This is one of the few good books around about how to tackle and heal diabetes – I have previously reviewed quite a few atrocious books on the subject, particularly those published by Reader´s Digest.

First, I will point out a few minuses about the book. Dr. Fuhrman is not yet privy to the new research regarding cholesterol and saturated fats; both kinds of cholesterol are necessary for our bodies, and when high cholesterol is found in persons with health problems, this is because the additional cholesterol is coming to the rescue. Low cholesterol can be deadly. Also, consuming cholesterol-containing foods does not affect our blood cholesterol (see the books mentioned at the end of the review). However, the author´s lack of knowledge about these points does not affect the excellence of the book.

It primarily addresses the problems endured by type 2 diabetes patients, though the author´s diet solution can also assist type 1 diabetes patients, and all others, too.

Dr. Fuhrman has worked with and assisted thousands of patients to reduce their weight and eradicate their diabetes; in fact, he advises hundreds of other doctors so they too can help heal their patients of the disease,

His system is based on the equation: “Your Health future (H) = Nutrients (N)/Calories (C). This means that one´s health is determined by the nutrient-per-calorie density of one´s diet, “When you eat more foods that have a high-nutrient density and fewer foods with a low-nutrient density your health will dramatically improve and your diabetes will melt away.”

He calls his diet “Eat to live”, and I see he is the author of a book of that name.

This book presents a fascinating, successful case history at the start of each chapter.

The author gives precise instructions regarding reducing and completely cutting out insulin and other medications.

The diet he recommends is a vegan diet, though one can eat a few non-vegan products, if desired. It is a vegetable-based diet composed mostly of “greens, beans, nuts and seeds”.

With this diet, there will be no highs or lows in blood sugar. The patient will be able to reduce medications in the first week, and typically by 100 % within six months. The need for insulin is eliminated, usually within the first week. The patient will gain a normal, lean body weight, a normal life span, the reversal of diabetes and prevention of diabetes-related complications.

“The bottom line is this; you can get rid of your diabetes, not just `manage` it.”

The author informs us that following a good diet and exercise plan as a remedy should not be labelled alternative medicine. “It is simply the way all properly educated doctors should be practicing. Everything else should be called malpractice medicine.”

I love Dr. Fuhrman´s strict, uncompromising attitude and statements, also as regards the necessity of exercise. “Exercise is your prescription of choice.” Type 2 diabetes is caused by too little exercise and too much fattening food. There is no excuse for not exercising. Time is not an excuse. “If you have time to take a shower, brush your teeth, and go to the bathroom daily, you can put aside ten minutes twice a day to exercise.” Walking up flights of stairs is the very best exercise.” He gives us precise, detailed instructions regarding other easy ways to exercise.

He calls his diet a “nutritarian” diet and compares it to the SAD (Standard American diet) – an appropriate name! The SAD consists of foods from low-nutrient, high-calorie processed foods, animal products, dairy products, and sweets; whereas natural plants such as vegetables and beans contain thousands of protective micronutrients, such as antioxidants and phytochemicals. “When we eat a diet rich in colorful plant foods, we glean a full symphony of nutritional factors that enable better cell functions and resistance to aging and stress.

“Micronutrients are nutrients that appear in trace amounts in foods but are essential for health and growth and that do not contain calories.”

The secret for losing weight and improving your health is not to count calories, but to focus on micronutrients. “True health lies in a high-quality diet – eating foods packed with micronutrients.”

He explains the difference between true hunger and toxic hunger.

He is a wonderful proponent for eating a vegan diet – we must eat more foods rich in vegetable protein and less of the foods with animal protein. He has devoted several pages to the advantages of going vegan.

We learn about resistant starch; this is difficult to digest, and the more resistant starch that reaches the colon undigested, the fewer calories are absorbed from that food. Calories from resistant starch are listed on the food labels, but almost 90% of those calories do not get absorbed and they do not raise blood sugar at all. Resistant starch is especially associated with one type of SCFA (short-chain fatty acids) called butyrate, which “offers a wide array of health benefits, including strong protection gainst colon cancer”. It improves diabetic glucose numbers the day after it´s eaten.

Beans are the very best source of resistant fibre, and the resistant starch found in beans powerfully reduces hunger.

The book contains recommended menus, including really good recipes.

It comprises much, much more than I have had space to mention, and I recommend it highly. It´s the best book on nutrition I´ve read for years!

Additional reading: 1) “Fat and cholesterol are good for you” – Uffe Ravnskov. 2) “The great cholesterol con” – Malcolm Kendrick ( )

I try to keep personal details out of my reviews--this is, after all, the internet. But I don't know how to review this, how to contribute to the discussion about it and get feedback about it, without getting personal and giving my context and with it the reasons for my deep skepticism and why I won't be trying Fuhrman's program. I was diagnosed with breast cancer about a month ago. I had to have a Pet Scan to make sure it hadn't spread--it hadn't, and my prognosis is excellent. But I couldn't complete the procedure the first time I tried. It requires consuming radioactive sugars at a low blood sugar after a fast of several hours. Mine was 313--normal should have been 70 to 110. I have diabetes. I do believe they call that a one-two punch. Because they needed to get the blood sugar down fast for the test and because I was going to soon start chemotherapy, they put me on insulin. So I've gotten a fast education on diabetes. I've met with a nutritionist, a diabetes educator and an endocrinologist. I'm telling you all this because I'm going to share what I've learned from them that makes me feel dubious about this book.

First, what Fuhrman recommends--his "nutritarian" plan, is basically a "Vegan" diet. He believes that ideally we should eat no meat, fish, poultry, eggs or dairy. His plan concedes enough to individual tastes to allow (very restricted and occasional) fish and poultry: one ounce three times a week. Now, I am convinced by what I've read that we Americans do consume far too much meat and dairy--especially high fat kinds--and too few vegetables. I'm on board with that. But I also suspect advocacy of vegetarianism and veganism has more to do with a social and political agenda than health. This is what Fuhrman has to say on the subject:

Humans are primates, and all primates eat a diet of predominantly natural vegetation. If they eat animal products, it is a very small percentage of their total caloric intake. (Page 133)

When we hear something over and over, starting when we’re young children, we accept it as true. For example, the myth that plant proteins are “incomplete” and need to be “complemented” for adequate protein is repeated over and over. (Page 145)

AND

For many years, most Americans incorrectly believed that only animal products contained all the essential amino acids and that plant proteins were incomplete. False. They were taught that animal protein is superior to plant protein. False. They accept the outdated notion that plant protein must be mixed and matched in some complicated way that takes the planning of a nuclear physicist for a vegetarian diet to be adequate. False.

I guess they never thought too hard about how a rhinoceros, hippopotamus, gorilla, giraffe, or elephant could become so big while eating only vegetables. Animals do not make amino acids from air; all the amino acids originate in plants. Even the nonessential amino acids that are fabricated by the body are just basic amino acids that are modified slightly by the body. So the lion’s muscles can only be composed of the protein precursors and amino acids that the zebra and the gazelle ate. Green grasses (or leafy greens) made the lion and are the mother of all the protein that built all the creatures on planet Earth. (page 234)

I find such reasoning breathtakingly idiotic. Yes, we and monkeys and apes are all primates. So what? Whales and dolphins and porpoises are all cetaceans. Do you have any idea how diverse the species are in that order? And their very different dietary needs? Humans have been hunters since the species began. We're omnivores--NOT herbivores. Our teeth and bowels are along those lines. We don't have multiple stomachs to break down grasses--we do have stomach acids to break down meat. Even if it were true that vegetarianism is the healthiest possible diet, his reasoning for it is specious.

Note, he recommends a supplement of "Long-Chain Omega-3 (EPA and DHA)"--found in fish. If his diet is optimal and natural for humans--why would it need supplements--one found precisely in one of the foods he tells us to avoid? I'd note I've also often seen that vegetarians should consume supplements of B-12--again, because you don't get that in plant food. Iron and calcium are better absorbed by humans through meat and dairy than through plant sources. Moreover, the vegetarians I know, even the vegan ones, are careful to get complete proteins--if not through eggs and dairy, then by soy and quinoa and by matching complimentary proteins--such as rice and beans. Furhman's plan includes beans, and often oats and forms of soy, and one recipe includes wild rice. It's just that considering his dismissal of the necessity I don't trust he does so enough. I used the SparkPeople site to run through the numbers of Day One of Furhman's plan, and this was the result and feedback:

Calories: 1,265
Fat: 52
Carbohydrates: 161
Protein: 46
Fiber: 39

Feedback:
Fiber, total dietary My Goal – 25-35 Today – 39
While a high-fiber diet has many benefits, too much fiber can cause problems. Eating more than 50-60 grams of fiber a day can interfere with nutrient absorption and cause digestive distress.

Protein My Goal – 60-136 Today – 46
Protein is an essential nutrient that does more than build muscles. It plays a role in cell repair, hormone production and fluid balance, to name a few. So pump up your protein intake to stay fit and healthy.

I had to run the numbers through SparkPeople because Furhman doesn't give the nutrition facts for his plan. And estimate amounts at times using the Meal Planning Guide given to me by my nutritionist, because Furhman eschews giving portions much other than for his recipes. This isn't the way I'm being told how to eat. For one, the calories are too low--at least for me. I'm told chemo is like running a marathon--I'm told to drink loads of water--and the nutritionist recommended 1,500 calories a day. (And I've read low calorie diets can lower your metabolism, sabotaging a diet.) I was also told to include not just 3 meals but a snack, and space them about 4 hours apart so as to not overload the pancreas. Furhman believes in only 3 meals a day to "rest the pancreas." My nutritionist said the carbs should be spread out evenly between breakfast, lunch and dinner, each of which should have about 50 to 55 grams of carbs each, with the snack about 15 grams. Fuhrman's breakfast the first day is 271 calories (38 grams), Lunch 448 (66 grams), Dinner 480 (40 grams). I'd add that given beans are categorized as a starch, it's hard to go vegan and yet follow the standard recommended diabetic diet. My nutritionist, for instance, recommended that if I want a meatless meal of grains and beans I also have some greek yogurt.

This also isn't an easy diet to follow--especially for someone new to the disease who has a busy life--whether as a person preparing food for themselves or a family. It can be overwhelming making changes when diagnosed with diabetes. It's much easier to make a veggie egg white omelet with toast or pour some Kashi GoLean cereal with soy milk and blueberries for breakfast, grill some fish or poultry for lunch or dinner with some rice, throw together a salad and steam some veggies. But preparing a 10 serving pot of soup of a dozen ingredients then figuring out what to do with the leftovers? (I tried making Dr. Fuhrman's "Famous Anti-Cancer Soup." It sounded tasty--but it did not go well. These aren't all easy recipes.) And much of his plan requires some out of the way (to say the least) and expensive ingredients--at least for many Americans, even if as a New Yorker I can find all of these: organic vegetables and fruits, wild rice, tofu, edamame, bok choy, white miso, nutritional yeast, coconut water, carrot and celery and pomegranate juice, date sugar, tahini, exotic mushrooms, ground flaxseeds, almond butter, hulled barley, wheat germ, lemongrass, black fig vinegar, riesling reserve vinegar, spicy pecan vinegar, Bragg liquid aminos, soy or hemp or almond milk. And VegiZest and MatoZest--sold on Fuhrman's own website for $18.75 for an 8 oz container.

I'm not saying vegetarianism isn't a valid, healthy life style for many--and superior to the usual American diet. I am saying I'm deeply skeptical it's optimal, and that people recommending it are doing so on solid evidence rather than their own deeply held personal beliefs that are often anchored by views on animal rights and the environment rather than nutritional and medical science. And given a choice between following the advice of a man trying to sell books, supplements and food additives, and the people on my medical team whose only interest is to get me healthy... well.

Diabetes is a scary disease--that's why the book caught my eye. But for that very reason, I'm not about to take chances with my health. And if not well managed, diabetes is dangerous--not something to experiment with from a book on your own without careful monitoring and cooperation from your doctor. So I find it scary that some diabetics might try this on their own.

There is some useful information here the medical professionals I've talked to agree with, which is why I'm not rating this even lower. For instance, the importance of diet, glycemic index and load. My nutritionist says the jury is out on organic food but if you want to be cautious, you could avoid the "dirty dozen" of the worst offenders--something Furhman pointed to. Both my endocrinologist and nutritionist encouraged me to eat more beans--and like Furhman, believe the supposed link between soy and cancer has been debunked. Exercise is key too, though I was encouraged to do mine after meals, not before as Furhman recommended. Notably my nutritionist agrees that for many Type 2s diabetes can be reversed--or more precisely made to go dormant so you become asymptomatic and can manage without medication--if you eat right and exercise. And people didn't need to follow Furhman's program (or go vegetarian) to do it.

Addendum: June 1, 2014: My most recent AC1 was 4.9--normal--and I was taken off all diabetes medications over a week ago and my fasting sugars remain below 95. I did this following the advice of my doctors and nutritionist--not Fuhrman. Notably as my weight went down so did my insulin dosage until it was down to nothing with Januvia remaining my only diabetes med. I've lost over 60 pounds--and from what I've read and been told, especially for newly diagnosed diabetics, it's possible to "reverse" the disease if you lose as little as ten percent of your body weight. Don't misunderstand--I'm not cured. Once you cross that threshold into diabetes there are changes on the cellular level currently irreversible. I haven't turned back the clock--I can't drink alcohol or eat sugary foods and expect to react like a non-diabetic. But I may be able to avoid the progression and complications of the disease through diet and exercise alone for the rest of my life--not a small thing.

It wouldn't surprise me if Fuhrman's program worked too. It's so restrictive, and for so many so unappetizing, many would lose weight following his guidelines and that might be enough--but it's not the only way to do this--as I've found. Portion (and carbohydrate) control goes a long way--even while eating plenty of Fuhrman's demonized animal proteins and vegetable oils. People looking to control the disease should know that. ( )