4/16/2018

Plant-Based Eating:  Helping Clients Succeed

Suzy Sorensen RD, LD, CDE April 19, 2018

Plant-Based Eating

 Meals are composed primarily of plant foods: , , , & .

Plant-Based Variations

 Vegan (no animal products)

 Vegetarian (dairy +/or egg)

 Pescatarian (adds fish to vegetarian diet)

 Flexitarian or Semi-vegetarian (willing to occasionally eat meat)

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Why Choose Plant-Based?

 Compassion

 Improve health

 Environmental concerns

A Growing Trend

Helping Clients Succeed

#1 Create balanced meals #2 Aim for variety #3 Choose whole foods #4 Keep it Interesting # Supplement if needed

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#1 Create Balanced Meals

+ +

+ +

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Embrace Plant Protein  Beans/legumes (black bean, baked bean, lentil…)  Soy Foods (, , , edamame, TVP…)  Meat Analogs (not dog, , chix strip…)  Dairy Alternatives (soy or pea protein milks, yogurts…)  (seitan, …)  Nuts (peanut, almond, nut …)  Seeds (sun seeds, pumpkin seeds…)  Whole Grains (oatmeal, bread, , brown rice…)

Plant Proteins

Plant Proteins

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Dairy Alternatives

Egg Alternatives

#2 Aim for Variety

 “Veganize” favorite recipes trying different substitutes for animal product

 Try new recipes: online searches, videos, cook books

 Try veg-friendly restaurants to get ideas (vegguide app)

 Go to a vegan pot-luck to try new foods

 Eat the rainbow & in season

 Try meal delivery (Purple Carrot, Hungry Root, Daily Harvest, Green Chef…) to get new ideas

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#3 Eat Whole Foods (mostly)

#4 Keep it Interesting

#5 Supplement if Needed

 Vitamin D: 600-4000 IU/day  Summer Sunshine! 20-30 minutes/day

 B12: 25-100 mcg/day or 1000 mcg 2x/week  Fortified foods: bars, plant milks, Braggs

 Omega 3: 200-300 mg 2-3x/week  Walnuts, flaxseed, hempseed, chia seed, Ripple

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Assess... Assess Micronutrient Intake

Calcium Iron  Plant foods:  Soy beans/meat  collards, turnip & mustard analogs greens, okra, bok choy, kale, calcium set tofu,  Beans & Legumes , blackstrap molasses, figs, chia,  Seeds and nuts sesame seeds, tahini, almond butter  Iron-fortified foods (, bars) Fortified foods: plant milks, cereals, bars, yogurts, juice

Assess Micronutrient Intake

Zinc Iodine  RDA 8 mg women, 11 mg  RDA 150 mcg/day, 220 in men pregnancy 250 in lactation

 Plant eaters may need  Important for women of more child bearing age

 Sources: pumpkin seeds,  Sources: salt (1/2 tsp of hummus, tofu, tahini, iodized/day), supplement, cashews, lentils, black navy beans, strawberries, beans, quinoa, oatmeal potatoes, prunes, corn, seaweed*

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Health Benefits

“…appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle…”

“Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of , , whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that…contribute to reduction of chronic disease.” ~Academy of Nutrition and Dietetics Position Paper on Vegetarian Diets (Dec. 2016)

Healthy Weight

Mean BMI of different types of vegetarians in AHS-2 study cohort

Healthy Hearts

 Dr. :  Tested lifestyle modification in patients with known heart disease.  Vegetarian diet  No smoking  Manage stress  Walking  Results  TC 24%, LDL 37%, weight 22#  Angiogram showed reversal of vessel disease

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Healthy Hearts

 Average total cholesterol Average LDL Non veg = 194 117 Vegetarian = 177 103 Vegan = 146 67

 Plant-based diet reduces risk of ischemic heart disease

Healthy Hearts

 Hypertension  Vegetarians have 55% less risk of developing HTN

 Protective effects  Mediterranean  DASH

Cancer Risk

 Vegetarians had 8% risk reduction of overall cancer  23% risk reduction for cancers of the GI  35% risk reduction for prostate cancer

 AICR: “Plant-based foods are the source for many cancer fighting compounds. Be sure to fill your plate 2/3 (or more) with a variety of vegetables, fruits, whole grains, and beans and 1/3 (or less) of animal protein.”

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Diabetes

Prevalence (%) of self-reported type 2 diabetes in AHS-2 study population by diet

 Studies on intramyocellular lipid

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PCRM 12 Week Pilot Study

 Can glycemic and lipid control improve through vegan diet…without exercise?

Control Experimental (LF-C) (LF-V) BG 12% 28%

Weight 3.8 kg 7.2 kg

Reduce or 0 4 stop meds

PCRM 14 Week Second Study

 Design  59 Subjects  Change diet, not activity level  No limit on energy intake  Control: NCEP Step II Guidelines  Experimental: vegan, low fat Results  All lost weight, but vegans lost ~1#/week continuously  24% increase in sensitivity in experimental group

Plant-Based Dietary Intervention in T2D

 Funded by a grant from the NIH  Researchers from PCRM, George Washington University, University of  99 people with type 2 diabetes were followed for 22 weeks  Computer randomly assigned subjects to the control or experimental group

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 Control (50)

 ADA Guidelines:  Met with RD to individualize meal plan to control carbs, fat, and decrease calories for weight loss

 Experimental (49)  Vegan  Low-Fat/Oil  Low-GI

 No carb restriction

 No calorie restriction

 Daily multi-vitamin

Typical Day’s Meals

 Breakfast  Lunch  Oatmeal with raisins  Chunky veggie chili  Blueberry pancakes  Bean burrito  Breakfast tofu  Veggie burger scramble  Salad  Cantaloupe  Baked sweet potato  Rye toast or

whole bagel with jam

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Typical Day’s Meals

 Snack  Dinner  Banana  Lentil soup with crackers  Fruit smoothie  Spaghetti with veggie balls  Sweet and sour tempeh on rice

 Steamed broccoli  Apple slices

Low-Fat Vegan Meal Plan

Low-Fat Vegan Meal Plan

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Low-Fat Vegan Meal Plan

Plant-Based Dietary Intervention in T2D

Measure Control Experimental

A1C  0.4%  1.2%

Weight  3.1 kg  6.5 kg

LDL  9.3% 21.2%

Reduce or stop 13/50 (26%) 21/49 (43%) DB meds

(those with no medication changes, n = 24 vegan, 33 ADA)

8.1

7.9

7.4 7.5

7.2

6.8

P = 0.01

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New Approach for T2D: 3 Key Factors

 Vegan  No animal products

 Low in fats and oils  Calories less concentrated  “Unclog” cells

 Low Glycemic Index  Avoid rapid rise in blood glucose

Practical Application

Carb Counting Low-Fat Vegan  Continue eating the  Avoid animal foods you are products and only familiar with eat plant foods  Control food portions  Don’t add fat or oil by measuring and reading labels  Eat as much as you  The focus is on how want much you eat  Choose low GI foods

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Rx for Type 2 Diabetes: A Low-Fat Vegan Diet in Five Easy Steps:

Eliminate Animal Products: Limit High-Fat Foods: Steer clear from meat, fi sh, Avoid oils, pastries, fried and dairy products (yogurt, foods and limit olives, milk, eggs, and cheese). avocados, nuts and seeds. Look for foods that have three grams of fat or less per serving.

Supplement with vitamin B12:

You have several Fill Up on Fiber: options to get your daily dose: a Aim to consume 40 multivitamin, a B12 grams of fi ber a day supplement, or from vegetables, fortifi ed foods. fruits, w hole grains, and legumes.

Favor Low- Glycemic Options:

The glycemic index gives you an extra bonus. It identifi es foods that increase blood sugar rapidly and allow s you to favor foods that stabilize it. High-glycemic-index foods Low-glycemic-index foods

sugar, w hite potatoes, w hite and w heat bread, pumpernickel or rye bread, oats, bran cereals, most fruits, sw eet potatoes, pasta, rice, and most cold cereals barley, couscous, beans, peas, lentils and most vegetables

Practical Application

 Keep it simple!  Tastes can change.  3 week trial, jump in with both feet  Health care team assure safety:  Balanced nutrition  Daily vitamin B12  Hypoglycemia teaching

Specific Teaching Points

 Avoid meat, dairy, eggs: use low-fat plant-based alternatives

 Avoid adding fats or oils and skip high-fat foods:  ≤ 3g fat/serving or <5g fat/entrée

 Low GI: choose rye or pumpernickel bread, sweet potato, hot

 New 4 Food Groups: legumes, fruit, veg, whole grains = balance and fiber

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Case Study

 Mr. G 58 yo M, T2D x 2 years, NAFL, high lipids, obesity Diet= fast food 2x/day Metformin 500mg BID, check BG <1x/day  A1C 8.8%, FBG 192  TC 218  LDL 123  HDL 33  TG 309  Weight 249#

Case Study

3 Weeks Later 3 Months After Initial

 Past 2 weeks all BG <105  A1C 6.7%

 Weight 233# (16#)  Weight 219# (30# total)

 Highly motivated to  Highly motivated continue LFV meals  Fatty liver resolved by US  Had a few dietary questions  TC, LDL in goal, TG by 50%  Provider d/c’d Met & reduced lipid med

Case Study

Mr. R

 50yo, new dx T2D, high lipids, obesity, sedentary job

 Family Hx of DB in grandfather, aunt

 Diet= “lots of donuts”, candy, chips, pizza A1C= 14.6%  Wt 347#

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Case Study

 6 months later

 Findings  FBG 74-109* (only 1 >100)  Pre-meal 79-110  2 hour post 80-136  Weight 308# ( 39#)  Jogs 2 miles/day & walking  Continuing with low-fat vegan diet

Case Study

 Mr. A  64 year old admitted for DKA and diagnosed with T2D  A1C= 13.3%  Weight at diagnosis 285.5#  Discharged on Glargine 50 units/day & mealtime 25-40-40-0

Summary

 A low-fat vegan diet is simple, safe, and effective.

 Our patients want to improve health.

 Patients like the plant-based approach!

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Recommended

 Certificate of Training Program: (eatright.org)  Vegetarian Nutrition Dietetic Practice Group (VNDPG.org)  AADE Community of Interest: Plant Based Nutrition (myaadenetwork.org)  Nutritioncme.org (pathogenesis of T2D)

Resources:Sites

 Pcrm.org

 Vegetariannutrition.net

 Vrg.org

 Nutritionfacts.org

Resources: Books

 Becoming Vegan by Brenda Davis, RD & Vesanto Melina MPH, RD  Vegan for Life by , RD & Virginia Messina, MPH, RD  Dr. Neal Barnard’s Program for Reversing Diabetes- also a new associated cookbook

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