Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
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Cleveland Heartlab 5th Annual Symposium: Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
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Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
- 1. A Plant-Based Dietary Intervention for Type 2 Diabetes Neal D. Barnard, MD Adjunct Associate Professor of Medicine The George Washington University School of Medicine Physicians Committee for Responsible Medicine
- 2. A Lesson from Japan
- 4. 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.
- 8. Rising Fat Intake in Japan Fat (grams/day) 60 50 40 30 20 10 0 1955 1965 1975 1985 1994 Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.
- 9. Falling Carbohydrate Intake in Japan Carbohydrate (grams/day) 430 400 370 340 310 280 250 1955 1965 1975 1985 1994 Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.
- 10. Overweight in Japan Women Men BMI ≥ 25kg/m2 National Health and Nutrition Survey Japan, 2006 http://www0.nih.go.jp/eiken/english/research/pdf/nhns2006_outline.pdf
- 11. 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.
- 12. A Lesson from the U.S.
- 13. U.S. Per Capita Meat Intake (lb) 220 200 180 160 140 120 100 80 60 40 20 1909 2004 123.9 lb 201.5 lb 2012 181.5 lb (Includes red meat, poultry, and fish) 1900 1920 1940 1960 1980 2000 Source:US Department of Agriculture, Economic Research Service, http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc, accessed August 15, 2009.
- 14. U.S. Per Capita Chicken Intake (lb) 60 50 40 30 20 10 0 1909 2006 10.4 lb 60.9 lb 1900 1920 1940 1960 1980 2000 2012 56.6 lb Source:US Department of Agriculture, Economic Research Service, http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc, accessed August 15, 2009.
- 15. U.S. Per Capita Cheese Consumption (pounds) 40 30 20 10 0 1960 8.3 lb 2012 33.5 lb 1909 3.8 lb 1900 1920 1940 1960 1980 2000 Source:US Department of Agriculture, Economic Research Service, http://www.ers.usda.gov/data-products/dairy-data.aspx#.Ui9QRT_4LTI, accessed September 10, 2013
- 32. Diabetes Prevalence 2009 www.cdc.gov/diabetes 0 - 6.5 6.6 - 8.0 8.1 - 9.4 9.5 - 11.1 > 11.2
- 33. Adventist Health Study – 2 60,903 participants, aged ≥30, enrolled 2002-2006 Tonstad S, et al. Type of vegetarian diet, body weight and prevalence of type 2 diabetes. Diabetes Care 2009;32:791-6.
- 34. Adventist Health Study – 2 Tonstad S, et al. Type of vegetarian diet, body weight and prevalence of type 2 diabetes. Diabetes Care 2009;32:791-6.
- 35. Weight-Control Study 2 rules: 1. No animal products 2. Minimize oils No exercise 14-week study
- 36. Typical Day’s Meals Breakfast Blueberry pancakes or Oatmeal with cinnamon and raisins Half cantaloupe Rye toast with jam Lunch Chunky vegetable chili Garden salad with sesame dressing Snack Banana Dinner Lentil soup with crackers Linguine with artichoke hearts and seared oyster mushrooms Steamed broccoli
- 37. Results at 14 Weeks 13 lb average weight loss 2-inch drop in waist measurement Increased insulin sensitivity
- 38. Weight at 1 and 2 Years Turner-McGrievy GM. Obesity 2007;15:2276-81.
- 39. 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, NIH Diabetes Action Research and Education Foundation
- 40. Plant-Based Diet for Type 2 Diabetes Intervention: Vegan, low-fat, low-GI Control: ADA guidelines (2003) 22-week study, 1-year follow-up n = 99 Barnard ND, et al. Diabetes Care 2006;29:1777-1783. Barnard ND, et al. Am J Clin Nutr 2009;89(suppl):1588S-96S.
- 41. SSttuuddyy CCoommpplleetteerrss Vegan Group ADA Group N = 49 N = 50 Completers at 22 weeks 49 (100%) 50 (100%) Completers at 74 weeks 42 (86%) 45 (90%)
- 42. Hemoglobin A1c at Baseline and at 11 and 22 Weeks P = .089 8.05 7.93 7.37 7.08 (n = 49 vegan, 50 ADA) 7.34 Week 0 Week 11 Week 22 8.5 8.0 7.5 7.0 6.5 Vegan ADA A1c (%) 7.33
- 43. Hemoglobin A1c at Baseline and at 11 and 22 Weeks Individuals with no medication changes, n = 24 vegan, 33 ADA Week 0 Week 11 Week 22 8.5 8.0 7.5 7.0 6.5 Vegan ADA P = 0.01 8.07 7.88 7.42 7.18 7.50 6.84 A1c (%)
- 44. Hemoglobin A1c, All Participants (n = 49 vegan, 50 ADA) ADA 7.94 7.65 8.05 7.93 P = 0.03 0 11 22 35 48 61 74 8.5 8.0 7.5 7.0 6.5 Vegan Weeks Data shown are last values before any change to hypoglycemic medications carried forward. For between-group comparison of changes from baseline to final values, P = 0.03. A1c (%)
- 45. Body Weight (n = 49 vegan, 50 ADA) (Missing values returned to baseline) ADA 96.7 99.3 (-2.6 from baseline) (-3.7 from baseline) Week 0 Week 11 Week 22 Week 74 105 100 95 90 85 Vegan 93.3 97.0 P=0.36 Weight (kg)
- 46. Low Density Lipoprotein Baseline to 74 Weeks or Last Value before Medication Change (n = 49 vegan, 49 ADA) Week 0 Week 74 130 120 110 100 90 80 Vegan ADA P = .001 104 91 118 114 -13% LDL (mg/dl) -3%
- 47. Nutrition in Diabetic Neuropathy Crane (1994): Test of low-fat vegan diet N = 21 Total remission in 17 participants
- 48. Screened (n = 71) Group 1 (n = 17) Enrolled (n= 35) Excluded: Withdrew from consideration (10) Pain/symptoms did not meet criteria (5) No diabetic neuropathy (3) No diabetes (2) Did not meet other inclusion criteria (2) Group 2 (n = 18) Completed (n= 17) Completed (n= 17) Withdrew (n = 0) Withdrew (n = 1) Neuropathy Study Men and women 18-65 y Type 2 diabetes Painful diabetic neuropathy for at least 6 months
- 49. Intervention Arms Experimental: Vegan diet + B12 (1000 mcg/d) Control: B12 only
- 50. Inside the Cell Glucose Insulin ● ● ●●●● ● ● Intramyocellular lipid
- 51. Three Keys: 1. Vegan 2. Low in fats and oils 3. Low-glycemic index
- 53. PCRM 2009 USDA 2011
- 54. FFaatt CCoonntteenntt ((PPeerrcceennttaaggee ooff CCaalloorriieess ffrroomm FFaatt)) • Leanest beef 29% • Skinless chicken breast 23% • Sea trout 32% • White tuna 16% • Broccoli 8% • Beans 4% • Rice 1–5% • Sweet Potato 1%
- 56. There were a few missteps along the way…
- 57. Body Weight P-value < 0.0001 Am J Health Promotion, In press
- 58. Waist Circumference Am J P-value < 0.001 Health Promotion, In press
- 59. Study Sites vegan control Buffalo, NY Woodbury, NY Fredericksburg, VA
- 60. Body Weight (pounds) 210 205 200 195 190 Control Intervention Week 0 Week 18
- 61. Hemoglobin A1c 8.0 7.5 7.0 6.5 6.0 Control Intervention Week 0 Week 18
- 62. Beginning a Healthful Diet Step 1. Check out the possibilities
- 63. Breakfast Lunch Dinner Snack Foods to Try
- 64. Healthy Breakfasts • Cinnamon Raisin Oatmeal • Blueberry Pancakes • Bran Flakes with Almond Milk • Hot Whole Wheat with Dates • Breakfast Scrambler • Fantastic Fruit Smoothie • Whole-Grain Bagel with Jam • Swiss Style Muesli • Slow Cooker Whole-Grain Porridge • Orange-Pineapple Crush
- 65. Lunches and Dinners • Veggie Pizza • Chunky Vegetable Chili • Bean Burrito • Seitan & Mushroom Stroganoff • Portobello Mushroom Steaks • Oven-Barbecued Tofu Steaks • Roadhouse Hash • Sweet & Sour Tempeh • Southern Beans & Greens • Seitan Cassoulet • Mandarin Stir-Fry • Stuffed Vegetable Rolls • Zucchini & Herb Calzones
- 66. Italian Cuisine
- 67. Mexican Cuisine
- 68. Chinese Cuisine
- 69. Japanese Cuisine
- 70. Fast-Food Options Veggie sub Bean burrito, hold the cheese
- 71. Beginning a Healthful Diet Step 1. Check out the possibilities Step 2. Do a 3-week test drive Optional: Use transition foods
- 74. PCRM.org
- 75. PCRM.org
- 76. International Conference on Nutrition and Cardiovascular Disease Washington, DC July 31-August 1, 2015 www.pcrm.org George Washington University School of Medicine Physicians Committee for Responsible Medicine
- 77. Thank you! Neal D. Barnard, MD Adjunct Associate Professor of Medicine The George Washington University School of Medicine Physicians Committee for Responsible Medicine pcrm.org
Editor's Notes
- Age-Adjusted Prevalence of Diagnosed Diabetes per 100 Adult Population, by State, United States
- We saw no change in body weight in control group participants, but an average of 11 pound weight loss in participants in the vegan group. 16 control-group participants began the optional program initiated at their site. These participants attended an average of 46% of meetings and lost a mean of 9 lb. Attendance was significantly correlated with weight loss (r = -0.61, P = 0.01). Of participants who attended &gt;50% of meetings (n = 8), mean weight loss was 13 lbs.
- As you would expect, waist circumference also decreased in the vegan group – about two inches smaller (or X cm).