Disease Proof : Disease Proof : Health & Nutrition News & Commentary : Dr. Joel Fuhrman

It is widely known that sugar-sweetened beverages promote weight gain and type 2 diabetes.^1-3 However, artificially sweetened beverages are regarded by many as safe alternatives that will satisfy sweet cravings while preventing the dangerous surge in blood glucose from their sugar-sweetened counterparts, thereby circumventing the weight gain and associated increase in diabetes risk.

Are people who drink diet soda less likely to end up with diabetes?

The newest research says no. A recent French study following 66,118 women for 14 years uncovered strong trends of increased diabetes risk in women who consumed greater amounts of either sugar-sweetened or artificially sweetened beverages; for each type of beverage, as consumption increased, risk increased. The authors note that this effect was only partly dependent on body mass index (BMI); that means that it wasn’t just that overweight people were the ones drinking the diet soda and getting diabetes. Women who drank at least one 20-ounce diet soda per week had a risk more than double (a 121% increase in risk) that of women who did not consume any sweetened beverages. High consumers of sugar-sweetened beverages, who drank 12 ounces per week or more, had a 34% increase in diabetes risk.⁴

Artificial sweeteners, weight gain and diabetes

Since a major purpose of artificial sweeteners is to avoid calorie load, it seems counterintuitive, but artificial sweeteners have been associated with weight gain in several (though not all) observational studies.^5,6 In the Multi-Ethnic Study of Atherosclerosis (MESA), drinking diet soda at least once daily was associated with high waist circumference and a 67% greater risk of type 2 diabetes seven years later.⁷ Similarly, saccharin use (during the 1970s) was associated with weight gain during the following eight years in the Nurses’ Health Study.⁸ In the San Antonio Heart Study, normal weight subjects who consumed 21 or more artificially sweetened beverages per week almost doubled (93% increase) their risk of overweight or obesity eight years later.⁹

How might artificial sweeteners promote weight gain?

Artificial sweeteners mimic the sweet taste of sugar, but do not provide the high calorie load – but it seems that it’s not that simple. What happens in the body when we consume a diet soda? Just because diet sodas do not contain calories doesn’t mean they don’t have any physiological effects.

First, simply because they taste sweet, artificial sweeteners promote desire for and dependence on excessively sweet tastes. These excessively sweet tastes are unnatural, hundreds or thousands of times sweeter than table sugar, which in itself is unnaturally sweet. Throughout human history, the body has been accustomed to the more subtle, naturally sweet tastes in fruits and starchy vegetables. Someone who consistently consumes artificially sweetened foods or beverages is training their taste buds to prefer excessive sweetness. Therefore, artificial sweeteners are counterproductive in that they keep the body craving excessively sweet flavors rather than naturally sweet flavors. Some research has suggested that increased use of artificial sweeteners indeed increases appetite or sweet cravings.¹⁰ There is also evidence that consuming artificially sweetened beverages between meals (in the absence of calories) increases appetite and food consumption during the next meal.¹¹ Sweet tastes also produce reward signals in the brain, and there is some evidence that artificial sweeteners produce “incomplete” reward signals, leading to incomplete satisfaction and cravings for more food.¹⁰

Another potential explanation is the concept of “informed overcompensation.” For example, perceiving that she has “saved” calories by drinking a diet soda with her dinner, a woman decides to order dessert.  Interestingly, it has been shown that knowingly (but not unknowingly) consuming artificially sweetened foods led to overcompensation with increased caloric intake.^11,12

Another interesting explanation is a possible dysregulation of hunger and satiety signals in the body. This may occur due to an inconsistent relationship between sweetness and amount of calories supplied.  The body uses information from the sweetness and calorie load of previous meals in order to predict calorie load from the level of sweetness in future meals. Artificially sweeteners may “uncouple” sweetness and calories, impairing normal physiologic mechanisms that regulate energy balance. There is evidence for this impaired energy balance with several artificial sweeteners. Rats regularly exposed to artificially-sweetened food (or drink) were less able to regulate their calorie intake when given sugar-sweetened, calorie-dense meals, and they gain excess weight.^6,13 

Steer clear of artificial sweeteners, and prevent diabetes naturally

The safety of many of these artificial sweeteners has been questioned; most are relatively new compounds, and their long-term health effects are still uncertain.¹⁴  These are not natural, whole foods, so it is wise to avoid them. The evidence suggests that they are not helpful for weight loss, and certainly not the solution to obesity and diabetes epidemics. However, you can protect yourself against type 2 diabetes, or reverse type 2 diabetes if you already have it, by simply following a health-promoting eating style and exercising frequently. The dietary program described in my book The End of Diabetesis a vegetable-based eating style, including naturally sweet foods like fresh fruits and squashes, designed to maximize nutrient content per calorie. For type 2 diabetes, this approach results in complete reversal of diabetes for the majority of patients. For type 1 diabetes, it eliminates the excessive highs and lows and prevents dangerous complications. Both type 1 and type 2 diabetics can maintain excellent health and quality of life into old age with natural foods and exercise.

References:

1. Malik VS, Schulze MB, Hu FB: Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274-288.
2. Malik VS, Hu FB: Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages. Curr Diab Rep 2012.
3. Malik VS, Popkin BM, Bray GA, et al: Sugar Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A Meta-analysis. Diabetes Care 2010.
4. Fagherazzi G, Vilier A, Saes Sartorelli D, et al: Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr 2013.
5. Anderson GH, Foreyt J, Sigman-Grant M, et al: The use of low-calorie sweeteners by adults: impact on weight management. J Nutr 2012;142:1163S-1169S.
6. Pepino MY, Bourne C: Non-nutritive sweeteners, energy balance, and glucose homeostasis. Curr Opin Clin Nutr Metab Care 2011;14:391-395.
7. Nettleton JA, Lutsey PL, Wang Y, et al: Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2009;32:688-694.
8. Colditz GA, Willett WC, Stampfer MJ, et al: Patterns of weight change and their relation to diet in a cohort of healthy women. Am J Clin Nutr 1990;51:1100-1105.
9. Fowler SP, Williams K, Resendez RG, et al: Fueling the obesity epidemic? Artificially sweetened beverage use and long-term weight gain. Obesity (Silver Spring) 2008;16:1894-1900.
10. Yang Q: Gain weight by "going diet?" Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. Yale J Biol Med 2010;83:101-108.
11. Mattes RD, Popkin BM: Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr 2008;89:1-14.
12. Mattes R: Effects of aspartame and sucrose on hunger and energy intake in humans. Physiol Behav 1990;47:1037-1044.
13. Swithers SE, Martin AA, Davidson TL: High-intensity sweeteners and energy balance. Physiol Behav 2010;100:55-62.
14. Center for Science in the Public Interest: Chemical Cuisine. Learn about Food Additives. [http://www.cspinet.org/reports/chemcuisine.htm]

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Marty is your typical, middle-aged male that knew his health was precarious, but he was living in denial of the seriousness of it. Being a Store Team Leader for a Whole Foods Market he wanted to become a better leader by getting a grasp on healthy eating so he signed up to attend one of Dr. Fuhrman’s week-long Health Immersions for Whole Foods team members. His decision to attend was mostly a professional one for the betterment of his career, but he did have a slightly personal goal to lose some weight in the process also. He wanted to lead by example; not just have a bunch of head knowledge. However, he discovered a shocking surprise at the Health Immersion. Welcome to Disease Proof, Marty.

What was your life like before attending the Health Immersion?

I was 41-years-old and had reached my highest weight of 286 lbs. (5’9”) last spring.  Even when I was obese I was a happy person; I had a great family, wife, and job, but I was clueless about my health. I played sports all the time, even when I was that heavy. I was on a soft ball team and was embarrassed to be an obese athlete and so out of shape. I clearly recall one game where I was running to first base and suddenly became out of breath. I thought, “What’s happened that I’ve let myself get this out of shape? I can’t believe I’ve let myself go this far.”  

I attributed my declining fitness to working sixty hours a week at a sedentary desk job. I never made any connection to the food that I was putting into my body. My body ached all over, and I was lethargic and thirsty all the time so I’d drink a six-pack of caffeinated soda every day. The caffeine caused sleep deprivation which created a vicious cycle of fatigue and the need for more stimulation to keep me awake during the day.   I started having blurred vision, but associated all the negative symptoms in my life to “old age” creeping up on me. I never liked to go to doctors so I had no idea that my health was rapidly deteriorating. 

What happened that changed your life around?

On the first day of the Health Immersion my blood was drawn. A short time later the nurse sat down with me, and looked at me straight in the eyes and asked, “Do you realize that you have diabetes?”

At first I was shocked to hear those words, but then I had an “ah ha” moment. I instantly made the connection: unquenchable thirst, blurred vision, and overwhelming fatigue. My younger brother had been diagnosed with diabetes just a few years earlier and everything made sense to me in that moment. All of a sudden attending the Health Immersion became very personal to me. Then I found out that I had hypertension too. My blood pressure was 156/96 and that was shocking as well! I was also told that due to my  declining health numbers and body fat percentage that I had the biological age equivalent to a 72-year-old! 

The events of that morning were my wake-up call. The denial had ended, and I suddenly had a piqued interest to learn all the information that Dr. Fuhrman was going to be presenting that week. I was no longer there just to learn information to better my profession, but to save my life. I felt like I had just heard the worst news of my life, yet I had won the lottery at the same time! I realized that I had this incredible opportunity in front of me to change and be in control of my future health, and I accepted the challenge!  

How do you feel now?

I’m down to 205 lbs. so far, and I feel AMAZING! My fasting blood sugars are between 70 – 80, and my blood pressure averages around 105/70 with absolutely no medications!  My body doesn’t hurt anymore, and I’m no longer tired and thirsty all the time.   I have energy for the first time in years.  The guys on my soft ball team are continually amazed at my progress, and I’m a totally different person because I feel so good now. I no longer have shortness of breath, and people who haven’t seen me in the past six months don’t even recognize me anymore!

What success tips do you have to share?

 

• Don’t be ignorant and in denial of poor health. If you are continually tired, thirsty, and/or have shortness of breath, go to a doctor and get a diagnosis as soon as possible. Don’t put it off. 

• Knowledge is power. You can change your health destiny. I am the same, happy man that I was before, but now I’m much healthier and in control of my life. If you follow Dr. Fuhrman’s program you can fix your health issues and be off medications. It will save your life!

• “Good things will come to those who wait”. It took me two months of eating nutritarian foods before I enjoyed them. I fought it. I did not enjoy eating unsalted food, or vegetables, and I did not like giving up sodas. It took two months for my taste buds to change. It was tough, but I discovered that you have to give eating this way a chance. You can’t give up if you want to see results. If you stick with it, and don’t go back to old habits, you will eventually enjoy it! I love eating this way now!

Congratulations Marty on winning the lottery of discovering the way to excellent health ~ keep up the great job! You are an inspirational role model to many!

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Diabetes is a serious disease that shortens one’s life expectancy. Most adults with Type 2 diabetes die of heart attack and stroke, and these deaths occur at a younger age compared to people without diabetes. Diabetes also ages the body more rapidly, causing harm to the kidneys, nervous system and eyes, and also increases the risk of cancer. Premature death and the devastating complications of this disease simply do not have to happen. Type 2 diabetes is a devastating disease, but it is both preventable and reversible.

The vast majority of those with type 2 diabetes who adopt my nutritional and exercise recommendations reverse their disease; they lose their excess weight, become non-diabetic, and no longer need medications. They simply get well.

I met Don at my recent Health Immersion in Chicago, and he told me that he and his wife both got off all their medications and reversed their diabetes by following my recommendations. Here is Don’s story:

(Don and Alicia: before and after)

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“I was a fast food junkie, eating out 7 to 10 times a week. The rest of the time was processed foods, meats and dairy.  Hated vegetables but always said with enough butter and/or cheese they could be edible.  I would eat the occasional fruit and loved all breads and rolls.

I had wanted to be in the best shape of my adult life by the time I turned 50.  I started the Atkins and failed, gaining back even more weight and feeling lousy.  I was put on Wellbutrin then Prestiq for depression, refilled Lomotil for the IBS I was diagnosed with 25 years earlier, a few different pain killers as needed for degenerative arthritis of the lower back and hips.  Last but not least Viagra, hmmm I wonder why?

In May of 2012 my A1C went up to 11 on Glucophage and Actos.  My doctor then added Glyburide. My numbers came down into the sixes but I was experiencing low sugar episodes, and she wanted to start me on insulin.  My numbers may have been better, but I would not want to live with the swings the Glyburide was giving me.

I heard about Eat To Live in July and started it in August of 2012 also discontinuing my Glyburide right away.  My numbers had fallen and stabilized so I cut out the Actos and cut the Glucophage in half on the second week. Still my numbers looked great so I cut Glucophage out, and because my blood pressure had lowered and stabilized I cut out the Accupril. 

Meanwhile it was time for my 3 month diabetes checkup and my doctor was happy with my numbers yet still mentioned starting insulin. I told her what I was doing, and she was concerned that I had stopped my meds.  After seeing that my cholesterol was good I stopped the Lipitor as well.  I couldn't believe how good I was feeling.

The weight was coming off at about 7 pounds a week.  I hadn't started this plan for weight, but I can't say I was disappointed either.  Three months went by, and I hadn't taken so much as an aspirin since September.  I was exercising and feeling great.

I back slid around the Holidays, just a little, and put back on 5 pounds and started feeling bad again.  I was reminded of a refrigerator magnet that read “nothing will taste as good as you will feel.”  I have better stuck to the plan since then.   

I started in August at 272 pounds.  I stand 6'1" and I had so many aches and pains I just laid around being very uncomfortable. I have lost 60 pounds and have been medication-free for over 4 months.  My wife started in September and she has lost 36 pounds and is off her Glucophage and her allergy medicine.  We are both medication-free, happy, and getting healthier all the time.

Boy has my life changed.  I believe if I can do it anyone should be able to, you just have to get fed up with being sick and tired.

I got a chance to meet and thank Dr. Fuhrman in Chicago and I showed him a picture, on my phone, of all the meds I no longer take. This man needs to be in charge of our Government medical and nutritional standards!”

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As Don’s story clearly illustrates, the human body has an amazing capacity for healing, even from diabetes.  All we have to do is establish the optimal nutritional environment with high-nutrient foods and let the body do its work. A long, healthy life, free of diabetes and its tragic complications is possible, and it is your choice; you are the one who chooses whether you are going to live with your diabetes or get rid of it.

My new book, The End of Diabetes, outlines in detail my program for reversing (or preventing) type 2 diabetes with a nutritarian eating style and exercise.  If you are overweight or have diabetes you must read it, then share what you learn with your doctor, and get ready to enjoy excellent health.  

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Diabetes is a serious disease that poses considerable risks to the vascular system, particularly to the crucial and delicate blood vessels of the eyes.  

Diabetes is the leading cause of blindness in adults.¹

Nonrefractive visual impairment refers to a visual defect that cannot be corrected with glasses, and diabetic retinopathy is a common cause of nonrefractive visual impairment. Retinopathy is quite common among diabetics; about one-third of diabetics over the age of 40 have diabetic retinopathy.² Retinopathy can lead to serious vision loss, preventing sufferers from driving and living independently.

A new study has uncovered an alarming upward trend in nonrefractive visual impairment, and provides evidence that the diabetes epidemic is likely the cause.

Nonrefractive visual impairment increased by 21% among adults between 1999 and 2008 – a dramatic increase in a short period of time. When broken down by age, the largest increase in prevalence occurred in younger people – 20 to 39 years of age, compared to older age groups. This is a stark finding that predicts climbing rates of disability among middle-aged and younger adults in the near future.

The researchers then looked to the risk factors for this type of visual impairment to find the potential underlying causes.  The risk factors include older age, poverty, lower education level, lack of health insurance, and diabetes. Diabetes rates increased by 22% among U.S. adults from 1999 to 2008, and the other risk factors remained relatively stable, suggesting that the increase in visual impairment was due to the increase in diabetes.

Once diabetes is diagnosed, the damage to the body progresses over time, and the risk of complications progressively rises. Having diabetes for at least 10 years was linked to greater risk of nonrefractive visual impairment, and a greater proportion of the population had been living with diabetes for at least 10 years in 2008 compared to 1999; in adults younger than 40, this proportion doubled. ² Type 2 diabetes is becoming more common in younger populations, and therefore diabetes is beginning to do its damage earlier in life, bringing dangerous complications, such as vision impairment, earlier in life.

This is alarming data that begs for action; it indicates that medical advances toward better glucose control are not preventing vision loss due to diabetes. Managing glucose with drugs is not enough – we must get rid of diabetes to get rid of the risk.

Preventing and reversing diabetes

For type 1 and type 2 diabetics, the risk of vision-related complications can be eliminated with a nutritarian eating style plus frequent exercise.  The vegetable-based dietary program described in my book The End of Diabetes  is the most effective dietary approach for those with diabetes and is much more effective than drugs. For a Type 2 diabetic, this approach results in complete reversal of the diabetic condition for the majority of patients. For a Type 1 diabetic it eliminates the excessive highs and lows, dramatically reduces insulin requirements and prevents the degenerative diseases common in later life in those with type 1 diabetes.  Both type 1 and type 2 diabetics can maintain excellent health, proper eyesight and quality of life into old age.   Now is the time for us individually and collectively to utilize modern nutritional science to save our vision and save lives. 

References:

1. American Diabetes Association: Diabetes statistics [http://www.diabetes.org/diabetes-basics/diabetes-statistics/]
2. Ko F, Vitale S, Chou CF, et al: Prevalence of nonrefractive visual impairment in US adults and associated risk factors, 1999-2002 and 2005-2008. JAMA 2012, 308:2361-2368.

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I have taught for years that beans are nutritionally superior to whole grains, and should be the preferred starch source for diabetics – I often call my dietary recommendations for diabetics “the greens and beans diet” (learn more in my new book The End of Diabetes) A new study published by the research group of Dr. David Jenkins (who originally developed the concept of the glycemic index) has confirmed the advantages of beans over whole grains, especially for diabetics.¹

One-hundred twenty-one type 2 diabetics were split into two groups; a “low-glycemic index legume diet,” which emphasized beans and other legumes, and a “high wheat fiber diet,” which emphasized whole wheat foods and other whole grains. The bean group was instructed to consume 1 cup/day of beans, lentils, or other legumes and the grain group was instructed to consume an equivalent amount of a cooked whole grain or whole wheat bread, pasta or cereal daily for three months.

The table below summarizes the changes that occurred over the three-month period in each group, and whether the improvement in the bean group was significantly greater than that in the grain group:

Fiber and Glycemic load (GL)
As you can see from the table, the bean group’s fiber intake increased more and GL decreased dramatically more compared to the grain group. This highlights important nutritional differences between beans and whole grains. When it comes to fiber content, even intact whole grains don’t even come close to beans. Plus, much of the starch in beans is resistant starch and slowly digestible starch, which limits the overall glycemic effect of the carbohydrate in beans and are fermented into anti-cancer compounds in the colon. Beans are also higher in resistant starch than most grains.

Glycemic control
Hemoglobin A1c, or HbA1c is a measure of the percentage of the hemoglobin in the blood that has been glycated (has had a sugar molecule added to it); the higher your blood glucose, the more glycation occurs. The HbA1C result is an indicator of blood glucose levels over the previous three months. After three months on the bean-enriched or grain-enriched diets, this measure of long-term glycemic control was improved in both groups, but a greater improvement was seen in the bean group.

Although it may seem small, a 0.5% decrease in HbA1C is actually quite large, considering that a “healthy” (nondiabetic) A1C is below 6.0%, and a poorly controlled diabetic level is 8.0% or higher. The authors note that A1C reductions in the range of 0.5-1% translate into significant risk reductions for complications such as kidney damage.^3,4 A small improvement in HbA1c (like the half-point improvement here) is very significant, as it could represent years of lifespan gained or lost. Beans as the major starch source in the diet have the potential to make a huge positive impact on the long-term health of diabetics.

These improvements in health are cumulative with other dietary changes that improve HbA1c. So a small improvement from more beans and squashes, comes with a small improvement from berries and greens, and an small improvements from using nuts and seeds, and a small improvement from not snacking and so on, and all these small improvements which at first may seem like just a few tenths in HbA1c cumulatively result in massive benefits and for most, the end of diabetes.

Blood pressure and heart disease risk
People who eat more beans tend to have lower blood pressure (not to mention greater fiber and mineral intake, lower body weight, and smaller waist circumference).⁵ Beans are rich in fiber (especially soluble fiber) and minerals, and low in GL – characteristics that have anti-hypertensive effects.^1,6-10

The decrease in blood pressure in the bean group significantly improved their calculated Framingham risk score, an estimate of heart disease risk over the next ten years. This is an extremely important point, since most diabetics die of heart disease or stroke.¹¹

Comparing two healthful food groups: grains are good, beans are better.
When diabetics switch from white flour, sugar and white rice to whole grains, they get significant health benefits. Plus, even when they switch from white potato to whole grains they get significant glycemic and other benefits, since whole grains have a comparatively lower glycemic index and more fiber than white potato.¹²

This study shows that when diabetics rely on beans as their primary carbohydrate source, they get even more benefits than with whole grains; more evidence of how special beans are – their nutritional superiority as a carbohydrate source.

 
In the End of Diabetes reversal program, when choosing carbohydrate sources I recommend:

• No white flour, white rice or white potato
• Small amounts of whole grains
• More kiwi, berries, pomegranate, squash and beans

Of course, these carbohydrate sources are consumed in conjunction with plentiful low-calorie vegetables – greens, eggplant, onions, mushrooms, tomatoes, etc. , plus nuts and seeds daily for a phytochemical-rich, low-glycemic dietary profile with substantial anti-cancer and cardiovascular benefits.

References:
1. Jenkins DJ, Kendall CW, Augustin LS, et al: Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus: A Randomized Controlled Trial. Arch Intern Med 2012:1-8.
2. Sievenpiper JL, Kendall CW, Esfahani A, et al: Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diab tologia 2009;52:1479-1495.
3. Patel A, MacMahon S, Chalmers J, et al: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-2572.
4. Stratton IM, Adler AI, Neil HA, et al: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-412.
5. Papanikolaou Y, Fulgoni VL, 3rd: Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002. J Am Coll Nutr 2008;27:569-576.
6. Streppel MT, Arends LR, van 't Veer P, et al: Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005;165:150-156.
7. Houston MC: The importance of potassium in managing hypertension. Curr Hypertens Rep 2011;13:309-317.
8. Houston M: The role of magnesium in hypertension and cardiovascular disease. J Clin Hypertens (Greenwich) 2011;13:843-847.
9. DeFronzo RA, Cooke CR, Andres R, et al: The effect of insulin on renal handling of sodium, potassium, calcium, and phosphate in man. J Clin Invest 1975;55:845-855.
10. Chiasson JL, Josse RG, Gomis R, et al: Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA 2003;290:486-494.
11. American Diabetes Association: Diabetes statistics [http://www.diabetes.org/diabetes-basics/diabetes-statistics/]
12. Halton TL, Willett WC, Liu S, et al: Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr 2006;83:284-290.

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Recently, the National Institutes of Health (NIH) stopped their Look AHEAD (Action for Health in Diabetes) trial, which was investigating an “intensive lifestyle intervention program” to reduce the considerable cardiovascular risk associated with type 2 diabetes, compared to traditional diabetes support and education. After 11 years, there was no difference in incidence of cardiovascular events (e.g. heart attack and stroke) between the two groups, prompting the NIH to end the trial.

Why didn’t the intensive lifestyle intervention work? The major flaw in this study was that the intensive lifestyle intervention was not “intensive” at all. The program consisted of four years of instruction and counseling, encouraging subjects to follow a conventional low-fat diet (less than 30% of calories from fat and less than 10% of calories from saturated fat) and exercise three hours per week, with the goal of losing 7% of their body weight and maintaining that weight loss throughout the trial.¹ However, the suboptimal 7% goal was not even met.

The average weight loss was less than 5 percent.Of course there was no reduction in cardiovascular risk! For a diabetic starting at 200 lbs., that is a weight loss of less than 10 lbs. Why would anyone expect this tiny amount of weight loss to significantly improve someone’s health; especially someone with diabetes – a disease whose primary risk factor is excess weight?²

To meaningfully reduce the serious cardiovascular risks associated with diabetes, diabetics must achieve a healthy weight; losing a few pounds is simply not enough. Conventional recommendations to reduce fat intake or portion sizes do not bring about meaningful weight loss. Even the study’s authors  acknowledged that subjects who lost more weight fared better: Analysis of Look AHEAD after one year found that a 5-10% weight loss was associated with reductions in HbA1c, blood pressure, C-reactive protein, and improved lipid profile; 5-10% was a step in the right direction, but greater weight losses translated into greater reductions in those risk factors. In the words of the authors, “Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.” The magnitude of the weight loss correlated to the magnitude of improvement in risk factor measurements.^3,4 If the subjects were coached to reach a healthy weight with a nutritarian diet, rather than just to lose a few pounds, the researchers probably would have seen a dramatic reduction in cardiovascular events. My results are unequaled in this field. Most of the type 2 diabetics who follow my nutritarian program become non-diabetic.

The goal must be set high – the goal is to reverse diabetes.

At this point in time, when obesity and diabetes have become epidemic, we cannot set suboptimal goals. The ubiquitous watered-down advice saying that losing 5-10% of one’s body weight will significantly improve health has no place here; it is misleading and dangerous. Cardiovascular disease is the most common cause of death among diabetics – having diabetes more than doubles the risk of heart attack and stroke. More than 11% of American adults have type 2 diabetes, and it is the 7th leading cause of death in the U.S.⁵ Lifestyle interventions must be aggressive if we want to prevent heart attacks and strokes, reverse diabetes and save lives.

It’s not that lifestyle interventions don’t work – it’s just that modest changes are not enough. A slightly lower fat version of the standard American diet cannot complete the demanding task of reversing diabetes. Only radical changes will produce radical results – a radical lifestyle change, to a natural, high-nutrient, vegetable-based (nutritarian) eating style, plus frequent exercise.  In a recently published study, my colleagues and I investigated the efficacy of a nutritarian diet-style for treating patients with type 2 diabetes. Within just 7 months, 62% of the participants reached normal (nondiabetic) HbA1c levels, triglycerides dropped and the average number of medications dropped from four to one.  A nutritarian eting style has tremendous potential to reverse diabetes and ameliorate the associated cardiovascular risk.⁶

The choice to make is this: do you want to lose a few pounds, or do you want to get rid of your diabetes?

High-nutrient eating derails toxic hunger and food addictions, and has enabled my overweight clients to achieve dramatic weight loss results, in contrast to the modest results achieved by slight modifications to the disease-causing standard American diet. Hundreds of my patients and readers have reversed their diabetes, many losing 100 pounds or more:  Charlotte, Calogero, and Robert  just to name a few. They now live healthy active lives, and the cardiovascular risk that loomed over them has diminished with the disappearance of their diabetes.

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Dr. Fuhrman’s new book The End of Diabetes will be released on December 26^th. It is a must-read! Pre-order on Amazon.com to get your copy as soon as it becomes available.

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One of the most popular and misunderstood  topics in Dr. Fuhrman’s book, Eat to Live, is the famous 90 Percent Rule for adopting the nutritarian eating-style for life, and every person has his / her own interpretation of it:

“I eat healthy for a week, and then I celebrate.”

“I try to eat healthy, but I know I have that 10% to fall back on if I want to.”

“I use that 10% for when I eat out, because I know I’ll have salty foods and dessert.” 

“I’m not that hardcore following Eat to Live, after all, Dr. Fuhrman even said that we can cheat 10% of the time.”  

For those unfamiliar with the 90 Percent Rule, starting on page 223 of Eat to Live, Dr. Fuhrman wrote about it, and I’ll highlight below a few points that many misuse as a free-for-all license to go back to the standard American diet at liberty.  

 

• For longevity and weight loss, the Life Plan diet should aim to be made up of at least 90 percent unrefined plant foods. My most successful patients treat processed foods and animal foods as condiments, constituting no more than 10 percent of their total caloric intake.

• To hold to the 90 percent rule, I recommend women consume no more than 150 calories per day of low-nutrient food, or about 1,000 calories weekly. Men should not consume more than 200 calories of low-nutrient food daily, or about 1,400 calories weekly.

• Using the 90 percent rule, you are allowed to eat almost any kind of food, even a small cookie or candy bar, as long as all your other calories that day are from nutrient-dense vegetation.    

   

Let’s set the record straight. The 90 Percent Rule is not the excuse to intentionally cheat. There is no valid reason to consume the worst foods that we can get our hands on, because junk food kills and perpetuates more food addiction.

The 10 percent allowance of low-nutrient foods is permissible; however, Dr. Fuhrman never intended for that to be the license for cheating, or anything close to that mindset.  He would prefer that everyone eat 100% of high-nutrient foods for the best health that’s possible. However, he also realizes that optimal health is not everyone’s priority, and everyone has that right to choose their own health destiny by the foods they select. 

Eating 100% high-nutrient foods is most beneficial for breaking food addictions, and eradicating obesity, cancer, diabetes, heart disease, strokes, and a myriad of other diseases. 

Most of us have been consuming fake foods our entire lives so consuming 100% high-nutrient foods is especially crucial for us to reverse years of damage already done within our bodies. Dr. Fuhrman has stated that we may “look healthy” on the outside when we are close to an ideal weight, but we still have much damage on the cellular level to heal and restore due to years and years of conventional eating abuse. 

It’s not a matter of how far one can push a boundary line and get by with it, but how much one desires to heal damaged cells and feel alive and well; excited to be alive! 

Scrupulous, yes.

Sensible, absolutely.

Who in their right mind would want obesity, cancer, heart disease, depression, dementia, arthritis, or diabetes at retirement age?

With that being said, living in the best health that’s possible is totally one’s personal choice. If one wants to repeatedly eat traditional holiday meals; or pizza, chips and cake at parties; or ice cream blizzards on the way home from work; or glazed donuts at Sunday School; or buckets of buttered popcorn and boxes of candy at the movies; and then feel crappy, crabby and bloated; plus feed cancer cells and blow out precious beta cells in the process, no one is going to care. It’s one’s personal choice. Each person is in control of his or her own health destiny. 

So does Dr. Fuhrman himself follow the 90 Percent Rule?

 

 “What do you think I’m crazy?! My father had leukemia, why would I want to put 10 percent low quality food in my body? That is just for people who can’t yet grasp that nutritarian food tastes better and is more enjoyable to eat, and is the food we actually prefer to eat. Nevertheless, this is not a religion, and if on a rare occasion I want to have something conventional that is delicious, I can.”  

Be wise. Use good judgment and always be in control of your health destiny, 100% of the time!

[The obese belly above was mine a few years ago when I was in my 40's.  Now I'm 51-years-old and feeling younger & healthier than twenty years ago!]

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A year ago this month I received a phone call from my sister informing me that my mom had experienced a stroke and was en-route to the ER via an ambulance. Living five minutes from the hospital I made a mad dash there only to discover my mother intensely suffering in a triage unit. The next day would be her 86^th birthday, but at that moment her future looked grim. 

Having older parents who have faithfully put their trust in their doctors’ instructions over the years, I’ve been with them through their heart attacks, bypass and stent surgeries, and ongoing maladies and procedures. I’ve witnessed the negative side effects of their multiple (and astronomically expensive) pharmaceuticals that filled their kitchen counter top. I’ve seen first hand the results of conventional disease management, yet this episode was different. As my mom lied there on the gurney, writhing in excruciating pain from a leg spasm, paralyzed on one side of her body, unable to speak clearly, and crying; I could tell that this was the ultimate nightmare that she didn’t want to be experiencing. However, thankfully my mom discovered that it’s never too late to improve one’s health by eating to live.

What was your life like before following Dr. Fuhrman’s nutritarian eating-style?

I was tired all the time, but I thought it was due to old age; not wrong food choices. Because my mother had diabetes, suffered a stroke at age 66, and my siblings and I cared for her in my parents' living room for two years before her death, I made a conscious decision to carefully follow everything that my doctors told me to do over the years; not knowing that it would lead me down a dangerous path. Plus, other women my age were also being instructed to do the same so I thought I was doing the right thing. There was no different way at the time. 

Around age 60 I developed diabetes and was put on an oral diabetes medication for a couple of years, and then the doctor put me on insulin. I followed the recommended meal plan, insulin calculations and dosages; and when my blood sugars kept rising I complied with increasing the units of insulin. I even carried a glucose meter and injections in my purse so I would never miss a shot. 

I also ate animal protein at every meal; it was a part of the food plan that the diabetic educators instructed me to follow: eggs with breakfast, lean meats with lunch and dinner, and a peanut butter sandwich before bed. Every endocrinologist that I went to said the sandwich before bed was important to prevent dangerously low blood sugars in the night. Even with carefully following instructions, my blood sugars were either too high or too low. I lived in fear of the lows, especially when I was out in public or during the night. I even took a sandwich and juice to bed with me, just in case. 

Then my blood pressure also climbed higher with each passing year so blood pressure medications were added to my growing list of medications. However, even with four medications, my cardiologist could never get it below 199/99.  I had two heart attacks and multiple stents put into my body over the years: four stents in my kidneys, seven in my legs, and four in my heart, but I never got well. By the time of my stroke, I also had congestive heart failure and weighed 215 lbs. (5'8") 

Even though you [Emily] improved your health through Eat to Live, I was too dependent upon my doctors’ instructions to feel safe to make such radical changes at my age. Plus, a part of me thought it was too late to change; what’s the use.

What changed your mind?

Having the stroke changed my mind.  I was paralyzed on the entire right side of my body. My leg went into an intense spasm that wouldn’t let up, even with medication to try to relax it. I couldn’t speak so that others could understand me. I couldn’t swallow my food. I couldn’t even swallow a drink of water without a special ingredient to thicken it. My hand was clutched tight and I couldn’t open it. I couldn’t use the toilet without help. I wore adult diapers.  I was suddenly trapped in a body that was immobile which required 24/7 nursing care; totally dependent upon others for everything. 

After being discharged from the hospital, I was transferred to a nursing home for ongoing care and therapy. The night staff neglected to clip my call button onto my gown for me to reach it. I’d accidently wet myself during the night and couldn’t call anyone for help. I was totally at the mercy of someone discovering my situation early the next morning. Needless to say, my family transferred me to a stroke rehab facility that following day; but even with the best care, the total loss of independence was enough to change my mind. I was ready to do anything to get better if/when I would be discharged; no matter if my doctors approved it or not. * 

When did you start following Eat to Live?

After spending five weeks eating pureed meat and processed institutional foods, totally void of color, I was delighted to watch Dr. Fuhrman’s 3 Steps to Incredible Health that aired on our local PBS station the weekend after I returned home. Something “clicked” that day; plus I liked watching TV versus reading a book as my eyesight hadn't been good for the past couple of years. I totally understood what Dr. Fuhrman was talking about in his presentation. I began eating for health from that moment onward, and I’ve never looked back!

What’s happened since then?

I’ve been off insulin for over six months now, and after giving myself four shots a day for over twenty years it’s been wonderful to be totally free from them!  Also, with eating this way I don’t experience low blood sugars anymore so that all-consuming fear is gone.

I’ve lost about 65 lbs so far, and my blood pressure is never higher than 115/65. I’m down to just ½ dose of a blood pressure medication now, compared to four medications and continual, dangerously high blood pressures before following Eat to Live.

I’m more alert, I don’t tire so easily, and I even have the stamina to ride a stationary bike for 2 ½ miles/day; plus, I lift weights and do various exercises to continue to strengthen my arms, legs, back, and facial muscles. I noticed this past winter when I got a cold and cough that it only lasted for a couple of days. The same thing happened with a sore and infected toe; it healed quickly, when it used to take a long time for a wound to heal.   

Had I not followed high-nutrient eating this past year, there’s no way that my weakened muscles from the stroke could’ve supported the obese weight. It would be very difficult for me to get around with sixty-five extra pounds on my body. I use a walker for stability, but I can now walk in grocery stores, go to the mall with assistance, attend church and family events, and see my friends. I know that I would be completely homebound without following Eat to Live. 

Do you have any success tips to share?

 

• Yes, keep it simple. You [Emily] had knee surgery at the same time that I started eating high-nutrient foods so I had to find an easy way to make it work on my own. Where there’s a will, there’s always a way. I kept the meals simple. I steamed enough vegetables to have on hand for several meals. I made a pot of lentils once a week. I made sure to include cooked mushrooms and chopped onions daily. Bob [her husband of sixty-five years and my dad] has always grown a big garden, and he helped me prepare the vegetables, but I haven’t made fancy recipes yet; that may come this next year.

 

• However, the most important tip is that one’s health should come first above all other priorities. Health first; everything else second! That’s got to be the mindset or other things will crowd it out. My main occupation now is making time for my food preparation, daily exercises, and adequate rest.  If you are young, don’t wait until you are old to change your eating habits. If you are old, it’s never too late to change and get health restored. Don’t cheat yourself out of the best health that’s possible.

Congratulations Mom ~ I’m truly proud of you for overcoming a myriad of obstacles to contend for your health, no matter what. And happy eighty-seventh birthday this year!

[By the way, the top picture was taken the day after the stroke, on her 86th birthday.  She had a smile on her face only because the grandchildren were in the room with balloons and cards to celebrate her birthday.] 

* Helen has been medically supervised, via phone consultations, by Jay Benson, D.O. Dr. Benson is board certified in family medicine, specializing in nutritional medicine, and sees patients at Dr. Fuhrman’s Medical Associates in Flemington, New Jersey. 

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Colon cancer is the third most common cancer type, and the second leading cause of cancer death in the U.S.¹ These cancers are the ones most closely linked to lifestyle; the good news is, that means that colon and rectal cancers are also highly preventable by following healthful lifestyle habits – including avoiding disease-causing foods.

Scientists believe that elevated insulin levels contribute to cancer development; insulin in high concentrations may promote growth and division of cancer cells, and cancerous cells often have elevated levels of insulin receptors.² Foods with a high glycemic load (GL) such as white bread, white rice, sugar, and white potatoes, produce dangerous spikes in blood glucose, and consequently insulin levels. Diets including large quantities of high GL foods increase the risk of several chronic diseases, and a recent meta-analysis of several studies found a 26% increase in colorectal cancer risk in people who consumed the most high glycemic load foods in their diets.^3,4

Examples of high, medium and low GL carbohydrate sources:^5,6

According to the American Institute for Cancer Research, there is suggestive evidence that cheese and foods containing animal fats increase the risk of colon and rectal cancers. Cheese, the fattiest food in the American diet, is particularly high in saturated fat, which is known to impair insulin sensitivity.^7,8

New research suggests that over time, these dietary factors – excess, low-nutrient carbohydrate and fat – may disturb carbohydrate and fat metabolism in the colon by altering DNA methylation in colon cells.

DNA methylation acts essentially as an on/off switch for a gene, usually decreasing (but sometimes increasing) the amount of protein made from that genetic code. Dietary factors are known to affect DNA methylation, and too much or too little methylation can contribute to the development of cancer.⁹

A recent study compared methylation patterns of thousands of genes in the colon mucosa of control subjects without colon cancer to normal mucosa of colon cancer patients; the researchers found hundreds of genes whose methylation patterns differed in the two sets of subjects. When they looked at those genes with the greatest differences in methylation, they made an interesting observation: a common theme among many of these genes was that they are involved in carbohydrate and lipid metabolism – one of these was the insulin gene. In short, “normal” colon cells in colon cancer patients were making more insulin than normal colon cells from healthy subjects – and we know that excess insulin promotes cancer.

The authors hypothesize that an unhealthy diet full of refined carbohydrate and excess fat may cause this metabolic change – and once excess insulin is being produced by colon cells, it then feeds the growth of cancerous cells.¹⁰

Though the research may be complex, the message is simple: refined foods like sugar and white bread, and low-nutrient fats like oils and cheeses are harmful to the health of your colon. Colon cancer is a preventable disease – whole, natural foods provide the fiber, resistant starch, and phytochemicals that will keep the cells of the colon healthy and expressing the proper genes in the proper amounts.

References:

1. American Cancer Society. What are the key statistics about colorectal cancer? [http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-key-statistics ]
2. Vigneri P, Frasca F, Sciacca L, et al: Diabetes and cancer. Endocr Relat Cancer 2009;16:1103-1123.
3. Gnagnarella P, Gandini S, La Vecchia C, et al: Glycemic index, glycemic load, and cancer risk: a meta-analysis. Am J Clin Nutr 2008;87:1793-1801.
4. Barclay AW, Petocz P, McMillan-Price J, et al: Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627-637.
5. Carbohydrates and the Glycemic Load. Harvard School of Public Health: The Nutrition Source. http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/carbohydrates-and-the-glycemic-load/. 
6. Atkinson FS, Foster-Powell K, Brand-Miller JC: International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281-2283.
7. WCRF/AICR Expert Report, Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective.: World Cancer Research Fund; 2007.
8. Vessby B, Uusitupa M, Hermansen K, et al: Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diab tologia 2001;44:312-319.
9. Kulis M, Esteller M: DNA methylation and cancer. Adv Genet 2010;70:27-56.
10. Study shows how high-fat diets increase colon cancer risk. 2012. EurekAlert! http://www.eurekalert.org/pub_releases/2012-03/tu-ssh030712.php. Accessed March 28, 2012.

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Over 20 million people in the United States (about 8% of the population) have type 2 diabetes.¹ Worldwide prevalence of diabetes in adults is about 6%, and Asian countries have somewhat higher rates (9% in China and Korea, and 11% in Japan).^2,3 This is interesting to consider. In spite of considerably more overweight and obesity in the USA and our dangerous diet, there is considerably more diabetes in China, Korea and Japan. This is mostly because of white rice.

Type 2 diabetes arises out of insulin resistance, a state in which the body’s cells cannot respond properly to insulin – a hormone that allows for the transport of glucose into the body’s cells and storage of the energy contained in that glucose. Carrying excess fat and eating high glycemic load (GL) foods contribute to the development of insulin resistance (and of course, eating high glycemic foods contributes to weight gain).

Refined carbohydrates like white rice, devoid of fiber to slow down absorption of sugars, raise blood glucose more and faster than their intact, unprocessed counterparts. The effect of a food on blood glucose is indicated by its glycemic index (GI) – a 1-100 measure of the blood glucose response per gram of carbohydrate. Glycemic load (GL), a related indicator, takes into account both the GI and the carbohydrate content of a typical portion size.

A new meta-analysis has explored the link between white rice and diabetes
An analysis of four prospective studies on white rice consumption and diabetes has recently been published – it included 2 studies in Asian populations and 2 in Western populations. In Asian countries, where white rice is a staple food, the average intake of white rice was 3-4 servings per day, and in Western countries the average was 1-2 servings per week. A comparison of the highest vs. lowest white rice intake groups yielded a 55% increase in diabetes risk in Asians, and a 12% increase in Westerners. Overall, the researchers found that each daily serving of white rice increased the risk of diabetes by 11%.⁴

This new research serves to remind us: High-glycemic, nutrient-depleted, refined carbohydrates (like white rice) are more than just empty calories – they are disease-causing foods.

Westerners on average ate less than one daily serving white rice – but what about the other high-GL foods that Americans eat daily? White pasta, white potato, and white bread are also high in GL and therefore likely to be just as dangerous. It’s no wonder that U.S. diabetes rates have tripled in the past 30 years, and are expected to double or even triple by 2050.²
 

Indeed, more and more research is demonstrating potato consumption is associated with diabetes, and this association was found to be most likely due to glycemic load (not due to preparation or added fats). Substituting 1 serving of whole grains per day with potatoes was estimated to increase diabetes risk by 30%.⁶ Also, in a 6-year study of 65,000 women, those with diets high in refined carbohydrates from white bread, white rice, and pasta were 2.5 times as likely to be diagnosed with type 2 diabetes compared to those who ate lower-GL foods such as intact whole grains and whole wheat bread.⁷  

Not just diabetes – cancer too
High GL foods have dangers that reach beyond diabetes. Diets including large quantities of high GL foods increase the risk of several chronic diseases including diabetes, heart disease, and cancers.⁸ Let’s make it clear: white rice, white flour products, and white potatoes are foods that should not be central in our diets. Low-nutrient, high glycemic foods are not only unfavorable from the perspective of weight gain and diabetes, but could also contribute significantly to cancer by causing excessive insulin secretion. High insulin levels in the blood can promote the growth of cancer cells, in part by interacting with the receptor for insulin-like growth factor 1 (IGF-1).⁹ A recent study of Korean women found that each daily serving of white rice increased breast cancer risk by 19%.¹⁰ Similarly, a recent U.S. study found a link between starch consumption and breast cancer recurrence.¹¹ Diabetics are 30% more likely to develop colorectal cancer, 20% more likely to develop breast cancer, and 82% more likely to develop pancreatic cancer than non-diabetics. This increased risk of cancer observed in diabetics is thought to be due in part to cancer-promoting effects of insulin therapy.^12,13

In the past, white rice was looked upon as a healthful, low fat staple in a vegetarian diet. We have progressed in knowledge and science and it is clear that white rice can no longer be considered healthful, or even neutral – it is a disease-causing food. The damaging effects of high-GL foods have been brought to light, and we now know that the most healthful carbohydrate sources are those that minimize glycemic effects – beans, peas, intact whole grains, and starchy vegetables.
 

References:
1. American Diabetes Association: Diabetes statistics [http://www.diabetes.org/diabetes-basics/diabetes-statistics/]
2. World Health Organization. Diabetes Fact Sheet. [http://www.who.int/mediacentre/factsheets/fs312/en/ ]
3. IDF Diabetes Atlas: Fifth Edition. International Diabetes Federation; 2011.
4. Hu EA, Pan A, Malik V, et al: White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012;344:e1454.
5. Atkinson FS, Foster-Powell K, Brand-Miller JC: International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281-2283.
6. Halton TL, Willett WC, Liu S, et al: Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr 2006;83:284-290.
7. Salmeron J, Manson JE, Stampfer MJ, et al: Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997;277:472-477.
8. Barclay AW, Petocz P, McMillan-Price J, et al: Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627-637.
9. Gallagher EJ, LeRoith D: The proliferating role of insulin and insulin-like growth factors in cancer. Trends Endocrinol Metab 2010;21:610-618.
10. Yun SH, Kim K, Nam SJ, et al: The association of carbohydrate intake, glycemic load, glycemic index, and selected rice foods with breast cancer risk: a case-control study in South Korea. Asia Pac J Clin Nutr 2010;19:383-392.
11. Emond JA, Patterson RE, Pierce JP: Change in Carbohydrate Intake and Breast Cancer Prognosis. In San Antonio Breast Cancer Symposium, vol. Presentation #P3-09-01; 2011.
12. Pollak M, Russell-Jones D: Insulin analogues and cancer risk: cause for concern or cause celebre? Int J Clin Pract 2010;64:628-636.
13. Experts call for further research into the relationship between insulin therapy and cancer. 2010. EurekAlert! http://www.eurekalert.org/pub_releases/2010-03/w-ecf030210.php. Accessed October 20, 2011.

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