BUILDING A HEALTH-BOOSTING DIET
As mentioned earlier, there are many ways to build a wholesome, disease-fighting diet. There are no hard and fast rules about how many meals and snacks you must eat daily; how many grams of protein, fat, or carbohydrate to include each day; whether you must eat meat or should never eat meat; and so many other diet factors. Many people have strong opinions about what constitutes the ideal diet, but science hasn’t yet—and probably never will—identify a single best diet for everyone or a single best diet to prevent diabetes. Your best diet is the one that is made up of mostly nutrient-dense, health-boosting foods and is one you enjoy, keeps you energized and satisfied, and is a diet you can stick with.
As you go through this book and implement new strategies, you will find your best diet. Expect your diet to change over time. A complete diet overhaul rarely lasts, but one with gradual (and delicious) changes is more likely to stick.
Foundations of a Health-Boosting Diet
Even without weight loss, healthful eating boosts health. The word “diet” means nothing more than the foods we eat. Everyone then has a diet, and no one needs to be on one. When we talk about being on a diet, we are typically referring to a very restricted food plan and often one that leads to feelings of deprivation. When I ask about my patients’ diets, I’m simply asking about their usual food intake. When I assess a diet’s healthfulness, I care about what the person usually eats and usually omits.
Often, however, patients are quick to tell me about the foods or ingredients they avoid. They look for foods labeled no added sugars, no artificial sweeteners, low sodium, gluten-free, nonfat, grain-free, and the like. Somewhere in recent decades, avoiding foods and ingredients has become the focus of healthful eating. This scenario is frustrating and sad because so many people avoid what they consider “bad foods” or “bad ingredients,” yet they eat so little of the nourishing foods the body optimally runs on and requires to best prevent chronic diseases. For example, fat-free, low-sodium pretzels might be a better snack than cookies, but pretzels don’t compare to nuts, fruits, yogurt, hummus, vegetables, and many other nutrient-dense foods. And pretzels will do little to prevent heart disease, type 2 diabetes, or cancer. And just because Americans eat too much added sugar doesn’t mean that we have to stop eating all added sugars. For all their mouth-puckering tartness, I’d never be able to eat cranberries without some added sweetness. Yogurt too is quite tart. If it takes adding some sugar to enjoy the flavors and health benefits of yogurt and cranberries, I’m all for it. But only when good sense is applied.
In Chapter 4, we’ll discuss dietary strategies for weight management, and in Chapter 5, we’ll look at various meal-planning techniques. In this chapter, we start with discussing healthful eating in general and food that might be beneficial for diabetes prevention and blood glucose control specifically. That’s because I don’t want you to fall into the common trap of emphasizing only one health concern. Too often, people focus only on calories for weight, carbs for blood glucose, sodium for blood pressure, or fat for cholesterol. This myopic view of health and diet rarely leads to good outcomes.
The good news is that a healthful diet for diabetes prevention overlaps nicely with dietary strategies for the prevention or treatment of other common health problems such as obesity, stroke, heart disease, colon cancer, and more. These preventive measures are not conflicting with one another as many people believe.
What Does Nutrient-Dense Mean?
Very simply, nutrient-dense foods are foods with lots of nutrients in a small amount or for few calories. Fruits, vegetables, whole grains, beans, nuts, seeds, lean meats, fish, and low-fat and nonfat dairy are nutrient-dense foods. Aside from vitamins, minerals, and fiber, plants also offer phytochemicals or phytonutrients. Scientists have identified thousands of these disease-fighting compounds, and each plant food has its own profile of nutrients and phytonutrients. The only way to get the proper mix is to eat a large variety of plant foods and other nutrient-dense foods in ample quantities. It’s not enough to eat a variety of food groups; good nutrition also requires a variety of foods within each food group.
Often, foods marketed as being good for you really aren’t. They may be labeled low-fat, grain-free, or sugar-free, but these are not descriptions of nutrient density. These labels simply identify what’s not in a food, which may or may not even be important. The bottom line is, look at what’s in your food, not just what is missing from your food. Health-boosting foods are nutrient-dense and provide important nutrients and/or phytochemicals that contribute to health and shield you from disease.
Focus on Eating Patterns
In recent years, federal guidelines like the 2015–2020 Dietary Guidelines for Americans, health associations such as the American Diabetes Association, and health care professionals have talked more about dietary patterns or eating patterns and less about individual foods and nutrients. The sum of all the foods and nutrients you eat affects your well-being. The combination and amounts of foods and nutrients you consume interact to work for you or against you. Snacking on wholesome walnuts and almonds, for example, likely has a different effect in the diet of someone who eats greasy fast food and rich desserts daily than it does in the diet of a more health-conscious person.
Of course, dietary patterns are made up of individual foods, so we can’t avoid talking about them. We’ll cover more about the foods and types of foods that make up wholesome dietary patterns later in this chapter.
Types of Eating Patterns
One study in Finland followed more than 4,000 middle-aged and older men and women for 23 years. Researchers found that the adults who consumed the most fruits and vegetables were the least likely to develop type 2 diabetes. And those who consumed diets rich in butter, potatoes, and whole milk were the most likely to be diagnosed with the disease. This result doesn’t prove that butter, potatoes, or whole milk cause diabetes, but it does tell us that differences in dietary patterns matter. After an extensive review, the 2015 Dietary Guidelines Advisory Committee concluded that evidence exists that a dietary pattern higher in vegetables, fruits, and whole grains and lower in red and processed meats, high-fat dairy products, refined grains, sweets, and sugar-sweetened beverages reduces the risk of developing type 2 diabetes.
In the following discussion of healthful dietary patterns, you will see many differences. But the similarities are greater than the differences. Wholesome, disease-fighting eating patterns are built around fruits, vegetables, beans, whole grains, nuts, and seeds. That doesn’t mean that wholesome diets contain only these foods. Some patterns regularly include fish, dairy, eggs, beef, poultry, and cooking oils. Fortunately, every health-boosting dietary pattern can squeeze in a little of the extra fun stuff, too, like sweets and fried foods.
The typical American diet is full of unhealthful foods and nutrients, including excess calories, saturated fats, added sugars, fatty meats, baked goods, and highly processed grains. The diet tends to be low in fish, fruits, vegetables, whole grains, and beans. This type of eating pattern destroys health and is linked to type 2 diabetes, metabolic syndrome, overweight and obesity, heart disease, and many types of cancer. Whether or not your diet resembles this typical American dietary pattern, chances are good that your diet leaves at least a little room for improvement. And if you become consistent with positive dietary changes, you will experience better health.
As you learn more about dietary patterns or eating patterns to prevent diabetes and other chronic health problems, think about how you will make changes to your own eating pattern. Could you eat less of certain foods and more of others? Can you swap one type of snack for another? Would trimming portions improve your diet? What about cooking at home more often? There are infinite ways to improve your diet. Just keep an open mind as you learn more.
Mediterranean-style diet
People who live in countries surrounding the Mediterranean Sea have traditionally eaten health-promoting diets. Although the typical foods vary from country to country, the basics are the same. The common refrain in this book partly describes a Mediterranean-style diet: choose mostly whole and minimally processed foods and eat lots of vegetables, legumes (like chickpeas, kidney beans, and lentils), fruits, and whole grains. Diets in the Mediterranean region are also rich in nuts, olive oil, and fish. People living there tend to consume wine in moderation and eat bakery items only now and then. Fruit is a common dessert. The diet is not low in fat, but it is fairly low in saturated fats and fairly rich in unsaturated fats. Meals are eaten leisurely, which may help prevent overeating.
Research has linked Mediterranean-style diets to lower risks of developing type 2 diabetes, less incidence of metabolic syndrome, and reduced risks of heart attacks, stroke, and even dementia. A large meta-analysis of more than 100,000 participants from around the world found that individuals whose diets most resembled a Mediterranean-style diet were 23% less likely to develop diabetes. A large study in Spain found that after 4 years, those participants assigned to follow a Mediterranean-style eating pattern were 52% less likely to develop type 2 diabetes than individuals assigned to a low-fat diet. Reduction in risk occurred even without significant weight loss. This information should empower you to focus on healthful food choices whether you lose weight or not. You can learn more about Mediterranean-style diets at Oldways (oldwayspt.org).
DASH diet
DASH stands for Dietary Approaches to Stop Hypertension. This healthful dietary pattern was designed and tested by the National Heart, Lung, and Blood Institute (NHLBI). The DASH diet is rich in fruits, vegetables, low-fat or nonfat dairy, whole grains, poultry, legumes, and nuts. It is low in sodium, added sugars, and saturated fats. It differs from a traditional Mediterranean-style diet by being much lower in fat and richer in dairy products. Although DASH includes more poultry, both diets are rich in plant foods.
The DASH research compared three eating plans: a typical American pattern, the American pattern with additional fruits and vegetables, and the specially devised DASH plan, as described above. Individuals in the extra fruits and vegetables group experienced lowered blood pressure. Those in the DASH group saw their blood pressure levels drop even more. Even when researchers lowered the sodium in the American eating pattern, DASH dropped blood pressure better. Since the development of DASH, researchers have found that it is also linked to less type 2 diabetes, better heart health, and smaller waist sizes. One study found that DASH reduced the risk of developing type 2 diabetes by 20%. Learn more about DASH on the NHLBI website (https://www.nhlbi.nih.gov/health/health-topics/topics/dash).
Vegan diet
A vegan diet omits all animal products. The strictest vegans even avoid honey because bees make it. While a carefully chosen, well-balanced vegan diet is certainly wholesome, a vegan eating pattern is no guarantee of good nutrition. There’s no balance in a breakfast of almond milk and cornflakes, a lunch of a peanut butter sandwich, snacks of pretzels and chips, and a dinner of spaghetti and tomato sauce. While this menu is vegan, it is not full of health-boosting fruits, vegetables, whole grains, nuts, and legumes. It is not rich in fiber, phytonutrients, vitamins, potassium, magnesium, unsaturated fats, and more.
Many people at risk for developing type 2 diabetes worry about adopting a vegan diet because of its high carbohydrate content. However, the quantity of carbohydrate is only one part of a diet. The quality of carbohydrate is also important. And a balanced vegan diet rich in disease-fighting foods is no comparison to the pretzel-chip-cornflake diet described above. And it’s also no comparison to the typical American diet, which emphasizes unhealthful sources of both fats and carbohydrates. One study found that individuals eating a vegan diet had half the risk of developing type 2 diabetes compared to people eating typical nonvegetarian diets.
Vegetarian diets
There are many variations of a vegetarian diet.
• Ovo vegetarians eat no animal products except eggs.
• Lacto-vegetarians consume dairy products.
• Lacto-ovo vegetarians eat both dairy products and eggs.
• Pescatarians eat fish. They may or may not eat eggs or dairy products.
Regardless of the type of vegetarian diet followed, as long as it is based on wholesome foods, it appears to confer protection against type 2 diabetes and other health problems. Keep in mind that many unhealthful foods such as sugary beverages and cookies are vegetarian. A wholesome diet, however, consists of two parts: ample health-boosting foods and few unhealthful foods. For more information about vegan and vegetarian diets, check out The Vegetarian Resource Group (http://www.vrg.org).
Low-fat or low-carbohydrate diets
Low-fat diets are typically described as containing no more than 30% of total calories as fat. There is no widely accepted description of a low-carb diet. In research studies, some diets described as low-carb contain as little 40 grams carbohydrate per day or as much as 50% of total calories as carbohydrate, which could be much more than 200 grams per day. Having varying definitions of low carb makes comparing research studies difficult. For the most part, however, when it comes to weight loss, low-carb diets win in the short-term. But by the end of a year and beyond, there tends to be little weight loss difference between low-carb diets and other weight loss diets.
A concern about low-fat and low-carb diets is that these plans emphasize what is to be avoided more than what is to be enjoyed. Once I had a patient who came to see me for weight loss and disease prevention. Her diet was very low in fat and also very low in nutrients. She had fully bought into the low-fat dogma of the 1980s and 1990s, even though we were well past those decades. Her diet was full of foods like bread, fat-free pretzels, fat-free ice cream, and fat-free turkey. Even though fruits, vegetables, and legumes are quite low in fat, she wasn’t eating much of them. Her diet was terribly unbalanced. Fortunately, she was willing to embrace another way of eating. We reduced the highly processed fat-free foods in her diet and added more whole foods—some with fat and others without. Overall, she consumed more vitamins, minerals, protein, unsaturated fats, and phytonutrients. Her weight dropped, and her energy jumped. This story speaks to my preference to put more emphasis on the quality of fat rather than the quantity of fat. The original Diabetes Prevention Program recommended a low-fat diet. These days, the American Diabetes Association and other organizations emphasize fat quality over quantity.
The problem with low-carb diets is similar. In recent years, carbohydrates in general and sugar in particular have become common targets for omission. But foods with carbohydrates give us fiber, vitamins, minerals, phytonutrients, plant-based proteins, and more. Carbohydrates are found in vegetables, fruits, whole grains, legumes, milk, yogurt, and even nuts and seeds. Many of these foods contain natural sugars, too. These are precisely the foods linked to good health. I am not pushing a high-carbohydrate diet, but I have strong concerns when people focus on the quantity of carbohydrate over the quality of the food containing carbohydrates. There is good reason to be carb-aware and fat-aware, but there’s no reason to be carb- or fat-phobic.
Flexible omnivore diet
An omnivore eats both plants and animals. Most of us are omnivores. My own diet is omnivorous, with mostly wholesome foods and mostly plants. To me, this is the sweet spot for good health, good taste, ease, convenience, and flexibility. In one study, researchers followed more than 200,000 health professionals for more than 2 decades. They learned that even moderately reducing animal foods was associated with less risk for type 2 diabetes. The greatest protection came not from simply reducing meat, but from including mostly healthful plant foods. A plant-rich diet built around mostly health-boosting foods was associated with a 34% reduction in the risk of developing type 2 diabetes. If I were forced to categorize my diet as one of the healthful eating patterns above, I’d label it Mediterranean-style. But because I enjoy a variety of foods and flavors that are not traditional in the Mediterranean region, I say that I have a flexible omnivore diet.
You can learn more about health-boosting eating patterns in the 2015–2020 Dietary Guidelines for Americans (health.gov/dietaryguidelines). Not only should your diet be built around healthful foods, it should be tasty, affordable, and suited to your cultural and religious preferences. Fortunately, there are many ways to do these things. The following graphic shows you two examples. Additionally, you’ll find more menu ideas in Chapter 6.
Let Your Plate Be Your Guide
The simple Plate Method is one of the easiest tools to help you build a wholesome meal consistent with any number of healthful eating patterns. Start with a 9-inch plate, and draw an imaginary line down the middle. Fill one-half of the plate with non-starchy vegetables like broccoli, cabbage, tomatoes, carrots, or string beans. Draw another imaginary line across the other half of your plate, so you have two sections equal to one-quarter plate. Put a protein-rich food such as low-fat cottage cheese, black beans, salmon, or lean beef in one section, and a starchy food like corn, peas, quinoa, potato, or brown rice in the last section.
Mediterranean-style plate of salmon, asparagus, and a sweet potato.
Vegan plate of rice, beans, and a variety of vegetables.
What’s the Gut Got to Do with Diabetes?
The gut is home to more than 300 species of bacteria. The number of bacteria in the gut is about 10 times greater than the total number of human cells throughout your body. By some estimates, we are each walking around with at least 3 pounds of gut bacteria. And these bacteria are not just sitting there minding their own business. They are influencing your well-being. Collectively, the microbes residing in the intestines comprise nearly 2 million genes (called the microbiome). The microbiome is about 100 times greater than the human genome or the number of human genes. When we look at the fact that our bodies have hugely more bacteria genes than human genes, it’s not so hard to understand that the bacteria affect health and disease. Indeed, researchers are discovering how intestinal microbes influence obesity, prediabetes and type 2 diabetes, heart disease, and many other illnesses. We have known for a long time that gut microbes synthesize vitamins, break down cancer-causing compounds, release disease-fighting compounds from foods, ferment some types of fibers and other carbohydrates, and perform many other important roles. But so much more is being studied and learned now.
Some recent studies show that people with obesity have less diverse bacterial species. Individuals with obesity also tend to have more bacteria that are quite good at digesting the remnants of our meals, leaving us to absorb additional calories that would have otherwise been excreted into the stool. So is it possible that having an abundance of this type of bacteria leads to weight gain by making more calories available, or is it possible that being obese leads to more of these bacteria in the intestines? Both are possibilities and may actually occur at the same time. Additionally, the types of predominant bacteria in your intestines may influence inflammation, insulin resistance, and even hormones that help to regulate appetite.
The gut microbiome is far more complicated than this brief description. Scientists continue to untangle the roles bacteria and other microbes play in our health. We also know that the medications we take and the foods we eat greatly affect the types of microbes we harbor in our guts. Studies suggest that a Western-style way of eating (a diet heavy in animal protein, animal fat, refined grains, and added sugars) is associated with a less healthy mix of intestinal bacteria. On the other hand, dietary patterns that include an abundance of whole grains, fruits, vegetables, and legumes are associated with a healthy mix of gut bacteria and health benefits.
Is Your Diet Healthful?
These 19 questions should help you identify some of your dietary strengths and weaknesses. This is not a perfect quiz to determine the healthfulness of your diet. It’s simply a way for you to pinpoint an area or two or more to tweak or revamp. Give a second look at each question for which you answer “no” or “sometimes.” Then decide if it’s an area you want to work on. Some questions may not even apply to you. For example, if you choose a vegan eating pattern, you would not include fish twice weekly. And if you rarely eat between meals, the question about snacks does not concern you. Each of these topics is discussed more fully in later chapters.
1. Do you eat fruits and/or vegetables at most meals, including each breakfast, lunch, and dinner?
yes no sometimes
2. Do you eat at least 1 1/2 cups of vegetables and 1 cup of fruit daily? (Usually more is better.)
yes no sometimes
3. Do you eat the calories and portion sizes that are appropriate for your weight or desired weight?
yes no sometimes
4. Do you eat protein-rich foods like dairy, fish, meat, beans, tofu, or eggs at most meals?
yes no sometimes
5. Do you eat at least three small servings of whole grains daily?
yes no sometimes
6. Do you eat legumes like black beans, lentils, and pinto beans several times per week?
yes no sometimes
7. In a given week, do you eat at least 20 varieties of fruits, vegetables, whole grains, and legumes?
yes no sometimes
8. Do you eat fatty fish like salmon, tuna, lake trout, and herring a couple of times each week?
yes no sometimes
9. When you snack, do you typically choose nutrient-dense foods like nuts, fruits, yogurt, and vegetables?
yes no sometimes
10. Do you limit animal fats and solid fats like fatty cuts of meat, bacon grease, butter, and coconut oil?
yes no sometimes
11. Do you recognize and listen to your body’s hunger and fullness cues?
yes no sometimes
12. When cooking, do you use liquid oils like canola oil more than solid spreads and semi-solid oils like butter, stick margarine, and coconut oil?
yes no sometimes
13. Do you favor flavorful herbs and spices over salt in your food?
yes no sometimes
14. Do you avoid sugary drinks like regular sodas and sweet teas?
yes no sometimes
15. Do you drink alcohol in moderation (defined as no more than 1 drink daily for women and no more than 2 drinks daily for men) if you drink alcohol at all?
yes no sometimes
16. Do you limit highly processed foods like most chips, snack bars, and white bread?
yes no sometimes
17. When you eat sweets, fried foods, and other “treat foods,” do you limit your portion?
yes no sometimes
18. When shopping for groceries, do you read food labels to determine the healthfulness of your foods?
yes no sometimes
19. Do you eat with attention to your food, so you experience pleasure from your meal?
yes no sometimes
Specific Foods for Diabetes Prevention
Compared to eating a typical American diet, any of the health-boosting eating patterns above will likely bring about a healthier you. In general, keep this in mind: various phytonutrients likely act in the intestines to slow down glucose absorption and act in other areas of the body to affect glucose metabolism and increase insulin sensitivity. There are probably both short- and long-term actions, so it’s smart to eat plant foods with most meals and snacks. Whether or not the above diets will help you lose weight will depend on your total calorie intake and expenditure. Chapter 4 goes into more detail on weight loss.
A Diet for Longevity
In his book The Blue Zones, National Geographic explorer Dan Buettner tells of his travels around the globe to identify the diets, habits, and attitudes of the world’s longest-living populations. Buettner and teams of scientists visited five communities in which people celebrated their 100th birthdays at rates 10 times greater than in the U.S. Although the specific foods available and eaten varied based on location, the researchers learned that the diets of each of these healthy populations had a plant slant. While they may eat meat, the focus is on fruits, vegetables, and beans.
Some specific foods and other dietary factors are also linked to less risk of type 2 diabetes and better blood glucose control. But even in well-designed research studies, it’s hard to tease out the reasons some foods appear to be beneficial and the people most likely to benefit. A food may reduce the risk of disease because when people eat it, they eat less of another food. For instance, when people snack on nuts, they are less likely to snack on candy bars, and when people eat more beans for supper, they may eat less pizza. Plus, the phytonutrients in fruits, vegetables, nuts, and other plants interact with other nutrients and our gut bacteria. So people with different bacteria populations may respond differently to the same foods. Here are some foods to include in your diabetes prevention dietary pattern.
Oats
Oats are a whole grain and contain the soluble fiber β-glucan. β-Glucan improves insulin action and lowers blood glucose levels and also sweeps cholesterol from your digestive tract before it reaches your bloodstream. Hence, oats may help lower your risks for both heart disease and type 2 diabetes.
Barley
Barley also contains cholesterol-lowering, insulin-sensitizing β-glucan.
Legumes and Pulses (Beans, Peas, Lentils)
You know they’re good for the heart, but beans are also good for diabetes and diabetes prevention. Both legumes and pulses are studied for their health effects. Because you’ll see both words in the news and because they tend to be confusing, I’ll define them here. Legumes are the plants in which fruit is enclosed in a pod. Common legumes are soybeans, black beans, chickpeas, kidney beans, and lentils. Pulses are part of the legume family, but they refer only to the dried seed. Pulses include split peas, chickpeas, lentils, and dried beans like kidney beans, black beans, and pinto beans. Soybeans, including tofu and edamame, are legumes, but they are not also pulses. Don’t let the choice of word in a news report confuse you. Just know that all of these plant-rich proteins are good for you and are worth seeking out. Studies show that diets rich in legumes have beneficial effects on both short- and long-term fasting blood glucose levels. Not only are they full of plant protein, they contain potassium, magnesium, B vitamins, and dietary fiber, including a special type called “resistant starch.” As the name suggests, resistant starches resist digestion in the small intestine. Instead, they travel to the colon where they feed our gut bacteria. In the process, the beneficial bacteria produce short-chain fatty acids that seem to protect the colon cells, make the gut environment more suitable for the friendly bacteria and less suitable for their harmful cousins, and even improve the way our bodies respond to insulin.
Other Sources of Resistant Starches
Legumes are not the only foods with this source of beneficial non-digested carbohydrate. Under-ripe or green bananas contain it. So do uncooked oats (think muesli over cottage cheese or yogurt), brown rice, and potatoes and pasta that have been cooked and cooled (a great reason to enjoy a small serving of potato salad or pasta salad). The U.S. Food and Drug Administration (FDA) recently approved a qualified health claim regarding a specific resistant starch that manufacturers may now put on food labels. You might see labels with the following claim: “High-amylose maize resistant starch may reduce the risk of type 2 diabetes, although FDA has concluded that there is limited scientific evidence for this claim.” Although wordy and somewhat confusing, this statement means that there’s some pretty good evidence that high-amylose maize resistant starch helps prevent type 2 diabetes, but the evidence is not 100% solid. Food manufacturers may add high-amylose maize resistant starch (or other types of resistant starch) to products such as pasta, pretzels, snack bars, and breads.
Nuts
Some studies show that when people with type 2 diabetes consume nuts, their blood glucose levels improve, as do measures of their heart health. Although not seen in all research, many studies show that eating nuts also helps prevent type 2 diabetes. Very likely, the benefit depends on the total diet. Just like every fruit and every vegetable has a unique profile of nutrients and phytonutrients, each nut is also unique. In general, nuts provide unsaturated fats, vegetable protein, fiber, folate, magnesium, and a host of other vitamins and minerals. Don’t fall for the trap that you should eat only one type of nut. Enjoy them all. Almonds give us a good dose of vitamin E. Pistachios have lots of blood pressure–friendly potassium and lutein, which is an antioxidant. Walnuts are the ones with omega-3 fatty acids, and peanuts tend to be easier on the budget than other nuts, even though they are packed with nutrition, too. Keep portions in mind, however, because nuts are calorie dense. Good news on the calorie topic, though: Research has shown that both walnuts and almonds may actually give us fewer calories than the packages say. That’s probably because we don’t fully digest the nuts, leaving some of those calories to be excreted in the feces. On average, we absorb 21% fewer calories from walnuts and 17–25% fewer calories from almonds. The calories from almond butter are fully absorbed. It’s possible that other nuts behave similarly in our digestive tracts, but we don’t have the research to know for sure.
Whole Grains
Because there are so many types of whole grains and so many ways to eat them, researching them as a group is confusing. However, according to the 2015 Dietary Guidelines Advisory Committee, healthful patterns that include whole grains appear to be associated with less type 2 diabetes. Here are some examples of whole grains:
• Whole wheat
• Wheat berries
• Farro
• Freekeh
• Sorghum
• Amaranth
• Whole rye
• Oats, oatmeal, rolled oats
• Whole-grain corn
• Whole-grain barley
• Wild rice
• Brown rice
• Millet
• Popcorn
• Quinoa
Unsaturated Fats
We hear a lot about avoiding trans fats and saturated fats for the sake of our hearts. Research shows that when we replace these unhealthful fatty acids with either unsaturated fats or wholesome sources of carbohydrates, our risk for heart disease drops. Switching to the more healthful monounsaturated and polyunsaturated fats appears to boost insulin sensitivity, too. A Mediterranean-style diet is typically rich in monounsaturated fatty acids and low in saturated fats. A few sources of unsaturated fats include the following:
• Olive, canola, and peanut oils
• Tree nuts and peanuts, nut butters
• Avocados
• Olives
We’ll cover more about dietary fats in Chapters 4 and 6.
Yogurt
Although studies are mixed, many suggest that dairy foods have a protective effect against type 2 diabetes. Perhaps the strongest link is the association between yogurt and less risk of diabetes. One large population study found that an increase of one serving of yogurt per day was associated with an 18% lower risk of developing type 2 diabetes. It’s unclear how yogurt could influence health this way, but it may be related to its probiotics or unique nutritional profile. Some studies also link yogurt to lower obesity risk.
Berries
A Finnish study found that middle-aged and older men who consumed the most berries had a whopping 35% lower risk of developing type 2 diabetes. Enjoy a variety. Choose strawberries, blueberries, raspberries, and others.
Fruits
In general, eating fruits is associated with less chronic disease, not more. Yet many people fear fruit because of its carbohydrate content. Specifically, most of the carbohydrate in fruit is sugar, so it’s not surprising why many people worry. While it is true that carbohydrate raises blood glucose levels more than other nutrients, it is not true that fruit raises blood glucose more than other carb-containing foods. It’s important to recognize that foods are much more than their macronutrient (carbohydrate, protein, and fat) content. Avoiding carbohydrate because it raises blood glucose is like throwing the baby out with the bathwater. Fruits, along with other plant foods, contain so many disease-fighting, insulin-sensitizing compounds that it’s a bad idea to forgo them.
Herbs and Spices
These flavor boosters provide us with the same types of disease-fighting phytonutrients that are in fruits and vegetables. Add taste with both fresh and dried seasonings. Cinnamon in particular has been studied for its potential effects on blood glucose levels. Add some to oatmeal, cottage cheese, yogurt, and even coffee.
Vinegar
Research suggests that vinegar consumed with a high-carbohydrate meal improves both blood glucose and insulin levels. Sprinkle some on your salad, roasted vegetables, and other foods.
Coffee
Several studies link drinking coffee (decaffeinated or regular) to less risk of developing type 2 diabetes. But it’s important to consider how you prepare and drink your coffee. Unfiltered coffee, such as coffee made with a French press, contains cafestol and kahweol, compounds that raise LDL (bad) cholesterol levels. Filtering your coffee with a paper filter removes these harmful compounds. Keep your coffee low-calorie and healthful by drinking it plain or with a splash of milk. A heavy hand with syrups, sugars, and cream will turn your coffee into quite a nutritional goof.
Tea
Drinking tea may also shield you from type 2 diabetes. One analysis suggests that the more tea an individual drinks, the greater the benefit, with as little as 1 cup per day dropping the risk of developing the disease by 3%. Again, pay attention to what you put into your tea to avoid excess calories, added sugars, and saturated fats.
Alcohol
Consuming small amounts of alcohol is also linked to less type 2 diabetes. But alcohol in excess is linked to more, as well as many other problems. That’s why the American Diabetes Association and other organizations do not recommend drinking for the prevention of disease. If you do drink, you don’t need much. The benefits of drinking alcohol appear to occur with as little as one-half standard drink daily. Consuming alcohol in moderation is also associated with reduced risk of dying from heart disease. Alcohol might protect the heart by increasing HDL (good) cholesterol. Additionally, the phytonutrients and other antioxidant compounds in red wine may further benefit the heart by protecting the blood vessels from oxidative damage. Remember that moderate drinking is defined as no more than one drink daily for women and no more than two drinks daily for men. And the size of those drinks matters. What we pour ourselves or receive in bars and restaurants is often much more than a single standard drink.
Bottom Line
Once again, the bottom line is that a dietary pattern or an eating pattern to prevent type 2 diabetes is a general health-boosting diet. Build your diet around a variety of foods and food groups with an emphasis on whole plant foods.
Be Empowered
• Commit to a diet rich in whole foods and relatively low in refined and highly processed foods. It’s okay to make gradual changes.
• Assess your diet with the quiz on page 54. Then pick two to five small dietary changes to work on. Create SMART goals around your selected dietary changes.
• Using the list of foods that are associated with less risk of diabetes, create your weekly grocery list. See Chapter 6 for smart shopping tips.