DIABETES REVERSAL by diet & execise final.PPT

diabetes reversal

1. Reversal of Type 2 Diabetes
NTPC HOSPITAL KORBA
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2. WHO Definition of Health
“Health is a state of
complete physical,
mental and social well-
being and not merely the
absence of disease or
infirmity”.
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3. Type 2 Diabetes reversal
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4. Global Economic Burden of Diabetes in
Adults: Projections From 2015 to 2030
•The global economic burden will increase
from U.S. $1.3 trillion in 2015 to $2.1 trillion
by 2030.
•Share of global GDP from 1.8% in 2015 to
2.2% in 2030.
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5. Indian perspectives
Ramachandran et al (2016) analyzed the urban-
rural expenditure on diabetes in Indian patients.
Total median expenditure on health care was Rs
10,000 ($227) in urban and Rs 6,260 ($142) in
rural subjects. Treatment costs increased with
duration of diabetes, presence of complications,
hospitalization, surgery, insulin therapy and
urban setting.
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6. Lifestyle diseases are common
Result of PME in all NTPC PROJECTS:
60% employees >= 40 yrs are suffering from
lifestyle disease like hypertension, diabetes,
ischemic heart disease and metabolic
syndrome.
Why is it so?..
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7. NTPC perspective
Average cost of diabetes treatment per
month= Rs 3000/-per patient
Average cost for 400 patients (estimated no
of employees and dependents with T2DM at
Korba):
Rs 1,200,000/-(Twelve lakhs) per month
Rs 1.50 crore per year.
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8. Diabetes evolution
Primitive man Homo sapiens Homo diabeticusMillions of years Few years

9. 9

10. Life style diseases can be prevented
by life style changes
Medication
should be
the last
resort.
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11. SHOW RIGHT DIRECTION
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12. Reversing Type 2 Diabetes: Global evidence
1.Sarah J Hallberg, Victoria M Gershuni, Tamara L Hazbun, and
ShaminieJ Athinarayanan. Reversing Type 2 Diabetes: A Narrative
Review of the Evidence. Nutrients. 2019 Apr; 11(4): 766.
Results: Evidence exists that T2D reversal is achievable using bariatric
surgery, low-calorie diets (LCD), or carbohydrate restriction (LC).
2.Diabetes Remission Clinical Trial (DiRECT)-the 2nd year results of
DiRECTtrial were presented on 6th March 2019.
Results: 36% had sustained remission at 24 months. HbA1c significantly
reduced(<6.5), 50% reduction in use of diabetes medications. (Mainly
through dietary interventions and weight loss maintenance)
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13. Reversing Type 2 Diabetes: Global evidence
3.Furmli S, Elmasry R, Ramos M, Fung J. Therapeutic use of
intermittent fasting for people with type 2 diabetes as an
alternative to insulin.BMJ Case Rep. 2018;2018. pii: bcr-2017-
221854.
4.Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D.
The effects of a Mediterranean diet on the need for diabetes
drugs and remission of newly diagnosed type 2 diabetes: follow-
up of a randomized trial. Diabetes Care. 2014;37:1824-1830.
5.Hall KD, Chung ST. Low-carbohydrate diets for the treatment of
obesity and type 2 diabetes. Curr Opin Clin Nutr Metab Care.
2018;21:308-312.
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14. Reversing Type 2 Diabetes: Global evidence
All the above studies suggest that
T2D reversal is achievable using
dietary interventions, exercise and
weight loss maintenance
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15. Diabetes epidemiology
•Globally-108 million cases in 1990 to 422
million in 2018.
•Global prevalence among adults >18 years of
age-4.7% in 1990 to 8.5% in 2018.
•India-72,946,400 cases of diabetes in 2018
or 8.7% diabetic population in the age group
of 20 and 70 years.
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16. Diabetes predictions
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17. Bill Gates rightly said
Treatment without
prevention is
simply
unsustainable
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18. Prevalenceof DM >40 Years
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19. DIABETES MELLITUS
<40 Years vs>40 Years
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20. DIABETES MELLITUS
(Last 05 year data)
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21. Fatty Liver on USG Abdomen
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22. HbA1c
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23. Understanding Diabetes
Diabetes is a disease in which the body cells
cannot utilize glucose for energy release.
Cause??
Relative or absolute lack of insulin
Result
High blood sugar and related complications
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24. Understanding Diabetes
Complex disease
Digestion breaks down
carbohydrates sugar
(glucose)
Sugar bloodstream
Insulin moves sugar
into cells for energy
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25. Body Function Without Diabetes
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26. Type 1 vs. Type 2 Diabetes
No insulin (key) means that sugar
cannot enter the cell.
Insulin (key) cannot unlock the cell
door. Insulin resistance or inability of
body to use insulin.
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27. Diagnostic criteria for Diabetes
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29. Fallacies of treatment
Present treatment focuses on symptom of
disease i.e. an elevated blood glucose
concentration.
Root cause-insulin resistance
Initial treatment of insulin resistance-
•limit carbohydrate intake,
•regular exercise
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30. Fatty liver is precursor of type 2
diabetes
In a genetically predisposed person stress and
unrestricted carbohydrate diet increase cortisol
secretion, this causes hyperglycemia and
hyperinsulinemia.
Hyperinsulinemia converts glucose to fat and
this causes fatty liver and insulin resistance
resulting in type 2 diabetes.
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31. How this insulin resistance can be
reversed ?
•By avoiding STRESS
•Changing the dietary habits: taking whole
grains, plant-based food and
•doing controlled exercise.
If we take low glycaemic index food in our
diet, we can control our blood sugar and
HBA1c level by diet alone.
If we can reverse insulin resistance and fatty
liver, diabetes can be reversed in early stage.
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32. Advantages of reversing diabetes
1.Freedom from medication and repeated
visit to lab
2.Blood glucose value begins to fall
within days and weeks.
3.Prevention of complications.
4.Less financial burden
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33. How much time it takes for
reversal?
Depending on age of patient, duration of
illness, level of sugar control and
number of medications this could take
anywhere between few days to a year in
most cases
One can see the evidence through
relevant laboratory tests
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34. Total diabetes reversal programme
70%-dietary interventions
30%-exercise, nutrition, mind
detoxification, support from peers.
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35. Change food
habits
Exercise
Follow the diet
chart for three
weeks and
continue further
Change your habit
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36. Your diet controls your destiny
It requires a strong determination to
change habits and there is nothing a person
can not achieve with will power and strong
determination.
Keep a daily diary–it is an effective tool
to check your progress and achieve your
goal
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38. Lifestyle & Dietary interventions at KSTPS
•40-45 diabetics were advised lifestyle & dietary
modifications (low glycaemic index raw/semi boiled food).
•Parameters observed-
•Blood sugar & HbA1c
•Number of drugs
•Result-
•Around 50% showed reduction in Blood sugar and HbA1c
•Euglycemiamaintained with fewer or no drugs.
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39. 39

40. Plant protein
•Plant protein
improves insulin
sensitivity
•Animal protein
decreases insulin
sensitivity
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41. Plant vs Animal Protein-Evidence
1.A plant-based diet in overweight individuals in a 16-week randomized
clinical trial: metabolic benefits of plant protein. Nutrition & Diabetes
volume8, Articlenumber:58 (2018)
Result-Plant protein, as a part of a plant-based diet, is associated with
improvements in body composition and reductions in both body weight and
insulin resistance.
2.Association between dietary protein intake and type 2 diabetes varies by
dietary pattern. Diabetol Metab Syndr. 2018; 10: 48.
Result-All participants were divided into three patterns according to the
dietary source of protein (legumes and seafood; red meat; refined grains).
Overall, plant protein intake was significantly and inversely associated with
T2DM. 41

42. Plant vs Animal Protein-Evidence
3.Plant versus animal based diets and insulin resistance, prediabetes and type 2
diabetes: the Rotterdam Study. EurJ Epidemiol.2018; 33(9): 883–893.
Result-a more plant-based and less animal-based diet may lower
risk of insulin resistance, prediabetes and T2D.
4.Dietary proteins and protein sources and risk of death: the Kuopio Ischaemic
Heart Disease Risk Factor Study. The American Journal of Clinical Nutrition,
2019.
Result-Men who favouredanimal protein over plant-based
protein in their diet had a greater risk of death in a 20-year
follow-up.
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43. Inference
All the above studies indicate that if
the protein is consumed from a plant
source that too in its natural state
then it helps in insulin sensitivity
and reduces the risk of type 2
diabetes.
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44. Animal food or dairy product
•Say no to white sugar, maida and food of
animal origin.
•Limit the use of ghee, ice cream, butter and
other milk products.
•Take nut milk or coconut water.
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46. Raw food
•Overcooked food is directly proportional
to the risk of developing diabetes.
•Eat natural raw food-fruits, vegetables,
sprouts and nuts.
•No processed food or packed food.
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47. 47

48. Glycaemic index
The Glycemic Index (GI) is a
relative ranking of carbohydrate in
foods according to how they affect
blood glucose levels.
Carbohydrates with a low GI value
(55 or less) are more slowly
digested, absorbed and metabolised
and cause a lower and slower rise in
blood glucose and, therefore usually,
insulin levels.
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50. Glycaemic index-evidence from trials
1.The Effect of Dietary GlycaemicIndex on Glycaemia
in Patients with Type 2 Diabetes: A Systematic
Review and Meta-Analysis of Randomized
Controlled Trials. Nutrients. 2018 Mar; 10(3): 373.
Result-The low-GI diet is more effective in
controlling glycated haemoglobinand fasting blood
glucose compared with a higher-GI diet or control in
patients with type 2 diabetes.
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53. We can survive
Even without chawal or roti.
Diabetes reversal diet-fruits and vegetables,
nuts, seed, herbal tea and nut milk.
Alternative options-
Diabetic chapati 1or 2 or
Brown rice 3 tablespoons (in lunch and dinner).
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54. Diabetic chapati
Constituents:
joer
bajra
chana
soyabeanseed
250gms each.
Normal atta250
gm can be added
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55. Breakfast
50 gms sprouts
50 gms coconut
20 gms almonds soaked
overnight
One large tomato
One medium-sized beet root
One green chilli
Few coriander (Dhania) leaves
Lemon to taste
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56. 56DIABETES REVERSAL DIET CHART

BEFORE 12 NOON
STICK ONLY TO FRUITS DIET –
Papaya, Pomegranate,
2 to 3 types at least 800 gm.


LUNCH /DINNER







PLATES
PLATE NO.1
 400 to 500 gm of 3 to 4 types
vegetables,
 that can be taken raw- raw Tomato,
 Capsicum,


 Carrot,


 Radish,


 Cucumber

PLATE NO.2
 Your Favorite Food - rice, dal, subji,
etc

EAT TILL 8 PM



STOP EATING


1. Package food
2. Refined food
3. Dairy/Animal food
4. Nutrinational supplementary
5. Avoid Drinks tea/coffee. Specially before lunch.
6. Never eat after 8 pm

57. Lunch/Dinner
•50% from Rainbow
vegetables & fruits
•Raw or mild steamed
•Don’t remove outer
coverings (eg-apples
get oxidized)
•Very little salt
•50% Normal diet
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58. Lunch/Dinner
50% comprising of:
Two large tomatoes
300 gm bottle gourd (lauki) / ridge gourd (Tauri)
100gm French beans
2 large capsicum
1 green chilli
Coriander (Dhania) leaves
Lemon to taste
50%Normal diet
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59. 200 gm snacks
•11.30 AM
•05.30 PM
Only citrus fruits & dry fruits (soaked 6
hours)
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60. Edward Stanley has rightly said
Those who have no time for
healthy eating will sooner or
later have to find time for
illness.
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61. Rules for healthy lifestyle
Eat before you feel hungry
Take time to eat
Timely eat
Keep extra stock of food
Limit intake of milk products, refined , packed
foods, sugar, salt and oil
Sunshine-1 hour
Exercise-30 min
Close monitoring of sugar and reducing the dose of
medicines slowly.
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62. Exercise
We are using
only 20 muscles
out of total 640
skeletal muscles!
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63. How does exercise lower blood sugar?
•Increases insulin sensitivity.
•Stimulates another mechanism that
allows muscles to absorb and use
sugar for energy, even without
insulin.
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64. How much exercise do you need?
At least two and a half hoursof moderate to vigorous
intensity physical activity per week(i.e., brisk
walking, water aerobics, swimming, or jogging).
Two to three sessions of resistance exercise per week.
No more than two days in a row without physical
activity.
Breaking up sitting time every 30 minutes during the
day.
Flexibility exercises, like stretching or yoga.
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65. •Dietary Intervention
•Physical Activity
•Yoga, Meditation
•Lifestyle Modification
Keep hope of recovery
What Should be Our Approach
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66. The knowledge that T2D can
potentially be reversed might
be all the strength that one
needs to fight back the
disease.
Our Recommendations & take-
home message
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67. •Counselling
•YOGA
•Minimize stress
•Healthy Food and seasonal fruits
•Walking with peer groups.
•“Open GYM” at Park.
•Swimming pool availability round the Year.
•Encourage Cycling in Township.
Participation of HOP and HODs for encouragement
Our Recommendations & take-
home message
67

68. 68
नदीजबकिनाराछोड़देतीहै,
राहिीचट्टानतितोड़देतीहै,
बातछोटीसीभीअगरचुभजाएकदलमें,
कजिंदगीिेरास्ोिंिोमोड़देतीहै।

69. “Determined we will win the battle”
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71. How to make nut milk
•Take 8 to 10 almonds
•Wash and soak them for 4 to 6 hrs in limited
water.
•Now add 200ml water in a blender along with
almonds and blend it for 2 to 3 minutes.
•Nut milk is ready to drink
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73. Reversal of diabetes-reference case
One young 34 yrs patient came with a blood sugar
report of FBS-220mg%, PP-340mg%, HBA1c-
9.5
He was anxious. Treatment advised-diet, exercise,
antidiabetic tablet. He was not convinced and
went to a well known diabetologist of Apollo
hospital who did investigations costing Rs
25000/-and took consultation fees of Rs 1500/-.
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74. Advised 3 medications to be taken lifelong. More
anxious he came back to hospital again and said
he does not want to take any medications. He was
advised to take minimal complex carbohydrate
diet and regular exercise. After 3 months his
FBS-110mg, PPBS-146mg, HBA1c 6.6. He is
maintaining this since then.
His diet is topic of this presentation.
EXPERIENCE CONTD …
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75. Conclusion from reference cases
1.Consuming fat from the plant-based food in
its natural state can help in decreasing the
risk of diabetes
2.The fat from animal food or industrial fat
such as various kinds of refined oil can be
harmful and result in increasing the risk of
diabetes.
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76. Link of Vitamin D deficiency and diabetes
Does high-dose vitamin D supplementation impact
insulin resistance and risk of development of diabetes in
patients with pre-diabetes? A double-blind randomized
clinical trial. Diabetes Res Clin Pract. 2019 Feb;148:1-9.
Result-In patients with pre-diabetes and
hypovitaminosis D, high dose vitamin D
improves insulin sensitivity and decreases risk
of progression toward diabetes.
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