Nuts & Seeds for Reversal of Diabetes and Obesity
By Joel Fuhrman, M.D. www.drfuhrman.com
Epidemiologic studies show an inverse association between frequency of nut consumption and body mass index. Interestingly, their consumption may actually suppress appetite and help people get rid of diabetes and lose weight.1
In other words, people consuming more nuts and seeds are likely to be slim, and people consuming fewer seeds and nuts are more likely to be heavier. Well controlled nut-feeding trials that looked to see if eating nuts and seeds resulted in weight gain found the opposite—eating raw nuts and seeds promoted weight loss, not weight gain. Several studies also have shown that eating a small amount of nuts or seeds helps dieters feel satiated, stay with the program, and have more success at long term weight loss.2
Because nuts and seeds are rich in minerals and fiber and have a low glycemic index, they are favorable foods to include in a diet designed for diabetics and even the obese. Researchers from Harvard noted that people eating one ounce of nuts five times a week reduced their risk of developing diabetes by 27 percent.3
“Vegan” Diet For Diabetes?
The features of a diet that make it diabetic-favorable are not adequately described by the word “vegan.” There are lots of vegan foods and vegan diets that would be diabetic-unfavorable, especially the inclusion of lots of oil, finely ground grains, and foods made from white flour and white potato. The aspects to be considered before calling a diet maximally favorable for diabetics are:
- overall calories and weight loss results;
- amount of fiber consumed per meal and micronutrient diversity and completeness;
- glycemic index of the meals;
- antioxidant and photochemical index; and
- satiety and removal of food cravings and addictions.
In the vegan diabetic study entitled “A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes,” published in the August 2006 issue of Diabetes Care, the word “vegan” did not adequately describe the features of the diet that made it favorable because they were careful to remove all vegetable oils and white flour products. If they called it a “high-fiber, low-fat, vegan diet,” it would have been more descriptive of the diet used.
The diet tested was a significant improvement over the diet the vast majority of vegans eat, but it still was not an ideal diet, and the results, even though much better than a traditional ADA diet, still suffered because of the imperfect design for a diabetic patient. In this study, only 21 of the 49 patients in the vegan intervention group were able to reduce their diabetic medications. I consider those results only fair. If the micronutrient density or phytochemical index and other favorable features above were considered, the menus and recipes would more resemble my diabetic dietary recommendations, and much more dramatic results would have been possible.
Typical vegan diets do not show dramatic improvements in lipids, triglycerides, glucose, or weight loss. One important design feature for better health is the reduction of high-starch vegetables and grains and the replacement of those calories with nuts and seeds. For example, another representative study done on a low-fat vegan diet showed women on a low-fat vegan diet lowered LDL cholesterol 16.9 percent4 while a similarly done study including nuts and seeds (following the dietary guidelines I recommend) dropped LDL cholesterol 33 percent.5 For protection from all types of heart disease, apparently a vegan diet with the inclusion of raw nuts and seeds is simply a much healthier diet. However, the reduction in grains, and the inclusion of more green vegetables and low-starch vegetables in place of the grains and starchy vegetables, plays a much more dramatic role in the lipid-lowering benefits and weight loss, as well.
The beneficial results of this diet-style are dramatic and enable the diabetic to dramatically reduce or eliminate medications. This is so important because certain diabetic drugs interfere with weight loss and can prevent achieving a complete recovery. When the diabetic diet is more carefully designed with the addition of nuts and seeds, patients are able to stop insulin and sulfonylureas (primary offenders restricting weight loss) as soon as possible.
Extremes in fat intake should be avoided. One to two ounces of nuts and seeds in a diet add about 150-300 calories from fat. If it were a 1600 calorie diet, their inclusion would increase the fat intake of a vegan diet from 10 percent to a more favorable 20 percent. It is even more important for children, people who are thin, who exercise a lot, and who are pregnant or nursing to consume sufficient fat. The healthiest diet for all ages is one that includes some healthful fatty foods. This diet will prevent and reverse disease. There is no need for a person with heart disease to move to a special type of extremely low-fat vegan diet, void of raw seeds and nuts, thinking this restriction is necessary or valuable for their cardiac health.
Weight Loss Risks
The main risk of weight loss is weight re-gain after the weight is lost. Dietary improvements that are not maintained are of no long-term benefit, and rapid weight gain is health unfavorable. The other most likely risk from weight loss is the formation of gallstones or cholelithiasis.
My experience is that people losing weight following my brand of nutritional excellence or Eat To Live have an extremely low rate of gallstone formation. Certainly, the formation of gallstones and the possibility of requiring a laparoscopic removal of one’s gallbladder is still a reasonable price to pay for losing 40 to 140 pounds of life-threatening body fat. Nevertheless, it is important to note that the inclusion of raw nuts and seeds in the diet, especially while losing weight, is important to protect against gallstone formation. Nuts are rich in several compounds that protect against gallstone disease.
As reported in the American Journal of Clinical Nutrition, when 80,718 women from the Nurses’ Health Study, who were 30-55 years old in 1980, were followed for 20 years, it was found that the consumption of nuts and seeds offered dramatic protection against gallstone formation. Women who consumed five ounces of nuts per week had a dramatically lower risk than did women who only consumed them rarely. Further adjustment for fat consumption (saturated fat, trans fat, polyunsaturated fat, and monounsaturated fat) did not alter the relation.6 These findings were duplicated studying a cohort of men.7
I believe the reason that I have not observed a high rate of gallstone formation in the hundreds of my patients who have dropped 50 to 150 pounds, and thousands of people around the country who have lost similar amounts of weight with my Eat To Live approach, is that I include nuts and seeds in the program. Though it is difficult to ascertain who might be at higher risk for stone formation, it is wise to include at least one ounce of raw nuts and seeds in any weight loss program to at least offset this real risk of healthy weight loss.
Fat Deficiency and Failure To Thrive
For many people, the undue emphasis on extremely low fat intake has resulted in health difficulties, and many individuals following such recommendations have not thrived on a vegan or flexitarian diet. Most often, they never realize what the problem is and go back to eating large amounts of animal products again, not realizing they were fat deficient on their low-fat vegan diet. They might have developed dry skin, thinning hair, muscle cramps, poor sleep, and poor exercise tolerance. For most of these individuals, eating more healthful fats, taking DHA, and eating less starchy carbohydrates clears up the problem. Some people simply require more essential fatty acids, both omega-6 and omega- 3, than others.
Many members of DrFuhrman.com report that their prior high-starch, low-fat diet had derailed their weight loss, caused high triglycerides, and prevented their cholesterol level from coming down. Insufficient fat in the diet also can compromise the absorption of fat-soluble vitamins and healthful phytochemicals. When you eat a nut- or seed-based dressing on a salad, you absorb much more of the carotenoids in the raw vegetables. More than 10 times as much of certain nutrients is absorbed. A study detecting blood levels of alpha-carotene, beta-carotene, and lycopene found negligible levels after ingestion of salads with fat-free salad dressing, and high levels after the same foods were eaten with fatty dressings.8
A Daily Menu
When we look at two daily menus of equal calories, one with and one without nuts and seeds, we see some subtle but important nutritional differences.
You can see that the menu with nuts and seeds is higher in protein and much higher in the amino acid arginine. Arginine has special properties that benefit the heart, promoting vasodilatation and preventing blood clotting. But even the higher amounts of protein, vitamin E, and minerals do not adequately reflect the major difference, which is that the menu without nuts and seeds greatly retards the absorption of most of the carotenoids and other phytochemicals contained in the meals. They simply are not well absorbed in such a low-fat environment.
Remember, it is best to eat nuts and seeds raw or only lightly toasted. When you roast nuts and seeds, you form carcinogenic acrylamides as the food is browned, and you decrease the protein and create more ash. The more it is cooked, the more amino acids are destroyed. You also lower levels of calcium, iron, selenium, and other minerals in the roasting process.
The health properties of nuts and seeds notwithstanding, it is important that they not be overeaten. Don’t sit in front of the TV and eat an entire bag of nuts in an hour. Healthful eating means avoiding excessive calories and not eating for recreation. Eat only an ounce a day if you are significantly overweight; but if thin, physically active, pregnant, or nursing, eat two to four ounces according to your caloric need.
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6. Tsai CJ; Leitzmann MF; Hu FB; Willett WC; Giovannucci EL. Frequent nut consumption and decreased risk of cholecystectomy in women. Am J Clin Nutr. 2004; 80(1):76-81.
7. Tsai Cj: Leitzmann Me; Hu FB; et al. A prospective cohort study of nut consumption and the risk of gallstone disease in men. Am J Epid 2004; 160(10): 961-8.
8. Brown MJ; Ferruzzi MG; Nguyen ML; et al. Carotenoid bioavailability is higher from salads ingested with full-fat than with fat-reduced salad dressings as measured with electrochemical detection. Am J Clin Nutr. 2004; 80(2):396-403.