Starch-Based Diets No Answer for Diabetics

From the September 2003 edition of Dr. Fuhrman’s Healthy Times:

While they are a step in the right direction, grain- and starch-based diets pose risks for diabetics. I want to make it clear that diabetics can’t just “eat better.” They have to go all the way and follow the vegetable-based diet I call Eat To Live (ETL). This is the only dietary approach that lowers cholesterol, improves the cholesterol ratio, and lowers triglycerides.

With only one or two exceptions, other vegetarian diets simply are not as effective or safe because they typically rely heavily on cooked starchy vegetables, such as bread, grains, and potatoes. The recommendations of vegetarian diet authors, such as Dean Ornish and John McDougall, can be helpful for the general public but are far from ideal for those with diabetes. Certain individuals may experience beneficial changes after adopting recommendations such as these, since they are a big improvement over the Standard American Diet (SAD), but most diabetics will not achieve the results available to them unless they adopt the ETL approach.

Diabetics need to avoid baked starchy vegetables and flour-based products. Most low-fat and vegetarian-type diets are cooked starch- and grain-based, not steamed vegetable-based. By utilizing more green vegetables, beans, nuts, and even fruit, the ETL approach sets the stage for more dramatic weight loss and more effective glucose lowering.

The ETL vegetable-based dietary program is the only dietary intervention ever shown in medical studies to lower cholesterol more effectively than cholesterol-lowering medication. Other styles of plant-based dietary interventions—because they are grain- and potato-based— have been relatively ineffective at lowering cholesterol. Although the low-fat vegetarian diet lowered LDL cholesterol 16 percent, it raised triglycerides 18.7 percent, and the LDL/HDL ratio remained unchanged, reflecting minimal overall improvement.1

The ETL approach differed in that the LDL cholesterol was more significantly lowered (33 percent) without unfavorable impact on HDL or triglycerides, reflecting sizable improvement in reducing the risk of heart attack. ETL simply is the most cardio-protective dietary approach one can follow, which is of crucial importance since diabetics have such an increased cardiac risk.

Exposure to advanced glycation end products

Another reason why typical vegetarian diets are not ideal for diabetics is they are not designed to avoid exposure to advanced glycation end products (AGEs). There is a huge body of literature documenting that the high sugar in the bloodstream in diabetics promotes the formation of AGEs in the body as the sugars react with body proteins. The formation of advanced glycation end products (AGEs) on connective tissue and within cells stiffens and ages your blood vessels and accelerates aging throughout the body. AGEs are a significant causal factor of the horrible side effects of diabetes, such as blindness, kidney failure, heart attacks, and strokes.The chemical modifications of cells that occur as a result of the accumulation of AGEs are one of the primary hallmarks of aged and diseased tissues.

But the accumulation of AGEs in the body does not result solely from increased sugar in the bloodstream. AGEs also are formed when starchy foods are cooked at higher temperatures, causing molecular rearrangement. Acrylamides are an example of AGEs that occur from cooking carbohydrates—such as potatoes and grains—in the absence of water. The higher the temperature, the more these toxic compounds are formed. Neither acrylamides nor other AGEs are formed when vegetables are steamed or cooked in soups.

Refined carbohydrates in bakery products and processed foods can cause heart attacks even in people who are not diabetic,2 but these products are even more dangerous for diabetics, since diabetics are more sensitive to the damaging effects of AGEs. Vegetarians (my wife calls them “vegjunktarians”) who eat large quantities of cooked starches and honey were found to have higher measurable levels of AGEs than people eating a more omnivorous diet.3 To be lifespan-promoting and diabetic-reversing, vegetarian diets must be designed to minimize exposure to large amounts of cooked starches and simple sugars. In addition, they must be very high in fiber to maximize glucose lowering. My high-nutrient ETL approach meets all of these criteria. 1. Barnard ND, Scialli AR, Bertron P, et al. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol 2000 Apr 15;85(8):969-72.

2. Kanauchi M, Tsujimoto N, Hashimoto T, et al. Advanced glycation end products in non-diabetic patients with coronary artery disease. Diabetes Care 2001;24(9):1620-1623.

3. Krajcovicova-Kudlackova M, Sebekova K, Schinzel R, et al. Advanced glycation end products and nutrition. Physiol Res 2002;51:313-316.
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Comments (4) Read through and enter the discussion with the form at the end
Natalie - August 31, 2008 10:22 PM

I love your book and have been reading Dr McDougall's website that insists that starch is the way to go and plants are not. I know you all are advocating healthy diets, it's just hard for me to decide which of you is right, as each claims starch/plants are better. Help!

MATT - April 21, 2009 12:05 AM

hey natalie, i think that dr. fuhrman's approach with a plant based diet is much better for people who are sick or need to recover from certain illness. but mcdougall's diet is more of a maintainence diet and more sustainable in the long run.

Sean Mac - September 27, 2010 2:08 PM

I changed to a starch based diet after having diabetes for 15 years on on insulin for two, and seeing my condition progressively worsen. Sixty days on the McDougle starched based, plant diet has seen my diabetes return to those without diabetes diagnosis, and I take not medication whatsoever. My last A2C was 5.2. My cholesterol went from 220 to 128, my HDL, 148, my LDL, 46. Posting to the contrary here is dumb...my diabetes is cured as my fasting blood glucose is about 94 +/-. This has been going on for two + months with no worsening and constant normal readings.

Peter - October 27, 2011 3:00 PM

Dr. McDougall's starch based diet does seem to help people lower their cholesterol and lose fat, although muscle mass gain is a separate issue. There was a man that lost fat, and lowered his cholesterol after sixty days eating and drinking nothing but potatoes and water. But Dr. Fuhrman's ETL diet would be generally healthier and more tasty in the long term because of all the many types of plant foods it includes.

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