change her way of thinking and talking to herself. She began to focus on why she wanted to get better, why she wanted to regain control of her health. You should start answering that question, too: good health for what? To dance at your child’s wedding? To fit into your favorite dress? To play catch with your grandson? To climb the steps of the Parthenon on a cruise to Greece? You can read a lot more about “Good health for what” in chapter 4. 2. Then Nancy began to work on her toxic self-talk. She started to deliberately minimize the “misery” of eating broccoli and squash. The whole time she’d been telling herself, “Eating vegetables is the absolute worst thing I could possibly endure,” she was reinforcing that greatly exaggerated version of the truth (the Holocaust would be worse. Death would be worse. As a matter of fact, the overweight, blindness, and pain she’d been suffering were worse). The truth was, at first she’d have simply preferred an ice cream cone to a stalk of celery. Most people would, and even that can be overcome. But she didn’t have to have the ice cream, and she didn’t have to hate vegetables. Now, the mind is a very
powerful thing. Habits, beliefs, even moods can change when you know how to change them. So in addition to conquering her diabetes, Nancy also conquered what in drug and alcohol rehab they’d call her “Stinkin’ Thinkin’.” The sense of power and self-determination that came from that change remains a vital force in Nancy’s life, and we want you to master it, too. See chapter 8 for much more on toxic self-talk, and “I would prefer” v. “I must.” The other key to Nancy’s triumph, by the way, was the enormous variety and quality of the delicious, natural foods we promote. Our plant-based diet is not “bunny food,” by any stretch of the imagination. Every day at the table in our gourmet restaurant, the Windcrest, and in our cooking school, we watch skeptics undergo miraculous conversions. Halfway through lunch, big, burly cattle ranchers from Texas look up from their plate and say, “Wow, doc! This stuff is really good.” Again, it’s all about trying new things (“If you keep doing what you’ve been doing, you’re gonna’ keep getting what you got”) and the power of positive thinking. Don’t look at our program as a restrictive “diet,” but look at it as an adventure in new, more healthful, natural foods that will lead to optimal health. And try to have a sense of humor about things, too. Using her power to choose how she thought about it, even Nancy began to like certain vegetables the way we taught her to prepare them. And by the way, for most people, this process doesn’t take a year.
Chinese kids are 6.6 lbs. heavier than they were 30 years ago. See: Calum MacLeoud. “Obesity of China’s kids stuns officials.” USA Today. January 9, 2007. ii Li YP, Yang XG, Zhai FY et al. “Disease risks of childhood obesity in China.” Biomed Environ Sci. 2005, 18(6):401-410.
More on Fiber
Remember that fiber refers to the part of plant foods that our digestive enzymes can’t break down. As a result, it passes through our gastrointestinal tract (that’s the tube about 25 feet long that runs from our mouth to our rectum), helping regulate the process of the digestion and absorption of food, as well as the elimination of waste. Dr. Arnott is right: fiber is everyone’s friend. Some fiber is termed soluble, meaning it is dissolvable in water. Soluble fiber is what gives some plant foods a gummy, sticky consistency—think of oatmeal, for example. Fiber that cannot be dissolved in water is called insoluble, and it is this type of fiber that gives some food its crunchy, chewy texture, such as almonds. Soluble and insoluble fibers are very important in our diet. Both add bulk, which makes us feel full and satisfied, so we naturally consume fewer calories when we eat high fiber foods. Soluble fiber also slows the digestion and absorption rates of starches and sugars, thus slowing the rise of blood sugar after a meal. These two factors make it important for people with diabetes to include lots of fiber in their diet. That’s one reason we recommend beans twice a day for those with diabetes.
GI Guidelines for a Plant-based Diet Your goal is to plan meals that result in a small blood sugar rise by controlling the amount of carb (Carb Counting) and choosing low glycemic (GI) carbs. A low GI diet is especially important for people who have diabetes, are overweight, insulin resistant, prone to low blood sugar (hypoglycemia), or have heart diseasei. Of course, if it is beneficial for these individuals, it is also good for everyone who wants to prevent these disorders and stay healthy. Calorie for calorie, high GI meals raise the blood sugar faster and higher, and stimulate more insulin secretion than low GI meals. This will tax the insulin-making beta cells of the pancreas. These factors, in turn, can lead to insulin resistance and bring on or worsen diabetesii. This process can
start early. One recent study showed that in overweight Latino children nine to 13 years old, those consuming the most sugar and sugar-sweetened beverages – both high GI carbs – signs of early beta-cell death were already presentiii. Fiber v. HFCS: Two Ends of the GI Range The evidence is out there that we Americans are consuming a lot more carbs than we used to, mainly the refined “junk” kind, and mainly in the form of high fructose corn syrup (HFCS)iv, a main culprit in the obesity epidemic that began in the 1960s, and has since swept over a majority of us. A diet full of this kind of rapidly-absorbed (high GI) carb is associated with a higher risk of developing Type-2 diabetesv. One proven strategy to avoid those epidemics is to choose lowGI foods naturally high in fiber. This will help your glycemic control, and if you keep it up, it can be as useful to you as diabetes medicinevi.
i Brand‐Miller JC. “Glycemic load and chronic disease.” Nutr Rev. 2003, 61:S49‐S55.
Ludwig DS. “The Glycemic Index. Physiological Mechanisms Relating to Obesity, Diabetes, and Cardiovascular Disease.” JAMA.. 2002, 287:2414‐2423. Davis JN, Ventura EE, Weigensberg MJ, et al. “The relation of sugar intake to ß cell function in overweight Latino children.” Am J Clin Nutr. 2005, 82:1004-1010. iv Bloomgarden, ZT. “Diet and Diabetes.” Diabetes Care. 2004, 27(11):2755-2760. v Schultze MB, Liu S, Rimm EB et al. “Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.” Am J Clin Nutr. 2004, 80:348-356. vi Brand-Miller JC, Hayne S, Petocz P et al. “Low-Glycemic Index in the Management of Diabetes.” Diabetes Care. 2003, 26:2261-2267.
More on Smoking and Diabetes
Smoking more than doubles the risk of heart attacki. Smoking also limits the hemoglobin available to bind oxygen to the red blood cells. Because oxygen is essential to feed the heart and working muscles during activity, smoking limits the progress of training, and jeopardizes the safety of your program. One more thing – strange but true – is that quitting smoking is simply smart—literally. Did you know that better educated people are actually far less likely to smoke? Among adults 25 and older who smoke, 26 percent of those with no diploma are smokers; 43 percent of those with a G.E.D. smoke; 23 percent of those with some college smoke; 21 percent of those with an Associate’s degree smoke; 21 percent of those with a Undergraduate degree smoke; and only 7 percent of those with a Graduate degree smokeii. Mark Twain might have been the exception to this rule. He certainly had more education than his famous character, Huck Finn—but they both smoked. Twain reminds us that smoking cessation takes perseverance: “It’s easy to quit smoking,” he writes. “I’ve done it a thousand times.” More on Depression and Diabetes Dr. Neal Nedley is a former member of the board of directors of the LCA. He has hosted two 18-day sessions at LCA for people with depressioniii. While there are many causes of depression – and many treatments – we have found that a lifestyle approach is very helpful. To us, it makes sense that people on a PBD and practicing a healthy lifestyle would be less depressed than their counterparts on the Standard American Diet (SAD). A large study done by Dr. Dean Ornish proved it. Dr. Ornish set out to demonstrate that a PBD could prevent heart
disease (which he did!). But an interesting finding came from that study: one year after adopting a PBD, the vegetarians studied not only felt better physically, but mentally as well, contrasted to the control group of non-vegetarians. The people on the PBD had a decrease in depression and anxiety, fewer problems with stress, even improved interpersonal relationshipsiv. “Vegetarians tend to enjoy life more, and even have a better social life than before becoming vegetariansv.” Other studies back this up: in one Puerto Rican study, vegetarians, when contrasted to non-vegetarians, were significantly less depressed and anxiousvi. In one study of non-Mexican-American Hispanic adults with diabetes, a full 78 percent of patients believed they had diabetes because it was “God’s willvii.” This is good evidence for the idea that when doctors address the “whole” patient with diabetes – including their spirituality or religious beliefs – the patients’ health outcomes are betterviii. “Treating diabetes and healing from it are not necessarily the same activityix.” This might be why some diabetes education programs sponsored by churches are so effectivex. But it needn’t be a church doing the healing.
Heart and Stroke Facts. American Heart Association. “Tobacco Use Among Adults – United States, 2005.” Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention in USA Today. February 20, 2007. iii Nedley, Neal. Depression: The Way Out. Ardmore, Oklahoma: Nedley Publishing, 2005. This list is adapted from Dr. Nedley’s chapters on diet and lifestyle treatments for depression, 65-97. iv Ornish D, Brown SE et al. “Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial.” The Lancet. 1990, 336(8707):129-133. v Nedley, Neal. Depression: The Way Out. Ardmore, Oklahoma: Nedley Publishing, 2005, 76. vi Rodriguez Jiminez J, Rodrigues Jr, Gonzelez MJ. “Indicators of anxiety and depression in subjects with different kinds of diet: vegetarian and omnivores. Bol Assoc Med PR. 1998, 90(4-6):58-68. vii Zaldivar A, Smolowitz J. “Perceptions of the importance placed on religion and folk medicine by non-MexicanAmerican Hispanic adults with diabetes.” Diabetes Educ. 1994, 20(4):303-306. viii Newlin K, Melkus GD, Chyun D et al. “The relationship of spirituality and health outcomes in Black women with type 2 diabetes.” Ethn Dis. 2003, 13(1):61-68. ix Paik JE. “No One an Island: The Geography of the Whole Patient.” MS JAMA. 2000, 284(13). Http://www.jama.com.
Samuel-Hodge CD, Headen SW, Skelly AH et al. “Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors.” Diabetes Care. 2000, 23(7):928-933.
More on Stress and Diabetes
Major stress increases blood sugar levels, whether you have diabetes or not. Extreme stress on the body, such as occurs during serious illness or trauma, causes the body to release hormones to keep enough sugar in your system as energy to weather the intense stressi. That’s why we react to stress the way we do—to survive immediate threats while remaining more or less in equilibrium. But even moderate stress, largely because of its association with increased glucose in the bloodstream, can prevent you from keeping your diabetes in check. Over the long haul, this can seriously damage your body. For one thing, while you’re stressed, some of the shortterm body processes that are less “essential” than survival – things like sleep and digestion – are inhibited. And of course stress can also cause you to eat more, get physically active less often, feel exhausted and depressed, and fall off your health program altogether. Alarmingly, extreme stress seems to be one possible culprit in the onset of Type-1 diabetes, in which the part of the pancreas that makes insulin essentially dies. Some of our Type-1 acute onset diabetes patients report having gone through traumatic events in their lives – the death of a spouse or the loss of a job, etc. – usually just a few months prior to their diagnosis. There’s controversy on this subject, with some studies backing the claimii , but at least one recent large systematic review of past studies supporting the idea that stress and the diabetes process are related—but refuting the idea that Type-1 diabetes is caused by stressful life events
Fleming, Alison. “Motivational Issues from a Psychobiological Perspective.” University of Toronto. 2007. Shiloah E, Witz S, Abramovitch Y et al. “Effect of Acute Psychotic Stress in Non-diabetic Subjects on ß-Cell Function and Insulin Sensitivity.” Diabetes Care. 2003, 26:1262-1467.
More on the Cost of Diabetes
People with Type-2 diabetes comprise 6.3 percent of the American population, but they account for 19 percent of all health dollars spent.i Diabetes makes up about 33 percent of the Medicare budget, with drug costs doubling or tripling in the past few yearsii. In 2002, the government estimated the total cost attributable to diabetes. It was $132 billion ($92 billion in direct medical costs, and $40 billion in disability, work loss, and – this is a fun government euphemism – “premature mortality.”)iii The scariest part of that statistic is that it’s already six years old. The numbers are going up. In 2004, hospitals alone spent $58 billion on the six million stays of patients with diabetesiv. That’s nothing contrasted to what the Veteran’s Administration incurred: more than $216 billion in out- and in-patient expenditures over a four-year study periodv. And across the country, “the ranks of American diabetics have swelled by a distressing 80 percent in the last decade.” Some cities, like New York, have seen an “explosion” of cases: 140 percent more. There are 4,100 new cases of diabetes diagnosed every 24 hours in America.vi
Jackson, Derrick Z. “Diabetes and the trash food industry.” The Boston Globe. Editorial, January 11, 2006.
Agency for Healthcare Research and Quality (AHRQ). “Proportion and Medical Expenditures of Adults Being Treated for Diabetes, 1993 and 2003” in Diabetic Microvascular Complications Today Nov/Dec 2006, 9. iii National Institute of Diabetes and Digestive and Kidney Diseases. iv “Agency for Healthcare Research and Quality (AHRQ). “Proportion and Medical Expenditures of Adults Being Treated for Diabetes, 1993 and 2003” in Diabetic Microvascular Complications Today Now. 2006, 9. v Maciejewski ML, Maynard C. “Diabetes-related utilization and costs for inpatient and outpatient services in the Veteran’s Administration.” Diabetes Care 2004, 27 (Suppl 2): B69-B73. vi Kleinfeld, N.R. “Diabetes and Its Awful Toll Quietly Emerge as a Crisis.” New York Times. January 9, 2006.
More on “The Disease of Kings”: Poor Us
We have yet another take on the concept of the “Diseases of Kings.” See our chapter on “The Disease of Kings” in the book. But this disease is a disease of the brain, and of the soul. It’s rampant in America today. Bear with us for a few pages here—we promise this will circle back to diabetes in a very important way. Brian Tracy, one of the world’s leading experts on time management and life balance, tells us in many of his publications that the greatest poverty we face as a culture is “time poverty.” Back in 1924, 87 percent of wives did more than four hours of housework a day. By 1977, it was down to 43 percent. In 1999, only 14 percent of housewives (themselves largely diminishing as a class) did more than four hours of housework per dayi. Now we suspect it’s actually dropped off significantly again. This is not a treatise on how housewives are not working hard enough; just the opposite. The whole time our hours- per-week of housework was decreasing, all kinds of other demands on housewives were increasing (work outside the home, for one thing, and chaperoning kids to soccer, dance, Karate, band, and everything else on the menu for kids today). The great contradiction here, of course, is that those devices and systems we’ve invented to save us time – the Internet, PDAs and e-mail spring to mind – are the very things that enslave us, now ravenously consuming our time. Our culture works more hours and produces more than virtually any other culture in the history of the Earth. Seems like a good thing. But are we happier? Studies show we’re notii iii. Which is odd, because it’s not all toil for zero gain. We also have more money than ever before. Fewer of us are poor. Many more of us are in the upper middle class than in previous
generations, and more are superrich. You’d think that’d make us happy. It might or it might not surprise you to know that in fact, it doesn’t. Studies from all over the world show that unless you start from true poverty and find enough money to lift you out, increasing wealth does not correspond with increasing happinessiv. In fact, for many, it’s just the opposite: money breeds misery. Just look at all those whining (and often deeply disturbed) Hollywood celebrities and pop stars on the entertainment programs. We’ve treated celebrities at LCA, and some of them are well balanced. But many are not. These people have told us they were amazed when they realized you can have many of millions of dollars, and an entourage treating you like a deity, but you can still feel lower than a snake’s belly. What about choices? That’s a pillar of our democracy, a mainstay of the American way. Just check out a recent issue of Consumer Reports magazine, spend some time at a shopping mall, or watch some TV commercials. There are some 220 new cars out this year; 250 cereals to choose from; 35 shower heads to choose from; countless computers; infinite cell phones, and on and on. But do we really want this stuff? We must, mustn’t we? If no one were buying, wouldn’t the market disappear or at least shrink? Does all this freedom of choice make us happy? Gregg Easterbrook, in his illuminating book, The Progress Paradox, says no. “Most of what people really want in life – love, friendship, respect, family, stature, fun – is not priced, and does not pass through the market. If something isn’t priced you can’t buy it, so possessing money may not help muchv.” Go ahead and try asking at the Wal-Mart for “five bucks worth of respect.” We have three times as much earning power as our grandparents did, and considerably more choices, but we can’t buy what we really want, which is peace of mind, love, health, and
happiness. We have cultivated an advanced technological culture that keeps on progressing, but unfortunately, it takes much of our lives to learn how to exist in it. Yet we consistently report that we’re no happier. With every advance in society, our stress levels go up. And with every passing day that we keep consuming but never getting what we really want, we become increasingly stressed and restless. And that’s where our health comes in. In the 1980 movie, “The Gods Must Be Crazyvi,” a Kalahari bushman who never encountered Western culture before stumbles on a glass Coke bottle thrown out of an airplane. Long story short: at first the tribe relishes the artifact, and finds multiple, creative, time-saving uses for it. Eventually, though – and mainly because one Coke bottle is not enough to go around – the new gadget becomes a source of bitter in-fighting, even a potential culture-killer, which they dub “the evil thing.” The tribe decides it must be thrown off the edge of the world. Haven’t you ever wanted to do that with your cell phone or your laptop computer? We have. Studies show the quantity of available information in the world doubles every 600 daysvii. There were 161 “exabytes” of digital data – that’s about 161 billion gigabytes – generated in 2006, and that amount is already rising fastviii! What are we supposed to do with all that information? The deeper question is, are we paying too high a price with our health to experience the spoils of modern life? Does the pace and pressure of our existence contribute to disease? Well, yes, if you really look at the etymology of that word “disease.” Has modern life caused a disease for most of us? The answer to that is simple. A U.S. News & World Report editorial from 2000 reported that the average American workweek has been increasing at a rate of two hours per decade, to 47 hours (we bet it’s already up to 48). Forty-four percent of us consider ourselves workaholics—and many more of us don’t
even know we areix. And around 2000, a new term entered our lexicon: “24/7.” Nowadays, we don’t so much start our day with an alarm, but a starting gun. We dash out five e-mails, respond to a half-dozen text messages, fax some orders, join a conference call or two, make some cell phone calls, and then before we know it, it’s time for breakfast! Most of us don’t really ever stop “working”—not at home, not during our commute, and not even while we’re on vacation. How often have you said, “You can reach me anytime on my cell”? Can you imagine if a close associate didn’t respond to your messages within, say, two days? It wouldn’t matter that she was in Tibet. “Can’t she at least check her e-mail?” you’d wonder. “This is important.” There have been some recent backlashes against this kind of stressful 24/7 connectedness. A few folks have eschewed their “Crackberries” for one day a week. Even fewer have managed to avoid the Internet and e-mail. But most of just give up and join this rat race, not only to compete, but to survive.
Easterbrook, Gregg. The Progress Paradox. New York: Random House, 2004, 28. Dan Baker and Cameron Stauth. What Happy People Know. St. Martin’s Griffin, 2004. iii Easterbrook, Gregg. The Progress Paraxox. New York: Random House, 2003. iv Dan Baker and Cameron Stauth. What Happy People Know. St. Martin’s Griffin, 2004. v Easterbrook, Gregg. The Progress Paradox. New York: Random House, 2004, 177. vi The Gods Must Be Crazy. Directed by Jamie Uys. 20th Century Fox 1992. vii Deaton, Dennis. The Book on Mind Management Second Ed. Mesa, AZ: Quma Learning Systems, Inc., 2003, 108. viii For perspective, that’s the equivalent of about one million digital copies of every book in the Library of Congress, or 213 gigabytes of information generated for each person in North America—in just 2006. See: Kessler, Michelle. “Days of officially drowning in data almost upon us.” USA Today. March 6, 2007. ix Timothy Lamer. “Stressful Leisure.” U.S. News & World Report. 21(22) June 26, 2000.
More on the Liver’s Function in Diabetes
Sugar Factory We reviewed in this chapter the fact that the carbs we eat become blood sugar in our body. But our body has another way of making sugar, called “gluconeogenesis” (gluco = sugar; neo = new; genesis = creation) We make this sugar primarily in two organs. One is the liver. If we’re not eating, the liver produces enough blood sugar to keep us alive. And did you know the kidneys are not just for making urine; they make sugar too. About 15 percent of the blood sugar that’s made in the body – some of the sugar we don’t get from our food – is made in the kidneys. The rest comes from the liver. This liver source of sugar kicks in when we fast or are involved in vigorous prolonged exercise. Not only is the body able to manufacture blood sugar (the body’s preferred fuel) both in the liver and the kidneys, it also has a number of ways of storing sugar that is taken in as food but not immediately needed to fuel the cells’ activities. Fat is one of the body’s ways of storing extra sugar. Another two places to tuck some extra supply of sugar is in the liver and muscles. In the muscles, it’s stored in the form of glycogen, and can be freed up as sugar almost immediately when an extra burst is needed. That glucose cannot get into the general circulation to be used by our non-muscle cells.
More on the Right Attitude for Overcome Diabetes
It goes without saying that it takes introspection to overcome our lack of conscious awareness about the connection between lifestyle decisions and their outcomes. Introspection can become so all-absorbing that we might come to think that it’s “All About ME.” Max Lucado, a well known inspirational writer, wrote a worthwhile book with this as a title: It’s Not About Mei. His point is that there is a balance worth seeking that keeps us from becoming narcissistically selfabsorbed. One decision in the interest of experiencing that balance is to “share.” Consider getting involved. You might decide to volunteer your time and effort to another person, get involved in a service group, be a pink-lady volunteer at the local hospital, or join an active church group. Sharing is one way to keep us in balance and gives us a reason to maintain good health. Sharing what you’re learning and practicing about lifestyle medicine and diabetes can also increase its benefits to you, even while helping others, through a process known as “Superlearningii.” Here some wise aphorisms that we think can help you in your struggle:
Freedom and happiness consists of understanding one principle: There are certain things you control and certain things you can’t. It is only after you have learned to distinguish what you can control from what you cannot, that inner harmony and outer effectiveness become possible.iii
If you see a difference between where you are and where you want to be – consciously change – your thoughts, words, and actions to match your grandest vision. This might require tremendous mental and physical effort. It will entail constant, moment-to-moment monitoring of your every thought, word, and deed. It will involve continued choice-making—consciously. This whole process is a massive move to consciousness. What you will find out if you undertake this challenge is that you’ve spent half your life unconsciousiv.
… if you really want to be self-helping, wise, and ‘rational,” decide that you will ONLY rate your acts, deeds, thoughts, feelings, and other behaviors and that you will not – yes, NOT, -- rate your SELF, your being, your essence, your totality, at all. Yes, preferably not at all, though this may be somewhat unrealistic because you and the rest of us humans seem to have a biological tendency to rate both our behaviors and our self.v
To believe that I need something requires, by definition, that I also believe that I cannot be okay without that something. It may be an object or an experience that I demand. In this view of reality, if I don’t get it, that very not-getting threatens my well-being, my hopes of happiness, my ability to be okay. When I use unhappiness in order to help myself get what I want, or to get you to give me what I want, I live in that need. That experience is self-extinguishing—it is the state of
non-being. The very thing I do to help myself cripples me, choking my life force and my ability to create. The experience of preferring is self fulfilling. It allows happiness now. It permits a sense of well-being, of okay-ness. It simply acknowledges, “more” would be welcomed, this is the more that I welcome.vi
REBT [Rational Emotive Behavior Therapy] shows that when you believe, “I preferably should succeed and win the approval of significant others,” you explicitly or tacitly include buts and alternative solutions to your desires, such as “But if I don’t succeed, I can try harder next time.” “But if I’m not approved of— too bad, it’s not the end of the world.” When your prefer[ances] are not fulfilled, REBT holds, you normally feel healthily sorry, disappointed, and frustrated (rather than unhealthily panicked, depressed, and self-hating). On the other hand, when you strongly believe, “Because I want to succeed and be approved of by significant others, I absolutely, under all conditions and at all times must do so,” you create anxiety when you may not do well and severe depression when you do not act well or win other’s approval. For with your absolute, under all conditions shoulds and musts, you allow yourself no alternative solutions to your desires, box yourself in, and needlessly make yourself miserable.vii
If you would stop, really stop, damning yourself, others, and unkind conditions, you would find it almost impossible to upset yourself emotionally—about anything. Yes, anything.viii
Socrates used to say that he was the smartest man in Athens because he knew he was really dumb. When it comes to controlling our diets, strength requires knowing that we will be weak. Recognizing our future weaknesses allows us to minimize how frequently we will fail and to limit the damage done when we are feeling weakest.ix For some immediate inspiration, consider the sage advice of the Buddha: “The secret of health for both mind and body is not to mourn for the past, nor to worry about the future, but to live the present moment wisely and earnestlyx.” This puts the will within us, and reminds us that we have a responsibility to look after ourselves, even when we believe firmly in God. Again, the Buddha: “Every human being is the author of his own health or diseasexi.”
Lucado, Max. It’s Not About Me: Rescue from the Life We Thought Would Make Us Happy. Integrity Publishers, 2004. ii See the works of Brian Tracy for other tips on how to accelerate your learning of this and any other practice. See also, the originator: Sheila Ostrander and Lynn Schroeder. Super-learning 2000: New Triple Fast Ways You Can Learn, Earn, and Succeed in the 21st Century. New York: Dell (reissue ed.), 1997. iii Epictetus. Enchiridion. iv Walsch, Neal Donald. Conversations with God. New York: Putnam Adult. 1996, 77. v Ellis, Albert. “Reason and Emotion in Psychotherapy.” 1994.
Mandy Evans. Joe Vitale. Emotional Options. Garden City: Morgan James Publishing, 2004
Excerpt from “General Semantics and Rational Emotive Behavior Therapy” by Albert Ellis. Amherst, NY:
Prometheus Books, 2004. Ellis, Albert and Robert A. Harper. A Guide to Rational Living Third Edition. Chatsworth: Wilshire Book Company, 127.
ix x viii
Terry Burnham and Jay Phelan. Mean Genes. New York: Penguin Books, 2000, 45. Attributed to the Buddha . xi Attributed to the Buddha.
More On The Why Our Government Has Failed Americans With Diabetes
The sole purpose of the USDA is not to protect the health and well-being of the American citizenry. It has a major, competing agenda, which is to protect and uphold the economic health and viability of American agriculture. Unfortunately, that’s a conflict of interest, and it means the USDA remains shy of 100 percent trustworthy when it comes to its recommendations for what we should eat. Whenever you look at what it recommends, you should ask yourself, just whose interests are they protecting? Who’s number one? • Do you know how you get on the board of an influential government agency making national nutritional recommendations? Usually, only huge, powerful, money-making lobbies, such as the National Cattlemen’s Association, the American Meat Institute, and the Grocery Manufacturers of America, as well as sugar, fast-food, and junk food industries get a say. In the past, new guidelines and new versions of the Food Pyramid have been delayed while the meat, dairy, and egg lobbies jockeyed for positioning. The resulting message has been that if you want to get enough protein, you had better eat enough meat, dairy and eggs. That’s just nutritional nonsense. • There is some hope, though. We say that big business and lobby groups “usually” dominate the food guidelines process, but the “power of the people” can be quite a juggernaut, too, once it starts rolling. This is a consumer-based economy, after all. As long as consumers keep clambering for white bread and fried pie (yes, it’s a real thing), they’re going to be abundantly available. But as soon as people
became convinced of the perils of trans fat, customers used the power of the pocketbook and the tide started to turn. First the Food and Drug Administration called for food manufacturers to list trans fat on their labels starting in 2006. Then in January, 2007, Starbucks rolled out no-trans fat recipes in half of its 5,600 American stores, and started scrambling with local bakeries who supply ingredients in the remaining marketsi. In July, 2007, the largest restaurant market in the U.S., New York City, began phasing in a ban on all trans fat. A strong word of caution: it will be possible forii restaurants to avoid trans fat in their menus by using interesterified fats, which may be worse for you than trans fat. The safest option is to avoid fast food restaurants, as well as fried foods in general (plant-based or not).
Arndt, Michael. “How KFC Went Trans-Fat Free.” http://www.BusinessWeek.com. January 3, 2007. http://businessweek.com/innovate/content/jan2007/id20070103_466580.htm. ii Wansink, Brian. Mindless Eating. New York: Bantam Books, 2006, 187.
More on Trans-fats and Interesterified Fats
Saturated fats like you’ll find in steak, butter, and ice cream, are naturally-occurring, and come mainly from animal sources (meat and dairy). Saturated fats raise blood levels of triglycerides, total cholesterol, and LDL cholesterol (aptly named “bad cholesterol” because it blocks arteries). Because of this, having them in your diet will increase your risk of heart attack and other vascular diseases. Unsaturated fats are also natural, and you can find them mainly in plant-sources of foods, like whole grains, avocados, nuts, olive and canola oil. Their carbon atoms are not totally saturated with hydrogen. They’re better for you, and are even associated with lowering total and LDL (“bad”) cholesterol, thus reducing your risk of coronary and other artery blockages. Lastly, trans fats are those unnatural, manufactured fats that behave like saturated fats in our bodies. In fact, they are more dangerous, because not only do they raise triglycerides, total cholesterol, and LDL (“bad”) cholesterol, but they also lower HDL (“good”) cholesterol. They have also been shown to increase the risk of developing Type-2 diabetesi.” In our experience we’ve found that of all the things we teach patients during our 18-day residential program, the single most important marker for long term weight loss (and therefore, for lowering insulin resistance and keeping diabetes in check) is sticking to a total plant-based diet. The fewer the number of days our patients stay on a plant-based diet once they go home, the less weight they are able to lose and keep off. When the number of days gets to zero (the patients revert to eating meat or dairy again daily) they start to put weight back on. It is true, though, what “they” say about red meat. In our follow-up studies, we find that patients who ate
even small and infrequent amounts of red meat (equal to less than one day a week) were less likely to have successful weight loss than those who ate no red meat at all. Since the inclusion of trans fat on nutrition labels, and the removal of trans fat from some fast food restaurants and municipalities, you’d think we were in the clear. Not so. In some commercial food products, unhealthy trans fats have now been replaced with another kind of manmade modified fat called interesterified fat, which has been shown to be as dangerous to our health as trans fat. The study discovered that interesterified fats, like trans fat and saturated fat, raised the ratio of LDL/HDL cholesterol significantly. Interesterified fat also increased fasting blood glucose and depressed insulin, which are both common precursors to diabetes. In fact, interesterefied fat raised fasting blood glucose levels as much as 20 percent in one month as contrasted to the natural saturated fat used in the study (palm oil). That was even more than trans fat. So far in America, there’s no legal requirement to list interesterified fat on the Nutrition Facts Panel along with the saturated and trans fat, but you will be able to find it in the ingredient list. It will be listed as “interesterified” or “fully hydrogenated fat.” Bottom line: it’s time to choose another product if you run across any of the following terms in the ingredient list: “partially hydrogenated oil” (trans fat), “interesterified fat,” or “fully hydrogenated oil.” Just a sample of some foods currently sold using interesterified fats: • Sunbelt Fudge Dipped Chocolate Chip, Chewy Granola Bars with whole grain oatsii.
• • •
Pepperidge Farm, soft baked sugar cookies Pepperidge Farm Chocolate Delight Seville Triple Chocolate Cookies Little Debbie German Chocolate cookie rings with caramel and coconut
More on Animal-Borne Diseases: Mad Cow There’s another sinister disease transmissible to humans from animals—bovine spongiform encephalopathy (BSE), more commonly known as “mad cow disease.” This disease is 100 percent fatal. It is has been shown to be transmissible from cows to a number of different animal species, including humans. The incubation period for the disease ranges from two and a half to eight years in cows, during which time they will show no evidence of the diseaseiii. This is troublesome, because a typical beef cow is taken to market between 14 and 20 months of ageiv. They may show no signs of illness, yet they could still harbor the disease and transmit it to the consumer. The agent responsible for the disease is not destroyed by temperatures used for cooking meat, so thorough cooking will not offer protection. And it’s not just beef that poses a risk. Mad cow-like illnesses have been observed in deer, elk, goats, and pigsv. There’s a concern that fish, too, might be affectedvi, especially farmed fish given feed made with contaminated meat and bone meal. It remains legal in the U.S. to place renderings from cows into the feed of chickens, pigs, fish, and household pets. Likewise, it is permissible to place renderings of these animals into cow feed. This can result in animals infecting each other in a roundabout fashion. Currently the U.S. tests for mad cow disease in only one in 2,000 cows that are slaughtered: in fact, as amazing as it sounds, the
USDA has stopped private ranchers from testing their herds voluntarily and at their own expensevii!
Salmeron J, Hu FB, Manson JE, Stampfer MJ, et al. Am J Clin Nutr. 2001, 73:1019-1102. Wow! Whole grain oats? These must be good for you. iii Bovine Spongioform Encephalopathy – “Mad Cow Disease” Fact Sheet, USDA Food Safety and Inspection Service. iv Ritchie HD, A review of applied beef cattle nutrition, Michigan State University Extension Beef Bulletins Jan 1, 1994. v NeuroCenter, University of Bern, Switzerland. http://www.neurocenter-bern.ch/tse_e.shtml. vi “News in Brief.” The Lancet. 2003, 361. vii McNeil, Donald G., Jr. “U.S. Won’t Let Company Test All Its Cattle for Mad Cow.” New York Times. April 10, 2004.
More on Nature v. Nurture and the Diseases of the West
So what we have here is an interesting, and not at all balanced, combination of nature and nurture. These diseases of the West are the result of our bodies’ natural adaptive responses to their environments. T. Colin Campbell, who conducted the single largest study of human nutrition ever undertaken, has shared the results of his landmark research in a remarkable book called The China Study. In it he proves that in addition to diabetes and coronary artery disease, even cancer (leukemia, breast, colon, lung, stomach, liver, childhood brain) is directly related to what he calls the West’s “nutritional extravagancei”. The prevalence of Type-2 diabetes among adults in rural, traditional communities in the developing world is less than 3 percent but among their counterparts who live in more Westernized cities, there’s a five to ten-times higher prevalenceii iii! In the U.S., the rates are increasing every year. In other words, in impoverished places, and places that haven’t been infiltrated by McDonalds and company, people don’t get these diseases nearly as much. Why? Well, a small part of it might be genetics. But the overwhelming part has to do with dietary habits.
we’ll argue strongly in this book that diabetes is a lifestyle disease, largely under your control, it’s clear that there is a minor genetic factor at play, as well. As the adage goes, though, “genetics only loads the gun—lifestyle pulls the trigger.” But we believe that genetics plays only a small part. The good news is that puts a lot in your hands. Here’s a good example of how that works: The Pima are genetically very similar to brethren in various tribes across the border in Mexico. The Pima’s Mexican counterparts live a more traditional (less American) life, and eat a more traditional (more rural Mexican) diet. As a result,
the incidence of Type-2 diabetes among them is far lower, almost non-existent. Ian spent time writing on a Native American reservation, and he witnessed the “abrupt changes in lifestylev” that accounts for the difference between the native North Americans on either side of the border. Among many tribes, economic, geographic, and political conditions have led to fast food, alcohol, and the ubiquitous “government surplus cheese” and its ilk becoming staples. The American couch potato culture is another culprit. Of course the science backs up this anecdotal “evidence.” The adoption of an Anglo diet and lifestyle play a major role in the development of diabetes among the Pima and across the globe
Campbell, T. Colin. The China Study. Dallas: BenBella Books, 2004, 76. Janet E Fulton.and Harold W Kohl III. “The Epidemiology of Obestiy, Physical Activity, Diet, and Type 2 Diabetes Mellitus,” in Lifestyle Medicine, edited by James Rippe. Malden, MA: Blackwell Science, 870. Harris MI. Epidemiological studies on the pathogenesis of non-insulin-dependent diabetes mellitus (NIDM). Clin Invest Med 1995, 18:231-239. Ravussin E, Vlanecia ME, Esparza J et al. “Effects of a traditional lifestyle on obesity in Pima Indians.” Diabetes Care. 1994, 17(9):1067-1074. Ravussin E, Vlanecia ME, Esparza J et al. “Effects of a traditional lifestyle on obesity in Pima Indians.” Diabetes Care. 1994, 17(9):1067-1074.
Final Thoughts on Mastering Our Thoughts
We’d like to end this section with some relevant quotes we’ve found helpful over the years: “Behavior is mind driving body in fulfillment of dominant thoughti.” It is time to make a choice. What will it be for you, responsibility or nonresponsibility? You cannot have it both ways. Either you are a helpless product of genetics and environment wherein you accept the Nature-Nurture Doctrine as your constitution, or you accept the Doctrine of Choice and Responsibilityii. “All that we are is the result of what we have thoughtiii.” Of all the tools at your disposal, none is as powerful as your example. It is hard for someone to argue about how dangerous a vegan diet is if you are the only one in the office that doesn’t have a serious health problem, such as high blood pressure, high cholesterol, or diabetes. Myths about vegans having trouble getting enough protein will evaporate if you are the fittest person in your circle of friends or business associates. Instead of trying to convince someone that vegan foods taste wonderful, invite them over or bring something special to the company gettogether. It is amazing what you can accomplish without saying much at alliv. “Eat, drink, and be merry, for tomorrow you may die!” has its distinct limitations, for tomorrow you will probably be alive with a hangover! Maximum selfactualizationv can, therefore, largely be achieved by people’s aiming for intensive and extensive pleasures today and tomorrow; and where the former (as in many
addictions) sabotage the latter, immediate gratification had often better be avoided and long-range hedonism … sought out and abettedvi.
Deaton, Dennis. The Book on Mind Management. Second Ed. Mesa, AZ: Quma Learning Systems, 2003, 41. Deaton, Dennis. The Book on Mind Management. Second Ed. Mesa, AZ: Quma Learning Systems, 2003, 47. iii Attributed to the Buddha. iv Brenda Davis and Vasanto Melina. Becoming Vegan: The Complete Guide to Adopting A Healthy Plant-Based Diet. Summertown, TN: Book Publishing Company, 264 v This term was coined by Dr. Abraham Maslow. It refers to our desire for fulfillment, to become actually what you are potentially. “A musician must make music, an artist must paint, a poet must write, if he is to be at peace with himself.” vi Ellis, Albert. “Achieving Self-Actualization.” New York: Albert Ellis Institute: http://web.archive.org/web/19981205062817/rebt.org/essays/achieve1.html.
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