© 2015 Irving A. Cohen 1 Irving A. Cohen, MD, MPH, FACPM Fellow- American College of Preventive...

© 2015 Irving A. Cohen 1

Reversing Diabetesand

Beating the Obesity Epidemicthrough

Natural DietingIrving A. Cohen, MD, MPH, FACPM

• Fellow- American College of Preventive Medicine• Preventive Medicine Associates, Topeka, KS• Foundation for Prevention• Volunteer Physician and co-leader of Weight-loss Group, Marian Clinic, Topeka, KS•Author of Diabetes Recovery, Reversing Diabetes with the New Hippocratic Diet ®

[email protected]

Afternoon session


Preventive Medicine

• is a specialized field of medical practice … to promote and maintain health and well-being and prevent disease, disability and premature death.

****

Public lectures and responses to questions are general in natureand do not constitute medical care.

See your personal health care providerfor specific individual medical care and advice.


1.Understand the Obesity & Diabetes

Epidemics You must first understand what has happened to you,

then

2. Fight Back !when you are be prepared to succeed.

There are two steps to getting better


Morning SessionHow did we get into this mess?

• What are the obesity and diabetes epidemics?• Myths & Half Truths about diet, overweight & diabetes• Why is this epidemic really happening now?

Afternoon SessionHow can we reverse it?

• Losing weight. What works, what is safe?• What is a reasonable personal goal?• Special issues for diabetics • Feeling good as you diet


Many Ways People Try• Laser Slight cosmetic benefit, no health benefit• Liposuction Major cosmetic benefit, risks & complications• Rx Works while taking it, highly dangerous (Cocaine, Speed)

• OTC Non-Rx Fraudulent claims, magic potions, dangerous• Food Plans Some work in short-term, miserable experience

but high-costs keeps people on plan, return to overeating• Exercise with no diet or wrong diet Usually ineffective for loss• Gastric surgery Forces temporary diet, rapid loss, risks,

complications, costs, only 1 of 3 have long-term success• Diets Can work well if effective, but unfortunately most are

not


Many Ways People Try• Laser Slight cosmetic benefit, no health benefit• Liposuction Major cosmetic benefit, risks & complications

?


Many Ways People Try• Rx Works while taking it, highly dangerous (Cocaine, Speed)

• OTC Non-Rx Fraudulent claims, magic potions, dangerous• Food Plans Some work in short-term, miserable experience

but high-costs keeps people on plan, return to overeating


Exercise without the right diet

may increase hunger!

Many Ways People Try• Exercise with no diet or wrong diet Usually ineffective


Many Ways People Try• Gastric surgery Forces temporary diet, rapid loss, risks,

complications, costs, only 1 of 3 have long-term success


Diets can work well if effective,but unfortunately most are not !


Campbell et al., 2000; Hebl & Xu, 2001; Kristeller & Hoerr, 1997; Maiman et al., 1979; Price et al., 1987

Physicians ViewObese Patients as:• Noncompliant• Lazy• Lacking self control• Weak-willed• Unsuccessful• Unintelligent• Dishonest

© 2015 Irving A. Cohen 12Bagley et al., 1989; Hoppe & Ogden, 1997; Maroney & Golub, 1992

Nurses view obese patients as:

• Noncompliant• Overindulgent• Lazy• Unsuccessful

In one study:31% “would prefer not to care for obese patients”24% agree that obese patients “repulsed them”12% “would prefer not to touch obese patients”


Berryman et al., 2006; McArthur et al., 1997; Oberreider et al., 1995

Registered Dietitiansexpress:

• Negative attitudes• Beliefs that obesity is due to emotional

problems• Pessimism about adherence

• Dietetic students view obese patients to be:• Overeaters• Lacking self-control and willpower• Unattractive• Insecure• Slow

© 2015 Irving A. Cohen 14Davis-Coelho, Waltz, & Davis-Coelho, 2000; Hassel, Amici, Thurston, & Gorsuch, 2001

Psychologists Ascribeto obese patients:

• More pathology• More severe symptoms• More negative attributes• Worse prognosis

© 2015 Irving A. Cohen 15Bertaki & Azari, 2005; Edmunds, 2005

Reactions of Patients• Report feeling berated and disrespected by

physicians• Parents of obese children feel blamed and

dismissed


Why does this happen?1. They recommend ineffective methods2. These do not work3. They view the patient as the failure,

not the ineffective diet

4. Next step, off to surgery


?energyeaten

energyused

simple advice . . .

but just not quite right!




simple advice . . .but just not quite right,

unless you are locked in a cage!



Remove the restrictions and things are different.

In reality, diets fail when they are difficult to follow.


Dieting Diets fail when they keep you constantly

hungry and anxious.

They make you respond naturally, by eating!


…unless your body recognizes it is time to burn stored fat


• Physiologic state for optimum fat utilization• Recommended for thousands of years• Many recent attempts (Atkins, Stillman & others)

• Not all are equal• Confusion regarding the role of protein

& dangerous liquid high protein diets

• Suppress hunger• Marker for fat loss

Fat-Burning (ketogenic) diets

Arafat A, Perschel F, Otto B, Weickert M, Roschlitz H, Schofl C, Spranger J, Mohlig M, Pfeiffer A: Glucagon suppression of ghrelin secretion is exerted at hypothalamus-pituitary level. J Clinical Endocrinol Metab 2006, 91(9):3528-3533.


…this can be measured and predicted


Opposing Ideas1979, US DHEW

because 16% of adults overweight, educate the public to:

•decrease fat consumption•increase carbohydrate consumption

Health Objectives for the Nation for 1990

circa 400 bce, Hippocratic view

That is the recommended method to gain weight !

translation of Littre


To Lose1. foods glistening from sesame

(increased proportion of fat)2. do not eat bread

(primary source of carbohydrate,extracted sugar having not yet reached the region)

3. this will reduce appetite(consistent with ketosis)

4. resulting in smaller portionsTo Gain• do just the opposite

• Translation of Maximilien Paul Emile Littre (Paris, 1849) , Du régime à suivre pour pedre ou gagner de l’embonpoint in Sixieme Volume , Oeuvres Complètes D’Hippocrate

• Cohen I.A., New Hippocratic Diet™ Guide, Center for Health Information, 2008

Diet recommendations of Hippocrates


An ideal diet should:

1. Keep carbohydrate very low

2. Have enough protein to meet your needs, but not more

3. Have enough healthy fat to maintain steady fat-burning

4. Avoid chemicals designed to make you eat more


“That was me before”

All photos used with patient permission.


Setting a goal• BMI is a useful statistical and screening tool BUT• Poor tool for goal setting• Ignores age, sex and body type• In the obese or athletic, recommended BMI may be too low • It may even be below lean body mass

• Use % Body Fat• Many ways of obtaining (Caliper, BIA, DEXA)• Take into account age, sex, athleticism, weight history and

personal desire


Reversal inType 2 Diabetes

Duke diabetes study

• Low glycemic index arm had 62% of subjects reduce or eliminate diabetic medication. 15 pound (6.9 kg) weight loss in 24 weeks.

• Low carbohydrate arm had 95% of subjects reduce or eliminate diabetic medication.24 ½ pound (11.1 kg) weight loss in 24 weeks. Increased HDL (good cholesterol).

Westman, EC et al The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus,

Nutrition & Metabolism 2008, 5:36


Insulin Sensitivity Improves with Weight Loss in Patients

with Type 2 Diabetes

Insu

lin (

pmol

/L)

Before

Wing et al. Arch Intern Med 1987;147:1749.

0-2.4 2.5-6.9 7.0-14.0 >15Percentage of weight lost


Diabetics who diet should:

1. Have a doctor who understands what they plan to do.

2. Reduce or stop diabetic medication under their doctor’s supervision, as soon as they start to diet.

3. Check glucose levels regularly (4 x day is best).

4. Keep their doctor informed.5. Be consistent.


Diet can improve these:

Sudden Death

Early Death

Depression

Fatigue

Osteoarthritis

Heart Disease

Cancer

Kidney Disease

Diabetes

High Blood Pressure

Respiratory Problems

Snoring

Sleep Apnea

Asthma

Gastric Reflux

Menstrual Problems

Infertility

Sexual Problems

Premature dementia

Skin Problems

…and many moreObesity, Volume 17, Sep 2009


Morning SessionHow did we get into this mess?

• What are the obesity and diabetes epidemics?• Myths & Half Truths about diet, overweight & diabetes• Why is this epidemic really happening now?

Afternoon SessionHow can we reverse it?

• Losing weight. What works, what is safe?• What is a reasonable personal goal?• Special issues for diabetics • Feeling good as you diet


In Conclusion

• Weight-reduction has major health benefits, and reverses the effects of the obesity epidemic.

• Type 2 Diabetics, in particular, can benefit, but medications must be reduced!

• Always work with your physician or health care provider when reducing medication.

• Set goals individually.• Effective ketogenic dieting reduces hunger and improve

success.• Previous diet failures mean you learned the wrong methods,

you did not fail, your diet failed you.

Irving A. Cohen, MD, MPH, MPH

© 2015 Irving A. Cohen 1 Irving A. Cohen, MD, MPH, FACPM Fellow- American College of Preventive...

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