Critical Acclaim
Defeating Diabetes – A no-nonsense approach to type 2 diabetes and the diabesity epidemic
By Brenda Davis RD & Tom Barnard MD
Healthy Living Publications USA
Brenda Davis is a registered dietitian and Tom Barnard, MD, is a University Professor both living in Canada. This book is intended for use by people with type 2 diabetes. The authors address the epidemic of diabetes with this lifestyle book which highlights the urgent need for strategies for change. The 280 pages takes an innovative and holistic approach that advocates a plant based (vegan) diet and other lifestyle changes in the treatment of type 2 diabetes and the prevention of complications.
Defeating Diabetes covers all areas of diabetes, beginning with a clear explanation of the disease and looks at the various dietary components that affect health. It addresses the diet industry, glycaemic index, medications and lifestyle changes including taking exercise and reducing stress. Each chapter is summarised with ‘practical pointers’ and references are detailed by chapter at the end of the book. However, I would have found it more helpful to have had the references within the text.
It is an easy read, well organised, up-to-date and throughout supported by practical advice in making lifestyle changes, including kitchen tips and recipes on how to achieve this. It certainly has a unique approach but it is quite radical and whether patients would be willing to make such changes to their diet and lifestyle has to be questioned. For example, the 50 pages of recipes, although reasonably easy to make, are generally very different from those of the general population eg Scrambled Tofu, Fresh Spinach Salad and Barley Burgers! Nevertheless, the book is inspiring and for the motivated patient, it is a practical and useful reference book - perhaps this is the radical approach we need to take and after the Atkins diet book, this may be the next one to take the market by storm!
Review by Sandra Hood, Diabetes Specialist Dietitian, 27.8.03
Watching a member of your family suffer from the ravages of a chronic, debilitating disease can be a shattering, heart-wrenching experience, especially when you realize the diesease could have been prevented by lifestyle changes. Authors of Defeating Diabetes, Brenda Davis, a registered dietician and Dr. Tom Barnard, a specialist in disease assessment and management, were both in that unenviable position.
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."
Set realistic goals.
Center your diet on whole plant foods.
Use beverages to your advantage.
Limit fat intake to not more than 25 percent of calories.
Build healthful habits
Make physical activity a priority in your life.
Take care of your inner being.
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 by Vegetarian Reading, August 2003
Empowerment
at Its Best, April 21, 2003
This book gives comprehensive dietary
and nutrition information to empower readers. Because diet and lifestyle factors
are the primary causes of Type 2 diabetes, most Type 2's can control their
diabetes completely. This is good news because the health problems that can
occur as a result of untreated diabetes include blindness, early heart disease,
and amputation of body parts. With over half of those with Type 2 not knowing
they have it, following the suggestions in the book makes sense whether you have
diabetes or not.
The authors explain ways to catch
diabetes and pre-diabetes (the precursor to diabetes). They explain insulin
resistance and point out that although being overweight puts one at high risk
for diabetes, one can be thin and have insulin problems due to "metabolic
obesity," which is explained further in the book.
Blood-sugar levels and factors
affecting them are clearly explained. The myth that simple sugars are bad and
complex carbohydrates are not is dispelled. "This is not only a gross
oversimplification; it is inaccurate. Simple carbohydrates are found in highly
refined, nutrient-depleted foods like table sugar, but they are also found in
highly nutritious whole foods like fruits and vegetables. Complex carbohydrates
are found in heavily processed foods like white bread and pastries, but are also
present in nutrient-dense foods such as wheat berries and beans."
Knowing glycemic indexes is
important, but understanding how other foods affect blood-sugar control (like
fats) is also important. Factors such as the following are considered: the
number of grams of carbohydrate present; the type of sugar (glucose, fructose,
sucrose, lactose); the amount and type of fiber present; the kind of the starch
(amylose versus amylopectin); the form of the food (cooked, raw, dry, liquefied,
paste, ground, or otherwise processed); and the presence of other components in
the food or in foods eaten with the carbohydrate-rich food.
The authors offer a two-step process
for dietary reform. "Step 1 - Take out the trash" and "Step 2 - Pile on the
protectors." Trans fatty acids are an example of an item on the trash list. In a
recent Nurses Health Study, replacing 2 % of calories from trans fatty acids
with polyunsaturated fat reduced the risk for type 2 diabetes by 40%.
The authors pinpoint many
health-promoting foods. For example, many whole plant foods contain
phytochemicals and antioxidants, and blueberries are "one of the most protective
foods on the planet." Their ability to quench free radicals from the body was
found to be the highest, often 5 times higher than most other vegetables and
fruits. Other protectors in food such as fiber, plant protein, and certain fats
are given thorough treatments as well.
Another section of the book includes
"Healthy Weight for Life." "Obesity . . .elevates your risk of most of the
chronic degenerative diseases plaguing the Western world. The strength of this
link cannot be ignored." The problems with high-protein diets are addressed, but
you might be surprised to know that the problems with very-low-fat, high-fiber
diets are addressed, as well. For example, the authors state that the very low
fat diets often allow for too many refined carbohydrates, and this can be a
problem. Another problem with too little fat in your diet will reduce the
absorption of certain nutrients, and important foods like nuts and seeds, which
are good sources of trace minerals and Vitamin E, may be overlooked. Seven steps
to achieving a life-long healthy weight are given.
Two popular tools for diabetics -
exchange lists and carbohydrate counters - are explained and reviewed. Both
systems have their problems. For example, neither "adequately distinguishes
among different forms of carbohydrate. Both systems favor animal over plant
protein sources. . . . Neither system fully recognizes the huge variations in
health effects of different types of fat." Practical information is given about
understanding the glycemic index of foods, and sample menus (a week of
breakfast, lunch, dinner, and snacks) and suggested servings that ensure
nutritional adequacy without excessive calories are included. This is especially
helpful to diabetics who may be transitioning to the type of diet recommended in
this book.
Many people still think of diabetes
simply as a sugar problem. Though this is an important issue, there are many
other issues, including fat, fiber and micronutrients of which one should be
aware. "Making Sense of Sweets" gives information on both nutritive (those with
calories) and nonnutritive (no significant calories) sweeteners. There are clear
tables for each category including any cautions one should know.
Additional sections of the book
include the following:
"Defensive Dining" includes advice
for how to handle eating out.
"Survival of the Fittest" addresses
the need for exercise and other fitness needs. "It appears we can live longer
simply by living well. What is more, it is not only the length of our lives that
improves with fitness, but the quality of living." All facets of fitness are
addressed including aerobics, weight training, flexibility, even emotional
fitness and sleeping, and more.
"Self Care: A Daily Maintenance
Routine" deals with how we need to take care of ourselves on a daily basis and
includes a checklist for our daily assessments of ourselves.
"When Diet and Exercise Are Not
Enough" deals with the different medications available to help control diabetes.
In addition to prescription medications, the authors investigate vitamins,
minerals, herbals, and botanicals.
Finally, "Kitchen Wizardry . . .
Tricks of the Trade," helps people to understand what to buy when grocery
shopping. It includes an extensive shopping list, suggestions for where to shop,
information on reading food labels, and food storage guidelines. The book
finishes with a delightful recipe selection to jump-start you on the road to
good health and diabetes management.
Overall, the book is well documented
with selected references appearing at the ends of each chapter. Defeating
Diabetes is a practical, easy-to-read, well-thought-out guide to healthy living
and diabetes management. The basics of the health issues that are used to defeat
diabetes are sound advice for maintaining good health whether you have diabetes
or not.
Reviewed by Allison "AMMG" (Dresher, PA United States)