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Sugars
Simple carbohydrates - 1-2 sugarsComplex carbohydrates – long chains of sugars
Blood Sugar
Table Sugar
“Fruit” Sugar
Are sugars toxic?www.kidneylifescience.ca
Faith M S et al. Pediatrics 2006;118:2066-2075Fruit juice intake predicts increased adiposity gain in children from low-income families
Juice and Childhood Obesity
Increased offerings of whole fruits were associated with reduced adiposity gain
www.kidneylifescience.ca
Sugar Sweetened Beverages
Nurses Health Study 1991-99Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged WomenJAMA 2004;292(8):927-934 Schulze MB
Consistent <1/wk
Consistent >1/day
<1/wk to >1/day
>1/day to <1/wk
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
2.04 2.21
4.2
0.15
Wei
ght G
ain
(kg)
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Increased Diabetes
Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women JAMA 2004;292(8):927-934 Schulze MB
<1/mo 1-4/mo 2-6/wk >1/d0.8
1
1.2
1.4
1.6
1.8
2
11.06
1.49
1.83
Risk of DiabetesO
dds
Ratio
Nurses Health Study 1991-99
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Hormonal Obesity Theory
FatteningCarbohydrates
Increased Insulin level
Insulin Resistance Time Dependent
Fibre Obesity
High TGLow HDL
Hypertension
Diabetes
Metabolic Syndrome
Fatty Liver
High Protein
Cortisol
Vinegar
www.kidneylifescience.ca
Carbohydrates raise blood glucose
Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetesDiabetes. 2004 Sep;53(9):2375-82 Gannon MC
Usual Diet55% CHO Diet20% CHO Diet Co-factors
FatFibre Speed of Digestion
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Fructose is ‘healthy’
1983 “We see no reason for diabetics to be denied foods containing sucrose” John Bantle NEJM
1986 “No conclusive evidence (sugars) demonstrates a hazard” FDA
2006Can substitute sucrose “for other carbohydrates in the meal plan” ADA
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Fructose
Natural
Food
Pre WW
21977
19942000
0
10
20
30
40
50
60
Fructose Consumptiong/day per capita
Fructose
Berry AJCN 2007 88;895
Adolescent 1994 72.8 g/day
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High Fructose Corn SyrupFructose
Low glycemic indexCheaperSweeter than glucosePrevented freezer burnMixes easilyExtends shelf-lifeHelps breads brownKeeps them soft
Found in almost all processed foods especially low fat foods
55% fructose 45% glucose
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Total Sugars
Refined Sugar
HFCS
“High Fructose Corn Syrup “or “High Fructose Table Sugar”
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Fructose causes insulin resistance
Impaired cellular insulin binding and insulin sensitivity induced by high-fructose feeding in normal subjectsAm J Clin Nutr. 1980 Feb;33(2):273-8 Beck-Nielsen H
Insulin Tolerance Tests25% worse with fructose
Glucose Fructose
Fructose causes insulin resistance
6 days of high fructose dietIndication of hepatic insulin resistance
Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin Sensitivity in Healthy MenDiabetes July 2005 54; no. 7 1907-1913, Tappy L
Endo
geno
us g
luco
se p
rodu
ction
www.kidneylifescience.ca
Fructose causes insulin resistance
Glucose Fructose
Oral Glucose Tolerance Testwww.kidneylifescience.ca
Fructose causes hyperinsulinemia
Glucose Fructose
Oral Glucose Tolerance Test
www.kidneylifescience.ca
Fructose causes Insulin Resistance
Insulin Resistance!
JCI April 20, 2009 Havel et al. www.kidneylifescience.ca
Hormonal Obesity Theory
FatteningCarbohydrates
Increased Insulin level
Insulin Resistance
Fibre Obesity
High TGLow HDL
Hypertension
Diabetes
Metabolic Syndrome
Fatty Liver
High Protein
Cortisol
Vinegar
Fructose
www.kidneylifescience.ca
Fructose Overfeeding and Triglycerides
Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin Sensitivity in Healthy MenDiabetes July 2005 54; no. 7 1907-1913, Tappy L
TG increased 79%
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Sugar and Triglycerides
NHANES 1999-2006
JAMA. 2010;303(15):1490-1497 VosCaloric Sweetener Consumption and Dyslipidemia Among US Adults
Mean of 15.8% of consumed calories were added sugars
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Sugar and HDL
JAMA. 2010;303(15):1490-1497 VosCaloric Sweetener Consumption and Dyslipidemia Among US Adults
www.kidneylifescience.ca
TG LDL HDL apoB sdLDL
18.213.9
3.5
27.2
44.9
2.5 3.6
-2.4
3
13.3
Fructose Glucose
% in
crea
se
Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humansJCI April 20, 2009 Havel et al.
Fructose and Lipids
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Fructose and Blood Pressure
NHANES III 2003-2006 4,528 adults who developed hypertensionIncreased Fructose Associates with Elevated Blood PressureJ Am Soc Nephrol 21: 1543–1549, 2010 Jalal D www.kidneylifescience.ca
Reducing SSB lowers blood pressure
Reducing Consumption of Sugar-Sweetened Beverages Is Associated with Reduced Blood Pressure: A Prospective Study among U.S. AdultsCirculation. 2010 June 8; 121(22): 2398–2406 Chen L
Tertiles of reduction in sugar sweetened beverages
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Fructose and Fatty Liver
Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic De Novo Lipogenesis and Insulin Sensitivity in Healthy MenDiabetes July 2005 54; no. 7 1907-1913, Tappy L
6x increase in DNL
www.kidneylifescience.ca
“An increase in liquid carbohydrates leads, perversely, to even greater caloric consumption”
SSBs are addictive
JAMA. 2004;292(8):927-934 Schulze MB
www.kidneylifescience.ca
Hormonal Obesity Theory
FatteningCarbohydrates
Increased Insulin level
Insulin Resistance
Fibre Obesity
High TGLow HDL
Hypertension
Diabetes
Metabolic Syndrome
Fatty Liver
High Protein
Cortisol
Vinegar
Fructose
Sugar
www.kidneylifescience.ca
Broadbalk Wheat Experiment
Evidence of decreasing mineral density in wheat grain over the last 160 yearsJ Trace Elem Med Biol. 2008;22(4):315-24 Fan MS
Introduction of high yieldSemi dwarf wheat
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Up to 5% of the wheat kernel removed
70% of the germ
Whole Wheat
Contains most of vitamins, protein and fat
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Amylopectin
Amylopectin C is the least digestible (Legumes)Amylopectin B (Bananas, potatoes)Amylopectin A (Wheat)
Most digestible
Whole W
heat Bread
Banan
a
Snick
ers Bar
Kidney Bean
s0
1020304050607080
Glycemic Index
Wheat is more efficiently converted to blood sugar than nearly all other carbohydrate foods
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Exorphins
Digestion of gluten yields morphine-like compounds ‘exorphins’
Ability to cross blood brain barrier
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COMFORT FOODS
Comfort foods (affect mood) often contain wheat and other highly refined carbohydrates
Mashed Potatoes and Gravy
Ice Cream
Apple Pie
Mac and Cheese
Pancakes
Spaghetti and Meatballs
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Problems with Wheat1. Modern wheat is of lower
nutritional value2. Modern processing removes
most of vitamins, fibre and fats
3. Modern milling (as opposed to stone ground) increases speed of digestion
4. High in amylopectin A (highly digestible)
5. May be addictive “Wheat Belly”
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The China Study
“In both China Study I and II, wheat is the strongest positive predictor of body weight (r = 0.65, p<0.001) out of any diet variable”rawfoodsos.com
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Asian conundrum
FatteningCarbohydrates
Increased Insulin level
Insulin Resistance
Fibre Obesity
High TGLow HDL
Hypertension
Diabetes
Metabolic Syndrome
Fatty Liver
High Protein
Cortisol
Vinegar
Fructose
WheatSuper-carbohydrate
www.kidneylifescience.ca
How can we break the cycle?
FatteningCarbohydrates
Increased Insulin level
Insulin Resistance
Fibre Obesity
High TGLow HDL
Hypertension
Diabetes
Metabolic Syndrome
Fatty Liver
High Protein
Cortisol
Vinegar
Fructose
WheatSuper-carbohydrate
Resistance requires:1. High Level2. Persistence
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Fasting
“Our food should be our medicine. Our medicine should be our food. But to eat when you are sick is to feed your sickness." Hippocrates
www.kidneylifescience.ca
Fasting mythsPuts body in “starvation mode” Deprives body of nutrientsWeight loss from muscle/ waterCauses hypo-glycemia“Yo-yo” dietOverwhelmed with hungerIt’s “crazy”
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HUNGER DISAPPEARS“The most astonishing aspect of this study was
the ease with which prolonged starvation was tolerated.” E Drenick JAMA 1964 Jan 11; 187:100-105
“A sense of well-being was associated with the fast” JAMA. 1962;181(4):309-312 Duncan GG
Effect of an acute fast on energy compensation andfeeding behaviour in lean men and women
Int J Obesity (2002) 26, 1623 – 1628 Stubbs RJ
Increased intake from 2436 to 2914 calories on the day after a fast
Over 2 days (2436 x 2) = 4872
Fasting 2914
Net deficit 1958 calories
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382 day fast
Weight 456 to 180 lbs then remained stable Features of a successful therapeutic fast of 382 days' duration Postgrad Med J(569); Mar 1973
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Fasting reduces plasma insulin
Glucose remains in normal limits but plasma insulin decreases significantlyN Engl J Med 1974; 291:1275-1278
Plasma Insulin02468
1012
BaselineFasting
Fasting: The History, Pathophysiology and ComplicationsWest J Med 1982 Nov; 137:379-399
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Fasting reduces plasma insulin
Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolismAm J Clin Nutr 2005;81:69 –73 Heilbronn LK
Stable blood sugars
www.kidneylifescience.ca
Fasting maintains resting metabolic rate
Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism Am J Clin Nutr 2005;81:69–73 Heilbronn LK
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Fasting improves insulin sensitivity
Effect of intermittent fasting and refeeding on insulin action in healthy menJ Appl Physiol 99: 2128–2136, 2005 Halberg N
Glucose Infusionrate
Euglycemic clamp
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Fasting increases norephinphrine
Resting energy expenditure in short-term starvation is increased as a result of an increase in serum norepinephrineAm J Clin Nutr 2000;71:1511–5 Zauner C
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Fasting increases Growth Hormone
Growth Hormone:Increases availability and utilization of fats for fuelPreserves muscle mass
Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in manJ Clin Invest. 1988 April; 81(4): 968–975 Ho KY
Integrated GH concentration
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Intermittent caloric restriction is better
Randomized trial25% caloric reduction
The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers Int J Obes (Lond). 2011 May ; 35(5): 714–727 Harvie MN
www.kidneylifescience.ca
Baseline 1 month 3 months 6 months4.8
5.3
5.8
6.3
6.8
7.3
IERCER
Int J Obes (Lond). 2011 May ; 35(5): 714–727 Harvie MN
Insulin
Intermittent caloric restriction is better
www.kidneylifescience.ca
Fasting preserves lean muscle mass
Improvements in Coronary Heart Disease Risk Indicators by Alternate-Day Fasting Involve Adipose Tissue ModulationsObesity (2010) 18, 2152–2159 Varady KA
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Fasting breaks the cycle
FatteningCarbohydrates
Increased Insulin level
Insulin Resistance
Fibre Obesity
High TGLow HDL
Hypertension
Diabetes
Metabolic Syndrome
Fatty Liver
High Protein
Cortisol
Vinegar
Fructose
WheatSuper-carbohydrate Fasting
But Insulin resistance IS diabetes
www.kidneylifescience.ca
Diabetes USA
American Diabetes Association recommends diabetics eat MORE carbohydrates not less
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Fasting reduces Diabetes
The Effect of Short Periods of Caloric Restriction on Weight Loss and Glycemic Control in Type 2 Diabetes Diabetes Care. 1998 Jan;21(1):2-8 Williams KV
P<0.05
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Fasting associated with reduced Diabetes and CAD
Usefulness of Routine Periodic Fasting to Lower Risk of Coronary Artery Disease among Patients Undergoing Coronary AngiographyAm J Cardiol 2008 Oct 1; 102(7); 814-19 Horne BD
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Fasting associated with less Diabetes and CAD
Prospective cohort study
Age BMI DM CAD0
10
20
30
40
50
60
70
80
FastNon Fast
Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography Am J Cardiol. 2012 Jun 1;109(11):1558-62 Horne BD
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Diabetes is a Reversible Disease!
Changes of insulin sensitivity and beta cell function are reversibleReversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerolDiabetologia 2011 Oct;54(10):2506-14, Lim EL
Hepatic Glucose Production
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Surgical Treatment
Roux-En-Y Gastric BypassSleeve GastrectomyLaparoscopic banding
>90% cure rates for diabetes
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Surgery cures diabetes
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with DiabetesN Engl J Med 2012;366:1567-76 Schauer PR
Basically surgically enforced fasting regimenswww.kidneylifescience.ca
Fasting vs. Bariatric Surgery
Rapid Improvement of Diabetes After Gastric Bypass Surgery: Is It the Diet or Surgery?Diabetes Care. 2013 Mar 25, Lingvay Ihttp://www.ncbi.nlm.nih.gov/pubmed/23530013
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0
1
2
3
4
5
6
7
87.3
4 DietDiet + Surgery
Wei
ght L
oss
(kg)
Series11200
1250
1300
1350
1400
1450
1500
1293
1478
Dai
ly G
lyce
mia
Pre
vs P
ost
FatteningCarbohydrates
Increased Insulin level
Diabetes
High Protein
Fructose
WheatSuper-carbohydrate
Fasting
Fasting
Bariatric surgery without the surgery – Fasting!
How to Cure Type 2 Diabetes
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Can We Cure Type 2 Diabetes?
No Diabetes – no diabetic nephropathy, no diabetic foot ulcers, diabetic retinopathy, reduced stroke, MI, cancersNo Drugs, no surgery, no cost, no long term side effects6-12 month intensive fasting regime to cure diabetes
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