Sponsored ByEnergetic Nutrition

*Presented By

Kirk Hamilton, PA-C*

Prescription 2000, Inc.*

Health Associates Medical Group*

Chronic diseases are preventable and reversible. Heart disease, cancer, stroke, osteoporosis, high

blood pressure, diabetes, kidney, eye and progressive neurologic disorders, etc., tax our health care system and economy, and cause great personal suffering, are preventable and sometimes reversible.

Diabetes is a chronic disease that is in epidemic proportions in the U.S. and world-wide, and is mostly preventable, and in many cases reversible.

I am here to show you this epidemic need not exist.

There are successfully aging cultures from around the world that have minimal diabetes (Okinawan elders, Sardinians, Nicoyans, Hunzans, Tarahumara Indians, etc.).

Traditional living Asian and African cultures before modern day urbanization didn’t get diabetes eating their more agrarian, starch and plant-based diets.

Type II diabetes (adult onset) becomes dramatically more prevalent in all ethnicities within a generation of their immigration to U.S..

Reversible causes? Excess calories from high fat, high sugar, highly refined carbohydrate diets and increased animal food consumption, environmental toxic exposure, altered bowel flora, vitamin D deficiency (type 1) and early cow’s milk exposure (type 1).

….and sedentary lifestyles!

But There Is Good News!...The solution is simple, safe and very cheap!

All cells need sugar (glucose) for energy.

When sugar can’t get into the cell high blood sugar (glucose) occurs – diabetes.

Insulin from beta cells in the pancreas drives sugar (glucose) into the cell to produce energy.

Lack of insulin or insulin resistance increases blood sugar.

Pre-diabetesPre-diabetes: blood sugar higher than normal (fasting 100-125) but not high enough for a diagnosis of type 2 diabetes. Still can have adverse health effects on blood vessels, kidneys, eyes & nerves.

Type 1 diabetes5-10 % of diabetics. Body fails to produce insulin, the hormone that allows glucose to enter and fuel your cells. Usually occurs in children. Causes: autoimmune reaction, infection, vitamin D deficiency, early cow’s milk exposure.

Type 2 diabetes90-95% of diabetics. Results from the body not using insulin properly (insulin resistance). Genetic predisposition. Associated with obesity, environmental toxicity, gut micro-flora imbalance and a sedentary lifestyle. Occurs more frequently with aging.

Gestational diabetes4% of pregnant females develop gestational diabetes. Placental hormones inhibit insulin’s actions, creating insulin resistance. Can lead to type 2 diabetes after pregnancy.

Diabetes: 24 million children and adults -- 8.0% of the U.S. population.

Diagnosed: 18 million people - - Undiagnosed: 6 million people.

Pre-diabetes: 57 million people – 19% of the U.S. population

Blood sugar problems effect more than a quarter of the U.S. population!

Diabetes is the 7th leading cause of death in the United States; 70,905 deaths

1 in 3 Americans, and 1 in 2 minorities, will develop diabetes in their lifetime.

Each day almost 4,400 people are diagnosed with diabetes or 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older each year.

Under 20 years of age - Children and Adolescents Pre- diabetes - 2 million adolescents (1 in 6 overweight adolescents) aged 12-19. Small percentage, 0.22% or 186 ,000 of this age group have diabetes – Mostly

type I or insulin dependent diabetes. Type I diabetes - one in every 400 to 600 children and adolescents. Type 2 diabetes – rare but occurring more frequently in children and adolescents,

particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Adults 20 years or older: 23.5 million, or 10.7% of all people in this age group have

diabetes. 60 years or older: 12.2 million, or 23.1% of all people in this age group have

diabetes. Men 12.0 million, or 11.2% of men > 20 Women 11.5 million, or 10.2% of women > 20

Heart disease: 615,651 Cancer: 560,187 Stroke (cerebro-vascular diseases): 133,990 Chronic respiratory diseases (COPD, emphysema): 129,311 Accidents (unintentional injuries): 117,075 Adverse drug reactions 100,000 plus deaths Alzheimer's disease: 74,944 Diabetes: 70,905 Influenza and Pneumonia: 52,847 Kidney Diseases (Nephritis, nephrotic syndrome, etc): 46,095 Septicemia: 34,851 Intentional self-harm (suicide) 33,185 Chronic liver disease and cirrhosis 28,504 Hypertension and hypertensive renal disease: 23,769 Parkinson’s disease: 20,136 Assault (homicide): 17, 520

DIABETES FACTS 220 million people worldwide have diabetes. More than double by 2030. Most people with diabetes in low and middle income

countries are middle-aged (45-64), not elderly (65+). WHO projects that diabetes deaths will increase by more

than 50% in the next 10 years without urgent action. 80% of diabetes deaths occur in low- and middle-income

countries. Half of diabetes deaths occur in people under the age of

70 years; 55% of diabetes deaths are in women. Diabetes causes about 5% of all deaths globally each year.

Heart Disease, high blood pressure, stroke Eye Complications (retinopathy), blindness Kidney disease (nephropathy) / kidney transplantation Sexual dysfunction – erectile dysfunction, reduced sensation Pregnancy complications Periodontal diseases and dental disease increase Infections and illness increase Neuropathy and nerve damage Foot complications, poor wound healing and amputations (more

than 60% of non-traumatic amputations are diabetes related). Gastro paresis - where the stomach takes too long to empty.

Happens when nerves to the stomach are damaged or stop working. Depression Reduce ability to carry out the activities of daily living in elderly.

Who is at Greater Risk for Type 1 Diabetes? Siblings and children of type 1 diabetics. Early infection, autoimmune trigger, environmental exposure? ***Early dairy product introduction and/or vitamin D insufficiency?

Who is at Greater Risk for Type 2 Diabetes (Lifestyle Disease)? People with pre-diabetes. People over age 45 Family history of diabetes. Overweight Sedentary People with low HDL cholesterol, high triglycerides, high blood

pressure. Certain racial and ethnic groups (e.g., Non-Hispanic Blacks,

Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives).

Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth.

*Often people with type 2 diabetes have no symptoms

Type 1 Diabetes

Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue Irritability

Type 2 Diabetes

Any of the type 1 symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in the hands/feet Recurring skin, gum or bladder infections

What You Can Do Notice mid-section weight gain and reduced physical activity.

Ask your doctor each visit to check your urine and fasting blood sugar especially if your are overweight or gaining weight.

Be proactive if your blood sugar is 95 mg/d or more, you are overweight and sedentary….DO SOMETHING NOW!

What Your Doctor Can Do Diabetes is simple for clinicians to pick up. Especially if they are

looking at the patient’s fasting glucose, weight, insulin, sugar in the urine, HbA1c and blood fats.

↑Central Weight + ↑blood sugar + ↑sedentary lifestyle = Diabetes IIEnvironmental Toxins, Abnormal Bacteria (2nd)

Normal blood sugar 70-(90)100 mg/dl fasting. Pre-diabetes - blood sugar 100-125 mg/dl fasting. Pre -diabetes or impaired glucose tolerance (IGT),

blood sugar 140-199 mg/dl 2 hours after 75 gm of glucose or a meal.

Diabetes – blood sugar ≥ 126 mg/dl after 8 hour fast. Diabetes – blood sugar ≥ 200 mg/dl 2 hours after 75

grams of glucose, a meal or any time.

Start paying attention to a FBS >90 mg/dl, central weight gain and sedentary lifestyle.

Direct and Indirect Costs of Diabetes in the United States

Total annual economic cost of diabetes in 2007 - $174 billion.  Direct diabetes related medical expenditures - $116 billion.

Indirect costs – $58 billion (Disability, work loss, premature death) This is an increase of $18 billion from 2002. http://care.diabetesjournals.org/content/26/3/917.full

$218 billion total diabetic costs (add in undiagnosed $18 billion, pre-diabetics $25 billion and gestational diabetics $623 million).

Medical expenditures are 2.3 times greater for diagnosed diabetics compared to non-diabetics.

“With increasing globalization and East-West exchanges, the increasing epidemic of type 2 diabetes in Asia has far-reaching public health and socioeconomic implications.”

“In 2007, more than 110 million individuals in Asia were living with diabetes, with a disproportionate burden among the young and middle aged. Similarly, rates of overweight and obesity are increasing sharply, driven by economic development, nutrition transition, and increasingly sedentary lifestyles.”

“The "metabolically obese" phenotype (ie, normal body weight with increased abdominal adiposity) is common in Asian populations. “

“Type 2 diabetes is an increasing epidemic in Asia, characterized by rapid rates of increase over short periods and onset at a relatively young age and low body mass index. Prevention and control of diabetes should be a top public health priority in Asian populations.”

Diabetes and its complications impose significant economic consequences on individuals, families, health systems and countries.

Most people with diabetes in low and middle income countries are middle-aged (45-64) impacting the work force.

WHO estimates that over the next 10 years (2006-2015), China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes alone.

Obesity and excess weight. Excess calories. Diets high in fats and oils, sugars, meats,

cheeses and refined grains. Processed foods versus whole foods. Lack of physical activity. Environmental toxicity – ↑GGT –

Glutathione need – NAC, selenium Abnormal bacteria – probiotics Nutritional deficiencies – vitamin D, etc.

Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009 Dec;90(6):1453-6. Epub 2009 Oct 14.

BACKGROUND: The major drivers of the obesity epidemic are much debated and have considerable policy importance for the population-wide prevention of obesity. OBJECTIVE: The objective was to determine the relative contributions of increased energy intake and reduced physical activity to the US obesity epidemic. DESIGN: We predicted the changes in weight from the changes in estimated energy intakes in US children and adults between the 1970s and 2000s. …RESULTS: For children, the measured weight gain was 4.0 kg (8.8 lbs), and the predicted weight gain for the increased energy intake was identical at 4.0 kg (8.8 lbs). For adults, the measured weight gain was 8.6 kg (18.92 lbs.), whereas the predicted weight gain was somewhat higher: 10.8 kg (22.44 lbs). CONCLUSIONS: Increased energy intake appears to be more than sufficient to explain weight gain in the US population. A reversal of the increase in energy intake of approximately 2000 kJ/d (500 kcal/d) for adults and of 1500 kJ/d (350 kcal/d) for children would be needed for a reversal to the mean body weights of the 1970s. Alternatively, large compensatory increases in physical activity (eg, 110-150 min of walking/d), or a combination of both, would achieve the same outcome. Population approaches to reducing obesity should emphasize a reduction in the drivers of increased energy intake.

Note: A 500 calories per day increase is a pound (3500 cal/lb) of weight gain per week!.

Note: Obesity is defined as a BMI of 30.0 or higher.

Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and survey. survey. (NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and (NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004). 2001-2004). Source: Health, United States, 2006, NCHSSource: Health, United States, 2006, NCHS..

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WHO’s latest global projections (2005) By 2015, approximately 2.3 billion adults will be

overweight (30% of the world’s population of 7.2 billion) and more than 700 million will be obese (10% of population).

At least 20 million children under the age of 5 years are overweight globally in 2005.

“Once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.”

Eating more food-away-from-home: 32% vs. 18% since mid 1970s.

Easy access to more and higher calorie dense foods. Meat consumption record high in 2000. Cheese increase 287% from 1950s to 2000. Average use of added fats and oils in 2000 was 67 percent above

annual average use in the 1950s. Caloric sweeteners record high in 1999. Grains consumption has risen since 1950s, mostly refined grains.

Only 7% of U.S. gets 3 or more servings of whole grains. Today Americans are consuming 600 more calories per person each

day than in 1970 (2775 (2007)vs. 2172 (1970) = 603) This 28% increase in daily calories provides enough energy for 1 lb of

weight gain (3500 calories) every 6 days compared to 1970!

Eat For Health, by Joel Fuhrman, M.D., 2008, page 59.

Large population studies from Asian and African countries where rice, grains, starchy vegetables, beans and noodles were dietary staples showed diabetes to be rare.

People in these countries ate more carbohydrates than those in North America and Europe yet diabetes and weight problems were less.

When these populations migrate to North America and adopt the Western diet diabetes, obesity and other chronic diseases increase.

The diet becomes much higher in added fats and oils, added sugars, protein and animal foods (and calories) while starchy foods are reduced.

Tarahumara Indians, Mexico – 80% carbohydrate diet – no diabetes. Genetically related Pima Indians in Arizona, eat refined Western diet – 50% of adults diabetes. (The Jungle Effect, Daphne Miller, M.D., 2008. http://diabetes.niddk.nih.gov/DM/pubs/pima/obesity/obesity.htm)

Extra fat in the muscle cell (intramyocellular) is like “gum in a lock,” inhibiting insulin’s action, increasing blood sugar and insulin.

Getting fat out of the cell by weight loss and dietary fat restriction (no animal products, no dairy, no added oils, nuts/seeds or avocados) can reduce intramyocellular fat and restore appropriate insulin action and glucose utilization of carbohydrate – The body’s optimal fuel!

When fat is gone out of the cell both blood sugar and insulin levels drop because carbohydrate is being burned efficiently again.

Genetic predisposition to type II – Lifestyle determines expression.

Toxicity may effect diabetic expression – chronically elevated GGT plus obesity increase diabetes risk.

Glutathione increase with 1000-2000 mg/d N-acetylcystiene and selenium 200-400 mcg/d may be of benefit.

Beneficial gastrointestinal flora – improves insulin resistance and obesity.

Treating Diabetes “Conventionally” Type 1 diabetes – people must have insulin by injection or a pump. Diet

and exercise are still very important.

Type 2 diabetics can be controlled with an exercise program, diet, losing excess weight and may need oral medication.

Many people with diabetes also need to take medications to control their cholesterol and blood pressure.

Among adults with diagnosed diabetes: 14% take insulin only; 13% take both insulin and oral medication; 57% take oral medication only; and 16% do not take either insulin or oral medications.

“Have the mentality that you are going to REVERSE your diabetes, not just control or live with it!”

Eat a whole food diet. Eat an antioxidant, phytonutrient rich plant-based

diet. Exercise daily. Normalize weight. Daily multivitamin/mineral, vitamin D and probiotic. Detoxification: antioxidant diet, NAC, selenium. Check your bloods sugar and weight daily. Notify your physician of weight loss and BS reduction. Reduce your medications with weight and BS drop. Continue your health education and reinforcement.

Eat Unrefined, Complex Carbohydrates – whole or sprouted grains, beans, starchy root vegetables in general have a lower glycemic index….They are good for diabetics!

High carbohydrate fiber-rich foods have a slow blood sugar absorption reducing stress on the pancreas (gland that produces insulin).

High fiber –carbohydrate rich foods have more volume and less calories encouraging weight loss which improves insulin’s actions.

High fiber-carbohydrate rich foods are low in fat, reducing fat in the cell which improves insulin’s action.

If the grain product is “enriched” it has the fiber and the germ removed losing vitamins, minerals, good fats and a higher glycemic state.

Avoid the “whites” – white flour, white potatoes, white bread, white rice, etc.

The positive influence that physical activity has on health has been well established. Among adults, regular physical activity has been associated with a reduced risk of stroke, impaired glucose tolerance, type 2 diabetes, mortality, and cardiovascular disease incident events. Engaging in physical activity daily has also proven to be helpful in both losing weight and maintaining weight loss…(2000 and 2005 National Health Interview Surveys).

Most type II diabetes are overweight.

Overweight leads to insulin resistance (GGT ?).

“….In fact, reducing to a more desirable body weight is the main treatment of individuals with type II diabetes.”

“Often when a person with type II diabetes loses weight, the insulin resistance improves and the available insulin once again becomes adequate, reversing the disease.”

Multivitamin/Mineral, Vitamin D and Probiotic B complex 50-100 mg per day Vitamin C 500-2000 mg per day Vitamin D 2000-10,000 iu per day Vitamin E mixed tocopherols 400 iu/d Chromium picolinate 200-800 micrograms per day Magnesium 300-600 mg per day Selenium 200-400 mcg per day Zinc 20-40 mg per day Alpha lipoic acid 300-1200 mg per day Omega-3 (fish oil) 1-2 grams per day N-acetylcysteine 1000-2000 mg per day Flaxseed 2 tablespoons ground per day Probiotics 10-20 billion bacteria daily

Weigh yourself daily, preferably morning and evening.

Check glucose fasting a.m. and non-fasting in the p.m..

Goal - fasting blood sugar less than 90 mg/dL.

2 hrs after eating less than 140 mg/dL

Hemoglobin A1c – average blood sugar over the last 3 months. 1st goal < 7; permanent goal < 6.

Urine negative for sugar, protein and ketones.

Lipids LDL < 100 mg/dL; triglycerides < 150 mg/dL; vitamin D > 50 nmol/L.

Diabetes (I & II) is rare in cultures eating their traditional unprocessed diets. Diabetes is increasing rapidly in all age groups with “modernization” of the diet and

lifestyle in the United States, developed and developing countries world wide. Obesity is a very significant and modifiable risk factor for diabetes (II). Environmental toxicity and/or altered intestinal flora may increase the risk insulin

resistance and obesity. A sedentary lifestyle is a significant and modifiable risk factor diabetes (II). Carbohydrates do not cause diabetes – excess calories from fat, animal foods, refined

carbohydrates, added fats, oils, sugars, cheeses in conjunction with a sedentary lifestyle, cause insulin to not work correctly, resulting in poor sugar utilization.

A low-fat, whole food, high fiber plant-based diet can reduce “intramyocellular fat”, reduce weight and improve insulin’s action and sugar utilization in the cell reversing or dramatically improving the diabetic condition and subsequent health risks.

A low fat diet of vegetables, whole grains, beans, fruit, nuts and seeds can do this. Diabetes (II) epidemic could be stop within one generation (actually within months), as

fast as it has come on with aggressive lifestyle change in diet and exercise. Type I diabetes may possibly be prevented with the avoidance of infant cow’s milk

introduction, and periconceptional, infant and childhood vitamin D normalization.The Diabetes Epidemic Does Not Have To Happen and Can Be Reversed!

Books on Diabetes Prevention, Treatment & Reversal Dr. Neal Barnard’s Program for Reversing Diabetes by Neal Barnard, M.D., 2007;272 pages. Eat To Live: The Revolutionary Formula For Fast and Sustained Weight Loss, Joel Fuhrman, MD, 2003, 292 pages. Healthy at 100, John Robbins, 2007, 357 pages. The Blue Zone: Lessons For Living Longer From The People Who Live Lived The Longest, Dan Buettner, 2008, 277

pages. The Jungle Effect: A Doctor Discovers the Healthiest Diets From Around the World - Why They Work and How to Bring

Them Home, Daphne Miller, M.D. , 2008, 370 pages. The Okinawa Program: How the World’s Longest-Lived People Achieve Everlasting Health - And How You Can Too,

Bradley J. Willcox, M.D, D. Craig Willcox, Ph.D. , Makoto Suzuki, M.D., Ph.D., 2001, 484 pages.

Staying Healthy Today Interviews On Diabetes Prevention, Treatment and Reversal

Chronic Disease Prevention and Real Health Care Reform Using Lessons from Indigenous Diets From Around The World - An Interview With Daphne Miller, M.D.

Diabetes Reversal with The McDougall Program – An Interview With John McDougall, M.D. Diabetes Reversal With The “Eat For Health” Approach – An Interview With Dr. Joel Fuhrman Diabetes Reversal In Less Than 60 Days – A Case Study Diabetes Reversal With The Portfolio Diet - An Interview With Dr. David Jenkins Diabetes Reversal With The HCF Diet – An Interview With Dr. James Anderson Diabetes Reversal Without Drugs - An Interview With Dr. Neal Barnard

Questions??? Kirk Hamilton@prescription2000. com

www.prescription2000.com

Research and medical abstracts have shown diabetes reversal with a very low-fat, high fiber, whole food, plant-based diet mainly using 4 food groups – vegetables, fruit, whole grains and beans for more than 40 years.

Key Researchers:Neal Barnard, M.D. – vegan diets and diabetes.James W. Anderson, M.D. – HCF Diet and diabetes.David A. J. Jenkins, M.D., DSc., Ph.D. – Dietary Portfolio, Glycemic Index and

diabetes.

Successful Diabetes Reversal In Clinical Practice The McDougall Program, John McDougall, M.D. – www.drmcdougall.comThe Eat For Health Program, Joel Fuhrman, M.D. – www.drfuhrman.com

In Successfully Aging Cultures Type I and/or Type II Diabetes Is Rare

Healthy at 100, John Robbins, 2007, 357 pages. (Excellent overview of successfully aging societies and their lifestyles: Abkhazians, Caucasus; Vilcabambans, Peru; Hunzans, Pakistan; Centenarians of Okinawa with lessons for modern society).

The Blue Zone: Lessons For Living Longer From The People Who Lived The Longest, Dan Buettner, 2008, 277 pages, National Geographic Society (Sardinians, Italy; Adventists, California; Nicoyans, Costa Rica; Okinawans, Okinawa).

The Jungle Effect: A Doctor Discovers the Healthiest Diets From Around the World - Why They Work and How to Bring Them Home, Daphne Miller, M.D. , 2008, 370 pages.

The Okinawa Program: How the World’s Longest-Lived People Achieve Everlasting Health - And How You Can Too, Willcox BJ, Willcox C, Suzuki M, Reviews the 25 Year Okinawa Centenarian Study. 2001, 484 pages.

 

Veganism and its relationship with insulin resistance and intramyocellular lipid.

RESULTS: Vegans had a significantly lower systolic blood pressure and higher dietary intake of carbohydrate… and polyunsaturated fat , with a significantly lower glycemic index . Also, vegans had lower fasting plasma triglycerides and glucose… IMCL levels were significantly lower in the soleus muscle . CONCLUSION: Vegans have a food intake and a biochemical profile that will be expected to be cardioprotective, with lower IMCL (intramyocellular lipid) accumulation and beta-cell protective.

Eur J Clin Nutr. 2005 Feb;59(2):291-8.

A vegan diet can lower intramyocellular fat and improve the sugar metabolism lower blood sugar and insulin levels…good for diabetics, especially if overweight!

“High Fiber Diet For Diabetes: Safe and Effective Treatment ”

…The high complex carbohydrate, high fiber diet advocated by Dr. James W. Anderson, M.D. can significantly lower blood lipids, reduce the risk to cardiovascular disease, reduce fasting blood sugar, glycosylated hemoglobin and blood lipids, help maintain desirable body weight, reduce insulin and oral hypoglycemic medications or eliminate them all together. This diet includes 70% calories as complex carbohydrates with 35 gm of dietary fiber…can reduce insulin requirements by 30% to 40% for type I patients and 75% to 100% for type II diabetic patients. In most cases insulin has been discontinued after ten to 21 days of dietary treatment in type II patients. Serum cholesterol levels are reduced 30% for type I diabetes and 24% for type II. Water soluble fibers are particularly effective coming from oat bran and dried beans. Their recommendations for a high carbohydrate, high fiber diet for home use includes 50 to 60% calories from carbohydrates (2/3rds of which are complex carbohydrates), 15% to 20% protein (minimum of 45 gm/d) and 20% to 25% fat (less than 10% saturated fat), 200 mg or less of cholesterol daily and 40 to 50 gm total dietary fiber (25 gm/1000 kcal) and 10 to 15 gm soluble fiber daily. Excellent water soluble fiber sources are oat bran, oatmeal, oat bran muffins, beans, psyllium and soy fiber.

Postgraduate Medicine, August 1990;88(2):157-168. 9535 Anderson, James, M.D.

Management Of Obesity In Diabetes Mellitus…Hypo caloric high-fiber diets have been found to be effective in achieving weight loss, as well as aiding in glycemic and lipid control. Very low calorie diets, administered under medical supervision, are useful for obese NIDDM patients with 18-55 kilograms of weight to lose…Diabetes Educ. 1992 Sep-Oct;18(5):407-10. Anderson JW et al.

Recent Advances In Carbohydrate Nutrition And Metabolism In Diabetes MellitusThe last decade has brought a tremendous turnaround in nutritional recommendations for diabetes management, moving from low-carbohydrate, high-fat diets to high-carbohydrate, high-fiber, low-fat diets….J Am Coll Nutr. 1989;8 Suppl:61S-67S. Anderson JW

New Perspectives In Nutrition Management Of Diabetes Mellitus.

Diet remains the cornerstone in the management of diabetes mellitus… The current consensus diabetes diet recommends 55 to 60 percent of energy as carbohydrate, 12 to 20 percent as protein, and less than 30 percent fat. Total cholesterol intake should be less than 300 mg per day. Fiber appears to have distinct benefits in improving glucose and lipid levels; therefore, an intake of up to 40 g per day… Am J Med. 1988 Nov 28;85(5A):159-65. Anderson JW et al.

High-Carbohydrate, High-fiber Diets For Insulin-treated Men With Diabetes Mellitus

…The daily dose of insulin was lower for each patient on the high-carbohydrate, high plant fiber (HCF) diet than on the control diet. The average insulin dose was reduced from 26 units/day on the control diets to 11 on the HCF diets. On the HCF diets, insulin therapy could be discontinued in nine patients receiving 15 to 20 units/day and in two patients receiving 32 units/day. Fasting and 3-hr postprandial plasma glucose values were lower in most patients on the HCF diets than on the control diets despite lower insulin doses. Serum cholesterol values dropped from 206 on the control diets to 147 on the HCF diet… Am J Clin Nutr. 1979 Nov;32(11):2312-21. Anderson JW et al.

Vegetarian and vegan diets offer significant benefits for diabetes management. …individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens… Vegetarian And Vegan Diets In Type 2 Diabetes Management, Nutr Rev. 2009, May;67(5):255-63.Barnard ND, Jenkins DJ, et al.

A Low-fat Vegan Diet Improves Glycemic Control And Cardiovascular Risk Factors In A RandomizedClinical Trial In Individuals With Type 2 Diabetes.

... RESULTS: 43% (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group... A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group. Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group…LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group. After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24 h) than in the ADA group (10.9 mg/24 h). CONCLUSIONS: Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet. Diabetes Care. 2006 Aug;29(8):1777-83. Barnard ND, Jenkins DJ, et al.

The Effects Of A Low-fat, Plant-based Dietary Intervention On Body Weight, Metabolism, And Insulin Sensitivity.

PURPOSE: This study investigated the effect of a low-fat, plant-based diet on body weight, metabolism, and insulin sensitivity, while controlling for exercise in free-living individuals. …An index of insulin sensitivity increased from 4.6 to 5.7 in the intervention group… CONCLUSION: Adoption of a low-fat, vegan diet was associated with significant weight loss in overweight postmenopausal women, despite the absence of prescribed limits on portion size or energy intake. Am J Med. 2005 Sep;118(9):991-7. Barnard ND et al.

Type 2 Diabetes And The Vegetarian Diet“…there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes…the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyper filtration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. …” Am J Clin Nutr. 2003 Sep;78(3 Suppl):610S-616S. Jenkins DJ, Kendall CW, Barnard ND, Anderson JW et al.

Toward Improved Management Of NIDDM: A Randomized, Controlled, Pilot Intervention Using A Low fat, Vegetarian Diet…Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were randomly assigned to a low-fat vegan diet (seven subjects) or a conventional low-fat diet (four subjects)…. the 28% mean reduction in fasting serum glucose of the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dl), was significantly greater than the 12% decrease, from 9.86 to 8.64 mmol/L (179 to 157 mg/dl), for the control group. The mean weight loss was 7.2 kg in the experimental group, compared to 3. 8 kg for the control group . Of six experimental group subjects on oral hypoglycemic agents, medication use was discontinued in one and reduced in three. Insulin was reduced in both experimental group patients on insulin. No patient in the control group reduced medication use. CONCLUSION: The use of a low-fat, vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise. Prev Med. 1999 Aug;29(2):87-91. Barnard ND et. al

Diet And Exercise In The Treatment Of NIDDM. The Need For Early Emphasis.

“…Medical charts obtained from 4,587 participants in a lifestyle modification program were screened for patients with NIDDM. A total of 652 patients was identified…Fasting glucose level was reduced from 10.0 to 8.45 mmol/l, and 71% of 197 subjects taking oral hypoglycemic agents and 39% of 212 taking insulin were able to discontinue their medication. Of the 243 not taking medication, 76% reduced their fasting glucose levels to < or = 7.84 mmol/l. Blood pressure was significantly reduced, and of the 319 initially taking anti-hypertension drugs, 34% had their medication discontinued. Serum total and low-density lipoprotein cholesterol were reduced by 22% and triglycerides by 33%. The ratio of total to high-density lipoprotein cholesterol was reduced by 13%. Diabetes Care. 1994 Dec;17(12):1469-72. Barnard RJ, et al.

Chronic Exposure To The Herbicide, Atrazine, Causes Mitochondrial Dysfunction And Insulin Resistance. Diabetes Care, 2006, Nov:29 (11)2567

http://www.ncbi.nlm.nih.gov/pubmed?term=4[volume]+AND+4[issue]+AND+e5186[page]+AND+2009[pdat]

A strong interaction between serum gamma-glutamyltransferase and obesity on the risk of prevalent type 2 diabetes: results from the Third National Health and Nutrition Examination Survey. Clin Chem. 2007 Jun;53(6):1092-8. Epub 2007 May 3. http://www.ncbi.nlm.nih.gov/pubmed?term=53[volume]+AND+6[issue]+AND+1092[page]+AND+2007[pdat]

Association between serum concentrations of persistent organic pollutants and insulin resistance among non- diabetic adults: results from the National Health and Nutrition Examination Survey 1999-2002. Diabetes Care. 2007 Mar;30(3):622-8. http://www.ncbi.nlm.nih.gov/pubmed?term=30[volume]+AND+3[issue]+AND+622[page]+AND+2007[pdat]

A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Nutrition Examination Survey 1999-2002: response to Lee et al. Diabetes Care. 2006 Nov;29(11):2567; author reply 2568. http://www.ncbi.nlm.nih.gov/pubmed?term=29[volume]+AND+11[issue]+AND+2567[page]+AND+2006[pdat]

Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009 Dec;90(6):1453-6. Epub 2009 Oct 14. BACKGROUND: The major drivers of the obesity epidemic are much debated and have considerable

policy importance for the population-wide prevention of obesity. OBJECTIVE: The objective was to determine the relative contributions of increased energy intake and reduced physical activity to the US obesity epidemic. DESIGN: We predicted the changes in weight from the changes in estimated energy intakes in US children and adults between the 1970s and 2000s. …RESULTS: For children, the measured weight gain was 4.0 kg (8.8 lbs), and the predicted weight gain for the increased energy intake was identical at 4.0 kg (8.8 lbs). For adults, the measured weight gain was 8.6 kg (18.92 lbs.) , whereas the predicted weight gain was somewhat higher ( 10.8 kg (22.44 lbs). CONCLUSIONS: Increased energy intake appears to be more than sufficient to explain weight gain in the US population. A reversal of the increase in energy intake of approximately 2000 kJ/d (500 kcal/d) for adults and of 1500 kJ/d (350 kcal/d) for children would be needed for a reversal to the mean body weights of the 1970s. Alternatively, large compensatory increases in physical activity (eg, 110-150 min of walking/d), or a combination of both, would achieve the same outcome. Population approaches to reducing obesity should emphasize a reduction in the drivers of increased energy intake.

http://www.ncbi.nlm.nih.gov/pubmed/19828708?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1

Note: A reduction of 500 kcal/d = 1 lb of fat calorie per week.