A Plant Based Diet for the Treatment and Prevention of Type 2 Diabetes

8/17/2019 A Plant Based Diet for the Treatment and Prevention of Type 2 Diabetes

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Evidence-Based Eating Patterns

for Type 2 Diabetes


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Learning Objectives

2. Consider key nutrition intervention

messages for patients

1. Understand therapeutic dietary patterns

for people with type 2 diaetes.


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Epidemiology

1 in

3

!mericans has

either

diaetes orprediaetes


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Mechanics


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Insulin is made in the ancreas


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Type 1 Diabetes

The pancreas no longer makes insulin

Type 2 Diabetes

The cells resist insulin’s action. The pancreas

makes more insulin but cannot keep up.

Gestational Diabetes

Occurs during pregnancy, similar to type 2.


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"nsulin

Inside the !ell#lucose

"ntramyocellular lipid


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Evidence


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" Lesson #rom $apan


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%ice is a traditional staple in $apan&


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Diabetes revalence in $apan

"n adults over age $%

Prior to 1'()* 1+,-


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.estern eating habits are

introduced in $apan&


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%ising /at Inta0e in $apan/at gramsday

&urata &. !m ' Clin (utr 2%%%)*2+suppl,1*/0-0.


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/alling !arbohydrate Inta0e in $apan!arbohydrate gramsday

&urata &. !m ' Clin (utr 2%%%)*2+suppl,1*/0-0.


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Over4eight in $apan

(ational ealth and (utrition 0urvey 'apan3 2%%4http55www%.nih.go.6p5eiken5english5research5pdf5nhns2%%47outline.pdf

5MI 6 2,7gm2Men

.omen

http://www0.nih.go.jp.eiken/english/research/pdf/nhns2006_outline.pdfhttp://www0.nih.go.jp.eiken/english/research/pdf/nhns2006_outline.pdf


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Diabetes revalence in $apan

"n adults over age $%

Prior to 1'()* 1+,-

By 1//% 11+12-


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" Lesson #rom the 8&9&


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1')'*12./ l

2)12*11.8 l

2)):* 2%1.8 l

8&9& er !apita Meat Inta0e lb

0ource U0 9epartment of !griculture3 Economic :esearch 0ervice3http55www.ers.usda.gov59ata5;oodConsumption5;ood!vail0preadsheets.htm


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1')'*1%.$ l

2)12*84.4 l

2));* 4%./ l

8&9& er !apita !hic0en Inta0e lb

0ource U0 9epartment of !griculture3 Economic :esearch 0ervice3

http55www.ers.usda.gov59ata5;oodConsumption5;ood!vail0preadsheets.htm


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1')'*. l

2)12*.8 l

1';)* . l

8&9& er !apita !heese Inta0e lb

0ource U0 9epartment of !griculture3 Economic :esearch 0ervice3

http55www.ers.usda.gov5data-products5dairy-data.asp=:?7$@?"!ccessed 0eptemer 1%3 2%1

http://www.ers.usda.gov/data-products/dairy-data.aspx#.Ui9QRT_4LTIhttp://www.ers.usda.gov/data-products/dairy-data.aspx#.Ui9QRT_4LTI


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0

20

40

60

80

100

High fructose corn syrup Rened cane and beet sugar

Other sweeteners Total

Total Sweeteners

%e#ined cane and beet sugar


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Diabetes revalence 1'':


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Diabetes revalence 1'',


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Diabetes revalence 1'';


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Diabetes revalence 1''=


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Diabetes revalence 1''(


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Diabetes revalence 1'''


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Diabetes revalence 2)))


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Diabetes revalence 2))1


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Diabetes revalence 2)):


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Diabetes revalence 2)),


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Diabetes revalence 2))=

0 - 6.5

6.6 - 8.0

8. - !."

!.5 - .

# .2


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Diabetes revalence 2))(

0 - 6.5

6.6 - 8.0

8. - !."

!.5 - .

# .2


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Diabetes revalence 2)1)

0 - 6.5

6.6 - 8.0

8. - !."

!.5 - .

# .2


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Diabetes revalence 2)11

0 - 6.5

6.6 - 8.0

8. - !."

!.5 - .

# .2


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Dietary "pproaches #or

Diabetes


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!arbohydrate !ontrol

2. $alorie %e&icit

. $arbohydrate counting

0tandards of &edical Care in 9iaetes A2%1$. Diabetes Care. 2%1$)*01$-0%.

;armer B. >utritional ade?uacy o# plant+based diets #or 4eight management* observations #rom the >


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What Other Dietary Patterns Are

Commonly Precribed?1. @ow-carohydrate

2. @ower-fat

. &editerranean-style

$. 9ietary !pproaches to 0top

ypertension +9!0,

8. Plant-ased +vegan or vegetarian,

0tandards of &edical Care in 9iaetes A2%1$. Diabetes Care. 2%1$)*01$-0%.


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Lo4+!arbohydrate Diet

' !voids grains3 sugars3 starchy vegetales

' ;ocuses on high-protein foods

' !llows low-carohydrate vegetales

' Carohydrate amounts vary

' #rains avoided


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Lo4+!arb Diet %is0s

' !ssociated with increased mortality.

' "ncreased risk for cardiovascular disease.

' @ong-term effects are unknown.

?richopoulou !3 et al. Lo4+carbohydrate+high+protein diet and long+term survival in a general populationcohort& Eur J Clin Nutr . 2%%*)418*8-81.;ung ??3 et al. Lo4+carbohydrate diets and all+cause and cause+speci#ic mortality* t4o cohort studies& Ann Intern Med . 2%1%)18%2/-2/.

@angiou P3 et al. Lo4 carbohydrate+high protein diet and incidence o# cardiovascular diseases in 94edish

4omen* prospective cohort study& BMJ. 2%12)$$e$%24.


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Lo4er /at Diet

' :esearch is limited.

' :educed risk for heart disease3 cancer3

and oesity.

' ;atty foods include meat3 dairy

products3 fried foods3 desserts3 and oils

Pi-0unyer D3 Blackurn #3 Brancati ;@3 et al.3 @ook !E!9 :esearch #roup. :eduction in weight and

cardiovascular disease risk factors in individuals with type 2 diaetes one-year results of the @ook !E!9

trial. Diabetes Care 2%%*)%1*$A1.

ooper @3 !delhamid !3 &oore ;3 9outhwaite 3 0keaff C&3 0ummerell C9. E##ect o# reducing total #atinta0e on body 4eight* systematic revie4 and meta+analysis o# randomised controlled trials and cohort

studies& 5M$& 2)12@3:,*e=;;;;&


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AMediterraneanB Diet

"nspired from the diets of countriesalong the coast of the &editerranean.


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1. @ittle to no red meat and replace with white meat

2. ;ish F = per week

. ;avor unsaturated fats +olive oil, over saturatedfats +utter,

$. Consume more plant-ased foods

8. Eat more whole foods and fewer processed foods

4. 9rink wine in moderation

AMediterraneanB Diet


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Evidence #or AMediterraneanB Diet

aseline 1 !ear"

"#"

6

6#"

$

$#"

8

8#"


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Baseline 1 Kear2*

2*.8

2

2.8

2/2/.8

%

%.8

1

1.8

5MI

Elhayany3 !.3 et al. ! low carohydrate &editerranean diet improves cardiovascular risk factors and diaetes

control among overweight patients with type 2 diaetes mellitus ! 1-year prospective randomiGed intervention

study. Diabetes Obes Metab. 2%1%)122%$-2%/.

Evidence #or AMediterraneanB Diet


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' ow does the &editerranean diet incorporate

the followingL

o :ed meat

o ;ish

o ?ypes of fats

o #eneral animal vs plant consumption

o 9egree of food processingo !lcohol

AMediterraneanB Diet Cui


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!(0E:0

o @ittle to no red meat

o ;ish M =5week

o ;avor unsaturated fats +olive oil to utter,

o igher intake of plant-ased foods

o &ostly whole-foods

o &ay drink red wine in moderation

AMediterraneanB Diet Cui


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' ow does 9!0 incorporate the followingL

o :ed meat

o ;ish and poultryo ?ypes of fats

o #eneral animal vs plant consumption

o 9egree of food processingo 0alt5&ineral intake

D"9<

Dietary "pproaches to 9top


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!(0E:

0imilar to the &editerranean diet A focusplaced on whole foods

"ncludes an emphasis on decreased intake of

sodium3 with an increased intake of potassium3

magnesium3 and calcium

D"9<

Dietary "pproaches to 9top


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' :andomiGed crossover trial

' 1 patients with type 2 diaetes

' weeks on 1st diet' $ weeks washout period

' ?hen weeks on 2nd diet

D"9< Diet #or Type 2 Diabetes

!Gadakht @3 et al. Effects of the 9ietary !pproaches to 0top ypertension +9!0, eating plan on cardiovascular

risks among type 2 diaetic patients a randomiGed crossover clinical trial. Diabetes Care. 2%11)$88-8*.


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eek % eek 1$%

1$8

18%

188

14%

148

1*%

Contr

ol

.eight in lbs

Evidence #or D"9< Diet

!Gadakht3 @.3 et al. Effects of the 9ietary !pproaches to 0top ypertension +9ash, Eating Plan on Cardiovascular

:isks among ?ype 2 9iaetic Patients ! :andomiGed Crossover Clinical ?rial. Diabetes Care $.1 +2%11, 88-*. Print.


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Evidence #or D"9< Diet

!Gadakht3 @.3 et al. Effects of the 9ietary !pproaches to 0top ypertension +9ash, Eating Plan on Cardiovascular

:isks among ?ype 2 9iaetic Patients ! :andomiGed Crossover Clinical ?rial. Diabetes Care $.1 +2%11, 88-*. Print.

eek % eek 8

8.8

4

4.8

*

*.8

.8

Contr

ol


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' 9escrie the 9!0 eating pattern in

your own words to a patient.

D"9< Cui


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M t ! ti d Di b t %i 0


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nowdon '& et al# oes a *egetarian diet reduce the occurrence of diabetes3 Am J Public Health# 18"/$","0$"12# 5raser %# 'ssociations between diet and cancer& ische)ic heart disease& and all-cause )ortality in non-Hispanic white 7alifornia e*enth-day 'd*entists# Am J Clin Nutr. 1/$0,"2"8#

Meat !onsumption and Diabetes %is0

!s meat consumption increases3 so does the

prevalence of type 2 diaetes.

"dventist


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"dventist


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y

Tonstad (, et al. Type o& )egetarian diet, body *eight and pre)alence o& type 2 diabetes. %iabetes $are 200!+2!-6.


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' $$%3%%% participants

o 1%% grams of red meat +.8 oG,

1/J increased risk

o 8% grams processed meat

81J increased risk

Meat and Diabetes %is0


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Evidence #or lant+5ased Diet

• :andomiGed clinical trial

• // participants with diaetes

• @ow-fat low-#" vegan diet vs carohydrate

counting and calorie reduction

• 22-week study3 1-year of follow-up

Barnard (93 et al. ! low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomiGed clinical

rrial in individuals with type 2 diaetes. Diabetes Care. 2%%4)2/1***-1*.


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Evidence #or lant 5ased Diet*


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Evidence #or lant+5ased Diet* eight Control

;erdowsian :3 Barnard (93 oover O'3 et al. ! multicomponent intervention reduces ody weight and cardiovascular risk

at a #E"CQ corporate site. Am J Health Prom. 2%1%3)2$3$-*.


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Study Sites


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Study Sites *egan

control

u9alo& :!

;oodbury& :! 7he*y 7hase& (

?a+eland& 5?

5rederic+sburg&


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5ody .eight +pounds,

Control

"ntervention


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.hy lant+5asedF

' &ore effective than standard

recommendations in randomiGed control

trials.

' :educes risk for heart disease3 cancer3and oesity.

' "ncreases fier intake.

$raig /, et al. 1osition o& the merican %ietetic ssociation )egetarian diets. 200!+0!266-282.


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l h# l #


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Produced y microorganisms A plants andanimals can not synthesiGe B12.

itamin 512 !obalamin

i i 512


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itamin 512

' :9! for adults 2.$ mcg.

' 0upplements for anyone over age 8% or on

vegan diet.


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utting >utrition

Into ractice

.hat 4ould you sayF


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Kour patientRs fasting lood glucose is 1$%3 and his

!1c is .%. e asks what diet could give him the

est chance at a healthy life. hat do you sayL

.hat 4ould you sayF


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Great $obH

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A Plant Based Diet for the Treatment and Prevention of Type 2 Diabetes

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