The Low-Starch Diabetes Solution Six Steps to Optimal Control of Your Adult-Onset (Type 2) Diabetes with the Science of Insulin Resistance and the Glycemic Load ROB THOMPSON, M.D. RECIPES BY DANA CARPENDER New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2010 by Robert Thompson, M.D. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-162160-1 MHID: 0-07-162160-1 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-162150-2, MHID: 0-07-162150-4. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETE- NESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contents Introduction 1 Part 1 The Toxin 1 A Gift from the Fertile Crescent 5 2 Lowering Blood Sugar the Old-Fashioned Way 9 3 Glycemic Load: The New Old-Fashioned Way 17 4 The Culprit, Revealed 37 5 The Highly Peculiar Effects of Dietary Starch 55 6 Sugar-Containing Beverages: Starch’s Slippery Mimic 65 7 The Starch-Vulnerable Individual: How Insulin Resistance Works 75 8 Things That Get Better When You Eliminate Starch 85 9 Kicking the Addiction 95 iii iv Contents Part 2 Six Steps to Optimal Control of Your Diabetes 10 Step 1: Purging Starch from Your Diet 111 11 Step 2: Inhibiting Starch Absorption 121 12 Step 3: Sensitizing Your Muscles to Insulin 129 13 Step 4: Getting Your Liver to Cooperate 143 14 Step 5: Making Up Any Insulin Defi cit with Insulin 153 15 Step 6: Optimizing Your Cholesterol and Blood Pressure 163 Part 3 Low-Starch Cuisine: Discovering a Tastier Way to Eat 16 Starch Substitutes That Taste Better than Starch, by Dana Carpender 173 17 The Art of Baking with Starch-Free Flours, by Dana Carpender 201 18 A Seven-Day Low-Starch Meal Plan 227 Appendix A: Metric Conversion Factors 235 Appendix B: References 237 Appendix C: Websites and Suggested Reading 243 Index 245 Introduction U ntil recently, doctors thought adult-onset diabetes was the same as childhood diabetes—that both were caused by lack of insulin. In the 1980s, scientists made the remark- able discovery that they’re entirely different diseases. Whereas kids with diabetes lack insulin, most adult-onset diabetics make plenty of insulin—often more than normal. The problem is that their bod- ies lose sensitivity to it. Now doctors refer to the disease that young people get as type 1 diabetes and to the kind that middle-aged adults get as type 2-diabetes. This book is for people with adult-onset, or type 2, diabetes. In times past, the diagnosis of diabetes had tragic implications. Children and young adults with type 1 diabetes often wasted away and died from it. Insulin, when it came along in the 1920s, was the miracle drug for these patients. It allowed them to live normal lives. In those days, the troubles of middle-aged and older folks with type 2 diabetes seemed minor compared with young people with type 1 diabetes. Adult-onset diabetics could live for years with hardly any treatment at all. They could usually get their blood sugar down to reasonable levels by just taking some pills and watching their diet. Doctors rarely prescribed insulin for these patients; they fi gured it wasn’t worth the trouble. In the 1990s, new research showed that while patients with type 2 diabetes rarely died as a direct result of their diabetes, their 1 2 Introduction mildly elevated blood sugar levels—if these went on long enough— could result in damage to their eyes, kidneys, and blood vessels, and the attendant increase in heart attack rate was alarming. As a result, doctors started taking adult-onset diabetes more seriously, treating it as they would type 1 diabetes, using stronger pills and insulin when necessary to get blood sugar levels as close to normal as possible. In 2008, researchers released the results of two large studies on the effects of this more vigorous approach to treating adult-onset diabetes. The results were disappointing. Heavier doses of insulin helped patients avoid eye and kidney damage but did little to reduce the rate of heart attacks. What worked for patients with juvenile diabetes didn’t work as well for people with adult-onset diabetes. Those results are not really surprising, considering that type 2 diabetes is a completely different disease from type 1. It has differ- ent causes, results in different complications, and requires a differ- ent approach to treatment. The goal of treating type 1 diabetes is simple: replace the missing insulin. Type 2 diabetes is more compli- cated. The body becomes resistant to the effects of insulin, which not only raises blood sugar but brings on cholesterol, blood pres- sure, and weight problems that cause as much trouble as the high blood sugar does. This often requires a multipronged approach to treatment. The good news is that you can live to a ripe old age without suffering any health problems from your type 2 diabetes. When the nineteenth-century sage George Bernard Shaw said the secret to good health is to get a chronic disease and take good care of it, he might as well have been talking about adult-onset diabetes. When you do what you need to do to treat it, you reverse many of our modern lifestyle’s harmful effects on your health and general well-being. Indeed, you might fi nd yourself feeling better than you have for years. This book will give you six simple steps to follow that should give you excellent control of your type 2 diabetes. First, however, it is important to understand the logic behind its treatment. Once you see what brought on your condition, you will know exactly what you need to do to reverse it. Part 1 The Toxin This page intentionally left blank 1 A Gift from the Fertile Crescent A bout ten thousand years ago, something happened near the eastern edge of the Mediterranean Sea that changed the course of history. Like all prehistoric people, the inhabitants of that region were hunter-gatherers. They lived on wild game and vegetation. However, they had become so effi cient at hunting animals and gathering vegetation that they began to deplete their food supply. To thrive, they needed a new source of calories. They found one in an area that encompassed parts of modern Syria and Iraq known as the Fertile Crescent. The Fertile Crescent had a unique climate. The summers were so hot and dry that they were deadly for most vegetation, but the winters were temperate and moist—ideal for plant growth. Those conditions fostered the evolution of a particular kind of plant, one that could mature fast enough during short growing seasons to drop its seeds before being killed by the scorching summers. The wild ancestors of wheat and barley fl ourished in the Fertile Crescent. The secret of their success was their seeds. 5