Tackling Diabetes, Keeping a Healthy Heart

Type 1 Diabetes

The pancreas no longer makes insulin.

Type 2 Diabetes

The cells of the body resist insulin’s action.

Gestational Diabetes

Occurs during pregnancy, similar to type 2.

A Lesson from Japan

Diabetes Prevalence in Japan

In adults over age 40:

Prior to 1980: 1-5%

Kuzuya T. Prevalence of diabetes mellitus in Japan compiled from literature. Diab Res Clin Practice. 1994;24 Suppl:S15-S21.

Rising Fat Intake in Japan

Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.

Fat (grams/day)

0

10

20

30

40

50

60

1955 1965 1975 1985 1994

Falling Carbohydrate Intake in Japan

Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.

Carbohydrate (grams/day)

250

280

310

340

370

400

430

1955 1965 1975 1985 1994

Overweight and Obesity in JapanOverweight and Obesity in Japan

Yoshiike N. Obes Rev 2002;3:183-90. Yoshiike N. Asia Pac J Clin Nutr 2002;11(Suppl 8):S727-31.

24.5

20.5

14.5

2.32.010.8

0

10

20

30

1976-80 1991-95 2000

BMI 25-29.9

BMI ≥ 30

%

%

%

%% %

%

Prevalence in MenPrevalence in Men

Diabetes Prevalence in Japan

In adults over age 40:

Prior to 1980: 1-5%

By 1990: 11-12%

Kuzuya T. Prevalence of diabetes mellitus in Japan compiled from literature. Diab Res Clin Practice. 1994;24 Suppl:S15-S21.

A Lesson from the U.S.

U.S. Per Capita Meat Intake (lb)

1900 1920 1940 1960 1980 2000

20

40

60

80

100

120

140

160

180

200

220

Source:US Department of Agriculture, Economic Research Service,http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc,accessed August 15, 2009.

1909

2007

123.9 pounds

200.6 pounds

(Includes red meat, poultry, and fish)

U.S. Per Capita Chicken Intake (lb)

1900 1920 1940 1960 1980 20000

10

20

30

40

50

60

Source:US Department of Agriculture, Economic Research Service,http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc,accessed August 15, 2009.

1909

2007

10.4 pounds

59.9 pounds

Diabetes Prevalence 1994

Diabetes Prevalence 1995

Diabetes Prevalence 1996

Diabetes Prevalence 1997

Diabetes Prevalence 1998

Diabetes Prevalence 1999

Diabetes Prevalence 2000

Diabetes Prevalence 2001

Diabetes Prevalence 2002

Diabetes Prevalence 2003

Diabetes Prevalence 2004

Diabetes Prevalence 2005

Diabetes Prevalence 2006

Diabetes Prevalence 2007

Neal D. Barnard, M.D. Joshua Cohen, M.D. David J.A. Jenkins, M.D., Ph.D. Gabrielle Turner-McGrievy, M.S., R.D.Lise Gloede, R.D., C.D.E. Stanley Talpers, M.D. Paul J. Poppen, Ph.D. Amber Green, R.D. Brent Jaster, M.D. Kim Seidl, M.S., R.DSusan Levin, R.D.Earnest Noble, M.D. Terry Ritchie, Ph.D. Robyn Webb, M.S.

George Washington University George Washington University University of Toronto University of North Carolina Private practice, Arlington, VA George Washington University George Washington University PCRM PCRMPCRMPCRMUniversity of California, Los AngelesUniversity of California, Los AngelesRobyn Webb Associates

Plant-Based Dietary Intervention in Type 2 Diabetes

Funding: National Institute of Diabetes and Digestive and Kidney Diseases, NIHDiabetes Action Research and Education Foundation

Study design:

Low-fat vegan diet vs ADA diet guidelines

22-week study with 1-year follow-up

Track hemoglobin A1c

P = 0.01

8.1

7.9

6.8

7.5

Individuals with no medication changes, n = 24 vegan, 33 ADA

7.4

7.2

The Glycemic Index:

• Invented in 1981 by Dr. David Jenkins.

• Separates foods that raise blood sugar quickly from those that raise it slowly.

Glycemic Index at a Glance

High-GI Foods: • Sugar • White and wheat

breads • White potatoes • Most cold cereals

Low-GI Replacements:

• Most fruits• Rye or pumpernickel• Yams, sweet

potatoes • Oatmeal, bran

cereals

The Glycemic Index does not take the place of other considerations:

1. Vegan foods

2. Low-fat foods

Important

A daily multivitamin for vitamin B12.

Be alert to medications that can cause hypoglycemia.

Check blood glucose regularly.

`

A Healthy Heart A Healthy Heart

Lifestyle Heart TrialLifestyle Heart Trial

Dean Ornish, M.D.Dean Ornish, M.D.Preventive Medicine Preventive Medicine Research InstituteResearch Institute

Ornish D. Lancet 1990;336:129-33.

Lifestyle Heart TrialLifestyle Heart Trial

Ornish D. Lancet 1990;336:129-33.

Experimental program:

1. Vegetarian foods

2. Half-hour walk daily

3. Manage stress

4. Avoid tobacco

Lifestyle Heart TrialLifestyle Heart Trial

Experimental

Cholesterol ↓ 24%

LDL ↓ 37%

Weight ↓ 22 lbs

Reversal82% of

participants

Ornish D. Lancet 1990;336:129-33.

Why Do We Have Cholesterol? Why Do We Have Cholesterol?

Raw material for making hormones

(estrogens, testosterone)

Key ingredient in cell membranes

In excess, cholesterol leads to artery blockages

Understanding Your Blood TestUnderstanding Your Blood Test

Total cholesterol LDL (“bad”) cholesterol

HDL (“good”) cholesterol

Triglycerides (blood fats)

Goals <200 mg/dl <100 mg/dl

Women: >55 Men: >45

<150 mg/dl

Lowering LDLLowering LDL

Avoid: meat, dairy, eggs, hydrogenated oils, tropical oils

Increase: oats, beans

Fat ContentFat Content(Percentage of Calories from Fat)(Percentage of Calories from Fat)

• Leanest beef 29%

• Skinless chicken breast 23%

• Sea trout 32%

• White tuna 16%

• Broccoli 8%

• Beans 4%

• Rice 1–5%

• Potato 1%

Cholesterol in Foods Cholesterol in Foods

Not the same as fat.

In meats, cholesterol is found mainly in the lean portion.

Cholesterol is found in animal products.

Plant foods have essentially no cholesterol.

Special Cholesterol-Lowering Special Cholesterol-Lowering FoodsFoods

Soluble fiber (oats, barley, eggplant, okra): 20 grams

Soy protein (soy milk, tofu): 40 grams

(Whole almonds: 28 grams)

(Sterol/stanol-enriched margarine: 2 grams)

Listed quantities are for a 2,000-calorie diet

Jenkins DJA. JAMA 2003;290:502-510.

Special Cholesterol-Lowering Special Cholesterol-Lowering FoodsFoods

In 4 weeks:

LDL (“bad”) cholesterol ↓ 29%

Cholesterol-lowering drugs ↓ 31%

Jenkins DJA. JAMA 2003;290:502-510.

Boosting HDLBoosting HDL

Exercise

Vitamin C-rich foods

Tackling TriglyceridesTackling Triglycerides

Avoid animal products

Avoid high-GI foods

Exercise

HypertensionHypertension

High pressure in the arteries

1st number (systolic): pressure during the heartbeat

2nd number (diastolic): pressure between beats

HypertensionHypertension

Target: 120/80

If you have diabetes: <130/80

Reducing Blood Pressure

Reduce sodium

Increase potassium: vegetables and fruits

Avoid saturated fat: ↓ blood viscosity

Vegetarian/vegan diets