1. Tackling Diabetes, Keeping a Healthy Heart

3. 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.

4. A Lesson from Japan

6. 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.

10. Rising Fat Intake in Japan Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S. 1955 1965 1975 1985 1994

11. Falling Carbohydrate Intake in Japan Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S. 1955 1965 1975 1985 1994

12. Overweight 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. BMI 25-29.9 BMI ≥ 30 % % % % % % Prevalence in Men

13. 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.

14. A Lesson from the U.S.

18. Diabetes Prevalence 1994

19. Diabetes Prevalence 1995

20. Diabetes Prevalence 1996

21. Diabetes Prevalence 1997

22. Diabetes Prevalence 1998

23. Diabetes Prevalence 1999

24. Diabetes Prevalence 2000

25. Diabetes Prevalence 2001

26. Diabetes Prevalence 2002

27. Diabetes Prevalence 2003

28. Diabetes Prevalence 2004

29. Diabetes Prevalence 2005

30. Diabetes Prevalence 2006

31. Diabetes Prevalence 2007

33. 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

34. Study design: Low-fat vegan diet vs ADA diet guidelines 22-week study with 1-year follow-up Track hemoglobin A1c

35. 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

37. The Glycemic Index: Invented in 1981 by Dr. David Jenkins. Separates foods that raise blood sugar quickly from those that raise it slowly.

38. 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

39. The Glycemic Index does not take the place of other considerations: 1. Vegan foods 2. Low-fat foods

40. Important A daily multivitamin for vitamin B 12. Be alert to medications that can cause hypoglycemia. Check blood glucose regularly. `

41. A Healthy Heart

42. 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;336:129-33.

43. Lifestyle 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

44. Lifestyle Heart Trial Experimental Cholesterol ↓ 24% LDL ↓ 37% Weight ↓ 22 lbs Reversal 82% of participants Ornish D. Lancet 1990;336:129-33.

45. Why Do We Have Cholesterol? Raw material for making hormones (estrogens, testosterone) Key ingredient in cell membranes In excess, cholesterol leads to artery blockages

46. 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

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

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

49. 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.

50. 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.

51. Special Cholesterol-Lowering Foods In 4 weeks: LDL (“bad”) cholesterol ↓ 29% Cholesterol-lowering drugs ↓ 31% Jenkins DJA. JAMA 2003;290:502-510.

52. Boosting HDL Exercise Vitamin C-rich foods

53. Tackling Triglycerides Avoid animal products Avoid high-GI foods Exercise

54. Hypertension High pressure in the arteries 1st number (systolic): pressure during the heartbeat 2nd number (diastolic): pressure between beats

55. Hypertension Target: 120/80 If you have diabetes: <130/80

56. Reducing Blood Pressure Reduce sodium Increase potassium: vegetables and fruits Avoid saturated fat: ↓ blood viscosity Vegetarian/vegan diets