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Group of slides related to metabolic health, low carbohydrate diets, low carbon diets, the "sustainable diet" and epidemiologic trends shaping the health of our nation.
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  • 1. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised Low Carbon, Low Carbohydrate Ted Eytan, MD, MS, MPH • @tedeytan 05.13.18 Photo: Half-way to 2 degrees centigrade: warmest December in Washington history Washington, DC USA, 2015 • Ted Eytan, MD• https://flic.kr/p/BGnw1x
  • 2. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Ted Eytan, MD MS MPH Family Physician Washington, DC @tedeytan Health, DC, !,🥛3/4 full 05.27.18 “Bouncing a Ball Alone: Grokking Failure” Detroit, November, 2012 https://youtu.be/y54qTlY4N38
  • 3. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised 10.29.18 My Story 2016 2018 Normoglycemic • Normotensive • Formerly Fat • Eating a Low Carbohydrate, Healthy Fat Diet
  • 4. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Disclaimers/Disclosures • Information provided here should not be considered medical advice; individuals should consult their personal physician regarding their specific health situation • The views presented are strictly mine and should not be attributed to any organization • I do not have any financial interest or ties to, and have not received any honoraria from, pharmaceutical, diagnostics, food, or device manufacturers • No endorsement of third party products or services should be implied 03.28.19 (Probably not) New York State Journal of Medicine : Medical Society of the State of New York (1807- ) : Internet Archive https://archive.org/details/ newyorkstatejour5719medi via @internetarchive No known copyright restrictions
  • 5. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan No Dollars For This Doc 10.29.18 https://openpaymentsdata.cms.gov Where’s Ted? He’s not here ✌
  • 6. Ted Eytan, MD, MS, MPH @tedeytan revisedThis slide contains copyrighted material that may only be shared with appropriate rights assignment 05.27.18 What Happened? “Most people became heavier at about the same time. …We believe it is implausible that each age, sex and ethnic group, with massive differences in life experience and attitudes, had a simultaneous decline in willpower related to healthy nutrition or exercise." Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US obesity epidemic. Lancet Public Heal [Internet]. 2018 Mar; Available from: http://linkinghub.elsevier.com/ retrieve/pii/S2468266718300215 “Well kept refrigerator for the man- about-town.” - Date Created/ Published: 1965 June (date added to Look's library) - http:// www.loc.gov/pictures/collection/ lmc/item/2016717351/
  • 7. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Projected U.S. Adult Population with Diabetes 10.24.2018 Millionsof People 0 10 20 30 PercentofU.S. Population 0 1.5 3 4.5 6 7.5 1958 1970 1982 1994 2006 Percentage with Diabetes Number with Diabetes Source: CDC’s Division of Diabetes Translation. United States Diabetes Surveillance System available at http://www.cdc.gov/diabetes/data Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr [Internet]. BioMed Central; 2010 Oct 22 [cited 2018 May 27];8:29. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/20969750
  • 8. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Rising Insulin Resistance 05.29.18 CHANGE IN HAVING HIGH FASTING PLASMA GLUCOSE UNITED STATES, 1990-2016%7 6 WASHINGTON, DC 41.1% INCREASE Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA [Internet]. 2018;319(14):1444–72. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.0158
  • 9. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan With Little Awareness 05.28.18 PREDIABETES & KNOW THEY HAVE IT, UNITED STATES Bullard KM, Cowie CC, Lessem SE, Saydah SH, Menke A, Geiss LS, et al. Prevalence of Diagnosed Diabetes in Adults by Diabetes Type — United States, 2016. MMWR Morb Mortal Wkly Rep [Internet]. 2018 Mar 30 [cited 2018 Mar 30];67(12):359–61. Available from: http://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm? 12% 33% PREDIABETES, US, 2016 1.67 MILLION PEOPLE IN DC/MD/ VA HAVE PREDIABETES OR UNDIAGNOSED DIABETES Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag [Internet]. Mary Ann Liebert, Inc.; 2017 [cited 2018 May 27];20(1):6–12. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/27124621 (Pharma funded study)
  • 10. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan With Little Awareness 05.28.18 1.67 MILLION PEOPLE IN DC/ MD/VA HAVE PREDIABETES OR UNDIAGNOSED DIABETES Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag [Internet]. Mary Ann Liebert, Inc.; 2017 [cited 2018 May 27];20(1):6–12. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/27124621 (Pharma funded study)
  • 11. Ted Eytan, MD, MS, MPH @tedeytan revisedThis slide contains copyrighted material that may only be shared with appropriate rights assignment 08.27.18 From: The Carbohydrate-Insulin Model of Obesity Beyond “Calories In, Calories Out” JAMA Intern Med. 2018;178(8):1098-1103. doi:10.1001/jamainternmed.2018.2933 Explanatory Models of Obesity A, Conventional model. B, Carbohydrate-insulin model. Dietary Recommendations Carbohydrate-Insulin Model • Reduce refined grains, potato products, and added sugars—high-glycemic load (GL) carbohydrates with low overall nutritional quality • Emphasize low-GL carbohydrates, including nonstarchy vegetables, legumes, and nontropical whole fruitsa • When consuming grain products, choose whole kernel or traditionally processed alternatives (eg, whole barley, quinoa, traditionally fermented sourdough made from stone ground flourb) • Increase nuts, seeds, avocado, olive oil, and other healthful high-fat foods • Maintain an adequate, but not high, intake of protein, including from plant sourcesc • For individuals with severe insulin resistance, metabolic syndrome, or type 2 diabetes, restriction of total carbohydrate intake, and replacement with dietary fat, may provide greatest benefit45 Dietary Recommendations
  • 12. revisedTed Eytan, MD, MS, MPH @tedeytan This slide contains copyrighted material that may only be shared with appropriate rights assignment March 2016 www.publichealthadvocacy.org www.healthpolicy.ucla.edu A Generation in Jeopardy PREDIABETES WHAT WHY HOW WHO fact MORE THAN HALF 1 OUT OF 3 YOUNG ADULTS HIGHER AMONG ADULTS OF COLOR KEY FINDINGS VARY SIGNIFICANTLY 3 Insulin Resistance: 55% of Californians Babey SH, Wolstein J, Diamant AL, Goldstein H. Prediabetes in California: Nearly Half of California Adults on Path to Diabetes [Internet]. 2016. Available from: http:// healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1472,UCLA Center for Health Policy Research, Copyright © 2006 The Regents of the University of California. All Rights Reserved. 05.16.18
  • 13. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised 05.28.18 Public event on drug pricing, May, 2018 Photographs by Ted Eytan, MD https://twitter.com/tedeytan/status/992017143473623040 https://beyondtype1.org/the-10-most-expensive-liquids- in-the-world/ Raise Your Insulin Resistance
  • 14. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised 07.25.18 Photographs by Ted Eytan, MD, 2018 Topic: Clinician Well-Being Topic: Healthy Environment Topic: Drug Pricing Raise Your Insulin Resistance The Health Professional Meetings meals are processed, insulinogenic, plant-based (in this case)
  • 15. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised 07.25.18 Don’t Raise Your Insulin Resistance The Citizen Science Meetings (Health Professionals included) “a celebration of life for those who value the continuous benefits of nutritional ketosis” Photographs by Ted Eytan, MD, 2017, 2018 “dietary education and support” no food served meals are not-processed, not-insulinogenic, plant-based and plant-free
  • 16. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised 05.13.18 Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019. Available from: https://doi.org/10.2337/dci18-0019 - Used under license for Non- commercial re-use, Version 1.0 http://www.startribune.com/son-s-death- pushes-mom-into-drug-price-spotlight/ 482344871/ https://www.flickr.com/photos/taedc/ 36128835431/ Photograph by Ted Eytan, MD - 07.30.2017 Cost of Insulin
  • 17. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised Non-Alcoholic Fatty Liver Disease 24 % of the North America Population 05.27.18 Figure © European Union, 2017: CORDIS, http://cordis.europa.eu/; Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology [Internet]. 2016 Jul 1 [cited 2017 Aug 7]; 64(1):73–84. Available from: http://doi.wiley.com/10.1002/hep.28431
  • 18. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ Ted Eytan, MD, MS, MPH @tedeytan revised Continuous Glucose Monitoring Gives New Insights “There are some foods that result in elevated glucose in the majority of adults. A standardized meal of cornflakes and milk caused glucose elevation in the prediabetic range (>140 mg/dl) in 80% of individuals in our study. It is plausible that these commonly eaten foods might be adverse for the health of the majority of adults in the world population.” 08.06.18 Hall H, Perelman D, Breschi A, Limcaoco P, Kellogg R, McLaughlin T, et al. Glucotypes reveal new patterns of glucose dysregulation. 2018; Available from: https://doi.org/ 10.1371/journal.pbio.2005143 39g net CHO 42g net CHO 50g net CHO
  • 19. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan What is a Sustainable Diet? 08.06.18 Photographs by Ted Eytan, MD, 2018 Foreground: Pharmaceuticals Background: Meat
  • 20. revisedTed Eytan, MD, MS, MPH @tedeytan This slide contains copyrighted material that may only be shared with appropriate rights assignment 05.28.18 The Vehicle is the Problem https:// www.theguardian.com/ science/2018/feb/02/ultra- processed-products-now- half-of-all-uk-family-food- purchases
  • 21. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Benefits of Real Food Ultra-processed diets cause excess calorie intake and weight gain 03.05.19 Source: Hall KD. Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake. NutriXiv; [cited 2019 Mar 4]; Available from: https://osf.io/preprints/nutrixiv/w3zh2 - images used with CC0 1.0 Universal license Ultra-processed Un-processed Weight UP 0.8 kg Weight DOWN 1.1 kg 508 kcal/day greater intake decreased insulin resistance (HOMA-IR) No differences in familiarity, pleasantness, sense of hunger, satisfaction, capacity to eat
  • 22. Ted Eytan, MD, MS, MPH @tedeytan revisedThis slide contains copyrighted material that may only be shared with appropriate rights assignment 05.28.18 Strange Behavior Photos by Ted Eytan, MD Washington, DC Feb 4, 2018 https://www.flickr.com/ photos/taedc/albums/ 72157693049063025 http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Heart-CheckMarkCertification/Heart-Check-Mark- Certification_UCM_001179_SubHomePage.jsp#; http://www.icantbelieveitsnotbutter.com/campaigns/whats-new/images/its-vegan-large.png
  • 23. revisedTed Eytan, MD, MS, MPH @tedeytan This slide contains copyrighted material that may only be shared with appropriate rights assignment Behavior, A little Less Strange in 2019 03.31.19 American Diabetes Association “For people with type 2 diabetes or prediabetes, low- carbohydrate eating plans show potential to improve glycemia and lipid outcomes for up to 1 year” (62–64,86–89) American Diabetes Association. 5. Lifestyle management: Standards of Medical Care in Diabetes- 2019. Diabetes Care 2019;42(Suppl. 1):S46–S60 Used under license: http://www.diabetesjournals .org/content/license Saslow, et.al Hallberg, et. al 62. Saslow LR, Daubenmier JJ, Moskowitz JT, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low- carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes 2017;7:304 63. Hallberg SJ, McKenzie AL, Williams PT, et al. Effectivenessand safety ofa novel caremodel for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes disclosures 😉 Also • Relaxation of sodium restriction • Relaxation of fat restriction
  • 24. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Choose Diabetes Reversal Over Progression 04.08.19 (A) plays in the overall success is important. In cases of spontaneous energy intake reduction the specific mechanism behind this reduction would help in the overall personaliz approach. (A) • Bariatric Surgery • Most effective • Costly, potential complications • Low Calorie Diet (LCD) • Adherence a challenge • Potential long term unfavorable metabolic changes • Low Carbohydrate Diet (LC) • Good adherence at 2 years • Weight loss without caloric restriction • Follow-up so far limited to 2 years Source: Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ, Hallberg SJ, Gershuni VM, et al. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients [Internet]. 2019 Apr 1 [cited 2019 Apr 2];11(4):766. Available from: https://www.mdpi.com/2072-6643/11/4/766
  • 25. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Adventures in CGM 09.08.18 last meal with sensor Glycemic Index = 0 Overall glucose trend photographbyTedEytan,MD
  • 26. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Adventures in CGM Mealtime Patterns on a Low-Carbohydrate, Healthy Fat Diet 10.12.18 CGM Results 🥚🥓 🐟🥗 🥩🍗🥑
  • 27. revisedTed Eytan, MD, MS, MPH @tedeytan This slide contains copyrighted material that may only be shared with appropriate rights assignment Diabetes Reversal Education Tale of Two Specialty Societies 03.07.19 Sources: http://elearning.rcgp.org.uk ; http://www.theabfm.org , Royal College of General Practitioners - American Board of Family Medicine 😀 😢
  • 28. revisedTed Eytan, MD, MS, MPH @tedeytan This slide contains copyrighted material that may only be shared with appropriate rights assignment Risks of Vegan Diets The current scientific evidence is too low to conclude that vegan diets are generally healthy diets, in particular concerning their long-term impact on the risk of several diseases and all- cause mortality. These diets can therefore not be recommended, in a disease prevention optic. When people choose a vegan diet, their motivations are in general very strong, however these are not necessarily health-based convictions. 08.27.18 Source: Federal Commission for Nutrition. Vegan diets: review of nutritional benefits and risks. Expert report of the FCN [Internet]. 2018. Available from: https://www.eek.admin.ch/eek/de/home/pub/ernaehrungsbezogene-und- gesundheitliche-vor--und-nachteile-einer.html
  • 29. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Metabolic Advantages of a Low Carbohydrate Diet Total energy expenditure changes: people on lower carbohydrate diets were able to eat more food and keep their weight stable following weight loss 11.20.18 Source: Ebbeling CB, Feldman HA, Klein GL, Wong JMW, Bielak L, Steltz SK, et al. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ [Internet]. 2018;363:4583. Available from: http://dx.doi.org/10.1136/bmj.k4583 Used under - CC BY-NC-SA license.
  • 30. This slide is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ revisedTed Eytan, MD, MS, MPH @tedeytan Cholesterol Changes on an LCHF Diet Study comparing fat-adapted and carbohydrate-adapted ultra-endurance athletes 11.12.18 Lipoproteininsulin resistanceindex 10 20 30 40 50 High Carbohydrate Low Carbohydrate 5.8 26.7 TG/HDL-CRatio 0.625 1.25 1.875 2.5 High Carbohydrate Low Carbohydrate 0.67 1.15 LDL-C 62.5 125 187.5 250 High Carbohydrate Low Carbohydrate 161 mg/dl 88 mg/dl HDL-C 37.5 75 112.5 150 High Carbohydrate Low Carbohydrate 102 mg/dl 64 mg/dl Triglycerides 37.5 75 112.5 150 High Carbohydrate Low Carbohydrate 63 mg/dl 70 mg/dl TotalCholesterol 100 200 300 400 High Carbohydrate Low Carbohydrate 278 mg/dl 169 mg/dl favors high carbohydrate favors low carbohydrate Individual lipid measures for high-carbohydrate (n=10) and low-carbohydrate (n=10) ultra-endurance athletes. Bars represent mean±1SD. HDL-C, high-density lipoprotein- cholesterol; LDL-C, low-density lipoprotein-cholesterol. TC, total cholesterol; TG, triglyceride. Source: Creighton BC, Hyde PN, Maresh CM, Kraemer WJ, Phinney SD, Volek JS. Paradox of hypercholesterolaemia in highly trained, keto-adapted athletes. BMJ Open Sport Exerc Med [Internet]. 2018 Oct 4;4(1):e000429. Available from: http://bmjopensem.bmj.com/lookup/doi/10.1136/bmjsem-2018-000429
  • 31. This slide is licensed under a Creative Commons Attribution 4.0 Internatio
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