The following blog is comprised of excerpts from an interview with a major Health magazine regarding The Diabetes Miracle, Diane Kress’ all inclusive book on preventing and controlling type 2 diabetes. It contains the core Miracle diet and lifestyle program that promises weight loss, blood sugar control on little to no medication and improvements in cholesterol, triglycerides, blood pressure, energy levels, and focus/concentration as well as all the information a person with type 2 diabetes NEEDS to gain control and knowledge of this controllable disease.
The Diabetes Miracle is available in hardcover and can be preordered in paperback for a December 19, 2012 release! http://www.amazon.com/The-Diabetes-Miracle-Prevent-Permanently/dp/0738216011/ref=tmm_pap_title_0
Can you talk about why you decided to write the Diabetes Miracle?
I never in my wildest dreams thought that I would one day find it necessary to rework the traditional diet for diabetes (the 50-55% carb, 20% protein, 30ish % fat diet) that had been the center of diabetes teaching since the ADA began the “Exchange List Diet” in the 1950’s. I am a registered dietitian, certified diabetes educator, have practiced for over 30 years (many of those years directing the nutrition component of Diabetes Centers in teaching hospitals), and have had type 2 diabetes for 15 years. I didn’t enter specialize in medical nutrition management of type 2 diabetes with the goal of becoming a trail blazer!
I taught “by the book” for over half my career….but I noticed something during those first 15 years. The patients I taught who were just diagnosed with type 2 diabetes…and those who had diabetes for years before I met them….seemed to be on a train with a one way ticket to acquire worsening blood sugar requiring more and different medications and a cohort of co-morbidities (elevated weight, cholesterol, triglycerides, blood pressure) that required increasing doses and stacked medications. No one ever really improved….despite following the prescribed diet and lifestyle program.
Somewhere in the back of my mind I thought that it had to be non-compliance. “There should be no way these patients did not lose weight, did not improve their blood sugar for more than a honey-,moon period, and got sicker with metabolic syndrome if they were living the program I taught them.”
During those first 15 years of my career…I practiced what I preached. I followed a 1200 calorie ADA, low fat/low cholesterol diet. I chose that particular calorie level because…dang it….I was gaining weight around the middle, despite my healthy diet and daily exercise. Guess what? I didn’t lose this weight on the 1200 calorie diet. I was never a saturated fat eater…I hadn’t eaten red meat or used butter since I was in elementary school…and yet my cholesterol began to rise. Over the years my once low blood pressure rose to normal and then….hypertension! The coup de grace was a diagnosis of type 2 diabetes at the age of 38. All of the while I had been diligent about diet and exercise…the calorie based ADA diet with exercise.
I began to collect data on my patients. Sure enough there was a commonality. Most had increasing indices of metabolic syndrome that progressively worsened on the traditional protocol.
A quote I’d read many times over the years began to worry me…”If you are lucky enough to live long enough with type 2 diabetes, you WILL require insulin.” It seemed to be true….and now that was my fate!
I spent years working with the diet…taking it apart to its components….reviewing the physiology of diabetes….reworking theories….collecting more data….updating research….until at last, I had a proto-type I wanted to test.
I was well respected in the medical/endocrine community (I’d been working with the physicians for many years). I left the teaching hospital that I had worked in for years and opened a private practice next to the most respected endocrinology group in the area. They were willing to offer their patients a choice: I could teach the standard diet for diabetes (many patients had lived it without results) or they could learn the new program I was working on.
My practice flourished! I kept clean data. I refined principles. I watched progress regarding objective markers: long term weight loss, fasting blood sugar, hemoglobin A1C, fasting insulin, total cholesterol, HDL, LDL, trigylcerides, and eventually Vitamin D, CRP. The endocrinologists were thrilled, and now I was seeing patients from cardiologists and endos from the tri state area.
My patients on the program flourished regarding all objective markers. AND…..they also told me over and over that they had more energy, less depression/anxiety, and looked younger and healthier than they had in years. Medication doses and types dropped. Many type 2’s on insulin were now on oral medication. Many oral medication patients required no medication. I was one of them!
The years passed. When I taught the program to over 3000 patients, I decided it was time to give the program to the world. My plan was to begin the program for those with metabolic syndrom….and The Metabolism Miracle was released in April, 2009. It is now sold around the world, is a NY Times Bestseller, was named the #1 diet book in the UK by the Daily Mail (serialized as a front page story over 4 days, January 2010), and is now licensed in 6 languages.
After writing its companion cookbook, it was time. The time to release The Diabetes Miracle. The Holy Grail of diabetes self- management books, it is an all inclusive lifestyle program for anyone with prediabetes or type 2 diabetes. It contains the core Miracle program but also covers all the components of information needed by someone trying to prevent or control type 2 diabetes.
In this time in world history, when obesity and diabetes have reached epidemic proportions, I am thrilled to be able to help the millions (over 100 million people in the US alone) who have prediabetes and type 2 diabetes with a program that works.
Can you provide an overview of the book and what the Diabetes “Miracle” really means?
Initially, I was not fond of the Miracle in the book’s name. My publisher thought it was a good choice as this is a very different management program for diabetes that gets amazing positive results. I actually fought to change the name! Then, I decided to run a focus group with my patients and asked them…if they could use one word to describe the program they were following to treat their diabetes/pre diabetes what would it be? Amazingly, the word MIRACLE was used more than any other. I sheepishly smiled and stopped the fight…and honestly, it is a miracle.
Through my research, and the research goes back to the 1950’s, metabolic syndrome (midline adiposity, elevated blood lipids, elevated blood pressure, elevated blood sugar) was a real phenomena. Uncontrolled, it could lead to atherosclerosis, overweight, hypertension, and type 2 diabetes.
The theory had always been….since the patients with metabolic syndrome get fat around the middle and the fat levels in their blood (cholesterol/triglycerides) rose over time….metabolic syndrome must be linked to excess calorie intake, inadequate physical activity, and excessive saturated fat intake. Thus began the birth of the calorie controlled, low fat, low cholesterol diet. If a diet was to be controlled with calories and fat….it was natural that protein and fat would have to decrease, which left carbohydrates to increase. Afterall, the macronutrient carbohydrate is low in calories (4 kcals/gram) and contains no fat/cholesterol.
A dietary intake that is high in carbohydrate intake will not work for metabolic syndrome and, in my opinion, was/is a major cause of the epidemics of obesity and type 2 diabetes.
As it turns out, those with metabolic syndrome develop an inherent imbalance of the fat gain hormone insulin. Excess insulin release causes increased fat deposition in the blood and on the body. Excess insulin, and increased fat storage, causes insulin resistance. Insulin resistance leads to an overworked pancreas. An overworked pancreas leads to type 2 diabetes. (WOW…that is basic, but gets the point across). The nutrient that causes insulin release = carbohydrate.
The core Miracle program takes 3 things into account:
1. Step 1 is a necessary 8 week “rest period” for the overworked pancreas/liver combination. Carb intake is kept to a level that allows for rest of metabolic mayhem
2. Step 2 is the reintroduction of carbohydrates based on the following factors
A. A specific amount of carb grams
B. Low glycemic index, low glycemic load of carbohydrates
C. Proper timing of carbohydrates throughout the day and even during the night
3. When you reach your desired weight, are on as little medication as possible to maintain excellent labwork and blood pressure, and you love the way you look and feel…the program continues….in maintenance fashion..with a true balanced diet. You cannot cure type 2 diabetes. You can control it…and the Diabetes Miracle does….but you need to respect your metabolism for life.
The Diabetes Miracle also spends much time on increasing physical activity as a method to control weight by utilizing blood glucose and minimizing insulin release. No gym required, I focus a lot on exercise that can be worked into a busy day.
The book covers labwork, diagnosis, complications, medications, case studies, real life Q&A, all the current medications, monitoring, blood sugar targets, insulin and insulin injection, treating hypoglycemia/hyperglycemia, sample menus and so much more. For the first time, a reader will really understand what metabolic syndrome (Metabolism B for ease), pre diabetes, and type 2 diabetes mean, how they relate, and how blood sugar, weight, and key health markers can be normalized.
The book was written for people with prediabetes and type 2 diabetes. Why the decision to address both groups?
Thankfully, we now know that there is often a period of time when fasting blood sugar is over the normal range, but is not yet high enough to be diagnosed as irreversible type 2 diabetes.
Back in the day, this stage was called “borderline diabetes” or “a touch of diabetes.” We now know that this period (fasting blood glucose 100-125mg/dL) is a last chance to stop the train speeding down the tracks to type 2 diabetes. It is no longer just a matter of time before type 2 “happens”….pre diabetes is a time where positive lifestyle changes can be made that can save the pancreas from burn out and prevent type 2 diabetes.
I am all about pro-activity and I now have a program that can actually change the health history and outcome for millions. (79 million Americans have pre diabetes). Following the Diabetes Miracle can help return fasting glucose and hemoglobin A1C into the normal range.
The very same program stops the progression of type 2 diabetes to a disease of multiple oral meds/injectables/insulin and complications can also stop the progression of pre diabetes to type 2 diabetes.
One of the things you take exception with is the American Diabetes Association’s daily carb recommendations. Can you explain why?
Answered previously regarding the 1950’s theory that the problem was one of calories, fat intake, lack of physical activity. But….after 60 years of data proving that this style diet DOES NOT WORK….it is time to use the current science and open our minds to an idea that does work. They need not reinvent the wheel…I invented it in The Diabetes Miracle. An endorsement of the program that is based in real science, has no downside and allows for objective measures of tremendous positive implications should be given and we should all work to do what we are here for…to promote the health and well-being of those with diabetes.
Are there other specific elements to the American dietary problem that is leading to the increased prevalence of type 2 diabetes or do you see it mainly coming from too many carbs over an extended period of time?
In the 1950’s and 1960’s, when the position was taken that the healthy diet should be low in calories and fat…the entire food line in the US changed. Low calorie, low fat, fat free products were everywhere and the “balanced diet” was changed to a “food pyramid” with carbohydrates at the base of the pyramid!
Since those changes were implicated…(fat free dressing, fat free potato chips, fat free ice cream, etc, etc along with large carb portions….NY size bagels, soft pretzels, sweetened drinks and sodas, large sandwich buns, fries, pizza, Mexican food)….foods contained more CARB than they should contain. Low fat foods are naturally higher in carb content and the portion sizes are off the chart!
All those with the genetic propensity for metabolic syndrome, pre diabetes, type 2 diabetes were doomed if they followed a high carb diet.
As if that were not enough, we added fuel to the fire with a more sedentary lifestyle (less outdoor play, less walking, less physical work and play) and a more stressful lifestyle.
I believe it’s a combination of large carb intake, refined carbs (high glycemic index/high glycemic load), lack of activity, lots of stress….superimposed on genes that cannot tolerate this lifestyle = obesity/metabolic syndrome, pre diabetes, type 2 diabetes.
As someone with type 2 diabetes, what specific knowledge of the disease helped you develop strategies to combat the disease and incorporate them into your book?
The fact that I was a registered dietitian who always specialized in metabolic syndrome and diabetes….for years before I developed type 2 diabetes….gave me an excellent perspective on the disease and the treatment. I was trained traditionally, practiced traditionally, lived the life…watched my patients and myself on a downward health spiral….and made it my mission in life to find the solution.
In step two, you recommend 11-20 carbs. Why so low?
Well, you have to begin realizing that Step Two follows 8 weeks of a low carb diet that is intentionally limiting carb intake to a point that dietary intake of carbohydrate foods and liver glycogen release cannot stress the pancreas for insulin release. (On Diabetes Miracle, we don’t count every carb gram ingested…incidental carb grams in primary proteins, fat, and neutral veggies are not counted so the program’s Step One is not carb free by any means).
After this rest period, I found that it is not prudent to progress to a glycemic load over 20 net carb grams, nor is it beneficial to have a carb intake per meal less than 11 grams. I worked and reworked this program until I found that 11-20 grams of lower glycemic index carbs gives excellent results; not too much to demand excess insulin, but high enough to keep the liver from releasing glycogen stores. This figure wasn’t chosen arbitrarily, it was chosen based on the outcome. Weight loss continues in Step Two as does continued improvements in labs and medication needs.
Are there any particular carb staples that you recommend people should try to incorporate to help them with a low-carb diet?
The Diabetes Miracle is not a low carb diet. It begins with a low carb Step (8 weeks) to rest the pancreas and liver…continues to an increased carb program (low glycemic index, low glycemic load) spread appropriately throughout the day…some people are using over 100 grams of net carb/day plus carb grams from “neutral” veggies, primary protein (nut butters, soft cheese), primary fats (nuts). Step 3 …the Step of Diabetes Miracle that one lives on….is part of a balanced diet! Remember the balanced diet before we became a country suffering from epidemics of obesity and type 2 diabetes. Step 3 is meant to provide about 35% carbs, lean protein, heart healthy fat, liberal neutral veggies!
After someone has gone through the three steps, you still recommend a varying but very low amount of daily carbs for everyone. What is the amount of fat and protein you recommend to people going forward once they graduate from the Diabetes Miracle?
See above answer. Step 3 is not a low carb diet. It is part of a truly balanced diet of healthy carb choices, lean proteins, heart healthy fats, liberal neutral veggies. In fact, the recommendation is about 33% carbohydrate, 33% protein, an 33% healthy fat! Now that is balance!
What is it about the Diabetes Miracle that stands out and is different from other diabetes programs?
The Diabetes Miracle lifestyle program promotes permanent sustainable weight loss, blood sugar improvement to normal levels on as little medication as possible, decreased LDL cholesterol, blood pressure, triglycerides and increased Vitamin D, HDL, energy, and quality of life.
This is what is different about the Diabetes Miracle!