controlling carbs and preventing disease low carb, obesity, cardiovascular disease and diabetes...

CONTROLLING CARBS AND CONTROLLING CARBS AND PREVENTING DISEASEPREVENTING DISEASE

Low carb, obesity, cardiovascular Low carb, obesity, cardiovascular disease and diabetesdisease and diabetes

Jacqueline A. Eberstein, R.N.Jacqueline A. Eberstein, R.N.

ObesityObesity

Now effects all age groupsNow effects all age groups Is a global epidemicIs a global epidemic Overweight is having a body mass index (BMI) between Overweight is having a body mass index (BMI) between

25 and 29.925 and 29.9 Obesity is having a BMI of 30 or more.Obesity is having a BMI of 30 or more. Body Mass Index is a computation relating height with Body Mass Index is a computation relating height with

weight. It is a useful guideline but can be inaccurate for weight. It is a useful guideline but can be inaccurate for those with significant muscle mass.those with significant muscle mass.

To compute your BMI. Search BMI on the Internet and To compute your BMI. Search BMI on the Internet and enter your numbers.enter your numbers.

Do not use adult BMI charts for ages 2 to 20.Do not use adult BMI charts for ages 2 to 20.

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1990BRFSS, 1990

No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



BMI > 30, or ~ 30 lbs. overweight for 5'4" person

2004

Important to rememberImportant to remember Insulin- a hormone produced in the pancreas that carries sugar Insulin- a hormone produced in the pancreas that carries sugar

from the blood into the cells to be used for energy.from the blood into the cells to be used for energy.

Blood sugar- the amount of glucose in the blood stream at any Blood sugar- the amount of glucose in the blood stream at any given time. It is higher after eating.given time. It is higher after eating.

Insulin is a “fat storage hormone”.Insulin is a “fat storage hormone”.

Glucagon- a hormone to counter the blood sugar lowering Glucagon- a hormone to counter the blood sugar lowering effects of insulin. In a properly functioning body insulin and effects of insulin. In a properly functioning body insulin and glucagon are in balance.glucagon are in balance.

Insulin resistance- a consequence of heredity, excess body fat, Insulin resistance- a consequence of heredity, excess body fat, hormone changes and even some medications that prevents our hormone changes and even some medications that prevents our cells from using insulin to regulate blood sugar effectively.cells from using insulin to regulate blood sugar effectively.

The body attempts to keep the blood sugar The body attempts to keep the blood sugar within a fairly narrow range- insulin/glucagon within a fairly narrow range- insulin/glucagon balance.balance.

Hyperinsulinism- an excess production of insulin.Hyperinsulinism- an excess production of insulin. Insulin in too large amounts over time damages Insulin in too large amounts over time damages

the body and leads to diabetes and heart the body and leads to diabetes and heart disease. High insulin levels can effect cancer disease. High insulin levels can effect cancer cells.cells.

Metabolic syndrome is an insulin resistance Metabolic syndrome is an insulin resistance syndrome. It frequently leads to type 2 diabetes syndrome. It frequently leads to type 2 diabetes and heart disease.and heart disease.

Diabetes- a nutritional wear and Diabetes- a nutritional wear and tear diseasetear disease

Stage 1-insulin resistance of cellsStage 1-insulin resistance of cells Stage 2-insulin resistance with hyperinsulinism.Stage 2-insulin resistance with hyperinsulinism. Stage 3-insulin resistance and reactive Stage 3-insulin resistance and reactive

hypoglycemia or unstable blood sugar.hypoglycemia or unstable blood sugar. Stage 4-insulin resistance, hyperinsulinism with Stage 4-insulin resistance, hyperinsulinism with

impaired glucose tolerance AKA prediabetes.impaired glucose tolerance AKA prediabetes. Stage 5- diabetes with high insulin resistance Stage 5- diabetes with high insulin resistance

and hyperinsulinism.and hyperinsulinism. Stage 6-diabetes with low or virtually no insulin Stage 6-diabetes with low or virtually no insulin

production. Burnout of the islet cells of the production. Burnout of the islet cells of the pancreas.pancreas.

Risk factors for diabetesRisk factors for diabetes

ObesityObesity DietDiet Sedentary lifestyleSedentary lifestyle HeredityHeredity EthnicityEthnicity History of gestational History of gestational

diabetesdiabetes

Metabolic syndromeMetabolic syndrome Elevated blood sugarElevated blood sugar Abnormal lipidsAbnormal lipids High blood pressureHigh blood pressure Advancing ageAdvancing age

Blood sugar by the numbersBlood sugar by the numbers

Normal fasting blood sugar is generally 65 to Normal fasting blood sugar is generally 65 to 99mg/dL.99mg/dL.

Impaired fasting blood sugar or prediabetes is Impaired fasting blood sugar or prediabetes is between 100 and 125 mg/dL.between 100 and 125 mg/dL.

Impaired glucose tolerance or prediabetes is a 2 Impaired glucose tolerance or prediabetes is a 2 hour blood sugar between 140 and 199 mg/dL.hour blood sugar between 140 and 199 mg/dL.

Diabetes is a fasting blood sugar of 126 mg/dL Diabetes is a fasting blood sugar of 126 mg/dL or greater on 2 readings: or 2 hours after food a or greater on 2 readings: or 2 hours after food a blood sugar reading of 200mg/dL or greater. blood sugar reading of 200mg/dL or greater.

Effects of high insulinEffects of high insulin Increases deposition of excess body fatIncreases deposition of excess body fat Increases fat in the blood in the form of triglycerides Increases fat in the blood in the form of triglycerides

leading to heart disease.leading to heart disease. Promotes the manufacture of LDL cholesterol by Promotes the manufacture of LDL cholesterol by

stimulating the enzyme HMG-CoA reductase.stimulating the enzyme HMG-CoA reductase. Causes an unstable blood sugar by depressing the Causes an unstable blood sugar by depressing the

effects of glucagon.effects of glucagon. Increases sodium retention and water retention leading Increases sodium retention and water retention leading

to edema and high blood pressure.to edema and high blood pressure. Depresses glucogen thus preventing fat burning. Depresses glucogen thus preventing fat burning. Negatively effects other hormones such as those from Negatively effects other hormones such as those from

the adrenals and eicosanoids.the adrenals and eicosanoids.

Stimulates growth of smooth muscle cells Stimulates growth of smooth muscle cells lining arteries.lining arteries.

Increases inflammatory markers leading to Increases inflammatory markers leading to CHDCHD

Increases prothrombotic markers.Increases prothrombotic markers. Promotes glucose and protein to fat storage.Promotes glucose and protein to fat storage. Insulin-like growth factor may stimulate Insulin-like growth factor may stimulate

cancer cells to grow.cancer cells to grow. Can increase breast cancer death rates.Can increase breast cancer death rates. PCOS/ infertility/ diabetes/ heart diseasePCOS/ infertility/ diabetes/ heart disease

Complications of diabetesComplications of diabetes Can begin about 10 years before the diagnosis Can begin about 10 years before the diagnosis

is made-if it’s made.is made-if it’s made. About 1/3 of diabetes cases are undiagnosed.About 1/3 of diabetes cases are undiagnosed. The body is damaged by glycation due to high The body is damaged by glycation due to high

blood sugars. blood sugars. Complications are caused by damage to all Complications are caused by damage to all

blood vessels leading to heart disease, stroke, blood vessels leading to heart disease, stroke, blindness, kidney failure, painful neuropathy, blindness, kidney failure, painful neuropathy, and amputations.and amputations.

Direct and indirect costs from diabetes reached Direct and indirect costs from diabetes reached 132 billion dollars for 2002.132 billion dollars for 2002.

SolutionSolution Can control all but your geneticsCan control all but your genetics Control your weight.Control your weight. Rebalance your bodies’ hormones specifically Rebalance your bodies’ hormones specifically

insulin to regulate blood sugar.insulin to regulate blood sugar. Dietary fat has a negligible effect on insulin.Dietary fat has a negligible effect on insulin. Protein in excess can impact insulin and Protein in excess can impact insulin and

glucose. Eat the right amount of protein.glucose. Eat the right amount of protein. Carbs are the main macronutrient that stimulates Carbs are the main macronutrient that stimulates

insulin.insulin. Control both the quantity and quality of carbs.Control both the quantity and quality of carbs. Exercise to improve insulin resistance.Exercise to improve insulin resistance.

Harvard Nurses Health StudyHarvard Nurses Health Study

“ “Our findings suggest that a high intake of rapidly Our findings suggest that a high intake of rapidly digested and absorbed carbohydrate increases digested and absorbed carbohydrate increases the risk of CHD independent of conventional the risk of CHD independent of conventional coronary disease risk factors. These data add to coronary disease risk factors. These data add to the concern that the current low-fat, high the concern that the current low-fat, high carbohydrate diet recommended in the United carbohydrate diet recommended in the United States may not be the optimal for the prevention States may not be the optimal for the prevention of CHD and could actually increase the risk in of CHD and could actually increase the risk in individuals with high degrees of insulin individuals with high degrees of insulin resistance and glucose intolerance.”resistance and glucose intolerance.”

The American Journal of Clinical Nutrition, 2000The American Journal of Clinical Nutrition, 2000

The Controlled Carb AdvantageThe Controlled Carb Advantage Physical improvements:Physical improvements: Improved lean body mass to fat mass ratio.Improved lean body mass to fat mass ratio. Increased exercise capacity.Increased exercise capacity. Maintain weight loss w/o negative side effects.Maintain weight loss w/o negative side effects.

Prevents/ corrects hyperinsulin-related conditions:Prevents/ corrects hyperinsulin-related conditions: DiabetesDiabetes HypertensionHypertension Cardiac risk factors ( high triglycerides, low HDL, Cardiac risk factors ( high triglycerides, low HDL,

small dense LDL particles)small dense LDL particles)

ADA diet vs. controlling carbs in ADA diet vs. controlling carbs in People with DiabetesPeople with Diabetes

“ “ High carbohydrate intake is generally recommended, High carbohydrate intake is generally recommended, resulting in suboptimal glycemic control and lipoprotein resulting in suboptimal glycemic control and lipoprotein profile, gradually increasing insulin and/or oral profile, gradually increasing insulin and/or oral hypoglycemic medication requirement and weight gain. hypoglycemic medication requirement and weight gain. On the other hand, restriction of dietary carbohydrate is On the other hand, restriction of dietary carbohydrate is associated with improvement in glycemic control and associated with improvement in glycemic control and other parameters of insulin resistance including body other parameters of insulin resistance including body mass and lipid profiles.”mass and lipid profiles.”

“…“…data demonstrates that the benefits of a low data demonstrates that the benefits of a low carbohydrate diet on glycemic control are independent of carbohydrate diet on glycemic control are independent of weight loss and are primarily due to carbohydrate weight loss and are primarily due to carbohydrate restriction.”restriction.”

““Emerging evidence suggests that low carb diets may Emerging evidence suggests that low carb diets may actually have beneficial effects on LDL cholesterol by actually have beneficial effects on LDL cholesterol by decreasing LDL particle concentration and increasing decreasing LDL particle concentration and increasing LDL size to less atherogenic forms.”LDL size to less atherogenic forms.”

““A final irony is the report that physicians frequently A final irony is the report that physicians frequently choose low carb diets for themselves while choose low carb diets for themselves while recommending low fat for their patients.”recommending low fat for their patients.”

The Case for low carbohydrate diets in diabetes management, Dr., Samy The Case for low carbohydrate diets in diabetes management, Dr., Samy McFarlane, Nutrition and Metabolism, 2005.McFarlane, Nutrition and Metabolism, 2005.

Is a 60% carb, low fat diet working?Is a 60% carb, low fat diet working?

A review of patients by the ADA published A review of patients by the ADA published in JAMA, January 2004 stated that only in JAMA, January 2004 stated that only 30% of people with diabetes were 30% of people with diabetes were reaching treatment goals for blood sugar, reaching treatment goals for blood sugar, blood pressure and cholesterol. This blood pressure and cholesterol. This despite the use of a number of prescription despite the use of a number of prescription medications.medications.

Research supports safety and Research supports safety and efficacy of controlling carbsefficacy of controlling carbs

There have been more than 60 published studies and papers There have been more than 60 published studies and papers focusing on the benefits of a controlled carb lifestyle.focusing on the benefits of a controlled carb lifestyle.

Effective in weight loss and maintenance, seizures, PCOS, Effective in weight loss and maintenance, seizures, PCOS, metabolic syndrome, diabetes, GERD, lowering triglycerides, metabolic syndrome, diabetes, GERD, lowering triglycerides, increasing HDL, improving particle size of LDL, decreasing increasing HDL, improving particle size of LDL, decreasing inflammation markers (CRP), increasing insulin sensitivity inflammation markers (CRP), increasing insulin sensitivity and other symptoms. and other symptoms.

Studies done by Duke, Harvard, University of Pa., University Studies done by Duke, Harvard, University of Pa., University of Conn., The American Heart Association, American of Conn., The American Heart Association, American Diabetes Association among others.Diabetes Association among others.

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