 Did you ever wonder if the food you eat has a direct effect on your health, well-being, and longevity? Well, I'm here to end that mystery. You are the food you eat. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger. Today we look at the best way to control diabetes, starting with the remarkable results of a crossover study randomizing hundreds of people with diabetes to one and a third cup of millet every day. How does millet come to the help of diabetics? A substantial portion of the starch in millet is resistant starch, meaning resistant to digestion in our small intestine, so providing a bounty for the good bugs in our colon. All way more than more common grains like rice or wheat, but proso and codo millet lead the pack. What's going on? The protein matrix in millet not only acts as a physical barrier, but actually also partially sequesters your starch-munching enzyme, and the millet polyphenols can also act as starch blockers in and of themselves. Millet also has a markedly slower stomach emptying times than other starchy foods, and if you eat white rice, boiled potatoes, or pasta, your stomach takes about an hour to digest it before you're starting to slowly dump it into your intestines, and two or three hours to empty about halfway. Whereas you eat sorghum or millet, and stomach emptying doesn't even start until two or three hours. I mean, take five hours to empty even halfway. Note this was for both a thick millet porridge or for just like millet couscous. So since the non-viscous millet couscous meal was also equally slow in emptying, this suggests there may just be something about millet itself that helps slow stomach emptying, which should blunt the blood sugar spike, but you don't know until you put it to the test. And indeed, millet caused about a 20% lower surge in blood sugar than the same amount of carbs in the form of rice. Remember how excited I was to show you how it only took the body, like half the insulin, to handle sorghum compared to a grain like corn? Well, millet did even better. Give a group of pre-diabetics only about three-quarters of a cup of millet a day, and within six weeks their insulin resistance dropped so much their pre-diabetic fasting blood sugars turned into non-pre-diabetic blood sugars. This so-called self-controlled clinical trial, the same subjects before and after, that's just a sneaky way of saying an uncontrolled trial. There was no control group that didn't add the millet or added something else, and we know just being in a study under scrutiny can cause people to eat better in other ways. So we don't know what role, if any, the millet itself played. What we need is a randomized controlled crossover trial where the same people eat both a millet-containing and non-milit-containing diet and see which works better. And here we go, a randomized crossover study having hundreds of patients both doing American Diabetes Association-type diet with or without about one and a third cup of millet every day, and the millet-based diet lowered the hemoglobin A1c levels, meaning an improvement in long-term blood sugar control, along with some side benefits like lowering cholesterol. The target for good blood sugar control recommended by the American Diabetes Association is an A1c less than seven. They started out at an 8.37, but after a few months on millet, dropped to an average of 6.77. Is it just because they lost weight or something? No, suggesting that it was in effect specific to the millet. But they didn't just give millet. They mixed the millet with split black lentils and spices, and we know from dozens of randomized controlled experimental trials in people with and without diabetes that the consumption of pulses, meaning beans, split peas, chickpeas, or lentils, can improve long-term measures of blood sugar control like A1c levels. So, while the researchers conclude that millets have the potential for a protective role in the management of diabetes, a more accurate conclusion might be a mix of millet and lentils can be protective, though, hey, maybe the spices help too. They didn't say which ones they used, and I couldn't get hold of the authors, but a similar study done by one of the same researchers included about a tablespoon a day of a mixture of fenugreek, coriander, cumin, and black pepper with a fifth spice, perhaps a cinnamon or turmeric. In our next story, we look at the reason why professional diabetes associations recommend being chickpeas, but being lentil consumption as a means of optimizing diabetes control. How did doctors treat diabetes before insulin? Almost a thousand medicinal plants were described as anti-diabetic agents, most of which have been used in traditional medicine, and these included beans. Of course, just because something's been used for centuries doesn't mean it's safe. Other treatments for diabetes have included arsenic and uranium. Thankfully, many of these remedies fell by the wayside, but scientific interest in the anti-diabetic potential of beans never vanished completely and even was raised in the past decade. Health authorities from all over the world universally recommend increasing the consumption of whole grains and legumes for health-promoting diets. And one of the reasons is that they may decrease insulin resistance, the defining trait of type 2 diabetes. Diabetes is a global public health epidemic, although oral hypoglycemic medications and injected insulin, or the mainstay treatments of diabetes and are effective in controlling high blood sugars, they have prominent side effects and fail to significantly alter the course of diabetic complications. Common side effects include weight gain, swelling, liver disease, but I want to emphasize the second part. The mainstay of diabetic treatment fails to significantly alter the course of diabetic complications. Shouldn't that be the whole point of treatment? Thankfully, lifestyle modifications have proven to be greatly effective in the management of this disease, and if there's one thing diabetic should eat, it's legumes, beans, chickpeas, split peas, and lentils. The European Association for Study of Diabetes, the Canadian Diabetes Association, and the American Diabetes Association all recommend the consumption of dietary pulses as a means of optimizing diabetes control. What are pulses? They're peas and beans that come dried, so a subset of legumes, so excluding green beans and fresh green peas, which are considered more like vegetables, and also excluding the so-called oil seeds, soybeans, and peanuts. This review compiled 41 randomized controlled experimental trials, including more than 1,000 patients, corroborating the official Diabetes Association nutrition guidelines, recommending the consumption of pulses as a means of optimizing diabetes control. Any better than any of the others? Well, some of the strongest evidence came from the studies that used chickpeas. And in terms of beans, pentose and black beans made beat-out kidney beans, compared to the blood sugar spike of straight white rice, black beans and rice, and pinto beans and rice, appeared to beat out kidney beans and rice. This may be because dark red kidney beans can have lower levels of indigestible starch. One of the reasons beans are so healthy is they contain compounds that partially block our starch-digesting enzyme, which allows some starch to make it down to our colon to feed our good gut bacteria. In fact, the inhibition of the starch-eating enzyme amylase, just by eating beans, approximates that of a carb-blocking drug called a carbosoldus precoce, a popular diabetes medication. The long-term use of beans may normalize hemoglobin A1C levels, which is how you track diabetes, almost as well as the drug without drug side effects with names like acute generalized exanthematous postulosis. Finally today, we look at the best diet for diabetes prevention. There are all sorts of different scoring systems to rate diet quality. My favorite for its simplicity is the dietary phytochemical index, a fancy name for a simple concept. It's just the percentage of your calories from whole plant foods, so 0 to 100. The average American diet has a score of 12, 12 out of 100, so like on a scale of 1 to 10, our diet is a 1. You can split people up based on how they score and show how the higher you score, the better your metabolic markers when it comes to diabetes risk. There appears to be like this stepwise drop in insulin resistance and insulin-producing beta cell dysfunction as you eat more and more plant-based, and that highest group was only scoring about 30. Less than a third of their diet was whole plant foods, but better than the lowest, which was down around the standard American diet. No wonder. Diet centered around plants, emphasizing legumes around beans, split peas, chickpeas, and not those whole grains. Vegetables, fruits, nuts and seeds, and discouraging, most or all animal products, are especially potent in preventing type 2 diabetes, and as a little bonus, has been associated with much lower rates of obesity, hypertension, hyperlipidemia, cardiovascular mortality, and cancer. And not just preventing type 2 diabetes, but treating it as well. A systematic review and meta-analysis found that the consumption of vegetarian diets is associated with improved blood sugar control, but how much improved? Here's one of the latest trials. The effect of a strictly plant-based diet centered around brown rice was done in Asia, versus the conventional diabetic diet on blood sugar control of patients with type 2 diabetes, a 12-week randomized clinical trial. For the diabetic control diet, they set up food exchanges and calculated specific calorie and portion controls, whereas on the plant-based diet, people could eat as much as they want. That's one of the benefits. The emphasis is on food quality rather than quantity, and they still actually lost more weight. But even after controlling for the greater abdominal fat loss in the plant-based group, they still won out. Of course, it only works if you actually do it, but those that pretty much stuck to the healthier diet dropped their A1c levels 0.9%, which is what you get taking the leading diabetes drug, but of course only with good side effects. Yeah, but would it work in an underserved population? The impact of a plant-based diet support program on mitigating type 2 diabetes in San Bernardino, the poorest city of its size in California, a randomized controlled trial, but not of a plant-based diet itself, as the title suggests, but of just an education program telling people about the benefits of a plant-based diet for diabetes, and then it was up to them. And still got a significant improvement in blood sugar control. Here are the numbers. Got a little better in the control group, but way better in the plant-based instruction and support group. And more plant-based diets are not just effective in the prevention and management of diabetes, but also its complications. One of the most devastating complications of diabetes is kidney failure, the decline in kidney function in eight diabetics in the one or two years before switching their diets. They all showed this steady inexorable decline on a fast track to complete kidney failure and dialysis, but then they switched to a special supplemented vegan diet, and their kidney decline was stopped in its tracks. Imagine if they had switched a year or two earlier. Most diabetics don't actually end up on dialysis though, because they die first. Cardiovascular disease is the major cause of premature mortality among diabetics. That's why plant-based diets are perfect. There's a general scientific consensus that the elements of a whole food plant-based diet, legumes, whole grains, fruits, vegetables, and nuts with limited or no intake of processed foods and animal products are highly beneficial for preventing and treating type 2 diabetes, equally important. Plant-based diets address the bigger picture by simultaneously treating cardiovascular disease, our number one killer, along with obesity, high blood pressure, lowering inflammation, and we can throw cancer into the mix to our number two killer. The bottom line is that the case for using a plant-based diet to reduce the burden of diabetes and improve overall health has never been stronger. We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org slash testimonials. We may share it on our social media to help inspire others. To see any graphs, charts, graphics, images, or studies mentioned here, please go to the nutritionfacts podcast landing page. There you'll find all the detailed information you need, plus links to all the sources we cite for each of these topics. For a vital, timely text and the pathogens that cause pandemics, you can order the e-book, audiobook, or the hard copy of my second to latest book, How to Survive a Pandemic. For recipes, check out my latest, the How Not to Diet Cookbook. It's beautifully designed with more than 100 recipes for delicious and nutritious meals. And of course, all proceeds I receive from the sales of my books go to charity. NutritionFacts.org is a non-profit, science-based public service where you can sign up for free daily updates and latest in nutrition research via bite-sized videos and articles. Everything on the website is free. There's no ads, no corporate sponsorship. It's strictly non-commercial. I'm not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.