Wednesday, December 30, 2009

The Best Life Guide to Managing Diabetes and Pre-Diabetes by Bob Greene

The Best Life Guide to Managing Diabetes and Pre-Diabetes by Bob Greene is the latest in many books on diabetes and given the author’s affiliation with Oprah Winfrey there is no doubt that this book will be a huge seller, probably even have a lovely life on the best-seller list. This is unfortunate. In chapter one, the author discusses insulin as a medicine. Insulin is not a medicine. It is a hormone the body naturally produces. For diabetics and pre-diabetics either their pancreas is not producing enough or any insulin or the organs are not properly absorbing the insulin the body is producing which results in high glucose levels. Of course, this could be considered a syntactical oversight and something one could overlook. I am obviously not the one to overlook it and, psychologically, the impact of calling insulin a medicine is not to be underestimated. In chapter two, the author erroneously suggests that a glucose level of 180 two hours after a meal is acceptable. This was true, once upon a time, but the American Diabetes Association has modified this number and lowered it to 150. If this book were a few years old, such a mistake could, and one could even argue should, be overlooked. So given that the book is pretty much off to a poorly researched start, in spite of the collaborative efforts of John J Merendino, MD and Janis Jibrin, MS, RD, is there any merit in reading further? During the chapter on Phase One, Greene (and/or one of his “experts”) says that it is safe to exercise unless your glucose level is 300 or higher. According to the American Diabetes Association, it is safe to exercise if your level is 250 or lower. That is a 50 point difference which anyone with diabetes can tell you is not an insignificant mistake. I commend Greene for outlining a conservative approach to increasing the daily exercise. Adding two minutes of aerobic/cardio exercise per week while adding one or two strength training exercises per activity level is gradual enough that most people following his suggestion are not only likely to experience success but unlikely to cause themselves injury. (for the record, Rob's diabetes team--including certified diabetes practitioners, nutritionists, etc.--recommend adding one minute per day to his cardio exercise which is obviously a faster increase than Greene is suggesting.) But really . . . as I was reading I kept jumping back to how messed up it is the book says 300 is the upper limit when it is actually only 250. Any one of the mistakes I have pointed out would be merely a nuisance or a slight carelessness. Perhaps even a publisher’s oversight. However, this is already one too many and we have more than one erroneous piece of information being presented as professional advice. I can only pray that anyone who reads this book has the sense to listen to their diabetes team, to the American Diabetes Association, and to their own common sense and the messages of their own body. This book should not be the “go to” resource for anyone with diabetes and/or pre-diabetes. The Mayo Clinic has released a wonderful book that has superior medical advice than this book has. It does not, however, have recipes or online charts and resources for you to use, which Bob Greene’s book offers. Of course, all of these free resources are also available through the ADA and do not come with an offer to get additional help from Oprah’s personal trainer for less than $3 per week. And this is what worries me the most because this is Oprah’s personal trainer and so many people will immediately think that because Greene works with Oprah that somehow anything and everything he says is accurate. Given the complications that come with diabetes if it is not properly managed, this book and its inevitable best-selling popularity frankly scares me. However, I digress. Phase One focuses on how carbohydrates impact glucose levels, on increasing your activity level, and on a few other essential details including possible medications (once again mistakenly saying that insulin is a medication!) someone with diabetes may have. In Phase Two the dietary focus shifts over to proteins and fats. The fact that beans are often considered a protein is mentioned but the truth is somewhat buried in the content and I was surprised that the author did not take the time to highlight more clearly that although beans are a protein they impact the body the way a carbohydrate does. In other words, for a diabetic or pre-diabetic person, beans are not a protein but should be counted as a carbohydrate; more specifically beans are considered starch exchange rather than a meat exchange. Given how unhappy I already was (am) with the book at this point in the reading, let me state for the record that although this very important information is not given the focus it requires and frankly deserves, I am not going to begrudge Greene and/or the publishers for not choosing to emphasize this point. Phase Two also addresses the introduction/use of dietary supplements like multi-vitamins. The information is not unlike what can be found on the ADA website or in most other nutrition/diet books. Ie. The best offense is a well-balanced diet; supplements may help but are not the answer nor will they make up for unhealthy eating habits, etc. Phase Three builds upon the suggestions made in Parts One and Two and there is good practical advice for the reader on how to avoid discouragement and offering a list of healthcare professionals that the diabetic will need including some that might be needed. The next chapter, “Drugs Used to Treat Diabetes and Prevent Complications,” unfortunately lumps insulin as a medication. At this point, I was neither surprised nor disappointed by this nonsense. Early in the chapter Greene states “people tend to lump diabetes medicines into two categories, pills or insulin” and never does he correct this statement. Forget altogether the argument that insulin is a naturally produced hormone in the body (like estrogen and testosterone), diabetes medicine is usually “lumped” in two ways: medicines that help the body produce insulin and medicines that help the body absorb insulin. So let’s add this to the increasing list of mistakes this book makes and move on. Last but not least, the book concludes with meal plans and some recipes. I want to commend Greene for not focusing solely on the diabetic who is trying to lose weight. Too many diabetes resource focus so much on losing weight which makes it difficult and frustrating for the diabetic who is trying to lose weight to find the necessary information that will support the individual’s individual needs. Soy milk seems to be the dairy choice for Greene and the fact that Silk Soy Milk carries the Best Life seal I suppose explains this emphasis. There are arguments for drinking soy milk, obviously, but there are also reasons why some people, especially some women, might prefer to avoid soy milk. That this is never mentioned in the book is unfortunate. Greene explains how grilling meats releases carcinogens back in Phase Two so I don’t know why the same concern isn’t expressed regarding the consumption of soy milk. It behooves the reader to be educated but, given that this book is supposed to be a trusted resource for the reader, it would be nice to see the author being as forthcoming about products with his company’s stamp of approval as he is with those products that don’t have it. The recipes are good. I tried a few and didn’t hate them, didn’t love them, didn’t feel the need to share them in my blog. I was disappointed that the soup recipes all included beans. I would have liked a recipe that was free from starches (a hearty vegetable soup perhaps) or even high in protein (egg-drop soup). Of course, the book is not trying to present an exhaustive collection of possible recipes. There is just enough for someone to make gradual changes to their daily fair. No need to completely overhaul the diet although the reader can choose to follow the proscribed menu plan to begin the necessary lifestyle changes. I realize that some people may think I am being nit-picky about a few mistakes but when there are resources available that do not have these mistakes, resources that offer the same advice, I don’t understand why this book contains any mistakes nor why it should become a resource upon which anyone would rely. For anyone considering buying this book, please reconsider. Read resources that will not compromise your health or well-being. Living with diabetes is hard enough without thinking something is safe when it is not or thinking you are doing the right thing when you are not. This book . . . it could have been better and it should have been better and, although there is some merit in the content, there is not enough for me to say this book is a better choice than any of the others I have already read. For a basic overview of diabetes, how glucose and insulin work in the body, and the complications of diabetes if it is not well managed, I highly recommend the Mayo-Clinic book. For the most up-to-date information on diabetes and diabetes research, you can’t go wrong reading the ADA website. If you want delicious recipes that will help you maintain healthy glucose levels and possibly help you lose weight if that is your goal, check out DLife, a weekly program that airs on CNBC Sundays at 7pm; the website offers the videos so those without cable can enjoy the educational resources. Like I said, there are other, better, resources out there. Like I also said, odds are that because Bob Greene is Oprah Winfrey’s personal trainer, this book will inevitably be a best-seller. It’s unfortunate. I hope that those who are newly diagnosed with diabetes will not choose this book as a primary resource. Anyone who has had the disease and is already educated about the disease, the debatable merit of this book will be too quickly apparent and the book just as quickly tossed aside. Full Disclosure: Following is a list of what I learned from reading this book in no particular order.
1) What to do when blood glucose drops too low—how to respond responsibly without overshooting and pushing the too low glucose into the too high range. 2) Neuropathy may be caused by a vitamin B12 deficiency.
Now, this either suggests that I have done a good job educating myself about this disease or it suggests that this book doesn’t offer much in the way of necessary information. I think it is more the former than the latter, especially in light of my finding any mistakes, let alone more than one. I hope that more people will be able to see through the glamour of endorsement through to the truth of this resource’s so-called merit. Thank goodness, there are other far more reliable resources available.
For my review of Mayo-Clinic on Managing Diabetes click here.

2 comments:

  1. Satia:

    Saw the Bob Greene book in the bookstore and came home to read the Amazon.com reviews. Your's way thoughtful and well written. I really appreciate your insight and that you took the time to share it.

    Best wishes from a fellow Alantan,

    ---Zak

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  2. Hello Zak and thank you. I was appalled this past week when DLife referenced this book. I wanted to leave a comment on the site about my alarm and concern but apparently they don't have space for comments on their articles.

    I haven't had a chance to look at it thoroughly but The Diabetes Detour Diet looks like a good resource if you are trying to lose weight. At this point, I still mostly recommend the Mayo Clinic book for basic information.

    I'm reading as much as I can without getting too overwhelmed with information. It must be working. My fiance's A1C was 6.3 so we must be doing something right!

    Here's a link to my review of the Mayo Clinic's book:

    http://satia.blogspot.com/2009/07/mayo-clinic-on-managing-diabetes-edited.html

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