Most people who have been recently diagnosed with type 2 diabetes have a couple of other things in common besides having too much glucose in their blood: they also have too much low-density (LDL) cholesterol in their blood, and too much fat on their bodies.

These are serious matters. An excess of fat tends to promote insulin resistance. An excess of low-density cholesterol aggravates the cardiovascular problems that go hand-in-hand with insulin resistance. If you have been diagnosed with type 2 diabetes, it’s very likely that the two most important things you need to do are to reduce your body fat and reduce your LDL cholesterol. Exercise helps with both of these problems, but if you rely on exercise alone to solve them, you're probably not going to be able to do nearly enough of it to get the job done. You really have to take a look at your diet, too.

The good news here is that there is a simple change you can make to your diet which might go a long way toward solving both of these problems. The bad news is that most people don’t want to make this change.

I doubt that there is an ideal diet that is right for all type 2 diabetes patients. On the whole, you are probably better off experimenting on yourself to see what works for you. By “what works”, I mean what empowers you to drive your weight, BG, and cholesterol values into the normal range, and keep them there. If you haven’t yet found a way of feeding yourself that supports those goals, your search for the right diet is not over.

However, any search has to start somewhere, and I do have a suggestion about what you should try first. If you’re looking to improve your eating habits in a significant way, the most effective change you can make (and in a way the simplest) is to start eating vegetarian meals. A diet that consists entirely, or at last mainly, of plant foods is more or less automatically going to reduce your intake of saturated fat, and probably your intake of calories in general. As a method of losing or controlling weight, vegetarianism has a better track record than anything else that’s been looked at, and it has other health advantages as well.

Nevertheless, vegetarianism is a mighty hard sell. Most people take a negative view of it. Well, actualy, "negative" is putting it too mildly. An amazing number of people are not only uninterested in eating a vegetarian diet (which is a reasonable feeling) but are also strangely eager to denounce anyone who does (which is not a reasonable feeling). It’s not just that they assume vegetarian foods to be dull and unsatisfying; if that was all that bothered them, the subject of vegetarianism would merely bore them; instead, it upsets them. They cannot hear the word "vegetarian" mentioned without wanting to declare how weird and unhealthy vegetarians are, and how misguided they are to want to eat a plant-based diet. Clearly, there are issues in play here that have nothing to do with nutrition. Vegetarianism is somehow seen as threatening, and the perceived threat inspires a lot of defensive maneuvering. It is messy issue altogether.

I recently saw an interesting example of the pointless sniping that vegetarianism, as an issue, can trigger. On Gary Vaynerchuk's web site (which features videos devoted to wine and wine tasting), he devoted an episode about pairing wines with steak. I wrote to him, saying all the advice about food/wine pairings that I had seen was about meat dishes, and asking him for advice on pairing wines with vegetarian dishes. He responded by doing an episode on the subject. This episode produced the following comments from viewers:
  • "Is being vegetarian automatically healthier way of eating? I don’t see how a vegetarian diet is supperior to a regular, balanced diet! I’m not unhealthy because I eat red meat…"
  • "Just cause someone is a vegetarian doesn’t mean they’re healthy. I know several vegetarians who do it for health reasons, and I’d say overall the vegetarians I know have more health problems than the omnivores I know."
  • "Screw vegetarians — since they like being miserable for made up reasons, why the hell should we try to make them any happier? Eat a mouthful of leaves in the fall and then throw up in your mouth to make it taste better. It’s far from proven to be healthier — how many professional athletes are vegetarians?"
Allow me to point out how curious these responses are. Nobody had asked these people for their opinion of vegetarianism or the people who practice it. Vaynerchuk had not said that there was anything wrong with people who ate meat (and was clearly a meat-eater himself). When he did an episode on pairing wines with steak, vegetarians didn't raise any objections. But when he did an episode on pairing wines with vegetable dishes, some meat-eaters couldn't just let it pass.

Apparently, it is widely assumed by meat-eaters that merely to eat vegetarian meals, even occasionally, is to attack them personally. It's as if they think vegetarians are engaged in a conspiracy to take away their hamburgers, and must be stopped.

Part of the problem is that there are many ways to define vegetarianism, and many possible motives for it — and our choice of motive affects our choice of definition. For example, some people feel that eggs and dairy products count as vegetarian foods because you don't have to kill the animal to get them, but obviously that makes no sense if you don't think of vegetarianism mainly as a moral issue. 

Certainly there are people who adopt vegetarianism because they believe some kind of religious, environmental, or moral principle is at stake, but I suspect there are more people who adopt a vegetarian diet, or at least a diet that minimizes animal foods, because (like me) they haven't been able to think of a better trick for getting their weight and cholesterol under control. Those of us who see vegetarianism as a useful way to learn how to eat better, and not as an absolute moral principle, are perhaps more inclined to compromise. We do have to live in a largely carnivorous society, and that means we sometimes find ourselves in social situations where it isn't practical to try to practice vegetarianism. Do you really want to tell your hosts that you can't eat anything they're trying to serve you? Even eating at a restaurant can be a challenge. Many restaurants offer their vegetarian customers a single option that is either not good or not vegetarian (you have to wonder where they think cheese omelets come from).

Because of all the many types and degress of vegetarianism, when two people have an argument about vegetarianism, they’re probably not even discussing the same subject (although they both think they are). Such arguments have been going on for a surprisingly long time.

Contrary to popular belief, vegetarianism isn’t a modern idea. The ancient Greek mathematician and philosopher Pythagoras was a vegetarian, and in fact vegetarians used to be called “Pythagoreans” until the word vegetarian was coined in 1847. During all this time, meat-eaters have been insisting that vegetarianism is eccentric and unhealthy, and vegetarians have had no way to get the upper hand in the debate, except by outliving their critics, as George Bernard Shaw did (“It is nearly fifty years since I was assured by a conclave of doctors that if I did not eat meat I should die of starvation”).

Most Americans take a dim view of vegetarianism, for three reasons (one of which is sincere):
  1. They think vegetariansim means avoiding all foods that taste good or satisfy hunger.
  2. They imagine that a vegetarian diet makes people frail and sickly.
  3. They assume that vegetarianism is some kind of cult, and that all the people involved in it are weird.
That first objection is, of course, the real one. The other two are just excuses. Most people doubt that they could ever be happy eating vegetarian meals, but this by itself doesn’t sound like a strong enough argument against vegetarianism, so they feel a need to invent reasons why they shouldn’t be asked to try it. Hence the curiously vehement claims that vegetarians are not only less healthy than meat-eaters, but are also a bunch of neurotic misfits who should have outgrown their hippie phase by now. Jokes designed to illustrate both these points (“Vegetarians don’t live longer — they just look older!”) are heard whenever vegetarianism is up for discussion. But what a dopey pair of objections to raise! One is patently untrue, and the other is irrelevant.

The claim that vegetarianism makes people weak and unhealthy is simply too stupid to be worth discussing at any length. In a world where the sport of marathon-running is entirely dominated by Kenyan athletes operating on a training-diet of corn and chickpeas, it’s beyond me how anyone can still be clinging to the notion that only a meat-based diet can make a person strong and energetic. The evidence says that vegetarians are at least as fit and healthy as anyone else is, and probably more so.

The perception that vegetarians tend to have health problems could arise because some people don't pursue vegetarianism until they have some kind of health problem to deal with (I didn't). Still, studies of long-term vegetarians (such as the Seventh Day Adventists) keep finding that as a group they don't have more health problems than other people, and in fact seem to be better off in terms of many specific health problems (osteoporosis, for example). When populations of different countries are compared, those that eat the most animal foods have the highest rates of most serious chronic diseases, and those that eat the most plant foods have the lowest.

The other complaint, that vegetarians tend to be unacceptably strange people, is neither provable nor important. Even if we assume, for the sake of argument, that most vegetarians are weird — how exactly does that affect you? It hardly matters whether most vegetarians are weird people or not, because vegetarianism is not something you join, it’s something you do. Becoming a vegetarian doesn’t require you to change anything but your eating habits. You don’t need to become a member of a club, or sign a petition, or become an activist, or make a new set of friends. Nor, for that matter, do you need to attend weekend retreats, burn incense, meditate, gaze into crystals, or wear sandals woven from unbleached organic hemp. You don’t even need to adopt any particular moral stance about the treatment of animals. A decision to avoid eating meat does not necessarily reflect an attitude of solidarity with cattle, and it should not be assumed by meat-eaters that anyone who doesn’t eat meat is claiming moral superiority over those who do.

There are a lot of different reasons why people adopt plant-based diets, probably including some that I’ve never heard of — and what of it? It doesn’t matter to me why someone else makes particular dietary choices. If you don’t eat bananas, fine — I don’t need to know why not. If you can't stand asparagus, great — I'll have yours. It really shouldn't matter to you who else is a vegetarian, or why they made that choice, or what you would think of them if you knew them well.

Whatever might motivate someone to start eating plants instead of animals, the simple truth of the matter is that the diet we think of in America as "normal" is pretty sure to give you more calories and saturated fat (and less fiber and vitamins) than you would get from a plant-based diet. A meat-centric diet does give you more protein, but that isn't necessarily an advantage; most people get more protein than they need, and despite the popular belief that protein is entirely benevolent, consuming more protein than you need is not harmless. (Rather than letting the surplus protein go to waste, the body converts it to glucose; this process leaves behind toxic waste products such as ammonia and urea, which are believed to have harmful effects,
particularly on bones.)

But the real problem with a meat-centric diet is not so much what it includes but rather what it tends to leave out. A "well-balanced" diet needs to include a lot of fruits, vegetables, and nuts, whether you eat meat or not; the trouble is, if you eat a conventional American diet dominated by meat and dairy products, you end up not getting enough fruits, vegetables, and nuts. As a practical matter, the meat and cheese and processed corn-based products you're eating tend to crowd the produce out of your diet (which is why the American diet tends to be dangerously low in fiber and other beneficial substances that come primarily or entirely from plants). In theory, you can get enough plant foods into your diet without giving up meat; in practice, it rarely works out that way. The only people who really seem to eat a lot of vegetables are the people who aren't eating anything else.

Also, the meat and cheese and processed corn-based products which dominate the conventional American diet tend to be calorie-dense foods; it is very hard to eat that kind of diet and not gain weight. Vegetarians generally have an easier time keeping their weight under control.

It is, of course, possible to rig a vegetarian diet (or to rig your definition of vegetarianism) so that it becomes just as unhealthy as eating cheeseburgers all day. If you work at it hard enough, you can be a "vegetarian" (at least by your own definition) and still be eating junk. Still, if you want to make a dietary change that is far-reaching in its effects without being over-complicated, vegetarianism is your best bet. Compared to most diet plans, “eat plants” is pretty easy to remember.

The thing is, I don't actually believe that animal foods have to be utterly excluded from one's diet for health reasons, nor do I believe that achieving that would be a very practical goal, at least for me. I can't avoid all animal foods in all situations. I eat animal foods sometimes, mainly when no good vegetarian option is available to me; that's the way life goes. I don't think a piece of chicken is going to kill me. The problem is that, if I don't at least try to exclude animal foods from my diet, they inevitably come to dominate it. The only way I'm going to get enough fruits and vegetables in my diet is to try to eat entire meals that consist of fruits and vegetables and nothing else.


Vegetables

Vegetables typically contain lots of vitamins and fiber, and very little sugar or fat. In other words, vegetables are a marketing disaster.
Children tend to view the vegetable portion of their supper as a bitter pill, a feeling which their parents may secretly share. Because food preferences formed early in life have a tendency to last, many of us have never quite shaken off a childish reluctance to eat our vegetables. Why should we eat them, then?

Because they have what we need. Vegetables contain many beneficial substances, including vitamins, minerals, fiber, and anti-oxidants. Some vegetables are remarkably generous in this regard. A serving of chopped kale, for example, more than satisfies your vitamin A requirement for the whole day. Many vegetables also contain substances which are helpful in reducing LDL cholesterol and preventing cancer. When your mother told you to eat your vegetables, she wasn’t kidding around.

However, there is often a wide gap between what we need and what we want. If, despite being old enough to have type 2 diabetes, you have still not overcome a reflexive dislike of vegetables, it is worth investing some effort in learning to prepare them in a more appealing way. There is a bad old tradition of boiling vegetables until they have lost most of their color, texture, flavor, and vitamins. Please don’t take that approach. Try stir-frying them or cooking them in a bit of broth. Or try steaming them, and then flavoring them with a small amount of oil, or soy sauce, or lime juice, or something spicy. Try putting more vegetables (and less meat) in familiar recipes. Find some vegetable recipes you like. In particular, look for recipes from those parts of the world where meat is considered a luxury and much attention is lavished on vegetable dishes. Also, try vegetables that are new to you. Maybe there are some unfamiliar ones that you’d really like if you gave them a chance.

A point worth noting: fresh vegetables may not always be the best kind to buy. Very often, “fresh” vegetables have had to spend a lot of time in transit between the farm and your grocery store (particularly if they’re not in season locally), and they may have lost something along the way. Frozen vegetables, which are usually chilled down quite soon after being harvested, may actually retain more of their nutritional value than the kind-of-fresh vegetables in the produce section of your local grocery. If there is a farmer’s market in your area, you stand a better chance of getting fresh local produce that really is fresh, but failing that, frozen vegetables are well worth having around. Keep bags of several different varieties in your freezer, so that you’ll always have something handy.

Let me mention some vegetables that seem to be especially beneficial...

Peppers

Sweet, hot, or in between, peppers offer a variety of beneficial ingredients, including Vitamin C, Vitamin A, folic acid, and potassium. If they’re really hot, they also stimulate your endocrine system to release endorphins (hormones which make you feel good), and while I think it’s better to get your endorphins by working out, I think feeling good is a good idea.

Cruciferous vegetables

The plants of the mustard family, often called the cruciferous plants (the name refers to a cross-shaped structure in the flowers) provides us with a great many well-known vegetables, including:
  • Broccoli and cauliflower
  • Brussels sprouts and cabbage
  • Collards, mustard greens, and kale
  • Rutabaga, turnips, and radishes
  • Watercress
  • Bok choy
These vegetables are particularly rich in the natural anti-cancer agents known as phytochemicals. Many of them are also good sources of vitamins, minerals, and fiber.

Pumpkins, acorn squash, and sweet potatoes

These yellow-orange vegetables are rich in carotenoids — another kind of anti-cancer agent. Because of their carbohydrate content, however, you don’t want to get carried away with serving sizes. Sweet potatoes don’t have to be huge (and even if you’re stuck with a huge one, remember that you have at your disposal the technology required to cut them in half).

Tomatoes

Fresh tomatoes offer vitamins and fiber, but when they are cooked they release something extra: a powerful anti-oxidant known as lycopene, which has demonstrated cancer-fighting abilities. There is apparently something else in tomatoes, besides lycopene, which protects against cancer; a study of prostate cancer found that lycopene itself (taken as a pill) does reduce the risk of this disease, but whole tomatoes reduce it more.

Olives

Those who think that dietary fat is always bad, and who have figured out where olive oil comes from, like to warn the public against eating olives, on the grounds that olives are a high-fat food. Maybe so, but there are fats and fats, and olive oil is an especially healthy type of fat. It’s mostly monounsaturated, which means that it tends to promote a healthy lipids profile (that is, a low ratio of LDL to HDL).

The best olive oil is the “extra-virgin” grade — a phrase which, obviously, cries out for explanation. “Virgin” in this case means that the oil was extracted from a first pressing, and “extra” means that the pressing process was purely mechanical, and did not involve the application of heat or chemicals. Olive oil in this pure form provides beneficial extras, including Vitamin E and other anti-oxidants, as well as phytochemicals to fight cancer.


Fruits

For a long time after I was diagnosed, I assumed that I shouldn’t eat much fruit because fruit contained “a lot of sugar”. However, I didn’t get into my quantitative-thinking mode on this issue, and the embarassing truth is that I couldn’t have told you what I meant by “a lot of sugar”. I didn’t look up the numbers on various fruits to found out how they stacked up against other foods. As a result, I avoided fruit, but continued to eat foods which were just as bad as fruit in this regard, if not more so.

There is no question that fruits are high-carb foods; an apple provides almost no protein or fat, and about 22 grams of carbohydrate. But the apple also provides about 5 grams of fiber, so the effective carb count is more like 17 grams. In other words, the apple is roughly equivalent to a slice of bread in terms of its impact on your BG, but it provides beneficial ingredients (vitamins and cancer-fighting phytochemicals) that you probably wouldn’t get from a slice of bread. It will probably be more satisfying to you as well. If, like me, you tend to get hungry in mid-afternoon, you could do worse than to quell your hunger with an apple. (By the way, don’t peel that apple — the peel contains beneficial ingredients that you don’t want to discard.)

Berries are an especially good type of fruit, from the standpoint of diabetes management, because their high fiber content limits their impact on BG. Cranberries, blueberries, raspberries and strawberries are all rich in Vitamin C, folic acid, and potassium. Berries also contain phytochemicals and are strong antioxidants.

By the way, fruit juice is not the same, nutritionally, as whole fruit, because what you’re usually getting is the sugary nectar, with much of the fiber removed. Juice is more calorie-dense than whole fruit. Therefoer, when you drink fruit juice, drink it in small servings. There’s a reason why traditional juice glasses are small.


Nuts

Nuts, like olives, have been denounced as “fat factories” which all health-conscious persons should be avoiding like the plague. This is ridiculous. Although nuts and seeds are indeed high in fat, the fat is predominantly unsaturated. I eat a lot of nuts, particularly peanuts and almonds, and this has not elevated my lipids. On the contrary: my LDL cholesterol and triglycerides are now lower than they were when I was trying to avoid all high-fat foods.

Obviously you don’t want to go wild in terms of serving sizes, but nuts eaten in reasonable quantities are not by any means an unhealthy choice. A nice thing about nuts is that they are more nutritionally balanced than most other foods: in addition to the unsaturated fat, they also provide significant amounts of protein and carbohydrate.


Herbs

Several common herbs and spices (cloves, turmeric, bay leaves, cinnamon, and many others) are said to have a beneficial effect on type 2 diabetes, but it’s hard to say how much truth is in these claims. Most of them haven’t been investigated in any depth. They probably aren’t going to be, either. You can’t get a patent on bay leaves; why spend time and money finding out whether or not bay leaves are useful, if nobody’s going to get rich out of it? The best-studied of these herbs is cinnamon, but even in that case we are far from having a complete picture of what cinnamon can and can’t do for diabetes patients. As you cannot afford to wait for decades to see what researchers find out about these herbs (especially as researchers are largely uninterested in studying them anyway), you must either conduct your own experiments or forget the whole thing.

The only herb I want to discuss at any length is cinnamon, because it is the most promising of them. There is good (though certainly not definitive) evidence that people with type 2 diabetes can obtain significant benefits from it. Although cinnamon has long been alleged to increase insulin sensitivity, it was only recently that scientific evidence for this claim was gathered. It came about because of an accidental discovery. Richard Anderson at the US Department of Agriculture's Human Nutrition Research Center in Beltsville, Maryland, was studying the effect of various foods on BG, and was surprised to discover that foods containing cinnamon (such as apple pie) do not raise BG as much as would be expected from their carbohydrate content.

Investigation of this oddity resulted in the discovery that MHCP (a polyphenol compound found in cinnamon) is a kind of insulin mimic. MHCP activates insulin receptors, and it reinforces whatever insulin activity is already taking place in cells. At least, that is what has been observed in test tubes, but apparently it works within the body, too. Taking at least one gram of cinnamon daily (about half a teaspoon) has been found to increase insulin sensitivity. The consequences, demonstrated in a 2003 clinical trial involving type 2 diabetes patients, include reductions in glucose, and LDL cholesterol, and triglycerides (all of which are impacted by insulin action). In the study (which lasted for 40 days), BG was reduced by 20% on average, and in some cases by as much as 30%. This effect developed gradually over a period of a few weeks, and wore off gradually when patients stopped taking the cinnamon.

Admittedly, clinical studies of this kind do not always stand up well under further investigation, and it may turn out that the benefits of cinnamon are being greatly overstated here. On the other hand, you don’t have much to lose by trying it. Although some of the compounds in cinnamon could be harmful if taken in massive doses, a gram of cinnamon per day is considered safe, and it’s not even very expensive. You might as well give it a shot, and see if it helps. Take your cinnamon daily for a month, and see if your average BG that month is significantly lower than in previous months. If it is, great. If it isn’t, at least you know you gave it chance.

Of course, there is the problem of how to take in that much cinnamon. It’s a potent flavoring, after all. A light dusting of it on oatmeal is nice, and a hint of it in certain stif-fry dishes can work, but a gram of the stuff goes a mighty long way. Like cocoa, cinnamon is too bitter to get by on its own merits; it usually has to be surrounded by culinary distractors such as sugar and butter (which is too bad, because you really can’t start the day with a cinnamon roll and call it diabetes therapy). Find something that you can mix a lot of cinnamon into and still find palatable (perhaps peanut butter or yogurt). Better yet, see if you can find capsules of the stuff (some stores that specialize in health foods and supplements cary them).

By the way, I should mention that you really need to use cinnamon that is in powdered or stick form; cinnamon oil is not an acceptable substitute, because there is little or no MHCP in it.

My own experience with cinnamon was that, when I started taking it a few years ago, it seemed to reduce my BG (though not as dramatically as it reportedly does for some people). However, my BG was already pretty well under control; maybe that’s why cinammon didn’t make as big a difference in my case. (Two acquaintances to whom I recommended cinnamon said that it made a noticeable difference for them.) Eventually, with my diabetes essentially eliminated (my fasting averages have consistently been with in the normal range), I began to feel that there was no need for me to take cinnamon anymore, so I stopped (without any negative consequences). Now I'm not sure if I just fooled myself into thinking it was helping me earlier; BG is so volatile that you can never be sure whether or not you've correctly identified the reason for a change. But my feeling, for whatever it's worth, is that it did help me a bit, when I needed it, but I stopped needing it, because I had built up my insulin sensitivity.