As Dr. John McDougall, MD reports, 16 million people in the US have type 2 diabetes, which shortens lifespan up to 15 years, leads to almost 300,000 deaths and costs $100 billion annually.  As with most chronic illnesses, diabetes is caused by poor eating habits, not faulty genetics.  In other words, we cannot blame mom and dad’s genes for our suffering.  However, you learned your eating habits from mom and dad, which could lead to diabetes that they suffered from.  Diabetes is caused by the typical SAD diet (Standard American Diet) which is high in bad fat, high in animal protein, low in healthy carbohydrate, high in salt, low in fruits and vegetables, and high in processed food.  In contrast, Asians with diabetes who live in their native country and follow a rice, vegetable, and fruit-based diet with foods low in fat and cholesterol have few diabetic complications.  However, Asians who live in Hawaii who eat the rich American diet have marked increases in blood cholesterol and triglycerides and severe complications of atherosclerosis (gone again is the heredity excuse).  Dr. McDougall states that the same high complex carbohydrate, high fiber, low fat, no cholesterol, moderate protein diet that will help people with diabetes is the same diet which prevents diabetes.   This is the key to prevention of adult onset diabetes and complications seen with both forms of diabetes.

There are 2 types of diabetes.  The first is called Childhood Onset Diabetes, or Type 1 Diabetes, or Insulin Dependent Diabetes.  Type 2 Diabetes is more common and is also called Adult Onset Diabetes or Non-Insulin Dependent Diabetes.

The most important action we must take is to prevent diabetes, and both Type 1 and Type 2 diabetes are preventable.  Again, diabetes is not caused by genes or heredity; it is caused by poor food choices.  It is especially important to prevent Type 1, as damage to the pancreas may be permanent and typically insulin shots are needed for a lifetime.  This more severe type of diabetes comprises less than five percent of diabetic sufferers.  Although many say that science is not clear of the cause of childhood onset form of diabetes, I disagree, as there is much more Type 1 diabetes in countries where people eat foods high in fats, dairy products, processed foods, and protein, and is rare in parts of the world where meals are based on starches and limited or no dairy.  Some suggest it is possibly due to a virus that attacks the pancreas.  Even if this is so, Dr. McDougall and Dr. Weil remind us that children who are properly nourished and in good health are more likely to resist viral infections and may increase resistance to childhood onset diabetes.  Most importantly, Dr. Weil mentions research which suggests cow’s milk protein may trigger an autoimmune reaction that destroys insulin-producing cells of the pancreas.  Dr. Weil, Dr. McDougall, Dr. Dan Murphy DC and I, among others, have found that patients with problems of allergy, atopic diseases (asthma, sinus infections, allergies, ear infections, skin problems, etc.) and autoimmunity (rheumatoid, gout, lupus, chronic fatigue, fibromyalgia, etc.) often improve on lower protein diets, especially on plant-based diets that eliminate animal protein in general and milk protein in particular (milk, cheese, cottage cheese, yogurt, ice cream, cream and butter).  For these reasons, I recommend that no cow’s milk protein be fed to infants and young children, including dairy containing formula (babies should be breast fed).  Dr. Weil suggested no dairy for children under 2 years old, and I suggest longer, if possible.  The longer you delay your children being exposed to dairy products, the longer you decrease the chances of creating an autoimmune problem which could injure the pancreas.

I often suggest to parents of sick children, and to adults with atopic diseases mentioned, to eliminate dairy products.  The people that try complete elimination of dairy for a couple of weeks usually notice significant improvements in their health (changes are often noticed in a few days).   Healthy food choices are better safeguards than junk foods and other high fat, high protein foods provided in the rich American diet.  Some children and adults that already require insulin injections can also benefit from changing to a healthy diet, sometimes decreasing their insulin needs dramatically, possibly reducing the numerous side effects of insulin injections.  The commonly recommended diabetic exchange diet is similar to the rich American diet that made you ill in the first place so this is probably not an effective choice.  Children and adults that want to undergo a new diet to improve their health should work closely with their medical physician, as medications may need to be adjusted early (see Dr. McDougall’s information for recommendations).  This reduction in daily insulin is only a minor benefit for a person with childhood-onset insulin dependent diabetes.  The decreased risk from complications of diabetes is the real gain.  No one deserves the benefits of healthy eating habits more than a young victim of diabetes.  Better yet, we should focus on prevention.  This may offer Type 1 diabetic sufferers the best opportunity for enjoying a long life with his or her body parts functioning properly in later years.

Insulin is a hormone produced in the pancreas that regulates the amount of sugar in the blood among many other important functions.  Insulin helps sugar pass through cell membranes to provide the cell with energy.  In the case of diabetes, sugar is not passing through the cell membrane and the cells begin to starve.  The result is a higher blood sugar level.  When sugar cannot get in to the cells, the body switches to fats for energy.  Fats are broken down into fatty acids, which can enter the cell without insulin and be used for energy production.  Fats are then burned and the metabolic end products (the “exhaust”) include ketones and acids.  Because fat does not burn as cleanly as glucose, this metabolism causes an acidic system leading a loss of cell fluids and mineral imbalances.  This is one serious consequence of the popular high protein, low carbohydrate diets.  The excess sugar in the blood spills out of the body through the kidneys into the urine.  Sugar draws with it water, which can lead to dehydration and thirst.  When we lose sugar into the urine we are losing calories, but many diabetics in this country are too fat to begin with and can afford to lose calories.  Better yet these people should take in fewer calories from their diet.  It is becoming rare in this country to see diabetics waste away as most diabetics are too fat to begin with.

In most cases of adult onset Type 2 diabetes, insulin is being produced and shots are not needed, but the effectiveness of the insulin is lowered.  In both types of diabetes there is poor blood sugar control (hyperglycemia) and insulin cannot escort sugar into cells.  The sugar in the blood attaches to various body proteins and distorts them.  This leads to decreased oxygen to the tissues, distorted nerve and kidney function, eye damage and degeneration, and higher levels of atherosclerosis, heart attacks, strokes, and amputations of the lower extremities.  Dr. McDougall states the goal of all people, including diabetes sufferers, should be to enjoy a diet that supports health, which is low in fat, salt, reasonable in protein, high in fiber and complex carbohydrates, with no cholesterol.  It is easy to plan meals around starches, vegetables, and fruit.  This type of diet will decrease the diabetic complications.  Research also shows that a low-fat, high health diet dramatically improves the poor condition of the retina of the eye.

If you have been raised on a healthier diet it is highly likely you will not be diabetic.  Diabetes is rare among Africans, Asians, and Polynesians whose diet consist primarily of starches, vegetables, and fruits.  When these people eat the rich Western diet, full of animal protein, fat, and processed foods, the numbers of people with diabetes and atherosclerosis rise.  There are many harmful components of the SAD diet (Standard American Diet) which causes diabetes: hydrogenated, saturated, and trans-fats and oils, a lack of healthy starchy low glycemic index carbohydrates and grains, lack of fiber (there is no fiber in any animal products including beef, chicken, fish, dairy and eggs), too much protein, and too many processed foods with processed carbohydrates and sugar, chemicals, excitotoxins, and hydrogenated and trans-fats.  Fish oil may be helpful, and you can read about fish oil in other newsletters.

Treating and preventing diabetes with significant dietary change is not a new concept.  Dr. I. M. Rabinowitch successfully treated his diabetic patients with a high carbohydrate, low fat diet 70 years ago.  Dr. Rabinowitch stated a potential diabetic could be transformed into a complete diabetic by administration of the time honored carbohydrate-free diet of meat and fat.  Dr. McDougall reminded us in 1927, Dr. E. P. Joslin, founder of the famous Joslin Diabetic Center in Boston, suspected that high fat, high cholesterol diets might increase the rate of diabetes and atherosclerosis.  Dr. Joslin wrote: “I believe the chief cause of premature atherosclerosis in diabetes…is an excess of fat in the diet.  With an excess of fat diabetes begins and from an excess of fat diabetics die, formerly of coma, recently of atherosclerosis.”  Many diabetics suffer needlessly because their physicians have failed to give them this information.  As healthcare practitioners we can do better than stand by helplessly as we watch diabetic patients become blind and disabled and finally die because too few knew of the effective treatments from a dietary standpoint to prevent the course of diabetic deterioration.

This rich American diet that causes diabetes also causes much higher rates of cancer, heart disease, arthritis, osteoporosis, high blood pressure, heart attacks, and stroke.  An article on Medscape.com in 2000 reminded us that during WWII in occupied European countries the death rate from diabetes decreased dramatically when consumption of more whole grains and vegetables replaced rich foods high in fat and cholesterol.  Why aren’t more victims of diabetes aware of the improvements in health that they can gain by changing their diet and increasing exercise?  Unfortunately recommending simple food changes and exercise is advice that makes profits for no one, especially doctors and drug companies.  The medical care delivery system has little financial incentive for spreading this information among the diabetic population and for prevention.

In John Robbins’ book, Diet for New America, he references an article from the British journal Lancet.  Eighty diabetic patients were restricted to very low-fat diets of 20-30 grams of fat per day and no sugar.  Within six weeks over 60% of the patients no longer required insulin.  In the weeks that followed the figure rose to 70% and those who needed insulin were on a much smaller dose.  The reduction of dietary fat, particularly saturated fat, can be of great significance to diabetics (and for the prevention of diabetes) because it lowers the concentration of fat in the blood and allows insulin to work more effectively.  The American Journal of Clinical Nutrition reported a study in which 20 diabetics on insulin were put on a high fiber, very low-fat diet.  After sixteen days 45% of these patients were able to stop insulin injections.  Approximately 75% of diabetics who need insulin therapy and 90% of diabetics that take diabetic pills (sulfonylureas) can be freed from their need from medication in a matter of weeks on a low-fat, high fiber plant-based diet.  Adult onset non-insulin dependent diabetics who take pills more than double the risk of heart attacks.  Prescribing medication which more than doubles the risk of death from heart disease does not make sense.  Even childhood onset diabetics who omit meat and other high-fat, low fiber foods need 30% less insulin, have more stable blood sugar levels and are less brittle, which decreases their suffering.

John Robbins states that millions of Americans suffer enormously from diabetes and they do not know their agony could be greatly relieved by different food choices.  A diabetic’s life expectancy is much shorter than normal, and the quality of their lives is significantly altered.  Eighty percent of diabetics suffer serious eye damage which is the leading cause of new cases of blindness in this country.  This is caused by degeneration in the arteries bringing blood to the eyes, and the protein distortions of the retina previously mentioned.  Diabetics have 18 times the average rate of serious kidney failure.  As circulation continues to degenerate amputation of a foot or leg may occur and may be life threatening.  Diabetic males also have a much higher rate of impotence than the general population.  Within seventeen years of onset of diabetes most of the diabetics suffer a major health catastrophe, usually a heart attack, kidney failure, stroke, or blindness.  Robbins states the pancreas will secrete insulin in response to sugar in the blood in order to keep blood sugar levels within a certain range.  Many diabetics need insulin shots but this is not because the pancreas is not secreting enough insulin.  In fact, many diabetics produce more insulin than normal, but still need injections.  The reason is the insulin is not able to effectively move sugar across the cell membranes and blood sugar levels rise.  The common cause for the malfunction of insulin is the high level of fat in the blood.  The reduction of dietary fat, particularly saturated fat, hydrogenated and trans-fats can be of greatest significance to diabetics because it lowers the concentration of fat in the blood and allows insulin to work more efficiently.  In Micronesia, there is a small island called Nauru, near the equator just west of the Gilbert Islands.  Before WWII the native Polynesians lived in isolation and were healthy and happy, and they called their land Pleasant Island.  On this island there are enormous deposits of bird dung which accumulated over the centuries.  After the war the phosphates from this bird dung were coveted by the industrialized nations.  As a result the Nauruans became very wealthy and began to emulate the West, gorging themselves on rich foods, canned and frozen meats, oils, and soft drinks.  The consumption of fiber plummeted and fat skyrocketed.  Now the island is not as pleasant as over one third of these people have developed diabetes.  Robbins also mentions an enormous scientific project, which studied more than 25,000 people for 21 years finding that vegetarians have a much lower risk of diabetes than meat eaters.  One of the authors, University of Minnesota Epidemiologist, Dr. David Snowden, stated: “We suspect it is the absence of meat that may explain our findings.  In this study we looked at various levels of meat consumption and as those levels got lower and lower, the risk of diabetes also decreased.”  Dr. Snowden also commented: “My meat consumption has dropped significantly…since completing the diabetes study.”

The ADA states that nutrition, physical activity, and self-monitoring of both fasting and postprandial (after eating) glucose remain the cornerstones of therapy.  It sounds like the ADA agrees that proper nutrition and physical activity are the most important factors in improving and preventing diabetes.  Although sulfonylureas pills produce rapid improvements in glycemic control, they become less effective after several years of use and it has been suggested that these agents may play a role in inducing premature beta cell (pancreas) failure.

Dr. Dean Ornish, MD states you can eat more and weigh less but not if you eat a lot of simple carbohydrates (processed food, sugar, white flour, alcohol).  On typical high fat, rich American diets, insulin effectiveness is reduced, the pancreas secretes more insulin, and the pancreas may “burn out.”  On the other hand, says Dr. Ornish, complex carbohydrates (fruits, vegetables, grains and legumes, in their natural form) are absorbed slowly thus causing blood sugar to remain more stable and less insulin is needed.  You don’t have to give up pasta, bread, or rice; change to whole-wheat pasta, whole wheat bread, and any rice except short grain white rice.  Even white flour pasta is fine in moderation especially when consumed with vegetables which slow absorption.  The main reason people who eat pasta gain weight is not the pasta, it is the oil, cheese and meat on top.  One tablespoon of any oil, including olive oil, has 14 grams of fat, the same as a scoop of ice cream. It is not unusual to have 2-3 tablespoons of oil (2-3 scoops of ice cream) on a serving of pasta.  If you eat a low-fat diet consisting primarily of fruits, vegetables, grains and beans (complex carbohydrates), then you will get full before you take in too many calories.  You can eat whenever you’re hungry, you can eat until you’re full (but not stuffed), and you will likely lose excess weight without counting calories and without deprivation.

Dr. Julian Whitaker, MD, concluded most physicians ignore the use of diet and exercise in treating diabetes.  For fifty years researchers have been screaming that diet and exercise are powerful tools available now for helping patients with diabetes and other conditions.  What is the “miracle cure” for helping millions of diabetics become drug free and healthy?  Education and motivation to follow a high complex carbohydrate, high vegetable, high fiber, low protein, no processed food, low-fat diet with exercise.  Dr. Whitaker agrees with the other authors referenced here that people with Type 1 diabetes will almost always require insulin injections but the amount of insulin can usually be reduced with a health supporting diet.  Severe Type 1 can develop in people with no family history (diet is the key; it’s not genes and heredity).  Sadly, Dr. Whitaker reports that the concept of insulin losing its effectiveness due to high fat in the diet with Type 2 diabetes is usually not discussed with patients.  Many diabetics are told to restrict carbohydrates.  This recommendation is made under the assumption that carbohydrates cause or bring on the diabetic condition by flooding the blood with glucose.  Healthy, low glycemic index carbohydrate intake should actually be increased, not restricted. Dr. Whitaker’s dietary recommendations are 70-80% complex carbohydrates, 10-15% fat, and 10-15% protein, and high fiber.  Fiber needs to come from grains, fruit, oat bran and vegetables.  Processed foods such as candy, white bread and short grain white rice have had much of the fiber removed.  Fiber is long chains of sugar molecules resistant to digestion.  Nature mixes these long chains of sugars with digestible complex carbohydrates and simple sugars, which are present in starchy foods, fruits and vegetables.  Fiber slows and regulates sugar absorption from the gut.  There is a gradual release of sugar into the blood which is better synchronized with insulin.  Dr. Whitaker reminds us that too much protein can be dangerous.  Beef, eggs, chicken and fish are void of carbohydrates and fiber, providing protein and fat only.  Dairy has some carbohydrates but no fiber and still mostly fat and protein, so these foods need to be reduced.  Dr. Whitaker also reminds us that exercise helps clear the blood of glucose, increases insulin sensitivity of cells, helps thin the blood naturally and may help prevent eye problems and strengthens normal and diseased hearts.

Nutrition goals for all people including those suffering with diabetes should be eating foods low in saturated, hydrogenated, and trans-fats, salt, reasonable in protein, high in fiber and complex carbohydrates, with low cholesterol.  Healthy carbohydrates include yams, sweet potatoes, beans, rice (except short grain white rice), stone ground whole grain bread, whole wheat pasta, and other whole grains.  This type of diet eaten by diabetics has been shown to decrease atherosclerosis and heart attacks, strokes, circulation problems, kidney failure and lower cholesterol.  Contrary to the belief of many health professionals, triglycerides are also lowered by a high complex carbohydrate and increased plant fiber diet.  Fruits with simple sugars may need to be restricted when triglyceride levels need to be decreased, but healthy non-diabetic people should enjoy fruit.  Fruit usually can be reintroduced after triglyceride levels are healthy again.  Healthy eating habits help improve the health of diabetics, and many may be able to reverse their diabetes if they follow these recommendations.  Again, work closely with your medical physician before starting a major food change.

Edible plants provide enough vitamins and minerals; nature made no mistake with the design of foods or the human intestines.  Adding vitamins and supplements are not likely to improve health without a change in diet.  Food choices should be based on nutrition value, not on appeal to taste buds or the eyes or nose.  Starches, vegetables, and fruit are the best choices.  These foods lack harmful ingredients and are generous in the content of protein, carbohydrates, fiber, vitamins, and minerals.  To take the fullest advantage of nutrients, food should be consumed in the raw and natural state when possible.  In addition, simple cooking or grinding of food without removing fiber makes certain foods more palatable.  Losing weight makes the cells of the body more responsive to insulin and this may cure and prevent diabetes, and healthy eating habits will help you lose weight.  Exercise promotes weight loss and increases the sensitivity of cells to insulin, so exercise to your ability.  You should eat as much as you want of starchy foods and vegetables without stuffing yourself.  This food plan usually results in a healthy, appropriate 1-2 lb. weight loss each week in obese persons.  It is up to you how much change you will make.  If you improve your nutrition and exercise by 50%, you will get 50% results.  Dr. Andrew Weil, Dr. John McDougall, Dr. Dean Ornish, and Dr. Julian Whitaker can provide cookbooks and recipes to help you enjoy your new foods, and keep your meals exciting and flavorful.  Remember that eating more slowly usually results in smaller portions of food consumed.  Eat more slowly and enjoy the different tastes, odors, and textures of food.

For some people, they may find fish oil supplementation (Omega 3 essential fatty acids) helpful in the healing process.  Again, if you decide to try fish oil supplements, talk to your medical physician and consult with a health care professional knowledgeable in essential fatty acids and supplements.  Some of my patients have seen improvements in cholesterol levels, blood pressure, multiple sclerosis, ADD, and AD/HD, and other patients have enjoyed pain relief from fish oil.  You can read more about fish oil in my other newsletters.

Please remember that dietary change is the top priority in preventing and treating diabetes, and exercise will provide additional assistance if you are able.  Do not make dietary changes or undergo a new exercise program without advice of your physician first.  Diabetics of all types and those interested in a healthier life should include chiropractic care in their health program.  Chiropractic is not only for back pain treatment.  Chiropractic is focused on improving the function of the nervous system and the body as a whole, and may be beneficial for diabetics too (see my other articles for additional information of the benefits of chiropractic care).

References and recommended reading

1. McDougall, J.  The McDougall Program-12 Days to Dynamic Health.  New York, NY: Plume, 1985.
2. Weil, Andrew.  Eating Well for Optimum Health.  New York: Alfred A. Knopf, 2000.
3. Robbins, J.  Diet for a New America.  Tiburon, CA: HJ Kramer Inc., 1987.
4. Ornish, D.  Everyday Cooking with Dr. Dean Ornish.  New York: HarperCollins, 1996.
5. Whitaker, J.  Reversing Diabetes.  New York: Warner Books, 1987.
6. PIMA Indians, NEJM 1993; 329; 1988-1992. LILLIOGA S., Mott DM, Spraul M, et al.  Insulin resistance and insulin secretory dysfunction as precursors of non-insulin dependent diabetes mellitus.  Prospective studies of PIMA Indians.
7. “Early and aggressive treatment of Type II diabetes” by Stephen V. Edelman, MD.  Medical Education Collaborative, Medscape.com.  1800 Jackson St., Suite 200, Golden, CO  80401 (303-278-1900).
8.  drmcdougall.com, drweil.com, mercola.com

Written by Dr. Scott Fuller, DC, CCST, DACNB  November 2001, revised June 2004 and October 2007