Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
A Plant-Based Dietary Intervention for 
Type 2 Diabetes 
Neal D. Barnard, MD 
Adjunct Associate Professor of Medicine 
The...
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 Ja...
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...
Falling Carbohydrate Intake in Japan 
Carbohydrate (grams/day) 
430 
400 
370 
340 
310 
280 
250 
1955 1965 1975 1985 199...
Overweight in Japan 
Women 
Men 
BMI ≥ 25kg/m2 
National Health and Nutrition Survey Japan, 2006 
http://www0.nih.go.jp/ei...
Diabetes Prevalence in Japan 
In adults over age 40: 
Prior to 1980: 1-5% 
By 1990: 11-12% 
Kuzuya T. Prevalence of diabet...
A Lesson from the U.S.
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 ...
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 200...
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 ...
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 
0 - 6.5 
6.6 - 8.0 
8.1 - 9.4 
9.5 - 11.1 
> 11.2
Adventist Health Study – 2 
60,903 participants, aged ≥30, enrolled 2002-2006 
Tonstad S, et al. Type of vegetarian diet, ...
Adventist Health Study – 2 
Tonstad S, et al. Type of vegetarian diet, body weight and prevalence of type 2 
diabetes. Dia...
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 ...
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.
Plant-Based Dietary Intervention in Type 2 Diabetes 
Neal D. Barnard, M.D. 
Joshua Cohen, M.D. 
David J.A. Jenkins, M.D., ...
Plant-Based Diet for Type 2 Diabetes 
Intervention: Vegan, low-fat, low-GI 
Control: ADA guidelines (2003) 
22-week study,...
SSttuuddyy CCoommpplleetteerrss 
Vegan Group ADA Group 
N = 49 N = 50 
Completers at 22 weeks 49 (100%) 50 (100%) 
Complet...
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 ...
Hemoglobin A1c at Baseline and at 11 and 22 Weeks 
Individuals with no medication changes, n = 24 vegan, 33 ADA 
Week 0 We...
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 ...
Body Weight 
(n = 49 vegan, 50 ADA) 
(Missing values returned to baseline) 
ADA 
96.7 
99.3 
(-2.6 from baseline) 
(-3.7 f...
Low Density Lipoprotein 
Baseline to 74 Weeks or Last Value before Medication Change 
(n = 49 vegan, 49 ADA) 
Week 0 Week ...
Nutrition in Diabetic Neuropathy 
Crane (1994): Test of low-fat vegan diet 
N = 21 
Total remission in 17 participants
Screened 
(n = 71) 
Group 1 (n 
= 17) 
Enrolled 
(n= 35) 
Excluded: 
Withdrew from consideration (10) 
Pain/symptoms did n...
Intervention Arms 
Experimental: Vegan diet + B12 (1000 mcg/d) 
Control: B12 only
Inside the Cell 
Glucose Insulin 
● 
● 
●●●● ● 
● 
Intramyocellular lipid
Three Keys: 
1. Vegan 
2. Low in fats and oils 
3. Low-glycemic index
PCRM 2009 USDA 2011
FFaatt CCoonntteenntt 
((PPeerrcceennttaaggee ooff CCaalloorriieess ffrroomm FFaatt)) 
• Leanest beef 29% 
• Skinless chic...
There were a few missteps along the way…
Body Weight 
P-value < 0.0001 
Am J Health Promotion, In press
Waist Circumference 
Am J P-value < 0.001 Health Promotion, In press
Study Sites vegan 
control 
Buffalo, NY 
Woodbury, NY 
Fredericksburg, VA
Body Weight (pounds) 
210 
205 
200 
195 
190 
Control 
Intervention 
Week 0 Week 18
Hemoglobin A1c 
8.0 
7.5 
7.0 
6.5 
6.0 
Control 
Intervention 
Week 0 Week 18
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 wit...
Lunches and Dinners 
• Veggie Pizza 
• Chunky Vegetable Chili 
• Bean Burrito 
• Seitan & Mushroom Stroganoff 
• Portobell...
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 ...
PCRM.org
PCRM.org
International Conference on Nutrition 
and Cardiovascular Disease 
Washington, DC 
July 31-August 1, 2015 
www.pcrm.org 
G...
Thank you! 
Neal D. Barnard, MD 
Adjunct Associate Professor of Medicine 
The George Washington University School of 
Medi...
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes
Prochain SlideShare
Chargement dans…5
×

Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes

Cleveland Heartlab 5th Annual Symposium:
Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes

  • Identifiez-vous pour voir les commentaires

Neal Barnard, A Plant-Based Dietary Intervention for Type 2 Diabetes

  1. 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. 2. A Lesson from Japan
  3. 3. 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.
  4. 4. 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.
  5. 5. 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.
  6. 6. 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
  7. 7. 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.
  8. 8. A Lesson from the U.S.
  9. 9. 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.
  10. 10. 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.
  11. 11. 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
  12. 12. Diabetes Prevalence 1994
  13. 13. Diabetes Prevalence 1995
  14. 14. Diabetes Prevalence 1996
  15. 15. Diabetes Prevalence 1997
  16. 16. Diabetes Prevalence 1998
  17. 17. Diabetes Prevalence 1999
  18. 18. Diabetes Prevalence 2000
  19. 19. Diabetes Prevalence 2001
  20. 20. Diabetes Prevalence 2002
  21. 21. Diabetes Prevalence 2003
  22. 22. Diabetes Prevalence 2004
  23. 23. Diabetes Prevalence 2005
  24. 24. Diabetes Prevalence 2006
  25. 25. Diabetes Prevalence 2007
  26. 26. Diabetes Prevalence 2008
  27. 27. Diabetes Prevalence 2009 www.cdc.gov/diabetes 0 - 6.5 6.6 - 8.0 8.1 - 9.4 9.5 - 11.1 > 11.2
  28. 28. 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.
  29. 29. 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.
  30. 30. Weight-Control Study 2 rules: 1. No animal products 2. Minimize oils No exercise 14-week study
  31. 31. 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
  32. 32. Results at 14 Weeks 13 lb average weight loss 2-inch drop in waist measurement Increased insulin sensitivity
  33. 33. Weight at 1 and 2 Years Turner-McGrievy GM. Obesity 2007;15:2276-81.
  34. 34. 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
  35. 35. 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.
  36. 36. 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%)
  37. 37. 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
  38. 38. 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 (%)
  39. 39. 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 (%)
  40. 40. 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)
  41. 41. 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%
  42. 42. Nutrition in Diabetic Neuropathy Crane (1994): Test of low-fat vegan diet N = 21 Total remission in 17 participants
  43. 43. 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
  44. 44. Intervention Arms Experimental: Vegan diet + B12 (1000 mcg/d) Control: B12 only
  45. 45. Inside the Cell Glucose Insulin ● ● ●●●● ● ● Intramyocellular lipid
  46. 46. Three Keys: 1. Vegan 2. Low in fats and oils 3. Low-glycemic index
  47. 47. PCRM 2009 USDA 2011
  48. 48. 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%
  49. 49. There were a few missteps along the way…
  50. 50. Body Weight P-value < 0.0001 Am J Health Promotion, In press
  51. 51. Waist Circumference Am J P-value < 0.001 Health Promotion, In press
  52. 52. Study Sites vegan control Buffalo, NY Woodbury, NY Fredericksburg, VA
  53. 53. Body Weight (pounds) 210 205 200 195 190 Control Intervention Week 0 Week 18
  54. 54. Hemoglobin A1c 8.0 7.5 7.0 6.5 6.0 Control Intervention Week 0 Week 18
  55. 55. Beginning a Healthful Diet Step 1. Check out the possibilities
  56. 56. Breakfast Lunch Dinner Snack Foods to Try
  57. 57. 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
  58. 58. 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
  59. 59. Italian Cuisine
  60. 60. Mexican Cuisine
  61. 61. Chinese Cuisine
  62. 62. Japanese Cuisine
  63. 63. Fast-Food Options Veggie sub Bean burrito, hold the cheese
  64. 64. Beginning a Healthful Diet Step 1. Check out the possibilities Step 2. Do a 3-week test drive Optional: Use transition foods
  65. 65. PCRM.org
  66. 66. PCRM.org
  67. 67. 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
  68. 68. 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

×