diabetes, covid-19 and more the diet connection
TRANSCRIPT
Diabetes, COVID-19
and More –
The Diet Connection
Caroline Trapp, DNPDirector of Diabetes Education & Care
Physicians Committee for Responsible Medicine
NMDOH 11/20/20
Common Problems for our Senior Citizens
– What Do They Have in Common?
• Type 2 Diabetes
• Heart Disease
• Alzheimer’s Disease
• COVID-19
CERTAIN DIET PATTERNS HAVE AN IMPACT
• SAD Diet linked to higher rates of diabetes, heart disease, Alzheimer’s Disease
• Plant-based diet linked to lower rates of diabetes, heart disease and Alzheimer’s Disease
COVID-19
New York COVID-19 Patients
Obesity41.7%
Diabetes33.8%
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes
among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020 April 22 [Epub
ahead of print].
Hypertension
56.6%
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020 April 22 [Epub ahead of print].
12 New York
area hospitals
5,700 COVID-19
patients
Health Issues Can Make COVID-19 Worse
COVID-19 Severe DiseasePrevalence in Hospitalized Patients
Under-weight
0%
Over-weight
29%
Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a
designated hosptial in Shenzhen, China. Diab Care. 2020;43:1392-8.
Normal-
weight
19%
Obese
39%
Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China.
Diab Care. 2020;43:1392-8.
COVID-19 Severe Disease in China
Prevalence in Hospitalized Patients
Covid-19 Mortality in People with Diabetes
Diabetes
No Diabetes
7.8%
2.7%
Zhu L, She ZG, Cheng X, et al. Association of blood glucose control andoutcomes in patients with COVID-19 and pre-existing type 2 diabetes.Cell Metab. 2020;31:1-10. June 2, 2020.
COVID-19 Death Rates
Zhu L, She ZG, Cheng X, et al. Association of blood glucose control and outcomes in patients
with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31:1-10. June 2, 2020.
COVID-19 Mortality in People with Diabetes
0
5
10
Poor Control
11%
Good Control
1%
Zhu L, She ZG, Cheng X, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31:1-10. June 2, 2020.
Dramatic Lessons about
Nutrition
• Norway
• U.S.
• Okinawa
Norway During World War II
What has changed?
Estimated Per Capita Sweetener Consumption
(Pounds per capita)
1909: 123.9 lb
2012:181.5 lb
2004: 201.5 lb
U.S. Per Capita Meat Intake (lb)
Source: US Department of Agriculture, Economic Research Service,
https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/. Accessed
October 4, 2018.
1909: 10.4 lb
2012:56.6 lb
2006: 60.9 lb
U.S. Per Capita Chicken Intake (lb)
Source: US Department of Agriculture, Economic Research Service,, https://www.ers.usda.gov/data-products/food-
availability-per-capita-data-system/. Accessed October 5, 2018.
1909: 3.8 lb
2012:33.5 lb
1960:8.3 lb
U.S. Per Capita Cheese Intake (lb)
Source: US Department of Agriculture, Economic Research Service,
https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/. Accessed October 5, 2018.
Much of what I was taught
about nutrition was wrong…
Which people live the longest?
Why?
Okinawa Longevity Diet
An Educator Gets Educated
Weight loss, better blood sugar, better blood pressure, off medication, less joint pain, more energy.
Before Now
What is a Plant-Based Diet?
BreakfastOatmeal with cinnamon& raisins, coffee with soy milkbanana
Protein = ~17 grams
LunchBean burrito, Steamed broccoliApple
Protein = ~ 20 grams
DinnerWhole wheat pasta marinara,minestrone soup, whole wheat breadOrange
Protein = ~30 grams
Total Protein = ~67 gramsFiber = ~ 40 grams
Fiber is Filling
Fiber tells the brain you’re full.
Approved June, 2017:
RESOLVED, That our American Medical Association hereby calls on US hospitals to improve the health of patients, staff, and visitors by
(1) providing a variety of healthful food, including plant-based meals and meals that are low in fat, sodium, and added sugars,
(2) eliminating processed meats from menus, and
(3) providing and promoting healthful beverages.
Chickpea and BeanThe Plant Powered Couple
Chickpea and BeanThe Plant Powered Couple
Kim & Marc Ramirez
Plant-Based Eating:
The Power Plate
Good nutrition has never been
more important.
Your work has never been more
important.
Documentaries - For More Inspiration: …
Check Out These Resources:
• Chickpeaandbean.com
• NativePowerPlate.org
• ByAnyGreensNecessary.com/starterguide
On your iPhone or Android
Free Phone App – Meal Plans, Recipes,
Grocery Lists, Celebrity Videos
COMPLETE NUTRITION
Caroline Trapp, DNP
Director of Diabetes Education & Care, Physicians Committee
NUTRITION BASICS
1. Eat whole plant foods2. Avoid animal products3. Minimize oils 4.Take vitamin B12,
consider vitamin D
FRUITS
FRUIT: MYTH VS. FACT
Myth: Sugar in fruit is bad for you.
Fact: Sweet fruits are superfoods
Myth: I have diabetes, so I can’t have fruit.
Fact: Fruit is good for people with
diabetes
Du H, Li L, Bennett D, et al. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PloS Medicine. Published online April 11 2017
FRUIT: THE ULTIMATE FAST FOOD
Wash and eat:
• Bananas
• Blueberries
• Grapes
• Raspberries
• Strawberries
• Pears & apples
• Peaches & plums
5-Minute prep:
• Melons
• Kiwis
• Mangoes
• Pineapple
• Oranges & citrus
• Kiwis
• Pomegranates
Du H, Li L, Bennett D, et al. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PloS Medicine. Published online April 11 2017
WHOLE GRAINS
• Oats
• Corn (including
popcorn)
• Brown Rice
• Quinoa
• Buckwheat
• Amaranth
• Sorghum
• Millet
• Wheat (cracked wheat,
wheat berries, durum,
bulgur)
• Wheat varieties (spelt,
kamut, farro)
• Barley
• Rye
* Yellow = gluten free grains
WHAT ARE MY OPTIONS?
WHAT’S A WHOLE GRAIN?
Image: https://wholegrainscouncil.org/what-whole-grain
• Reduced risk of disease:
– Stroke
– Type 2 diabetes
– Heart disease
– Colon cancer
– High blood pressure
– Lower cholesterol
Jonnalagadda, S., Harnack, L., Liu, R., McKeown, N., Seal, C., Liu, S., & Fahey, G. (n.d). Putting the Whole Grain Puzzle Together: Health Benefits Associated with Whole Grains Summary of American Society for Nutrition 2010 Satellite Symposium. Journal Of Nutrition, 141(5), 1011S-1022S.
WHAT CAN WHOLE GRAINS DO
FOR YOU?
VEGETABLES
WHAT CAN
VEGGIES DO?
Help lower BPRich in folate for moodHelp you stay regularFill you upImprove bone densityReduce cancer risk
• Eat all the colors of the
rainbow
• Raw and cooked
VARY YOUR VEGGIES
Images: www.Veggie-Quest.com https://dinnerthendessert.com/rainbow-roasted-vegetables/
• Start meals with a salad
• Have a green smoothie
at breakfast
• Stir baby spinach into
soups or pasta dishes
• Snack on veggies while
you cook
INCLUDE THEM AT EVERY MEAL
LEGUMES
LEG-WHAT?
• Rich in protein, iron, fiber
• Control hunger and blood sugar—
even the day after you eat them!
• Lower cholesterol
• Make it easy to “go”
• Feed good gut flora
BEANS ARE SUPERFOODS
Nilsson A, Johansson E, Ekström L, Björck I. Effects of a brown beans evening meal on metabolic risk markers and appetite regulating hormones at a subsequent standardized breakfast: a randomized cross-over study. PLoS ONE. 2013;8:e59985. WinhamDM, Hutchins AM. Baked bean consumption reduces serum cholesterol in hypercholesterolemic adults. Nutrition Research. 2007;7:380-386.
• Hearty chili
• Tasty taco, burrito,
enchilada filling
• Veggie burgers
• Salad topper
• Healthy chip dip or
sandwich spread
• Black bean brownies!
IDEAS FOR ENJOYING BEANS
5 Pro Tips
1. Start with ½ cup of beans at a time.
2. Soak dry beans 8-12 hours before cooking.
3. Drain the soak water; cook in fresh water.
4. Rinse canned/cooked beans.
5. Eat separately from fruit.
WHAT ABOUT GAS?
This Photo by Unknown Author is licensed under CC BY-NC
SPECIFIC
NUTRIENTS
WHERE DO YOU GET YOUR
PROTEIN?
Protein
Protein Protein
Protein
BreakfastOatmeal with cinnamon& raisins, coffee with soy milkbanana
Protein = ~17 grams
LunchBean burrito, Steamed broccoli
Protein = ~ 20 grams
DinnerWhole wheat pasta marinara,minestrone soup, whole wheat bread
Protein = ~30 grams
Total Protein = ~67 grams
HIGH-PROTEIN PLANT
FOODS
• B12 supplement required on a plant-
based diet
• Recommended for everyone 50+ or
on certain medications
• For nerve and blood health
• RDA: 2.4 mcg/day
• Supplement: 100 mcg/day or per your
healthcare provider
VITAMIN B12
IRON
• RDA for adults:
– Men 19+ / Women 51+ years: 8 mg/day
– Women 19-50 years: 18 mg/day
• Vegetarians consume as much or more iron
than non-vegetarians.
• Plant-based iron is safer.
• Vitamin C boosts iron absorption.
• Good sources: Beans, greens, whole grains
Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.
CALCIUM
RDA for adults:
• 19-50 years: 1,000 mg/day
• 51+ years: 1,200 mg/day
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. (2011).British Dietetic Association. Food fact sheet: calcium. https://www.bda.uk.com/foodfacts/Calcium.pdf. Published July 2017. Accessed April 25, 2018.
CALCIUM IN BEANS AND
GREENS(MILLIGRAMS PER CUP)
Black beans 103 Broccoli 94
Great northern beans121 Collards 358
Navy beans 128 Kale 94
Soybeans 175 Mustard greens150
Tofu 512 (Spinach 244)
White beans 161 (Swiss chard 102)
HOW MUCH CALCIUM IS
ABSORBED?
Brussels Sprouts 64%
Mustard Greens 58%
Broccoli 53%
Kale 40-59%
Fortified Orange Juice 36-38%
Milk (for comparison) 32%
Weaver CM, Plawecki KL. Am J Clin Nutr 1994;59(suppl):1238S-41S.Heaney RP, Weaver CM. Am J Clin Nutr 1990;51:656-7.
WHAT ABOUT GETTING
CALCIUM FROM DAIRY?
• Higher intake of dairy linked to:
– Bone and hip fractures
– Premature death
– Heart disease
– Some cancers
Michaelsson, K., Wolk, A., Langenskiold, S., Basu, S., Warensjo Lemming, E., Melhus, H., & Byberg, L. (2014). Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ, 349(oct27 1), g6015–g6015. https://doi.org/10.1136/bmj.g6015
Aune, D., Navarro Rosenblatt, D. A., Chan, D. S., Vieira, A. R., Vieira, R., Greenwood, D. C., … Norat, T. (2015). Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. The American Journal of Clinical Nutrition, 101(1), 87–117. https://doi.org/10.3945/ajcn.113.067157
IODINE
• RDA for adults: 150 mcg
• Good sources: Iodized salt, vegan sushi,
sea vegetables (e.g. nori, kombu, dulse)
– Sea vegetables may provide too much
• Vegan women of childbearing age
recommended to supplement 150 mcg/d
• Tips:
– When using salt at home, use iodized.
– Eat vegan sushi or sea veggies a few
times per week.
Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.
VITAMIN D
• RDA for adults:
–19-70 years: 600 IU/day
–71+ years: 800 IU/day
• Some recommend 1,000-2,000 IU
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. (2011).National Institutes of Health Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Updated March 2, 2018. Accessed April 26, 2018. Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.
VITAMIN D
• Sources: Sun, supplements, fortified
foods
• Two types: D2 and D3
–Equivalent when taken by mouth
• Deficiency → osteomalacia,
osteoporosis
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. (2011).National Institutes of Health Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Updated March 2, 2018. Accessed April 26, 2018. Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.
The major cause of the most common
chronic diseases is diet. (WHO, 2003).
7 out of 10 deaths in the U.S. are from
chronic diseases that can be prevented
through proper nutrition and other lifestyle
changes (Kung, et al., 2008).
x x x x x x x
TAKE-HOME POINTS
1. Eat whole plant foods: Fruits, veggies, whole grains, beans
2. Avoid animal products3. Minimize oils4.Take B12 (and vitamin
D if needed)