Moving from Treatment to Prevention
Neal D. Barnard, MD Adjunct Associate Professor of Medicine The George Washington University School of
Medicine Physicians Committee for Responsible
Medicine
A Lesson from Japan
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.
Rising Fat Intake in Japan
Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.
Fat (grams/day)
0
10
20
30
40
50
60
1955 1965 1975 1985 1994
Falling Carbohydrate Intake in Japan
Murata M. Am J Clin Nutr 2000;72(suppl):1379S-83S.
Carbohydrate (grams/day)
250
280
310
340
370
400
430
1955 1965 1975 1985 1994
Overweight in Japan
Women
Men
National Health and Nutrition Survey Japan, 2006 http://www0.nih.go.jp/eiken/english/research/pdf/nhns2006_outline.pdf
BMI ≥ 25kg/m2
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.
A Lesson from the U.S.
U.S. Per Capita Meat Intake (lb)
1900 1920 1940 1960 1980 2000
20
40
60
80
100
120
140
160
180
200
220
Source:US Department of Agriculture, Economic Research Service,http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc,accessed August 15, 2009.
1909
2004
123.9 lb
201.5 lb
(Includes red meat, poultry, and fish)
2012181.5 lb
U.S. Per Capita Chicken Intake (lb)
1900 1920 1940 1960 1980 20000
10
20
30
40
50
60
Source:US Department of Agriculture, Economic Research Service,http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm#mtpcc,accessed August 15, 2009.
1909
2006
10.4 lb
60.9 lb
201256.6 lb
U.S. Per Capita Cheese Consumption (pounds)
1900 1920 1940 1960 1980 20000
10
20
30
40
Source:US Department of Agriculture, Economic Research Service,http://www.ers.usda.gov/data-products/dairy-data.aspx#.Ui9QRT_4LTI, accessedSeptember 10, 2013
19608.3 lb
201233.5 lb
19093.8 lb
Diabetes Prevalence 1994
Diabetes Prevalence 1995
Diabetes Prevalence 1996
Diabetes Prevalence 1997
Diabetes Prevalence 1998
Diabetes Prevalence 1999
Diabetes Prevalence 2000
Diabetes Prevalence 2001
Diabetes Prevalence 2002
Diabetes Prevalence 2003
Diabetes Prevalence 2004
Diabetes Prevalence 2005
Diabetes Prevalence 2006
Diabetes Prevalence 2007
Diabetes Prevalence 2008
Diabetes Prevalence 2009
www.cdc.gov/diabetes
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.
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.
Weight-Control Study
2 rules:
1. No animal products
2. Minimize oils
No exercise
14-week study
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
Results at 14 Weeks
13 lb average weight loss
2-inch drop in waist measurement
Increased insulin sensitivity
Weight at 1 and 2 Years
Turner-McGrievy GM. Obesity 2007;15:2276-81.
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
Plant-Based Dietary Intervention in Type 2 Diabetes
Funding: National Institute of Diabetes and Digestive and Kidney Diseases, NIH Diabetes Action Research and Education Foundation
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.
Hemoglobin A1c at Baseline and at 11 and 22 Weeks
Week 0 Week 11 Week 226.5
7.0
7.5
8.0
8.5
VeganADA
Individuals with no medication changes, n = 24 vegan, 33 ADA
P = 0.01
8.07
7.88
7.42
7.18
7.50
6.84
A1c (%)
Hemoglobin A1c, All Participants(n = 49 vegan, 50 ADA)
0 11 22 35 48 61 746.5
7.0
7.5
8.0
8.5
VeganADA
Data shown are last values before any change to hypoglycemicmedications carried forward. For between-group comparison of changesfrom baseline to final values, P = 0.03.
Weeks
7.65
7.948.057.93
P = 0.03
A1c (%)
Body Weight(n = 49 vegan, 50 ADA)
(Missing values returned to baseline)
Week 0 Week 11 Week 22 Week 7485
90
95
100
105
Vegan
ADA
93.3
96.797.0
99.3
P=0.36
(-3.7 from baseline)
(-2.6 from baseline)Weight (kg)
Low Density LipoproteinBaseline to 74 Weeks or Last Value before Medication Change
(n = 49 vegan, 49 ADA)
Week 0 Week 7480
90
100
110
120
130
VeganADA
P = .001
104
91
118114
-13%
LDL (mg/dl)
-3%
Glucose Insulin
Intramyocellular lipid
Inside the Cell
●
● ● ● ● ● ●
●
Three Keys:
1. Vegan 2. Low in fats and oils 3. Low-glycemic index
PCRM 2009 USDA 2011
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 1%
Body Weight
P-value < 0.0001
Am J Health Promotion, In pre
Waist Circumference
Am J Health Promotion, In press P-value < 0.001
Study Sites vegan
control
Buffalo, NY
Woodbury, NY
Chevy Chase, MD
Virginia Beach, VA San Diego, CA Tucson, AZ Macon, GA Dallas, TX Lakeland, FL
Fredericksburg, VA
Body Weight (pounds)
190
195
200
205
210
Week 0 Week 18
Control
Intervention
Hemoglobin A1c
6.0
6.5
7.0
7.5
8.0
Week 0 Week 18
Control
Intervention
Beginning a Healthful Diet
Step 1. Check out the possibilities
Breakfast Lunch Dinner Snack
Foods to Try
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
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
Italian Cuisine
Mexican Cuisine
Chinese Cuisine
Japanese Cuisine
Fast-Food Options
Veggie sub
Bean burrito, hold the cheese
Beginning a Healthful Diet
Step 1. Check out the possibilities
Step 2. Do a 3-week test drive
Optional: Use transition foods
PCRM.org
Washington, DC July 31-August 1, 2015 www.pcrm.org George Washington University School of Medicine Physicians Committee for Responsible Medicine
International Conference on Nutrition and Cardiovascular Disease
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