Did you ever wonder if the food you eat
has a direct effect on your health, well-being, and longevity?
Well, I’m here to end that mystery.
You ARE the foods you eat.
Welcome to the Nutrition Facts Podcast,
I’m your host, Dr. Michael Greger.
Today we look at the best way to control diabetes,
starting with the remarkable results of a crossover study
randomizing hundreds of people with diabetes
to one and a third cup of millet every day.
How does millet come to the help of diabetics?
A substantial portion of the starch in millet is resistant starch,
meaning resistant to digestion in our small intestine,
so providing a bounty for the good bugs in our colon.
Here’s how the various millets do, all way more than more common
grains like rice or wheat, but proso and kodo millet lead the pack.
What’s going on? The protein matrix in millet not only acts
as a physical barrier but actually also partially sequesters
your starch-munching enzyme, and the millet polyphenols
also can act as starch blockers in and of themselves.
Millet also has markedly slower stomach emptying times
than other starchy foods. If you eat white rice, boiled potatoes,
or pasta, your stomach takes about an hour to digest it,
before starting to slowly dump it into your intestines,
and two or three hours to empty about half-way.
Whereas you eat sorghum or millet, and stomach emptying
doesn’t even start until two or three hours
and may take five hours to empty even halfway.
Note this was for both a thick millet porridge
and for just millet couscous.
Since the non-viscous millet couscous meal was also equally slow
in emptying, this suggests that there may just be something
about millet itself that helps slow stomach emptying,
which should blunt the blood sugar spike.
But you don’t know...until you put it to the test.
And indeed, millet caused about a 20% lower surge in blood sugar
than the same amount of carbs in the form of rice.
Remember how excited I was to show you how it only took the body
like half the insulin to handle sorghum compared to a grain like corn?
Well, millet did even better.
Give a group of prediabetics only about three-quarters of a cup
of millet a day, and within six weeks their insulin resistance
dropped so much their prediabetic fasting blood sugars
turned into non- prediabetic blood sugars.
This so-called “self- controlled” clinical trial,
the same subjects before and after, is just a sneaky way
of saying an uncontrolled trial.
There was no control group that didn’t add the millet
or added something else.
And we know just being in a study under scrutiny
can cause people to eat better in other ways.
So, we don’t know what role, if any, the millet itself played.
What we need is a randomized, controlled crossover trial
where the same people eat both a millet-containing
and non-millet containing diet and see which works better.
And here we go! A randomized, crossover study having
hundreds of patients both do an American Diabetes Association-type
diet with and without about one and one-third cup of millet every day,
and… the millet-based diet lowered hemoglobin A1C levels,
meaning an improvement in long-term blood sugar control,
along with some side benefits like lowering cholesterol.
The target for good blood sugar control recommended
by the American Diabetes Association is an A1C less than 7.
They started out at 8.37, but after a few months on millet,
dropped it to an average of 6.77.
Is it just because they lost weight or something?
No, suggesting that it was an effect specific to the millet.
But they didn’t just give millet.
They mixed the millet with split black lentils and spices,
and we know from dozens of randomized,
controlled experimental trials in people with and without diabetes
that the consumption of pulses (meaning beans, split peas,
chickpeas, or lentils) can improve long-term measures
of blood sugar control like A1C levels.
So, while the researchers conclude that millets have the potential
for a protective role in the management of diabetes,
a more accurate conclusion might be a mix of millet and lentils
can be protective, though hey, maybe the spices helped too.
They didn’t say which ones they used, and I couldn’t get ahold
of the authors, but a similar study done by one of the same researchers
included about a tablespoon a day of a mixture of fenugreek, coriander,
cumin, and black pepper, with a fifth spice, perhaps cinnamon or turmeric.
In our next story, we look at the reason why professional diabetes associations
recommend bean, chickpea, split pea, and lentil consumption
as a means of optimizing diabetes control.
How did doctors treat diabetes before insulin?
Almost a thousand medicinal plants were described as antidiabetic agents,
most of which have been used in traditional medicine,
and these included beans.
Of course, just because something’s been used for centuries doesn’t mean it’s safe.
Other treatments for diabetes have included arsenic and uranium.
Thankfully many of these other remedies fell by the wayside,
but scientific interest in the antidiabetic potential of beans never vanished completely
and even was raised in the past decade.
Health authorities from all over the world universally recommend
increasing the consumption of whole grains and legumes for health promoting diets.
And one of the reasons is that they may decrease
insulin resistance, the defining trait of type 2 diabetes.
Diabetes is a global public health epidemic.
Although oral hypoglycemic medications and injected insulin are the mainstay treatments
of diabetes and are effective in controlling high blood sugars,
they have prominent side effects and fail to significantly
alter the course of diabetic complications.
Common side effects include weight gain, swelling, liver disease.
But I want to emphasize that second part.
The mainstay of diabetic treatment fails to significantly
alter the course of diabetic complications.
Shouldn’t that be the whole point of treatment?
Thankfully, lifestyle modifications have proven to be
greatly effective in the management of this disease,
and if there is one thing diabetics should eat,
it’s legumes: beans, chickpeas, split peas, and lentils.
The European Association for the study of diabetes,
the Canadian Diabetes Association,
and the American Diabetes Association all recommend
the consumption of dietary pulses as a means of optimizing diabetes control.
What are pulses?
They’re peas and beans that come dried, so a subset of legumes,
so excluding green beans and fresh green peas, which are considered more like vegetables,
and also excluding the so-called oilseeds: soybeans and peanuts.
This review compiled 41 randomized controlled experimental trials,
including more than a thousand patients,
corroborating the official diabetes association nutrition guidelines
recommending the consumption of pulses as a means of optimizing diabetes control.
Any better than any of the others?
Well, some of the strongest evidence came from the studies that used chickpeas,
and in terms of beans, pintos and black beans may beat out kidney beans.
Compared to the blood sugar spike of straight white rice,
black beans and rice, and pinto beans and rice appeared to beat out kidney beans and rice.
This may be because dark red kidney beans can have lower levels of indigestible starch.
One of the reasons beans are so healthy
is they contain compounds that partially block our starch digesting enzyme,
which allows some starch to make it down to our colon to feed our good gut bacteria.
And in fact the inhibition of this starch-eating enzyme, amylase, just by eating beans,
approximates that of a carb-blocking drug, acarbose,
sold as Precose, a popular diabetes medication.
The long-term use of beans may normalize hemoglobin
A1C levels (which is how you track diabetes)
almost as well as the drug, without drug side effects
with names like acute generalized exanthematous pustulosis.
Finally today, we look at the best diet for diabetes prevention.
There are all sorts of different scoring systems to rate diet quality.
My favorite, for its simplicity, is the dietary phytochemical index:
a fancy name for a simple concept.
It's just the percentage of your calories from whole plant foods, so 0 to 100.
The average American diet has a score of 12.
Twelve out of a hundred; so, like on a scale of one to ten, our diet is a one.
You can split people up based on how they score, and show how the higher you score
the better your metabolic markers when it comes to diabetes risk.
There appears to be like this stepwise drop in insulin resistance and
insulin-producing beta-cell dysfunction as you eat more and more plant-based.
And that highest group was only scoring about 30,
less than a third of their diet was whole plant foods,
but better than the lowest, which was down around the standard American diet.
No wonder diets centered around plants, emphasizing legumes—
beans, split peas, chickpeas and lentils—
whole grains, vegetables, fruits, nuts and seeds,
and discouraging most or all animal products are especially potent
in preventing type 2 diabetes,
and as a little bonus has been associated with much lower rates of obesity,
hypertension, hyperlipidemia, cardiovascular mortality, and cancer.
And not just preventing type 2 diabetes but treating it as well.
A systematic review and meta-analysis found that the consumption
of vegetarian diets is associated with improved blood sugar control,
but how much improved? Here's one of the latest trials.
The effect of a strictly plant-based diet centered around brown rice—it was
done in Asia—versus the conventional diabetic diet on blood sugar control
of patients with type 2 diabetes: a 12-week randomized clinical trial.
For the diabetic control diet, they set up food exchanges and calculated
specific calorie and portion controls, whereas on the plant-based diet
people could eat much as they want; that's one of the benefits.
The emphasis is on food quality rather than quantity,
and they still actually lost more weight.
But even after controlling for the greater abdominal fat loss
in the plant-based group, they still won out.
Of course, it only works if you actually do it,
but those that pretty much stuck to the healthier diet dropped their
A1c levels 0.9%, which is what you get taking the leading diabetes drug,
but of course only with good side effects.
Yeah, but would it work in an underserved population?
The impact of a plant-based diet support program on mitigating type 2 diabetes
in San Bernadino, the poorest city of its size in California.
A randomized controlled trial, but not of a plant-based diet itself
as the title suggests, but of just an education program
telling people about the benefits of a plant-based diet for diabetes,
and then it was up to them.
And still got a significant improvement in blood sugar control.
Here are the numbers.
Got a little better in the control group,
but way better in the plant-based instruction and support group.
And more plant-based diets are not just effective
in the prevention and management of diabetes, but also its complications.
One of the most devastating complications of diabetes is kidney failure.
This shows the decline in kidney function in eight diabetics
in the one or two years before switching their diets.
They all showed this steady, inexorable decline
on a fast track to complete kidney failure and dialysis.
But then they switched to a special supplemented vegan diet,
and their kidney decline was stopped in its tracks.
Imagine if they had switched a year or two earlier!
Most diabetics don't actually end up on dialysis though because they die first.
Cardiovascular disease is the major cause of premature mortality among diabetics;
that's why plant-based diets are perfect. There is a general scientific consensus
that the elements of a whole-foods plant-based diet—
legumes, whole grains, fruits, vegetables, and nuts,
with limited or no intake of processed foods and animal products—
are highly beneficial for preventing and treating type 2 diabetes.
Equally important, plant-based diets address the bigger picture
by simultaneously treating cardiovascular disease, our #1 killer,
along with obesity, high blood pressure, lowering inflammation,
and we can throw cancer into the mix too, our #2 killer.
The bottom line is that the case for using a plant-based diet
to reduce the burden of diabetes and improve overall health
has never been stronger.
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