1 / 83

Diet and Disease

Diet and Disease. The Phantom Menace Part 5 of 6 The Aetiology of Obesity. Hormonal Obesity Theory. Vinegar. Fibre. Fructose. Obesity. High Protein. High TG Low HDL. Increased Insulin level. Fattening Carbohydrates. Hypertension. Cortisol. Diabetes. Wheat Super-carbohydrate.

limei
Download Presentation

Diet and Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diet and Disease The Phantom Menace Part 5 of 6 The Aetiology of Obesity

  2. Hormonal Obesity Theory Vinegar Fibre Fructose Obesity High Protein High TG Low HDL Increased Insulin level Fattening Carbohydrates Hypertension Cortisol Diabetes Wheat Super-carbohydrate Fasting Fatty Liver Insulin Resistance Metabolic Syndrome www.kidneylifescience.ca

  3. Diseases of Civilization Coronary Artery Disease Obesity Diabetes Colorectal cancer Breast cancer Tooth decay Constipation “My observations inclined me to attribute this to the fact that the native were living more and more after the manner of the whites” Dr. Schweitzer West Africa 1913 www.kidneylifescience.ca

  4. First Nations 1908 Smithsonian Institution’s Bureau of American Ethnology report • “Malignant disease, if they exist at all … must be extremely rare” • “Not one pronounced instance of advanced arterial sclerosis” www.kidneylifescience.ca

  5. Inuit 1952 Queen’s University “It is commonly stated that cancer does not occur in the Eskimos, and to our knowledge no case has so far been reported” 1950-1974 Upernavik 1 case of diabetes www.kidneylifescience.ca

  6. Masai Pastoralists – diet of milk, meat and blood Rarely eat fresh vegetables www.kidneylifescience.ca

  7. Tukisenta “Investigators found them to be fit, lean and muscular, with no sign of protein deficiency” (Trowell and Burkitt. Western Diseases. 1981) 94.6% of their energy intake as carbohydrate www.kidneylifescience.ca

  8. The Kitava Study 1990s - Kitavandiet 69% carbohydrate Fruit, vegetables, roots, fish and coconuts www.kidneylifescience.ca

  9. Low Serum Insulin despite high carb intake Swedish reference range 10-90% Low Serum Insulin in Traditional Pacific Islanders—The Kitava Study Metabolism, Vol 48, No 10 (Oct), 1999:1216-1219 Lindeberg S www.kidneylifescience.ca

  10. Okinawa Life expectancy among the highest in the world 85% Carbohydrate BMI average of 20.4 www.kidneylifescience.ca

  11. Conclusions Populations could be healthy with diets of 95% carbohydrate or 95% meat No refined/ processed foods No flour No sugar www.kidneylifescience.ca

  12. Populations in Transition

  13. Tokelau Island Migration Study “Their populations are notable for their low levels of blood pressure… coronary heart disease, obesity and diabetes” www.kidneylifescience.ca

  14. Tokelau Island Migration Study Impact of trading posts established on atolls www.kidneylifescience.ca

  15. Sugar consumption www.kidneylifescience.ca

  16. Tokelau Migrants Study Average weight increased by 20-30 pounds www.kidneylifescience.ca

  17. Diabetes Graph: www.wholehealthsource.blogspot.com

  18. Gout Graph: www.wholehealthsource.blogspot.com

  19. Tooth Decay Graph: www.wholehealthsource.blogspot.com

  20. New Zealand Maori 2006 High levels of physical activity www.kidneylifescience.ca

  21. Maori Obesity Staples of Maori diet - bread, flour, biscuits, breakfast cereals, sugar, and potatoes www.kidneylifescience.ca

  22. Increasing cancer with Westernization www.kidneylifescience.ca

  23. Increasing Cancer with Westernization Regions in order of Westernization From: US Treasury Public Health Reports 1934 Graph: www.wholehealthsource.blogspot.com www.kidneylifescience.ca

  24. Increasing cancer with Westernization Migration patterns and breast cancer risk in Asian-American women J Natl Cancer Inst. 1993 Nov 17;85(22):1819-27. Equal risk in 2 generations www.kidneylifescience.ca

  25. Increasing Cancer with Westernization Hong Kong The Breast, Volume 17, Issue 1, February 2008, Pages 42–5 Breast Cancer Incidence per 100,000 www.kidneylifescience.ca

  26. Geographic Risk of Heart Attack Source: Wholehealthsource.blogspot.ca Geographic Pathology of Myocardial Infarction Dr. KyuTaik Lee (Am. J. Cardiol. 13:30. 1964) www.kidneylifescience.ca

  27. The Saccharine Disease 1966 ‘Refined-carbohydratedisease’ Refining of Carbohydrates 1. Overconsumption– evades satiety signals 2. Removal of protein – speeds digestion 3. Removal of fibre – speeds digestion 4. Removal of fat – speeds digestion www.kidneylifescience.ca

  28. Metabolic Syndrome Abdominal obesity High triglycerides, low HDL Hypertension Diabetes Insulin resistance Elevated uric acid levels Alzheimers’ disease Gallstones Fatty liver Gerald Reaven (Stanford) www.kidneylifescience.ca

  29. Hormonal Obesity Theory Vinegar Fibre Fructose Obesity High Protein High TG Low HDL Increased Insulin level Fattening Carbohydrates Diseases Of Civilization Hypertension Cortisol Diabetes Wheat Super-carbohydrate Fasting Fatty Liver Insulin Resistance Metabolic Syndrome www.kidneylifescience.ca

  30. High Insulin levels are a risk factor for heart disease Hyperinsulinemia as an independent risk factor for ischemic heart disease NEJM 1996 Apr 11;334(15): 952-7 Despres JP www.kidneylifescience.ca

  31. Complications of Diabetes Type 1 and 2 Diabetes High Blood Sugars (Oxidative Stress) (Advance Glycation End Products) Complications of Diabetes www.kidneylifescience.ca

  32. ACCORD Hazard Ratio 1.22 The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med 2008;358:2545-2559 www.kidneylifescience.ca

  33. What about hyperinsulinemia? Type 2 Diabetes Increased Insulin High Blood Sugars Complications of Diabetes www.kidneylifescience.ca

  34. Insulin treatment has toxicity 12,272 new diabetics 1991-1996 Saskatchewan Insulin use and increased risk of mortality in type 2 diabetes Diabetes, Obesity and Metabolism 12: 47–53, 2010 Gamble JM “significant and graded association between mortality risk and insulin exposure level” www.kidneylifescience.ca

  35. Insulin treatment has toxicity 84,622 incident Type 2 DM cases Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyperglycemic Therapies in Type 2 Diabetes J Clin Endocrinol Metab 98: 668–677, 2013 Currie CJ www.kidneylifescience.ca

  36. Insulin is BAD for you 1986-2008 UK General Practice Research Database Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study Lancet 2010; 375:481-89, Currie CJ Oral Combination Insulin Adjusted Hazard Ratios by A1c www.kidneylifescience.ca

  37. Non-diabetics 11,092 patients in ARIC study GlycatedHemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults N Engl J Med 2010;362:800-11, SelvinE www.kidneylifescience.ca

  38. Long acting insulin increases risk www.kidneylifescience.ca

  39. Metformin versus Sulfonylurea Retrospective cohort study of 253,690 patients initiating treatment Comparative Effectiveness of Sulfonylurea and Metformin Monotherapy on Cardiovascular Events in Type 2 Diabetes Mellitus Ann Intern Med. 2012;157:601-610 Roumie CL www.kidneylifescience.ca

  40. Sulfonylurea versus Metformin Multicenter, randomized, double-blind, placebo-controlled trial Effects of Metformin Versus Glipizide on Cardiovascular Outcomes in Patients With Type 2 Diabetes and Coronary Artery Disease Diabetes Care, epub Dec 10, 2012 Hong Jie www.kidneylifescience.ca

  41. Glucose Control without Hyperinsulinemia

  42. ORIGIN Proportion of Participants with Events over Time. No measureable difference in outcomes The ORIGIN Trial Investigators. N Engl J Med 2012;367:319-328 www.kidneylifescience.ca

  43. Lowering glucose without raising insulin improves outcomes Acarbose Treatment and the Risk of Cardiovascular Disease and Hypertension in Patients with Impaired Glucose Tolerance JAMA 2003; 290: 486-494 Randomized 1,429 patients 3.3 year follow up 49% RRR 2.5% ARR www.kidneylifescience.ca

  44. Hypertension HR 0.66 P= 0.006 17% 11% www.kidneylifescience.ca

  45. 69 Stratified Analyses of CV Events: Pooled Data from Registration Trials (DPP-4 Inhibitors) Risk ratio 95% CI No. Sitagliptin1 0.68a [0.41–1.12] 64 0.43b [0.23–0.80] 40c Saxagliptin2 Linagliptin3* 0.34b [0.16–0.70] 34d 1.3 1.8 0.1 1 10 Risk ratio DPP-4 inhibitor better Comparator better *The maincontributor to the overall differences in the primaryendpointwas the events in the head-to-head study of linagliptin vs. glimepiride. Comparisons with placebo were not statisticallysignificant (Johansen et al 2012; Trajenta Canadian Product MonographJuly 2011). aCalculatedusingexact procedures for the Poisson processes; bCoxhazard ratio; cPatients with events: n = 22, saxagliptin; n = 18, control;dPatients with events: n = 11, linagliptin; n = 23, comparator. 1. Williams-Herman D, et al. BMC EndocrDisord2010; 10:7. 2. Frederich R, et al. Postgrad Med 2010; 122:16-27. 3. Johansen O-E, et al. CardiovascDiabetol2012; 11:3.

  46. Hormonal Obesity Theory Vinegar Fibre Fructose Obesity High Protein High TG Low HDL Increased Insulin level Fattening Carbohydrates Diseases Of Civilization Hypertension Cortisol Diabetes Wheat Super-carbohydrate Fasting Fatty Liver Insulin Resistance Metabolic Syndrome www.kidneylifescience.ca

  47. Diabetes

  48. Nutrition Recommendations 2008 “Intake of sucrose and sucrose-containing foods by people with diabetes does not need to be restricted because of concern about aggravating hyperglycemia” (it’s true – they really wrote this) Page S65 WTF?? www.kidneylifescience.ca

  49. Nutrition Recommendations 2008 “Dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended.” Diabetes Care 1 Jan 2008 Vol 31 S61-81 www.kidneylifescience.ca

  50. Overall Primary Outcome Results. No Benefit to Low Calorie Low Fat! 1200-1500 kcal low fat diet Exercise 200-300 min/ week Eat less, move more A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes N Engl J Med 2012; 366(24):2247-2256 www.kidneylifescience.ca

More Related