iThrive Wellness Summit 2020

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iThrive

Hana Kahleova

Diabetes and Beta-Cell Regeneration

Our topic today is diabetes and beta cell regeneration.

The United States is the highest healthcare spender in the world, spending more than 50% more than France or Japan or Sweden, the second and the third healthcare spenders in the world on healthcare.

But does all the money spent on health care also translate into better health outcomes?

What about diabetes prevalence, for example?

It turns out that diabetes prevalence is 2 times higher compared to Sweden.

So maybe we have more cases of diabetes, but maybe we treat them better and they don't develop as many complications.

What about, for example, lower extremity amputations as a result of diabetes?

It turns out that the amputations are 5 times higher in the United States compared with Sweden.

Do we have better outcomes in the United States?

We have more cases of cardiovascular death, 3 times more compared with Japan or France.

Because all the money in the world cannot compensate for the poor diet and the poor lifestyle in the United States.

3 out of 4 men and 2 out of 3 women in the United States are overweight or obese.

Is there anything we can do with a plant-based diet?

The Adventist Health Study 2 has clearly demonstrated a linear relationship between the amount of animal products and the risk of type 2 diabetes and also body mass index.

So The body mass index is the lowest in vegans and is the highest in non-vegetarians with lacto-vegetarians and pesco-vegetarians and semi-vegetarians in between.

And The same for diabetes prevalence, which is the lowest in vegans.

Barnard has shown that when we put people on a plant-based diet who are overweight or obese, they are losing about 1 pound a week.

And in 14 weeks, they lost 13 pounds on average and also 2 inches around their waistline, which makes jean chopping more enjoyable.

Why is it that plant-based diets work for weight loss even compared with calorie matched hypoenergetic diets?

We know that fruits and vegetables have a low energy density compared with more concentrated products like cheese and meat and compared to oil, which is a concentrated source of energy.

So we can eat more bulk, more volume of fruits and vegetables and legumes and whole grains compared with other more concentrated sources to get full.

And fiber works in different parts of the gastrointestinal tract to promote satiety and promote regulation.

We know that gut microbiome is crucial for the balance and for the weight regulation also.

There's a gut blood barrier and we know that a high-fat diet disrupts this barrier and that's the so-called leaky gut.

However, the tight junctions in the gut are important for our health and for the prevention of lipopolysaccharides and endotoxins being released into our bloodstream.

We know that gut microbiome diversity, the portfolio of the gut bacteria we have, how many kinds of bacteria live in our gut is to a large degree determined by where we live in the world.

For example, people in Africa have a more diverse microbiome compared to people living in Europe or in the United States.

But it's mainly the plant-based diet that promotes the diversity.

And it has been shown that gut microbiome diversity is also associated with lower arterial stiffness.

So if you have more kinds of bacteria living in your gut, then your arterial will be less stiff and it can explain about 8% of your arterial stiffness.

But it's not only about how many kinds of bacteria live in your gut, it's also about the composition, about the ratio between bacterioidetes and Firmicutes.

And there's a fascinating study comparing children living in rural Africa in Burkina Faso and children living in Italy.

And the study has shown that children living in Burkina Faso had much more bacteroidetes and pre-Botella compared with children in Europe who had more Firmicutes.

And this bacteroidetes-Firmicutes ratio can explain about 22% of your cardiorespiratory fitness.

So even before you step on a treadmill, we can predict 22% of your performance that day.

That means feed your microbiota well with prebiotics.

Not only with probiotics that are in fermented foods like in tempeh and sauerkraut, but also with prebiotics.

Prebiotics are the oligosaccharides that feed the good bacteria in our gut to produce more short-chain fatty acids.

And these prebiotics are mainly contained in all plant foods, but mainly the highest concentrations are in garlic, in onions, and in whole grains.

The gut is not only important because so many gut bacteria live there, but also for the incretin secretion.

Incretins are hormones that are being secreted in response to meal intake.

They promote satiety, they decrease the liver glucose output, they promote insulin secretion, and They also stimulate insulin secretion or regulate gastric emptying and decrease glucagon.

The incretin effect, which is the difference in insulin secretion after an IV infusion of glucose compared with the same amount of glucose ingested orally, the incretin effect is diminished in people with type 2 diabetes.

And therefore people with type 2 diabetes have higher concentrations of plasma glucose after a meal, and their insulin secretion is delayed and also dampened, depressed, while glucagon secretion is higher in people with diabetes.

And there's a two-way street between diabetes and diminished incurting effect.

First of all, people with diabetes already have a diminished incurting effect and this can be further diminished.

But also a diminished incurred in effect may eventually lead to the development of diabetes.

It has been shown that dietary fat impairs incurred in signaling in beta cells.

So particularly the saturated fat found in meat and dairy and cheese is disruptive to incretin signaling in beta cells.

With this in mind, what can we achieve with a diet?

And that's exactly a question that we asked with my former PhD student, Lenka Belinova.

And we were asking, can a plant-based diet be the magic for increting secretion for people with type 2 diabetes?

To answer this question, we invited 15 patients with type 2 diabetes into our lab early in the morning, and in a random order, they consumed either a vegan sandwich or a meat sandwich with the same amount of calories and with the same macronutrient composition.

And we found out that the incretin secretion was really flattened and diminished after the meat sandwich.

But we saw a nice peak in response to the vegan sandwich.

And the effect was pretty comparable to cytogliptin, Genuvia, which is a drug that has been specifically developed to treat this condition.

So for patients with diabetes who are on cytogliptin, switching over to a plant-based diet would give them the same effect.

In other words, a plant-based, 1 single plant-based meal worked as a magic for increase in secretion.

Now can a plant-based diet boost your metabolism?

It has been shown that brown fat is not only present in newborns, but it's also present in adults, around our spine, around our neck.

And this brown fat has a completely different function than white fat.

In your white fat on your belly you will just store the extra energy in the form of fat.

But your brown fat can actually release the extra energy in the form of heat due to uncoupling proteins.

And we know that brown fat is very rich in mitochondria because it's very metabolically active and due to uncoupling proteins it can release the extra energy in the form of heat.

Wouldn't that be wonderful to eat as much as you want and burn the extra energy in the form of heat?

Well, are there any foods that can activate your brown fat to burn the extra energy in the form of heat?

It turns out, yes, hot peppers and jalapeno peppers, which not everyone can tolerate.

You know, some people are more sensitive and their gastrointestinal tract might be irritated if they ate a lot of those.

So it's good news that it's L-arginine, which is an amino acid found in soy foods, beans, nuts, and seeds.

So in a variety of plant-based foods that also activates the brown fat.

Turning up the heat has been suggested as 1 of the strategies to combat the obesity and diabetes epidemic.

When we eat a meal, we increase the energy expenditure, which is called the thermic effect of food.

And that's, we know it from our own experience.

When it's cold, when it's winter, and you want to warm up, you eat something and then you feel warmer.

That's because you release some energy in the form of heat when you eat a meal.

That's called the thermic effect of food.

And it turns out that if you eat different foods, the thermic effect of food will be different.

For example, in this study, when the participants were eating a processed white bread sandwich, the thermic effect of food was lower compared with a whole grain sandwich.

Barnard was the first 1 to show in 2005 that when people start eating a low-fat vegan diet, their Thermic effect of food goes up by 16%, which may seem fairly small, but please realize that this happens after each meal, and over the course of years and decades, this can have significant effects on their body weight.

When we are supposed to point out 1 single food that's responsible for diabetes epidemic.

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Diabetes and Beta-Cell Regeneration

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