Color Me Dubious

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes - Joel Fuhrman

I try to keep personal details out of my reviews--this is, after all, the internet. But I don't know how to review this, how to contribute to the discussion about it and get feedback about it, without getting personal and giving my context and with it the reasons for my deep skepticism and why I won't be trying Fuhrman's program. I was diagnosed with breast cancer about a month ago. I had to have a Pet Scan to make sure it hadn't spread--it hadn't, and my prognosis is excellent. But I couldn't complete the procedure the first time I tried. It requires consuming radioactive sugars at a low blood sugar after a fast of several hours. Mine was 313--normal should have been 70 to 110. I have diabetes. I do believe they call that a one-two punch. Because they needed to get the blood sugar down fast for the test and because I was going to soon start chemotherapy, they put me on insulin. So I've gotten a fast education on diabetes. I've met with a nutritionist, a diabetes educator and an endocrinologist. I'm telling you all this because I'm going to share what I've learned from them that makes me feel dubious about this book.

First, what Fuhrman recommends--his "nutritarian" plan, is basically a "Vegan" diet. He believes that ideally we should eat no meat, fish, poultry, eggs or dairy. His plan concedes enough to individual tastes to allow (very restricted and occasional) fish and poultry: one ounce three times a week. Now, I am convinced by what I've read that we Americans do consume far too much meat and dairy--especially high fat kinds--and too few vegetables. I'm on board with that. But I also suspect advocacy of vegetarianism and veganism has more to do with a social and political agenda than health. This is what Fuhrman has to say on the subject:

<i>Humans are primates, and all primates eat a diet of predominantly natural vegetation. If they eat animal products, it is a very small percentage of their total caloric intake. (Page 133)

When we hear something over and over, starting when we’re young children, we accept it as true. For example, the myth that plant proteins are “incomplete” and need to be “complemented” for adequate protein is repeated over and over.</i> (Page 145)

AND

<i>For many years, most Americans incorrectly believed that only animal products contained all the essential amino acids and that plant proteins were incomplete. False. They were taught that animal protein is superior to plant protein. False. They accept the outdated notion that plant protein must be mixed and matched in some complicated way that takes the planning of a nuclear physicist for a vegetarian diet to be adequate. False.

I guess they never thought too hard about how a rhinoceros, hippopotamus, gorilla, giraffe, or elephant could become so big while eating only vegetables. Animals do not make amino acids from air; all the amino acids originate in plants. Even the nonessential amino acids that are fabricated by the body are just basic amino acids that are modified slightly by the body. So the lion’s muscles can only be composed of the protein precursors and amino acids that the zebra and the gazelle ate. Green grasses (or leafy greens) made the lion and are the mother of all the protein that built all the creatures on planet Earth.</i> (page 234)

I find such reasoning breathtakingly idiotic. Yes, we and monkeys and apes are all primates. So what? Whales and dolphins and porpoises are all cetaceans. Do you have any idea how diverse the species are in that order? And their very different dietary needs? Humans have been hunters since the species began. We're omnivores--NOT herbivores. Our teeth and bowels are along those lines. We don't have multiple stomachs to break down grasses--we <i>do</i> have stomach acids to break down meat. Even if it were true that vegetarianism is the healthiest possible diet, his reasoning for it is specious.

Note, he recommends a supplement of "Long-Chain Omega-3 (EPA and DHA)"--found in fish. If his diet is optimal and natural for humans--why would it need supplements--one found precisely in one of the foods he tells us to avoid? I'd note I've also often seen that vegetarians should consume supplements of B-12--again, because you don't get that in plant food. Iron and calcium are better absorbed by humans through meat and dairy than through plant sources. Moreover, the vegetarians I know, even the vegan ones, are careful to get complete proteins--if not through eggs and dairy, then by soy and quinoa and by matching complimentary proteins--such as rice and beans. Furhman's plan includes beans, and often oats and forms of soy, and one recipe includes wild rice. It's just that considering his dismissal of the necessity I don't trust he does so enough. I used the SparkPeople site to run through the numbers of Day One of Furhman's plan, and this was the result and feedback:

Calories: 1,265
Fat: 52
Carbohydrates: 161
Protein: 46
Fiber: 39

Feedback:
<i>Fiber, total dietary My Goal – 25-35 Today – 39
While a high-fiber diet has many benefits, too much fiber can cause problems. Eating more than 50-60 grams of fiber a day can interfere with nutrient absorption and cause digestive distress.</i>

<i>Protein My Goal – 60-136 Today – 46
Protein is an essential nutrient that does more than build muscles. It plays a role in cell repair, hormone production and fluid balance, to name a few. So pump up your protein intake to stay fit and healthy.</i>

I had to run the numbers through SparkPeople because Furhman doesn't give the nutrition facts for his plan. And estimate amounts at times using the Meal Planning Guide given to me by my nutritionist, because Furhman eschews giving portions much other than for his recipes. This isn't the way I'm being told how to eat. For one, the calories are too low--at least for me. I'm told chemo is like running a marathon--I'm told to drink loads of water--and the nutritionist recommended 1,500 calories a day. (And I've read that less than 1,500 calories lowers your metabolism, sabotaging a diet.) I was also told to include not just 3 meals but a snack, and space them about 4 hours apart so as to not overload the pancreas. Furhman believes in only 3 meals a day to "rest the pancreas." My nutritionist said the carbs should be spread out evenly between breakfast, lunch and dinner, each of which should have about 50 to 55 grams of carbs each, with the snack about 15 grams. Fuhrman's breakfast the first day is 271 calories (38 grams), Lunch 448 (66 grams), Dinner 480 (40 grams). I'd add that given beans are categorized as a starch, it's hard to go vegan and yet follow the standard recommended diabetic diet. My nutritionist, for instance, recommended that if I want a meatless meal of grains and beans I also have some greek yogurt.

This also isn't an easy diet to follow--especially for someone new to the disease who has a busy life--whether as a person preparing food for themselves or a family. It can be overwhelming making changes when diagnosed with diabetes. It's much easier to make a veggie egg white omelet with toast or pour some Kashi GoLean cereal with soy milk and blueberries for breakfast, grill some fish or poultry for lunch or dinner with some rice, throw together a salad and steam some veggies. But preparing a 10 serving pot of soup of a dozen ingredients then figuring out what to do with the leftovers? (I tried making Dr. Fuhrman's "Famous Anti-Cancer Soup." It sounded tasty--but it did <i>not</i> go well. These aren't all easy recipes.) And much of his plan requires some out of the way (to say the least) and expensive ingredients--at least for many Americans, even if as a New Yorker I can find all of these: organic vegetables and fruits, wild rice, tofu, edamame, bok choy, white miso, nutritional yeast, coconut water, carrot and celery and pomegranate juice, date sugar, tahini, exotic mushrooms, ground flaxseeds, almond butter, hulled barley, wheat germ, lemongrass, black fig vinegar, riesling reserve vinegar, spicy pecan vinegar, Bragg liquid aminos, soy or hemp or almond milk. And VegiZest and MatoZest--sold on Fuhrman's own website for $18.75 for an 8 oz container.

I'm not saying vegetarianism isn't a valid, healthy life style for many--and superior to the usual American diet. I am saying I'm deeply skeptical it's optimal, and that people recommending it are doing so on solid evidence rather than their own deeply held personal beliefs that are often anchored by views on animal rights and the environment rather than nutritional and medical science. And given a choice between following the advice of a man trying to sell books, supplements and food additives, and the people on my medical team whose only interest is to get me healthy... well.

Diabetes is a scary disease--that's why the book caught my eye. But for that very reason, I'm not about to take chances with my health. And if not well managed, diabetes is <i>dangerous</i>--not something to experiment with from a book on your own without careful monitoring and cooperation from your doctor. So I find it scary that some diabetics might try this on their own.

There is some useful information here the medical professionals I've talked to agree with, which is why I'm not rating this even lower. For instance, the importance of diet, glycemic index and load. My nutritionist says the jury is out on organic food but if you want to be cautious, you could avoid the "dirty dozen" of the worst offenders--something Furhman pointed to. Both my endocrinologist and nutritionist encouraged me to eat more beans--and like Furhman, believe the supposed link between soy and cancer has been debunked. Exercise is key too, though I was encouraged to do mine <i>after</i> meals, not before as Furhman recommended. Notably my nutritionist agrees that for many Type 2s diabetes can be reversed--or more precisely made to go dormant so you become asymptomatic and can manage without medication--if you eat right and exercise. And people didn't need to follow Furhman's program (or go vegetarian) to do it.