How Not to Die

  In terms of weight management, those eating meat-free diets consumed an average of 364 fewer calories daily.75 That’s about what most people on traditional weight-loss programs strive to cut out, meaning a meatless diet could be considered an all-you-care-to-eat version of a calorie-restricted weight-loss diet, without having to count calories or restrict portion intake.

  Those who eat plant-based diets may even have an 11 percent higher resting metabolic rate.76 That means vegetarians could be burning more calories even in their sleep. Why? This could be because vegetarians have a higher gene expression of a fat-burning enzyme called carnitine palmitoyltransferase, which effectively shovels fat into the mitochondrial furnaces in your cells.77

  So a calorie may not be a calorie when it comes to meat. A massive study with an equally massive name, the European Prospective Investigation into Cancer–Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity—commonly known as EPIC-PANACEA—was comprised of hundreds of thousands of men and women who were followed for years. It’s the largest study ever to investigate eating meat and body weight, and it found that meat consumption was associated with significant weight gain even after adjusting for calories. This means that if you had two people eating the same number of calories, it appears the person eating more meat would, on average, gain significantly more weight.78

  Reversing Diabetes

  What About Drugs and Surgery?

  As noted earlier, those with type 2 diabetes are at elevated risk for such serious health problems as heart disease, premature death, blindness, kidney failure, and amputations, as well as fractures, depression, and dementia. And the higher people’s blood sugar levels, the more heart attacks and strokes they tend to have, the shorter their life spans are, and the higher their risk of complications are. To see if these outcomes could be averted, a study was performed in which ten thousand diabetics were randomized into one of two groups, the standard therapy group (in which the goal was just to lower blood sugar levels) and an intensive blood-sugar-lowering group (in which the researchers put the diabetics on up to five different classes of oral drugs at the same time) with or without insulin injections. The goal was not just to drive down blood sugars, as is the case with standard therapy, but to drive them down consistently into the normal range.79

  Considering that type 2 diabetes is a disease of insulin resistance, high blood sugar is just a symptom of that disease, not the disease itself. So even by artificially forcing down blood sugars by any means necessary, we aren’t actually treating the cause—just like blood pressure-lowering drugs aren’t actually treating the cause. By lowering one of the disease’s effects, however, scientists hoped they could prevent some of its devastating complications.

  The results of this study, published in the New England Journal of Medicine, sent shock waves through the medical community. The intensive blood-sugar-lowering therapy actually increased subjects’ mortality, requiring the researchers to halt the study prematurely for safety reasons.80 The drug combinations may have been more dangerous than the high blood sugars they were trying to treat.81

  Insulin treatments themselves may accelerate aging, worsen diabetic vision loss, and promote cancer, obesity, and atherosclerosis.82 Insulin can promote inflammation in the arteries, which may help explain the increased death rate in the intensively treated group.83 So rather than trying to overcome insulin resistance by brute force—just pumping in more and more insulin—isn’t it better to treat the disease itself by eliminating the unhealthy diet that caused it? That reminds me of people who undergo bypass surgery for clogged arteries. If they keep eating unhealthfully, their bypasses will eventually get clogged too. It’s better to treat the cause than the symptoms.

  How about surgery for diabetes? Gastric bypass surgery—which effectively reduces the size of the stomach by 90 percent or more—is one of the most successful treatment methods for type 2 diabetes, with reported long-term remission rates of up to 83 percent. These results had led to the suggestion that gastric bypass surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for up to two weeks following the procedure to recover from the surgery. Extreme calorie restriction alone can reverse diabetes. So is the success of surgery the result of the operation itself or due to the restrictive diet?

  Once again, researchers designed a study to uncover the answer.84 They compared diabetics placed on the same postoperative diet before and after they actually had the surgery. Amazingly, they found that the diet alone worked better than the surgery even in the same group of patients: The subjects’ blood sugar control was better in the absence of the operation. This means the benefits of major surgery may be obtained without you ever having to go under the knife and getting your internal organs rearranged.85

  The bottom line: Blood sugar levels can normalize within a week of eating six hundred calories daily, because fat is pulled out of the muscles, liver, and pancreas, allowing them to function normally again.86

  This reversal of diabetes can be accomplished either by voluntary calorie restriction87 or involuntarily, by having most of your stomach removed, a form of compulsory food restriction. Undergoing surgery may be easier than starving yourself, but major surgery carries major risks, both during the operation and afterward. These risks include bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies.88

  Surgery or starvation? There’s got to be a better way, and, in fact, there is. Instead of changing the quantity of food you eat, it’s possible to reverse diabetes by changing the quality of that food.

  Does Eating Obesity Cause Obesity?

  The EPIC-PANACEA study, which found that meat consumption is associated with weight gain even independent of calories, identified poultry as potentially the most fattening meat,89 a finding that has since been confirmed in another study. Men and women eating even a single ounce of chicken a day (think two chicken nuggets) had a significantly greater gain in body mass index over the fourteen-year follow-up period than those who consumed no chicken at all.90 Perhaps this news shouldn’t be surprising, considering how fat chickens themselves are now genetically manipulated to become.

  According to the U.S. Department of Agriculture, about one hundred years ago, a single serving of chicken may have contained only sixteen fat calories. Nowadays, one serving of chicken may have more than two hundred calories of fat. The fat content in poultry has ballooned from less than two grams per serving a century ago to up to twenty-three grams today. That’s ten times more fat. Chicken now contains two to three times more calories from fat than from protein, leading nutrition researchers to ask, “Does eating obesity cause obesity in the consumer?”91 As the beef industry is proud of pointing out, even skinless chicken can have more fat, and more artery-clogging saturated fat, than a dozen different cuts of steak.92

  Reversing Diabetes with Food

  We’ve known since the siege of Paris in 1870 that type 2 diabetes can be reversed by an extreme reduction in food intake. Parisian doctors documented how glucose disappeared from their patients’ urine after people went weeks without food.93 Diabetes specialists have long known that iron-willed patients who are able to lose up to one-fifth of their body weight can reverse their diabetes and bring their metabolic function back to normal.94

  Instead of starving by eating less food, though, what if diabetics just ate better food, as in a 90 percent or more plant-based diet of all-you-can-eat greens, lots of other vegetables and beans, whole grains, fruits, nuts, and seeds? In a pilot study, thirteen diabetic men and women were told to eat at least one big salad every day, as well as veggie-bean soup, a handful of nuts and seeds, fruit at every meal, a pound of cooked greens, and some whole grains; to restrict their animal product consumption; and to eliminate refined grains, junk food, and oil. Then, the researchers measured their hemoglobin A1c levels, considered the best measure of how poorly blood sugars
have been controlled over time.

  At the onset of the study, the diabetics had A1c levels averaging 8.2. An A1c level under 5.7 is considered normal, between 5.7 and 6.4 is considered prediabetic, and above 6.5 is considered diabetic. However, the American Diabetes Association’s target is just to get most diabetics down below 7.0.95 (Recall that intensive blood-sugar-lowering trials using drugs, which tried to push A1c levels under 6.0, unfortunately ended up pushing many diabetics six feet under.)

  After about seven months of eating a diet centered on whole plant foods, the subjects’ A1c levels dropped to a nondiabetic 5.8—and this was after they were able to stop taking most of their medications.96 We’ve known diabetes can be reversed with an extremely low-calorie diet.97 Now we know that it can also be reversed with an extremely healthy diet, but is that because it was also low in calories? The study subjects lost about as much weight on the vegetable-packed, plant-based diet as people who went on semistarvation diets based on liquid meal replacements.98 But even if this type of diabetes reversal was just about calorie restriction, which would be healthier? Subsisting on mostly diet shakes made out of sugar, powdered milk, corn syrup, and oil, or eating a plant-based diet where you can enjoy real food and lots of it?

  Surprisingly, even participants who temporarily didn’t lose weight on the plant-based diet, or who actually gained weight, still appeared to improve their diabetes. In other words, the beneficial effects of plant-based diets may extend beyond weight loss.99 However, the study described just a handful of people, had no control group, and included only those who could stick to the eating plan. To prove plant-based diets could actually improve diabetes independent of weight loss, researchers would need to design a study in which they switched people to a healthy diet but forced them to eat so much that they didn’t lose any weight.

  Just such a study was published more than thirty-five years ago. Type 2 diabetics were placed on a plant-based diet and weighed every day. If they started losing any weight, they were made to eat more food—so much that some of the participants actually had trouble eating it all! The result: Even with no weight loss, subjects on the plant-based diet saw their insulin requirements cut by about 60 percent, meaning the amount of insulin these diabetics had to inject dropped by more than half. Furthermore, half of the diabetics were able to get off insulin altogether, despite no change in body weight—just by eating a healthier diet.100

  This wasn’t over the course of months or years, either. This was after eating a plant-based diet for an average of only sixteen days. Some of the subjects had been diabetic for two decades and had been injecting twenty units of insulin a day. Yet within two weeks of eating a plant-based diet, they were off insulin altogether. One patient was on thirty-two units of insulin per day at the onset of the study. After eighteen days, his blood sugar levels plummeted so low that insulin injections were no longer necessary. Even at approximately the same body weight, he had lower blood sugars on a plant-based diet using no insulin than when he had been on a regular diet using thirty-two units of insulin daily.101 That’s the power of plants.

  Curing Diabetic Neuropathy

  Up to 50 percent of diabetics eventually develop neuropathy, or damage to their nerves.102 Neuropathy can be very painful, and that pain is frequently resistant to conventional treatments. No medical treatment is considered effective for the condition.103 We doctors are left with only steroids, opiates, and antidepressants to try to ease our patients’ suffering. But then a remarkable study was published, entitled “Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet.” Twenty-one diabetics who had been suffering from painful neuropathy for up to ten years were placed on a whole-food, plant-based diet. After years and years of suffering, seventeen out of the twenty-one patients reported that they felt complete relief from their pain—within days. Their numbness noticeably improved too. And the side effects were all good: The diabetics lost an average of ten pounds, their blood sugar levels dropped, their insulin needs dropped in half, and, in five of the patients, not only was their painful neuropathy cured, so was, apparently, their diabetes. After having been diabetic for up to twenty years, they were off all blood sugar drugs in less than a month.104

  On top of that, the diabetics’ triglyceride and cholesterol levels improved on average as well. High blood pressures dropped by so much that half of the subjects also appeared cured of their hypertension. Within three weeks, the subjects’ need for high blood pressure medications dropped by 80 percent.105 (This is why it is critically important to work with your doctor when radically improving your diet, because if they don’t reduce or eliminate your medications accordingly, your blood sugar levels or blood pressure may drop too low.)

  We’ve long known that plant-based diets can reverse diabetes106 and hypertension,107 but reversing nerve damage pain with diet was new.

  This study involved a live-in program in which patients were provided meals. What happened after they were sent home, back into the real world? These seventeen subjects were followed for years, and in all cases but one, the relief from their painful neuropathy continued—or improved even further. How were the researchers able to achieve such a high degree of dietary compliance even in an uncontrolled setting? “Pain and ill health,” the researchers wrote, “are strong motivating factors.”108 In other words: Because plant-based diets work.

  Think about it. Patients walk in with one of the most painful, frustrating, and hard-to-treat conditions in all of medicine, and three-quarters of them were cured in a handful of days using a natural, nontoxic treatment—namely, a diet composed of whole plant foods. This should have been front-page news.

  How could nerve damage pain be reversed so suddenly? It didn’t appear to involve the improvement in blood sugar control. It took approximately ten days for the diet to control the diabetes itself, but the pain was gone in as few as four days.109

  The most interesting speculation was that trans fats naturally found in meat and dairy could be causing an inflammatory response in the patients’ bodies. The researchers found that a significant percentage of the fat under the skin of those who ate meat, or even just dairy and eggs, was composed of trans fats, whereas those who had been on a strictly whole-food, plant-based diet had no detectable trans fat in their tissues.110

  The researchers stuck needles into the buttocks of subjects who had been eating different diets and discovered that people who had been on a whole-food, plant-based diet for nine months or more appeared to have removed all the trans fat from their bodies (or at least from their butts!).111 But their neuropathy pain didn’t take nine months to get better. It improved in closer to nine days. It’s more likely that this amazing reversal was due to an improvement in blood flow.112

  Nerves contain tiny blood vessels that may become clogged, depriving the nerves of oxygen. Indeed, biopsies of leg nerves in diabetics with severe progressive neuropathy have shown arterial disease within the sural nerve in the leg.113 However, within days of eating healthier meals, blood flow may improve to the extent that neuropathy disappears.114 Within an average of two years of eating a plant-based diet composed mostly of rice and fruits, even diabetic vision loss can be reversed in as many as 30 percent of patients.115

  So why didn’t I learn about any of this in medical school? There’s little money to be made from prescribing plants instead of pills. The neuropathy pain reversal study was published more than twenty years ago, and the blindness reversal studies more than fifty years ago. As one commentator wrote, “The neglect of this important work by the broader medical community is little short of unconscionable.”116

  WHtR Versus BMI

  The body mass index (BMI) is a better predictor of disease than body weight alone, as BMI takes height into account. But BMI has long been criticized for not considering the location or the nature of your weight. Bodybuilders, for instance, have extremely low body fat but can have off-the-chart BMIs, because muscle is heavier than fat.

  Today, it’s generally accepted tha
t health risks can be determined as much by the relative distribution of body fat as by its total amount.117 What’s the worst kind? Abdominal fat—the kind that builds up around your internal organs. Having a potbelly may be a strong predictor of premature death.118

  Figure 3

  Both the men in figure 3 have the same BMI, but the distribution of weight is different. People with the so-called apple shape, with body fat concentrated in the abdominal region, may have the lowest life expectancy.119

  Fortunately, there may be an even better tool than BMI that we can use to gauge the health risks of body fat. It’s called Waist-to-Height Ratio, or WHtR.120 Instead of a scale, grab a simple measuring tape. Stand up straight and take a deep breath, exhale, and let it all hang out. The circumference of your belly (halfway between the top of your hip bones and the bottom of your rib cage) should be half your height—ideally, less. If that measurement is more than half your height, it’s time to start eating healthier and exercising more regardless of your weight.121

  Type 2 diabetes in the United States is reaching epidemic proportions. The CDC estimates that 37 percent of U.S. adults—and 51 percent of adults over sixty-five—have prediabetes. That’s eighty-six million people,122 most of whom will become full-blown diabetics.123 But type 2 diabetes can be prevented, arrested, and even reversed with a healthy-enough diet. Unfortunately, doctors don’t tend to educate their patients about diabetes prevention. Only about one in three prediabetic patients reports ever being told by their doctors to exercise or to improve their diets.124 Possible reasons for not counseling patients include a lack of insurance reimbursement for the extra time spent, a lack of resources, a lack of time, and a lack of knowledge.125 We’re just not training doctors how to empower the people they serve.