Diet and Diabetes

Diet and Diabetes

Carbohydrates (Starches) are Good for People with Diabetes John McDougall, MD PO Box 14039 Santa Rosa, CA 95402 www.drmcdougall.com Disclosure Stat...

3MB Sizes 0 Downloads 10 Views

Carbohydrates (Starches) are Good for People with Diabetes

John McDougall, MD PO Box 14039 Santa Rosa, CA 95402 www.drmcdougall.com

Disclosure Statement Dr. McDougall’s Health & Medical Center Dr. McDougall’s Right Foods McDougall Adventures Inc.

12 National Best Selling McDougall Books

What Causes Diabetes?

Type-1 caused by insulin insufficiency (Autoimmune damage, cow’s milk)

Type-2 caused by insulin resistance (Insulin levels normal or high)

Obesity = Type-2 Diabetes Excess body weight is the most important modifiable risk factor for the development of diabetes:

Risk ratios:

20.1 for overweight and obese

38.8 for morbid obesity

Overweight and obese (30 and 35 kg/m2) Morbid Obesity (> 35 kg/m2) Compared with a BMI <23 kg/m2

Nutr Met Cardiovasc Dis (2011), doi:10.1016/j.numecd.2011.03.009

Bariatric Surgery A recent meta-analysis included 3188 patients with type-2 diabetes:

78.1% = complete resolution 86.6% = improved or resolved Surgically-induced malabsorption and sickness

Am J Med. 2009 Mar;122(3):248-256.e5.

Type-2 Diabetes – the Expected Adaptation to Over-nutrition

Insulin Resistance Definition: A state of reduced responsiveness to normal circulating levels of insulin Lipotoxicity: Abnormalities in fatty acid metabolism may result in inappropriate accumulation of lipids in muscle, liver, and beta-cells.

Hypertension. 2005 May;45(5):828-33.

Low-carbohydrate Diets (High-fat) *An apology: Non-starch, red, green, & yellow vegetables *

Protein

Fat

Meat, poultry, fish, cheese, and eggs

Origin of Low-Carb Diets

…from 1915 until the discovery of insulin in 1922, prolonged fasting and permanent calorie restriction were championed in North America by Frederick Allen and Elliott Joslin.

Nutr J. 2011 Mar 11;10:23.

Low-carb Diets to Rx Diabetes

“Meta-regression analyses show that hemoglobin A1c, fasting glucose, and some lipid fractions (triglycerides) improved with lower carbohydrate-content diets. Overall effect on weight was equivocal…” J Am Diet Assoc. 2008 Jan;108(1):91-100.

Low-carb Induces Sickness “Signs of improved health appear to accrue, as measured by changes in a variety of “risk factors,” eg, cholesterol, triglycerides, uric acid, glucose, blood pressure, and body weight. Hence, the patient is declared healthier. However, this is not necessarily a correct assessment. Similar benefits, for similar reasons, are seen when patients undergo cancer chemotherapy, and physicians do not brag about these results.”

John McDougall, MD

Mayo Clin Proc. 2004 Mar;79(3):431;

All Major Studies Show an Increase in Disease and Death from Low-carbohydrate Diets No Studies of High-carbohydrate Diets Show Similar Effects

(1) Ignore the bulk of the science NIH Public Access Author Manuscript Ann Intern Med. Author manuscript; available in PMC 2011 September 7.

N IH P A A u th o rM a n u scr ip t

Published in final edited form as: Ann Intern Med. 2010 September 7; 153(5): 289–298. doi:10.1059/0003-4819-153-5-201009070-00003.

Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort Studies Teresa T. Fung, ScD D e p a r tm e n to fN u tr itio n ,S im m o n sC o lle g e ;D e p a r tm e n to fN u tr itio n ,H a r va r d S ch o o lo fP u b lic H e a lth

The animal low-carbohydrate score was associated with a higher all-cause mortality. Rob M. van Dam, PhD D e p a r tm e n ts o fE p id e m io lo g ya n d P u b lic H e a lth a n d M e d icin e ,F a cu lty o fM e d icin e ,N a tio n a l U n ive r sity o fS in g a p o r e ,D e p a r tm e n to fN u tr itio n ,H a r va r d S ch o o lo fP u b lic H e a lth

Susan E. Hankinson, ScD a n d Meir Stampfer, M.D., DrPH D e p a r tm e n to fE p id e m io lo g y,H a r va r d S ch o o lo fP u b lic H e a lth ;C h a n n in g L a b o r a to r y,D e p a r tm e n t o fM e d icin e ,B r ig h a m a n d W o m e n 's H o sp ita la n d H a r va r d M e d ica lS ch o o l.

N IH P A

Intern Med. 2010 Sep 7;153(5):289-98 Walter C. Willett, M.D., DrPH a n d Frank Ann B. Hu, M.D., PhD. D e p a r tm e n to fN u tr itio n ,H a r va r d S ch o o lo fP u b lic H e a lth ;C h a n n in g L a b o r a to r y,D e p a r tm e n to f M e d icin e ,B r ig h a m a n d W o m e n 's H o sp ita la n d H a r va r d M e d ica lS ch o o l

(1) Ignore the bulk of the science BMJ 2012;344:e4026 doi: 10.1136/bmj.e4026 (Published 26 June 2012)

Page 1 of 11

Research

RESEARCH Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study OPEN ACCESS 12

3

34

Pagona Lagiou professor , Sven Sandin scientist , Marie Lof scientist , Dimitrios Trichopoulos 25 23 367 professor , Hans-Olov Adami professor , Elisabete Weiderpass professor

Low carbohydrate-high protein diets, used on a regular basis… are associated with increased risk of cardiovascular disease. 1

Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M. Asias Street, Goudi, GR-115 27, Athens, Greece; 2Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA; 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77, Stockholm, Sweden; 4Department of Clinical and Experimental Medicine, University of Linköping, SE-58185 Linköping, Sweden; 5Bureau of Epidemiologic Research, Academy of Athens, Athens, GR-106 79, Greece; 6Cancer Registry of Norway, Montebello, N-0310, Oslo, and Department of Community Medicine, University of Tromso, Tromso, Norway; 7Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland

Abstract

Objective To study the long term consequences of low carbohydrate diets, generally characterised by concomitant increases in protein intake, on cardiovascular health. Design Prospective cohort study. Setting Uppsala, Sweden. Participants Froma randompopulation sample, 43 396Swedishwomen, aged 30-49 years at baseline, completed an extensive dietary

source of proteins, are associated with increased risk of cardiovascular disease.

Introduction

BMJ. 2012 Jun 26;344:e4026.

Overweight andobesityareriskfactorsfor several common chronicdiseases,1 andtheyhavebecomeendemicinmost economicallydevelopedcountries andbeyond.2 3 Increased physical activityisonewayof counteractingexcessiveenergy 4

(1) Ignore the bulk of the science

Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality… PLoS One. 2013;8(1):e55030.

Elliott Joslin, MD Prophetically wrote in 1927: “I believe the chief cause of premature atherosclerosis in diabetes, save for advancing age, is an excess of fat, an excess of fat in the body (obesity), an excess of fat in the diet, and an excess of fat in the blood. With an excess of fat diabetes begins and from an excess of fat diabetics die, formerly of coma, recently of atherosclerosis.”

Elliott Proctor Joslin (1869–1962) Ann Clin Med 1927;5:1061.

Obesity Worldwide

Diabetes Worldwide

Meat Consumed Worldwide

Milk Consumed Worldwide

Diabetes Up 12 Times In 30 years

The estimated prevalence of diabetes among a representative sample of Chinese adults was 11.6% and the prevalence of prediabetes was 50.1%. Projections based on sample weighting suggest this may represent up to 113.9 million Chinese adults with diabetes and 493.4 million with prediabetes. These findings indicate the importance of diabetes as a public health problem in China.

The prevalence of diabetes was less than 1% in the Chinese population in 1980 JAMA. 2013;310(9):948-958

History of Starch Eating

High-carbohydrate Diets (Low-fat) Fat Protein

Carbohydrate

Starches (beans, corn, potatoes, rice, wheat, etc.) Non-starch, red, green, & yellow vegetables and Fruits

Healthy Medical Students 2-days on carbohydrate-diet*

*sugar, candy, pastry, white bread, baked potatoes, syrup, bananas, rice, oatmeal

Arch Intern Med.1927; 40: 818-830.

Healthy Medical Students 2-days on high-protein diet*

*lean meat, whites of eggs

Arch Intern Med.1927; 40: 818-830.

Healthy Medical Students 2-days on high-fat diet*

*olive oil, butter, mayonnaise (egg yolk, 20% cream)

Arch Intern Med.1927; 40: 818-830.

One Healthy Medical Student high-fat vs. high carbohydrate diet

Arch Intern Med.1927; 40: 818-830.

Sugar Makes Diabetes Better Serum Glucose mg/dL.

180

45% vs. 85% Carbohydrate: FBS fell, OGT improved, fasting insulin lower

“These data suggest that the high carbohydrate diet increased the sensitivity of peripheral tissues to insulin.” N Engl J Med. 1971 Mar 11;284(10):521-4.

Classic Research, BMJ 1940

Br Med J. 1940 May 4;1(4139):719-22

Sugar Makes Diabetes Better Serum Glucose mg/dL.

180

45% vs. 85% Carbohydrate: FBS fell, OGT improved, fasting insulin lower (Over 10 days of feeding of formula feeding – dextrins and maltose)

“These data suggest that the high carbohydrate diet increased the sensitivity of peripheral tissues to insulin.” N Engl J Med. 1971 Mar 11;284(10):521-4.

Fruit Does Not Make Diabetes Worse

Eating less fruit had however no effect on HbA1c, weight loss or waist circumference. “We recommend that the intake of fruit should not be restricted in patients with type 2 diabetes.”

Blood Sugar Non Toxic

JAMA. 2014;311(3):279-286.

Medication = Weight Gain = Diabetes Downward Cycle

Diabetic Management “…it is important to remember that ‘diabetic control’ means a lot more than ‘blood sugar control.’” T.D.R Hockaday, 1987

Mortality and Morbidity Heart disease Eye disease Kidney disease Scand J Gastroenterol Suppl. 1987;129:124-31.

Lessons from the Past, Directions for the Future The WWI Starch Solution for Denmark

(1862-1945) Served as the manager of the Danish National Laboratory for Nutrition Research in Copenhagen and food advisor to the Danish government during World War I.

Lessons from the Past, Directions for the Future The WWI Starch Solution for Denmark

Madsen after 1 year of eating potatoes and a little fat “Minimum need for protein was so low for man that it could not be reached; therefore, removing meat would be of no adverse consequence.” From the book, Fuldkommen Sundhed og Vejen dertil (Perfect Health and the Path to Get It), 1934 by Mikkel Hindhede

WWI: Britain &Germany Blockade North Sea

Lessons from the Past, Directions for the Future The WWI Starch Solution for Denmark

Note: People of all ages showed reduction in death

Lessons from the Past, Directions for the Future Mortality from Diabetes in England and Wales during Wars

YEARS

Diet in the Etiology of AODM

During war, diabetic death rate falls due to food shortages England and Wales (pre- and post insulin use)

Proc Roy Soc Med. 1949; 42:323

Pritikin Longevity Center

J Appl Physiol. 2005 Jan;98(1):3-30.

James Anderson, MD University of Kentucky, College of Medicine Metabolic Ward Study Weight Maintaining Diet Insulin Usage: Average reduction 26 to 11 units daily

11 of 20 lean patients discontinued insulin CHO Initially = 43% 7 days average CHO intervention = 70% 16 days average

Am J Clin Nutr. 1979 Nov;32(11):2312-21.

Neal Barnard, MD Randomized Clinical Trial in Individuals With Type 2 Diabetes

Reduced Medication HgB A1c* Weight (Kg) LDL (% change)* Urine protein

Vegan

ADA

21/49 -1.23 6.5 21.2 15.9

13/50 0.38 3.1 10.7 10.9

P=.01 P=.001 P=.02 P=.013

Vegan diet = (10% of energy from fat, 15% protein, and 75% carbohydrate) ADA diet = (40 % fat, 20% protein, 40% carbohydrate, < 200 mg cholesterol

*No medication changes Diabetes Care. 2006 Aug;29(8):1777-83.

The Ultimate Diet

Am J Med. 1948 Apr;4(4):545-77

Walter Kempner, MD Walter Kempner, MD (1903 – 1997)

The Rice Diet Duke University Durham, NC

Decrease in heart size, improved kidney function, and hypertensive retinopathy reversal Reversal of obesity, diabetes, hypertension, and heart failure. Am J Med. 1948 Apr;4(4):545-77

Morbid Obesity Reversed

Morbid Obesity Reversed

Retinopathy Reversed 42-year-old male with an 18-year history of diabetes mellitus. Dietary compliance for 26 months.

Classical diabetic retinopathy: aneurysms, punctuate, preretinal or vitreous hemorrhage, waxy exudates, neovascularization, and retinitis proliferans. Average observation 22 months, 20 of 44 diabetics showed improvement. Retinal Physician April 2008 Postgrad Med. 1958 Oct;24(4):359-71. Am J Med. 1959 Aug;27:196-211.

Retinopathy Rx Low-fat Diet

Postgrad Med. 1958 Oct;24(4):359-71. Am J Med. 1959 Aug;27:196-211.

Severe Kidney Disease Reversed

Nephropathy 1946, Thomas Addis argued from personal clinical experience that reduction in renal "work" by judicious dietary protein restriction was effective in minimizing further loss of kidney function in patients with chronic kidney insufficiency from a variety of causes.

Thomas Addis, MD Stanford University 1881-1949

J Clin Invest. 2006 Feb;116(2):288-96.

Nephropathy A low-protein diet reduces the progression of their kidney disease and death on average by 33% to 50%.

Annu Rev Nutr. 1997;17:435-55.

Coronary Insufficiency Reversed

Heart Enlargement Reversed

Severe Hypertension Reversed

Composition of the Rice Diet White Rice, Fruit, Juice, and Table Sugar (Vitamins)

*White sugar may be used as desired (ad libitum); on average a patient takes in about 100 grams daily (400 calories) but, if necessary (to maintain body weight), as much as 500 grams (2000 calories) daily has been used.

Biography of Walter Kempner, MD

The McDougall Diet vs. The Rice Diet Walter Kempner, MD was very influential on my career.

His published work showed me the power of diet therapy and that nutritional deficiencies do not occur with simple plant-based diets (even with the addition of lots of sugar).

The McDougall Diet vs. The Rice Diet Before I was born (5-17-1947), Dr. Kempner had disproven concepts that are still held as true by most medical doctors today, such as: “Diet has little to do with heart disease.”

“Additional protein improves health.” “Carbohydrates cause diabetes.”

The McDougall Diet vs. The Rice Diet

The diet I recommend, the McDougall Diet, is for the

“living.” The Rice Diet is one that I reserve for the

“nearly dead.”

10-Day Residential Program All-You-Can-Eat (cafeteria style)

Starch-based Meal Plans

Light Exercises No Meditation, etc. Medical Care Medications Are Reduced Can Be Held in Any Hotel

7

Weight Loss In 7 Days - Womenn = 1102

cafeteria-style eating

6

pounds

5

4

3.1 3

2

1

0

s

All

140-179

180-239

240-279

> 280

9

Weight Loss In 7 Days - Men cafeteria-style eating

n = 580

8

7

pounds

6

5

3.6 4

3

2

1

0

s

All

160-199

200-260

260-320

> 320

200

Cholesterol Reductions In 7 Daysn = 1692

180

160

mg/dL

140

120

100

80

60

22.3

40

20

0

Day 1

Day 7

Average

Maximum

50

45

Cholesterol Reductions In 7 Daysn = 1692

The sicker they are the better they get

40

mg/dL

35

30

25

20

15

10

5

0

s

180-200

200-220

220-240

240-260

260-300

> 30

BP Reductions in 7 Days

30

High and In need of Rx 25

The sicker they are the better they get

Systolic

23.9 Diastolic

mmHg

20

15

14.5

10

5

0

s

>160/100

140/90 to 160/100

120/80 to 140/90

110/70 to 12

OHSU Diet for Multiple Sclerosis Study

McDougall Diet

OHSU / McDougall Diet & MS Study Compliance Over 1 Year Based on % Fat

45.00

Diet Group

40.00

Control Group

35.00 30.00 25.00 20.00

15.00 10.00 5.00

Post-6mo

Post-6wk

Month 12

Month 11

Month 10

Month 9

Month 8

Month 7

Month 6

Month 5

Month 4

Month 3

Month 2

Month 1

0.00

Baseline

Fat as a percentage of Calories (%)

50.00

OHSU Diet for Multiple Sclerosis Study

McDougall Diet

OHSU / McDougall Diet & MS Study Average Weight Change in 1 Year 181.1 182 180

Weight (lbs)

178

174.3

176 174

172.4 171.1

172 170 168

N=29 N=32

N=27N=26

166

Baseline

Final Visit

Control Group Diet Group

OHSU Diet for Multiple Sclerosis Study

McDougall Diet OHSU / McDougall Diet & MS Study Average Weight Change in Compliant Patients After 1 Year 181.1

185 180

Weight (lbs)

175

172.4

174.3

170 162.0

165 160 155

N=29 N=32

N=27

N=22

150

Baseline

Final Visit

Control Group Diet Group

OHSU Diet for Multiple Sclerosis Study

McDougall Diet OHSU / McDougall Diet & MS Study

200

Control Group Average Lipid Changes in 1 Year 186 180

180 160 140 120

112

106 89.2

100 80

86.8 56.8

56.2

60

40

N=29

20

N=2 7

0

Baseline LDL

HDL

Final Visit Triglycerides

Cholesterol

OHSU Diet for Multiple Sclerosis Study

McDougall Diet

OHSU / McDougall Diet & MS Study Diet Group Average Lipid Changes in 1 Year 178 159

180 160 140

101

95.0

120 100

57.1

57.8

80

91.7

83.6

60 40 20

N=2 2

N=3 1

0

Baseline LDL

HDL

Final Visit Triglycerides

Cholesterol

Ad Libitum Starch Diet 10 Months 210 to 120 pounds 160/100 to 122/70 mmHg Glucose: 113 to 79 mg/dL Cholesterol: 181 to 123 mg/dL

http://drmcdougall.com/stars/elizabeth_teselle.htm

Ad Libitum Starch Diet 10 years ago 150 pounds Weight loss took 4 years

http://drmcdougall.com/stars/cathy_stewart.htm

Ad Libitum Starch Diet 331 to 165 Two years Cholesterol: 192 to 140 mgdL

http://drmcdougall.com/stars/mike_teehan.htm

Ad Libitum Starch Diet Lost 110 pounds In 1991 (20 years ago)

http://drmcdougall.com/stars/joyce_rainwater.htm

Ad Libitum Starch Diet Lost 149 pounds in 2 years Four years ago 146/86 to 105/64 mmHg Cholesterol:250s to 163 mg/dL

http://drmcdougall.com/stars/nettie_taylor.html

Ad Libitum Starch Diet Lost 77 pounds

http://drmcdougall.com/stars/donna_byrnes.html

Ad Libitum Starch Diet Lost 100 pounds 7 years ago Cholesterol 281 to 142 mg/dL Glucose 103 to 78 mg/dL 140/90 to 115/75 mmHg

http://drmcdougall.com/stars/karen_barron.html

Ad Libitum Starch Diet Lost 92 pounds In 2 years 1 ½ pounds a week size 26 in jeans, to a size 4 Resolved stomach pains knee and hip arthritis gone

"enough syndrome” “not food approach”

http://www.drmcdougall.com/stars/cloudy_rockwell.htm

John Figlar

Oct. 2010

John Figlar (MAPTB) Program Date: October 31, 2010 Weight 372.2 Blood sugar 131/219 Cholesterol 122/101 Triglycerides 113/101

372 pounds

120Meds: Units HumunlinInsulin N 30 Humulin R 30 Actos 30 mg Varapamil 240 mg bid Benicar 40 mg Simvistatin 40 mg

One Diabetic Pill Three BP pills

John Figlar April 11, 2011: 6 months Lost 98 pounds 142/84 mmHg Blood Sugars = 150 to 250 mg/dL No Medications

Drew Powell, 56

Drew Powell, 56 May, 2011 276 pounds Kombiglyze XR 5-1000 (metformin ER 1000mg / saxagliptin 5mg Blood sugars = +200 mg/dL HbA1c was 9.0 (04/21/2011)

Drew Powell, 56

Drew Powell, 56 August 12, 2011 In 90 days Down 30 pounds No Medications Blood sugars = 100 mg/dL HbA1c= 5.6 %

Drew Powell, 56 January 27, 2012 My HbA1c is 5.2% No medication My weight is 215 lbs. 37 inch waist

My sleep apnea is gone I no longer use CPAP

Benjamin Eksouzian P r o g r a m D a t e : M a r c

Benjamin Eksouzian 4 Months later: July 12, 2011 268 pounds Lost 50 pounds No Medication Blood Sugars = 100 mg/dL Cholesterol = 202 mg/dL

Benjamin Eksouzian

Fat vs. Carbohydrate