This month we review a book that provides a sensible approach to combating diabetes with a plant-based diet and exercise.
By Brenda Davis, RD and Tom Barnard, MD
With 50 Easy Recipes by Barb Bloomfield
Healthy Living Publications, 2003
Both Barnard and Davis have personal stories to tell about how diabetes impacted the health of members of their families. Barnard begins the book describing his sister who has Type II diabetes and was awaiting heart bypass surgery. He knew his sister's health problems were the result of not taking care of herself by following a healthier diet.
While his sister was undergoing surgery, Dr. Barnard arranged for good food to be brought to her while she was recovering. He also had her work with Dr. Dean Ornish's Reversal of Heart Disease program. Years later he says she is "living well and prospering."
Brenda Davis describes her father, a 50-year-old smoker who had Type II diabetes and extremely high blood pressure (240/120). During an angiogram, the surgeon trying to clear his plaque-clogged arteries punctured his aorta. This led to major surgery to repair his arteries. The doctors said he had three months to live if he didn't quit smoking and maybe three years even if he did.
The surgery not only saved his life, but it also brought remarkable changes in his attitude toward diet and exercise. He gave up bacon and eggs for oatmeal. Beans and vegetables replaced burgers and chips. The former couch potato was now rollerblading, biking, weight lifting, and golfing. Twenty years later he is still alive, but still faces some of the ravages of his former lifestyle. The circulation problems remain, and he still feels pain walking up a hill.
In writing Defeating Diabetes, the authors have collaborated to develop "an aggressive plan for stopping the disease in its tracks." The plan is not to manage the disease with a complicated diet and special foods, but to reverse the disease with lifestyle changes incorporating simple whole foods, especially fruits and vegetables, and daily exercise. Their program is essentially a low fat, high fiber, low sodium plant-based diet.
Since weight control is essential for diabetics, the authors offer counsel on how to achieve a desired weight. They discuss Body Mass Index (BMI) and incorporate charts into the discussion so that people can determine whether they are overweight or obese and realize the dangers they face. They are quick to point out that there are no satisfactory quick fixes like pills, weight loss clinics, appetite suppressants, special diets that feature one food, high protein low carbohydrate diets, and even low fat high fiber programs.
Instead they offer "Seven Simple Steps to Lifelong Healthy Weight."
In designing a diet for diabetics Barnard and Davis have their own pyramid that is quite different from the one promoted by the USDA and scorned by many nutrition experts. Their pyramid of food choices is labeled "Plant-Based Food Guide for People with Diabetes." The daily program includes Grains and Starchy Vegetables (6 to 11 servings), Vegetables (4 or more servings), Legumes (4 to 6 servings), Fruits (2 to 5 servings), Nuts and Seeds (2 to 4 servings), Dairy Products (0 to 2 servings), Eggs and Other Animal Products (0 to 2 servings), Fats and Oils (0 to 4 servings), and Sugars (0 to 3 servings).
Dairy Products, Sugars, Fats and Oils, and Eggs and Other Animal Products are at the top of the pyramid and are labeled optional to allow some choice for people in transition to a healthy plant-based diet.
Surprising to the reader is the servings of sugars. The authors feel the occasional use of sugars is reasonable. They reveal that certain sugars, those that contain a higher proportion of fructose to glucose or sucrose, have less impact on blood sugar levels. One they mention is agave nectar or syrup that is 90% fructose and has a very low glycemic index.
Glycemic index is discussed in detail. This index is not just a measure of how fast sugar enters the blood stream. "The more glucose that reaches the blood stream in the first three hours, the higher the GI (Glycemic Index) will be." In a chart with glucose pegged at 100, it is surprising to find cornflakes with a glycemic index of 84 and white bread at 70. At the low end of the scale are peanuts at14 and soybeans at18.
Barnard and Davis offer numerous suggestions for those eating away from home in a chapter called Defensive Dining. They cover eating in restaurants, going to parties, traveling, and special occasions. They also provide a chart labeled "Energy and Fat Content of Selected Restaurant Favorites."
In chapters Essentials of Living Well and Self Care they address physical wellness through exercise, getting sufficient sleep, and achieving emotional and sexual fitness. They suggest starting each day with a safety check of muscles and joints, eyes and ears, skin and hair, feet, mouth, teeth, and gums. Also important is evaluating stress level and working to lower it with relaxation or meditation.
One of the most practical chapters is Kitchen Wizardry: Tricks of the Trade. Included here is a basic shopping list and suggestions on where to find these foods, such as grains, fats and oils, and beans, as well as storage guidelines. A list of basic kitchen equipment is provided. A section called Transforming Traditional Favorites offers suggestions of nutritious plant-based substitutes for meat, eggs, or dairy dishes.
To answer questions like, "But what do I eat?" the book provides 50 easy recipes from Barb Bloomfield. The recipes include suggestions for breakfast, breads, cereals, muffins, salads, soups, main dishes, side dishes, desserts, and snacks. Each recipe contains a complete nutritional profile with calories, fat, protein, fiber, and cholesterol as well as vitamin and mineral content. Also listed are diabetic exchange values. Completing the volume is a section of references to studies and information in the text, a glossary, and an index.
As the cover announces in large type, Defeating Diabetes is truly "A No-Nonsense Approach to Type 2 Diabetes and the Diabesity Epidemic." It is an essential handbook for anyone with diabetes or anyone who is overweight and likely to become diabetic. With its numerous charts, graphs, and sidebars and easy to understand text, the book presents a comprehensive overview of the subject. As is the case with so many degenerative diseases, lifestyle does matter.
Reviewed August 2003