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September 2014
Special Edition
Newsletter Special Edition - June 2014 - PFG Springfield
ARMSTRONGMARKETING
A Plant-Based Update for the
Diabetes Professional
Special Edition for Diabetes Education Services & Beverly Thomassian, RN, MPH, CDE, BC-ADM
September 2014
Every day you are on the forefront of The following will help provide you
selling health. Understanding the power of information on these foods and will
a plant-based diet to improve diabetes support you in supporting your patients.
management and in some cases reverse
diabetes is crucial in the care of your
patients. Health begins in our patient’s
kitchen, on their plate, in their pantry and
at their dining room table. Good food
choices promote good heath, and
learning what to eat and how to cook is
a vital part of wellness and
diabetes management. Many of us
simply do not know how to
prepare great tasting meals and
do not fully understand the impact
of our food choices.
The Academy of Nutrition and
Dietetics reports vegetarians and vegans
have lower weights, blood pressure and
cholesterol levels than non-vegetarians.
They also report decreased rates of type
2 diabetes, colon cancer, prostate cancer,
hypertension and heart disease.
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September 2014
Special Edition
Table of Contents
Plant-Based Articles Plant-Based Recipes
Preparing to Prescribe Plant-Based Very Primo Pasta ................................................ 24
Diets for Diabetes Prevention and
Treatment ................................................................. 3 Parmesan Cheese ............................................. 24
The Protein Myth ................................................. 12 King Kale and Purple Cabbage ............... 24
Breaking Medical News Green Monster Smoothie ............................ 25
Fruits & Vegetables May Prevent Seared Cauliflower........................................... 25
Early Death .............................................................. 19 Black Bean Chili .................................................... 25
Fiber Extends Life After A Heart Toasted Brown Rice ......................................... 25
Attack ........................................................................... 19
Plant-Based Foods Prevent Hip Pumpkin Steel Cut Oatmeal ....................... 26
Fractures .................................................................. 20 Chickpea Salad and Miso Dressing ..... 26
Animal-Based Protein May Lead to Portobello Fajitas .............................................. 26
Diabetes .................................................................... 20
Baked Potato with Vegetables and
Vegetarians/Vegans Have Low Heart Cheesy Sauce ....................................................... 27
Disease Risk ............................................................. 21
Mock Tuna Salad ................................................ 27
Beans Benefit Heart Health ......................... 21
Green Glamour Smoothie............................ 27
A Plant-based Diet Reverses Heart
Disease ....................................................................... 22 Black Bean Brownies ........................................ 28
Plant-Based Diets Are Better for Broccoli Salad ........................................................ 28
Weight Loss ............................................................ 23 Sweet and Sour Vegetable Stew .......... 29
Quinoa ........................................................................ 29
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September 2014
Special Edition
Preparing to Prescribe Plant-Based Diets for Diabetes
Prevention and Treatment
Caroline Trapp, MSN, APRN, BC-ADM, CDE, and Susan Levin, MS, RD
4
The number of people worldwide with type 2 lower prevalence rates of type 2 diabetes,
1 5 6
diabetes is expected to double by 2030. In the cardiovascular disease (CVD), hypertension,
7,8
United States, diabetes affects ~ 26 million and obesity and reduced medical care
people of all ages, about one-fourth of whom usage.9 Both the American Academy of
are not yet diagnosed.2 Despite the availability Nutrition and Dietetics and the American
of a wide range of pharmacological Diabetes Association (ADA) now include well-
treatments and the best efforts of diabetes planned, plant-based eating patterns
educators and other health care (vegetarian and vegan) as a meal-planning
professionals, good control of diabetes and its option in their nutrition recommendations for
10,11
comorbidities remains elusive for much of the people with diabetes. This article provides
population, as evidenced by rates of a brief discussion of research on plant-based
cardiovascular morbidity and mortality that eating pat- terns, relevant nutrition issues,
are two to four times higher than those of and practical applications for clinicians.
people who do not have diabetes.2
Prevention of Type 2 Diabetes
Although dietary habits and body weight play Diabetes prevalence in the United States is
undisputed roles in type 2 diabetes, the question lower among vegetarians than non-
12–15
of what eating pattern best addresses glycemia, vegetarians. In two large Adventist cohort
cardiovascular risk factors, and weight control studies (n = 25,698 and n = 60,903), the
remains controversial. The uniform, calorie- prevalence of diagnosed diabetes was 1.6–2.0
controlled diabetic diet plans of the past have times higher among non-vegetarians than
12,15
been replaced by individualized meal-planning among vegetarians or vegans. Part of the
approaches, and in more recent years, nutrition difference is attributable to higher body
guidance has focused on carbohydrate weight among non-vegetarians, but much of
counting and minimizing saturated and trans the difference persists after adjustment for
fats. With the release of the U.S. Department of body weight.
Agriculture’s 2010 Dietary Guidelines for
3 14
Americans came praise for plant-based eating A 2009 study found that, among a range of
patterns, which have been extensively studied diets from vegan to non-vegetarian, as
for weight management and disease prevention consumption of animal products increased,
and treatment. so did diabetes prevalence, ranging from
2.9% in vegans to 7.8% among individuals with
Individuals following a plant- based eating unlimited consumption of animal products.
pattern typically consume fewer calories and
less fat, saturated fat, and cholesterol and Data from the Harvard Women’s Health Study,
have lower BMIs than non-vegetarians. They the Nurses’ Health Study the Health
also consume more fiber, potassium, and Professionals Follow-Up Study, and other
15
vitamin C. trials were part of a systematic review of 12
cohort studies that found that men and
In prospective studies of adults, compared to women who ate the most meat had the
non-vegetarian eating patterns, vegetarian highest risk of type 2 diabetes. Intake levels
eating patterns have been associated with of red meat, processed meat, and fish were
13–18
all associated with risk of type 2 diabetes.
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September 2014
Special Edition
These studies suggest that the total amount Although medication changes were not a goal
of meat consumed may be more important of the study, requirements for medication also
than the type of meat. dropped; 43% (21 of 49) of those following the
vegan diet reduced their diabetes medications
Treatment of Type 2 Diabetes compared to 26% (13 of 50) in the conventional
Plant-based eating patterns combined with diet group. After 74 weeks, improvements in
exercise have been found to improve diabetes glycemia and plasma lipid concentrations
control and reduce the need for medication in remained greater in the vegan group.23
19,20
intervention trials as far back as 1976. A more An assessment was conducted of the nutrient
21
recent study funded by the National Institutes intake and dietary quality of participants in the
of Health set out to examine the effect of a two arms of the study described above. Using
plant-based eating pattern isolated from the Harvard School of Public Health’s Alternative
effect of exercise on type 2 diabetes. This Healthy Eating Index (AHEI), a nine-component
prospective, randomized study compared 49 dietary quality index that predicts the risk of
participants on a very-low-fat (10%), low–glycemic cardiovascular and other major diseases,24
index (GI), vegan (legumes, fruits, vegetables, and Turner-McGrievy et al.25 found that both
whole grains) diet to a control group of 50 nutritional approaches resulted in beneficial
participants following individualized diet plans decreases in total calories, total fat, trans fat,
that included animal products and were based and cholesterol.
on macronutrient recommendations from the
ADA’s 2002 nutrition principles and The vegan group increased intake of fruits and
recommendations.22 Those recommendations
included the following energy intake distribution vegetables, soluble and insoluble fiber, and
and cholesterol levels: carbohydrate and several micronutrients and demonstrated
monounsaturated fat together should provide improvements in AHEI score in all categories. The
60–70% of caloric intake, protein should provide AHEI score for those in the conventional diet
15–20% calories, saturated fat should account group remained unchanged.23
for < 7% of calories, and cholesterol should be
The study found that those in the vegan arm
limited to ≤ 200 mg/day. consumed adequate vitamin B (through fortified
12 foods) and iron, two nutrients often cited as
In the vegan group, portion sizes, carbohydrate concerns for those following vegan eating
intake, and energy intake were unrestricted; patterns. The authors concluded that both
subjects in the control diet group with a BMI ≥ 25 groups had difficulty meeting the recommended
kg/m2 (all but three) were prescribed an energy intake levels for vitamins D and E, calcium, and
intake deficit of 500–1,000 kcal/day. All potassium and consumed excessive sodium,
participants were instructed not to modify their although less than at baseline.
exercise habits during the intervention period.
CVD Prevention and Treatment
Both groups experienced improvements at 22 Low-fat, plant-based eating patterns have shown
weeks. However among medication-stable efficacy in reducing LDL cholesterol
participants after 22 weeks, the vegan arm had concentrations and result in significant
greater weight loss (14.3 vs. 6.8 lb, P < 0.001) and a reductions in CVD risk and cardiovascular
greater reduction in A1C (1.23 vs. 0.38 percentage 5,6,21,26–29 6
events. Appleby et al. studied
points, P = 0.01). Medication-stable participants in hypertension across a range of eating patterns
the vegan group lowered their LDL cholesterol and found that blood pressure control was
levels by an average of 22.6 mg/dl (21.2%) inversely proportional to the amount of animal
compared to an average reduction of 10.7 mg/dl products consumed, with those abstaining from
(9.3%) in the conventional group (P = 0.02). all animal products achieving the most significant
improvements. In a review of 27 randomized
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