Transcript Borger Diabetes and Nutrition

Amy Borger, RD, CDE
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Why Diabetes in an inflammatory disease
Review the 2015-2020 Dietary Guidelines for
Americans
RAD and RESET approaches
The anti-inflammatory way of eating
Foods to focus on
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Type 1
◦ Autoimmune disease with beta-cell destruction
◦ Beta-cells key for modulating stress and
inflammatory responses
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Type 2
◦ Insulin considered an “invader” due to excess levels
◦ Presence of insulin resistance
◦ Inflammation already linked to heart disease and
obesity, which are common in the T2 patient
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2015-2020 Dietary Guidelines for Americans
The Diabetes RESET Approach
◦ A new term coined by Dr. George King, MD, Chief
Science Officer at Joslin Diabetes Center
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The Glycemic Index vs. Glycemic Load
◦ A modestly useful tool, but not a diet
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Executive Summary
1. Follow a healthy eating pattern across the lifespan
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All food and drink choices matter
2. Focus on variety, nutrient density, and amount
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Choose a variety of nutrient dense foods across all
groups
3. Limit calories from added sugars and saturated
fats and reduce sodium
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Cut back on foods that are high in these components
4. Shift to healthier food and beverage choices
5. Support healthy eating patterns for all
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Create healthy eating patterns in homes, schools,
communities
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Americans should shift to a more plant based
diet
Consume less sugar, red meat, and especially
processed meats
Plant based diets promote health and are
environmentally sustainable
An optimal eating pattern includes fruits,
vegetables, whole grains, legumes, nuts, and
seeds as well as low-fat dairy and fish
No need to limit dietary cholesterol
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Coined by Dr. George King
RESET Food Choices: RAD (Rural Asian Diet)
◦ Dr. King’s research showed that the RAD decreased
inflammation and insulin resistance
◦ Cut fat intake in half and double the fiber
◦ Includes macronutrient breakdown of 70% CHO,
15% protein, and 15% fat
◦ Eat 15g fiber per 1000 calories consumed
◦ Eat foods high in antioxidants and phytonutrients
◦ Consistent with Dietary Guidelines Committee
Advisory Report
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Americans should limit sugar intake to no
more than 10% of daily calories (~200 cals or
12 teaspoons)
WHO recommends half that amount
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Water is the beverage of choice
One or two cups of coffee a day ok
Watch the coffee drinks
Skip soda and sugary beverages
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Excess body fat, infection, tissue damage as
well as other sources contribute to insulin
resistance
Eat a more anti-inflammatory diet, floss and
brush teeth at least twice daily, and quit
smoking
Control blood glucose levels
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Get 7-8 hours of quality sleep per night
Lack sleep can lead to increased levels of
stress hormones and cytokines
Consistent restful sleep improves insulin
sensitivity and protects beta-cells
Lowers overall risk of developing diabetes
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Insulin resistance in the muscles one of the
most important underlying defects
Associated with obesity and sedentary
lifestyle
Muscle use increases insulin sensitivity and
decreases glucose levels
Aerobic activity 5 days per week and
resistance training 2-3 days per week
recommended
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Originated from the term “glycemic response”
Reference may provide a modest benefit vs
when total CHO is considered as a single
factor
Compares postprandial responses to constant
amounts of different CHO containing foods
Based on a 50g CHO portion of food
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To simplify the concept of glycemic
response, researchers created the Glycemic
Index to categorize foods
Each food is given a numeric value that
ranks the food based on its blood glucose
response
Pure glucose=100; white bread has a score
of 100, so it is used as the standard to
compare to other foods
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The higher the number, the greater the blood
glucose response
◦ High:
70 or more
◦ Medium:56-69
◦ Low:
55 or less
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Oats
Barley
Bulgar
Beans
Lentils
Other Legumes
Pasta
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Apples
Oranges
Milk
Yogurt
Ice Cream
Oat Bran Bread
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The GI sounds logical, but the concept has
been controversial for years
As a diet regimen, it has been very
oversimplified
The GI only reflects how quickly a food
raises blood sugar levels, not the total
carbohydrate content in a typical serving
of that food, which is an even more
important part of the glycemic response
This is why the Glycemic Load is important
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A low GL food is 10 or less, medium 11-19,
and high would be 20 or more
Once the total CHO in a serving is
considered, it is possible that a high GI food
has a low GL
Example: carrots have a GI of 92, but in a
typical serving of ½ cup there is only 4.2g
CHO, so the GL is 3.9
So, you’d have to eat a TON of carrots in
one sitting to elicit a true GI response
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Glycemic Index score x grams of CHO/100
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Trans fats
◦ Intake has been associated with systemic markers
of inflammation
◦ Two types, natural and industrial
◦ Industrial “unrecognizable” fat in the body
◦ Laws have mandated food labeling, but can still be
present
◦ Need to read ingredients…look for anything
hydrogenated or partially hydrogenated
◦ Raise LDL cholesterol
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Sugar
◦ Excessive intake can alert the body to send out
immunity messengers like cytokines
◦ Excessive intake associated with weight gain and
obesity
◦ ADA recommends no more than 32 grams/day
◦ Better to consume the “real thing” over artificial
sweeteners?
◦ Fructose
 Lower post prandial response
 Not recommended as a sweetening agent
 No reason to avoid fruits and veggies
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High Glycemic Index foods
Saturated fats
◦ High in arachidonic acid (omega-6), a natural
creator of inflammation
◦ Raise LDL cholesterol
◦ Reduce intake to 5-6% of calories
◦ Better than industrial trans fats
◦ Cholesterol?
 The body makes LDL cholesterol naturally, liver
regulated
 Trans fats and saturated fats raise LDL cholesterol
independently of what the body makes
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Alcohol
◦ Can create a “leaky gut” over time
◦ Is converted to sugar
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Omega-6 Fatty Acids
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Can be harmful if taken in excess
Saturated fats
Overuse of vegetable oils
Increase the Omega-3’s for balance
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The fats in whole dairy foods are highly
complex and may contain beneficial
ingredients
More than 400 fatty acids have been
identified in whole milk
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62% saturated
30% monounsaturated
4% polyunsaturated
4% other types like trans fats and CLA
These fats may have distinct biological effects
and warrant individual evaluation
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Milk fat is not consumed in isolation
◦ Contains protein, calcium and other compounds
that may modulate effect of fat on health
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The benefits of whey protein
◦ Very high biological value, all amino acids present
◦ Very high in the AA cysteine
◦ Cysteine needed to make glutathione
 Important antioxidant only made by body
 Very anti-inflammatory
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Recommend approximately 3 servings of
dairy per day…consider calories as well
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All veggies, full of phytonutrients, vitamins,
minerals, fiber
Fresh and frozen fruits, full of phytonutrients,
anti-oxidants and fibers that modulate sugar
uptake
Grains such as oats, quinoa, wild rice, wheat
berries, brown rice
Legumes
Flax, pumpkin seeds, walnuts,
◦ Good plant sources of omga-3 fatty acids
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Fish and shellfish: salmon, sardines,
anchovies, flounder, cod, halibut, shrimp,
oysters, some sea basses
◦ Salmon, sardines, anchovies high in omega-3’s
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Lemon water, very alkalizing
Coconut milk as a dairy replacement
◦ Contains MCT’s which are easy to digest and are
anti-inflammatory
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Water, water, water, color, color, color
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Eating a more plant based, anti-inflammatory
diet helps maintain intestinal health
Intestinal tract first line of defense and full of
immune tissue (GALT)
Probiotics important
Plant based diets provide pre-biotics and
helps maintain healthy gut flora
“Leaky gut” can create systemic, vague,
inflammatory conditions
A poor diet perpetuates a “leaky gut”
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Diabetes can be considered an inflammatory
disease
Inflammation can be modulated through diet and
lifestyle change
Eat low GI/GL
Eat a more plant based diet and as low to the
ground as possible…color, color, color
Keep the gut healthy
And remember…everything in moderation and it’s
what you do the majority of the time that counts
Questions?
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International Immunology, 2012 June24 (6) 339-46
US Dept of Health and Human Services & US Dept of Agriculture 20152020 Dietary Guidelines for America, Dec 2015
The Diabetes Reset: Avoid it. Control it. Even Reverse it. A Doctor’s
Scientific Program, by George King, MD
Improvement of Insulin Sensitivity by Isoenergy High Carbohydrate
Traditional Asian Diet, Plos One, 2014; 9(9): e106851, 2014 Sep 16,
George King, MD, et al
Dietary intake of trans fatty acids and systemic inflammation in women –
American Journal of Clinical Nutrition. 2004 Apr; 79 (4): 60612,
Mozaffarian, D, et al
Consuming fructose sweetened beverages increase visceral adiposity and
lipids: Journal of Clinical Investigation 2009, May: 119(5); 1322-34,
Stanhope, et al
American Heart Association – Know Your Fats
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An open label dose response study of lymphocyte glutathione levels in
healthy men and women receiving whey protein isolate supplements,
International Journal of Food Science Nutrition, 2007 Sept; 58(6) 429-36,
Zavorsky, GS, et al
Todaysdietitian.com/news/exclusive0912.shtml
http://health.gov/dietaryguidelines/2015/guidelines/
www.glycemicindex.com