Category Archives: Diabetes

A Better Approach to Diet for Type 2 Diabetes

Diet For Diabetes by Taylor BensonFor years I’ve sent my newly diagnosed and poorly controlled patients with type 2 diabetes to diabetes education classes.  There they are taught many helpful skills, including how to test their blood sugars at home, how to watch for complications of diabetes like foot ulcers and infections, and a big focus is on how to eat to control their blood sugars.  I’m coming to believe that mainstream medicine, and the American Diabetes Association are not taking the best approach to diet to control type 2 diabetes.  The traditional approach is based on limiting simple carbohydrates, spreading out feedings, and essentially trying not to overload the ability of a patient’s pancreas and metabolic system with excess glucose.  This is sometimes helpful, and i certainly have had patients who embrace this approach and do pretty well.  Still, for most of my patients, counting carbohydrates, limiting calories, and using a low simple carbohydrate diet has not led to excellent control of their blood sugars.

Recently, as a part of my own self-education and motivation to maintain my low-fat vegan diet, I listened to a Rich Roll podcast of an interview with Dr. Neal Barnard about managing diabetes with a low fat, vegan, low-glycemic index approach to eating. This approach resonates with me, and appears to lead to vastly improve glycemic control for diabetic patients who embrace the approach.  I believe this is a valid and improved approach over the standard ADA diet approach.  

Here are the basic tenants of how and why this works:T

  • Type 2 Diabetes is a disease caused by insulin resistance.  Cells are unable to accept insulin as a facilitating molecule to allow glucose to enter cells and keep the level of blood sugar in the bloodstream in a normal range.
  • The underlying cellular mechanism of this insulin resistance is that lipids, essentially dietary fat in the bloodstream, clog the insulin receptor site in cell walls, keeping insulin from being able to attach to the cell walls and open the cell membrane to allow glucose to enter cells.
  • By eating a very low fat diet and completely avoiding animal fat and cholesterol cell membranes very quickly regain their ability to allow insulin to work properly and enable glucose to properly enter cells.  Electron microscopy has demonstrated this change in a little as a week.
  • With improved insulin sensitivity the need for strict avoidance of dietary carbohydrates is reduced, blood sugar control improves, and measures like Hemoglobin A1C, the standard measure of a diabetic’s blood sugar control trend significantly downward.

Here are the highlights of what the eating approach involves:

  • First eat no animal products.  This is a black-and-white thing.  All animal products contain saturated fat and cholesterol, and undermine the success of this approach. So no meat, fish, poultry, eggs or dairy products.  This sounds extreme, but it’s far less extreme than coronary bypass surgery, amputation of the infected legs of advanced diabetic patients, or other medical procedures we use to treat complications of uncontrolled diabetes.
  • Focus on non-animal foods you enjoy. Eat all you want of fruits, vegetables, beans, and whole grains.  Try to avoid high fat vegan products like large amounts of nuts and avocado
  • Avoid adding processed vegetable oil to foods when possible.

One problem is the difficulty in finding dietitians and health care workers to guide you through this approach. Here are resources to much more informed and expert authorities on this topic:

Rich Roll Podcast of interview with Dr. Neil Barnard.

The Physician’s Committee for Responsible Medicine  a website with many resources for vegans and health improvement ideas

A Book by Dr. Barnard on managing Diabetes with this Diet.

Artwork at the top courtesy of Taylor Benson.  You can find more of her work on Instagram.

Let me know what you think in the comment’s section.

Where Will Invokana (canagliflozin) Fit in Type 2 Diabetes Therapy if Approved

Canagliflozin, brand name Invokana, appears poised to join the already crowded  field of medications for the non-insulin treatment of type 2 diabetes. The FDA advisory committee recommended the approval of this new Jansen Pharmaceuticals drug this week.    Invokana has a unique mechanism of action, preventing the reabsorption of glucose in the kidney and so allowing… Continue Reading

Drugs Discovered to Help Conditions Far Different from Their Original Indications: Off Label Drug Use

or Why Am I Taking a Seizure Medication for Foot Pain? As the physician spouse of a wonderful woman living with ovarian epithelial cell cancer the recent article in Cancer documenting that women with type 2 diabetes who take metformin to have better survival rates than control patients with ovarian cancer who do not take… Continue Reading

Traits of a Superstar Diabetic

Who is a superstar type 2 diabetic?  I give this label to my patients who do what it takes to month after month and year after year control their blood sugars and make whatever lifestyle changes are needed to reduce their other cardiovascular risk factors.  They lose weight, stop smoking, control their lipids and blood pressure,… Continue Reading

Don’t Be Afraid taking a Statin May Cause Diabetes

Readers may recall previous discussions of the potential for statin treatment leading to diabetes, and how this concern might lead some patients who would benefit from statin therapy to prevent cardiovascular events from taking a statin. Good news on this front from a recent Lancet article which further analyzes the data from the JUPITER trial that raised… Continue Reading

Doctors Die Too, but Maybe Differently

I stumbled across this terrific article titled: How Doctors Die by Ken Murray a FP at USC.   It is largely anecdotal, but is a really an interesting perspective on how at least some physicians choose to forgo futile end-of-life treatments because they know the limits of modern medicine first hand. Also Enjoy: Octogenerian’s Letter to… Continue Reading

Muffin Test and Assorted Potpourri For Weekend Consumption

Muffin Test for Diabetes :.-)   (tongue-in-cheek) Just for fun you may want to check out the Muffin Test for diagnosis of diabetes. I think I’ll get one done every Saturday morning just to be sure.  Actually there is debate over whether a muffin from the local bakery followed by a blood sugar measurement may… Continue Reading

Victoza and the Incretin System Modulator Medications for Diabetes

Victoza is among what is becoming an increasingly crowded market for drugs that affect the incretin system of pancreatic beta cell function and control of insulin release.  The whole incretin system has been a bit more confusing to me than it needs to be primarily because of the nearly unpronounceable terms and similar acronyms.  I’ve… Continue Reading

Lyrica vs Gabapentin: A Family Doctor’s Perspective

After at first being a skeptic I am finding a significant role for Lyrica in treatment of neuropathic pain syndromes.  Lyrica first came to market in December of 2004 in the US with approval for diabetic neuropathic pain and post herpetic neuralgic pain.  I was a slow adopter of this drug. It seemed essentially a… Continue Reading