How to Treat Pre-Diabetes with Diet


How to Treat Prediabetes with Diet

Written by:  
For people with prediabetes, lifestyle modification is considered “the cornerstone of diabetes prevention.” Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).

The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.

According to the American Diabetes Association’s official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3’s, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).

If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it’s safe and highly effective, why don’t more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

It may be because doctors aren’t getting paid to do it. Why haven’t reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.

“The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?”

How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education “has not changed since 1910.”


I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That’s actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I’m doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Alden Chadwick / Flickr


Like this article? Share the love!

Michael Greger, M.D., is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous “meat defamation” trial. Currently Dr. Greger proudly serves as the Director of Public Health and Animal Agriculture at the Humane Society of the United States.


Vegetable Spring Rolls – the Perfect Warm Weather Dish!

As the weather gets warmer, our bodies seem to gravitate towards foods that are filled with water such as fruits and vegetables.  These Vegetable Spring Rolls are the Perfect Summer Dish because they will provide your body with the nutrients and energy it needs to get you through the day, keep you cool and not weight you down.

Step 1: Cut up your favorite veggies into large chunks and chop/shred in a food processor:  Here I used celery, radish, carrot, orange bell pepper, cucumber and avocado (chopped by hand)  You don’t need to use this many, I just had them in the house and wanted to experiment!  Notice all of the gorgeous colors!  Each one contains different vitamins and minerals to help your body fight disease and look its best!

Step 2: Place the rice wraps in a bowl of water and submerge for 30 seconds until it softens.  Then wet a clean wash cloth/towel and place it on your counter.  When you take the rice wrap out of the water, lay it flat on the towel.  Line the center with veggies.  Then fold the bottom and top pieces over, then roll the right side all the way towards the left until its binded almost like a burrito.

Step 3: Enjoy your veggie summer rolls!  Here I added a peanut dressing, but feel free to add your favorite!  I think low sodium soy sauce or ginger dressing would taste great too!

Surprising Foods that Increase the Risk of Diabetes

The Physicians Committee

Diabetes Here I Come

Wed, 2016-04-13 09:24

Diabetes here I come.” Controversy quickly brewed this week after a Starbucks barista wrote those four words on a customer’s grande white mocha. But rather than put those words on a specialty coffee, let’s put them where they really belong. With 422 million adults worldwide living with diabetes, I’d like to see the blunt warning on packaging for the most diabetogenic foods exacerbating this global epidemic.


  • Red Meat: Diabetes here I come. An increase of more than half of a serving of red meat per day increases the risk for type 2 diabetes by 48 percent, according to one study. Decreasing red meat intake resulted in a decreased risk for diabetes. Many other studies show the same.
  • Eggs: Diabetes here I come. Another recent study found that consuming three or more eggs per week increases an American’s risk for type 2 diabetes by 39 percent. It’s just one of many studieslinking egg consumption to diabetes.
  • Dairy, Chicken, and Fish: Diabetes here I come. A study released earlier this month found that those who consumed the highest amount of animal protein increased their risk for type 2 diabetes by 13 percent. But participants who replaced 5 percent of their protein intake with vegetable protein decreased their risk for diabetes by 23 percent.

There’s plenty of other evidence showing that animal products increase diabetes risk, while plant-based diets can often prevent and reverse diabetes.

Diabetes here I come. It’s a message many don’t want to hear. But with about 1.5 million newly diagnosed type 2 diabetes cases and nearly 250,000 diabetes-related deaths in America each year, it’s an easier pill to swallow than the consequences of getting the disease.



Do you Follow a Low-Carb Diet?

The Atkins Diet lives on in the current bestselling books Wheat Belly by William Davis, MD and Grain Brain by David Perlmutter, MD.

Robert Atkins, MD, creator of the Atkins Diet, was upfront with his recommendations to eat a diet almost exclusively made up of meat, poultry, cheese, butter, fish, and eggs, with very little plant-foods. The first Atkins Diet book was published in 1972; since then well-informed people have come to understand (through their own readings and personal experiences) that eating an animal-based, high-fat, low-carbohydrate diet is wrong. They have learned that following this eating pattern causes epidemic diseases, including type-2 diabetes, coronary heart disease, and common cancers; and that the livestock industry is at the root of climate change. Many people are also wrestling with their conscience as they deal with the moral issues of animals being killed unnecessarily for food, supporting the horrors of factory farming, and depleting our oceans. Therefore, a diet book titled Eat More Animals to Lose Weight would meet a mostly unfriendly audience.

Wheat Belly and Grain Brain take a backdoor approach to the Atkins low-carbohydrate method. As the titles of these books suggest, wheat causes a big belly and grains damage the brain. Within their pages you learn that all starchy foods, including rice, corn, and potatoes—the traditional foods consumed by billions of people throughout human history—are now unhealthy and must be minimized or, better yet, avoided altogether. If you believe these authors, then what is left to eat in order to meet your energy requirements? Meat, dairy, fish, and eggs (the original Atkins Diet).*

In order for the authors of these two books to pull off the monumental task of luring otherwise intelligent people into inherently dangerous diet plans, they have had to (1) ignore the bulk of the science, (2) exaggerate the truth, and (3) make false associations.

Ignoring the Science: Low-Carbohydrate Diets Contribute to a Higher Risk of Death and Disease
Low-carbohydrate diets can cause weight loss, but weight loss should not be the primary goal of individuals, medical doctors, dietitians, insurance companies, or governments. The goal is to live longer and stay healthy. Three major scientific reviews show that low-carbohydrate diets increase the risk of sickness and death.

1) The 2010 Annals of Internal Medicine published the article “Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality.” Their conclusion: A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based, low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.

2) The 2012 British Medical Journal published the article “Low-Carbohydrate, High-Protein Diet and Incidence of Cardiovascular Diseases in Swedish Women: Prospective Cohort Study.” Their conclusion: Low-carbohydrate, high-protein diets, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.

3) The 2013 Public Library of Science journal published the article “Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies.” Their conclusion: Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence.

There are no comparable studies suggesting high-carbohydrate (starch-based) diets increase mortality, cardiovascular disease, or other common diseases. (Any negative references to carbohydrates in these articles apply to simple sugars, not starches.)**

Exaggerating the Truth about Inflammation
Promoters of low-carbohydrate diets, those high in meat, dairy, fish, and eggs, claim dietary carbohydrates are packed with inflammatory ingredients, and that inflammation is at the heart of virtually every disorder and disease. The evidencelinking carbohydrates to inflammation is convoluted, theoretical, and largely limited to an uncommon condition, Celiac disease.

Inflammation is the consequence of injury, such as from a cut, burn, or infection. The pain, redness, swelling, and heat that follow are natural, necessary processes for healing. These symptoms and signs of inflammation resolve after the single event. However, with repetitive injury, inflammation can become long-standing, referred to as “chronic inflammation.” One common example of chronic inflammation is bronchitis from inhaling cigarette smoke 20 times a day. Stop smoking and the inflammation stops, and the lungs heal (scar tissues and other residuals of the damage can be left behind).

For dietary diseases, including atherosclerosis, primary sources of repetitive injury are meat, cheese, and eggs. Once the injury is stopped, then healing occurs and the inflammation resolves. Reversal of coronary heart disease is seen on follow up examinations.

Research does not support the theory that carbohydrates from wheat, other grains, or starchy vegetables are the source of injury that leads to chronic inflammation. In contrast, scientific research does solidly support that the source of injury leading to chronic inflammation is animal foods.

Animal Foods, Not Plant Foods, Cause Inflammation

The 2013 European Journal of Nutrition published the article “Consumption of Red Meat and Whole-Grain Bread in Relation to Biomarkers of Obesity, Inflammation, Glucose Metabolism, and Oxidative Stress.” Their conclusion: The results of this study suggest that high consumption of whole-grain bread is related to lower levels of GGT, ALT, and hs-CRP, whereas high consumption of red meat is associated with higher circulating levels of GGT and hs-CRP. (Lower inflammatory markers, like CRP, are associated with better health.)

The 2013 Nutrition Reviews published the article “Dietary Pattern Analysis and Biomarkers of Low-Grade Inflammation: a Systematic Literature Review.” A major conclusion: Patterns identified by reduced rank regression as being statistically and significantly associated with biomarkers of inflammation were almost all meat-based or due to “Western” eating patterns.

The 2014 American Journal of Clinical Nutrition published the article “Associations Between Red Meat Intake and Biomarkers of Inflammation and Glucose Metabolism in Women.” Their conclusion: Greater red meat intake is associated with unfavorable plasma concentrations of inflammatory and glucose metabolic biomarkers in diabetes-free women.

Grains (Including Wheat) Do Not Increase Inflammation

The 2010 Journal of Nutrition published the article “Whole Grains Are Associated with Serum Concentrations of High Sensitivity C-reactive Protein among Premenopausal Women.” Their conclusion: Women who consumed >or= 1 serving/d of whole grains had a lower probability of having moderate (P = 0.008) or elevated (P = 0.001) hs-CRP, according to the AHA criteria, compared with non-consumers.

The 2012 Nutrition Reviews published the article “Effect of Whole grains on Markers of Subclinical Inflammation.” Their findings: Epidemiological studies provide reasonable support for an association between diets high in whole grains and lower C-reactive protein (CRP) concentrations. After adjusting for other dietary factors, each serving of whole grains is estimated to reduce CRP concentrations by approximately 7%.

The 2013 Nutrition Journal published the article “The Potential Role of Phytochemicals in Whole-Grain Cereals for the Prevention of Type-2 Diabetes.” Their findings: Diets high in whole grains are associated with a 20-30% reduction in risk of developing type-2 diabetes… biomarkers of systemic inflammation tend to be reduced in people consuming high intakes of whole grains.

There are no comparable studies suggesting meat decreases inflammation or that whole grains, including wheat, increase inflammation. (CRP is a reliable marker of inflammation.)

Several mechanisms have been proposed to explain how animal foods injure our bodies. For example, atherosclerosis (chronic inflammatory artery disease) has been explained by the “cholesterol hypothesis” and by the “TMAO hypothesis.” Another sound mechanism identifies cow’s milk as the culprit. Most important for the consumer to understand is that these mechanisms consistently blame meat, dairy, and/or eggs as the source of the repeated injury and chronic inflammation. No debate here.

Relevant to the argument that inflammation is not the underlying cause of obesity and disease is the fact that treating inflammation with powerful anti-inflammatory medications does not favorably change the course and progression of the disease. To quote respected researchers, “In fact, to our knowledge, no anti-inflammatory therapy cures the majority of patients with a disease in which inflammation plays a major contributory role…” To repeat, inflammation is the result of injury, not the cause of disease.

Making False Associations: Using Celiac Disease to Demonize All Carbohydrates for All People

The main take-away that readers will get from Wheat Belly is that wheat is the major cause of obesity, heart disease, diabetes, and almost all other major health problems that people suffer from. Wheat can be very troublesome for a small percentage of the population. Celiac disease is a condition that affects fewer than one in one hundred people following the Western diet. These people must avoid gluten, found in high concentrations in wheat, barley, and rye. However, to put this real concern into a global, historical perspective, consider the importance of these three grains: they have served to fuel the development of civilizations throughout human history and still are a major source of calories, protein, vitamins, and minerals for billions of people. People without celiac disease, or the few other conditions that warrant elimination of these three specific grains, will find them an excellent source of nutrition.

Whole Grains Are Consistently Found to Be Healthy
A recent review of 45 prospective cohort studies and 21 randomized-controlled trials (RCT) compared people who rarely or never consume whole grains with those reporting an average consumption of three to five servings per day and found by comprehensive meta-analysis that those consuming the grains had a 26% reduction in the risk of type-2 diabetes and a 21% reduction in the risk of heart disease (independent of known CVD risk factors). Furthermore, there is an inverse relationship between whole grain intake and weight gain. Examples of whole grains included whole wheat, dark bread, oats, brown rice, rye, barley, and bulgur.

Even those few people intolerant of gluten (wheat, barley, and rye) can healthfully consume non-gluten rice, corn, oats, and other grains. Low-carbohydrate promoters enthusiastically demonize these grains too.

Making False Associations about Diabetes and Carbohydrates
The main take-away that readers will get from Grain Brain is that grains and other starchy foods are the cause of type-2 diabetes, Alzheimer’s disease, obesity, and most of the other chronic health problems suffered in the Western world. The truth is that people with type-2 diabetes are ill with many disorders of the body and brain. But grains and other starchy vegetables do not cause type-2 diabetes. The Western diet, loaded with meatfat, and empty calories, makes people overweight and diabetic.

Type-2 diabetes is cured by a starch-based, high-carbohydrate diet. To take this point to the extreme, the Rice Diet, consisting of white rice, fruit, fruit juice, and table sugar (more than 90% of the calories are from carbohydrate) has been shown to cause profound weight losses in the severely obese, cure type-2 diabetes, and reverse heart disease. Dietary fat increases blood sugar levels and causes people with type-1 diabetes to require more insulin.

Regardless of the effects on blood sugar, the underlying animal-based, low-grain, low-starchy-vegetable diet consisting of those very foods recommended in the books Wheat Belly and Grain Brain, is the major reason people with type-2 diabetes are so sick with heart and other diseases.

Looking Beyond the Smoke and Mirrors
The truth is that the rich Western diet makes people fat and sick. Steering people away from the few healthy components of our diet (grains and other starchy vegetables) and toward the unhealthy foods (meat, dairy, fish, and eggs) makes matters worse. People are desperate for a solution to their weight and health problems, and many of them are easily deceived. Especially when told that prime rib and cheddar cheese are good for them—people love to hear good news about their bad habits. Just as important for the rising popularity of low-carbohydrate diets, books like Wheat Belly and Grain Brain enhance the profits of the meat, dairy, egg, and fish industries.

Although these industries spend hundreds of millions of US dollars advertising “their science” and influencing national nutrition and health policies, the truth is simple and easy to understand: All large successful trim healthy populations of people throughout human history have obtained the bulk of their calories from grains and other starchy vegetables. Consumption of meats along with other rich foods in any significant quantity has been limited to the diets of fat, sick aristocrats (kings and queens)—until recently. To regain our lost health and save planet Earth, the smoke and mirrors behind popular diet books must be exposed.

*In an effort to partially compensate for important nutritional deficiencies, like dietary fiber, vitamin C, and thousands of other phytochemicals found only in plants, non-starchy green, red, and yellow vegetables (for example, broccoli, Brussels sprouts, celery, kale, lettuce, parsley, peppers, and zucchini), and a few fruits are commonly added to these low-carbohydrate diets, including newer versions of the Atkins Diet. Only plants make carbohydrates, thus “low-carbohydrate” is in practical terms synonymous with meat, poultry, cheese, butter, fish, and eggs.

**Simple sugars, like glucose and fructose, are refined ingredients found in sodas, cakes, cookies, and table sugar. Starches (sometimes referred to as complex carbohydrates) are foods with “natural sugars,” such as, barley, corn, millet, oats, potatoes, sweet potatoes, rice, and wheat.

Originally published in a McDougall Newsletter and republished with permission. Click hereto sign-up for the McDougall Newsletter for free.



Want to Upgrade your Immune System?

The Physicians Committee

Gut Bacteria: The Good, the Bad, and the Ugly

Mon, 2016-02-22

Three Tips to Create a Set of Disease-Fighting Microbes

This is a guest blog by Physicians Committee associate director of diabetes nutrition education Meghan Jardine, M.S., M.B.A, R.D.N., C.D.E.

The bacteria living in our gut performs many functions, such as controlling metabolism, immune function, and maybe even our thoughts and moods.  How can these tiny cells be so powerful in controlling human health? It depends on the types of bugs living in us and what we feed them.

To cultivate a set of disease-fighting versus disease-spreading microbes, move plant-based foods like vegetables, especially leafy greens, legumes (beans, peas, lentils), and whole grains to the center of your plate.  Avoid meat and other high-fat, animal-based foods.

If you’re not sure where to start, follow this three-step plan for a thriving microbiome:


Step 1: Eat More Vegetables. When it comes to championing optimal health and slashing the risk for disease, dark leafy green vegetables take home the gold.  A new study finds that the sugar (sulfoquinovose) in leafy greens such as spinach, kale, and watercress feed healthy bacteria that live in our digestive tracts, or gut. This bacteria flourishes and crowds out unhealthful varieties, while secreting bactericides that kill off harmful bacteria. Plus, good habits pay off. A 2015 study from RUSH University shows older adults who eat at least two servings of leafy greens each day reduce their risk for dementia.

Step 2: Add Beans to Your Diet. Beans, a member of the legume family, are a dieter’s best friend, since they are rich in fiber, leaving us feeling full, with just 115 calories per 1/2-cup serving. Legumes also have an amazing effect on our gut bacteria. The fiber in beans is not digested in the small intestine.  When it gets to the large intestine beneficial bacteria are waiting. They ferment the fiber and release short chain fatty acids (SCFA), which provide all kinds of benefits. SCFA help our body absorb essential minerals (calcium, zinc, magnesium), increase satiety (improving weight loss), decrease inflammation, reduce the risk of colon cancer, prevent and treat diabetes, and may even reduce the risk of asthma.

Step 3: Avoid meat, dairy, eggs, and fatty foods, which are high in calories and associated with insulin resistance. This can lead to type 2 diabetes and other forms of chronic disease.  Here’s how it works:

Animal products promote the growth of detrimental bacteria and result in the release of toxic chemicals that are harmful to our health. Like carbohydrates, proteins are fermented by the bacteria living in the large intestine. Fermentation of protein causes a release of toxic metabolites (ammonia, phenolic compounds, and amines) that promote the formation of tumors (colon cancer), and increase the risk of inflammatory bowel disease, ulcerative colitis, schizophrenia, and liver problems. Animal protein from meat, eggs, and dairy products are metabolized in the gut to release a metabolite (trimethylamine-N-oxide), which has been linked to cardiovascular disease.

Fats are mostly absorbed in the small intestine. Studies have demonstrated that fat in the diet reduces the production of those beneficial short chain fatty acids by inhibiting the growth of healthy bacteria. Fats also need bile to be digested and absorbed. Bile is secreted from the liver into the small intestines. So now the bacteria also have to metabolize this bile and that causes a growth of “bile-tolerant” bacteria. Bile-tolerant bacteria have been associated with inflammatory bowel disease, higher levels of inflammatory factors in the blood, and may also increase the risk of liver cancer.

The good news is we have 40 trillion bacteria living inside our body. With a few modifications it’s easy to create a new biological system to enable our body to focus on larger tasks, like climbing Mount Everest or helping our children with their science project, instead of constantly combating pathogens.

Partner these tips with gut-friendly pre- and probiotics to give your body the fuel it needs to succeed.

Meghan Jardine, M.S., M.B.A., R.D., L.D., C.D.E., is the associate director of diabetes nutrition education for the Physicians Committee for Responsible Medicine, and works to develop programs to educate physicians, health care professionals, and the public about nutrition as preventive medicine. 

For more on gut bacteria, Ms. Jardine will be speaking about the microbiome’s role in diabetes at the International Conference on Nutrition in Medicine in Washington, D.C., this summer. Join us!