Doctor's Note

OK, so what kind of diet does help diabetics? See Plant-Based Diets and Diabetes, for example, or Diabetics Should Take Their Pulses.

Why is that the case? See Why is Meat a Risk Factor for Diabetes? and How May Plants Protect Against Diabetes?

Healthier diets can even reverse some of the complications of diabetes once thought irreversible. See Can Diabetic Retinopathy Be Reversed? and the part of my annual review From Table to Able: Combating Disabling Diseases with Food that discusses the remarkable reversal of painful diabetic neuropathy.

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  • Joe Caner

    Not what I was expecting based upon the title. Diets, such as the one promoted by the PCRM ( http://www.pcrm.org/shop/byNealBarnard/dr-barnards-program-for-reversing-diabetes ), have been shown to be effective for many people as opposed to diets based merely upon caloric and carbohydrate restriction.

    • Thea

      Joe Caner: From my understanding of the video, I don’t think the video is disagreeing with you. Also check out the Doctor’s Note.

      • Joe Caner

        I understand that Thea. It was more a poll to determine if there was anyone who did not see benefit from WFPB diets in regards to diabetes. It is my expectation that benefits would be near universal, although, it couldn’t hurt to ask the question…

        • Thea

          Ah, I see. Well, I’m interested in your question too. Of course, the results people get would depend on how well they truly sick to a super low fat plant based diet. Some people may claim to have done so and not really done so. But I also know that there is a small group of thin people who have commented on NutritionFacts who believe that only a high fat plant based diet has helped them to control blood sugars. They make a pretty good case to my non-expert ears. They may have a different, and pretty rare type of T2 diabetes compared to the majority of people. So, maybe in their cases, eating high fat plants is best???
          .
          Let’s see what sort of answers you get.

          • Tom Goff

            The problem there, Thea, is that as this video shows controlling blood sugar doesn’t necessarily translate to reduced mortality and reduced adverse events generally. Consequently, I am still a bit cautious about the implications of these reports of thin people with T2D. I understand that some such people may even be misdiagnosed T1 diabetics, which further complicates the issue
            http://blog.joslin.org/2014/05/thin-and-type-2-non-obese-risk-factors-for-developing-diabetes/

            Also, I suspect that the type (and ratio) of plant fats that they consume may make a significant difference here ie saturated, monounsaturated and polyunsaturated. And this will vary between the individuals concerned. But I’d really like to see some studies on this.

          • mbglife

            There is an interesting 4 minute video on this where Dr McDougall speaks on a panel about this point and he cites studies that sugar and white rice cure diabetes.

            In another longer video of his he explains that consuming no sugar treats a symptom, not the disease, and people die from the disease.

            Mark G

          • Tom Goff

            Thanks, Mark.
            Yes, I assume that McDougall was referring to the Kempner Rice Diet.
            His point about conventional approaches to T2D erely treating symptoms and not the disease is also an important one. Very often, symptoms (fever, coughing, sneezing, swelling, redness etc) are the body’s active defences against infection and trauma. Suppressing these symptoms can often do more harm than good. For example, the inventor of the RICE (rest, ice, compression, elevation) approach to sports’ injuries now concedes that it harms rather than heals. This was the unfortunately named Dr Mirkin ……
            http://www.drmirkin.com/fitness/why-ice-delays-recovery.html

            It’s quite possible therefore that aggressively attacking blood sugar symptoms may in and of itself cause problems – although it may equally be that other side effects of the drugs or dietary regimen are the ones that that cause related cardiovascular problems.

          • JS Baker

            Wow, Tom, thanks for the reference to the Dr. Mirkin site. I’ve been using ice on injuries for years.

          • Thea

            Tom Goff: I don’t disagree with anything you say. I suspect you are right and it’s mostly my personal opinion too. But I also know I’m not a medical expert. I’m trying not to assume I know more than I do.
            .
            Some time ago, a poster, Russel (sp?), supplied a link to what seemed like a pretty legitimate site, which said that T2 diabetes could also be caused (if I’m remembering correctly) by a failure of the pancreas to make insulin. I had understood that that was the definition of T1, not T2. But if there is something more complicated about the official T2 definition than I understand or is commonly stated, then maybe there is a different treatment for some people with T2 compared to most. I’m not saying that’s true or that I believe it. Just that I acknowledge it is possible. Russel even said that he had explained the particulars of his case to someone at PCRM or something like that and they had no answer for him (because his situation had not been studied?). Perhaps Russel will see this conversation and jump in. I may be misrepresenting the situation.
            .
            One more thought: I fully understand and truly appreciate your point about, “…controlling blood sugar doesn’t necessarily translate to reduced mortality and reduced adverse events generally.” Agreed. At the same time, we also know that not controlling blood sugar causes serious problems. If I was someone who was seeing what I considered to be dangerous blood spikes on eating a low fat whole plant food diet, I might feel desperate about the situation and resort to eating high fat plant foods. I’m not saying that it is the healthiest route to take. I’m just saying that I can understand why some people are going that route.

          • Tom Goff

            Thanks Thea. I am no expert either and this is a complicated area. My understanding is that for most people with T2D or prediabetes, dietary fat of any kind is thought to be part of the problem although dietary saturated fat is particularly problematic eg

            “Substitution of unsaturated fat for saturated fat not only reduces LDL cholesterol but contributes also to reduce plasma triglycerides in insulin resistant individuals.”
            http://www.clinicalnutritionjournal.com/article/S0261-5614(04)00026-3/fulltext

            “Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition. A recent multicenter study (KANWU) has shown that shifting from a diet rich in saturated fatty acids to one rich in monounsaturated fat improves insulin sensitivity in healthy people while a moderate alpha-3 fatty acids supplementation does not affect insulin sensitivity.”
            http://www.ncbi.nlm.nih.gov/pubmed/15297079?

            “The relationship between dietary fat and glucose metabolism has been recognized for at least 60 years. In experimental animals, high fat diets result in impaired glucose tolerance. This impairment is associated with decreased basal and insulin-stimulated glucose metabolism. Impaired insulin binding and/or glucose transporters has been related to changes in the fatty acid composition of the membrane induced by dietary fat modification. In humans, high-fat diets, independent of fatty acid profile, have been reported to result in decreased insulin sensitivity. Saturated fat, relative to monounsaturated and polyunsaturated fat, appears to be more deleterious with respect to fat-induced insulin insensitivity.”
            http://www.sciencedirect.com/science/article/pii/S0021915099005043

            This small group represented by Russell is apparently doing well on a high vegetable fat diet. I remain cautious but it is apparently consistent with at least one observational study which found
            “A high score for vegetable protein and fat was not significantly associated with the risk of T2D overall but was inversely associated with T2D in men aged <65 y (HR: 0.78; 95% CI: 0.66, 0.92; P for trend = 0.01, P for interaction = 0.01)."
            http://ajcn.nutrition.org/content/93/4/844.long

            Perhaps the source of the fat does make a difference or perhaps it is the baggage that comes along with animal and vegetable sources of fat that make the difference.

          • Russell

            Great links, Tom. Thanks for sharing those. Virtually all of the studies on saturated fats relate to people who substitute vegetable fats for animals fats, so its going to be awhile before there are studies comparing different types of vegan diets against meat-eating control groups. I’m quite hopeful that having a higher LDL than recommended by Greger is not as big a risk factor as omnivores with the similar LDL levels, but time will tell. Meanwhile, I try to consume fats with the lowest saturated levels, e.g. hemp, chia, flax, hazelnut and almond butters, and no added oils.

          • Joe Caner

            No Oil!

          • Thea

            Tom: Great post!
            .
            Here’s where I’m coming from: Remember you referred me to a Wikipedia page once? I think it only fair that I get to do the same. So, here’s a quote from Wikipedia on T2 diabetes: (from https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2)
            .
            “Diabetes mellitus type 2 … is a metabolic disorder that is characterized by hyperglycemia (high blood sugar) in the context of insulin resistance and relative lack of insulin. … Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance…. The proportion of insulin resistance versus beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion and others with slight insulin resistance and primarily a lack of insulin secretion.”
            .
            This isn’t the same definition that I saw some time ago, but it gets at the confusion. The vast majority of the time, I have seen T2 defined as “simply”/only a problem of insulin resistance. But maybe that is a simplification that doctors like Greger and Barnard use to communicate with the masses/me? Wikipedia is defining T2 as a combination of insulin resistance and insufficient insulin production. Now I had understood that insufficient insulin production is T1, where producing no insulin is the ultimate/worst form of T1. But the Wikipedia page says that only when someone produces no insulin at all, do they have T1.
            .
            Those definitions do not make sense to me in terms of being helpful/practical. But if the medical practice is to diagnose T2 that way, then someone could easily have a dual problem – both producing too little insulin and having insulin resistance–and have those dual medical problems diagnosed as only T2. The link that Russell provided addresses the idea of having both problems: http://www.diabetesselfmanagement.com/diabetes-resources/definitions/type-1-5-diabetes/
            .
            So, what is a person to do if their bodies are not producing enough insulin AND they are insulin resistant? If I were faced with this problem, I would work on the insulin resistance by going low fat whole plants and work on the production problem by taking relatively small amounts of insulin to make up for the lack. Over time, the hope would be that the insulin resistance problem would fix itself with the low fat diet. And if that happened, then at least one very serious problem would be solved. And perhaps even the production problem would start to resolve since I would be on a healthy diet. However, I can understand why someone would not want to try this. I understand that taking insulin can have it’s own problems. And there might be a scary adjustment period where blood sugars are higher than desired for a time. I don’t know if this is a sound idea or not. But it makes more sense to me than going high fat right off the bat.
            .
            After thinking this through for a couple of days, this what my lay person’s brain has come up with: If the true definitions of T1 and T2 are anything like what Wikipedia says or even what the “Diabetes Self-Management” site says, I think we are missing the mark. I think more helpful definitions would be: T1 is an insulin production problem, where the body does not produce some or all of the necessary insulin. And T2 is an insulin resistance problem where the insulin is not working correctly to get the glucose into the cells. (Generally thought to be a problem of having too much fat in the cells.) And then we have to acknowledge that people can have both types of problems at once at varying levels. Once people understand what (set of) problems they have, they can focus on relevant solutions.

          • Russell

            Your reasoning is logical, but the problem for those of us with autoimmune-related insulin sufficiency, but still making some insulin, is that MDs are frightened to put us on insulin since there is a non-insignificant risk of death from overdosing. Therefore they don’t want to prescribe it until it turns into full-blown diabetes (my own endocrinologist refused, when I asked him).

            The other issue is that for many of us thin pre-diabetics, we have zero insulin resistance due to very low body weights. My own lab tests confirmed this. So, we’re left with a Hobson’s choice of a high plant fat diet, OR adding more carbs but raising our A1C levels and increasing the odds of getting diabetes. I guess there’s a third choice — drop our food intake and reduce weight even further. At some point, it will stabilize, at BMI of 17 or whatever. But looking like a skeleton is not high on my list. :)

          • Thea

            Russell: That makes perfect sense to me. What a pickle. Thanks for your patient explanations again. This is a complicated subject for some of us/me. I feel like I’m just starting to get some of the complexities.
            .
            Best of luck to you!

          • Russell

            My pleasure. And I think we’re all doing pretty well so the “pickle” isn’t actually too bad. Our LDL’s, as I mentioned, are all just below or slightly above 100, which is probably fine given other good lipid results. We just have to watch carbs and LDL. Other than that, we’re all in pretty good health. So far…. Thanks for your interest in our little cohort!

            Best — Russell

          • Wilma Laura Wiggins

            I disagree about the result of your choices. Adding more carbs (and keeping fat very low) does not increase A1C. On the contrary, it reverses diabetes. But it does cause short-term spikes in blood sugar which apparently stimulate the body to make more insulin and/or increase insulin sensitivity. And apparently this is a good thing.

          • Russell

            What you are saying is true if you have insulin resistance, which none of us have. We have all done the HOMA and/or C-Peptide analyses and it turns out that the issue is poor beta cell insulin production. Diet can’t solve that. Please see Dr. Richard Bernstein ‘s work.

          • Tom Goff

            Thanks, Thea. Yes, it’s a complicated area, as we’ve discussed before, and I don’t really understand the full details. Much of what passes for common knowledge is a simplification of the full picture that works well-enough in most cases but doesn’t cover all cases. Russell. Suepy and Daniel have pointed out some of these complexities.
            You are right that Wikipedia does gives us an idea of just how many different forms of diabetes there can be, so it”s logical that there isn’t a single dietary/lifestyle “cure” for all cases. Even in “simple” type 2 diabetes, there are many genes and gene/environment interactions which may be responsible.
            https://en.wikipedia.org/wiki/Genetic_causes_of_diabetes_mellitus_type_2
            In fact, I notice that Wikipedia also discusses “ketosis prone diabetes” or KPD which is different (although it is sometimes termed ketosis prone T2D or even Type 1a or Type 1b diabetes) from types 1, 2 and 1.5 (LADA). To make matters even more complex, KPD itself comes in four different forms………………………
            https://en.wikipedia.org/wiki/Ketosis-prone_diabetes
            http://press.endocrine.org/doi/full/10.1210/jc.2003-030180

          • Jim Felder

            Tom, Thea and Russell. I too think that a simple T1/T2 definition is way too course. In another post I put forward an alternate nomenclature. But I have thought about that in the last day and like you say above, diabetes has two primary and somewhat independent components, insulin resistance level and insulin production levels. I think it would be a lot more useful if there was a classification system that reflected where a given person sat on the spectrum of these two different and somewhat independent axes.

            Maybe the number could used to describe where they are on the insulin resistance production spectrum and a letter “sub-type” to indicate the insulin resistance status, which might be more binary.

            So Type I would be very little to no insulin production with T1a being those with no insulin resistance and T1b for those with insulin resistance. It would be pretty much the same as the current T1. Type II would be for folks who produce reduced amounts of insulin compared to normal production, but still substantially more than T1. Type IIb would pretty much correspond to the current T2. Type IIa would be new and unique. This would mostly be for folks who had T2b, but had reversed their insulin resistance to transition to T2a, With no insulin resistance, Folks with type IIa would lead an otherwise very normal life without drugs or injections, but their impaired insulin production would leave them especially prone to relapse should the insulin resistance return. So maybe they do stay “diabetic” for live. Lastly there would type IIIb. These would today’s “pre-diabetic”. They have insulin resistance, but the pancreas is capable of still cranking out the insulin in large amounts that manage. And of course type IIIa doesn’t exist since this would be healthy people with full insulin sensitivity and no reduction in insulin capacity.

          • Tom Goff

            Thanks, Jim. Some interesting ideas there.
            However, you have to convince The American Diabetes Association who still think that the Type 1, Type 2 and Gestational Diabetes classification system works well enough for now …. and that we just don’t know enough about these unusual sub-variants to come up with an adequate classification system for them.
            They came up with a broad position paper on this topic a month ago but provided a more detailed discussion back in 2014.
            http://care.diabetesjournals.org/content/39/Supplement_1/S13.full
            http://care.diabetesjournals.org/content/37/Supplement_1/S81.full

            In addition, of course, perhaps your taxonomy needs to include Alzheimer’s Disease which has been termed type 3 diabetes. A 2008 review concluded:
            ” the term “type 3 diabetes” accurately reflects the fact that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 diabetes mellitus and T2DM.”
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/

          • Thea

            Jim: That some good thinking. I think that whatever happens going forward, we should have a system in place that acknowledges the complexity and allows patients to take small amounts of insulin if needed. Sounds like we need some studies on how to safely give small amounts of insulin to people who have only partial Type 1. If a new classification system will help us move to that point, I’m all for it.

          • Daniel Hunter

            Jim, Sue from our group just shared two very interesting links that I think you would find valuable, the first pointing up the need to catch this early, before we have to treat end stage disease, because the years of high insulin have already wreaked havoc long before the DM diagnosis:

            JOSEPH KRAFT: WHY HYPERINSULINEMIA MATTERS – http://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/

            and the second, showing Kraft’s system of dividing diabetes into groups:

            Detection of Diabetes Mellitus In Situ (Occult Diabetes) – http://meridianvalleylab.com/wp-content/uploads/2012/08/GITT-Article-Re-type1.pdf

            – Dan

          • Wilma Laura Wiggins

            I think most of this confusion could be cleared up by reading what Dr. McDougall has to say about it. His way of eating most of the time results in reversal of T2diabetes. As he says your blood sugar level is SUPPOSED to spike after you eat. But long term, the A1C goes down.

          • Russell

            Thea, thanks for mentioning our group. I found a link for you which explains the differences between three types of autoimmune diabetes. There is Type 1 late onset (LADA), Type 1.5, and Type 2 with autoimmune issues:

            http://www.diabetesselfmanagement.com/diabetes-resources/definitions/type-1-5-diabetes/

          • Thea

            Russell: Great article! I thought it was really helpful. Thanks for posting that link. And I’m grateful that you and seupy jumped in as I’m unqualified to discuss your situation.

          • Wilma Laura Wiggins

            Ii can certainly understand it, too. I was quite fearful when I was seeing spikes, but after following Dr. McDougall’s career for 30 years and finding him right on everything I went through, I decided to just close my eyes and trust that he was right about carbs not being harmful. I decided to stop testing for spikes and just got tested for A1C and every test found my level lower until my doctor no longer felt the need to test me. I considered myself cured (and still do)

          • Kaz

            Hi Wilma – it was good to read your post! I have T2 and was on a low carb diet which reduced my blood sugars to a normal range so I was delighted. However i was then advised that the low carb diet would ultimately cause me more problems with my diabetes and that I should do a low fat plant based diet. I’ve started doing it and my blood sugars are steadily rising which is freaking me out! Was tempted to go back to the low carb but your post has made me think twice. Can you remember how long it took for your blood sugars to start reversing on the plant based diet?

          • Wilma Laura Wiggins

            I have heard of people reversing in 2 weeks but for me, it took a full year. I got tested every 3 months and it went down each time until finally normal. I was tested a few more quarterly times and it stayed normal so the doctor no longer tests for it.

          • mbglife

            Hi Thea. I just posted to Tom’s reply to you as a reply to you both.

            Mark G

          • Thea

            Thanks. I would say that Barnard and Greger and Brenda Davis and probably many others agree with the general sentiment you wrote. I agree with it myself. As I responded to Tom, I’m just not 100% sure I know the full technical/medical definition of T2 and thus if there really is some rare set of T2 people who have a different cause and thus treatment for T2.

          • suepy

            Thank you Thea for mentioning our high-fat vegan group. See our response to Joe following your comments.

        • Russell

          Yep, I’m part of the group that Thea referred to — the low-carb, high-fat, Eco-Atkins (vegan) diet people. We’ve all used it very successfully to improve our A1C values far beyond what we could do with a low-fat WFPB diet (that’s a glucose measurement over prior 60-90 days, for those who don’t know of it). The problem for all of us is that carbs, starchy vegetables, and fruits and other sweets drive glucose WAY up, so given that none of us has insulin resistance, the issue is simply poor insulin production. This is apparently quite common in Asia for some reason, but not so much in Western countries. Anyway, for us this diet really works.

          • Joe Caner

            Interesting. Thank you for sharing your experiences Russell.
            How high is your daily SF intake?
            What levels are trying to hold your carbohydrates to?

          • Russell

            Between 7-10 grams of saturated, 90-120 grams total fat, but carbs vary a lot because there are so many mitigating factors, i.e. exercising or walking after a meal, food fiber content (high fiber seriously blunts glucose), low vs high GI foods, etc. The trusty post-meal glucose meter becomes the speed limit. For me, 100-150/day is about the max I can do.

          • Joe Caner

            That does not sound like an irresponsible amount of SF. Assuming a 2000 calorie, it is below the AHA recommendations for daily SF intake. Presumably, a total fat intake of 90-120 grams would also have an effect on one’s cholesterol numbers.

          • suepy

            I am also part of Russell’s group, having followed this high fat-moderate carb and protein diet for over a year now. On an average I eat 1800 calories a day with 150g carbs, 60g fiber, 90g protein, 95g fat, 12g saturated fat. As Russell said, the higher fiber really helps slow down a carb response. All of us are getting our carbs from beans and barley, low GI veggies and fruit, and nuts. We are conscientiously monitoring our lab results, and mine have show marked improvement in all areas, even though initially they were better than average after 6 years of a vegan diet. My cholesterol has dropped to 155, inflammation is low, A1c 4.9, and insulin sensitivity is high. Our problem is not insulin resistance; we are quite lean and have no extra weight to lose. We have insufficient insulin, or more like type 1 as my doctor says, but since we don’t take any medications or insulin, our carb intake needs to be low. Weight loss and a low fat diet are meant to reverse insulin resistance, and that is effective for the vast majority of people with impaired glucose metabolism who are overweight. Just don’t squeeze us into that category!

          • Joe Caner

            Perish the thought. One size does not fit all.

          • Russell

            I’ve never found anything suggesting a link between non-saturated fats with LDL, only saturated. Have you ever seen any studies on that? Anecdotally, I’ve done lab comparisons where I held total fats constant, while reducing total saturated fats, and my LDL value decreases modestly. And subsequently, the opposite test, and it increases again. But there may be some minor impacts of total fats but that’s clearly not the big driver in the equation.

          • Joe Caner

            Nor have I seen anything that directly implicated non-SFs with LDLs. The reason that I transitioned to a low fat WFPB (LF-WFPB) diet was my cholesterol levels and my arterial ultrasound results. The results that Esselstyn and Ornish got in reversing with LF-WFPB diet without oils made it an attractive alternative to a life long regime of statin drugs. Since there is SF’s in all whole foods, I suppose that restricting overall fat intake helps to limit SF’s which is why they recommend a low fat diet.

          • Russell

            You’re right, even my high fiber barley breakfast cereal has 1gram of saturated fat per 45 gram serving!

            But still, for Ornish and Esselstyn to conflate total fat and saturated fats is inaccurate, not to mention unscientific.

            Moreover, some fats, like chia, hemp, and flax, for example, have less saturated fat than my barley cereal for the same caloric dose. In the interest of simplistic nutritional marketing messages, they fail to mention that.

          • Joe Caner

            It is not their conflation. It is my own. For about three years, I limited my daily intake of SF’s to 4 grams or less per day. The only way I was able to do that was to be very careful about the foods I selected.
            Even flaxseeds, which are an excellent sources of healthy fats derive nearly 7% of their calories from SF’s, and flaxseeds, are nearly as good as it gets, although chia and hemp are both excellent choices.
            I have since relaxed this spartan regimen by adding other seeds, nuts and avocado to my diet, but for the longest time, a tablespoon of flax and a half a cup of oat groats with fresh fruit or berries made breakfast my most fat ladened meal of the day.

          • Russell

            Wow, that’s impressively low. With that diet, if you don’t mind my asking, how far did your LDL drop, and to what level? And now that you’ve added back some fats, where is it? I have ApoE4, so that makes it harder to get down below 100 but when I had saturated at 5.5 grams a day, it finally was. But so hard to do that when you can’t eat a lot of grains, which is why low-saturated fats have been important for me (and for others in our little group).

          • Jim Felder

            Once again nature proves to be more complicated than a simple yes/no answer. Thanks for helping me from thinking about type II diabetes in an overly simplistic way.

            Still I would think that for type II diabetics who can still produce normal or near normal amounts of insulin that a very low fat WFPB diet would represent a way to very quickly improve their insulin sensitivity by getting FFA out of the muscles while also avoiding potential lipotoxicity problems of a high fat (of any variety vegan or not) diet which can cause further fatty liver issues and hasten beta cell death.

            And if you do have permanently impaired but non-zero insulin production, does frequent meals that keep the total meal glycemic load low help to keep the demand for insulin better matched to the limited insulin production capability?

          • Russell

            Yes, you’re absolutely right about frequent meals. I snack all day long to avoid overloading my insulin production capacity, and I can’t have more than 500-600 calories in a single meal unless I’m headed to the gym afterwards. But unfortunately, substituting more carbs for fats reduces my ability to get enough calories each day because I’m trying to keep glucose under 120 or 130 at all times. I’ve actually tried this approach, and found that I can only get about 1400 calories/day, which is not a good idea for someone who is already at a BMI of 20. (5’10”, 142lbs.). But I’m with you in concept!

        • Jim Felder

          This is a fascinating conversation thread. Sometimes I find the comments to be as interesting as the video itself. From the comments from Russell and others who control their diabetes with a high fat vegan diet, I think there really needs to be another category of diabetes, perhaps a Type 3. Type 1 doesn’t really fit because that has an autoimmunity origin and usually results in a complete inability to produce insulin, and from Russel’s comments this group of diabetics still produces some insulin but less to much less than normal to the point that “normal” glucose levels can’t be maintained in the face of significant carbohydrate absorbtion rates. Type 2 doesn’t seem to apply either since this really isn’t a diabetes caused by insulin resistance. So I propose the following definitions:

          Type 1 – Either low or normal insulin sensitivity/No insulin production due to autoimmune disease.
          Type 2 – Low insulin sensitivity/Normal or near normal insulin production.
          Type 3 – Normal insulin sensitivity/Insulin production levels that are insufficient to control blood sugar in the face of significant carbohydrate absorption rate challenges (ie high spikes in blood sugar).
          Type 4 – basically the same as Type 1, but due to accumulated dietary insults resulting in insufficient or zero insulin production and so becomes dependent on external insulin for blood sugar control.

          I might go even a little further and split type 2 into two subtypes. Type 2a is what is currently called “pre-diabetes”. Pre-diabetes makes it sound like they aren’t quite sick yet, but might become diabetic someday. In fact it means that they are already sick with severely impared insulin sensitivity, but for the time being they still enjoy a robust insulin production capability and so can still “pound” the sugar into the cells with large amounts of insulin (probably why pre-diabetics are prone to gaining weight so fast).

          Type 2b then would be what is currently defined as type 2. This is when wear and tear and lipotoxicity starts to cause beta cells to start dying and insulin production capability dips below what is required to adequately control blood sugar with a low level of insulin sensitivity, but still adequate to control blood sugar if insulin sensitivity could be restored.

          So except for those who become diabetic due to an autoimmune disease, the progression and treatment/control options sounds like they go from

          Type 2a – easily reversible with a low-fat WFPB diet
          Type 2B – still reversible with a low-fat WFPB diet, but progressively less reversible as beta cell death accumulates. Type 2B would then be a spectrum blending seamlessly from 2a to 3
          Type 3 – not reversible with a low-fat WFPB diet, but possibly controllable with a high-fiber/low-moderate carbohydrate/moderate-high fat WFPB diet without drugs or external insulin
          Type 4 – insulin level too low to control blood sugar without external insulin

          How does that taxonomy sound?

          • Daniel Hunter

            I’m going to jump in and confuse the issue even more. I’m also part of Russell’s group and I can get away with a lower fat, higher carb diet than the rest of the group. But, this was achieved at what I would call an enormous effort over the course of about 6 months to improve my glucose tolerance using exercise to control my postprandial BG as I gradually challenged my beta cells with ever greater amounts of glucose. So my diet currently is WFPB 16-30-54 (% P-F-C), relying heavily on legumes and vegetables, avoiding grains/sugar. I restrict sat fat to under 6% of tot cals / day because I have the e4 version of APOE and thus am able to keep my LDL cholesterol at 85 mg/dl and my HDL at 70. So far, over the last 2 years, I seem to be seeing a possible beta cell improvement – not sure if this means there’s a type 2c or that those in 2b category just haven’t tried hard enough or used the right foods.

          • Jim Felder

            I have always wondered if there aren’t pancreatic beta stem cells. Maybe not a lot, but perhaps your diet is now so convivial to the health of beta cells that the trickle of new ones is now faster than the die-off rate. And maybe it takes this kind of very very controlled diet to get the various substances that are toxic to beta cells down enough to allow enough to accumulate. Perhaps even type 1 diabetics, who seem to do a lot better on a WFPB diet, the better A1c results might be due in part to a little trickle of new beta cells. It would be facinating to find out. OBTW, color me impressed at your dedication to manage your disease.

          • Daniel Hunter

            > I have always wondered if there aren’t pancreatic beta stem cells

            Jim, you might be interested in this very interesting article: Resurrecting the Beta Cell in Type 2 Diabetes:

            “An important feature is that beta cells do adapt. … There may be an increase in neogenesis, or new beta-cell formation (replication), and an increase in the beta-cell mass, or hypertrophy, that may occur. We also know that we probably lose beta-cell mass through apoptosis and perhaps necrosis. There is actually some evidence that non-apoptotic and non-necrotic mechanisms may also be involved in the loss of beta cells, but it is the balance between neogenesis and replication and cell death that really determines our beta-cell mass. There is an increase in mass and an adaptation to the increase in demand for insulin; there is also a change in function of the individual beta cells. … In a mouse fed a 10% vs a 45% fat diet, there is a marked expansion in beta cells. There is a very large increase in the number of beta cells and in the size of beta cells. Down here is the islet area; here is the beta-cell diameter in response. This does not take too long in the animal; about 6 weeks of feeding will cause this marked increase in beta-cell mass. … Beta-cell failure is probably what underlies the majority of type 2 diabetes. … In type 2 diabetes, restoring first-phase insulin secretion improves glucose tolerance and reduces free fatty acid levels. … as your blood glucose starts to go up — particularly as your fasting glucose goes up — you can see a marked loss of first-phase insulin secretion. … The thought is that it is the combined increased flux of free fatty acids and increased flux of glucose into the beta cell that has detrimental consequences. … When fat gets in the beta cells, lipid intermediates are generated that cause abnormal signaling and contribute to the intrinsic dysfunction, the intrinsic secretory capacity, of the beta cell. … Even before an animal becomes diabetic, there is dysfunction in the beta cells. You can see there are lipid droplets in the beta cells (shown by the little stars). … beta-cell failure really is a progressive disease. We talk about impaired glucose tolerance and about diabetes; I think it is really splitting hairs. … The pathogenesis of beta-cell failure is really a response to increased flux of glucose and fatty acids.
            http://www.medscape.org/viewarticle/544820

            My thought is that (esp re the mouse 10% vs 45% fat diets) in changing from 50% fat to 30% fat, my beta cell function may have been upregulated. That is speculative of course, but observable is that my unmedicated, fasting BG went from an average of ~100 to its current 80 and if this article is correct, that means my first phase insulin secretion may have been somewhat restored.

    • https://plus.google.com/115774777181877344300 Allen Crider

      There are fans of the ketogenic, very-high fat diet, who achieve better blood sugar numbers and believe that is the best way to handle type 2 diabetes. Of course, they haven’t reversed type 2 diabetes. All they have done is severely reduce the amount of carbohydrates for their body to metabolize. THey still have insulin resistance and it gets worse by the day on a very high-fat diet.

    • Rhombopterix

      I dropped some 40 pounds in the first months then plateaued. Why wasn’t I continuing to my ideal weight? I didn’t think I was cheating. But I was. I was looking for loopholes. Then I found a new reserve of strength resolve and …. terror. She said if I didn’t go the full Esselstyn monty I’d be wearing a rolling pin for a bonnet. I didnt want that so now I can say I’m lean, happy, active, off those d*** drugs and…ITS ALIVE!

      • Wilma Laura Wiggins

        Could you explain “I didn’t think I was cheating. But I was. I was looking for loopholes” Did you really think you weren’t cheating?

        • Rhombopterix

          I meant that I still wanted that “overfull” feeling. I ate when I wasnt hungry. Even healthy food will keep you fat if too much goes in.

    • charles grashow

      http://link.springer.com/article/10.1007/s00125-011-2204-7/fulltext.html
      Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol

      • Bryan Brown

        This is the hard road that most ignore. Probably due to the pain associated with it. But it does seem to be the most successful route I have seen in the last 3 years associated with the reversal of type 2 diabetes. Thanks for mentioning it.

        • Mike Quinoa

          But how long can one endure a calorie-restricted diet, and what happens when they resume a normal eating pattern? I eat a lot of plant food and a lot of carbs, but so far blood sugar and HbA1c are great.

          • Bryan Brown

            I don’t know the long term effects of the diet, but the documentary I watched, all had normal blood sugar after resuming a normal diet.

        • 2tsaybow

          I think eating a whole food plant based diet along with taking a teaspoon of amla every morning is a lot better way to reverse type 2 diabetes. It’s been profoundly successful for me. Why would you consider surgery a better answer?

          • Bryan Brown

            This article refers to a 600 cal/day diet for 8 weeks, not surgery.

          • 2tsaybow

            Same response. Why restrict calories when all I had to do was eliminate animal products.

  • Thea

    from the video: “It’s good that the dietary intervention wasn’t killing anyone, but why wasn’t it actually helping people live longer? Because they didn’t actually put them on a healthier diet… Whereas, individuals following healthier diets may experience improved reductions in blood sugar, body weight, and cardiovascular risk.”
    .
    Clearly the devil is in the details here. The key question is: What is a healthy diet? Dr. Greger is talking about the diet recommended on this site and by Dr. Esselstyn and by Dr. Barnard. Do you or someone you love have diabetes or pre-diabetes? Dr. Barnard wrote a book that covers the clinical evidence on the diet that is proven to be more effective at reversing T2 diabetes than the ADA diet. Just as important, the book includes meal plans and recipes so that you can learn exactly what counts as a healthy diet for T2 diabetes. For anyone interested, this is the book: http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?ie=UTF8&qid=1454508475&sr=8-1&keywords=barnard+diabetes
    .
    Also, be sure to check out the Doctor’s Note above. It lists some videos on NutritionFacts which the evidence supporting healthy diets and T2 diabetes.

    • Kim

      I haven’t read Barnard’s book (on diabetes), but I expect the diet it recommends is similar to what he recommends elsewhere, and is low-fat. Is there any evidence actually showing that low-fat whole foods, plant-based diets are better than slightly or much higher fat whole foods, plant-based diets? Low-fat (10% or less) diets are often harder to stick to than ones that allow for a bit more (20%, say). Many diabetics might find that easier to stick with. I wonder if there’s any evidence comparing these kinds of differences in diets.

      • Thea

        Kim: Yes, it’s pretty much the same diet. I don’t know if there is a study like the one you are asking about. But in regards to your last point, I don’t think Dr. Barnard has had any trouble getting people with diabetes to stick to his recommended diet. That’s just what I remember from the book. Quite the opposite. I think people refuse to go off the diet even as part of a control part of an experiment. I don’t have a quote in front of me, so I may be remembering from that comment from somewhere else.
        .
        My thoughts following up on your idea: I agree that it would be an interesting experiment to test exactly where the boundary lies in terms of healthy fat percentages for T2 diabetics. However, my opinion is that T2 is such a serious disease, it needs to be treated aggressively (meaning with strict diet, not drugs) with a proven solution right off. But what about when people’s insulin resistance gets under control? Would it then be ethical to do a study that tests a diet that is 10-12% fat with a diet that is say 20-25% fat for maintenance purposes? I think it would be ethical and a good question to answer. And then if that worked, you could possibly go back and test the 20% fat/whole plant food diet on people just diagnosed with diabetes or with pre-diabetes. That’s just my thoughts on the question. What do you think?

        • cgins

          I just watched Mark Hyman’s fat telesummit hoping for precisely this insight on how much fat, though in the context of heart disease. In the interview with Dean Ornish, the gold standard on nutrition research for me, he said that research on somewhat higher amounts of fat has not been done to conclude that the higher amounts are safe. They could be. We just don’t know. I thought Joel Fuhrman in his interview mentioned research he had done recently that did show positive results for a higher fat nutritarian (hihg-nutrient vegan) diet, but I couldn’t find it to share.

          • Beth RN CNP-E

            Dr Dean Ornish has recently updated his program. “After reviewing the accumulated validated research, we decided to include a limited amount of select nuts and seeds as additional choices. The addition of nuts and seeds does not change the Ornish Reversal Guidelines, but enhances these to include additional choices” http://ornishspectrum.com/zine/updated-ornish-reversal-program-dietary-guidelines/?utm_medium=email&utm_campaign=Ornish+Living+Newsletter+1282016&utm_content=Ornish+Living+Newsletter+1282016+CID_c2ea3c54c0797fd7cdb2e723a3030d87&utm_source=Email+marketing+software+CM&utm_term=Read+More

          • Thea

            cgins: re: “In the interview with Dean Ornish, the gold standard on nutrition research for me, he said that research on somewhat higher amounts of fat has not been done to conclude that the higher amounts are safe. ”
            .
            That’s an interesting statement given Ornish’s studies. For me, though, the gold standard is Esselstyn. And Esselstyn has seen increases in heart attacks when people who have had serious heart disease start to increase fat intakes by even a little. This still leaves the question about whether healthy people can eat *somewhat* (as you say) higher amounts of fats. I think the key is figuring out what somewhat is. And also figuring out what healthy is. Dr. Greger has discussed in other videos, people in America are starting to show fat streaks in their blood by age 10. And for a disturbingly large percentage of people, their first heart attack is their last. In other words, they had no idea that they had advanced heart disease. So, how many people in America at least could really be considered healthy when it comes to the heart? Shouldn’t we all be eating like we do have heart disease. The bottom line of all of this is that while we may not know exact percentages of fat may be healthy (or which kinds under which conditions), we do know enough to know, in my opinion, that the cautious/safe diet for the majority of people would be a whole plant food diet that is at the low end of fat intake.

          • cgins

            Thea, I’m inclined to agree with that. I watched the interview with Dr. Esselstyn as well. While Ornish acknowledged it was possible some higher fat might be okay, but it wasn’t proven, Esselstyn was, indeed, 100% clear on low fat, not even enthusiastic about the nuts for longevity that Dr. Greger and others have discussed. However, it is possible to have that small handful of nuts within the 10% as long as that’s about it for overt fats for the day, in my experience.

          • Thea

            cgins: re: “However, it is possible to have that small handful of nuts within the 10% as long as that’s about it for overt fats for the day, in my experience.” I think even Esselstyn agrees with that. Maybe not for people with known, advanced heart disease, but for the population in general. I remember hearing him say once something along the lines of he agrees that say 1 oz nuts a day is probably fine for most people. But if he says that too plainly or often (I’m not sure of his wording), then all people will hear is “nuts are OK” and eat too many. So, he leans away from nuts just so his opinion won’t be used to go astray heart-health wise. I know Dr. Greger encourages an ounce of nuts a day. And I *think* I heard once that Barnard doesn’t see nuts as a necessity, but that 1 ounce is probably OK. So, I think they are all pretty close in opinions with nuances that people can stress over if they want. I don’t stress. I just enjoy the nuts. :-) (Though more often than I’d like, I’m one of those people who eat too many of them.)

          • Jim Felder

            Mmmm, cashews, mmmm! Sorry, was I drooling? :-)

          • Thea

            Oh gosh. Now I’m drooling… :-O

        • Alan

          Whether it is ethical or not would not be my concern. If i was diabetic and had gotten very good benefits from a low fat WFPB then i would not even consider going on a higher fat diet or any kind of different diet for that matter. I would stick with what worked !!!

          • Wilma Laura Wiggins

            You say that, but have you tried it? I have done the low fat and still do and probably always will, but I can certainly understand wanting to be able to add more nuts, avocados, olives, etc. to your diet. I do that too now that keeping up my weight is my problem rather than losing it.

          • Alan

            Hi Wilma Laura Wiggins – I do eat a low fat diet. I do not use any added oils except a tsp about once every month, just in case i need it. I do eat 1 to 11/2 ounces of nuts or/and seeds a day. I very seldom eat avocados or olives, but like them real well, especially the avocados. I do eat lots of Carbs – White and sweet potatoes, butternut squash and oats, brown rice and other grains. My weight is also low, but i have always been on the thin side even when i was on the SAD. If i eat more to try to gain weight i do not feel very good. My body just cannot handle all that extra food.

      • https://plus.google.com/115774777181877344300 Allen Crider

        Since it is fat that causes insulin resistance, I very much doubt eating more fat would result in better outcomes for T2 patients.

        Perhaps after one has reversed their T2 numbers on a very low fat plant-based diet and also has achieved an ideal body mass index, then going to a 20% fat way of eating could be tested on an individual basis to see how much insulin resistance returns. But by that point maybe the patient will have gotten used to eating very low fat.

        In my own case, though not a diabetic, I’ve eaten very low fat for a couple of years and have adjusted so much that edible oils have become disgusting to me — especially when I get some on my fingers.

        • Blair

          I’m exactly the same. It’s true that any preferred diet is just what you’re used to. After eating WFPB and very low fat for a long time, any added fat disgusts me. As do added refined sweeteners. Just can’t stand them.

        • Wilma Laura Wiggins

          Adding fats does not mean adding oil. Oil is unhealthy for one and all. Adding fats means adding more nuts, avocados, olives, flax and chia seeds and tofu.

      • Charzie

        I can only speak for myself but I had to get my fats under 10% to reverse my diabetes. When I did it took about 2 weeks, so that’s where I stay.

        • Wilma Laura Wiggins

          That’s amazing you were able to reverse diabetes in two weeks. It took me a year to go to totally normal. And yes my fats were under 10%. I would not have thought such a fast turnaround possible.

    • Darryl

      the devil is in the details here

      In more ways than you suggest. While most anti-diabetic medications have off-target adverse effects (reflected in higher mortality in the ACCORD trial), one has been advocated as a candidate anti-aging drug and may reduce diabetic mortality to lower than age-matched “healthy” controls. Strikingly, natural food compounds like anthocyanins, genistein, capsaicin, curcumin, and EGCG similarly effect the likely mechanisms: AMPK activation and beneficial modulation of microbiota.

      • https://disqus.com/psych_md/ psych_md

        Great article, Darryl. I started taking metformin last year specifically as an anti-aging strategy. I also practice daily intermittent fasting in which all my food is consumed between noon and 8 PM. For me health is a hobby, like my car.

        • http://www.facebook.com/1617045999 Matt Smith

          Do you notice any mood improvement effects on metformin, a rich source of Nitrogen? You do know that diabetes is a side effect of many antipsychotic medications, which might shuttle Manganese and Thiamin Vitamin B1 out of the body. The weight gain and health consequences of antipsychotic medication. Have you considered that there might be a superior answer in the form of health and hobbies, such as through nutrition? Milk allergies, which lead to zinc deficiencies, and pellagra are common among the mentally ill. There are rumors that some doctors can gage the human throat and assess for mental health. The thicker the worse, very thick up top, too anxious. Very thick in the middle, too much pain. Thick in the bottom, too much pellagra (schizophrenia) from Niacin deficiency. Metformin might have mood benefits. How did you get yours without having diabetes? Many people would like to have health from food and Vitamins. Seeing disease as biochemical suggests great turnover and recovery potential. Cures are out there.

      • Thea

        Darryl: Very interesting link. The question in my head is how those taking metformin would compare to those people who eat a whole plant food diet. Comparing to a control group that eats SAD may not be telling us anything. :-) But then again, the idea is fascinating since I wouldn’t have expected a T2 diabetes group to beat any non T2 diabetes group in all cause mortality based on a drug.
        .
        I particularly appreciated your last sentence as that helps put things nicely into perspective.

  • HemoDynamic, MD – NF Volunteer

    Wow! Best summation ever about the truth and futility of diabetic pharmacotherapy!
    Plants and your body are smarter than our silly simplistic human interventions with drugs!

    • WFPBRunner

      And you can’t just lose weight–you have to eat healthfully!

  • VegGuy

    Managing type 2 diabetes is not just about lowering blood sugar, it’s not just about losing weight; it is about EATING A HEALTHY WHOLE FOODS PLANT BASED DIET!

  • justme

    Wow … until the very end I was about to feast on my hot dogs and burgers .. but instead, I got my bowl of beans .. slow cooked with tons of veggies. Thanks doc .. 30 yrs. T1 still no complications but doing so much better after finding NutritionFacts !!!! keep up the good works … btw .. mom is 95 and still going strong.

    • Rebecca Cody

      I wish I had discovered WFPB when my mom was in her 80s. She would have been open to it and could have made that 100 mark she wanted to. She did make it to 95, but had a stroke at 91 and had to be in a care home until she died. Last year would have been her hundredth.

  • rfeld993

    I would love to see this done with type 1 diabetic patients, such as myself. I have turned to a wfpb diet, two years before I became diabetic, and I believe it helped slow the progression, but I would very much like to see the science to back it up.

    • Rebecca Cody

      There is a documentary, Raw for 30 Days, where they brought six insulin-dependent diabetics to a center in Arizona, gave them a whole food all raw vegan diet, and kept them on it for 30 days, monitoring and measuring everything, working to help them learn how to continue the diet at home. The doctor was Gabriel Cousins and I think the center was called Tree of Life in Patagonia, AZ. The type 2 people were all off insulin within three days. There was one type 1 – so they thought at first – and he struggled more, being younger and wanting to drink, etc. Eventually, though he settled down and was able to cut his insulin back dramatically. Another man was at first thought to be type 2, bur turned out to be type 1. If I recall correctly, he was able to go off insulin. He was so impressed that he went back to college and became a naturopath. I’m thinking the diet may have been higher in fat than 10%, because raw vegans usually eat a lot of nuts.

      • rfeld993

        Thank you for the information! however I have seen this documentary many times, and I was a raw foodie for about 4 months, and I did notice that I needed less insulin, and was able to stop taking it completely, but then i started eating “normally” again and now it has been a struggle to get back to that type of lifestyle, and as a result, I have started taking insulin.. and my sensitivity has decreased so i keep having to increase my dosage every few months… but thank all of you for your concerns!

        • Rebecca Cody

          I couldn’t sustain a raw diet, either. Too much work! And also, I couldn’t keep warm when fall came.

          What does eating normally mean to you? Have you been eating WFPB? Are you getting too much fat? It seems that research now shows too much fat is what makes the body’s insulin ineffective, if I understand it correctly. I was slow to accept the need to cut down so drastically on fat, but then it hit me: oils, even olive and coconut oils, are processed foods! Dang! Why did that take me so long?

        • Wilma Laura Wiggins

          I think the extreme of all raw is not necessary to be healthy and reverse diabetes. I follow the Starch Solution by Dr. McDougall. Very livable. His program is available online, totally free, everything you need to follow it.

  • http://chinaoneorcutt.com maule5662h

    Watch Dr. Gabriel Cousins’ video on curing diabetes in 30 days — using an all-raw vegan diet — two of the six participants were Type 1 diabetics! One got off of insulin and one dramatically reduced the amount of insulin. You can access the video here: https://archive.org/details/reversing-diabetes

    • Jim Felder

      Sorry but I have real difficulty believing that a type 1 diabetic could stop taking insulin. The only way that I could see how this could be the case is if they still had functioning beta cells, but tiny amount being made made them fundamentally insulin dependent until insulin sensitivity was restored and they were able to get by on the amount of insulin still being made by their pancreas. I think we need to be very careful in claiming that a WFPB diet, raw or not, can cure type 1.

      • http://chinaoneorcutt.com maule5662h

        Watch the video — yes, you are correct — his pancreas had to be still functioning and was aided by the new diet. He has gone on to be in the medical field, too!

      • Rebecca Cody

        One thing about the diet used for that documentary was that it didn’t require a lot of insulin for anybody.

  • Robert Haile

    As a physician, I treated those who already had severe sequelae of diabetes: post stroke, post MI &CABG, MI requiring CABG complicated by stroke, single to multiple extremity bypasses and/or amputation/s, Diabetic Amyotrophy, polyneuropathy, and more. Every single patient was seen by a nutritionist. I would speak with the nutritionists and support positive dietary changes. Every patient was counseled by a psychologist to address depression, anxiety, family dysfunction and also smoking cessation, alcohol, or other substance abuse. Each patient was seen by a social worker to address family support, provision of needed equipment, insurance coverage and placement if needed. They saw PT, OT, Speech therapists, and where needed orthotists and prosthetists. We functioned as a cohesive team, meeting regularly to provide consistent intervention and support. We had one of the highest success rates in the country for prosthetic fitting and use in a very large prosthetic clinic. Overall we were highly successful in areas of mobility and function, but not habits. Before cigarettes were banned on hospital grounds, I would see patients smoking and later asking me why they healing was so slow, and I was never too shy or lazy to tell them. We would get them on great diets only to find evidence of fast food and candies in their rooms brought in by family and friends. However, we never stopped trying. It was not unusual to see a HbA1c of 12 and no matter what we did in both the short and long run, both the acute and short term results of diabetic control was dismal. However, these patients would die if not treated with insulin. In the study you reported, the hypoglycemia was killing these patients as hypoglycemic shock would trigger very low or no flow in the severely atherosclerotic clogged arteries, and not the insulin per se. Subsequent studies have shown for late stage diabetics, it is safer to keep the HbAic above 7. I have reviewed this issue in such detail to emphasize that some patients will just not modify their lifestyles and oral and injectable medications are needed. We must start with parents, small children, schools before bad habits become recalcitrant, and bad results are not always from lack of effort, I know, as with my remarkable team. Agribusiness has a stranglehold on this country. There are many fine health workers that try to change lifestyle first and work extremely hard at it. Your audience is far different from the cohort of end stage diabetics that I treated. We must elect public officials willing to write laws against the criminal behaviour of the big businesses who add toxic chemicals to our environment and refine the benefits out of our foods. Parents must get off their screens long enough to make their children decent meals and sit down and eat it with them. When I see a blind, neuropathic, diabetic with both legs bypassed & amputated, post MI & CABG, and one side paralyzed from stroke(and I’ve seen many) it is a little late to change their lifestyle despite the very best efforts of dedicated health workers. These patients need insulin.

    • Stewart E.

      Thanks for that post Robert. I really like hearing from those who show their passion about life.
      As a T1 diabetic I just wanted to say that I also really appreciate the very candid information you give your patients. I had been diabetic for about 8 years when I came across an article in the Journal of Chronic Diseases on the implications of differing levels of hyperglycemia on diabetic side effects.

      Side effects!? Nobody told me about no side effects! So I had a rather animated discussion with my doctor on this point the next time I saw him. His response was that no one wants to hear it. In fairness to him that is mostly true but no one asked me before electing to fail to give me good information.

      If one is determined to kill oneself then it should be done knowingly. It delights me that you seem to agree. Most people I have found will start to change if a critical mass of knowledge is achieved. What you do will have a positive effect though not necessarily with the one you are targeting. What you say must be reinforced over and over and over… That knowledge must become part of the culture so that it is not some far out fad information. The more sources are out there the more it will become part of patterns of behavior. So please keep up the good work.

      By the way, for years I had used meat somewhat sparingly but went totally whole food plant based when I developed psoriatic arthritis and read more and more about the inflammatory factors in animal products. Methotrexate struck me as a good way to take decades off my life so I looked for other alternatives. When I changed my diet, the arthritis disappeared and my insulin usage dropped almost 25%. Same low 6 A1c and much more carbohydrates. .

      • jackelope62

        A healthful lifestyle is hard work but rewarding. I am glad that you are doing so well. All the best.

    • Jim Felder

      The problem is that the standard ADA diabetic diet stresses the high fat/low carb foods that are a, if not the, root cause of the intramyocelluar lipids that in turn lead to insulin resistance. Thus the diet recommended to diabetic patients will make their underlying diabetes worse, not better. The only thing the ADA diet does is manage the symptoms of the disease by better regulating blood sugar levels.

      So I imagine that you tell your patients that diabetes is not curable, that they will remain diabetic for life (which is guaranteed if they follow the ADA diet) and that at best they have to look forward to if they do manage to adhere to this strict and rigorous diet of carb counting and take all these expensive drugs for the rest of their lives is perhaps a slowing of the damage done by the disease but never reversing it or even stopping further progression. So is it any wonder after being told at best you can offer them a slightly less gloomy future that many people just say f*ck it and ignore your advice.

      But what would be the difference if you told them it was completely within their power whether they want to remain diabetic or not. That they didn’t have to continue being sick. Don’t you think a few of them might celebrate the chance to escape this gloomy future even if that meant following another diet that asked them to make perhaps even more fundamental changes to what and how they eat. And as more and more people reverse their diabetes and provide such powerful confirmation of your message of hope that an even greater percentage of your patients will make the change in their diet. Eventually even the ADA won’t be able to ignore the fact that diabetes is not incurable.

      I do agree that we need to do a much better job of teaching our children healthy eating habits and that we must do more to keep the corrupting power of Big Food out of our school and branches of government so that people have a chance to eat a diet that keeps people from becoming diabetic in the first place. But I strongly disagree that patients won’t change. I feel that many will if you give them a message of hope of health rather than hopelessness. And it is really up to you to sell the idea really hard that it is within their power to reverse their disease. You will have to counter a lot of other information that they get mostly from the ADA and other diabetes docs. But you are their doctor, just one step down from God in many peoples eyes. You are in a unique position to help people shift onto a path that can lead them out and back to health. Will it work for every patient, probably not, but you at least owe it to them to try.

      • jackelope62

        I did not recommend the standard ADA diet. We were hopeful and optimistic and we did this over 40 years. I’m not sure you saw the types of patients that I was dealing with. If your leg was amputated, it was not healing. Would you quit smoking? Many of my patients would not. We are talking 50 to 80 years of a particular lifestyle. Many of my Type 1 diabetics were facing the same issues in their 20’s-50’s and and they can not be weaned off insulin. Furthermore denial is often a major issue. I am a vegan and lifelong athlete at age 67, continuing to surf, bike, play tennis, walk, as well as a non smoker and non drinker. I always tried to set a good example for my patients. You can not discuss war unless you have been there yourself. So please do not assume what it was like. I have fought many battles with hospitals and the healthcare system to change policies on nutrition, smoking, and behaviours, often to my own detriment. I live a simple life, don’t drive, and minimize purchases other than good food. Just because I’m fully aware of climate change does not mean I am not realistic about it.

        • Jim Felder

          My apologies if I came off as too harsh. It was a reflection of my general frustration with what I perceive as a general reluctance on the part of doctors to share the most effective treatment, in this case a WFPB diet, because they are sure the patients just won’t follow it. I am not a physician and have never been in the trenches. But I think doctors owe it to their patients to give them full information regardless of whether they think it will be followed and let the patient make their own decision with ALL the information. And from what you say you are one of the good doctors who do. So thank you for fighting the good fight.

          And I can understand how frustrating it must be to see people ignore advice to stop things that they know to be killing them. But could it be that patient compliance is so low because for things like Type II diabetes because the overall message is one of ultimate futility despite any changes the patient makes. So patients don’t see any point in sacrificing their pleasures for what they see as a dreary and joyless future since even if they give up “every” thing that makes them happy at best they will only see moderate reductions in the rate at which they are sliding towards an early grave.

          For the effectiveness of a positive patient empowering message I would point to Dr. Esselstyn as an example of an approach to showing patients the healing power of a plant based diet and show them a way OUT of their disease. He is able to achieve adherence rates of around 90% and then a disease reversal rate in those that conform to his diet of over 90%. Once people see that they can actually reverse their disease, they are much more willing to make the changes needed. And if you have seen his diet you understand just how far it is from even a nominal WFPB diet let alone the SAD, so his success rate isn’t because his diet is particularly easy to follow. I am very motivated WFPB eater and without the motivation of active disease I couldn’t keep Esselstyn-pure.

          Again, please don’t take anything I say as an attack on you. Like you said, I haven’t been in the trenches. Please keep fighting for change. We need doctors like you.

        • Wilma Laura Wiggins

          Are you Robert Haile? I can see both sides, and I am sure it seems kind of hopeless when people won’t quit smoking and change their diets, even under the worst health challenges. On the other hand, when enough “publicity” about what is actually healthful eating gets out there, when it is possible to go out to dinner and eat healthfully, and when eating WFPB doesn’t make you seem like a freak, I’m sure we will see improvements. I say when but I mean if. The ADA is like all the other “Associations” – they may start out with good intentions but then self-protection sets in, they want to keep their jobs (especially the head honchos) and maintenance of the status quo health-wise becomes the goal. Associations will normally give out only enough actual health advice to keep from being obvious frauds.And I am including the AMA, fer shur.

    • Jim Felder

      Dr. Haile, I owe you an apology. I was appalled at the tone and content when I reread my original posting. Please accept my heart felt apology. I was channeling my frustration at all the reports of doctors not giving patients full information because they are sure that they wouldn’t follow the advice. There are absolutely patients whose disease has progressed so far that it has caused irreparable damage to their bodies that no amounts of dietary intervention will every reverse, and who as you say would die without your treatment. I just worry that those pre-diabetics and those whose insulin production would still be adequate if they could restore their insulin sensitivity are not being told that it isn’t too late, that there is a way to still save themselves from this horrible progressive disease. Rereading your post I see the heroic efforts that you and the rest of your team make to help people ravished by diabetes. Thank you for service in this other war.

      • Robert Haile

        Thank you.

    • http://www.facebook.com/1617045999 Matt Smith

      Have you considered Thiamin, Vitamin B1, or any other Vitamin for your patients? Do your patients say “Can’t, Can’t?” I think they are victims of modern Medicine. Iron, Salt, and even sugar can be very good for you. Diabetes seems very similar to Beriberi disease indeed, for which Vitamin B1 was named one of the world’s most critical medicines.

      • jackelope62

        You should just ask Dr Greger what he thinks about supplements versus whole foods or just read his book How Not to Die: I did and his opinions are quite clear, and I fully agree with him.

        • http://www.facebook.com/1617045999 Matt Smith

          The Vegan diet did not treat my mood disorder. Vitamin supplementation did. Have you considered that people need more nutrition than can be found in processed plants? That we are not living with our native diet? That we are missing key information, perhaps about the future?

        • http://www.facebook.com/1617045999 Matt Smith

          Have you considered if excessive sleepiness is related to a salt deficiency? If you lick your palms, are they so salty you gag? If that is true, you have a salt deficiency. It’s related to a whole bunch of diseases. Doctors want you to believe the way to overcome any kind of disease is by slow, steady medication. It is actually better, according to any statistical rule, to flood the body with the missing nutrient. I think this suggests supplementation and extensive supplementation is required to cure any illness. There is not one fatal overdose form vitamins a year. There is no way too take to much vitamins. There are thousands of ways to take too few. Such as by taking none.

  • JB

    In your book on page 299 where you are discussing seedless watermelon, you say ” Watermelon seeds, on the other hand, have pretty respectable antioxidant levels, so I try to avoid seedless varieties. A spoonful of watermelon seeds may have as many antioxidants as a whole cup of melon balls.” So are you saying to eat the seeded varieties because they have higher antioxidants because of the seeds in them, or are you saying you actually eat the seeds?

  • Vito Caputo

    I read somewhere on this website that questions were welcome and should be posted as a comment on the associated page. I did that (http://nutritionfacts.org/video/turmeric-curcumin-for-prediabetes/#comment-2486157023). However… at the time I posted… the page was more than 2 weeks old… and my comment continues to be the last comment posted.

    I want to pursue the strategy to lower my A1C as described on the page “Turmeric Curcumin for Prediabetes”… but I ran into a problem: how much to start with… and how soon will it show a measurable effect on my INR. Obviously, the answer can only be a “ballpark” guideline… which would be far better than my WAG.

    The information you provide is really great… and is not readily available from professionals that have been subjected to the standard medical curriculum in the US. The shortcoming is that the reader has nowhere to go to find out where to start and what to watch for.

    Thanks for everything you do… and I really would appreciate some direction from you on this matter. Specifically, as asked in my referenced comment: “How many capsules should I take… and how soon after I begin should I have my INR checked?” (Details in my original post)

    • george

      Vito Caputo: I’m no medical expert but somebody who has been using turmeric as a spice and as a supplement for a long time. Unless you have gallstone problems, turmeric is quite safe. But people could be allergic to anything, so I’d start with a pinch of whole turmeric a day and gradually increase to 1 tsp a day, always with or after a full meal. containing fatty foods.

      • Vito Caputo

        Thanks for your input, George. I would not at all be concerned about consuming mass quantities of tumeric —IF— I was not taking Warfarin. Using the search engine of your choice… use keywords — tumeric warfarin — and you’ll see why I’m seeking more specific guidance.

        Warfarin is an anti-coagulant agent; so too is cucurmin. If the combination has a synergistic effect… coagulation time could become a real problem.

        • Wade Patton

          Loves me some various and sundry search engines, neat to see another such minded.

          • Vito Caputo

            Like me… I’m sure you have nothing to hide. Still… you might want to try a different one… that doesn’t track you — https://duckduckgo.com/about. It’s a different world outside that Search Bubble that you get put into.

    • Thea

      Vito Caputo: Are you asking for the dosage used in the experiments discussed in the video? If so, note that each video has a “Sources Cited” button to the right of the video. From there, you could hopefully use the reference information to get a copy of the study. Some studies require subscriptions to journals to read. But there are ways around that, such as using a local library or collage library.
      .
      If you are asking what dosage of turmeric would be safe with Warfarin, I don’t know that. I don’t know if anyone knows???
      .
      Note: It is true that you can post questions anywhere. But many questions go unanswered simply because no one knows the answer or because there isn’t enough volunteers to answer every question that comes up here.
      .
      Good luck. I hope you find the answer you are looking for.

      • Vito Caputo

        Thanks for you input, Thea. No… I wasn’t asking what the dosage was in the experiment. I read that from the information behind the “Sources Cited” list. Based on the dosing in the experiment… I plotted out my own experiment on my own body.

        THEN… with capsules in hand… I discovered that cucurmin interacted with Warfarin. Unable to find anything other than “they interact”… I posted a question here. The question is NOT “asking what dosage of turmeric would be safe with Warfarin”.

        Let me restate the question: I will start taking a conservative “shot in the dark” dose. That dose may not be sufficient to affect my INR… or it may severely affect my INR.

        Here’s the biggie: How soon after I begin taking the WAG daily dose should I have my INR checked? Is the effect immediate or does it take days or weeks or months to be observable?

        Once I start taking the initial WAG dose… I suppose I could periodically cut myself and see how long it takes for my blood to clot. However… for me… this would not an acceptable way to get the answer I’m seeking.

        • Thea

          Vito: Thanks for the clarification. I have no idea what the answer would be. With your clarification, people can see what you are trying to figure out. So, I’m sure if someone has some thoughts on the matter, they will jump in. Good luck.

  • Rhombopterix

    20 or 10 years ago, maybe we could excuse the persistence of the “medical dogma” that is killing us. But this is now. Does anyone with a medical degree read the literature anymore? How can the people at the coalface…the GP’s…MY DOCTOR continue to continue? Ignorance of the truth is no excuse. But it is hellaciously inconvenient

  • Brady Tierney

    I’m a type one diabetic who eats mostly vegan, do the findings with insulin mean I’m damned no matter what? I need insulin to live so I don’t really have an option.

    • Tom Goff

      Well, there was an interesting development at the end of 2015 which offers the possibility of removing the need for insulin therapy by people with T1D.
      .http://www.dailymail.co.uk/health/article-3334751/Could-end-daily-injections-people-Type-1-diabetes-Game-changing-treatment-restores-production-insulin.html

      And there are very positive stories about people with T1D who choose completely vegetarian (sometimes called “vegan”) diets which reduce the need for insulin
      http://www.forksoverknives.com/type-1-diabetes-vegan-diet/
      http://www.diabetesdailygrind.com/type1vegandiet/

      And eating low fat can also reduce the need for insulin
      http://www.pcrm.org/health/medNews/fat-matters-for-type-1-diabetes

      The only other thing I can say is that in non-diabetics, insulin is produced by the pancreas and we all need insulin to live – so perhaps we are all damned if insulin itself is a problem?

      • Stewart E.

        Tom I appreciate your pointing out how a healthy diet can also help T1 diabetics. The daily mail article is a bit difficult to sort out. My take though is that finding early stage T1 diabetics and intervening to stop further beta cell destruction might well cause a long term remission or at least partially. I’ve heard of other such trials but they were using some pretty heavy immune system supressors. I have not heard about any great successes though.
        When I first developed diabetes, after about a month of treatment, my insulin requirements went to 0 for about a week. Had I been eating then like I do now the remission might have been permanant. But who knew? Well not this hillbilly. I have been able to eliminate my psoriatic arthritis with this diet so methinks the outcome might well have been different had I known.

        Also your point about insulin being a problem in itself is interesting. I have seen that suggested in studies on mTOR. (gotta study that some more.) So the reduction of insulin as well as IGF-1 by eliminating animals from the diet seems to be an ever growing concern.

    • Stewart E.

      To Tom Goff’s point, I have T1 and have had it 45 years (since I was 21). I was using about 46 units per day with a standard deviation of 5 until I went completely vegan. Now its 36 per day with the same standard deviation. So I know for a fact this works. In addition to lowering the Saturated fatty acids and branch chain amino acids (overwhelmingly animal sourced) which cause insulin resistance, i have also reduced the glyco toxins in my diet by eliminating all animal products. These glycotoxins, both ingested and those produced by hyperglycemia, are the prime reason a T1 diabetic should be treated as having already suffered a heart attack as they accelerate atherosclerosis and other diabetic side effects. And they even add some more to insulin resistance.

      No cure is in the offing but we can improve things considerably. Actually until I started looking at NutritionFacts.org, I sort of thought in terms of “i’m damned no matter what.” I now expect to outlive most of the people I know who are my age. Knowledge is empowering.

  • Plantbased Chip

    Hey doc, and others in the know, are there any studies on canary seeds/milk curing diabetes? Keep seeing this as a “home remedy” but would love to know if any validity to it. Thanks for all the great content. We truly appreciate all you bring to the public.

    • Tom Goff

      I am not aware of any human studies in the scientific literature (in English at least) of its effectiveness. However, there’s at least one animal study that suggests it may be effective
      http://pubs.acs.org/doi/abs/10.1021/jf404539y
      As for human studies, there was something published in an alternative health journal two or three weeks ago but it is behind a paywall,
      http://www.ncbi.nlm.nih.gov/pubmed/26773317

      But, to repeat, it is not well studied and its safety and effectiveness are not established.

  • Keith Sadler

    On some videos you mention who funds the study denoting say an industry bias. I was wondering if you could regularly mention the funder even if it is not animal related, i.e. a study touting the benefits of garlic let’s say and possibly funded by the Garlic Growers Association could be as tainted as one funded by the Dairy people. Just full disclosure I guess. I support & practice the vegan lifestyle but am sceptical of capitalism under any flag.

    • Thea

      Keith: I don’t know if Dr. Greger does this *every* time since he does provide the sources to each video. But I have heard him mention plant based funders in several videos.

  • Matthew Smith

    For diabetes, this site would recommend hibiscus tea, cinnamon (not recommended as a poison), flax seed meal, amla, beans, coffee, soy, green tea, pulses (dried beans), Chamomile tea, purple potatoes, sprouts, whole grains, vinegar, and beans. Yeast is one of the richest sources of Vitamin B1, Thiamin, and some doctors say the symptoms among diabetes and Thiamin deficiency (Vitamin B1) are identical. Consider finding a source of Vitamin B1 or thiamin for diabetes.

  • Keziah

    Do all the references to insulin causing further problems apply only to those with Type 2???
    Surely it can’t increase all those problems for those following a WFPB diet with Type1.
    Love your work Dr Greger – but it would be really helpful if you referred to Type 2 or both if that were the case! :-)

  • jamie

    “…but the point of a lifestyle intervention is NOT just to fit people into skinnier caskets” great line

  • Ken

    Dr. Mcdougall claims most Diabetes can be reversed with a starch based diet with vegetables and fruit. Its not the sugar that caused diabetes, its the fat that clogs up the receptors so the insulin can’t get in to the cells. He states people who do this diet 100% meaning no oil either that if a Dr. looked at their bloodwork after this diet they wouldn’t be able to tell they were a diabetic. We now Heart disease can be halted and reversed with diet. people should watch his Starch solution video that’s about an hour of more

    • Wilma Laura Wiggins

      I can testify that Dr. McDougall’s way of eating reversed my T2 diabetes, as well as congestive heart failure.

  • sssa

    wheat causes diabetes by destroying pancreas beta cells. Not meat. Thats why there are many meat eaters without diabetes.

  • info@yethealth.com
  • https://www.facebook.com/app_scoped_user_id/10153383458820894/ Ryan Zim

    Can we please have a video on type 1 diabetics? I can’t find a single one, much appreciated

  • ST

    Hi Dr. McGregor (and readers!)

    I’m on a quest for a controlled clinical trial, or even an open study, published in a medical journal, that demonstrated that diet can resolve obesity. I am not looking for testimonials or personal experience (I enjoy hearing them but that’s not what this quest is about). I figured if anyone know if this existed, this web site would be the place to find them.

    What I’m NOT looking for:
    Comparing the diets of normal weight and obese individuals
    Comparison of diets that show minimal weight loss

    I’m looking for:
    1) Evidence that a dietary change took people with a BMI over 30, to a BMI under 25, or
    2) Resulted in the weight loss of 50 pounds or more, regardless of whether BMI of 25 was achieved.
    3) Diet or diet and exercise only – no drugs, surgery, devices, etc.

    The only one I am aware of is Kempner’s Rice Diet Study. I haven’t found any others.

    Treatment of Massive Obesity With Rice/Reduction Diet Program
    An Analysis of 106 Patients With at Least a 45-kg Weight Loss

    Walter Kempner, MD; Barbara C. Newborg, MD; Ruth L. Peschel, MD; Jay S. Skyler, MD
    Arch Intern Med. 1975;135(12):1575-1584.

    Are there others?