Tackling Diabetes, Keeping a Healthy Heart

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Tackling Diabetes, Keeping a Healthy Heart
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Type 1 Diabetes The pancreas no longer makes
insulin. Type 2 Diabetes The cells of the body
resist insulins action. Gestational Diabetes
Occurs during pregnancy, similar to type 2.

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A Lesson from Japan
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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. 199424 SupplS15-S21.

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Rising Fat Intake in Japan
1955 1965 1975 1985
1994
Murata M. Am J Clin Nutr 200072(suppl)1379S-83S
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Falling Carbohydrate Intake in Japan
1955 1965 1975 1985 1994
Murata M. Am J Clin Nutr 200072(suppl)1379S-83S
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Overweight and Obesity in Japan
Prevalence in Men




BMI 25-29.9 BMI 30



Yoshiike N. Obes Rev 20023183-90. Yoshiike
N. Asia Pac J Clin Nutr 200211(Suppl 8)S727-31.

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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. 199424 SupplS15-S21.

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A Lesson from the U.S.
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Diabetes Prevalence 1994
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Diabetes Prevalence 1995
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Diabetes Prevalence 1996
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Diabetes Prevalence 1997
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Diabetes Prevalence 1998
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Diabetes Prevalence 1999
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Diabetes Prevalence 2000
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Diabetes Prevalence 2001
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Diabetes Prevalence 2002
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Diabetes Prevalence 2003
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Diabetes Prevalence 2004
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Diabetes Prevalence 2005
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Diabetes Prevalence 2006
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Diabetes Prevalence 2007
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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, NIHDiabetes
Action Research and Education Foundation
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Study design Low-fat vegan diet vs ADA diet
guidelines 22-week study with 1-year
follow-up Track hemoglobin A1c
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Individuals with no medication changes, n 24
vegan, 33 ADA
8.1
7.9
7.5
7.4
7.2
6.8
P 0.01
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• The Glycemic Index
• Invented in 1981 by Dr. David Jenkins.
• Separates foods that raise blood sugar quickly
  from those that raise it slowly.

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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

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• The Glycemic Index does not take the place of
  other considerations
• Vegan foods
• Low-fat foods

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• Important
• A daily multivitamin for vitamin B12.
• Be alert to medications that can cause
  hypoglycemia.
• Check blood glucose regularly.

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A Healthy Heart
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Lifestyle Heart
TrialDean Ornish, M.D.Preventive Medicine
Research Institute
Ornish D. Lancet 1990336129-33.
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Lifestyle Heart Trial
Experimental program 1. Vegetarian foods 2.
Half-hour walk daily 3. Manage stress 4. Avoid
tobacco
Ornish D. Lancet 1990336129-33.
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Lifestyle Heart Trial
Experimental
Cholesterol ? 24
LDL ? 37
Weight ? 22 lbs
Reversal 82 of participants


Ornish D. Lancet 1990336129-33.
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Why Do We Have Cholesterol?
Raw material for making hormones (estrogens,
testosterone) Key ingredient in cell membranes
In excess, cholesterol leads to artery
blockages
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Understanding Your Blood Test

• Goals
• lt200 mg/dl
• lt100 mg/dl
• Women gt55 Men gt45
• lt150 mg/dl

• Total cholesterol
• LDL (bad) cholesterol
• HDL (good) cholesterol
• Triglycerides (blood fats)

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Lowering LDL
Avoid meat, dairy, eggs, hydrogenated oils,
tropical oils Increase oats, beans
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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 15
• Potato 1

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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.
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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-enr
iched margarine 2 grams) Listed quantities
are for a 2,000-calorie diet Jenkins DJA. JAMA
2003290502-510.
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Special Cholesterol-Lowering Foods
In 4 weeks LDL (bad) cholesterol
? 29 Cholesterol-lowering drugs
? 31 Jenkins DJA. JAMA 2003290502-510.
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Boosting HDL
Exercise Vitamin C-rich foods
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Tackling Triglycerides
Avoid animal products Avoid high-GI foods
Exercise
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Hypertension
High pressure in the arteries 1st number
(systolic) pressure during the heartbeat 2nd
number (diastolic) pressure between beats
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Hypertension
Target 120/80 If you
have diabetes lt130/80
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Reducing Blood Pressure
Reduce sodium Increase potassium vegetables and
fruits Avoid saturated fat ? blood viscosity
Vegetarian/vegan diets
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