Book Synopsis: The End of Diabetes

Image: Goodreads

Every bookstore and library is filled with aisles upon aisles of books on health, diet and self-help. I confess to having very mixed feeling about these books. My approach is to read some of these books to see if they contain anything useful, while being deeply skeptical of embracing any one book or author as the ultimate truth.

Most authors have a central thesis or pet theory. They are often guilty of cherry picking research studies with conclusions that support their pet theory. Don't get me started on how flawed and biased many of the research studies are in the first place. Most books are full of exaggerated claims and promises of a miracle. Authors go to great lengths to explain why everyone who believes anything different is flat out wrong.

But now and then I read these books anyway, because despite everything I just said, I've also come across valuable information, different viewpoints, messages of hope, ideas for changing habits and useful tips and recipes. There is a grain of truth in the hype. I will post a book review every now and then if I come across a book which says something interesting. This is one I read last month.

The End of Diabetes: The Eat To Live Plan to Prevent and Reverse Diabetes by Joel Fuhrman, MD.

The crux of the book is this: Type II diabetes can be prevented and reversed with a nutrient dense diet of plant based foods. Here's what I took away from each of the chapters in this book. Quotes from the book are in italics.

Chapter 1: Understanding diabetes
The actual discussion of the causes of type I and type II diabetes in this chapter was quite garbled, in my opinion. But there is one bit of discussion at the end of the chapter that I really liked. Fuhrman criticizes the system of food exchanges used by the American Diabetic Association (ADA), which is the basis of how most nutritionists teach new diabetics to eat (for example, me when I was diagnosed with gestational diabetes). The ADA tries very hard to work with the standard American diet, recommending small portions of low-nutrient, low-fiber foods. "Cereal is OK, just eat only 1/2 cup of it"- that sort of thing. This leaves patients hungry and struggling to comply with the nutrition plan. Instead of just reducing portions of rice and tortillas when I had GD, I wish I had the sense to add in substantial portions of non-starchy vegetables which would have left me sated. Anyway, I agree with Fuhrman that the standard nutritional advice given to diabetics is very poor and it misses the boat.

Chapter 2: Don't medicate, eradicate
"Clearly our present dependency on drugs to control diabetes without an emphasis on dietary and exercise interventions is promoting diabetic complications and premature death in millions of people all over the world". Fuhrman explains how medications-including oral pills and insulin- give type II diabetics a false sense of security that their diabetes is under control which leads patients to continue living the very same lifestyle that led to the disease in the first place. "The best medicine for diabetics is a high-nutrient, lower-calorie diet and exercise, not drugs. This is the only approach that lowers cholesterol, lowers triglycerides, and lowers blood pressure as it drops weight and blood glucose". 

Chapter 3: Standard American diet versus a nutritarian diet
Fuhrman recommends what he calls a "nutritarian" diet- a diet rich in micronutrients (vitamins, minerals, phytochemicals). The foods it emphasizes are familiar ones- vegetables, especially green leafy vegetables, beans, nuts, seeds and fruits. Animal foods are strongly discouraged. So, he is essentially recommending a vegan diet but minus high-starch foods like white rice, refined grains and bread products. I found this chapter interesting because I eat a vegetarian, predominantly South Asian diet and the recommended foods like vegetables, beans, lentils, nuts and seeds are the very pillars of Indian home cooking.

Chapter 4: Reversing diabetes is all about understanding hunger
"Toxic hunger appears at the lower plateau of the blood sugar curve, drives overeating behavior, and strongly increases the desire to consume more calories than the body requires, leading to weight gain and diabetes. True hunger, however, appears when the body has used up most of the calories from the previous meal...and is ready to be refueled. With a change of diet, toxic hunger gradually lessens and resolves, allowing individuals to be satisfied eating less".

"Wrong food choices lead to withdrawal symptoms that are mistaken for hunger...Initially, these symptoms are relieved after eating, but the cycle simply starts over again with the symptoms returning in a matter of hours. Eating when you experience toxic hunger in not the answer. Changing what you eat to stop toxic hunger is."

"...trying to eat fewer calories is ineffective and almost futile. The secret is to desire fewer calories. The high consumption of low-calorie, high-nutrient foods such as raw vegetables, cooked greens, beans and seeds prepared in delicious combinations makes you feel physically full from all the fiber and satisfied from all the chewing. You lost the addictive cravings and then you simply and naturally desire less food."

Chapter 5: High protein, low carb counterattack
Here Fuhrman spends a great deal of time talking about the dangers of low-carb diets that are based on animal protein. I understand advocacy of vegetarian and vegan diets or meat-heavy diets for that matter but I get uneasy when authors cherry pick scientific studies to support their statements. So this is the part where I just moved on. People have all sorts of reasons for eating what they want to eat. I've made my choices so I just want to know how to maximize them.

This chapter also emphasizes that many plant based foods such as beans, lentils and vegetables have a high protein content.

Chapter 6: The phenomenal fiber in beans
Legumes such as beans, lentils, peas and chickpeas have protein, soluble and insoluble fiber and another type of fiber called resistant starch which has health benefits. "Considering their favorable effects on blood sugar and weight loss, they (legumes) are the preferred carbohydrate source for people who have diabetes or are at risk for diabetes". 

Chapter 7: The truth about fat
Fuhrman emphasizes that whole plant-based high fat foods such as nuts, seeds and avocados are an important part of the diet. "I have encountered many individuals who have not thrived on vegan or flexitarian diets...Often they do not realize their real problem. They go back to eating large amounts of animal products, not knowing that they were fat deficient on their low-fat vegan diet. For most of these individuals, eating more healthy fats from nuts and seeds, taking a DHA supplement, and eating fewer starchy carbohydrates clears up the problem". 

Chapter 8: The nutritarian diet in action
In this chapter, Fuhrman outlines his recommendations: The unlimited foods to be eaten liberally are all raw vegetables, all cooked green vegetables and other non starchy vegetables like tomatoes, peppers, eggplant, mushrooms, onions and cauliflower. Some fruit can be eaten. 2 cups a day of beans are allowed along with some nuts and seeds. "The salad is the main dish". Fuhrman recommends starting every main meal with a big salad.

My take on his advice from this chapter: Fuhrman's diet does not endorse oil, not even for sauteing vegetables. His recommended diet is restrictive and unappetizing with almost no salt. I understand that Fuhrman's patients are often very sick and I don't know what their particular needs might be. For myself, I know that spices and seasonings and sauces are all wonderful things that will support me in eating better.

There is a whole spectrum between eating to live (food strictly as fuel, which is right there in the title of this book) and living to eat (food as entertainment and indulgence). But there is plenty of space to thrive in a middle zone where many of the pleasurable and emotional connections of food are retained while eating food that nourishes the body and is right for one's own metabolism.

Chapter 9: The six steps to achieving our health goals
These involve making the commitment, drawing up a plan, tracking progress, making it public, making your kitchen healthy and the exercise prescription. "In place of dependency-inducing drugs, the proper medical intervention for this disease is to focus on the aggressive use of diet and exercise".

Chapter 10: For doctors and patients
This chapter is a pep talk for physicians to recommend diet and exercise changes and not just prescribe medication.

Chapter 11: FAQ

Chapter 12: Menus and recipes
Breakfast recipes typically contain oats, fruits and nuts. Other recipes are a variety of dips and dressings, lentil and bean soups, bean burgers, vegetable curries and stir-fries.

In summary, this book has two interesting take-home messages. The first is that people diagnosed with diabetes or at high risk for becoming diabetic have very good reason to be optimistic that at any time and any stage, they can change their lifestyle and reverse the disease to a remarkable extent, even reducing or eliminating the need for medication.

The second message is that a plant based diet is compatible with preventing and reversing diabetes. This is reassuring to anyone who has chosen to eat a vegetarian or vegan diet (or mostly vegetarian or vegan) for whatever reason and who feels a bit defeated by the prevailing climate of meat-based low-carb diets.