Over one hundred years ago, Louis Pasteur stated, “Whenever I meditate on a disease, I never think of finding a remedy for it, but rather a means of preventing it.”(1) Many great scientists and researchers have sought to follow this advice. Since this process of preventive measures began, many dietary elements have been identified as important factors for the prevention of disease. Additionally, many diseases can be directly traced to specific dietary consumption; in this study, I have focused on type II diabetes and its accompanying risks. In the following pages, an alternate diet will be introduced as a viable option to assist in the prevention and cure of adult-onset diabetes, along with other factors. Both the positive and negative effects of diet change will be discussed as well as recent research conclusions regarding this alternative plan of care.

The American Diabetes Association defines diabetes as a “chronic disease in which the body does not produce or properly use insulin.”(2) Insulin, the hormone that permits the passage of glucose into the cell, is manufactured in the pancreas. Because insulin converts sugars, starches, and other foods into energy, diabetics suffer many additional risks. Diabetes is an endocrine disorder with no known medical cure; it is the fourth leading cause of death by disease in the United States.(3),(4) However, diabetics typically do not die from diabetes; instead, they die from complications, like heart attacks and kidney diseases.(5) In 1994 alone, the American Diabetes Association estimated that more than 160,000 Americans would die from the disease and its related complications.(6) There are two forms of diabetes — childhood (type I) diabetes and adult-onset (type II) diabetes; both involve the inability of the body to metabolize carbohydrates.(7) Normally, when high levels of glucose are available, the pancreas produces and releases insulin into the blood. Insulin attaches to the cell membrane, triggering a cell response on the molecular level to accept glucose. In effect, this process lowers glucose levels and efficiently prevents cellular starvation.

In juvenile (type I) diabetes, the pancreas is unable to produce adequate amounts of insulin for the metabolism of glucose. Even though glucose is present, the cell receives no energy from carbohydrates, because glucose can not enter without the presence of insulin. This condition results in high levels of glucose within the blood and inadequate energy for the cells to perform necessary cellular functions. When insulin is introduced into the bloodstream, the glucose enters the cells immediately and the blood sugar levels drop to normal. Because of this innate insulin deficit, type I diabetics are dependent on insulin injections throughout life. Classic signs of juvenile diabetes include frequent urination, unquenchable thirst, excessive hunger, sudden weight loss, weakness and fatigue, reduced concentration and coordination, blurred vision, and irritability.(8) Only five percent of all diabetics fall into this category, however; the remaining ninety-five percent have adult-onset (type II) diabetes.(9)

For type II diabetics, insulin is not unavailable, but only inaccessible. The pancreas often produces adequate to excessive levels of insulin.(10) Even though the levels of both glucose and insulin are high, the glucose is unable to enter the cell because of interference. A closer look reveals that insulin can be paralyzed by two factors—obesity or high fat content in the diet. Though surrounded by plenty of glucose, cells continue to starve because insulin is inactivated. Consumption of the typical American diet hinders not only natural, but also injected, insulin.(11) Symptoms of adult diabetes may include any of those experienced by type I diabetics, as well as recurrent infections (especially skin, gum, or bladder infections), numbness in the hands or feet, and retarded healing when bruised or cut.(12) Elevated sugar levels in both the urine and the blood reveal the presence of this disease.

Adult-onset diabetes is more prevalent in urban areas, especially in those who moved from a more rural environment. Women, as well as African-Americans, Mexicans, Puerto Ricans, Hispanics, and Pima Indians, are also more susceptible.(13) The change to a Western diet seems to precipitate many instances of non-insulin-dependent diabetes. For example, more than half of all American Indians are affected by diabetes. In one year period (between 1989 and 1990), diabetic complications were directly related to killing more than 60 percent of the Pima Indians in Arizona.(14) Although many cases of type II diabetes can be controlled with a healthy diet and strenuous exercise, these factors are not readily available on many reservations. One researcher found that Pima Indians have few opportunities to acquire fresh fruits and vegetables. Food staples, provided by the U.S. Department of Agriculture, typically have high-sugar, high-fat, and low-fiber contents.(15)

Primary causes for type II diabetes have been related to nutrition and lifestyle choices.(16) Though genetic factors may play a role, diet and exercise are probably more likely causes. Research has indicated that obesity triples the risk of developing type II diabetes.(17) Insurance companies confirm that overweight persons demonstrate greater risks for major diseases, particularly diabetes, arthritis, cardiovascular and gallbladder disease, and surgical complications.(18) Schroeder confirmed, “More obese people are diabetic than are thin people.”(19) This may explain why so many Americans are diabetic; a 1996 survey revealed that 74% of all Americans over twenty-five years of age are overweight.(20) Rubenstein reported similar figures among type II diabetics—seventy to eighty percent are obese.(21)

Diabetes mellitus is not an isolated disease, but rather a gateway to other diseases. Diabetics face higher risks for heart disease, stroke, kidney disease, hypertension, and blindness.(22) Amputations are sometimes necessary due to the complications of diabetes, including gangrene.(23) In both types of diabetes, hyperglycemia is evident and carries additional risks of its own. As the cells starve, the hormones released cause higher levels of glucose in the blood.(24) Glycogenolysis, lipolysis, and gluconeogenesis are utilized to provide more glucose from glycogen, fats, and other sources such as protein.(25) This breakdown complicates the situation by increasing glucose levels and the formation of ketone bodies. In turn, the high levels of ketones lower the physiological pH, causing the blood to become acidic. Acidity interferes with aerobic processes required to sustain life; these processes include the tricarboxylic acid cycle, pyruvate dehydrogenase complex, and the respiratory chain.(26) Failure to recognize and control diabetes often follows this pattern to diabetic acidosis, which results in confusion, unconsciousness, and potential death.(27)

Of the estimated thirty million diabetics worldwide, over half currently reside in the United States.(28) According to Hans Diehl, another American is diagnosed with diabetes every sixty seconds. Interestingly, eighty percent of the world’s population has no clinical diabetes [blood glucose levels above 115 points].(29) The diagnosed diabetics in the United States can be divided into three approximately equal groups, experimenting with three alternate treatment plans. One group uses regular insulin injections, though scientific research has not demonstrated that the injections prevent vascular complications. In 1995, 300,000 deaths among diabetics were directly traced to such vascular complications. Another group consumes special prescription drugs, which were first introduced in 1950. Although these drugs seem to help the diabetic regulate blood sugar levels temporarily, they also increase the likelihood of heart attacks by 250%.(30) The final group of diabetics in America enjoy a high-protein diet, known to increase the medical risks of the diabetic and cause greater susceptibility to kidney disease. As a result, the average diabetic has a risk for kidney disease eighteen times higher than a non-diabetic.(31) These statistics indicate that current medical options available to diabetics have several disadvantages. These include failure to cure the disease, frustrating ineffective results, and limited relief of symptoms.

The primary form of treatment used for diabetics involves the injection of insulin. This treatment, though, was not available until recent years. Before the introduction of insulin for human use, it was common for diabetics to die from diabetes-related comas.(32) In 1921, Banting and Best first extracted insulin from the pancreas of a dog. Later, Collip produced an adequately pure form of insulin for human use. It was not until 1955 that Sanger identified the structure of insulin. Ten years later, insulin was developed through protein synthesis. Techniques of genetic engineering were utilized in 1981 to manufacture insulin, the first genetically engineered hormone used in the treatment of human disease.(33)

Without adequate treatment, a diabetic’s life span is generally one-third shorter than a non-diabetic.(34) However, if adequate treatment is available and glucose levels are kept within safe ranges, diabetics can live “normal” lives. Type I diabetics, as well as some type II diabetics, require additional insulin to stabilize glucose levels. A diet rich in complex carbohydrates, with limited simple carbohydrates, divided into more numerous smaller meals, has been proven effective for diabetics who wish to avoid overloading their insulin supply. In these ways, concerned individuals can actively participate in their own cure.

Type II diabetics are not limited to insulin treatments, since only 40% actually benefit from added insulin.(35) As a result, many have chosen to make lifestyle changes in order to maintain better health. Medicine cannot cure any disease; it can only control the symptoms of the disease. As a result, medicine alone—in this case, insulin—does not seem to be the best choice. For the type II diabetic, healthy choices regarding both diet and exercise can provide freedom from the restraints and risks of adult-onset diabetes.

For many years, researchers and physicians have recognized that diet directly affects physical health.(36) Dietary trends in the United States over the past fourteen decades reveal significant shifts in American eating patterns, confirming the connection between diet and overall health. In 1860, the typical American diet could be classified in the following manner: 53% complex carbohydrates, 25% fat, 12% protein, and 10% simple carbohydrates.(37) In 1900, the nation’s death rate from diabetes was 1.84 per 10,000 individuals; by 1922, this figure had increased to 9.17.(38) The American diet at this time included 37% complex carbohydrates, 35% fat, and 16% simple carbohydrates; protein consumption remained unchanged since 1900.(39) By 1990, this ratio had changed drastically, as several factors shifted – 42% fat, 24% simple carbohydrates, 22% complex carbohydrates, and 12% protein. In 1990, the number of deaths directly attributable to diabetes had climbed to 47.7 per 10,000 individuals.(40) From these data, it is evident that protein and fat consumption increased, along with simple carbohydrates, while complex carbohydrate intake decreased. Nutrition experts from the U.S. Departments of Agriculture and of Health and Human Services have concluded that Americans generally eat too much food and, specifically, too much fat, cholesterol, sugar, and salt.”(41) These American dietary trends have resulted in numerous undesirable medical conditions, as acknowledged by the Senate Select Committee on Nutrition and Human Needs. Due to the prominence of obesity, diabetes, heart attacks, high blood pressure, and tooth decay in American society, the Committee recommended a 30% reduction of fat calories, and a 45% reduction of calories from refined sugars, along with other recommendations.(42) The dietary changes in America from 1900 to the present parallel the increase of deaths from diabetes in the United States.

Because of this obvious correlation between diet and diabetes, and the confirmation that countries with rich diets have more instances of diabetes, some individuals consider diabetes to be a self-induced disease. As seen in the following studies, fat intake is directly related to an increase in diabetic risk. Felber gave five men with normal glucose and insulin levels a lipid infusion, raising their levels of free fatty acids to levels considered “normal” for the typical American. Within two hours, the men were diabetic even though their insulin levels had increased fifty percent.(43) Sweeney performed a similar experiment with four different groups, divided by type of diet – (1) high protein, (2) high fat, (3) no food, and (4) high carbohydrate. After two days, the individuals in the first group were classified as borderline diabetics; those in the second and third groups were also clearly diabetic. Only those in the group consuming a high carbohydrate diet had maintained normal glucose levels.(44) In another study, Anderson utilized two diets to determine whether diabetes was more closely linked to sugar or fat intake. His control group ingested a diet of 80% sucrose and 5% fat, while the other group consumed foods resulting in a diet of 20% sucrose and 65% fat. At the end of two weeks, those with increased fat intake had high levels of triglycerides, in addition to the characteristics of diabetes. No subjects in the control group ever developed diabetes throughout the course of the study, even though the experiment was continued for eleven weeks. Anderson’s research confirms that fat, not sugar, is a primary factor leading to adult-onset diabetes.(45)

One classic example of the effect of the Western diet on type II diabetics was observed by Burkitt on the pacific island of Nauru, where both diabetes and hypertension were nonexistent. When the inhabitants became the most affluent per capita in the world (due to the discovery of phosphates), they adopted a western diet. Fifteen years later, 30% of Nauru’s inhabitants had developed diabetes and 60% showed hypertension. One Australian researcher noticed that aborigines who relocated to the cities—and subsequently consumed a typical western diet—developed heart disease, hypertension, and diabetes, along with other diseases not present among their counterparts in less populated areas. Ten type II diabetic aborigines were put on a 13% fat diet, like their rural counterparts. Within seven weeks, their diabetes had been reversed.(46)

Since evidence indicates that diabetes can be reversed, it can certainly be prevented. Dietary changes can also reduce the incidence of other Western diseases. For example, Walker proposed that a low-fat, high-fiber diet would result in low occurrences of diabetes, as well as atherosclerosis, appendicitis, gallstones, and certain forms of cancer.(47) Additional studies have confirmed that this reversal of diabetes is directly linked to dietary intake. As early as 1935, Rabinowitch proved that limiting fat intake could actually reverse diabetes. One hundred insulin-dependent diabetics were divided into two equal groups; the first group maintained the popular diabetic diet (56% fat), while the second group reduced fat intake to 21%. After five years, 24% of those on the low-fat diet no longer needed insulin, compared to 8% on the high-fat diet. In the low-fat group, those who still needed insulin had reduced their intake by an average of 58%.(48) Twenty years later, Singh placed eighty newly-diagnosed diabetics requiring insulin on an sugar-free, 12% fat diet. Six weeks into this study, 62% were off all insulin; after eighteen weeks, 72% were no longer diabetic.(49) Singh stated, “On a very low fat diet, the insulin produced by the body begins to exert its curative effect within days. Most people…are totally cured.”(50) A more recent study at the University of Colorado confirmed the effect of increased dietary fat on diabetes. They concluded that eating an extra forty grams of fat daily (as found in a four-ounce fast-food hamburger and large fries) triples one’s risk for diabetes.(51)

In addition to fat intake, carbohydrate levels also affect the development of diabetes. Kiehm discovered that a high carbohydrate diet, including sufficient amounts of dietary fiber, was effective for diabetics who needed less than thirty units of insulin daily.(52) When a diabetic eats a low-fat, low-sugar, high-fiber diet, the absorption of sugar into the bloodstream is slowed. As a result, the amount of insulin needed must be reduced by two or three units daily. Even individuals who needed insulin for ten years previously became insulin-independent after making these lifestyle and diet changes.(53)

Christine Beebe, the American Diabetes Association vice president, stated, “Diet is the cornerstone of diabetes therapy.”(54) However, many different types of diets have been recommended for diabetics throughout history. In 1550 BC, a high carbohydrate diet was recommended for diabetics by the Ebers Papyrus.(55),(56) By the late 1700s, animal products were encouraged, while plant-based foods were eliminated.(57) In the past few years, the American Diabetic Association has recommended a 60% high-carbohydrate diet with low fat intake while protein content should not exceed 20% of the diet.(58) The four goals of a diabetic include the following: (1) Maintenance of blood sugar levels, (2) Maintenance of blood triglyceride levels, (3) Good nutrition, and (4) Proper weight maintenance.(59) The foundation of the diabetic diet is based on a low-fat, high carbohydrate, and high-fiber diet.(60) To reverse diabetes, more natural foods must be consumed. A diet low in sugar and fat while high in grains and fiber assists in the reduction of diabetes and its symptoms. In one six-year study of 65,173 American women, those who consumed the most fiber and the least amount of refined foods decreased their risk to develop diabetes 2.5 times. Refined foods increase glucose levels, placing more stress on the pancreas to produce more insulin.(61),(62) In the fourth century BC, Hippocrates wisely stated, “To the human body it makes a great difference whether the bread be made of fine flour or coarse, whether of wheat with the bran or without the bran.”(63) The father of modern medicine recognized long ago what many Americans today fail to understand: that fiber, especially as found in whole grains, is essential for good health and well-being. In addition to diabetes prevention and reversal, whole grains are also filled with other essential nutrients that promote good health.

Because diabetes mellitus is most common among populations with low fiber intakes, Trowell theorized that diabetes was a fiber deficiency disorder as early as 1975.(64) Since that time, other researchers have proven that increased fiber can significantly prevent or slow the development of diabetes.(65),(66) As a result, the American Diabetic Association recommends 25-50 grams of fiber daily for diabetics.(67) Other individuals, like Dr. James Anderson, believe that the “ideal” diabetic diet would include as much as 70 grams of dietary fiber per day.(68) If adequate soluble fiber is consumed, it lines the stomach and small intestine, shielding starches and sugars from digestive enzymes, preventing sugars from being released into the blood rapidly and irregularly. In diabetics, this allows moderate blood sugar levels to be maintained more efficiently.(69) Dietary fiber also lowers triglyceride levels and blood pressure.(70) Fiber from whole grains—besides reducing the risk of heart disease and cancer—may actually prevent or reverse diabetes by maintaining moderate blood-glucose levels.(71) Other dietary factors which should be considered by diabetics involve the reduced consumption of refined foods. Fats and oils should also be avoided as much as possible.

Specific foods such as onions, legumes, broccoli, and some spices are extremely beneficial for the diabetic. For centuries, onions have been used to control diabetes, although its effects are not understood clearly. Some researchers have hypothesized that onions assist in liver metabolism by affecting the rate of insulin release—or by decreasing the rate at which the insulin is destroyed within the body.(72) In 1923, it was confirmed that onions actually suppress blood glucose levels.(73) Legumes also regulate insulin levels. Anderson has demonstrated that consumption of adequate quantities of beans (especially soybeans) can give type II diabetics insulin independence; type I diabetics with similar eating patterns reduced their need for insulin by 38%.(74) Navy beans, another type of high-fiber legume, were found to lower blood glucose levels and cholesterol levels.(75) Broccoli was found to activate insulin in another study performed by Anderson, who attributed this factor to chromium.(76) Anderson also discovered that cinnamon, cloves, turmeric, and bay leaves increased insulin activity three times, causing reduced blood glucose levels.(77),(78) Buckwheat and millet were found to increase the rate of glucose metabolism also.(79),(80)

Although diet is an important factor, exercise has also proved necessary for the type II diabetic. Other studies indicate that diabetics who exercise regularly exhibit more stable glucose levels than those who do not. This has led some researchers to conclude that non-diabetics could possibly prevent type II diabetes through regular physical activity.(81) Rubenstein recommends twenty to thirty minutes of exercise three times weekly; this exercise should maintain fifty to seventy-five percent of the individual’s maximum heart rate.(82) In one particular study involving 6,000 men, evidence supported this hypothesis. When 500 extra calories were burned through exercise, they decreased their risk of developing diabetes by 6%.(83) Since exercise causes the cells to demand glucose, they respond more readily to glucose even if inadequate levels of insulin are present.(84) Those who exercise also increase their number of insulin receptors, contributing to a further reduction of blood glucose levels.(85) Regular exercise is therefore essential in controlling diabetes; it is not an option.(86),(87) As early as 600 BC, Sushruta recommended exercise to assist his diabetic patients in managing their disease.(88)

One professor at the University of Texas stated, “Eighty-five percent of adult-onset diabetes could be controlled through diet and exercise alone.”(89) Barnard confirmed the importance of such lifestyle changes.(90) Though genetic factors can contribute to some individuals developing diabetes, data suggest that diet and exercise primarily suppress or allow the demonstration of such genetic tendencies.(91) Since evidence clearly indicates that lifestyle changes can prevent many diseases, it is surprising that the general public is so unconcerned about such information. Even diabetics report difficulty in adhering to diet plans.(92) Until the reasons for the aversion to healthy eating and regular exercise are removed, the health of the unconcerned will continue to deteriorate. Interestingly, it is not physical symptoms that cause the majority of people to refuse these lifestyle changes, but rather preference. As Dr. Denis Burkitt wisely stated, “Health is not determined by doctors or medicines; health is determined by the way we live.”(93)

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(1)Norman Temple, Ph.D., and Denis Burkitt, M.D., Western Diseases: Their Dietary Prevention and Reversibility (Totowa, New Jersey: Humana Press, Inc., 1994), p. viii.

(2)The Concise Columbia Encyclopedia, c.v. “Diabetes.” Columbia University Press, 1995.

(3)Neil A. Campbell, Biology, 4th edition (Menlo Park, California: Benjamin/Cummings Publishing Company, Inc., 1996), p. 930.

(4)The World Almanac and Book of Facts 1995, c.v. “Health: Diabetes.” Funk and Wagnall’s Corporation, 1994.

(5)Jane Heimlich, What Your Doctor Won’t Tell You. New York: HarperCollins Publishers, 1990, p. 177.

(6)The Concise Columbia Encyclopedia, c.v. “Diabetes.” Columbia University Press, 1995.

(7)P. William Davis, et.al., The World of Biology, 4th edition (Orlando: Saunders College Publishing, 1990), p. 736.

(8)Virginia Messina, M.P.H., R.D., “Diabetes and a Vegetarian Diet.” Originally published in the Vegetarian Journal Reports, 1990. The Vegetarian Resource Group. http://envirolink.org/arrs/VRG/diabetes.html (22 Dec. 1997).

(9)Campbell, p. 930.

(10)Messina.

(11)Beling, Stephanie, M.D. “Triumphing over Type II: If You’ve Got Diabetes, Go Veg and Get Moving.” Vegetarian Times, March 1994; no. 199, pp. 108-110.

(12)The Concise Columbia Encyclopedia, c.v. “Diabetes.” Columbia University Press, 1995.

(13)Arthur H. Rubenstein, “A 64-year-old Man with Adult-Onset Diabetes.” JAMA, 11 Sept. 1996; vol. 276, no. 10, pp. 816-822.

(14)Karen M. Sandrick, “The Wisdom of the Old Ways.” Hospitals and Health Networks, 20 Feb. 1997; vol. 71, no. 4, p. 42.

(15)Ibid.

(16)Julian Whitaker, M.D., Dr. Whitaker’s Guide to Natural Healing (Rocklin, California: Prima Publishing, 1995), p. 222.

(17)Rubenstein.

(18)Microsoft Encarta, c.v. “Obesity.” Funk and Wagnall's Corporation, 1994.

(19)Charles Roy Schroeder, Ph.D., Fat is Not a Four-Letter Word. Minneapolis: Chronimed Publishing, 1992, p. 185.

(20)Kenneth Cooper, M.D., M.P.H., Advanced Nutritional Therapies (Nashville: Thomas Nelson Publishers, 1996), p. 295.

(21)Rubenstein.

(22)Beling.

(23)The World Almanac and Book of Facts 1995, c.v. “Health: Diabetes.”

(24)Microsoft Encarta, c.v. “Diabetes Mellitus.” Funk and Wagnall’s Corporation, 1994.

(25)Elaine Marieb, R.N., Ph.D., Human Anatomy and Physiology, 2nd edition (Redwood City, California: Benjamin/Cummings Publishing Company, Inc., 1992), p. 567.

(26)Peck Ritter, Biochemistry: A Foundation (Pacific Grove, California: The Brooks/Cole Publishing Company, 1996), pp. 448-463.

(27)The Concise Columbia Encyclopedia, c.v. “Diabetes.” Columbia University Press, 1995.

(28)According to Rubenstein, up to sixteen million diabetics are American.

(29)Hans Diehl, Dr.H.Sc., M.P.H., C.N.S. Disarming Diabetes. Videocassette. Better Health: New Beginnings Series, 1995.

(30)Ibid.

(31)Ibid.

(32)Microsoft Encarta, c.v. “Diabetes Mellitus.” Funk and Wagnall's Corporation, 1994.

(33)Microsoft Encarta, c.v. “Insulin.”

(34)Ibid.

(35)Kate Lorig, et.al., Living a Healthy Life with Chronic Conditions (Palo Alto, California: Bull Publishing Company, 1994), p. 242.

(36)J. B. Clegg, “Travels with DNA in the Pacific.” The Lancet, 15 Oct. 1994; vol. 344, no. 8929, pp. 1070-1072.

(37)Diehl.

(38)The People’s Chronology, c.v. “Medicine, 1922.” Henry Holt and Company, Inc., 1994.

(39)Diehl. Actually these statistics are 1925 figures.

(40)U.S. Bureau of the Census, Statistical Abstract of the United States 1993, 113th edition (Washington, DC, 1993).

(41)Microsoft Encarta, c.v. “Nutrition, Human.” Funk and Wagnall's Corporation, 1994.

(42)Microsoft Encarta, c.v. “Nutrition, Human.” Funk and Wagnall's Corporation, 1994.

(43)Nathan Pritikin with Patrick M. McGrady, Jr., The Pritikin Program for Diet and Exercise (New York: Grosset and Dunlap, 1979), p. 357.

(44)Ibid.

(45)Pritikin, pp. 357-358.

(46)Ibid.

(47)A. R. P. Walker, “Diet and atherosclerosis.” Lancet (1955), pp. 565-566; quoted in Temple and Burkitt, p. 35.

(48)Pritikin, p. 358.

(49)Ibid, p. 359.

(50)Diehl.

(51)Jean Carper, Food—Your Miracle Medicine (New York: HarperCollins, 1993), p. 420.

(52)Pritikin, p. 359.

(53)Diehl.

(54)Shankar Vedantam, “Diabetes and Vegetarian Diet.” PCRM: Physicians Committee for Responsible Medicine. http://www.sai.com/pcrm/diabetes.html (22 Dec. 1997).

(55)Messina.

(56)Carper, Food—Your Miracle Medicine, p. 415.

(57)Messina.

(58)Rubenstein.

(59)Messina.

(60)Ibid.

(61)Salmeron, Jorge, et.al., “Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women.” JAMA: The Journal of the American Medical Association, 12 Feb. 1997; vol. 277, no. 6, pp. 472-477.

(62)Holly McCord, “Time for the Whole-Wheat Switch.” Prevention, Sept. 1997; vol. 49, no. 9, pp. 52-53.

(63)Temple and Burkitt, p. 2.

(64)Hugh C. Trowell, “Dietary fiber hypothesis of the etiology of diabetes mellitus.” Diabetes 24 (1975), pp. 762-765; quoted in Temple and Burkitt, p. 321.

(65)A. I. Vinik and M. A. Jenkins, “Dietary fiber in management of diabetes.” Diabetes Care 11 (1988), pp. 160-173; quoted in Temple and Burkitt, p. 322.

(66)Council on Scientific Affairs, American Medical Association, “Dietary Fiber and Health.” Journal of the American Medical Association 262 (July 28, 1989), p. 542-546.

(67)“Dietary Fiber.” Harvard Women’s Health Watch 3 (Sept 1995), p. 2.

(68)Messina.

(69)“Dietary Fiber.”

(70)Mark Kestin, et. al. “Comparative effects of three cereal brans on plasma lipids, blood pressure, and glucose metabolism in mildly hypercholesterolemic men.” American Journal of Clinical Nutrition 52 (1990), p. 661.

(71)McCord.

(72)Carper, Food—Your Miracle Medicine, p. 421.

(73)Jean Carper, The Food Pharmacy (New York: Bantam Books, 1988), p. 249.

(74)Ibid, pp. 133, 274.

(75)Earl Mindell, R.Ph., Ph.D., Earl Mindell’s Food As Medicine (New York: Simon and Schuster Publishing, 1994), p.141.

(76)Jean Carper, The Food Pharmacy Guide to Good Eating (New York: Bantam Books, 1991), p.242.

(77)Ibid, p. 230.

(78)Mindell, pp.116, 120.

(79)Ibid, p.107.

(80)Edward M. Wagner, M.D., and Sylvia Goldfarb, How to Stay Out of the Doctor’s Office (New York: Instant Improvement, Inc., 1992), p.117.

(81)“Diet and Exercise in Non-insulin-dependent Diabetes Mellitus.” National Institutes of Health Consensus Statement Online, 9-10 Dec. 1986; 6(8): 1-21. http://www.mesomorphosis.

com/nih_diet.html (22 Dec. 1997).

(82)Rubenstein.

(83)Artemis P. Simopoulos, M.D., et.al., Genetic Nutrition: Designing a Diet Based on Your Family Medical History (New York: MacMillan Publishing Company, 1993), p. 147.

(84)“Diet and Diabetes.” PCRM (Physicians Committee for Responsible Medicine) FactSheet. http://www.envirolink.org/arrs/essays/diabetes.html. (22 Dec. 1997).

(85)Marilynn S. Arnold, et. al., “Guidelines versus Practice in the Delivery of Diabetes Nutrition Care.” Journal of the American Dietetic Association, Jan 1993; vol. 93, no. 1, pp. 34-39.

(86)“Diet and Diabetes.” PCRM FactSheet.

(87)Mike Raymond, The Human Side of Diabetes (Chicago: The Noble Press, 1992), p.69.

(88)Michael A. Weiner, Ph.D., Maximum Immunity (Boston: Houghton Mifflin Company, 1986), p.127.

(89)Geralda Miller, “Managing Diabetes with Diet Changes.” The Daily Campus Online, 28 Jan. 1997. http://sdc.htrigg.smu.edu/HTMLPage/DC.01-28-97-n.diabetes.html (22 Dec. 1997).

(90)Carper, Food—Your Miracle Medicine, p. 418.

(91)Ibid.

(92)Arnold, et. al.

(93)Medical Training Institute of America, “How to Greatly Reduce the Risk of Common Diseases.” Basic Care Bulletin 2 (1990), p. 21.