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

Falling Carbohydrate Intake in Japan Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S

Overweight and Obesity in Japan Yoshiike N. Obes Rev 2002;3: Yoshiike N. Asia Pac J Clin Nutr 2002;11(Suppl 8):S BMI BMI ≥ 30 % % % % % % Prevalence 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.

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.D Susan Levin, R.D. Earnest Noble, M.D. Terry Ritchie, Ph.D. Robyn Webb, M.S. George Washington University University of Toronto University of North Carolina Private practice, Arlington, VA George Washington University PCRM University of California, Los Angeles Robyn Webb Associates Plant-Based Dietary Intervention in Type 2 Diabetes 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

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

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 B 12. 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 Lifestyle Heart Trial Dean Ornish, M.D. Preventive Medicine Research Institute Ornish D. Lancet 1990;336:

Lifestyle Heart Trial Ornish D. Lancet 1990;336: Experimental program: 1. Vegetarian foods 2. Half-hour walk daily 3. Manage stress 4. Avoid tobacco

Lifestyle Heart Trial Experimental Cholesterol ↓ 24% LDL ↓ 37% Weight ↓ 22 lbs Reversal 82% of participants Ornish D. Lancet 1990;336:

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 HDL (“good”) cholesterol Triglycerides (blood fats) Goals <200 mg/dl <100 mg/dl Women: >55 Men: >45 <150 mg/dl

Lowering LDL Avoid: meat, dairy, eggs, hydrogenated oils, tropical oils Increase: oats, beans

Fat Content (Percentage of Calories from Fat) Leanest beef29% Skinless chicken breast23% Sea trout32% White tuna16% Broccoli8% Beans 4% Rice1–5% Potato1%

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:

Special Cholesterol-Lowering Foods In 4 weeks: LDL (“bad”) cholesterol ↓ 29% Cholesterol-lowering drugs ↓ 31% Jenkins DJA. JAMA 2003;290:

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