What Is The Best Diet For Decreasing Diabetes Risk? with Brenda Davis R.D.

so moving on to type-2 diabetes there was a study that looked at all kinds of dietary patterns and diabetes risk and the authors said in their summary together with maintenance of ideal body weight the promotion of a so-called prudent diet characterized by a high higher intake of plant-based foods and a lower intake of red meat meat products wheats high-fat dairy and refined grains or a Mediterranean dietary pattern appear to be the best strategies for decreasing diabetes risk

so what are the rates among vegetarian or vegan populations well the Adventist Health Study 2 found that in health-conscious meat-eaters semi vegetarians pesco vegetarians lacto-ovo vegetarians and vegans as people consume less meat their their risk for diabetes decreased and so the rates were about 7.6 percent among the health-conscious non vegetarians 6.1 amongst the semi vegetarians 4.8 among pesco vegetarians and this is lacto-ovo vegetarians plus fish about 3.2 percent among lacto-ovo vegetarians and about 2.9 percent among vegans and taking the same cohort and following them for another 2 years who developed diabetes well the risk was 62 percent lower for developing diabetes for vegans than for non vegetarians was about 32% lower among lacto-ovo vegetarians and this was adjusted for everything for age gender education income television watching physical activity smoking and body mass index so they actually adjusted for body weight so this is very interesting there was a study looking at diabetes rates in Taiwanese Buddhists and for similar health-conscious near vegan and they looked at rates in similar health-conscious near vegan and omnivorous volunteers diabetes risk fully adjusted for all of these variables was 51 percent lower among near vegan men and about 75 percent lower for near vegan women and I want to tell you the pictures on this slide are very interesting because I was speaking at the su Chi International Medical Association conference in Taiwan and there are seven of the most highly regarded hospitals in Taiwan they are all Buddhist hospitals and they are all completely vegetarian this meal at the bottom was your typical cafeteria Meah whole grain rice and it's just a whole huge buffet of vegetables and tofu dishes and so forth I went I was taken into the kitchen and you see that the garbage bags in that corner they're all filled with greens for the patients fresh greens from the organic gardens that the Buddhist nuns were growing yeah I mean unbelievable can you imagine this concept of actually feeding sick people healthy food it's just unbelievable I you know and we have so much to learn from others around the world I was stunned when I saw those bags of greens you would never see that in a hospital here what about the diabetes rates among East Indians well over a hundred and fifty thousand adults 20 to 49 years of age comparing non vegetarians and this again is fully adjusted including BMIs lacto-ovo vegetarians were 33% less likely to develop diabetes lacto-ovo vegetarian or lacto-vegetarian 'he's 31 percent less likely so they didn't consume the laptop vegetarians were consuming milk but no eggs the lacto-ovo consuming both milk and eggs they didn't have a vegan population but semi vegetarians were 24% less likely to develop diabetes so what do we know about red meat and diabetes risk again from the Harvard studies health professional follow-up study in the Nurses Health Study almost a hundred and fifty thousand participants participants adding just half a serving one and a half ounces of meat a day increased risk of diabetes by 48 percent unbelievable so we also have a study this is another arm of epic not not epic Oxford but epic Norfolk and they did a study looking at fruit and vegetable intake and diabetes risk and what they found was that that that basically there was a strong inverse association between fruit and vegetable intake and diabetes incidents compared with people eating though in the lowest quartile of vegetable intake risk was reduced 30% for the second quartile 66% for the third quartile and 81% for the highest quartile of vegetable intake so the the quarter of the group that we're consuming the most vegetables eighty-one percent lower risk and remember we learned yesterday that only 2% of men and 3.5% of women actually get even the minimal amounts of fruits and vegetables recommended by the US government just unbelievable this is how much it would help if they improve their intakes so we also note about treatment using plant-based diets from PCRM they've had a number of studies comparing low-fat vegan diets to an American Dietetic Association or sorry American diabetic Association diet for the treatment of diabetes and those eating vegan diets lost more weight and had greater blood glucose reductions than those eating the american dietetic diabetic Association diets we also have research from a Czech team that found near vegan diets more effective than calorie restricted conventional diets in increasing insulin sensitivity and reducing medications and body fat so there are also of books that have been published on using plant-based diets to actually reverse diabetes or at least improve the you know the the risks of of complications of diabetes and the one on the left defeating diabetes is a book that I wrote back in 2004 and this book was responsible for getting me invited to the Marshall Islands and that's where we are now at the Marshall Islands story

so where are the Marshall Islands well you know where Hawaii is you know where New Zealand is the Marshall Islands are about 2,300 miles southwest of Hawaii and about 3,500 miles directly north of New Zealand they are about five to seven degrees north of the Equator and they are it's really interesting as you can imagine it's summer year-round and it's 82 degrees on average at midnight at 6:00 in the morning in the middle of the day 100 feet below the surface of the water in the ocean and wet and the coldest it ever gets is 77 degrees and the first week I was there it hit 77 because it was raining outside and people were shaking they were I'm not kidding you they were just shaking they were putting coats on and and and I have to tell you this story because it's so funny a doctor in the Marshall Islands his daughter was going to come to Canada they were seventh-day Adventists and she was going to go to an Adventist College in Alberta and he said to me and this is in Lacombe Alberta it's like minus 30 they're in the wintertime minus 40 and he said to me he said you know I've heard it's cold in your country he said you think she might need a sweater I told him to go into the kitchen enter the refrigerator stay there for a few hours and that had helped him decide if she needed a sweater I told them please do not send her to can't send her to California

like but in the Marshall Islands diabetes is a state of emergency they have the highest death rates from diabetes on the planet the estimated prevalence is about 50 percent in those 35 plus pre-diabetes or type 2 diabetes almost all adults at least 90 percent of adults have either pre-diabetes or diabetes about half of all surgeries on the islands our amputations due to diabetes

so was diabetes a problem in the past not at all it was practically unheard of 70 or 80 years ago the people were slim they were physically active and they lived off the land so what was the traditional diet well they eat they ate plants 50 to 60 percent of their calories came from coconut they ate bread fruit bananas they pandanus green leaves and of course whatever they could catch out of the ocean period that's all they ate they didn't have anything in a box or a bag

today what do they eat well the little girl on the far left is eating breakfast and I'm not kidding this was seven o'clock in the morning children eat whatever they want because parents have to still think that if they have a full belly they're well nourished that's the way it was for generations they didn't understand that any food wouldn't be nourishing they'd eat for lunch and dinner white rice sticky white rice and meat that's often spam or some sort of canned meat or chicken they eat all the parts of the animals that we don't want like turkey tails or any cheap animal parts you can see on the left hand corner it's all bins of meat for a celebration and it's bins of processed meat mostly the children's favorite snack oh and I should say it's all washed down with luau the number one ingredient for Lua luau is high fructose corn syrup the meal on the right is a celebration meal and so you can see it's white rice chicken ham sandwich a doughnut and some white soda biscuits so that's the food they're living on the favorite snack of the children is you know what ramen noodles are in those crinkly packages they're deep fried noodles salted noodles well that's the favorite snack and what they do is crack open a package they don't cook it they pour a bag of Europe a package of kool-aid powder on top so all the artificial colors and preservatives in one day I was watching a kid they poured their kool-aid powder on top and then they took something out of their pocket a package of white stuff and they started sprinkling the white stuff and I thought they can't be putting Salters yeah there's 1,800 milligrams of sodium in one of those packages they can't be putting something so I said to the person next to me I said are they putting on their ramen noodles and they said oh that's a scene immortal you notice any more toys pure msg yeah

so the top sources of calories and the marshalese diet are white rice white bread and rolls donuts and white flour baked goods spam and other canned meat chicken ramen noodles with kool-aid powder sprinkled on top sweetened beverages fish other meat salty snacks and that's about it it would be difficult for me to design a diet to induce diabetes any better than the diet these people have adopted and that's why they have such huge diabetes rates and that's why they have the highest highest death rates from diabetes on the planet

so in 2006 we began the diabetes wellness project in the Marshall Islands and the founder of this project was canvasback missions a seventh-day Adventist medical mission group that had been providing medical teams to the Marshall Islands for 20 years plus bringing in teams of oncologist teams of ENT doctors teams of dentists to try to help the people and they watched the diabetes epidemic really unfold and they were determined to do something so they got they applied for and were granted a grant got a grant a research grant from the US Department of Defense why because the US government the Marshall Islands were atomic bomb testing grounds after the Second World War and so there's some sort of relation you know sort of a relationship between the Marshall Islands and the United States and the United States does give a lot back to the Marshall Islands now and so wanted to do this as another giving back and the partners were the Marshall Islands Ministry of Health and Loma Linda University and I was brought on because the doctor that was hired to be the sort of director the medical director of the project had just been to a conference that I was speaking out on diabetes and he said I think I think you know we could use the program from her book as our program to try in the Marshall Islands so that's how I ended up getting involved

so what we did was we basically did a proper study where we work and we were comparing very aggressive lifestyle intervention with the usual care and we had 169 participants with a1cs over eight so they were diabetic or they were taking diabetes medications and we used a random randomized parallel design with five overlapping cohorts and they were with us for 24 weeks and what that means is overlapping design means before one group has stopped we're already starting another group okay so we did five groups and we did many others but only five were part of the actual research our goal was really simple our goal was to reverse the diabetes epidemic step one to prove that diabetes can be successfully treated with diet and lifestyle in the Marshall Islands and step two to get the government to adopt the program as standard treatment for all marshalese people

so here's what we did weeks one two four and six there are with us for weekdays for six hours a day weeks three five seven and eight they were with us twice weekly for five hours weeks nine to twelve they were with us weekly for about five hours and weeks 12 to 24 they were on their own but they would come for exercise and measure blood Sugar's and all of that sort of thing and the guys you see here all of these men are ministers of health or senators so we put through the leaders of the communities we had the president we had you know all of the the the you know princes and kings and all of those leaders because we wanted to educate the leaders it's a it's a quite a society where where there's it's a bit of a nepotistic society and and it's and and I should also say it's a beautiful society the people are absolutely incredible I have never heard people laugh as loud or you know sing as beautifully I one story I just have to tell you this doctor told me this story he first arrived to the Marshall Islands and he took a side road home to our hotel and and he said the first thing he saw was this gang of teenagers coming towards him and he got scared and he said it was a gang of teenage boys and as they approached and got closer he realized that they all had their arms around one another and they were all singing and as they got close to him they were so friendly and they were saying Yahweh Yahweh and and the witches hello and love and all of that stuff and he knew he was in a very special place it's a very special place

so they people would do a walk a blood glucose and breakfast on their own but we would provide their food this is in the intensive phase they come to the clinic for lunch and then they would be working during the day and then they would come at 3:00 and be with us till about 8:15 and in that time they would do an exercise class a cooking class they'd have dinner they have an you know an education session in the evening it was very intense and our diet goal was very simple to restore insulin sensitivity and to accomplish that tasks we must produce weight loss in the overweight participants we've got to improve blood glucose control we've got to reduce oxidation and inflammation and we have to restore their nutritional health because they are as you can imagine extraordinarily malnourished

so the diet design while it was a plant-based diet high in fiber it was a very low glycemic load I have to tell you this before I go on the high fiber thing the average fiber intake and the marshalese people was about 5 grams a day ok we got them to 40 to 50 grams a day so you can imagine what happened we had people that on average were going to the bathroom once every week or two yeah and so when they started going to the bathroom every day it scared them it scared them it was just so unusual for them and so it's really quite quite interesting so it would very low glycemic load minimal refined carbohydrates if any minimal ground grains we didn't use flour products we used intact whole grains moderate fat so we used some nuts and seeds low saturated fat zero trans fatty acids most of the saturated fat free coconut that we used and we did use coconut it's a really important traditional food for them and sufficient essential fatty acids using flax seeds because they're cheap we did allow them to eat some fish at home we'd never served any animal products at the clinic at all but they were allowed after the first few weeks if they wanted to have boiled fish not fried fish that was permitted because that's a very important part of their cultural diet as well the diet was anti-inflammatory high in phytochemicals high in antioxidants low in Pro oxidants contain moderate levels of sodium a lot of people say well and these girls at the bottom these are these ladies are our cooks and they're eating pandanus and pandanus is a really important source of vitamin A for these people and and anise is so fibrous that you can't really eat it you can only suck the juice out of it it's like you need to have dental floss if you can go near it but they love it it's quite flowery tasting so

so why not just return them to their local foods well of course it would be a great idea you know it would make sense from a health perspective and from a cultural perspective but from a practical perspective it's impossible because the island might sustain like Majuro the main island that we worked on might sustain 500 or a thousand people there are 30,000 people there so there's no way you have to import food so the answer is to get them to import healthy foods and to eat as many local foods as they can so it's just so important so the best choices are cheap imported foods but healthful ones like beans legumes barley low cost vegetables like cabbage and squash

so what else did we do in the program well they did daily exercise their favorite was dancing men and women they loved to dance so there were car and that you can see the women none of them have exercise clothes on because pants in their culture they're starting a little bit now but when we arrived if you were pants as a woman you were a prostitute and it was only people from Asia that would ever wear pants and they were prostitutes so women wore long dresses period and we had to abide by that of course as well and so they exercised in their long dresses and every this if you take nothing away from this for diabetes if you know of family or friends walking after meals is one of the most potent things that you can do to keep your blood sugar down even if it's only five minutes we had them walking about 20 or 30 minutes after meals we did cooking classes we did shopping tours we did education sessions in this none right here dr. Kamal was known as the butcher this is the man that cut the people's legs off and everybody was scared of him and he was the sweetest man on the planet he was a vegetarian himself and I absolutely loved him he was just such a dear person and he said if only I could convince people to come in before they have gangrene going up their body and I have to cut their legs off to save their lives but what they would do in their culture if they got sores on their feet they would try to treat it with local medicine because they were scared if they went to the doctor he'd cut their leg off so they would wait until they you know their leg was everything was black and they had gangrene going in it that's the only thing he could do so we brought him in to teach people about you know how to care for their feed and that he was he didn't want to cut their legs off so you know and we would teach people about lifestyle and chronic disease food and nutrition exercise stress management dental health feet and eye care and and gardening we tried to help people plant gardens even if only in buckets because the soil there you can imagine the a the atoll that they lived on is 30 miles long and three point seven square miles in area it's this long strip of coral reef and there's not good soil there at all so it's very difficult

so I'll tell you a little bit about the results in the first two weeks pain in the joints arms and legs was reduced or eliminated in almost everybody some of these people had intermittent claudication terrible pain in their legs it would disappear in the first week it was unbelievable they couldn't believe it they'd be able to sleep through the night they had increased energy they of course were no longer constipated they could think more clearly and 90% of the participants were able to stop taking their medications in the first two weeks was unbelievable

so and changes at two weeks and twelve weeks while you can see fasting blood sugar dropping 71 points in the first two weeks forty-eight in the first twelve because they were eating foods at home again a 1c dropped about two points by 12 weeks the insulin production went down which is wonderful because they were hyperinsulinemic BM eyes went down systolic blood pressure total cholesterol and the CRP the measure of inflammation went down about 1.2 points so this was all good and the committed participants the ones that really stuck to the program had the greatest success many of whom were able to reverse their disease completely the man on the top right this is Laura caloric his name is Laura caloric and he was a pilot and a lot of people in the Marshall Islands don't get well-educated but he was actually able to become a pilot and and you know fly planes which was really quite remarkable he lost his pilot's license because of diabetes and he came to the program and he completely reversed his disease he's now flying again so it was really exciting for him you know these people are really pioneers of the Pacific the participants of this program provided hope amid a very deep sense of hopelessness they overcame insurmountable mountains of spam donuts ramen noodles and Cola they put together low-cost healthful meals despite the high cost and poor quality of their produce and their lack of resources they don't have money they managed with little education and marginal English skills they succeeded with few gyms one to be exact no trails and a cultural taboo against women wearing exercise clothing

the challenge in the Marshall Islands however is that even the best education program in the world is not enough because the marshalese culture is very group oriented everything shared there's very few people with independent living units so community owner ship is really key and until changes are embraced by the entire culture it's very difficult for people to succeed long term

so what are we doing now our funding has run out so we are there doing what we can and we've shifted away from research to community efforts so we gave these little children this came from PCRM Carolyn Trapp came with me for a couple of weeks and handed these choose smart foods I choose smart foods bracelets to the children we we partnered with the Ministry of Health and the our my government this is World Diabetes Day and the president and the Minister of Health and so forth are all there and we're educating people we planted gardens in every single square inch of the hospital grounds we are teaching the children in the schools and getting them exercising as much as possible we're educating community groups and church congregations we've partnered with restaurants and grocery stores and we're still offering free lifestyle interventions free exercise classes and even and we keep going there every year

in 2014 we went also to ebuy and ebuy has an area of 0.14 square miles it's also part of the Marshall Islands the population is 15,000 people on point 1 4 square miles it's unbelievable we couldn't do what we could do in Majuro we had a very small space we had to use little cooktop stoves but we did our best and we taught people to garden we brought 177 earth boxes so people could could garden and of course things grow very very well we taught people to sprout we brought the hemp seed sprouting bags from the sprout man we got people walking we got people dancing and they had a lot of fun we did grocery store tours and here's the results in our mad row intervention last year fasting glucose average drop was a hundred and nineteen points her exercise 68 points and in ebuy it was the opposite average fasting glucose drop was 50 and after exercise a hundred and sixteen milligrams per deciliter

and people asked me could this program work at home and I say if there is hope in the Marshall Islands given the enormous barriers they face what is our excuse what is our excuse but the hope rests on demand from those affected and the integration of lifestyle medicine into our healthcare system it has got to be offered as a treatment option and so often physicians say to me all but my patients wouldn't do that and I always say how do you know if you don't offer it to them

and I quickly want to introduce you to the Vallejo family the Vallejo family ondrea's right here was diagnosed with cancer at 36 years of age and he actually went to Hippocrates he came to a few conferences one of which I was speaking at and he asked me if I could help him to design a diet that would give him the best chance of survival he had a sub salivary gland tumor and it was not good put it that way and we put him on a very high raw very nutrient-dense diet but what just amazes me is everyone on his family said ondrea's and he was a lawyer in Sanford he is a lawyer in San Francisco and he his favorite pastime was going to the best restaurant in whatever city he was buying the bit best steak and the best bottle of wine he wants he and his wife flew to Paris and spent $3,000 on one meal so they were really foodies okay and his whole family was like that but what really shocked me is his entire foodie family said ondrea's whatever diet you're put on we're doing with you just amazing

and his father Carlos here's what he was dealing with type 2 diabetic coronary heart disease he had just had a major heart attack he had uncontrollable high blood pressure high cholesterol peripheral artery disease his kidneys were failing and he had recurring gout he was on 40 units of insulin and 17 pills a day he was told by his vision physician that he probably had less than two years to live he never expected that the diet would do anything for him you know why because his doctor told him he had a progressive irreversible disease and that nothing that he did would change anything

after less than a year on a wholefoods plant-based diet Carlos took zero insulin and 0 pills his fasting glucose was 4.4 24.8 his a1c 4.9 his blood pressure 115 over 70s his arteries open dot up based on a PET scan he did without surgical intervention the scar tissue is disappearing there is no longer any sign of peripheral artery disease his kidney function is now perfectly normal and he has not had a single recurrence of gout since he became vegetarian after four years his numbers are still the same and his health continues to improve Carlos said I used to spend my days in pain and suffering I took my insulin I was dizzy from my pills and I just knew I was going to die he said no I don't even know what to do with all my time he said I spend two hours a day at the gym and he said I feel like I'm 25 years old he's in his 70s yeah

the take-home message Whole Foods plant-based diets reduce risk of type 2 diabetes and provide the most effective therapeutic treatment for people with type 2 diabetes plant-based diets also protect against cataracts vegans have a 40 cent reduce risk kidney stones have a 31 percent lower risk among lacto-ovo vegetarians and vegans diverticular disease 31 percent lower risk renal disease 52 percent lower risk

why the advantage very simple because well-planned plant-based diets maximize protective dietary components and minimize pathogenic dietary components they maximize fiber phytochemicals enzymes antioxidants anti-inflammatories plant sterols and stanols pre and probiotics and they provide adequate micro nutrients and healthy macronutrients they minimize pathogenic factors the trans fats the excessive saturated fats the refined carbs the sodium and artificial food additives in neu5gc and chemical contaminants and all the products of high-temperature cooking and the TMAO

and when we look at what Americans are eating 63% of the calories come from processed foods and 25% of the calories come from animal products only 12% from plant foods people get it this is you know you've heard of this heart attack grill anyone over 350 pounds eats for free all day every bit every day they even flaunt it you know here double bypass burger triple bypass burger quadruple bypass burger he was their mascot until he died at 29

and the bottom line is if you do not change directions you may end up where you're headed and a 5% change in direction will not change anything you need to make an about-face lifestyle medicine is one powerful treatment option medications and surgeries cannot reverse lifestyle induced diseases because they do not address the root causes of those diseases only profound lifestyle changes have ever proven effective in reversing lifestyle induced diseases and the bottom line is the more we change the more we heal

and I would like to make a call to action because it is time for food and nutrition policies to become a national priority and it is time but governments recognize that policies that may make healthy choices easier for people bring significant health economic social ecological and ethical advantages and with that I will close and say thank you so very much for your attention and I'm promoting my books which have all of this information in them thank you so much [Applause] [Music] thank you very much thank you