1. CONTROLLING CARBS AND PREVENTING DISEASE Low carb, obesity, cardiovascular disease and diabetes Jacqueline A. Eberstein, R.N.

2. Obesity Now effects all age groups Now effects all age groups Is a global epidemic Is a global epidemic Overweight is having a body mass index (BMI) between 25 and 29.9 Overweight is having a body mass index (BMI) between 25 and 29.9 Obesity is having a BMI of 30 or more. Obesity is having a BMI of 30 or more. Body Mass Index is a computation relating height with weight. It is a useful guideline but can be inaccurate for those with significant muscle mass. Body Mass Index is a computation relating height with weight. It is a useful guideline but can be inaccurate for those with significant muscle mass. To compute your BMI. Search BMI on the Internet and enter your numbers. To compute your BMI. Search BMI on the Internet and enter your numbers. Do not use adult BMI charts for ages 2 to 20. Do not use adult BMI charts for ages 2 to 20.

3. No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1990

4. No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1991

5. No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1995

6. No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1997

7. No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2000

8. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2001

9. BMI > 30, or ~ 30 lbs. overweight for 5'4" person 2004

11. Important to remember Insulin- a hormone produced in the pancreas that carries sugar from the blood into the cells to be used for energy. Insulin- a hormone produced in the pancreas that carries sugar from the blood into the cells to be used for energy. Blood sugar- the amount of glucose in the blood stream at any given time. It is higher after eating. Blood sugar- the amount of glucose in the blood stream at any given time. It is higher after eating. Insulin is a “fat storage hormone”. Insulin is a “fat storage hormone”. Glucagon- a hormone to counter the blood sugar lowering effects of insulin. In a properly functioning body insulin and glucagon are in balance. Glucagon- a hormone to counter the blood sugar lowering effects of insulin. In a properly functioning body insulin and glucagon are in balance. Insulin resistance- a consequence of heredity, excess body fat, hormone changes and even some medications that prevents our cells from using insulin to regulate blood sugar effectively. Insulin resistance- a consequence of heredity, excess body fat, hormone changes and even some medications that prevents our cells from using insulin to regulate blood sugar effectively.

12. The body attempts to keep the blood sugar within a fairly narrow range- insulin/glucagon balance. The body attempts to keep the blood sugar within a fairly narrow range- insulin/glucagon balance. Hyperinsulinism- an excess production of insulin. Hyperinsulinism- an excess production of insulin. Insulin in too large amounts over time damages the body and leads to diabetes and heart disease. High insulin levels can effect cancer cells. Insulin in too large amounts over time damages the body and leads to diabetes and heart disease. High insulin levels can effect cancer cells. Metabolic syndrome is an insulin resistance syndrome. It frequently leads to type 2 diabetes and heart disease. Metabolic syndrome is an insulin resistance syndrome. It frequently leads to type 2 diabetes and heart disease.

13. Diabetes- a nutritional wear and tear disease Stage 1-insulin resistance of cells Stage 1-insulin resistance of cells Stage 2-insulin resistance with hyperinsulinism. Stage 2-insulin resistance with hyperinsulinism. Stage 3-insulin resistance and reactive hypoglycemia or unstable blood sugar. Stage 3-insulin resistance and reactive hypoglycemia or unstable blood sugar. Stage 4-insulin resistance, hyperinsulinism with impaired glucose tolerance AKA prediabetes. Stage 4-insulin resistance, hyperinsulinism with impaired glucose tolerance AKA prediabetes. Stage 5- diabetes with high insulin resistance and hyperinsulinism. Stage 5- diabetes with high insulin resistance and hyperinsulinism. Stage 6-diabetes with low or virtually no insulin production. Burnout of the islet cells of the pancreas. Stage 6-diabetes with low or virtually no insulin production. Burnout of the islet cells of the pancreas.

14. Risk factors for diabetes Obesity Obesity Diet Diet Sedentary lifestyle Sedentary lifestyle Heredity Heredity Ethnicity Ethnicity History of gestational diabetes History of gestational diabetes Metabolic syndrome Metabolic syndrome Elevated blood sugar Elevated blood sugar Abnormal lipids Abnormal lipids High blood pressure High blood pressure Advancing age Advancing age

15. Blood sugar by the numbers Normal fasting blood sugar is generally 65 to 99mg/dL. Normal fasting blood sugar is generally 65 to 99mg/dL. Impaired fasting blood sugar or prediabetes is between 100 and 125 mg/dL. Impaired fasting blood sugar or prediabetes is between 100 and 125 mg/dL. Impaired glucose tolerance or prediabetes is a 2 hour blood sugar between 140 and 199 mg/dL. Impaired glucose tolerance or prediabetes is a 2 hour blood sugar between 140 and 199 mg/dL. Diabetes is a fasting blood sugar of 126 mg/dL or greater on 2 readings: or 2 hours after food a blood sugar reading of 200mg/dL or greater. Diabetes is a fasting blood sugar of 126 mg/dL or greater on 2 readings: or 2 hours after food a blood sugar reading of 200mg/dL or greater.

16. Effects of high insulin Increases deposition of excess body fat Increases deposition of excess body fat Increases fat in the blood in the form of triglycerides leading to heart disease. Increases fat in the blood in the form of triglycerides leading to heart disease. Promotes the manufacture of LDL cholesterol by stimulating the enzyme HMG-CoA reductase. Promotes the manufacture of LDL cholesterol by stimulating the enzyme HMG-CoA reductase. Causes an unstable blood sugar by depressing the effects of glucagon. Causes an unstable blood sugar by depressing the effects of glucagon. Increases sodium retention and water retention leading to edema and high blood pressure. Increases sodium retention and water retention leading to edema and high blood pressure. Depresses glucogen thus preventing fat burning. Depresses glucogen thus preventing fat burning. Negatively effects other hormones such as those from the adrenals and eicosanoids. Negatively effects other hormones such as those from the adrenals and eicosanoids.

17. Stimulates growth of smooth muscle cells lining arteries. Stimulates growth of smooth muscle cells lining arteries. Increases inflammatory markers leading to CHD Increases inflammatory markers leading to CHD Increases prothrombotic markers. Increases prothrombotic markers. Promotes glucose and protein to fat storage. Promotes glucose and protein to fat storage. Insulin-like growth factor may stimulate cancer cells to grow. Insulin-like growth factor may stimulate cancer cells to grow. Can increase breast cancer death rates. Can increase breast cancer death rates. PCOS/ infertility/ diabetes/ heart disease PCOS/ infertility/ diabetes/ heart disease

18. Complications of diabetes Can begin about 10 years before the diagnosis is made-if it’s made. Can begin about 10 years before the diagnosis is made-if it’s made. About 1/3 of diabetes cases are undiagnosed. About 1/3 of diabetes cases are undiagnosed. The body is damaged by glycation due to high blood sugars. The body is damaged by glycation due to high blood sugars. Complications are caused by damage to all blood vessels leading to heart disease, stroke, blindness, kidney failure, painful neuropathy, and amputations. Complications are caused by damage to all blood vessels leading to heart disease, stroke, blindness, kidney failure, painful neuropathy, and amputations. Direct and indirect costs from diabetes reached 132 billion dollars for 2002. Direct and indirect costs from diabetes reached 132 billion dollars for 2002.

19. Solution Can control all but your genetics Can control all but your genetics Control your weight. Control your weight. Rebalance your bodies’ hormones specifically insulin to regulate blood sugar. Rebalance your bodies’ hormones specifically insulin to regulate blood sugar. Dietary fat has a negligible effect on insulin. Dietary fat has a negligible effect on insulin. Protein in excess can impact insulin and glucose. Eat the right amount of protein. Protein in excess can impact insulin and glucose. Eat the right amount of protein. Carbs are the main macronutrient that stimulates insulin. Carbs are the main macronutrient that stimulates insulin. Control both the quantity and quality of carbs. Control both the quantity and quality of carbs. Exercise to improve insulin resistance. Exercise to improve insulin resistance.

20. Harvard Nurses Health Study “Our findings suggest that a high intake of rapidly digested and absorbed carbohydrate increases the risk of CHD independent of conventional coronary disease risk factors. These data add to the concern that the current low-fat, high carbohydrate diet recommended in the United States may not be the optimal for the prevention of CHD and could actually increase the risk in individuals with high degrees of insulin resistance and glucose intolerance.” “Our findings suggest that a high intake of rapidly digested and absorbed carbohydrate increases the risk of CHD independent of conventional coronary disease risk factors. These data add to the concern that the current low-fat, high carbohydrate diet recommended in the United States may not be the optimal for the prevention of CHD and could actually increase the risk in individuals with high degrees of insulin resistance and glucose intolerance.” The American Journal of Clinical Nutrition, 2000 The American Journal of Clinical Nutrition, 2000

21. The Controlled Carb Advantage Physical improvements: Physical improvements: Improved lean body mass to fat mass ratio. Improved lean body mass to fat mass ratio. Increased exercise capacity. Increased exercise capacity. Maintain weight loss w/o negative side effects. Maintain weight loss w/o negative side effects. Prevents/ corrects hyperinsulin-related conditions: Prevents/ corrects hyperinsulin-related conditions: Diabetes Diabetes Hypertension Hypertension Cardiac risk factors ( high triglycerides, low HDL, small dense LDL particles) Cardiac risk factors ( high triglycerides, low HDL, small dense LDL particles)

22. ADA diet vs. controlling carbs in People with Diabetes “ High carbohydrate intake is generally recommended, resulting in suboptimal glycemic control and lipoprotein profile, gradually increasing insulin and/or oral hypoglycemic medication requirement and weight gain. On the other hand, restriction of dietary carbohydrate is associated with improvement in glycemic control and other parameters of insulin resistance including body mass and lipid profiles.” “ High carbohydrate intake is generally recommended, resulting in suboptimal glycemic control and lipoprotein profile, gradually increasing insulin and/or oral hypoglycemic medication requirement and weight gain. On the other hand, restriction of dietary carbohydrate is associated with improvement in glycemic control and other parameters of insulin resistance including body mass and lipid profiles.” “…data demonstrates that the benefits of a low carbohydrate diet on glycemic control are independent of weight loss and are primarily due to carbohydrate restriction.” “…data demonstrates that the benefits of a low carbohydrate diet on glycemic control are independent of weight loss and are primarily due to carbohydrate restriction.”

23. “Emerging evidence suggests that low carb diets may actually have beneficial effects on LDL cholesterol by decreasing LDL particle concentration and increasing LDL size to less atherogenic forms.” “Emerging evidence suggests that low carb diets may actually have beneficial effects on LDL cholesterol by decreasing LDL particle concentration and increasing LDL size to less atherogenic forms.” “A final irony is the report that physicians frequently choose low carb diets for themselves while recommending low fat for their patients.” “A final irony is the report that physicians frequently choose low carb diets for themselves while recommending low fat for their patients.” The Case for low carbohydrate diets in diabetes management, Dr., Samy McFarlane, Nutrition and Metabolism, 2005. The Case for low carbohydrate diets in diabetes management, Dr., Samy McFarlane, Nutrition and Metabolism, 2005.

24. Is a 60% carb, low fat diet working? A review of patients by the ADA published in JAMA, January 2004 stated that only 30% of people with diabetes were reaching treatment goals for blood sugar, blood pressure and cholesterol. This despite the use of a number of prescription medications. A review of patients by the ADA published in JAMA, January 2004 stated that only 30% of people with diabetes were reaching treatment goals for blood sugar, blood pressure and cholesterol. This despite the use of a number of prescription medications.

25. Research supports safety and efficacy of controlling carbs There have been more than 60 published studies and papers focusing on the benefits of a controlled carb lifestyle. There have been more than 60 published studies and papers focusing on the benefits of a controlled carb lifestyle. Effective in weight loss and maintenance, seizures, PCOS, metabolic syndrome, diabetes, GERD, lowering triglycerides, increasing HDL, improving particle size of LDL, decreasing inflammation markers (CRP), increasing insulin sensitivity and other symptoms. Effective in weight loss and maintenance, seizures, PCOS, metabolic syndrome, diabetes, GERD, lowering triglycerides, increasing HDL, improving particle size of LDL, decreasing inflammation markers (CRP), increasing insulin sensitivity and other symptoms. Studies done by Duke, Harvard, University of Pa., University of Conn., The American Heart Association, American Diabetes Association among others. Studies done by Duke, Harvard, University of Pa., University of Conn., The American Heart Association, American Diabetes Association among others.