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: vegetable, fruit, grains, & legumes. 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) 1 4/16/2018 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 2 4/16/2018 #1 Create Balanced Meals + + + + 3 4/16/2018 Embrace Plant Protein Beans/legumes (black bean, baked bean, lentil…) Soy Foods (tofu, tempeh, soy milk, edamame, TVP…) Meat Analogs (not dog, veggie burger, chix strip…) Dairy Alternatives (soy or pea protein milks, yogurts…) Wheat Gluten (seitan, mock duck…) Nuts (peanut, almond, nut butter…) Seeds (sun seeds, pumpkin seeds…) Whole Grains (oatmeal, bread, quinoa, brown rice…) Plant Proteins Plant Proteins 4 4/16/2018 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 5 4/16/2018 #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 nutritional yeast Omega 3: 200-300 mg 2-3x/week Walnuts, flaxseed, hempseed, chia seed, Ripple 6 4/16/2018 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 soybeans, blackstrap molasses, figs, chia, Seeds and nuts sesame seeds, tahini, almond butter Iron-fortified foods (cereals, 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* 7 4/16/2018 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 vegetables, fruits, 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. Dean Ornish: 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 8 4/16/2018 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.” 9 4/16/2018 Diabetes Prevalence (%) of self-reported type 2 diabetes in AHS-2 study population by diet Studies on intramyocellular lipid 10 4/16/2018 PCRM 12 Week Pilot Study Can glycemic and lipid control improve through vegan diet…without exercise? Control Experimental (LF-C) (LF-V) Fasting 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 insulin 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 Toronto 99 people with type 2 diabetes were followed for 22 weeks Computer randomly assigned subjects to the control or experimental group 11 4/16/2018 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 grain bagel with jam 12 4/16/2018 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 13 4/16/2018 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 14 4/16/2018 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 15 4/16/2018 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 cereal New 4 Food Groups: legumes, fruit, veg, whole grains = balance and fiber 16 4/16/2018 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# 17 4/16/2018 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.