Editor's Note: The following article was adapted from the new book SUGAR NATION, written by renowned author Jeff O'Connell. For more information on the book, click here.
Keith W. Berkowitz, M.D., medical director of the Center for Balanced Health in New York City, must have felt like he was addressing a conference of cancer experts, only to be handed a pack of smokes for his trouble. “I was asked to give a lecture on diabetes at a hospital trying to raise money for care, and for lunch they served salmon glazed with sugar,” he says. “Can you imagine?”
Unglazed, salmon ranks among the healthiest foods a diabetic can eat, packed with protein and healthy omega-3 fatty acids, with nary a carbohydrate in sight. But it makes no sense for those charged with leading the fight against diabetes to sweeten up a healthy food, especially one that’s tasty without it.
Such institutional ignorance has reigned for decades where diet meets diabetes. The American Diabetes Association and other organizations have focused on warning diabetics about the perils about dietary fat. Their logic: Diabetics will often die from heart disease (true), and dietary fat is the leading cause of heart disease (false). So diabetics are steered toward a diet high in carbs, which become glucose when ingested.
It sounds, well, crazy, but our national approach to a lifestyle disease characterized by chronically high blood sugar has been to funnel more and more sugar into the blood of type-2 diabetics. “We’re manufacturing type-2 diabetes in the same way we would skin cancer if the guidance was for people to sit on the beach all day, every day,” says Ron Raab, past vice president of the International Diabetes Federation.
Now that one in three adult Americans now has type-2 diabetes or pre-diabetes, the time has come to stop sugarcoating the truth. Hence my new book, Sugar Nation (Hyperion, 2011). I believe that our nation’s approach to the diabetes prevention and management has been a windfall for the pharmaceutical industry, prosthetic-limb makers, and, perhaps, those who breed seeing-eye dogs. For the rest of us, however, it’s been a complete disaster. 
What’s worse, the rest of the world is mimicking our diet and following the lead of our diabetes guidelines. A very recent study by a team of experts working in concert with the World Health Organization pinned the number of diabetics at 350 million, 70 million higher than previous estimates, and more than double the number from 1980.
“Diabetes, along with obesity, is looming as the biggest epidemic in human history,” says Paul Zimmet, M.D., Ph.D., director of international research at the Baker IDI Heart and Diabetes Institute in Australia.
So where’s the cavalry? If you think your doctor will rescue you, consider a 2006, University of North Carolina study in the American Journal of Clinical Nutrition, based on surveys of all 126 accredited U.S. medical schools. A mere 30 percent of those schools were requiring students to take a dedicated nutrition course. Eighty-eight percent of the instructors surveyed said students were being underserved with nutritional science.
Okay, so how about food makers? Well, they pour 160 pounds of sugar per person per year into the food U.S. supply, a recipe for fat profit margins and waistlines both.
Insurance companies? Most don’t cover nutritional counseling for prediabetics, even though this is the last chance to forestall the onset of a dietary disease. Seems more than a little backwards, doesn’t it, like fastening your seatbelt after a crash.
Drug firms? They sell tens of billions of dollars worth of diabetes drugs every year to help us manage all that sugar. Diabetes will take its sweet time killing you, so you’ll be filling expensive prescriptions for years, if not decades, as it picks you apart.
THE SOLUTION LIES with you. If you’re among those with or threatened by type-2 diabetes, you can very likely beat the disease, starting with a diet overhaul. When I was diagnosed with prediabetes in 2006—a week after learning that my estranged father had lost a leg to the disease—I reengineered my diet. It wasn’t the only thing did; I also began exercising daily in specific ways, which I’ll outline in subsequent articles. But the cornerstone of my anti-diabetes plan was the elimination of what had become my metabolic poison: excessive carbohydrates, especially simple sugars.
The sugar load that comes from snack foods and soda has been divorced from the fiber that once surrounded it in foods; and concentrated in forms, such as soda, that allow vast quantities to jolt the bloodstream, panicking the pancreas and leading to an over-secretion of insulin. Our metabolic systems weren’t designed to handle anywhere near that load, and our body’s ancient sensors for hunger and satiety are now easily tricked.
My body certainly fell for it. For too many years, I asked my metabolic system, my body’s carburetor, to handle fuel it was never designed to handle.
Eventually, it broke.
Perhaps yours has as well. Fixing the problems of glucose intolerance and insulin resistance, which lead to chronically high and/or volatile blood sugar, and eventually type-2 diabetes, means learning basic truths about what you put in your body every day:
Control your carbs--or type-2 diabetes will control you. “The majority of Americans still think the ideal diet for their health is high in carbohydrate and low in fat,” says Rab. “To make a major difference in this diabetes epidemic, switching to a significantly lower-carbohydrate diet [should serve] as the mainstream advice.” A low-carb diet is ideal for anyone who has type-2 diabetes or is at high risk for it.
So how low is “low carb?” Someone with prediabetes or diabetes should be wary of consuming more than 100 grams of carbs a day, in my opinion, and those carbs should come from healthy sources such as vegetables and and nuts. The more you exercise, the more carb-tolerant your body will become. If you want to consume more than 100 carbs grams a day, work out more to account for them.
What can you eat? Here are the items I’ve used to ward off type-2 diabetes:
• Eggs (the best way to start your day, every day)
• Certain fruits (such as avocados, peaches, plums, apples, and cantaloupe)
• Certain vegetables (such as spinach, cucumbers, and celery)
• Certain nuts (such as almonds and walnuts; go easy on the cashews, which contain more than twice as many carbs as those two)
• All meat (such as turkey, chicken, and steak; exception: certain lunchmeats can be packed with a lot of sugar, and they’re not the healthiest option anyway)
• All fish (such as salmon, halibut, and sashimi, my favorite)
• Tuna, chicken, or egg salad (on lettuce wraps or Scandinavian Bran Crispbread)
• Soft cheeses (such as mozzarella and ricotta)
• Almond butter or cream cheese (great on celery for a snack!)
• Cottage cheese (spice it up with walnuts and cinnamon)
• Hummus (spread it on sliced cucumbers for a yummy snack)
• Herbal teas (with or without a packet of artificial sweetener)
• Coffee (with a nice splash of heavy whipping cream and no sweetener)
• Red wine (white wine, less frequently and in smaller amounts)
Complex carbs, like simple sugars, can easily be overconsumed. According to the experts with whom I spoke, a trickle of the wrong carbs is preferable to an avalanche of the better ones. Sure, whole-wheat bread falls lower on the glycemic index (GI) than white bread. Yet both products break down into glucose. The same goes for brown rice versus white rice. With a GI 10 points lower than white rice, carbs from brown rice enter the bloodstream more slowly. Yet they still arrive. Consume a lot of even low-GI carbs, and your bloodstream can become overwhelmed by too much glucose.
Whole foods are best, processed foods worst, but “engineered” foods can help you. These differ from typical high-calorie, processed foods—which harm rather than help the blood sugar-impaired—because engineered foods are designed to achieve specific means, rather than for mass production and consumption.
Protein powder is a prime example. Even more than healthy fats, protein forms the foundation of my low-carb diet. However, milk, for example, also comes with lactose, a simple sugar. The powder gives me what I want (protein) without the stuff that’s making me sick (sugar). All I have to do is blend the powder with 1 cup of cold water and a few ice cubes for the equivalent of a healthy milkshake.
A product like PaleoMeal fits with my eat-like-a-hunter-gatherer approach. It contains 13 grams of carbs, but 7 of them were fiber, so essentially it had only 6 grams of carbs. Other great ones are Isopure, by Nature’s Best; and Metabolic Drive, by Biotest. Both combine high-quality protein with few or no carbs. They also taste great. That’s what you want—something you’ll want to drink instead of a brew or soda.
No matter what, don’t assume you’re eating healthfully just because you’re not overweight. I’m tall, thin—and prediabetic. As it turns out, 10 to 15 percent of those with insulin resistance, the condition underlying type-2 diabetes, are not overweight. Among other populations, particularly in Asia, the percentage of normal-weight diabetics is actually much higher.
“People are eating a diet that predisposes them to diabetes, and that diet also causes a lot of people to gain weight,” says Dr. Wortman. “There are overweight people who don’t have metabolic problems, and normal-weight people who do have these problems. That’s telling us that weight gain isn’t the underlying cause of diabetes. Something else causes both, and it’s our [high-carbohydrate] diet.”
Adapted from SUGAR NATION, by Jeff O’Connell (Hyperion, 2011).
- Adam Bornstein
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