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2009-05-03 David Jenkins MD, PhD, DSc Diabetes Reversal

May 3, 2009, By Kirkham R. Hamilton, PA-C
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KIRK HAMILTON: Welcome to Staying Healthy Today, a radio show committed to bringing key experts in the fields of nutrition, prevention and integrative medicine. Hi. My name is Kirk Hamilton, your host of Staying Healthy Today. Our mission is simple. To provide you credible and useable health information from interviews and our educational resources to help you STAY and BE WELL in the busy modern world. In short, to provide information to help YOU prevent, slow or reverse chronic diseases that are plaguing modern industrialized society. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com site, the home of Staying Healthy Today Radio, for our health education services, which include our free weekly healthy letter called Rx2000 One Liners, our Educational Handouts on diet and lifestyle, the Expert Pearls for specific medical conditions, Educational Links to other credible health-oriented websites, the Staying Healthy Today Interview Archives and our special offers..

Today's show is entitled "Can A Low-Fat Vegetarian Diet That Includes Nuts Prevent, Control or Reverse Diabetes?" We are very fortunate today to have Dr. David J. A. Jenkins, M.D., PhD. DSc., who was born in London, is a sixth generation physician, and is one of the world's leaders in nutrition research. He is Director of the Clinical Nutrition and Risk Factor Modification Center at St. Michael's Hospital in Toronto, Canada. He received his M.D., PhD and DSc. degrees from Oxford University. He has served on committees in the United States and Canada that have formulated nutritional guidelines for the treatment of diabetes, as well as formulating recommendations for fiber and macronutrient intakes for the general population under the new Joint U.S./Canada Dietary Recommended Dietary Intakes. He has published over 200 original publications. His areas of research include plant-based diets and the treatment of cardiovascular disease, diabetes, cholesterol and cancer. His team was the first to define and explore the concept of the glycemic index of foods. In 2003, he showed that a vegetarian diet, or what is defined as the Dietary Portfolio incorporating soluble fiber, soy protein, almonds and plant sterol ester enriched margarine lowers serum cholesterol concentrations almost as effectively as early cholesterol lowering drugs, and this was the only dietary approach referenced in the guidelines of the United States National Cholesterol Education program.

KIRK HAMILTON: Welcome, Dr. Jenkins. Thank you for taking the time today to discuss this important topic and share your breadth of knowledge on the role of diet in diabetes. I would like to start off by getting a feel for the instance of diabetes in Canada compared to the United States. We have approximately 8%, or 24,000,000 people with diabetes and another 57,000,000 people with what is called pre-diabetes. How is the Canadian population fairing with the instance of diabetes and it is similar to the U.S.?

DR. DAVID JENKINS: I think the 49th parallel is a somewhat an artificial divide. I think we can just leave it at that. It's an artificial divide. Just as there are communities in the South, especially some of the Indian communities that are going to be at greater risk of diabetes, so they are in Canada, too. Those are more vulnerable.

KIRK HAMILTON: So the incidence is pretty much the same?

DR. DAVID JENKINS: Yes. And increasing. And the important thing is that it is increasing.

KIRK HAMILTON: I read one of your reviews on what is called "The Garden of Eden" and
essentially it was the evolution of the human diet from our Simian ancestry to the Paleolithic period to the Neolithic period. I am wondering if you could give a brief run-down of that transition of diet and maybe what you think the best human diet is, or what we are supposed to be eating? ("The Garden Of Eden: Plant-Based Diets, The Genetic Drive To Store Fat And Conserve Cholesterol, And Implications For Epidemiology In The 21st Century," Jenkins DJ, Kendall CW, Epidemiology. 2006 Mar;17(2):128-30).

DR. DAVID JENKINS: Well, I think it's a good point. I think the people are always looking now at evolution and biology to give an explanation, or at least stimulate thought. And I think that's true. We would certainly see ourselves as part of a larger sort of group of hominoids, where there's a sort of co-evolution of different habits. We started off, I think, probably eating more of a plant-based scenario simply because those were the sort of things we were able to eat and satisfy our needs with. I think as we rode out on the Savannah with the development of the Rift Valley, we were left on the flatlands with less of the tropical rainforest. It was a great feeding ground. On that side, we've left our cousins, the great apes, and we've traded the savannah presumably with a less hostile savannah perhaps than it is in Africa today. With more lakes and more shrubs and bushes. But nevertheless, our way of eating had to change and I think it is said we then we relied on carrion to some extent, so we could never be great hunters, but we needed to get food and so ate a lot of plant food still, with some carrion. A little later on, much later on, we developed the ability to harness fire. We weren't even Homo sapiens at that point. This is way before Homo sapiens. We managed to harness fire a little. Some say it was to cook meat. Others say it was to cook tubers, which would again be another very good source of food. At a later stage, we developed better weaponry and were able to hunt and during the height of the Paleolithic hunting period, 40,000 to 60,000 years ago, we probably had a very high meat intake. But again, even at that point, I think plant-based foods were still of great importance to us and these were all relatively high fiber. Then, of course, about 10,000 - 12,000 years ago, we hit the new age, the Neolithic period. The new stone age, probably driven by the fact that we had made a lot of the animals we had hunted either in very low numbers or we had caused extinction. I mean, we were not a benign force on the planet you might say, never have been and never will be called this. At that point, there was the harnessing of grains, especially legumes and most importantly, cereal crops, too, and that seemed to be universal. It seems to have been a co-evolution wherever humans were. In the Orient it was rice, and in the Fertile Crescent it was wheat. In the New World, it was corn. These were our big staples, along with beans. Beans have always been with all cultures, and they worked well because they really were our great success story in terms of ability to harness foods. It was really our ability to manipulate agriculture and manipulate the growing of cereals that gave us a very big head start. And that's when our population started to explode. And of course, unfortunately, it has not ceased to explode since then. We've continued exploding. But that was the big one, and of course in the early days we would now say they were healthy. There were whole grains, and there were legumes, there were beans, peas and lentils. So, living on these as the mainstay of our diet did us well. Then, of course, carnivora came back much more recently and is still with us today, and that gave us additional sources of protein. It's difficult to unravel it in terms of health. The latest health assessment published in the Archives of Internal Medicine suggests that that's part of the cause of our Western disease. Obviously, along with physical inactivity, which is the other major concern that we've got. So, we're really just heading just where we want it to. In other words, we've got plenty of food, we don't have to work too hard. That would seem an ideal combo, but interestingly, it's killing us. That, I think, is the situation we're in right now. We're are certainly in a major disharmony with nature, and having got what we want, we really shouldn't want it. And as Bernard Shaw said, you know, the Lord punishes in two ways. He punishes us by giving us what we don't want, and he punishes us by giving us what we want - And Bernard Shaw also said, "We dig our graves with our teeth", and I think that's a truth. Bernard Shaw was a vegetarian.

KIRK HAMILTON: Let me ask you. I've read Konner and Eaton's work on the caveman diet, the Paleolithic diet, and they tend to suggest that the agricultural revolution is where humans got smaller and had more problems. I am wondering if you could comment on the popularity of a higher protein, low carbohydrate diet, and the relationship that is correlated - you know, when they talk about the Paleolithic diet versus the grain-based diet. Can you comment on the differences and what might be closer to our evolutionary tree?

DR. DAVID JENKINS: Well, it really depends. If one follows on the thinking that bigger is better, then the more protein and the more energy you've got, and the bigger you get. But one of the things that's really struck me is - I'm not so keen on bigness. I want distance, and to me it's not so important how big I am, but how long I live. And, I think that we can say that there may have been some longevity but we don't know it in our ancestors, that the traditional paradigm has been, you know, bloody, brutish and short as the sort of description of our Paleolithic ancestors. If you take where we have the greatest longevity, for example in Okinawa, Japan, the people are small. So, I think Eaton's right. The agricultural revolution did breed small people. There's no question of that. But on the other hand, there are 20 centenarians per 100,000 in Okinawa. The best we could do is three or four, if we're lucky. And if you look at the Okinawans of the generation who lived to be 100, they're small people. There's no question about that. And, their children are bigger than they are, and their grandchildren are much bigger than they are, and their great-grandchildren are bigger still. That's very interesting, their grandchildren may be dying before the grandparents. I think that it depends what you want. If you want bigness and speed, then maybe that's the sort of diet (Paleolithic). If you want durability and length of days, then maybe you don't want the Paleolithic diet. It's a philosophical choice, I think. Some people will smoke and say, you know, I enjoy smoking. If I die young, I die young, but I've enjoyed it.

KIRK HAMILTON: Let me ask you about our makeup of being energy conservers and trying to store calories and what appears to be almost an epidemic of diabetes, and then chronic conditions that relate to excess calories. Can you comment on that, our ability to conserve calories, and now we have all these calories available?

DR. DAVID JENKINS: Well, I think that's right. The thrifty gene hypothesis is still with us. That's where we're built for thrift. So you're absolutely right. We never knew when the next food was coming along, and that's probably what the agricultural revolution did. It gave us the next meal. In the early days, it never gave us a lot of the next meal unless we did a lot beforehand. So that was a good equation. Now we're in a situation where the next meal is always there, but you don't have to work too hard for it. So, I think it's really a case of the energy part of the equation, but we're not using our bodies.

KIRK HAMILTON: Let me ask you. When did you become aware of the power of a plant-based diet in slowing, reversing or preventing diabetes?

DR. DAVID JENKINS: Well, I think that it's really a combination, for all of us looking at evolution of human activity or inactivity and human consumption. I don't think anyone would deny the fact that we're eating too much for the amount of energy we're expending. And then, if you look - the energy output is tremendously important. The only thing you're able to control is the diet. Then diets basically, which are bulkier, which delay the rapid absorption of nutrients into the blood stream, are all things that are going to be helpful when you're eating large amounts of food. It's not the ideal, but at least those are helpful. So I think one would say that this is helpful, if you combine that with the energy part of the equation, you're in very good shape because you're in a situation where you are not eating too much as you were with fast absorbed food. But you're able to expend the energy to utilize that food. I think that's a very good part of the equation. I have to say, the train in that thought which is along with that belief, is that the studies of Denis Burkitt and Hugh Trowell, especially Hugh Trowell, who in their work in Africa, as they put together the dietary fiber hypothesis, they made very strong comments that there was a direct link between the fiber intake from plant foods, and incidence of chronic Western diseases. They were in Uganda before Idi Amin came and they saw very little diabetes. When they came back to the West, they found that type 2 diabetes was really related to a very refined diet that people were eating, and that's where they drew that hypothesis. I can't claim that that's an original thought. It's an idea that had been growing, I think, during the middle to latter part of the 20th century, and it was very influential at that point. So, I think we certainly started looking at fiber in diabetes, and looking at sticky types of fiber, things that slow absorption, and showed that you could flatten the blood glucose response and reduce the insulin needs. That was the start to thinking more about plant foods, plant protein and other things that might have beneficial effects either on diabetes or its side effects, its complications.

KIRK HAMILTON: Let me ask you about the relationship of carbohydrate intake and diabetes. Are carbohydrates good for diabetes? Is there a big difference between refined and complex carbohydrate with regards to diabetes?

DR. DAVID JENKINS: Again, I think that the energy part of the equation is very important, and I think that if you're skinny and athletic, I don't think carbohydrates makes any difference one way or the other, fast or slow. I don't think it makes a great difference. Unfortunately, and I think that reason for the rise in diabetes is that our population is getting increasingly less athletic and increasingly more sedentary, and increasingly more overweight. And of course, increasingly older. I think all those things are the backdrop. I think if you take that as a really important driving backdrop, there's probably something to be said for the less refined carbohydrates and the more fiber rich carbohydrates with increased vegetable proteins such as the legumes, which release the carbohydrates into the blood more slowly. If you do that, then obviously your stress, repeated stress on the pancreas is less, and I think one's in better shape for preventing diabetes. There are studies now, like the Nurses Health Studies, that show a lower glycemic index or a lower glycemic load diet seems to be associated with the reduced incidence of diabetes. So, I think in that sense, you can say the type of carbohydrate may be important. More recently, there has been a suggestion, too, that sugars, especially fructose eaten in excess, may wind up in the wrong place, in other words presumably in muscle and liver, and increase insulin resistance. I think it's eating in excess and eating the more refined carbohydrates that may, on the basis of increased calories - I keep on emphasizing these increased calories and lack of exercise - will bring out, if you like, the worst of your genetics.

KIRK HAMILTON: Would you say that the best glycemic foods might be legumes and then what would be next, whole grains? And fruit?

DR. DAVID JENKINS: I think legumes are very important. I think intact grains are also important. When I say intact grains, I mean, the complete grain as opposed to milled flour. I think when you start milling a flour and getting it into a fine particle size, it's fairly readily taken up and it may be useful to have increased bran and increased protein still present in the flour. The classic whole grain milled flours are better than the white. I think that the food form is important. If you have things such as a pasta, there's a whole grain pasta, it's better than a white pasta, and a white pasta is certainly much better than white bread in terms of its blood glucose response. So, pastas are good. I think the traditional way of storing rice - if you have parboiled rice or so-called converted rice. Uncle Ben's does this with a range of converted rices. These rices are quicker to cook, also interestingly don't take up as much water, don't get digested as rapidly, and they give a flatter blood glucose response. You can now get these foods parboiled, or as converted type rices. There are brown rices and that's even better. So, those are two traditional things, two traditional ways of picking one's grain, either dried pasta stores - which probably store even better than flour, and parboiled rice or converted rice stores better than white rice or regular rice that's uncooked. These are traditional ways of storing grains. Legumes are very important, and so are temperate climate fruit like apples, oranges, berries, these sorts of things are good in terms of keeping the sugars fairly well locked up within their texture and releasing it relatively slowly when you eat it. Those are very traditional things that we've eaten.

KIRK HAMILTON: Let me ask you about fats in the diet. In recent interviews with Dr. Anderson and Dr. Barnard, fats came up as a very concerning issue and possibly that it might get ‘lodged' in the muscle cell, called intramyocellular fat, and then it causes problems with insulin binding. What are your comments on fat in the diet, saturated versus, let's say, fat from nuts and seeds, in diabetes?

DR. DAVID JENKINS: Well, I think the intramyocellular fat, intramyocellular lipids, muscle lipid, or intracellular hepatic fat, fat in the hepatocyte, these are all bad places to store your fat and cause insulin resistance, and, may be enhanced when one takes excess calories of any sort, and neither fat nor carbohydrates can be accused of being the sole reason for this. Both can contribute. So, refined carbohydrates certainly contributes and so can fatty acids. My belief is that a certain amount of fat certainly does absolutely no harm if it's taken in the context of a balanced diet, which does not increase your body weight. Again, back to body weight. Always back to body weight. If you can keep your body weight down, and not eat too much, which is the problem, not what one eats. What one eats has some importance, but it can be manipulated. If one could only wrestle the hunger demon to the ground you wouldn't have to worry about what you're eating. Nuts and seeds, I think, are excellent sources of unsaturated fats, which don't raise the cholesterol level and eaten in the form of nuts and seeds along with the protein and the other antioxidants found in these foods, and in the context of a weight-maintaining diet, are very useful and we find that they tend to raise the healthy HDL cholesterol and lower the bad cholesterol. Certainly, Frank Hu and others have shown, and Gary Frazer and with some of the groups in California, have shown that increased nut consumption is associated with reduced risk of heart disease. So, I think we can say that there's an all-around very good profile for nuts. So we've got a lot of neglected plant foods which I think Neil Barnard would raise attention to, and legumes, and even fruit. These are very often neglected now in the modern diet and these really should be part of our staples.

KIRK HAMILTON: Let me ask you about a very popular fat, the omega-3 fats, predominantly from fish oil, although it could come from, and does originally come from marine algae. On your diet, you'd be eating a mostly plant-based diet. Where would the person get their omega-3 fats? And is fish oil beneficial or harmful, or what do you think about that?

DR. DAVID JENKINS: Well, for a start, I think plant-based diets eaten as such, eaten from whole foods, can provide a lot of alpha-linolenic acid from nuts such as walnuts, and soybeans contain alpha linolenic acid. Even canola oils contains lots of the plant alpha-linolenic acid. If one's eating the right sort of oils, even the omega-6 oils, in moderate amounts, there doesn't seem, in terms of cohorts, to be negative effects. Alpha-linolenic acid is the plant source of the omega-3 fat. We can get plenty of fat, and some of it can be converted to EPA, and DHA has a relative block, and that's where people say we may need that for the brain and possibly have some cardioprotective effects, over and above what EPA has. We may need to have fish or marine sources for this fat. This fat I would say is possibly non-essential, because it is shown that people who are taking a really good diet and are taking exercise and consuming legumes, nuts and whole grain cereal products do well. No one has said that supplementing these diets with fish oil has an advantage. The big area where EPA and DHA, the fish oil type oils, have been said to be important is in heart disease. There are no studies that suggest that vegetarians who get no fish oil do worse in terms of heart disease than non-vegetarians. In fact, it's the reverse. I don't think that their essentiality has been shown. I do think, though, that in people who are otherwise compromised in their diets who may be sort of beef eaters who - with a six-pack and the chicken wings - watch other people exercise while they're on the couch. They may do well to have fish and fish oil. But it's a sad shame that they should have to, because I think the much more important things in terms of the fish oil debate now is the state of the ecology, the state of the ocean, and the loss of fish species and fish stocks. I think this means that we have to be very clear on why we're using fish oils rather than just saying we are eating fish and fish oil when we're not sure that we've got the stocks (fish), and know that we'd done bad things to, for example, the North American East Coast Cod, which was once prolific and is now not able to be fished in many areas. I think that more important considerations, environmental considerations, should be taken into account here because I don't think that fish under any circumstance is so essential that if we didn't smarten up on our other lifestyle attributes, we wouldn't be able to square all that fish could do for us, plus more, into the equation and be generally healthier.

KIRK HAMILTON: Perfect point. Can I ask you about, you're the discoverer or the founder of the Glycemic Index. If you take a high glycemic food, let's say a piece of sugar or piece of candy, and you put it in the context of eating it right in the middle of a mixed meal of legumes and such, which are low glycemic foods, does it blunt the response? I mean, because a lot of the glycemic index, if you take a food individually, that's not the real world -

DR. DAVID JENKINS: Yes, if you take a mixed meal, you tend to get what you expect from a mixed meal. In other words, if fats and protein being equal, if you take a large amount of low glycemic index foods, like pasta faggioli and you have some white bread with it at the same time. Depending on how much white bread you eat at the same time, you will raise your blood glucose over and above that what you would get from a low glycemic index response. So I would say stack up (foods) on top of each other, and I think that's reasonable. Fats and protein can modify it further. If you increase the protein or fats in the meal, in other words, if you increase the calories of the meal, then you tend to blunt the meal's glycemic response also. That may not be the best way of doing it because obviously you don't want to take in excess calories. I think to answer your question, yes, you do change the response, either by increasing it if you add more high glycemic index foods to the meal, or reducing it if you add a greater percentage of low glycemic index (foods).

KIRK HAMILTON: Let me ask you about your Portfolio Diet and it's probably what we've been talking about. Do you want to explain what that is?

DR. DAVID JENKINS: Well, it's just an idea that we've got. It's typical to talk of a financial portfolio nowadays, but everyone will laugh at you. But, there was a time when everything looked advantageous on the stock market, when people used to talk about keeping a portfolio and the aim of that was to try and spread one's benefits and one's risks broadly so that you could maximize the gains. And so it was in terms of diet. Diet is in fact a portfolio that you take of foods that you enjoy and foods that do you good, and it's a wide range of food. So, each time you eat, you're investing in a portfolio. So, we said, well, let's take this concept and think of a cholesterol-lowering portfolio. Take all the foods that we know lower cholesterol, put them into one diet and what advantage does this sort of cholesterol lowering portfolio convey on your blood cholesterol level.

KIRK HAMILTON: What are some of these foods? Can you mention those foods in the portfolio?

DR. DAVID JENKINS: Sure. Things like soy and legumes in general tend to lower cholesterol, probably related to their 7S globulin fraction. And nuts, for example, because of their fatty acid profiles and their proteins tend to lower cholesterol, so nuts would be another. Sticky types of fiber like oats and barley and their products. Psyllium and oats, or just psyllium by itself, is a sticky fiber which tends to lower cholesterol levels, and plant sterols that you find in oils. You can find them concentrated in margarines and other foods, tend to also lower cholesterol levels and this has been known for quite a long while. There's nothing very dramatic about this, all these four components, for example, which would be part of the current portfolio, have got FDA health claim approval for cardiovascular disease. So, that's known. So, we're not going out on a limb and looking at any cholesterol-lowering foods that aren't generally agreed upon to lower cholesterol. Although, I have to say that soy has been challenged recently for the degrees at which it lowers cholesterol. I nevertheless think it still lowers cholesterol and is useful. I still promote its use in that respect. So, if you put those four things together, then you can, if each of these lowers cholesterol 5%, then you can get 20% reduction, if you put 4 times 5 together. And that's about what you'll get if you take these foods. If you also have these foods as part of a low saturated fat, low cholesterol diet you'll get another 10% or so percent reduction in cholesterol. You could get about 30% which is what the older statins used to get. Obviously, that's under ideal conditions, but even if you only do sort of half a portion, you get 15%. That for many people is just what they want to lower cholesterol level. We think that just bundling things together in a portfolio is a good way of getting people aware of what they should be doing.

KIRK HAMILTON: Can I relate this back to diabetes? Does this portfolio diet, if applied strictly, the one that lower cholesterol maybe 30%, will this slow or even reverse some type II diabetic situations?

DR. DAVID JENKINS: Well, I think in the diabetes situation, that's one of the things that the portfolio diet should be applied to. It is something that we're involved in looking at now. I think you raise an important point because many of the foods that we've got in the cholesterol-lowering portfolio are also good for blood glucose control. So, you're right, and we could put in a few more. We could actually emphasize low glycemic index foods again as we tend to, in a dietary portfolio, and make it a more diabetes friendly portfolio. That again raising questions and things for the future.

KIRK HAMILTON: Do you think then, that if we applied your program aggressively, the portfolio diet, that diabetes type II wouldn't be a big issue, as well as increase physical activity?

DR. DAVID JENKINS: I think that's important, but I think obviously in all these situations, especially in the diabetic state, you have to be very careful about body weight and so it's lowering the body weight and the calorie intake. If you do that, I think this would work well. Again, it's going to be individual specific, and what one does is one looks at people's body weight. One does this in conjunction with looking at hemoglobin A1c. If anyone is going to do anything serious with diet, and I say serious - wants to take diet seriously - I really would strongly encourage them to involve their own physician for monitoring and advice. Do you know what I mean? I think that this is - we only do these things under controlled conditions where we know exactly what we're doing, we measure what we're doing, and everyone who we're looking at has measurements actually made to monitor their progress. We don't sort of shoot from the hip. I think that's important.

KIRK HAMILTON: In wrapping up here - you've been very kind with your time - do you have experience with your portfolio diet being of benefit to type I diabetics, as well?

DR. DAVID JENKINS: We've not looked at the low glycemic index diet in type I diabetes to any great extent. We tried doing it with children early on, and it seemed to work, but I have to say that the diets of children, who used to be the big issue with type I diabetes, now made it very difficult because children eat in a very haphazard way, and getting dietary strategies for them has been difficult. I think with those who've got type I diabetes, the lower glycemic index foods may well be helpful. They have to look at that themselves and do their own monitoring. I certainly don't see any harm. But obviously, these people have big swings with type I diabetes, and often they've got insulin regimens that have been developed specifically to cope with big swings. Again, one's in a situation where this would obviously be done in conjunction with one's physician.

KIRK HAMILTON: Do you have any knowledge of prevention of type I diabetes with, for example, possibly early cow's milk introduction or vitamin D deficiency?

DR. DAVID JENKINS: I think that's another interesting and important area in terms of the differences in the type of diet that people have had and the evolution of diabetes. Milk, as you say, is one issue where there's been a suggestion milk allergens may have some commonality with the beta cells and so that one may mount an attack, as it were, on the beta cell, and as a result, this may be responsible for the type I diabetes. The same has been said, I believe, for smoked meats and these sort of things that have been shown to relate to diabetes and various associations with the time of year and diabetes have been made. So, a lot of this which could relate to them (type I diabetes) indeed and other things. I think there are a lot of areas of growing interest where different foods may relate to type I diabetes, but again, I think these are areas of major, major research interest rather than, in my mind, definitive steps that can being taken now.

KIRK HAMILTON: If I could just kind of paraphrase what I think you said to me today, is that approaching diabetes or any of the chronic diseases, essentially we get too many calories and however you - I mean you want to eat whole foods, but however you reduce your caloric intake and increase your activity and normalize body weight is really the key to attacking most all these diseases. Is that a correct statement?

DR. DAVID JENKINS: I think that's right, and that goes along with your thrifty gene concept. I think that we've strayed too far from the very tight energy intake, energy output control that we used to have. And I think with that we can now, I call tinkering around the edges, which is changing the nature of the diet in order to try and bring us back into the right kilter. But it's really tinkering at the edges if you can't address the central issue. For some people, that's not altogether true and I have to say that. There are people who are genetically prone to these particular problems and they may be slim. There is not a lot they can do and for those, obviously we focus greatly on the diet and where the diet's inadequate, we go to medication. So, that's a significant group of people, but it's nothing near as large as the group of the people, a very large group of people, for whom the thrifty gene hypothesis holds the clue.

KIRK HAMILTON: Do you have any closing thoughts on diabetes and diet, or chronic disease and diet?

DR. DAVID JENKINS: I think that to me the issue really now has become - we've begun to realize first of all, we needed food so we got ourselves a food supply, and that's I think fairly secure in Western nations. Not always secure in other nations. But I think once we get a secure food supply, then we start noticing that we start developing ill health related to the security of our food supply. In other words, the abundance of our food and that I think is a sad comment. So, I think that the third stage that we are going to move into is noting that we've done terrible things to the planet in the name of a quest for food. I think that becomes a really problematic issue. I think we've got to start learning now to go back and correct things. We've got to start from the top downwards. First of all, I think we've got to learn what foods are sustainable and still allow other species their space and their food, and their own passway to evolution, as it were. At the same time, we then use our science to take these foods which are okay for us. They may not be as palatable and may not be as brilliant as we want, but these are the okay foods for use, and then see how we can put these back into the human diet along with physical activity and get us into a better place. But I don't think that the very egocentric way that we've been approaching nutrition is appropriate because it has such a vast environmental impact. I think we've got to start looking at what we're doing to the rest of the planet, the other life forms on the planet and start asking ourselves, is there a better way of eating? And I think if we do that and stop worrying quite as much in a focused way about how can we get more out of it ourselves, I think we'll probably end up being better overall because we will have a more complete solution to our problems if we learn how to solve the other problems that we've caused to other species and the rest of the planet in general.

KIRK HAMILTON: Thank you very much, Dr. Jenkins. We will talk to you again soon. If I could summarize some of the key points that Dr. Jenkins emphasized, it would be that the most important thing we can do is reduce our excess calorie consumption and stay lean if we want to be healthy and prevent not only diabetes but chronic disease. This comes from the thrifty gene theory that when we were evolving, we didn't have a lot of food around or calories so we became very efficient at storing calories. The problem is that we have excess calories available to us at any time and we're not very physically active, and this leads to obesity and this leads to problems with insulin sensitivity, heart disease and other chronic diseases. So, again, Dr. Jenkin's theme was however you do it, stay lean and an easier way to do it is to eat a more whole food, plant food diet that is high in fiber and bulky foods that are less calorically dense so you can eat and feel satiated but at the same time you get less calories. He calls his diet the Dietary Portfolio which is rich in soy, legumes, nuts and seeds, psyllium, oat bran fiber, vegetables, fruit and whole grains. When this is applied strictly, you can have a 30% reduction in cholesterol and this is also beneficial for diabetes, as well. When commenting on are we better suited for the Paleolithic or caveman diet higher in protein and calories versus the more agricultural or Neolithic diet of grains, he made a comment that those people might be bigger in the Paleolithic period but did they live longer? And if you look at the cultures that live the longest, and he took the Okinawans for example, they are more grain and vegetable based with small amounts of animal protein. They tend to be not taller or large in stature, but they live a long time and as he said, their second and third generations are getting bigger and heavier and having more chronic disease. So that was an interesting comment. Lastly, he closed with we need to think of how we get our food supply and how it affects the food supply for other species on the planet. For example, if we fish the oceans until there are very low populations of different species, or if we inhibit certain other species from getting their food supply because we're developing our own food sources. He implied that if we think of other species and how they are to survive we will probably also help ourselves.

In closing, yes, a more plant based Portfolio Diet definitely can slow or possibly reverse the instance of diabetes and again weight normalization is the most important thing. I would like to thank Dr. Jenkins for his outstanding work on the role of diet in health, and in particular diabetes for this show, and showing the benefit of a low fat plant based or Portfolio Diet in the prevention, control and reversal of diabetes. I want to thank you, the audience, for listening today in this edition of Staying Healthy Today Radio. And remember, until next time, Stay and Be Well.

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