Kick Diabetes Essentials… Designing A Diet To Reverse Diabetes, By Author: Brenda Davis, R.D.

just looking for all the tools thank you so much for for arriving early in the morning and being here and I’m really looking forward to just getting to know more people I’ve been so excited to get to know so many of you so looking forward to that and and this morning what we’re going to be talking about is kick diabetes essentials and that’s the title of actually my latest book and I’m excited about what I have to share with you this morning

so a very brief outline we’re going to talk about Ken diabetes be reversed then we’re going to delve into our plant-based diets effective in preventing and treating type 2 diabetes and I’ll share some of what I learned working in the Marshall Islands and then we’ll talk about what makes plant-based diets so effective for treating type 2 diabetes and then the practical piece so this is a little longer piece the essential sorry the essential ingredients for reversing type 2 diabetes and I’ll tell you that I’ve been one of the people involved in creating a continuing education program for physicians on diabetes through the American College of lifestyle medicine and a lot of what I’m going to share here today is part of that particular module for physicians

so the first question can diabetes actually be reversed and the answer is yes type-2 diabetes can be reversed in most but not all individuals so you would say well I wonder if it can be reversed in my case and I can tell you that for most people it’s reversible for the only people for whom it’s not our people that have basically completely destroyed their beta cells over men years so they might be people who have had diabetes for 30 or 40 years and and it’s been very severe their pancreas has been so overworked that the beta cells have conked out and and in those people it may not be reversible and in fact you know many many doctors learned during medical school that type-2 diabetes was a progressive irreversible disease and so many people still believe that but in fact even the American Diabetes Association created a consensus statement on diabetes reversal and released it in 2009 so we’ve known this for many years that diabetes is reversible and in this particular statement they had three requirements for complete remission or reversal of this disease so the patient has to be off of course all their diabetes medications they have to have normal glycemic measures like a normal a 1c and a normal fasting glucose and in this particular definition both of these must be maintained for at least a year and it’s the third point that’s quite controversial in you know among the experts some would say oh three months is enough some will say six months but the the first two are consistent everyone agrees they must be off all their medications and they must have normal glycemic measures to have the dot the the diagnosis reversed

so what are the lines of evidence for diabetes reversal well believe it or not one of the first lines of evidence was reversal in patients who had undergone bariatric surgery so bariatric surgeons were consistently witnessing the reversal of diabetes in fairly short order in their patients and it it was really quite a mystery but it was discovered that what was happening is the the fat the the the excess fat that accumulates in the liver is one of the first things to go after you’ve had bariatric surgery and that is probably the biggest contributor to insulin resistance is the fat in the liver and then the same people that did the bariatric surgery at least some of the same groups like Roy Taylor’s group did the same type of thing but using a very low calorie diet instead of bariatric surgery to see if just diet alone would work so they used a diet that was about six to eight hundred calories and lo and behold the Dizzy’s reversed then the third line of evidence is is patients who adopt a healthy lifestyle and get back to a healthy body weight and most often this is done using a whole food plant-based diet

so let’s talk a little bit more about the plant-based diet so our plant-based diets effective in preventing type 2 diabetes well we have a few studies that have looked at this and this is the Adventist Health Study this is the Adventist Health Study – and and I actually have a little laser pointer now but you can see here that that non vegetarians it’s a seven point six percent of them have type two type two diabetes in this particular cohort now what’s really interesting here is that these folks are all health-conscious individuals they exercise the same amount they drink the same amount of alcohol smoked the same amount so they they’re how conscious about their diets they eat fairly you know high levels of fruits and vegetables compared to the general population and they die at about half the rate of the general population so seven point six percent this is what I wanted to show you here in the general population elation twelve to fourteen percent of Americans have have diabetes and and this is the real shocker 37 to 38 percent have pre-diabetes and this is of course adults which means 49 to 52 percent of American adults have either type-2 diabetes or pre-diabetes it is absolutely shocking and in and it’s scary because diabetes often leads to heart disease and amputations and diabetes and so on and I’m sorry and and and blindness and kidney failure and so forth so 6.1 percent of semi vegetarians 4.8% of pesco vegetarians 3.2 percent of lacto-ovo vegetarians and only 2.9 percent of vegans with type 2 diabetes so you can see the huge difference so then they followed the people that didn’t have diabetes to see who would develop diabetes and compared to non vegetarians lacto-ovo vegetarians had 38 percent lower risk and vegans had 62 percent lower risk of developing the disease

now this study I discovered this morning I was absolutely stunned that I hadn’t seen it before I thought my eyes were failing me as I was looking at it about 6 o’clock this morning and epic Oxford I’ve been waiting for years for epic Oxford to release findings about diabetes and well they finally have compared to similar health-conscious meat-eaters the risk of developing diabetes was 53% lower among fish eaters that’s that’s people who are vegetarian plus fish and it was only 37% lower among vegetarians and vegans combined they didn’t separate the vegetarians and vegans so this was a real shock to me I did a double take when I looked because it’s not reflective of the other studies we’ve seen so why would people eating fish have lower risk well perhaps the vegetarians are eating a little more of this stuff that’s my guess they’re eating more refined carbohydrates in this particular cohort I don’t know that it’s a wild guess

so there there is another cohort that we’ve been following since about 2007 and this is in Taiwan they’ve been comparing a similar health-conscious non-vegetarian Buddhists with the vegetarian Buddhists and the vegetarian Buddhists are very near vegan they don’t really consume much dairy at all if any they have a little bit of egg once in a while but not a lot so they’re very very near vegan and the rates of diabetes were 51% lower among vegetarian men and 74 to 75 percent lower among the vegetarian women

and I just want to tell you about the pictures on this slide so this picture right here is a picture of a typical and the the colors aren’t very good on with this PowerPoint projector they’re actually much more vibrant in in real life but but basically you go into the cafeteria it’s completely vegan from what all I could see and and it’s the most colorful buffet food buffet you’ve ever seen that’s their cafeteria food and then I was taken on a tour of the kitchen and I was absolutely stunned when I walked in and there were bag these bags were this high just all of these bags of organic greens the nuns had just picked from the hospital gardens and I asked I said well what are what are these and they said oh this is the main food for our patients they need organic greens to heal their bodies and I went what a concept feeling a feeding hospital patients healthy food it just is mind-boggling but I was I was so impressed by what they were doing there

and then there was a study in India as well a large study comparing fairly young people 20 to 49 years of age and the lacto-ovo vegetarians in this study were 33% less likely to develop diabetes than non vegetarians and semi vegetarians were about 24% less likely so that’s sort of what we know about vegetarian rates versus non non vegetarians when we control for for other factors like smoking and drinking and so forth vegetarians seem to be at lower risk

so what about plant-based diets in the treatment of type 2 diabetes well the the research on this I would say really began with a pioneer by the name of James Anderson very famous nutrition researcher and he did a series of studies between 1976 and 1991 comparing people eating a plant-based diet versus people eating a more conventional American Diabetes Association diet in people with type 2 diabetes the plant-based diet was actually 70% carbohydrate so this is a very high carbohydrate plant-based diet and this diet contained 35 to 40 grams of fiber per thousand calories so this is really quite shocking because in a 2,000 calorie diet that’s 70 to 80 grams of fiber which is more than most vegans even would be eating so it was a very whole food plant-based diet before we called it that and the vegetarians had more favourable plasma glucose glucose tolerance insulin sensitivity and blood lipids and what was so impressive is most of the plant-based patient had to discontinue or dramatically reduce their insulin or medication and before we used to call it reversal many of these patients actually did experience reversal

David Jenkins is a researcher from Toronto Canada and he is one of the he’s really one of my heroes he is a just an extraordinarily brilliant man who is a very strong ethical vegan and so in his research he has done so much he’s the architect of the glycemic index so that’s one of the things that has made him quite famous he did many research studies showing favorable metabolic changes in people eating a very carefully designed diet that he called the portfolio diet which is a diet that that maximized many of the wonderful components and plant-based diets and again it was largely a whole food plant-based diet

and then we’ve got some research out of Europe from the Czech Republic this randomised controlled trial with 74 participants followed over 24 weeks and compared they basically compared a vegetarian diet and the animal products in this diet were limited to not more than one low-fat yogurt per day and they compared that to a conventional diabetic diet and the vegetarian diet was more effective than the conventional diet in improving insulin sensitivity reducing medications reducing visceral fat reducing oxidative stress markers and reducing cholesterol levels so very successful

and the lead author of this of these studies that came out of the Czech Republic is now one of the key researchers at the Physicians Committee for Responsible medicine so they’ve joined forces and PCRM the Physicians Committee for Responsible medicine has done a series of research articles the first three probably being the most important in terms of looking at specifically diabetes change the changes in in diabetes so they they did a pilot study in 99 and then in 2006 they followed 99 people for 22 weeks and and then 2009 they reported the results of following those same people for 74 weeks and they found both the low-fat vegan diet and the American Diabetes Association diet improved glycemic and lipid control but these improvements were actually significantly greater with the low-fat vegan diet and they didn’t see a lot of diabetes reversal but they did see a lot of people reducing medications

and then we had a research career research team comparing a carbohydrate route to vegan diet versus a conventional diabetic diet and both diets reduced a1 C’s but the vegan diet again more than double the conventional diet it reduced the a1c by about 0.5 points and in highly adherent patients it was 0.9 points so even even better results there

and then this study that dr. Fuhrman told you about yesterday very small study 13 participants but just exceptional results so he dropped a one C’s from 8.2 percent to five point eight percent two point four points at 7 months 62% of the participants achieved normal glycemic measures and they lost an average of 74 pounds their triglycerides dropped almost 70 milligrams per deciliter on average their LDL dropped over 15 milligrams per deciliter and HDL actually increased by 6 point 3 milligrams per deciliter which is very unusual with plant-based diets we often see a reduction and so these results were really stellar and showed reversal we don’t have a lot of studies that have solidly showed reversal so this is really a very promising

we have many reviews and meta-analyses 2016 3 – and 2017 3 and 2018 one so far – one in 2019 and they all said the same thing we have strong consistent evidence that whole food plant-based diets improve blood glucose improve insulin sensitivity improve blood lipids and that they reduce or eliminate the need for medication and the risk of complications of this disease

so I want to shift a little bit to tell you about the results of of the work that I’ve done in the Marshall Islands and so the Marshall Islands for those of you that that aren’t familiar with them are right here in this little red circle about 2,300 miles southwest of Hawaii and sort of between Hawaii and Australia in the middle of the Pacific with nothing anywhere close to them for thousands of miles in any direction they they are 82 degrees at about at pretty much every every you know 100 feet below the surface of the water at every part of the year it’s a very tropical climate

and in the Marshall Islands diabetes is a state of emergency the marshalese have among the highest prevalence of diabetes and the highest death rates from diabetes globally so they’re always in the top three it seems to be in terms of diabetes rates in 2019 the rates among adults was were 33.8% I don’t know the rates of pre-diabetes but I would guess that the the either diabetes or prediabetes would probably be close to 80% half of all the surgeries on the islands our amputations due to diabetes there oh and also there’s no dialysis in the Marshall Islands if your kidneys start to fail if you’re rich enough to go to Hawaii you can get dialysis if not you die and most people just died so it’s it’s just absolutely it just got wrenching it’s so sad

eighty years ago diabetes was pretty much non-existent in the Marshall Islands people were slim they were physically active and they lived off the land so what did they eat well they ate whatever they could gather or catch so they they obviously they caught fish and gathered probably seaweeds and there were it’s a coral reef so there’s not a lot of good soil but plenty of coconuts bread fruit bananas green leaves and and something called pandanus you see this fruit down here whoops I press the wrong thing down here this is a fruit that you just suck the juice out of you can’t eat it it’s a it’s too hard and fibrous to actually eat but it’s a really important source of some of the phytochemicals and and carotenoids

so how of the diets changed why all the diabetes now well the little girl on the left this she was eating this at about 6:30 in the morning on her way to school bottle of Pepsi and a popsicle there’s no no concept of nutrition people think if they have a full belly they’re well nourished lunch and dinner are white rice and and meat of some sort spam or barbecued chicken or something like that the meal over here that you see this is a meal from a funeral would be a birthday meal it would be any sort of celebration meal but this one was out of funeral and you can see chicken rice white bread and ham white doughnut white soda biscuits and and then on the bottom left this was a birthday party for a one-year-old these bins are all processed meat this is luau it’s a number one ingredient is high fructose corn syrup these are all the parts of the animals we don’t want like turkey tails which are mostly fat and they’re cheap and the children’s favorite snack is ramen noodles with kool-aid powder sprinkled on top ramen noodles are cheap and I can remember once seeing a child eating this and they were sprinkling white powder on their noodles and I said to the marshalese person next to me what are they sprinkling on the Roman noodles and they said oh that’s a sea Nemoto a sea Nemoto is pure msg so ramen noodles kool-aid powder and msg and as you can imagine a dietitian couldn’t design a diet to induce diabetes more efficiently than the diet the marshalese people have adopted it is the saddest thing in the world these are cheap foods readily available fairly non perishable and there are too many people on the island on the main island right now to be self-sufficient using Island food they can’t they have to import food

we went into the the Marshall our Islands and I mentioned the diabetes by design to do some research to see if we could get this epidemic turned around and we went in and and we had five overlapping cohorts we had a control group and and an intervention group and everybody that ended up in the control was allowed to be part of the intervention after they were a control so that they could experience the benefits as well and I can tell you within a week or two what happened to individuals who started to receive healthy food and daily exercise just blew my mind I I would have never believed it could happen that quickly people that couldn’t walk across a room for 10 or 20 years we’re walking without pain people that said their brain had been foggy for 10 or 15 years all of a sudden they said it’s like my brain cleared out just pain that they had experienced in their arms and so forth it was disappearing so quickly and you know this diet in the Marshall Islands maybe five grams of fiber a day if they’re lucky five or six or seven of course our diet was a little higher than that and they were they you know the changes they were starting to go to the bathroom every day and many of them were going to the bathroom once a week or once every two weeks and it scared them I think they thought there was something wrong with them when they were starting to go every day so it was very very interesting and so the lifestyle treatment program they were with us for four week days for about 6 hours a day at least four weeks one two four and six four weeks three five seven and eight they were with us in the evening for five hours and nine to twelve they had a weekly evening session and I’m gonna zip through this because I don’t want to take too much time with them but we did cooking classes we did shopping tours we taught them how to garden we brought in earth boxes we planted gardens in every quarter of the corner of the hospital grounds that we could we taught them to grow sprouts we did daily exercise classes we got them walking and if you do nothing else in terms of exercise for a person with diabetes walking after meals is powerful medicine it’s unbelievable the change it makes in people and so we did after every meal walking we did education sessions on everything food and nutrition gardening exercise stress management dental health eyes and he in all of that stuff this man was one of the hospital doctors and they called him the butcher and he was called the butcher because he was the surgeon that did the amputations and he himself as you can see is a pretty healthy specimen he just happened to be a vegetarian and he would come to our program to tell people that the last thing on earth he wanted to do was amputations he said you know I would do anything to save your limbs but when you come to me after you know your your wounds have turned into gangrene and they’re you know your leg is dead he said the only thing I can do to save your life is to cut your leg off so he was trying to help them understand that process and so tell you a little bit about our results we saw fasting sugars drop about 71 points on average in the first two weeks by 12 weeks people were eating more of their own food and it was about 48 points but we saw by 12 weeks a reduction in a1c of almost 2 points and and CRP came down about 1.2 points

so our results were really quite good

so what about the effort since this was in 2006 that we did this well we don’t we lost our funding of course we had a limited funding so we’ve shifted away from research to Community Action and we’ve created partnerships with the Ministry of Health and the and the Republic of the Marshall Island you can see there were we’re I’m there with the the president and and several other dignitaries speaking to children on World Diabetes Day we created a wellness restaurant to sustain the Wellness Center we had to bring in funds and so the restaurant has become really popular in the Marshall Islands and we have wonderful staff working there we do free lifestyle interventions for people in the Marshall Islands free exercise classes and I do go back periodically to lead interventions and in 2014 in Majuro we averaged I’m getting better at it we averaged fasting glucose drop in two weeks of almost 120 points in ebuy it was about 50 points and ebuy is a tiny little island I think it’s point 0.14 of a square mile and 15,000 people it’s unbelievable there is almost no produce on that Island in 2016 we did an intervention for people from bikini island where the atomic bomb testing was done after the Second World War and in this group we got a fasting glucose drops on average of 63 milligrams per deciliter but we had 11 participants who had drops of over a hundred milligrams per deciliter and this young man came in kicking and screaming he did not want to be there but his parents his mother was a former secretary of health who completely reversed her diabetes on this program she was in our first intervention and he and his dad came together and they became the biggest advocates of the program he did so well he had a blood glucose drop that was well over a hundred milligrams per deciliter

and then in 2017 I went in spent about a month there with a very dear friend a speech pathologist and we created a nutrition education curriculum for kindergarten to grade 6 for the public schools and trained every teacher in in the Marshall Islands so trying to start with the the children you know these people in the Marshall Islands are really pioneers of the Pacific the participants of these these programs have provided the marshalese a hope amid a very deep sense of hopelessness and that sense of hopelessness has been exacerbated by what’s happening in terms of climate change they will be the first place to go and it is absolutely devastating it’s the only home they’ve ever known so you can look up the Marshall Islands and some of the the reports that have been done it’s very very sad but these folks have proved that diabetes can be defeated we saw several people completely reverse their disease but can be defeated with healthy food and exercise they succeed despite poor quality of produce a lack of resources they’re very poor they persevere amid mountains of spam ramen fried chicken and stick rice and a very socially engaged culture they manage with very few gyms and no walking trails they’ve started you know when we first got to the Marshall Islands people didn’t walk at all they would be embarrassed to walk because it was a proof that they couldn’t afford a 25 cent cab ride now they have walk they have walks in the mornings and and walkathons that get hundreds of people involved so things really have changed

and people often ask me to think this type of program could work at home and my answer is very simple if there is hope in the Marshall Islands giving given the barriers that they face of course there’s hope at home it should be a breeze for us by comparison but of course the the hope rests on demand from those affected integration of lifestyle medicine into our health care systems it’s got to be offered as a treatment option for people and that’s my hope that it will be in it fairly shortly

so what makes Platte based diets so effective well whole food plant-based diets put a lid on the drivers of insulin resistance inflammation oxidative stress lipo toxicity and dysbiosis and we’ll talk about all four of those so how does inflammation Drive insulin resistance well inflammation is caused by excess body fat especially visceral fat which promotes the release of pro-inflammatory cytokines and the inflammation that results from that interferes with insulin signaling increasing insulin resistance

and if you look at plant-based eaters with a meta-analysis in 2016 that showed that people eating plant-based have reduced inflammatory profiles reduction in CRP and this was you know 29 studies and and looking at 100% plant-based or vegan diets we had two studies one from Brazil in 2017 the CRP levels and vegans average point 5 milligrams per liter compared to lacto-ovo vegetarians at point 8 and omnivores at one point one and the second study was from the United States in 2007 and this was fairly high raw vegans looking at CRP levels and it was 0.5 – in the vegans and in endurance athletes I’m sorry I don’t know what happened it was 0.75 and and so 0.75 in the endurance athletes who were omnivores not not vegetarians and then people eating Western diet it was two point six one and and so quite a lot higher than the omnivores in Brazil probably because the diet is so much worse in the United States

oxidative stress is the second driver oxidative stress damages proteins DNA cell membranes it promotes insulin resistance beta cell damage impaired glucose tolerance and it promotes the complications of diabetes so there’s a definite advantage for people eating plant-based studies very consistently demonstrate that people eating plant-based diets have more favorable antioxidant status than omnivores and that’s probably because they eat more antioxidants and they ate fewer Pro oxidants and so you can see a number of studies quoted there

lipo toxicity is one that you you may not be as as familiar with and lipo toxicity is very simply the accumulations are the accumulation of fats in non adipose tissue so we have this remarkable tissue to store limitless amounts of fat and it’s called adipose tissue our fat tissue and and so when sometimes when too much is coming in for our body to deal with it we can’t send it to adipose tissue fast enough what ends up happening his fat gets stored in our vital organs the liver the heart the pancreas and also in our muscle tissue as intra Mayo cellular lipids and this causes cell damage or cell death in some cases tissue inflammation mitochondrial dysfunction and insulin resistance and and it elevates triglycerides as well and blood glucose so what causes lipo toxicity well it’s caused by overconsumption of food leading to overweight and obesity diets that are high in fat saturated fat and or trans fatty acids are particularly problematic and diets that are high in refined carbohydrates especially sugars also contribute to lipo toxicity and we know there’s an advantage for plant-based eaters so people eating a hundred percent plant-based have the lowest rates of overweight and obesity of all dietary patterns they have lower levels of lipids in our muscles so intra Myo cellular lipids which are a marker of toxicity then matched omnivores they have the lowest intakes of saturated fat of all dietary patterns as well

and then the fourth driver of insulin resistance is called dysbiosis and dysbiosis is really just an unhealthy gut flora and so dysbiosis has been linked with obesity inflammation and insulin resistance all leading to the to the development of type 2 diabetes and the key mechanisms of action are that that dysbiosis increases gut permeability allowing things that shouldn’t get into the bloodstream in and that can cause inflammation increased production of cytokines which are these inflammatory compounds and it can cause metabolic endotoxin ‘ya because the the gram-negative bacteria that dye release these endotoxins that can get into the to the system and increase insulin resistance

so what causes dysbiosis well unhealthy western-style diets are a huge driving factor refined carbohydrates processed foods high meat high fat diets low fiber diets alcohol chemical Carson Cameco contaminants in the food supply can all contribute to dysbiosis antibiotics medications stress and poor dental hygiene are all important contributing factors to an unhealthy gut microbiome so again we see a plant-based advantage and we have a couple of studies a study from Brazil looking at about 268 participants and vegans in this study had the most favorable microbiota followed by lacto-ovo vegetarians and the conclusions of the author were that exposure to animal foods may favor an intestinal environment which could trigger systemic inflammation and insulin resistance and the second study from Italy they found it was a smaller study but lacto-ovo vegetarians and vegans ayats resulted in a more favorable microflora than omnivorous diets but the lacto-ovo vegetarian diet was even more favorable than the vegan diet in this particular case

so what we know is the most effective dietary patterns minimize pathogenic dietary components or harmful components and maximize protective dietary components and if we think about the factors in the diet that are most protective we think of things like fiber and phytochemicals and plant enzymes and antioxidants and anti-inflammatory compounds and plant sterols and stanols and pre and probiotics and macronutrients when they come from healthy sources with all of the above and micronutrients the same with all of the above and when you look at that list something that just stands out or even leaps out off the page at you is that every single one of these in particular comes either exclusively or predominantly from plant foods fiber comes only from plants Feitosa phytochemicals only plants plant enzymes only plants that can help convert phytochemicals into their bio active metabolites or their active forms and anti-inflammatory compounds mostly plants plant sterols and stanols only plants you get the picture this is where the stuff in food that protects us is concentrated

and then if we think about the pathogenic factors the trans fatty acids excessive saturated fat refined carbohydrates excessive sodium chemical contaminants products of high temperature cooking Pro oxidants new 5 GC TMAO endotoxins if you look at this list it is two categories of foods then and the World Health Organization named those two categories of foods back in 1990 the categories of foods that are most you know most profoundly contributing to disease risk are processed foods and animal products and so again if you look at this list trends whoops sorry about that trans fats are predominantly well they used to be predominantly in processed foods now they’ve been taken out of processed foods you get them predominantly in animal products but animal products processed foods processed foods chemical contaminants tend to move up the food chain so a lot of in animal foods products of high-temperature cooking fried foods processed foods pro-oxidant like heme iron in meat new 5 GC is a pro-inflammatory molecule in meat endotoxins from the gram-negative bacteria you know dead bacteria and that’s mainly in ground meat again you you just get the picture you know and the picture is that most of what people eat in in North America is a threat to health

and fortunately we have a choice as human about what we put in our mouth there is no doctor or dietitian that can eat for you or exercise for you that is up to you we have a choice and when you make a good choice it’s unbelievable what happens and this is my I share this case study often because I I love it it’s a it’s one that inspires me personally so much

this is Andres he received a rare cancer diagnosis at 36 years of age he went from being a food and wine efficient auto extraordinaire to being a whole food plant-based diet devotee and his cancer went into remission but the real story here is what happened to the rest of his family the the health changes they all saw were amazing because when Andre us went on the plant-based diet the entire family said Andres whatever diet you’re doing we’re doing with you because we want to support you and always be able to eat as a family and that’s the part that I don’t see very often I just thought it was so touching and what greater gift could you give to a loved one than then to support them in that way

but the real story here is about his father Carlos you see Carlos had had type 2 diabetes since the 80s he had had a serious heart attack he had won the just before andreas was diagnosed he had hypertension high cholesterol peripheral artery disease early stage renal failure recurring gout and his prognosis was not good he was told he had progressive irreversible diseases that he may as have as little as 2 years left he better get his affairs in order you know his kidneys were starting to fail things were not good he was being treated on 17 pills a day and 35 to 40 units of insulin and after less than a year on a whole food plant-based diet Carlos was taking zero insulin and zero pills and pretty remarkable you can see here as fasting glucose went down to 80 eighty-seven millimoles per milligrams per deciliter a1c 5.1 blood pressure 115 over 70 he couldn’t achieve that on two medications he they did PET scans his arteries opened up his peripheral artery disease disappeared his kidney function normalized he didn’t get one single referral further recurrence of gout he was getting six or seven or eight episodes a year and seven years later he’s still free of these diseases and these medications and here’s his cardiovascular disease reports you can see he had very severe heart disease he had an inferior wall infarct superimposed with ischemia he had hypokinesis he had a reduced ejection fraction look at this that was 2005 look at 2017 no evidence of abnormal cardiac activity no evidence of ischemia normal chamber size normal ejection fraction it’s unbelievable but this is what is possible

not everyone is willing to make the necessary lifestyle changes or the kinds of lifestyle changes that Carlos made but every single person has a right to know that lifestyle changes are a safe and highly effective treatment option and you know I often meet physicians who say oh well I believe you but my patients would never do that and what I say in response is how do you know how can they do that if you don’t inform them your job as a physician is not to decide for your patient what they will or will not do but rather to lay the options out on the table if you don’t lay it out as an option how can they possibly choose it and so I think we really need to get with the program you know the diet goal is simple it is diabetes reversal and nothing less that’s what we’re after

so in order to in order to accomplish this task we have to overcome insulin resistance which means producing weight loss in overweight patients it means overcoming lipo toxicity and inflammation an oxidative stress and dysbiosis it means restoring nutritional health and so what are these essential ingredients for diabetes reversal will essential ingredient number one is whole plant foods we want 10 or more servings of non starchy vegetables and fruits each day and a wide range of them what we know is that the more vegetables and fruits people seem to eat the lower the diabetes risk for every serving risk was reduced by 13% for green vegetables green leafy vegetables 10% for other vegetables 7% for fruits imagine if we had 10 servings of green leafy vegetables our reader or even 10 servings of other vegetables 10 times 10 no-nothing we’d be out of the woods

practical pointers here we want people to eat a rainbow of fruits and vegetables to be exposed to the widest variety of phytonutrients they can possibly be exposed to we want to make dark greens a daily staple at least three times a day or at least three cups a day and preferably more eat a giant salad six or eight cups of greens in that salad and and we want to include berries because they have the highest fiber and antioxidants and the lowest sugar of all fruits so overall we want to select unprocessed or minimally processed choices unprocessed like fresh fruits and vegetables minimally processed like frozen plain fruits and vegetables we want to moderate processed foods like unsweetened juices or canned fruits and vegetables the the exception would be green juices without a lot of sweetness I would say that would be a reasonable option to increase antioxidant status of the to all we want to completely avoid the highly processed choices like sweetened fruit based desserts and deep-fried vegetables

we want a lot of legumes for people with diabetes three or more servings a day would be optimal and we’re talking about a half a cop in a serving legumes lower diabetes risk there was a study of 65,000 women that found 38 percent lower risk in the highest vs. lowest quintile of legume intake and the reason I think it wasn’t higher is because the lowest vs. the highest they were both low so people that eat more I would expect to have an even better result it was 47 percent lower in the highest vs. lowest quintile of soybean intake which I thought was quite interesting

practical pointers here include at least one of those servings preferably more as whole legumes beans or lentils or sprouted lentils something like that feature legumes at every meal some people say well how do I eat it at breakfast well in the Marshall Islands one of the things we always served at breakfast was beans and greens and they loved it so you can do beans and greens with onions but the other thing that I do when I cook my grain for breakfast so I love Chemie berries Organic chem abused organic spelt berries I like the big chewy grains I just they’re very say da ting to me but I mix them with lentils and I cook the lentils with my whole green so if you’re cooking barley or oak groats or whatever throw some lentils in and I stick to whole grit of intact grains but I’ll tell you more about that later so throw legumes on your salads throw them in your soups ice and and if you’re eating pasta eat legume pasta like what they have out in the hallway there so you can get lentil based pastas or chickpea based pastas a select unprocessed or minimally processed like beans lentils peas or tofu tempeh or the bean pod moderately processed would be like veggie meats ready T canned or frozen bean dishes and highly processed would be things like deep fried tofu salty bean based snacks like being chips and crackers for example we want probably you know this is a really optional four depending on your caloric needs but for most people two or more servings of whole grains and stores and or starchy vegetables and these are the foods that you adjust based on your energy needs so once you’ve got you’ve consumed to the ten servings or more of veggies and fruits and the three serving of of legumes and and your your one serving or two of nuts and seeds and all of those things then you add in these more energy dense foods to make up for or to to get to where you need to be in terms of your your caloric needs

whole grains we know can lower diabetes risk particularly relative to refined grains there was a 2018 study that reported for every half ounce serving of whole grains diabetes risk was reduced by 11% for men and 7% for women and what about potatoes well there was a 2016 meta-analysis of five studies showing no association or decreased risk with potato intake two studies that showed increase risk but three out of three studies showing french fries increased risk no big surprise there

so the practical pointers here we want people to be selecting colorful starchy vegetables prepared without added fat selecting the lower GI options and selecting mostly intact whole grains because all whole grains are not created equal a granola bar does not equal a bowl of old-fashioned oatmeal and a box of kamut flakes does not equal a kamut very salad the the reality is even once you’ve eliminated all refined grains you’re not eating any white flour white or any of the products made with with that stuff you’re just eating whole grains you know a stone ground whole wheat whatever there is still a hierarchy within that group of whole grains and at the top of the hierarchy the best of the best are intact whole grains pretty much as they’re picked off the plant without you know you’re not adding anything that damages health you’re not taking away anything that is of benefit to health and and and so you’re eating you know you’re eating them as as they are with everything there and make them if you want to make them even one step better sprout them and watch the vitamin C increase and the and the anti nutrients decrease and and and things you know get more absorbable and so forth so that’s something you can do next would be cut whole grains all you’ve done is cut them like steel cut oats for example and bulgur then would be the rolled whole grains like rolled oats and then the shredded whole grains like shredded wheat and then the ground whole grains like whole wheat flour products and then the flaked ol greens like flaked cereals and at the bottom of the barrel you’ve got puffed whole grains like brown rice cakes or puffed brown rice so these are still whole grains but they’re puffed so why are we you know saying they’re getting worse and worse well as you go down this list you’re increasing the surface area of the grain and making it more absorbable it is more quickly absorbed and so you’re increasing the glycemic impact but also you’re reducing the nutritional value because the amount of processing required is increased okay so you’re exposing that grain to air and light and all of those things and so you want to stay if you have diabetes fairly close to the top of that list with more of the intact grains so unprocessed intact sprouted grains or plain starchy vegetables like yams minimally processed would be caught or rolled or shredded greens or frozen or mashed starchy vegetables moderately processed would be like flaked or puffed whole grains or whole grain flour products starchy vegetables with added fat and salt and you want to completely avoid highly processed whole grains like refined grains or whole grain snack foods with added fat sugar and salt

nuts and seeds one serving a day or more for some people if you can afford more calories but this is where a lot of your essential fatty acids reside no nuts we we don’t have a lot of studies on seeds but there’s a study on not showing that when fully adjusted diabetes risk was cut in half for those consuming four more servings of nuts a week compared to those consuming less than one practical pointers and we do have studies on seeds as well especially Chia and flax seeds showing some reduction as well one of the very interesting thing about nuts and seeds is they all offer something a little different and so I think it’s important to have variety so for example Chia flax and hemp seeds and walnuts are our key sources of omega-3s almonds and sunflower seeds are the highest in vitamin E almonds chia seeds poppy and sesame seeds are loaded with calcium iron is highest in cashews and seeds and you get the idea so as you go down the list even hazelnuts are highest in manganese and and Brazil nuts in selenium and so forth

so having the variety is really wonderful but you need to keep portions moderate because nuts have about six to eight hundred calories per cup and so you don’t want to be eating them by the bowlful what I do is I keep a nice bowl of nuts in the shell on on my kitchen counter and so if I want nuts I have a walnut you know I have one or two at most and so that to me it helps you limit your intake when you’re eating them from the shell and I also one of the things I do is I keep a mix of seeds Chia flax hemp pumpkin in a container together with chopped Brazil nuts and that goes on my breakfast bowl so I get that variety and I get the selenium thrown in there as well I keep it in a mason jar in the freezer so again you’re wanting unprocessed or minimally processed choices nuts or seeds in the shell rar shelled nuts are seeds soaked or sprouted nuts or seeds minimally processed like dry roasted moderately processed would be those with a little bit of added oil or salt not seed butters without its salt for example and highly processed are the nuts and seeds they’re coated in sugar chocolate so we need to avoid those

and herbs and spices are the one group that people forget about and we should not because they have more phytochemicals and antioxidants so you want to be having including them at every meal if you can and we have a number of studies showing that herbs and spices help fight diabetes and particularly things like like cumin and and tumeric and and ginger and garlic so a lot of evidence there and the practical pointers are just to incorporate them at every meal even breakfast you can put allspice you can put cinnamon if you’re doing a you know I sometimes do a little Indian lentil dish for breakfast and then you can put turmeric and cumin and all of those things in but add them at every meal you can drink spice or herb infuse teas add fresh herbs to salads there are lots of ways of getting them in

so essential ingredient number two is a restoration of healthy body weight and and you know it’s so interesting if you look at the research here sufficient weight loss often reverses diabetes no matter how its achieved the more the way the more weight is lost the greater the remission rate and this is the direct trial people that lost up to 11 pounds of had mission rate of 7% 11 to 22 pounds 34% remission 22 to 33 pounds 57% remission over 33 pounds 86% went into remission this is really amazing an even moderate weight loss improves insulin sensitivity so will weight loss of even just 5 to 10% of initial body weight can dramatically improve insulin sensitivity and

so how do we achieve this well now we’re thinking a lot about you know these these new approaches that involve some degree of fasting or modified fasting so time restricted feeding might be not eating for 12 hours a day so after dinner you stop eating so say it’s 6 o’clock or 7 o’clock you go 12 hours and you don’t eat before 7 o’clock the next morning so you’re not doing that nighttime eating you may do a 14 day your I’m sorry 14 hour or a 16 hour or you might do intermittent fasting where you’re fasting we call it 6 to 1 or 5 to 2 so you might fast one day a week on the 6 to 1 6 days of eating 1 day of fasting or 5 2 to 5 days of eating 2 days of fasting and then there’s periodic fasts are like these fasting mimicking diets where you’re you’re doing a fast or a modified fast for maybe 3 or 2 5 days once every 3 months so there are lots of ways of doing this and then of course the other way is continuous energy restriction which is pretty easy to do on a whole food plant-based diet

the practical pointers here we need to achieve negative energy balance so fewer calories and more calories out we need to exercise more and eat fewer calories it doesn’t mean we need to eat a smaller volume of food we can if we eat the right foods we can still eat a large volume and have fewer calories that’s one of the beauties of plant-based diets because if you look at the sort of calories per gram in foods there there’s eight point eight calories per gram of oil for in cheddar cheese for in doughnuts three point one in spam or fried chicken three compare that to you know beans and barley just over the 1 bananas not quite one and and other you know non starchy vegetables are so low that it allows you to eat quite a volume of food one of the key things I think for people with diabetes is to drink water not sugar and not artificially sweetened beverages either at which I’ll mention a little bit more about later but but people need to be drinking water they need to practice portion control we learned this in the Marshall Islands we started out giving them unlimited just letting them feel their plates we would put them the brown rice or the barley out and let them fill their plates and we didn’t get the results we were looking for in terms of their evening blood Sugar’s and so we had to start portioning it out and it just made all the difference in the world so for some of these more concentrated carbohydrate foods especially when you have insulin resistance it helps to to control portions of the you know of the of the really high starchy grains and and vegetables and of the concentrated fat sources like like nuts and seeds and avocados and olives and coconut and so forth I would suggest not snacking at all at least 4 to 6 hours between meals and drinking water or herbal tea between the meals and and if snacks are absolutely you just have to have a snack stick to raw vegetables or fresh fruit rather than anything else and one of the things that that that we used to think as dietitians is people shouldn’t be weighing themselves too often because it can be discouraging and all of these these reasons but we’ve learned in the last 10 years that this is a mistake people who weigh themselves at the same time every day in the moment say in the morning just after you wake up it actually leads to improve long-term weight maintenance and so I think of I have two friends that I know that have been weighing themselves every day for probably 50 years and both of them are still at the same weight they were in high school and I’m not kidding you one of them is my mother who’s 82 years old and she was a hundred and twenty-six pounds when she got married she’s five foot six and she still varies between 125 and a hundred and thirty pounds it’s just she’s done that all her life and if she gains a few pounds she doesn’t eat dessert she just cuts back her portions she’s just always done that and so it for a lot of people it’s a really good idea to be weighing on a daily basis and then of course increasing physical activity at least 150 minutes of structured exercise per week including aerobic and resistant exercise

essential ingredient number three is whole food carbohydrates you know when you look at how much carbohydrates people eat in diabetes risk the percent of calories from carbohydrates has little influence on diabetes risk the lowest rates of diabetes in the world are found in populations eating the highest carbohydrate diets it’s the quality of the carbohydrates that determines health outcomes carbohydrates from Whole Foods are consistently protective against diabetes carbohydrates from refined foods are consistently risky not just diabetes for every disease you can think of refined carbohydrates are associated with overeating and obesity insulin resistance non-alcoholic fatty liver disease inflammation and high triglycerides not good

so what our refined carbohydrates well they’re just high carbohydrate foods that have been stripped of almost everything of value to human health before we eat them you know so there are simple refined carbohydrates like sugars and sweet beverages and they’re complex refined carbohydrates like starches like white flour and white rice so when we refine a grain we remove so say we go from wheat to white flour we remove the bran and the germ well the bran is the outer husk of the kernel where a lot of the fiber and minerals are stored the germ is the most nutrient-dense part of the green it’s where the vitamin E is it’s where the protein is it’s where a lot of the vitamins like the B vitamins all of these things the phytochemicals are really concentrated there and when we make white flour we remove the brand and the term and all we’re left with with is something called endosperm which is pretty much pure starch a little bit of protein a little bit of vitamins and minerals but typically we lose 80 to 90 percent of the fiber 70 to 80 percent of the vitamins and minerals and 95 percent of the protective phytochemicals and then of course nobody eats a bowl of white flour right before you eat the flour you add fat and sugar and salt and additives and then you eat the white flour and therein lies the problem not only have we removed what is a value to human health we’ve added a bunch of things we know our pathogenic that contribute to disease risk and our body has to deal with this stuff it’s impossible impossible to ever achieve optimal health on a diet of refined carbohydrates replacing meat and potatoes with with you know bagels and and and all of these refined carbohydrate foods will not improve your health outcomes we know that

so what is a safe level of added sugars well the World Health Organization suggests not more than 10% of calories or 12 teaspoons of sugar in a day you might say who eats 12 teaspoons of sugar in a day yeah that’d be disgusting but you’ll see a lot of people they also add that fer for greater health benefits people would be better off keeping it under 5% or under 6 teaspoons of sugar per day well the average intake in the United States is 17 teaspoons a day for adults and for teens its 28 teaspoons a day because of the sodas and sweet drinks they consume

so how much is in food well you know that 12 teaspoon upper limit at the very upper limit you get in in and a 12 ounce soda or a large flavored coffee can provide as many as 18 teaspoons of sugar one of the things I do in the Marshall Islands is I I take a 20 ounce bottle of orange soda and and I take a arrow glass and I measure out the 20 plus teaspoons of sugar into the glass and I say to the children when you’re drinking this you’re drinking this it has quite the impact on them they’re shocked so these these foods even a cinnamon bun 12 teaspoons of sugar but even things that we don’t think of as being so concentrated in sugar like an energy bar may have 5 teaspoons a 1/4 cup of barbecue sauce 4 teaspoons of sugar so these numbers can get to that 60 spoon limit very very quickly and if we look at the sources of added sugar in the u.s. diet 47% from liquid beverages it’s shocking

what about the sugar in fruit we’ll whole food fruits are consistently protective to health why because they’re rich in fiber and antioxidants and phytochemicals and vitamins and minerals especially potassium and vitamin C and folate so all of the studies looking at diabetes risk and fruit intake tend to be favorable for fruit intake rather than the other way around but the body is well equipped to process the amount of fructose naturally present in fruits but when we add concentrated fructose to beverages the livers capacity to handle fructose very quickly becomes overwhelmed and that drives lipo toxicity so daily average fructose intakes average about 37 percent of total sugars and 9% of daily calories that’s just shocking to me

so carbohydrate common-sense we want our carbohydrates from whole plant foods we want to avoid added sugars especially in beverage and beverages and myzel refined carbohydrates both starches and sugars

essential ingredient number four is sufficient fiber we want at least 20 grams per thousand calories so for a lot of people that means 40 grams at least a day we have strong consistent evidence that meeting the adequate intakes are the recommended intakes for fiber which are from more than 40 equals to R more than 14 grams per thousand calories is associated with a 20 to 30 percent reduced risk of developing diabetes and we have a meta-analysis that showed that for every that there was a six percent decrease in diabetes risk for every two grams of fiber consumed imagine if we added 20 grams of fiber that would be a 60% reduction so fiber is important and in fact in a soluble fiber reduces diabetes risk so that’s the type in you know wheat and and there’s quite a bit in lentils and beans and corn and apples and so forth but then soluble fiber that more sticky fiber actually emplou improves glycemic control for people that already have diabetes and beans and barley and flax seeds and chia seeds and avocados and and beets and Brussels sprouts

if we look at the fiber in foods well legumes we’re looking at 10 to 20 grams of fiber in one cup avocados grains berries are all very high in fiber and then all other plant foods provide about 2 to 5 grams of fiber per serving only plant foods contain fiber refined carbohydrates are very low fiber sources fast foods very low in fiber and the no fiber foods are meat poultry fish eggs dairy products fats oils and sugars zero fiber so we want to include ideally a variety of high-fiber foods with each meal

essential ingredient number five is plant protein why well if you compare legumes to meat it’s really very simple the food components that we want to increase in the diet the fiber and phytochemicals of antioxidants and prebiotics and sterols and stanols are either high or very high in legumes and they are either zero or very low in meat and poultry and the dietary components that were trying to limit like the saturated fat and cholesterol heme iron and neu5gc and chemical contaminants and endotoxins are either lower zero in legumes and they are either moderate or high in animal products so it’s not rocket science you know if we look at protein type and diabetes risk there was a Harvard study of over two hundred thousand participants that showed that replacing five percent of energy from animal protein with plant protein resulted in a 23 percent reduced risk of diabetes and the Melbourne collaborative cohort study they found a 40 percent reduction of type 2 diabetes risk in the highest vs. lowest quintile of plant protein intake and in the highest vs. lowest quintile of animal protein intake it was a 23 percent increased risk so this is when you divide the group in a quintile in into five parts and you’re comparing the highest versus the lowest and and they had a meta-analysis of 11 studies it wasn’t quite as impressive but diabetes risk with higher intakes of plant protein was reduced by 5% in highest intakes of animal protein increased risk 19% and then there was a study from Canada by Levine in in 2014 people eating more than 20% protein who were 50 to 65 years of age increased their diabetes risk almost four times and those over 65 increased diabetes risk over ten times when eating that much protein but was really in what was really interesting is the associations were abolished or greatly attenuated when the protein came from plants it only was valid when it came from animal products

and this is a brand new remember last night for those of you that were here we talked about that that New Trier X couldn’t consortiums study that said they had new guidelines encouraging people to continue their current level of mediant a well in diabetes care in 2020 the the Diabetes Association wrote a response and you can see they say right here these recommendations are not justified in large part because of the flawed methodology used to review and grade nutritional evidence and they went on their expert conclusions were that there’s considerable evidence from long-term prospective cohort studies that have demonstrated that diets high in red and processed meat are associated with increased risk of type 2 diabetes cardiovascular disease cancer and all cause mortality and they said it’s important to follow current national nutritional recommendations by the American Diabetes Association and other professional and government organizations that emphasize dietary patterns high and minimally processed fruits and vegetables whole grains nuts and legumes while limiting red and processed meat refined carbohydrates saturated fat and sugar sweetened beverages that’s the American Diabetes Association so very interesting

essential ingredient number six is healthy fat from whole plant foods how low should we go where fat is consumed concerned well I you know we have had success with very low fat diets like Neel Barnard’s group we’ve had success with more moderate fat diets like the the Czech Republic or David Jenkins or or even dr. Anderson the the the thing is is we need to focus on quality of fat so we want to make whole plant foods our primary sources of fat because again they have fiber and antioxidants and stanols and sterols and phytochemicals concentrated fats and oils on the other hand provide a lot of calories with few nutrients so these are best limited or avoided so the type of fat and insulin sensitivity matters to saturated and trans fat have detrimental effects on insulin sensitivity whereas polyunsaturated fat improves it

how much saturated fat well the American Heart Association and the American College of Cardiology say not more than five to six percent of calories which would be a eleven grams on a 1600 calorie weight-loss diet will check out the amount of saturated fat in animal foods just a cup of milk is seven grams a double cheeseburger is 16 a pepperoni couple slices of pizza 15 where as with plant foods even high fat plant foods the amounts are very very low with the exception of coconut of course which is predominantly saturated fat

we want to minimize exposure to damaged fats so we want to avoid fried and highly processed foods we want to avoid oils and cooking particularly and to store high-fat foods including shelled nuts and seeds to protect them like in the refrigerator or freezer we want to optimize omega-3s and that means about two to four grams of alpha-linolenic acid a day and possibly DHA and EPA supplements because DHA because of desaturates enzymes that convert the plant fats to the long-chain omega-3s can be depressed

essential ingredient number seven I’m sorry I’m going so fast but I have only 7 minutes and 23 seconds left so a healthy gut microbiome a dysbiosis as we mentioned fuels insulin resistance and diabetes so how do we improve gut flora by eating more prebiotics where do you get prebiotics from the fiber in plant foods things like you know are a jerusalem artichokes and onions and garlic and all sorts of grains and and and other fruits and vegetables and all of these foods beans they all provide prebiotics food for bacteria we can eat food based probiotics so prebiotics are the food for bacteria probiotics are the bacteria themselves so we can do cultured and fermented foods we need to minimize our intake of foods that are associated with dysbiosis highly processed foods fried foods artificial sweeteners which I didn’t get to talk about much but they can actually cause dysbiosis and meat so we don’t want those things we want to oh I did have it there avoid artificial sweeteners of avoid excessive alcohol consumption

essential ingredient number eight is a low glycemic load we want to replace high GI foods with low GI foods because it improves glycemic control reduces inflammation and reduces risk of heart disease so how do we reduce it by emphasizing non starchy vegetables and legumes by controlling our serving sizes of starchy vegetables and legumes and by selecting lower GI foods within each category so sweet potatoes instead of white potatoes in tact rather than ground grains and we want to include foods known to reduce the glycemic impact of meals like legumes higher fat foods like nuts and seeds and avocados acidic foods like lemon or lime juice or vinegar they actually reduce the glycemic impact of the food we’re eating and some spices like cinnamon can help to reduce the glycemic impact

essential ingredient number nine is to load up on anti-inflammatory phytochemical and antioxidant rich foods and what we know is these foods can help to reduce diabetes risk so we want to emphasize colorful vegetables and fruits herbs and spices legumes nuts seeds whole grain sprouted foods fermented foods and even certain types of tea like green tea how do you do that think color the richest sources of phytochemicals are often the most colorful so purple instead of white onions may be black or red instead of brown rice or black or red quinoa instead of white dark instead of light greens we want to include a lot of variety we want to choose organic because it’s higher in phytochemicals and antioxidants than conventional sources we want to eat more raw foods because some of the enzymes they contain help to convert phytochemicals into their active forms especially with cruciferous vegetables and Allium vegetables we want to eat sprouts because when we sprout foods we magnify the phytochemical content it’s often increased five to fifty times we want to pie the herbs and spices drink the antioxidant rich teas add the fermented foods

an essential ingredient number 10 is low dietary contaminants so environmental contaminants and products of high-temperature cooking is what we’re talking about these can do a lot of damage they can cause oxidative stress fuel inflammation disrupt hormones and become obesogenic damaged our organs and damaged DNA in the central nervous system that all increases risk of diabetes and it’s complications we’re talking about pesticides in conventional produce heavy metals like mercury and fish and arsenic and rice and persistent organic pollutants in fish and meat and dairy products and what do we want to do well we want again choose organic when we can eat lower on the food chain and vary our grains arsenic can injure beta cells and we have so we need to limit or at least carefully select our rice if we eat it cook it in a large amount of water because we can get rid of a lot of the arsenic that way products of high temperature cooking like heterocyclic amines and polycyclic aromatic hydrocarbons and acrylamide and advanced glycation end-products the heterocyclic amines are only found in animal products but polycyclic aromatic hydrocarbons and acrylamide can be found in anything well acrylamide x’ more in potato products because of the asparagine there which gets converted to acrylamide so all of these things we need to reduce and the solution is to avoid charred or blackened foods especially meat poultry and fish avoid fried foods use moist cooking methods more often where you’re using water or broth

essential ingredient number 11 is to moderate sodium and very few people with diabetes meet the target the upper limit recommended for those with diabetes is 1500 milligrams and only 2.4 percent of people with diabetes meet that recommendation and those with the highest vs. lowest quartile of sodium had over double the risk of heart disease and over ten times the risk if they’re a 1 C was over 9 that’s scary 75 to 80 percent of sodium comes from processed foods and if you look at the amount of sodium food a teaspoon of salt has 2300 milligrams ramen noodles pickles vegetable soup tomato sauce veggie burgers Italian dressing whole-wheat bread you can eat an ounce of potato chips and an ounce of salted peanuts and get less salt than what you would get from two slices of bread is this shocking it’s because when you coat a food with salt you taste it but when you put it throughout the whole batter you don’t so you need to read labels

and finally essential ingredient number 12 is adequate micronutrient in takes people with diabetes often have micronutrient deficiencies so choosing nutrient-dense Foods helps to ensure adequate nutrients when calories are limited and so nutrient density becomes very important and the most nutrient-dense foods on the planet are green leafy vegetables and other non starchy vegetables and fruit legumes and starchy vegetables nuts and seeds are all good choices the lowest nutrient density of all foods oil and sugar nutrients of concern on plant-based diet b12 and vitamin D and b12 is important because met form for people on metformin it can really reduce the absorption

so I’ve got 30 seconds so the take-home message is every time you eat or drink you either feed disease or you fight disease whole food plant-based diets are very powerful medicine for people with type 2 diabetes and in my opinion it is time that health care systems offered lifestyle treatment programs as the first line of therapy for lifestyle induced diseases like type 2 diabetes and it is high time that food sir that that they offered food services that promote health rather than undermine it and and these are my two new books on diabetes which provide much more detail than when I than what I went into in this lecture thank you very much for your attention [Applause] you