Nutrition adequacy key in choosing diet to manage diabetes
ORLANDO — An expert at the American Association of Diabetes Educators Annual Meeting reviewed the nutrition adequacy of today’s array of popular diets and how they might improve outcomes for chronic disease, or even prevent or delay it.
Meghan Jardine, MS, MBA, RD, LD, CDE, RDN, of Physicians Committee for Responsible Medicine, explored the pros and cons of seven different eating patterns, identified related nutrients of concern for each and discussed supporting patients on their choices and goals.
“The most important thing is individualizing the approach — that’s what it’s all about,” Jardine said. “What does the patient want to work on? What are their preferences, based on their culture, their religion, health beliefs, goals, economics. … What are their metabolic goals?”
Very low carbohydrate
(Very low carbohydrate ketogenic of less than or equal to 21 grams of carbohydrates/day)
INCLUDES: High protein foods (meat, poultry, fish, shellfish, eggs, cheese, nuts and seeds); can range from Very Low (21-70 grams of carbohydrates/day) to Moderate (between 30 and 40% of calories from carbohydrates).
AVOIDS: Sugar-containing foods and grains such as pasta, rice and bread.
PROS: Extreme weight loss, glycemic control, higher protein intake decreases appetite; increased HDL cholesterol.
CONS: Very low carbohydrate eating patterns can potentially cause constipation, headache, muscle cramps and general weakness. Low carbohydrate diets score very low on the Alternative Healthy Eating Index (high scores are highly associated with lower risk of chronic diseases), are low dietary fiber, low in B vitamins, and are associated with cardiovascular and all-cause mortality. Observational studies have linked red and processed meat consumption with type 2 diabetes.
“The reductions in carbohydrates, sometimes extreme, decrease the insulin response, and low insulin levels will slow down lipogenesis and enhance fatty acid oxidation,” Jardine said.
INCLUDES: Grass-produced meats, fish and seafood, fresh fruits and veggies, eggs, nuts and seeds; healthful oils including olive, walnut and flaxseed.
AVOIDS: Cereals, grains, legumes, dairy, refined sugar, potatoes, processed foods, salt and refined oils.
PROS: Limits processed foods and encourages healthy plant-based foods; promotes better sleeping habits and physical activity; not enough studies to show health impact.
CONS: Few have access to wild animals and produce; limiting for whole grain intake.
“The thought is our genetics haven’t changed to adapt to our current eating style, and that’s what’s causing some of the obesity and diabetes,” Jardine explained.
INCLUDES: Foods excluding the protein found in barley, rye, oats and wheat.
AVOIDS: Barley, rye, oats and wheat (which cause sensitivities in 6 to 7% of US population, 1% of the population has celiac disease and 10% of people with type 1 diabetes have celiac disease, which is an autoimmune disorder triggered by gluten).
PROS: Encourages variety of whole grains including quinoa, potatoes, rice, amaranth, millet and corn; necessary for anyone with celiac disease.
CONS: Processed gluten-free food choices tend to be higher in fat, sugar and calories; can be more expensive, no glucose reduction.
“Gluten free is really no benefit as far as glucose control,” Jardine said. “There are no studies on gluten-free diets and people with diabetes because it’s not going to make a difference.”
INCLUDES: Vegetables; whole grains, legumes, and nuts and seeds; some fish, shellfish and smaller amounts of white meat, eggs, and dairy; fresh fruit daily and concentrated sugar or honey on special occasions; wine with meals; olive oil as the main lipid.
AVOIDS: Red meat and processed foods
PROS: Encourages eating minimally processed, seasonally fresh and locally grown foods. Has been found to improve glycemic control, help with weight loss, and improve triglycerides and HDL cholesterol.
CONS: Could be high in fat and calories; watching portion sizes is important for people with diabetes.
(Vegan eating pattern)
INCLUDES: Unlimited portions of whole grains, legumes, fruits and vegetables, and one ounce of nuts and seeds per day.
AVOIDS: All animal products including meat, chicken and fish, as well as eggs and all dairy.
PROS: Focus on whole foods that are unprocessed or minimally processed; lower mortality rate than meat eaters; environmental benefits. Scores high on the AHEI and is associated with lower rates of type 2 diabetes, cardiovascular disease and some cancers.
CONS: Requires Vitamin B₁₂ supplement (already a consideration for type 2 diabetes), is a dramatic change for many individuals, education and support may be required.
“A plant-based diet could be protective against type 2 diabetes,” Jardine said. “A vegan eating pattern has also been shown to be highly effective for cardiovascular disease, reversing atherosclerotic plaque and has been effective in reducing neuropathy pain.
INCLUDES: Uncooked food (<118 degrees F) makes up 50-74% of diet (by weight); most often vegan but sometimes includes raw meat and dairy; mostly focuses on fresh organic fruits, vegetables, nuts, seeds; sprouted seeds, legumes or grains; sea vegetables.
AVOIDS: Foods cooked above >118 degrees F.
PROS: “Living food” diet is thought to increase health through plants’ enzyme activity, releasing stored nutrients; high in antioxidants, fiber and healthful fats.
CONS: Dehydrators used to cook grains; high maintenance; grains are limited.
“It is normally plant-based, so we know it’s good for diabetes,” Jardine said. “If you have a patient wants to do this, they have to be highly motivated because it’s a lot of work.”
Calorie restriction (reducing calories by 15-40% per day). “The goal is to everyday eat less calories than your body needs,” Jardine explained. “The premise is this enhances longevity and it has been found to do that in animal models.”
Alternate-day fasting (intermittent reductions of 500-600 calories/day, 5:2 day ratio).
“This is difficult when you’re trying to help patients match their medications to their diet,” Jardine told Endocrine Today. “Many people fast for religious reasons. It is important for diabetes educators and health care providers to individualize and adjust medications as needed to avoid extreme hypoglycemia and hyperglycemia.”
Healthy, lasting diet plans
“Less than 10% of patients with diabetes actually see a dietitian, according to the American Diabetes Association, so we need to do better at that,” Jardine said. “And less than 50 percent get diabetes self-management education. So people need these skills on how to incorporate a healthy eating pattern.” — by Allegra Tiver
For More Information:
Jardine M. T05. Presented at: The American Association of Diabetes Educators Annual Meeting 2014; August 6-9, 2014; Orlando, Fla.
Disclosures: Jardine reported no relevant financial disclosures.