Moving from Treatment to Prevention · Neal D. Barnard, MD . Adjunct Associate Professor of Medicine . ... Tonstad S, et al. Type of vegetarian diet, body weight and prevalence of

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
















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

PCRM.org

http://pcrm.org/kickstartHome/

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

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=T_NyU7I29MB6VM&tbnid=rUpNMVa6xnlxuM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.allposters.com%2F-sp%2FFemale-Runner-Victorious-at-the-Finish-Line-in-a-Track-Race-Posters_i6071546_.htm&ei=oHW1U_GNFpDLsQTR34DYDQ&bvm=bv.70138588,d.cWc&psig=AFQjCNF7jFT1e2rc3YYRsYD9ZTrJfuj8aw&ust=1404487406615753

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

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Moving from Treatment to Prevention · Neal D. Barnard, MD . Adjunct Associate Professor of Medicine . ... Tonstad S, et al. Type of vegetarian diet, body weight and prevalence of