Diabetes and Nutrition: An Anti-inflammatory Approach

1. Diabetes and Nutrition:An Anti-inflammatory Approach Amy Borger, RD, CDE

2. Today’s Discussion • 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

3. Diabetes and the Inflammation Theory • 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

4. How Can Nutrition Help? • 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

5. 2015-2020 Dietary Guidelines • Executive Summary • Follow a healthy eating pattern across the lifespan • All food and drink choices matter • Focus on variety, nutrient density, and amount • Choose a variety of nutrient dense foods across all groups • Limit calories from added sugars and saturated fats and reduce sodium • Cut back on foods that are high in these components • Shift to healthier food and beverage choices • Support healthy eating patterns for all • Create healthy eating patterns in homes, schools, communities

6. 2015 Dietary Guidelines Committee Advisory Report • 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

7. The Diabetes RESET Approach • 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

8. RESET Sugar Intake • Americans should limit sugar intake to no more than 10% of daily calories (~200 cals or 12 teaspoons) • WHO recommends half that amount

9. RESET Your Beverage • Water is the beverage of choice • One or two cups of coffee a day ok • Watch the coffee drinks • Skip soda and sugary beverages

10. RESET Inflammation • 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

11. RESET Sleep • 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

12. RESET Muscles • 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

13. The Glycemic Index • 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

14. The Glycemic Index • 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

15. The Glycemic Index • The higher the number, the greater the blood glucose response • High: 70 or more • Medium:56-69 • Low: 55 or less

16. Example of Low GI Foods • Oats • Barley • Bulgar • Beans • Lentils • Other Legumes • Pasta • Apples • Oranges • Milk • Yogurt • Ice Cream • Oat Bran Bread

17. The GI Controversy • 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

18. The Glycemic Load • 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

19. Calculating Glycemic Load • Glycemic Index score x grams of CHO/100

20. Worst Foods for Inflammation • 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

21. Worst Foods for Inflammation • 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

22. Worst Foods for Inflammation • 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

23. Worst Foods for Inflammation • 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

24. What About Milk? Not All Fats are Created Equally • 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

25. What About Milk? • 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

26. Anti-inflammatory Foods • 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

27. Anti-inflammatory Foods • 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

28. Gut Health • 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”

29. Tying it All Together • 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

30. Thank you! Questions?

31. References/Resources • International Immunology, 2012 June24 (6) 339-46 • US Dept of Health and Human Services & US Dept of Agriculture 2015-2020 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

32. References/Resources • 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