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
Fat (grams/day)
60
50
40
30
20
10
0
1955
1965
Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.
1975
1985
1994
Falling Carbohydrate Intake in Japan
Carbohydrate (grams/day)
430
400
370
340
310
280
250
1955
1965
Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.
1975
1985
1994
Overweight and Obesity in Japan
Prevalence in Men
30
24.5 %
20.5 %
20
%
%
14.5
BMI 25-29.9
BMI ≥ 30
10
0.8
0
%
1976-80
2.01 %
1991-95
Yoshiike N. Obes Rev 2002;3:183-90.
Yoshiike N. Asia Pac J Clin Nutr 2002;11(Suppl 8):S727-31.
2.3 %
2000
Diabetes Prevalence in Japan
In adults over age 40:
Prior to 1980:
By 1990:
1-5%
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)
220
2007
200.6 pounds
200
180
160
140
1909
123.9 pounds
120
100
80
(Includes red meat, poultry, and fish)
60
40
20
1900
1920
1940
1960
1980
2000
Source:US Department of Agriculture, Economic Research Service,
http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc,
accessed August 15, 2009.
U.S. Per Capita Chicken Intake (lb)
2007
60
59.9 pounds
50
40
1909
10.4 pounds
30
20
10
0
1900
1920
1940
1960
1980
2000
Source:US Department of Agriculture, Economic Research Service,
http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc,
accessed August 15, 2009.
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
Plant-Based Dietary Intervention in Type 2 Diabetes
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.D
Susan 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
PCRM
PCRM
PCRM
University of California, Los Angeles
University of California, Los Angeles
Robyn Webb Associates
Funding: National Institute of Diabetes and Digestive and Kidney Diseases, NIH
Diabetes 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
Individuals with no medication changes, n = 24 vegan, 33 ADA
8.1
7.9
7.4
7.5
7.2
6.8
P = 0.01
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:
Low-GI Replacements:
•
•
•
•
•
•
•
•
Sugar
White and wheat breads
White potatoes
Most cold cereals
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
Lifestyle Heart Trial
Dean Ornish, M.D.
Preventive Medicine
Research Institute
Ornish D. Lancet 1990;336:129-33.
Lifestyle Heart Trial
Experimental program:
1. Vegetarian foods
2. Half-hour walk daily
3. Manage stress
4. Avoid tobacco
Ornish D. Lancet 1990;336:129-33.
Lifestyle Heart Trial
Experimental
Cholesterol
↓ 24%
LDL
↓ 37%
Weight
Reversal
Ornish D. Lancet 1990;336:129-33.
↓ 22 lbs
82% of
participants
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 Test
Total cholesterol
LDL (“bad”) cholesterol
Goals
<200 mg/dl
<100 mg/dl
HDL (“good”) cholesterol
Women: >55
Men: >45
Triglycerides (blood fats)
<150 mg/dl
Lowering LDL
Avoid: meat, dairy, eggs, hydrogenated
oils, tropical oils
Increase: oats, beans
Fat Content
(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
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
Foods
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
Foods
In 4 weeks:
LDL (“bad”) cholesterol
↓ 29%
Cholesterol-lowering drugs
↓ 31%
Jenkins DJA. JAMA 2003;290:502-510.
Boosting HDL
Exercise
Vitamin C-rich foods
Tackling Triglycerides
Avoid animal products
Avoid high-GI foods
Exercise
Hypertension
High pressure in the arteries
1st number (systolic): pressure during the
heartbeat
2nd number (diastolic): pressure between
beats
Hypertension
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