The Kick Diabetes Cookbook is Out!!!

The Kick Diabetes Cookbook by Brenda Davis and Vesanto Melina (publisher – Book Publishing Company) is available now. This book provides a tested plan for managing and reversing type 2 diabetes. With over 100 recipes and step by step guidelines, it will serve as an invaluable resource. All the recipes included are sugar-free, oil-free and meet the guidelines for <1500 mg sodium per day. The are based on whole, plant foods and help you to maximize the most protective components in the diet, while minimizing those found to be the most pathogenic. You will love how easy they are to prepare. 

 

Dr. Michael Greger (founder of nutritionfacts.org and author of How Not to Die) says, “If you intend to reverse diabetes or support someone in this process, get a copy of The Kick Diabetes Cookbook and make it your constant companion.”

Dr. John Kelly (founding president of the American College of Lifestyle Medicine) says, “Properly selected and prepared plant foods can reverse insulin resistance and type 2 diabetes. Reverse your diabetes and enjoy full remission using the nutritional approach so enjoyably presented in The Kick Diabetes Cookbook.”

Dr. Wes Youngberg (assistant clinical professor at Loma Linda University, founder of Diabetes Undone and author of Goodbye Diabetes) says, “I’ve been helping patients reverse diabetes for nearly 20 years. There is no one I would trust more to give me nutritional advice than Brenda Davis. Using this cookbook is your best bet for reversing diabetes.”

Julieanna Hever (co-author of Plant-based Nutrition Idiot’s Guide and The Vegiterranean Diet) says, “With the unprecedented rise of type 2 diabetes, there has been increasing confusion surrounding diet-related treatments. The Kick Diabetes Cookbook is a welcomed solution packed with simple advice, detailed charts and guidelines and delicious, easy recipes.”

Check out the recipe section for recipes featured from the book!

 

 

 

The Kick Diabetes CookBook




FIGHTING DISEASE WITH YOUR FORK




LEGUMES vs MEAT




10 Ways to Lose Weight




Methionine- Restricted Diet… Who needs it?

 

Methionine is an essential amino acid — one of the building blocks of protein that cannot be produced by the human body so must come from our food. It is one of two sulfur-containing amino acids (the other is cysteine). Methionine is an intermediary in the synthesis of cysteine, carnitine, taurine, and other compounds. It protects liver cells, and helps to prevent lipid peroxidation, and possibly atherosclerosis and elevated cholesterol. Although methionine is essential to human life, some people benefit by limiting, but not eliminating methionine in their diets. For such individuals a methionine-restricted diet may be advised.

 

Should I be on a methionine-restricted diet?

Some individuals need to restrict methionine due to inherited disorders that affect methionine metabolism. There is growing interest in methionine restricted diets for those who are unaffected by these genetic metabolic disorders. Evidence suggests that such diets could enhance longevity and help to prevent or treat certain chronic health conditions. The most common indications for a methionine-restricted diet are:

 

i) MTHFR variants. MTHFR gene mutations can lead to elevated homocysteine. Methionine restriction is commonly recommended to help reduce homocysteine accumulation.

 

ii) Cancer. While human studies are sparse, there is some evidence that cancer cells grow less robustly, and sometimes undergo apoptosis (cell death) when deprived of methionine.

 

iii) Depression. High methionine intakes can elevate homocysteine levels and risk of depression.

 

iv) Lifespan extension. Low methionine diets increase metabolic flexibility and overall insulin sensitivity and improve lipid metabolism while decreasing systemic inflammation.

 

v) Insulin resistance. Methionine restriction has been shown to reduce adiposity and improve insulin sensitivity.

 

vi) Homocystinuria. This inherited disorder of metabolism often requires a low methionine diet.

 

If methionine-restriction may help kill cancer cells and increase longevity, shouldn’t everyone be on a methionine-restricted diet?

We don’t know for sure, but it is an option for those who are interested in employing a novel dietary strategy for disease risk reduction. While severe methionine restriction is rarely advised, a moderate methionine restriction may be beneficial. The most concentrated methionine sources are animal products such as meat, poultry and fish. You will see from the table below that the eating pattern that is lowest in methionine is a purely plant-based diet or vegan diet. Other vegetarian or near-vegetarian diets are lower in methionine than omnivores diets, but not as low as vegan diets. For most people, simply eating a plant-based diet is likely sufficient for reducing methionine intake. Those with metabolic disorders or other conditions that may warrant methionine restriction can further restrict methionine by limiting high methionine plant-based foods.

 

If a methionine restricted diet is indicated for me, how much methionine should I be eating each day?

The RDA (recommended dietary allowance) for methionine + cysteine (adults 19 yrs+) is 19 mg/kg/day, while the EAR (estimated average requirement) is 15 mg/kg/day. People should not dip too much below these levels as they represent the lower end of what is needed for human health. Methionine-restricted diets allow 800-1200 mg methionine per day for most adults. For methionine alone, 15 mg/kg is thought to be a reasonable lower limit. So, if a therapeutic, methionine-restricted diet is indicated for you, multiply your healthy body weight by 15 to find a level of methionine intake that is appropriate. Let’s say your healthy body weight is 60 kg, you would need 900 mg methionine per day.

 

Are there any downsides to severely restricting methionine?

Absolutely. There is some evidence that a lack of methionine could reduce levels of S-Adenosylmethionine or SAM-e increasing risk of depression. A lack of methionine has also been linked to senile graying of hair. When you restrict methionine you are naturally restricting protein, at least to some degree.  Ensuring sufficient protein is essential to health. Protein is necessary for building, strengthening and repairing body tissues, for making antibodies, hormones, enzymes and other compounds that are critical to every body process.  A lack of protein can result in muscle loss, increased risk of bone fractures and undesirable changes in hair and skin. Seniors tend to absorb protein less efficiently, so they may need to consume 15-25% more protein than other adults in order to absorb the same amount. So while methionine restriction can be beneficial, it is important that we meet our needs for methionine, and for protein.

 

 

METHIONINE IN COMMON FOODS

(SOURCE: THE USDA NUTRIENT DATABASE RELEASE 28)

 

 

Methionine (mg/serving)

0-50 mg

51-100 mg

101-150 mg

151-200 mg

201-250 mg

251-300 mg

301+ mg

 

 

Vegetables

Weight

Measure

Methionine (mg)

Asparagus, cooked

180 g

1 cup

50

Green beans, cooked

125 g

1 cup

29

Yellow beans, cooked

135 g

1 cup

24

Beets, cooked, sliced

170 g

1 cup

32

Broccoli rab, raw, chopped

40 g

1 cup

19

Broccoli, raw, chopped

91 g

1 cup

35

Burdock root, raw

118 g

1 cup

11

Cabbage, chinese, cooked, shredded

179 g

1 cup

15

Cabbage, cooked

150 g

1 cup

9

Carrots, raw, chopped

128 g

1 cup

26

Cauliflower, raw, chopped

107 g

1 cup

21

Celery, raw, chopped

101 g

1 cup

5

Chard, swiss, raw

36 g

1 cup

7

Chard, swiss, cooked

175 g

1 cup

35

Collards, raw

36 g

1 cup

12

Collards, cooked

170 g

1 cup

68

Cucumber, raw

104 g

1 cup

6

Eggplant, cooked

99 g

1 cup

9

Endive, raw

50 g

1 cup

8

Kale, raw, chopped

67 g

1 cup

18

Kale, cooked

130 g

1 cup

23

Kohlrabi, raw

135 g

1 cup

18

Leeks, cooked

124 g

1 leek

12

Lettuce, raw, shredded

36-47 g

1 cup

6-7

Mountain yam, cooked

145 g

1 cup

33

Mushrooms, cooked

156 g

1 cup

34

Mustard greens, cooked

150 g

1 cup

32

Okra, cooked

160 g

1 cup

32

Onions, cooked

210 g

1 cup

23

Parsley, fresh, chopped

60 g

1 cup

25

Pepper, sweet, raw, chopped

149 g

1 cup

9

Pumpkin, cooked, mashed

245 g

1 cup

20

Radicchio, raw

40 g

1 cup

3

Radishes, raw

116 g

1 cup

12

Seaweed, laver, raw

26 g

10 sheets

38

Spinach, raw

30 g

1 cup

16

Squash, summer, cooked

180 g

1 cup

23

Squash, winter, cooked

205 g

1 cup

23

Taro, cooked, sliced

132 g

1 cup

9

Tomatoes, fresh

149 g

1 cup

9

Tomato sauce

245 g

1 cup

17

Turnip greens, cooked

144 g

1 cup

37

Turnips, cooked, cubes

156 g

1 cup

14

Watercress, raw

34 g

1 cup

7

Yam, cooked

136 g

1 cup

27

Yardlong bean, cooked

104 g

1 cup

37

Zucchini, raw, chopped

124 g

1 cup

22

Brussels sprouts, cooked

155 g

1 cup

54

Hearts of palm, canned

146 g

1 cup

61

Potatoes, white + skin

148 g

1 med

56

Spinach, cooked

180 g

1 cup

99

Sweet potato, cooked

200 g

1 cup

74

Corn, sweet, cooked

165

1 cup

112

Peas, cooked

160 g

1 cup

130

Peas, raw

145 g

1 cup

119

Fruits

 

 

 

Apples, raw, sliced

125 g

1 cup

1

Apricots, dried

65 g

0.5 cup

10

Apricots, raw

155 g

1 cup

9

Bananas, raw, mashed

225 g

1 cup

18

Blueberries, raw

148 g

1 cup

18

Cherimoya, raw

160 g

1 cup

34

Cranberries, raw, chopped

110 g

1 cup

3

Dates

147 g

1 cup

32

Figs, raw

64 g

1 large (2.5″)

4

Gogi berries, dried

28 g

5 Tbsp

24

Grapefruit sections

230 g

1 cup

12-18

Grapes, fresh

92 g

1 cup

19

Guava, fresh

165 g

1 cup

26

Kiwi, raw, sliced

180 g

1 cup

43

Limes, raw

67 g

1 fruit

1

Mango, raw

165 g

1 cup

13

Melon, cantaloupe, raw

177 g

1 cup

21

Melon, honeydew, raw

170 g

1 cup

8

Nectarines, raw, sliced

143 g

1 cup

8

Olives, ripe, jumbo

15 g

1

2

Orange, raw, sections

180 g

1 cup

36

Papaya, raw

145 g

1 cup

3

Peach, raw

154 g

1 cup

15

Pear, Asian, raw

122 g

1 fruit

7

Pear, raw, slices

140 g

1 cup

3

Persimmons, raw

25 g

1 fruit

2

Pineapple, raw, chunks

165 g

1 cup

20

Plantains, raw, sliced

148 g

1 cup

25

Plums, raw, sliced

165 g

1 cup

13

Plums, dried

174 g

1 cup

28

Raisins, seedless

165 g

1 cup

35

Strawberries, raw

152 g

1 cup

3

Tangerines, raw, sections

195 g

1 cup

4

Watermelon, raw, balls

154 g

1 cup

9

Avocado, raw, cubes

150 g

1 cup

57

Figs, dried

149 g

1 cup

51

Jackfruit, raw

165 g

1 cup

56

Legumes

 

 

 

Black-eyed peas, cooked

165 g

1 cup

74

Hummus, homemade

60 g

1/4 cup

48

Miso

17 g

1 Tbsp

22

Okara

122 g

1 cup

50

Soy sauce (tamari)

18 g

1 Tbsp

30

Soy sauce (wheat and soy shoyu, low Na)

14 g

1 Tbsp

13

Soy milk, fortified

243 g

1 cup

39

Fava beans, cooked

170 g

1 cup

105

Lentils, sprouted, raw

77 g

1 cup

81

Lima beans, cooked

170 g

1 cup

116

Pigeon peas, red gram

168 g

1 cup

128

Soybeans, sprouted, cooked

94 g

1 cup

84

Tofu, soft

120 g

2.5 x 2.75 x 1″

101

Tofu, regular (medium firm)

124 g

0.5 cup

134

Tofu, firm (with calcium sulfate and nigari)

126 g

0.5 cup

139

Veggie sausages

50 g

2 links

126

Adzuki beans, cooked

230 g

1 cup

182

Chickpeas, cooked

164 g

1 cup

190

Cowpeas, cooked

171 g

1 cup

188

Kidney beans, cooked

177

1 cup

200

Lentils, cooked

198

1 cup

152

Lupins, cooked

166 g

1 cup

183

Mung beans, cooked

202 g

1 cup

170

Refried beans, canned reduced sodium

238 g

1 cup

155

Split peas, cooked

196 g

1 cup

167

Black turtle beans, cooked

185 g

1 cup

228

Black beans, cooked

172 g

1 cup

229

Cranberry beans, cooked

177 g

1 cup

248

Edamame, cooked

155 g

1 cup

215

Great Northern beans, cooked

177 g

1 cup

221

Navy beans, cooked

182 g

1 cup

201

Pink beans, cooked

169 g

1 cup

230

Small white beans, cooked

179 g

1 cup

242

Veggie burgers or soyburgers

70 g

1 patty

204

Tempeh

166 g

1 cup

290

Tofu, firm (prepared with calcium sulfate)

126 g

0.5 cup

266

White beans, cooked

179 g

1 cup

261

Soybeans, mature, cooked

172 g

 

385

Soy nuts, dry roasted

93 g

1 cup

497

Grains

 

 

 

Hominy, yellow

160 g

1 cup

50

Tapioca, uncooked

38 g

0.25 cup

1

Noodles, japanese, soba, cooked

114 g

1 cup

82

Barley. cooked

157

1 cup

68

Buckwheat groats, cooked

168 g

1 cup

74

Cornmeal

39 g

0.25 cup

64

Pasta, wheat, cooked

124 g

1 cup

79

Pasta, gluten-free, cooked, corn and quinoa

166 g

1 cup

98

Pasta, gluten-free, cooked, corn

140 g

1 cup

77

Sorghum grain, uncooked

48 g

0.25 cup

81

Triticale, uncooked

48 g

0.25 cup

98

Rice, white, long grain

158 g

1 cup

100

Amaranth, uncooked

48 g

0.25 cup

109

Millet, cooked

174 g

1 cup

122

Oats, uncooked

39 g

0.25 cup

122

Oat bran, cooked

219 g

1 cup

109

Pasta, gluten-free, cooked, brown rice

169 g

1 cup

134

Pasta, gluten-free, cooked, corn and rice

141 g

1 cup

102

Rice, brown, long grain

202 g

1 cup

117

Spelt, uncooked

44 g

0.25 cup

112

Wheat bran

58 g

1 cup

136

Wheat, hard, uncooked

48 g

0.25 cup

111

Wheat, sprouted

108 g

1 cup

125

Quinoa, cooked

185 g

1 cup

178

Kamut, cooked

172 g

1 cup

167

Wild rice, cooked

164 g

1 cup

195

Teff, uncooked

48 g

0.25 cup

207

Teff, cooked

252 g

1 cup

315

Nuts

 

 

 

Acorns, dried

28.35 g

1 ounce

39

Almonds

28.35 g

1 ounce

44

Almond butter

16 g

1 Tbsp

20

Cashew butter

16 g

1 Tbsp

50

Chestnuts, dried, European

28.35 g

1 ounce

33

Coconut, fresh, shredded

80 g

1 cup

50

Coconut, dried, shredded

28.35 g

1 ounce

37

Coconut water

240 g

1 cup

31

Macadamia nuts

28.35 g

1 ounce

7

Coconut milk, canned

240 g

1 cup

86

Hazelnuts

28.35 g

1 ounce

63

Pecans

28.35

1 ounce

54

Pine nuts

28.35 g

1 ounce

59

Peanuts, dry roasted

28.35 g

1 ounce

82

Walnuts, English

28.35 g

1 ounce

67

Cashews

28.35 g

1 ounce

103

Pistachio nuts

28.35 g

1 ounce

102

Brazil nuts

28.35 g

1 ounce

319

Seeds

 

 

 

Tahini (sesame seed butter), raw

15 g

1 Tbsp

88

Flaxseeds

28.35

1 ounce

105

Sunflower seeds

28.35 g

1 ounce

119

Chia seeds

28.35 g

1 ounce

167

Pumpkin seeds

28.35 g

1 ounce

171

Sesame seeds

28.35 g

1 ounce

159

Hempseeds (about 3 Tbsp)

28.35 g

1 ounce

264

Animal products

 

 

 

Eggs

33 g

1 large

132

Cheese, brie

28.35

1 ounce

168

Cheese, gouda

28.35

1 ounce

204

Milk, 1%

245 g

1 cup

215

Milk, 3.25%

244 g

1 cup

203

Yogurt, low fat, fruit

170

6 ounces

219

Cheese, parmesan, hard

28.35

1 ounce

272

Yogurt, plain, skim milk

170

6 ounces

287

Beef, lean, cooked

85 g

3 ounces

648

Chicken breast, cooked

85 g

3 ounces

675

Crab, cooked

134 g

1 leg

730

Fish, cod

85 g

3 ounces

448

Fish, salmon

85 g

3 ounces

640

Fish, tuna, canned

85 g

3 ounces

733

Ham, cooked

85 g

3 ounces

435

Lobster, cooked

145 g

1 cup

689

Pork, cooked

85 g

3 ounces

609

Shrimp, cooked

85 g

3 ounces

565

Turkey, roasted

85 g

3 ounces

670

 

NOTES:

  1. These figures in this table were sourced from the USDA National Nutrient Database for Standard Reference Release 28. http://ndb.nal.usda.gov/ndb/nutrients/index

 

  1. The chart is set up using food groups (e.g. vegetables, fruits, legumes, etc.). Within each group, you will notice a variety of colors which represent different categories of methionine concentration (see key that precedes the chart). Within each color category, foods appear in alphabetical order.

 

Selected References

Cavuoto P, Fenech MF. A review of methionine dependency and the role of methionine restriction in cancer growth control and life-span extension. Cancer Treat Rev. 2012 Oct;38(6):726-36.

Durando X, Thivat E, Gimbergues P, Cellarier E, Abrial C, Dib M, Tacca O, Chollet P. [Methionine dependency of cancer cells: a new therapeutic approach?].  Bull Cancer. 2008 Jan;95(1):69-76.

Hasek BE, Stewart LK, Henagan TM, Boudreau A, Lenard NR, Black C, Shin J, Huypens P, Malloy VL, Plaisance EP, Krajcik RA, Orentreich N, Gettys TW. Dietary  methionine restriction enhances metabolic flexibility and increases uncoupled respiration in both fed and fasted states. Am J Physiol Regul Integr Comp Physiol. 2010 Sep;299(3):R728-39.

Orgeron ML, Stone KP, Wanders D, Cortez CC, Van NT, Gettys TW. The impact of dietary methionine restriction on biomarkers of metabolic health. Prog Mol Biol Transl Sci. 2014;121:351-76.

Patil YN, Dille KN, Burk DH, Cortez CC, Gettys TW. Cellular and molecular remodeling of inguinal adipose tissue mitochondria by dietary methionine restriction. J Nutr Biochem. 2015 Nov;26(11):1235-47.

Plaisance EP, Greenway FL, Boudreau A, Hill KL, Johnson WD, Krajcik RA, Perrone CE, Orentreich N, Cefalu WT, Gettys TW. Dietary methionine restriction increases fat oxidation in obese adults with metabolic syndrome. J Clin Endocrinol Metab. 2011 May;96(5):E836-40.

Tapia-Rojas C, Lindsay CB, Montecinos-Oliva C, Arrazola MS, Retamales RM, Bunout D, Hirsch S, Inestrosa NC. Is L-methionine a trigger factor for Alzheimer’s-like neurodegeneration?: Changes in A? oligomers, tau phosphorylation, synaptic proteins, Wnt signaling and behavioral impairment in wild-type mice. Mol Neurodegener. 2015 Nov 21;10(1):62.

Trimmer EE. Methylenetetrahydrofolate reductase: biochemical characterization  and medical significance. Curr Pharm Des. 2013;19(14):2574-93.

Wanders D, Burk DH, Cortez CC, Van NT, Stone KP, Baker M, Mendoza T, Mynatt RL, Gettys TW. UCP1 is an essential mediator of the effects of methionine restriction on energy balance but not insulin sensitivity. FASEB J. 2015 Jun;29(6):2603-15.




Defeating Type 2 Diabetes

 

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“The diabetes time bomb has been ticking for 50 years, and it’s been getting louder. Despite the warning, successive generations of world leaders have largely ignored the threat.”

International Diabetes Federation (IDF) President-Elect Martin Silink

 

According to the Centers for Disease Control and Prevention, one in eight American adults had diabetes in 2014. If the current trends continue, they estimate that as many as 1 in 3 adults will have diabetes by 2050. The rate of diabetes has increased from 0.9 percent in the late 1950s to 9.3 percent in 2014 (12.3% in those over the age of 20 years). The figures are even more staggering among American seniors (those aged 65 years or more) – over 25% have type 2 diabetes, and over 50% have prediabetes. While statistically, diabetes is the 7th leading cause of death in the United States, this figure belies the fact that most people with diabetes do not die of diabetes: they die heart disease, kidney failure, and other complications. Globally, diabetes has become the 21st century plague, crippling rich and poor nations alike.

 

 

Diabetes Statistics in the United States 2010

 

Diabetes rate among the entire population: 9.3%

Diabetes rate among Americans over 20 years of age: 12.3%

Diabetes rate among Americans over 65 years of age: 25.9%

Estimated prediabetes rate among the entire population over 20 years of age: 35%

Estimated prediabetes rate among the American population over 65 years of age: 50%

 

 

What is Diabetes?

 

Diabetes is a metabolic disorder that diminishes the body’s ability to usher glucose into cells so it can be used for energy. Glucose is the primary source of energy for the body, and in order for glucose to enter our cells a “gatekeeper” called insulin must let it in. People with diabetes either do not produce any insulin, do not produce enough insulin, or have become “resistant” to the insulin that they produce. This means insulin cannot do its job and blood glucose levels begin to rise. When blood glucose is elevated over time, body tissues become awash in sugar and health tumbles down a rather predictable slippery slope.

There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is characterized by lack of insulin production by the pancreas, and it is generally regarded as an autoimmune disease. It occurs suddenly, and most often affects children and adolescents. Type 2 diabetes is distinguished by the preservation of insulin production, but faulty insulin action. Essentially the product of diet and lifestyle, type 2 diabetes is an insidious disease, often going undetected for many years. Globally, type 2 diabetes accounts for over 90 percent of all diabetes cases. The rise in diabetes runs roughly parallel that of overweight and obesity, with risk doubling in those who are overweight and tripling in those who are obese. While excess body fat plays a strong role in this disease, the way the fat is distributed is perhaps even more significant. Weight concentrated around the abdomen and in the upper part of the body (apple-shaped) increases risk far more than weight that settles around the legs and hips (pear-shaped). Fat that collects in and around vital organs (visceral fat) is far more damaging than fat that accumulates close to the skin’s surface (subcutaneous fat). Type 2 diabetes was once referred to as “adult-onset diabetes” because it was a disease rarely occurred in people under 50 years of age. Today, type 2 diabetes is seen in young adults, teens, and even children. Untreated or poorly controlled type 2 diabetes is a leading cause of blindness, premature heart attack and stroke, kidney failure, nerve damage, and amputations. 

Diabetes is defined as fasting blood glucose of at least 126 mg/dl (7.0 mmol/L), while pre-diabetes occurs when blood glucose reaches at least 110 mg/dl (6.1 mmol/L). Pre-diabetes is often manifested as “metabolic syndrome”, a cluster of risk factors characterized by elevated blood glucose, abdominal obesity, elevated blood pressure, elevated triglycerides, and low HDL-cholesterol levels. A cascade of problems ensues that commonly results in full-blown type 2 diabetes. 

 

The Luck of the Draw?

 

Some people believe that type 2 diabetes is more a matter of bad genes than bad habits. While it is true that some populations have a greater susceptibility to the disease, genes serve primarily as a loaded gun; it is almost always diet and lifestyle that pull the trigger.

The people of the Marshall Islands provide a poignant example. The Marshall Islands are a group of islands about 2300 miles southwest of Hawaii with a total population of about 60,000 people. In the Marshall Islands, an estimated 28 percent of those over 15 years of age and 50 percent of those over 35 years of age have type 2 diabetes. Sixty years ago, diabetes was virtually unheard of in the Marshall Islands. While changes in genes were negligible during those few decades, changes in diet and lifestyle were profound. Sixty years ago the Marshallese were slim, physically active, and lived off the land and the sea. The diet consisted of edible plants such as coconut, breadfruit, taro, pandanas and leafy greens, and fish and other seafood. All of these foods were acquired through physical work. Today, the Marshallese diet consists primarily of imported, processed foods, and the Marshallese people have become largely sedentary. A typical breakfast consists of cake donuts or sweet pancakes and coffee. The first foods of the day for children are often popsicles, chips, soda pop, or dry ramen noodles with dry Kool-Aid powder sprinkled on top. Lunch and dinner feature sticky white rice with meat or fish. Favorite meats are Spam, canned corned beef, chicken, and variety meats such as turkey tails or pig’s intestines. The meal is predictably washed down with a sweet beverage. It would be difficult to design a diet that could more efficiently induce type 2 diabetes than the diet that has been adopted by the Marshallese people.

In a laudable effort to reverse the Marshallese diabetes epidemic, Canvasback Missions Inc. (a Christian, non-profit organization, specializing in medical missions to remote South Pacific islands), in partnership with Loma Linda University and the Marshall Islands Ministry of Health, launched a lifestyle-based diabetes research study in 2006. Brenda Davis was hired to serve as lead dietitian; to design and implement the diet portion of the treatment program. For each intervention, approximately half of the qualified participants were assigned to an intervention group and half to a control group. Intervention participants received diet and lifestyle instruction over a 3-6 month period, while the control group received the “usual care” (advice from a physician and/or other health care worker to exercise, eat more healthfully and take the appropriate medication). Control group participants were guaranteed a place in the intervention group once their six-month control period had been completed (although their data could not used be used in the analysis). The two key elements of the lifestyle intervention were diet and exercise. The primary objective of treatment was to overcome insulin resistance and to restore insulin sensitivity as much as was physiologically possible. The diet was designed to support blood glucose control, reduce inflammation, reduce oxidative stress and restore nutritional status.. To accomplish this task, the dietary parameters were set as follows:

 

  • Whole foods, plant-based diet
  • Generous servings of non-starchy vegetables and legumes
  • Controlled portions of intact (whole) grains, starchy vegetables fruits, nuts and seeds
  • Minimal refined carbohydrates
  • Minimal ground grains (e.g. flour)
  • Very high fiber (40-50+ grams per day)
  • High viscous fiber foods (flax, oats, barley, beans, guar gum, psyllium)
  • Moderate fat from healthful sources such as nuts and seeds (20-25% fat)
  • Low saturated fat (<7% of calories)
  • Zero trans fatty acids
  • Sufficient omega-3 fatty acids
  • High phytochemical and antioxidant foods
  • Low dietary oxidants
  • Low glycemic load
  • Moderate sodium (Less than 2300 mg/day)

 

In addition to a highly therapeutic diet, participants received daily education about nutrition and lifestyle. PowerPoint presentations, practical workshops, dine-outs, shopping tours, and spousal cooking classes were all fundamental components of each intervention. To help increase access to affordable produce, participants were taught how to grow their own vegetables. Soil and gardening experts were brought in to conduct workshops, and participants were taken on agricultural field trips. Daily exercise including twice daily walks, aerobic classes, strength and flexibility exercises were all integral parts of therapy. The program results were remarkable during the first 2 to 4 weeks of the program. Typical reductions in fasting blood glucose were in the 50-75 mg/dL (3-4 mmol/L) range; and weight loss averaged approximately 2 pounds (1 kg) per week. Total and LDL-cholesterol, triglycerides and blood pressure plummeted. Participants consistently reported dramatic reductions or complete disappearance of pain in the legs, arms and joints. Many noted increased energy, improved mental clarity, fewer nightly trips to the bathroom, and rapid relief of chronic constipation. The majority of participants stopped taking diabetes medications. After 12 weeks, progress varied according to the participant’s commitment to the program. Those who stuck to the program continued to see improvements. Some reversed their disease, eliminating the need for medication, and experiencing blood glucose levels well within the normal range. 

 

Could It Work at Home?

 

Some people ask if the kind of program we use in the Marshall Islands could work in North America and other developed parts of the world. If the impoverished people of the Marshall Islands can succeed with the enormous barriers they face, it should be a relative breeze at home. The Marshallese have somehow managed to overcome seemingly insurmountable mountains of Spam, donuts, ramen noodles, and sweet drinks.They have put together low cost, healthful meals despite the high cost and poor quality of their produce, their infertile soils, and their lack of resources. They have managed with little education and marginal English skills. They have succeeded with few gyms, no hiking trails, and a cultural taboo against women wearing pants, shorts or other fitness wear. Their example inspires hope for everyone, everywhere.

 

References

Salas-Salvadó J, Martinez-González MÁ, Bulló M, Ros E. The role of diet in the prevention of type 2 diabetes. Nutr Metab Cardiovasc Dis. 2011 Sep;21 Suppl
2:B32-48.
Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.
Centers for Disease Control and Prevention. Diabetes Report Card 2012. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2012.



Plant-based Diets and Gout

gout5

Gout has long been known as the “disease of kings” as it is most common in overweight or obese men who consume rich foods, and excessive alcohol. It is also associated with hypertension and renal impairment. Diet can help to reduce the incidence of gout, and can play an important role in the treatment of gout.

Generally, with active disease, dietary purines are restricted. In the body, purines are metabolized to uric acid. Purines can elevate uric acid in the blood. Although normal levels of uric acid can assist in scavenging free radicals, higher levels increase risk of gout. The richest dietary sources of purines are organ meats and small fish (internal organs are eaten with the fish). Diets rich in plant foods are not associated with increased risk of gout, even when higher purine plant foods are consumed. Generally, plant foods are less concentrated in purines than meat and seafood. Dairy products are low in purines and have not been found to increase risk, although high fat dairy products may contribute to cardiovascular disease and diabetes, so low or skim milk products are preferable to higher fat options.

 

Common Myth – Beans and Gout

 

It is commonly believed that beans are high purine foods and should be avoided by people who are at risk for gout, have high uric acid levels, or who have active gout. This is because most tables listing the purine content of foods list the amount of purines found in 100 grams (just over a half cup) of dried beans. When 100 grams of beans are cooked, the yield is about 1 1/2 cups of beans. A typical serving of cooked beans is about a half cup, thus the figures shown in most tables are triple the usual serving size. Using a one-half cup serving size, the purine content of beans ranges from about 20-75 mg per serving. See the chart below for the purine content of specific legumes.

 

 

Dietary Guidelines for Gout Prevention and Treatment

 

  1. Avoid very high purine foods and limit high purine foods to not more than a serving per day (see chart below). Avoid meat extracts, broths, bouillon and gravy.
  2. Avoid rich, high-fat, meat-centered meals. Rely on plant foods as your primary sources of protein.
  3. Eat several servings of fiber-rich plant foods such as whole grains, vegetables, fruits, each day.
  4. Minimize intake of refined carbohydrates, including both starches (white flour products) and sugar.  Concentrated fructose can increase uric acid levels and increase insulin resistance.
  5. Drink 2-3 L of fluids each day. Most of this should be water. 
  6. Avoid alcohol, as it tends to interfere with uric acid excretion.
  7. Maintain a healthy body weight. If you are overweight, aim for a slow gradual weight loss of ½-1 kg (1-2 lbs) per week. Rapid weight loss from fasting or severely calorie-restricted diets is not recommended as this can raise uric acid levels and aggravate gout.
  8. Increase your physical activity. (Check with your doctor first if you are currently not active).

 

 

Purine Content of Common Foods

 

Avoid very high purine foods (>200 mg purine per serving)
Minimize high purine foods (>100 mg purine per serving)
Moderate medium purine foods (50-100 mg/serving)
Enjoy low purine foods (< 50 mg/serving)

 

Food

Serving Size

Purines (mg)

Anchovies, fresh

100 g (3.5 oz)

411

Sardines, canned

100 g (3.5 oz)

399

Herring, canned

100 g (3.5 oz)

378

Sardines, fresh

100 g (3.5 oz)

345

Kidney, pig

100 g (3.5 oz.)

334

Anchovy fish, canned

100 g (3.5 oz.)

321

Liver (pork)

100 g (3.5 oz.)

289

Salmon, fresh

100 g (3.5 oz)

260

Mackerel, canned

100 g (3.5 oz)

246

Liver, chicken

100 g (3.5 oz.)

243

Red fish (ocean perch)

100 g (3.5 oz.)

241

Chicken heart

100 g (3.5 oz)

223

Mackerel, fresh

100 g (3.5 oz)

194

Shrimp, brown

100 g (3.5 oz.)

147

Tuna, canned

100 g (3.5 oz.)

142

Clams, fresh

100 g (3.5 oz)

136

Squid, fresh

100 g (3.5 oz)

135

Chicken meat

100 g (3.5 oz.)

130

Lamb

100 g (3.5 oz)

128

Steak, broiled

100 g (3.5 oz.)

121

Haddock, broiled

100 g (3.5 oz.)

119

Pork

100 g (3.5 oz)

119

White fish

100 g (3.5 oz)

116

Lentils, cooked

½ cup (99 g)

74

Oats, dry

½ cup (78 g)

73

Great northern beans, cooked

½ cup (88.5 g)

71

Small white beans, cooked

½ cup (89.5 g)

68

Tofu

100 g (3.5 oz)

68

Split peas, cooked

½ cup (196 g)

64

Soybeans, cooked

½ cup (172 g)

64

Pinto beans, cooked

½ cup (85.5 g)

57

Red beans, cooked

½ cup (85.5 g)

55

Select fruits and vegetables*

100 g (3.5 oz)

51-81

Large lima beans, cooked

½ cup (94 g )

49

Sunflower seeds

28 g (1 oz )

40

Flaxseeds

28 g (1 oz)

28

Peanuts

28 g (1 oz)

22

Garbanzo beans, cooked

½ cup (82 g)

19

Almonds

28 g (1 oz)

10

Yogurt (dairy)

4 oz (113 g)

9

Walnuts

28 g (1 oz)

7

Most other vegetables  and fruits

100 g (3.5 oz)

10-49

 

* Fruits and vegetables with moderate purine content: broccoli, peas, artichokes, apricots, mushrooms, spinach, bananas and green peppers.