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Amy Borger, RD, CDE 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 Type 1 ◦ Autoimmune disease with beta-cell destruction ◦ Beta-cells key for modulating stress and inflammatory responses 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 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 The Glycemic Index vs. Glycemic Load ◦ A modestly useful tool, but not a diet Executive Summary 1. Follow a healthy eating pattern across the lifespan All food and drink choices matter 2. Focus on variety, nutrient density, and amount Choose a variety of nutrient dense foods across all groups 3. Limit calories from added sugars and saturated fats and reduce sodium 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 Create healthy eating patterns in homes, schools, communities 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 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 Americans should limit sugar intake to no more than 10% of daily calories (~200 cals or 12 teaspoons) WHO recommends half that amount Water is the beverage of choice One or two cups of coffee a day ok Watch the coffee drinks Skip soda and sugary beverages 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 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 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 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 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 The higher the number, the greater the blood glucose response ◦ High: 70 or more ◦ Medium:56-69 ◦ Low: 55 or less Oats Barley Bulgar Beans Lentils Other Legumes Pasta Apples Oranges Milk Yogurt Ice Cream Oat Bran Bread 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 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 Glycemic Index score x grams of CHO/100 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 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 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 Alcohol ◦ Can create a “leaky gut” over time ◦ Is converted to sugar Omega-6 Fatty Acids ◦ ◦ ◦ ◦ Can be harmful if taken in excess Saturated fats Overuse of vegetable oils Increase the Omega-3’s for balance 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 ◦ ◦ ◦ ◦ 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 Milk fat is not consumed in isolation ◦ Contains protein, calcium and other compounds that may modulate effect of fat on health 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 Recommend approximately 3 servings of dairy per day…consider calories as well 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 Fish and shellfish: salmon, sardines, anchovies, flounder, cod, halibut, shrimp, oysters, some sea basses ◦ Salmon, sardines, anchovies high in omega-3’s Lemon water, very alkalizing Coconut milk as a dairy replacement ◦ Contains MCT’s which are easy to digest and are anti-inflammatory Water, water, water, color, color, color 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” 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? 1. 2. 3. 4. 5. 6. 7. 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 1. 2. 3. 4. 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