A good plan today is better than a perfect plan tomorrow.
-General George S. Patton
[Reminds me of “Don’t let the perfect be the enemy of the good,” an aphorism that helped me finally finish The Advanced Mediterranean Diet after years of effort. -Steve Parker, M.D.]
The U.S. already has 24 million people with diabetes and another 54 million with prediabetes. Approximately one of every three persons born in the U.S. in 2000 will develop diabetes in his or her lifetime, according to the Centers for Disease Control and Prevention.
Incredible.
And largely preventable if we have the will.
The British Medical Journal in 2008 published a study showing up to 83% reduced risk of developing type 2 diabetes with the Mediterranean diet.
Reference: Prediabetes FAQs at the CDC website.
I loved the sound of this phrase - hari hachi bu - even before I knew what it meant.
“Hari hachi bu” comes from the Japanese islands of Okinawa. It refers to eating a meal until you’re only 80% full, then stop eating. It’s a method to control weight.
Okinawa, remember, is one of the longevity hot spots in Dan Buettner’s Blue Zones.
But would it really work for many in Western culture? Probably not. We don’t have the discipline to stick with it long-term. Maybe for a day.
One of the currently popular dieting gimmicks is to eat every 3-4 hours while awake. The rationale is, “you need the energy.” If you eat 5-6 meals a day, you’re not cutting back on total calories even if you eat only until 80% full.
As long as you’re eating a fair amount of carbohydrates, you can store plenty of energy as glucose in glycogen - in your liver and muscles - to easily live without eating for at least 8-12 hours. So, there’s no “need” to eat every 3-4 hours. If there were, we would have gone extinct years ago. At rest, you’re getting about 60% of your energy supplied by metabolism of fats, not carbohydrates. Most people can live without all food, but not water, for about two months.
Plenty of people have said, “I’m going to lose weight by cutting back on food intake.” I don’t have scientific data to back it up, but I’d bet that a food diary works better.
A simple weight-loss or management plan that would work better for Western world inhabitants would be:
Don’t eat anything man-made.
So off limits are bread, rolls, soft drinks, table sugar, high fructose corn syrup, pancakes, pizza, potato chips, Pringles, pies, cookies, cake, casseroles, cannolis, Doritos, Ding-Dongs, Snickers, etc. I’d complicate it just a bit by also avoiding naturally starchy foods like potatoes and corn.
For those who don’t like the negativity of “don’t eat that,” here’s the positive spin:
Eat only natural, minimally processed food.
In other words, eat fresh fruit, fresh vegetables, eggs, meat, chicken, fish, olive oil, nuts, etc. These are God-made foods, not man-made.
Researchers at the University of Wollongong (Australia) reviewed the scientific literature on the role for cereal grains and legumes in weight management.
In this context, ”cereal” refers to “a grass such as wheat, oats, or corn, the starchy grains of which are used as food” (American Heritage Dictionary).
Here’s their summary:
There is strong evidence that a diet high in whole grains is associated with lower body mass index, smaller waist circumference, and reduced risk of being overweight; that a diet high in whole grains and legumes can help reduce weight gain; and that significant weight loss is achievable with energy-controlled diets that are high in cereals and legumes. There is weak evidence that high intakes of refined grains may cause small increases in waist circumference in women. There is no evidence that low-carbohydrate diets that restrict cereal intakes offer long-term advantages for sustained weight loss. There is insufficient evidence to make clear conclusions about the protective effect of legumes on weight.
In July, 2008, I blogged about a study in the New England Journal of Medicine that showed better weight loss after two years on the low-carb Atkins diet compared to a low-fat (and higher cereal) diet. We’re not looking at huge differences here:
The Wollongong authors probably didn’t have access to that report. I suspect they would retract their opinion that “there is no evidence that low-carbohydrate diets that restrict cereal intakes offer long-term advantages for sustained weight loss.” Could depend on what they consider “long-term.”
I haven’t read the entire article but invite you to do so.
Reference: Williams, P.G., et al. Cereal grains, legumes, and weight management: a comprehensive review of the scientific evidence. Nutrition Reviews, 66(2008): 171-82.
Good Morning! This is God.
I will be handling all of your problems today. I will not need your help. So relax and have a great day!
[I keep a poster of this above my desk. It’s comforting to re-read it when I start to worry too much. I hope it does the same for you.]
I read James Hirsch’s book in 2006 but never got around to reviewing it. Better late than never? I give it four stars per Amazon.com’s rating system: “I like it.”
If you have diabetes or love someone who is afflicted by diabetes, you’ll benefit from this book. It’s an insider’s view into the world of diabetes, with a predominant focus on type 1 rather than type 2. Both are covered well.
Look elsewhere for a “how-to” book on managing diabetes. Cheating Destiny is about emotions, coping strategies, public policy, and history. Although I’ve been treating diabetes for over two decades, Mr. Hirsch taught me a thing or two. For instance, did you know . . . that some people with diabetes are offended if you call them diabetics? (They prefer “people with diabetes.”) That diabetes was considered shameful years ago? That even the preeminent Joslin Diabetes Clinic loses money and has to be supported by private donations? That the founder of d-Life TV was a patient of the iconoclastic Dr. Richard Bernstein? About the exciting story of the discovery of insulin by Fred Banting and Charles Best in 1922?
The author himself has type 1 diabetes. The heart-wrenching story of his son’s diagnosis at age 3 showcases Mr. Hirsch’s considerable writing skills.
To counter the sad and frustrating aspects of diabetes, the book is peppered with funny anecdotes. Did you ever duck in to a private booth at a girlie peep show to inject insulin? Mr. Hirsch has! [It’s not what you think.]
One undercurrent of the book I take issue with is the implication that the medical profession somehow perpetuates diabetes or purposefully provides inadequate care, because that’s where the money is. Why work hard to cure diabetes or prevent complications when the profession makes money off the disease and it’s complications? I don’t see it that way at all. It is true, however, that preventive care and cognitive medical services (as opposed to invasive procedures) are poorly funded by insurance. That’s an economic and political problem, not an ethical one in physicians and researchers.
Full disclosure: My defunct outpatient medical practice is mentioned in chapter five. The author outlines my efforts to provide conscientious care to people with diabetes - mostly type 2 - despite poor funding from insurers (primarily Medicare in my practice at the time). Poor pay for cognitive services forced me to close my office. I found Mr. Hirsch to be a thorough and accurate researcher.
[I’m a hospitalist and health blogger now.]
Other highlights of the book are discussions of Dr. Elliott Joslin, an overweight Southern black woman (the Diabetes Queen), intimate details about the type 1 diabetes experience from the patient and family perspective, Dr. Richard Bernstein, insulin pumps, islet cell transplants, origins of the Juvenile Diabetes Research Foundation, Douglas Melton and stem cell research, research rivalries and funding, and inspirational survivor tales.
Mr. Hirsch rightfully criticizes many aspects of the health and medical fields with regards to diabetes. Thankfully, he never suggests a sweeping government take-over of the healthcare industry. He urges diabetics - people with diabetes - to take care of their own disease and demand improvements in the current system.
The U.S. already has 24 million people with diabetes and another 54 million with prediabetes. Approximately one of every three persons born in the U.S. in 2000 will develop diabetes in his or her lifetime, according to the Centers for Disease Control and Prevention.
I agree with Mr. Hirsch that diabetes is “the country’s leading public health crisis,” driven by obesity and the aging of the population.” This book will help alleviate the damages.
Disclosure: I bought this book at Amazon.com. I was not paid to review it.
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