Dietary Protocols to Maximize Disease Reversal and Long-Term Safety
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AJLXXX10.1177/1559827615580971American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine 580971research-articleXXXX vol. XX • no X American Journal of Lifestyle Medicine Joel Fuhrman, MD Dietary Protocols to Maximize Disease Reversal and Long-Term Safety Abstract: This article covers some favorable diet for successfully health, cellular repair, and immune important concepts and controversies reversing obesity and type 2 diabetes. function. in modern nutritional science. It 2. The lifestyle medicine approach Using the presence or absence of describes a diet style designed to versus a drug-centered approach to animal products as the distinguishing maximize health, longevity, and most effectively and safely treat and characteristic is a narrow and disease reversal—foundationally reverse diabetes and heart disease. unsatisfactory way to characterize a diet structured on the quality and 3. Understand the potential risks of an designed to maximize health and comprehensive adequacy of unsupplemented low-fat vegan diet, disease reversal. A nutritarian diet style, nutrients rather than the balance of and how to prevent them. designed to maximally support health macronutrients, as is more popular today. I call such a diet, which attempts to optimize micronutrients, Americans consume about 55% of a nutritarian diet. I will review a calories from refined foods and small case series demonstrating typical results in diabetics and some approximately 30% of calories from of my clinical observations over the last 25 years treating people with animal products . a nutritarian diet, which could be either vegan or flexitarian. I will also discuss health concerns observed I divide food generally consumed into and longevity in a diverse population from an unsupplemented vegan diet, 4 main categories: produce, whole base, has 4 distinguishing specifically the risk of depression and grains, refined or highly processed foods, characteristics. later life dementia in individuals and animal products. Americans with enhanced need for long-chain consume about 55% of calories from 1. It strives to be high in micronutrients omega-3 fatty acids. refined foods and approximately 30% of per calorie. It achieves this with calories from animal products, with only increased consumption of nutrient- Keywords: nutritarian diet; omega-3; about 15% of calories from a rich plants, such as greens, berries, depression; dementia; diabetes combination of whole grains and seeds, and other colored produce. produce. This small amount of produce, 2. It strives to be hormonally favorable, Three Primary especially greens, mushrooms, onions, avoiding excess hormones that can Learning Objectives seeds, colorful vegetables, and fruits, promote aging and disease, especially leads to an overall deficiency in insulin and IGF-1. 1. To understand nutritional micronutrients, especially antioxidants 3. It strives to be nutritionally considerations in designing the most and phytochemicals necessary for normal adequate, comprehensively, using DOI: 10.1177/1559827615580971. From the Nutritional Research Foundation, Flemington, New Jersey. Address correspondence to Joel Fuhrman, MD, Nutritional Research Foundation, 4 Walter Foran Blvd, Suite 409, Flemington, NJ 08822; e-mail: [email protected]. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2015 The Author(s) 1 American Journal of Lifestyle Medicine Mon • Mon XXXX supplements when necessary to assure optimal levels of vitamin D, Table 1. vitamin B , iodine, zinc, 28 12 Glycemic Load of Common Foods . eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), based Food Glycemic Load Food Glycemic Load on dietary history, and when available, blood work. White potato 29 Rolled oats 13 4. It strives to avoid food containing White rice 26 Whole wheat 11 toxins, contamination, and infectious agents. White pasta 21 Mango 11 Chocolate cake 20 Lentils 9 It is well established that modest micronutrient insufficiency is ubiquitous Corn 18 Apples 9 and can lead to DNA damage, Sweet potato 14 Kiwi 8 mitochondrial decay, and telomere decay. If we classify phytochemicals as a Grapes 14 Green peas 8 form of micronutrients, because of their relation to immune function, disease protection, and longevity, then we must classify almost all Americans (both Hormonal Favorability: diabetes and heart disease but has vegetarians and meatatarians) as Insulin and Insulin-Like pro-angiogenic and cancer-promoting 19-23 micronutrient deficient, especially Growth Factor-1 (IGF-1) effects. For example, in a meta- regarding micronutrients derived from analysis of 39 studies, a high glycemic 1-10 green vegetables. Furthermore, we have to consider the load was associated with increased risk I present the equation H = N/C to second principle of a nutritarian diet— of colorectal and endometrial cancers,21 portray the basic principle that to hormonal favorability. It has become and a meta-analysis of 10 prospective maximize healthy life expectancy (H) increasingly evident that higher levels of studies demonstrated a link between we have to eat a diet rich in IGF-1 are linked to increased early life higher glycemic load and breast micronutrients (N) per calorie (C). My mortality, higher incidence of cancer, and cancer.24,25 Another study demonstrated ANDI (Aggregate Nutrient Density premature aging, including aging of the for every 100 grams of white rice Index) is a useful tool to help visualize brain.11-14 It is also well established that consumed per day, breast cancer risk the high concentration of diets with excessive amount of animal increased 19%, whereas the same micronutrients in greens and other protein elevate IGF-1, and that optimally amount of whole grain, brown rice, or colored produce compared with animal low levels are not achieved until a beans had almost the direct opposite products and processed foods. It significant reduction in animal products effect.26 utilizes over 30 separate nutritional is maintained in the diet. However, the High glycemic processed foods are so parameters to estimate a food’s overall exact percentage of calories or amount disease-causing, recent research suggests level of micronutrients per calorie. This of animal products below which would their promotion of heart disease is even has been demonstrated to be effective optimize IGF-1, and whether a higher more powerful than saturated fats from in increasing the sales and consumption IGF-1 might be more favorable in the animal products, a chilling concern of nutrient-rich produce, in Whole elderly, is yet to be determined.15-17 More considering all the white bread, white Foods Market. details about various protein sources and rice, and white potato products However, this is not all you need to varying animal protein and plant protein consumed by populations around the know to devise a diet with maximal intake to achieve favorable IGF-1 in all world and in this country.27 Table 1 health benefits, because some foods with decades of life is not the topic of this provides the glycemic load of common only a moderate nutrient density have presentation. However, studies foods. salient features that make them valuable demonstrate that with more than 5% to Consider white potatoes as an example for disease resistance. For example, 10% of calories from animal products of a high glycemic carbohydrate, with a mushrooms and flax seeds contain IGF-1 can rise significantly.18 favorable caloric density. The Nurses’ powerful anti–breast cancer components, There is also an overwhelming amount Health Study demonstrated an 18% not adequately appreciated in their of evidence that excessive production of increased risk of diabetes for each potato aggregate nutrient density score, and insulin in response to high glycemic eaten daily by overweight women. likewise nuts, though calorie-dense, have foods is disease-promoting and Notably, the glycemic load of potatoes cholesterol-lowering and other lifespan-shortening. Elevated insulin rather than the added or associated therapeutic benefits. does not merely increase risk of butter or oil was implicated.29 2 vol. XX • no X American Journal of Lifestyle Medicine arm to increase their intake of whole Table 2. grains by the same amount. A clear Starch and Fiber Fractions in Selected Food.28 benefit occurred for adding more whole grain, but more dramatic benefits Resistant Starch (%) Resistant Starch + Fiber (%)13 occurred for the addition of beans from individual baseline (Table 3).32 Black beans 27 70 Beans are not merely glycemically Navy beans 26 62 favorable themselves, but their fermentation and prebiotic effects lower Lentils 25 59 the glucose absorption from other foods Split peas 25 58 in the diet. These glucose-lowering benefits occur not merely in the meal Corn 25 45 eaten with the beans but later as well when no beans are eaten. This has been Brown rice 15 20 called the “second-meal effect.”33-35 Beans Rolled oats 7 17 have multiple benefits for favorable glycemic response, weight reduction, and Whole wheat flour 2 14 anticancer effects. Across a broad Pasta 3 9 spectrum of different regions and ethnicities, beans/legumes were found to Potato 3 5 be the most consistent and reliable predictor of longevity. An 8% reduction in death was reported for every 20 grams (2 tablespoons) of beans eaten daily.36 Ominously, data from the North Carolina diabetics, as meat, sweets, and high There are numerous anticancer Colon Cancer Study, with more than