Slide1: A New Dietary Approach to Diabetes Neal D. Barnard, M.D. Physicians Committee for Responsible Medicine


Slide3: Type 1 Diabetes The pancreas no longer makes insulin. Type 2 Diabetes The cells of the body resist insulin’s action. The pancreas reacts by making extra insulin, but cannot provide enough to move blood glucose into the cells efficiently. Gestational Diabetes Occurs during pregnancy, similar to type 2.


Slide4: Type 1 Diabetes Insulin must be given. Diet changes and exercise can minimize insulin doses and reduce the risk of complications. Between 5 and 10% of people with diabetes have type 1.


Slide5: Type 2 Diabetes When cells are less sensitive to insulin’s action, this is called insulin resistance. Insulin resistance runs in families, but it can become much better or worse depending on: 1. how much body fat you develop 2. the foods you eat 3. how much you exercise


Uncontrolled diabetes can lead to…Diabetes control is measured with a blood test called…: Uncontrolled diabetes can lead to… Diabetes control is measured with a blood test called… …Hemoglobin A1c ….problems from head to toe.


Slide7: Current Approaches to Type 2 Diabetes Keep total carbohydrate intake steady. Cut calories and add exercise for weight reduction. Limit fats for cholesterol control. Add oral medications to control blood glucose. Add insulin, if necessary.


Slide8: Science Brings a New Approach


Slide9: Population Studies Diabetes is rare in Asia and Africa among those following traditional plant-based diets. Diabetes becomes more common as diets are Westernized. Diabetes becomes more common when Asians move to North America. In the U.S. and Europe, vegetarians have much less diabetes than meat-eaters.


Slide11: Prior Studies


Slide12: Heart Patients Low-fat vegetarian diet Mild exercise No smoking Stress management Ornish D. Lancet 1990;336:129-33. Ornish D. JAMA 1998;280:2001-7.


Slide13: Heart Patients Low-fat vegetarian diet Mild exercise No smoking Stress management Ornish D. Lancet 1990;336:129-33. Ornish D. JAMA 1998;280:2001-7. → Near-elimination of chest pain Reversal of artery blockages in 82% of participants Weight loss: 22 lb in 1 year


Slide14: Weight-Control Study Low-fat vegan diet No exercise 14-week study


Slide15: Weight-Control Study Low-fat vegan diet No exercise 14-week study → 13 lb average weight loss in 14 weeks 2-inch drop in waist measurement Increased thermic effect of food Increased insulin sensitivity


Slide16: Increased thermic effect of food (TEF) apparently caused by improved insulin sensitivity


Slide17: Plant-Based Dietary Intervention in Type 2 Diabetes Physicians Committee for Responsible Medicine George Washington University University of Toronto Funding: National Institute of Diabetes and Digestive and Kidney Diseases, NIH Diabetes Action Research and Education Foundation Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Jaster B, Seidl K, Green AA, Talpers S. Diab Care 2006;29:1777-1783.


Slide18: Study design: Comparison of 2 diets: vegan, low-fat, low-GI ADA guidelines 22-week study with 1-year follow-up A1c was measured at beginning and after 22 weeks.


Slide19: P = 0.01 8.07 7.88 6.84 7.50 Individuals with no medication changes, n = 24 vegan, 33 ADA 7.42 7.18


Slide20: P = 0.02


Slide21: Advantages No calorie limits No carbohydrate limits No portion limits No counting or measuring Powerful for controlling weight and cholesterol Easier to follow


Slide22: The New Dietary Method for Diabetes Vegan (no animal products) Low-fat Low glycemic index


What is a vegan diet?: What is a vegan diet? No animal products—no meat, poultry, fish, dairy products, eggs, honey Abundant fruits, vegetables, whole grains, and legumes Read labels! Check for hidden ingredients like chicken stock, whey, casein, etc.


Fat Content(Percentage of Calories from Fat): 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% Sweet potato or yam 1%


Protein and Loss of Kidney Function : Protein and Loss of Kidney Function Harvard Nurses’ Health Study: Women with mild kidney damage, followed for 11 years: Animal protein intake was associated with continuing loss of kidney function. Knight EL Ann Intern Med 2003;138:460-7.


Prevalence of Decreased Kidney Function : Prevalence of Decreased Kidney Function GFR = Glomerular filtration rate, mL/min per 1.73 m2 Coresh J. Am J Kidney Dis 2003;41:1-12.


Slide28: The New Dietary Method for Diabetes Vegan (no animal products) Low-fat Low glycemic index


Keep it low-fat: Keep it low-fat Cut out high-fat foods: Oils and oily foods Nuts and seeds Avocados and olives Dressings and high-fat condiments High-fat meat and dairy substitutes


Keeping Oils Low : Keeping Oils Low All fats and oils have 9 calories per gram. Carbohydrates have only 4 calories per gram. All fats and oils are mixtures: saturated and unsaturated fats. Potato: 120 calories Cheese: 120 calories


Keep it low-fat: Keep it low-fat Aim for less than 20-30 fat grams per day. Aim for < 2 grams of fat per serving on food labels.


Keep it low-fat: Keep it low-fat No added oils Cook with vegetable broth or water Steam instead of fry Use non-stick cooking spray Top salads with non-fat dressings Use mustard instead of mayo on sandwiches Use bean spreads/hummus or jam instead of margarine Use applesauce in baked recipes


Keep it high-fiber: Keep it high-fiber Choose whole grains (try barley, oats, quinoa, millet, whole–wheat pasta, etc) Load up on beans Choose high-fiber cereals Eat abundant amounts of vegetables and fruits


Keep it high-fiber: Keep it high-fiber Aim for 40 grams per day (start slowly) Aim for at least 3 g per serving on labels and at least 10-15 grams per meal


Choosing Low-GI Foods : Choosing Low-GI Foods The glycemic index shows how quickly a food increases blood glucose.


Choosing Low-GI Foods : Choosing Low-GI Foods High-GI examples: Sugar White bread Cold cereals White potatoes


Choosing Low-GI Foods : Choosing Low-GI Foods Low-GI examples: Beans Green vegetables Fruits, except pineapple and watermelon Pasta Rye or pumpernickel bread


GI at a Glance : GI at a Glance High-GI (avoid) White or wheat bread Most cold cereals Watermelon, pineapple Baking potatoes Sugar Low-GI (enjoy) Pumpernickel or rye bread Oats, bran cereals, Grape-nuts Most fruits Sweet potatoes, yams Pasta, rice, barley, couscous Beans, peas, lentils Most vegetables


For more information: For more information Visit www.GlycemicIndex.com Use your handouts


Slide40: Important Take a daily multivitamin for vitamin B12. Have a relationship with health care provider. Check your blood glucose regularly. Are you on medications that can cause hypoglycemia? Carry a glucose meter. Be ready for hypoglycemia.


Shopping list: Shopping list Grains Pumpernickel or rye bread Old-fashioned oats All-bran cereal Barley Quinoa Buckwheat Whole-wheat pasta


Shopping list: Shopping list Vegetables Leafy greens like spinach, kale, collards Cruciferous like broccoli, cauliflower, cabbage Green beans, tomatoes, eggplant Limit pumpkin, carrots, parsnips, beets


Shopping list: Shopping list Fruits Most fruits are great Limit dried fruits (dates, figs, raisins), pineapple, and watermelon


Shopping list: Shopping list Beans Load up on beans! Black beans Pinto beans Fat-free vegetarian refried beans Garbanzo beans Kidney beans Black-eyed peas Lentils and split peas


So let’s plan our meals!: So let’s plan our meals! Breakfast Lunch Dinner Snacks Desserts


Slide46: PCRM