Nutrition Case 2 Diabetes (1) PDF

NUTRITION: DIABETES Dr. Adam NMT200 Gratton MSc ND September 25, 2023 LECTURE COMPETENCIES Understand the impact of dietary factors on blood sugar regulation in individuals with diabetes. Familiarize yourself with the nutritional interventions and strategies used for effective ma...

NUTRITION: DIABETES Dr. Adam NMT200 Gratton MSc ND September 25, 2023 LECTURE COMPETENCIES Understand the impact of dietary factors on blood sugar regulation in individuals with diabetes. Familiarize yourself with the nutritional interventions and strategies used for effective management of diabetes. Develop the ability to provide personalized recommendations and educate patients about dietary modifications for diabetes management. LECTURE COMPETENCIES Explain the significance of individualized meal planning and dietary modifications for individuals with diabetes. Discuss the principles of Mediterranean-style and DASH diets as therapeutic options for diabetes management. Identify the recommended daily calorie intake and macronutrient distribution for individuals with diabetes. LECTURE COMPETENCIES Understand the role of carbohydrate counting, glycemic index/load, and portion control in managing blood sugar levels. Explain the use of artificial sweeteners and sugar substitutes in diabetes management. Discuss the importance of regular meal timing, including breakfast, for glycemic control in individuals with diabetes. Understand the impact of proteins and different types of dietary fats on diabetes management. INTRODUCTION Focus on Type 2 diabetes (T2D) although some of this information would be applicable to Type 1 diabetes (T1D) T2D accounts for 90% of all forms of diabetes Approximately one-third of people who have T2D are unaware of the diagnosis resulting in significant physiologic change occurring prior to the diagnosis RISK FACTORS Genetics Obesity Age History of gestational diabetes Sedentary lifestyle Tobacco smoking BACKGROUND: CARBOHYDRATES Three monosaccharides: - Glucose - Fructose - Galactose Physiologically important disaccharides: - Sucrose (glucose + fructose) - Lactose (glucose + galactose) - Maltose (glucose + glucose) THERAPEUTICS NUTRITIONAL OPTIONS FOR T2D PREVENTION Requires early detection or clear establishment of risk Pre-diabetes HbA1c values from 5.7 – 6.4 Presence of risk factors discussed earlier Other medical conditions causing dysglycemia (PCOS, for example) Some medications https://www.healthycanadians.gc.ca/en/canrisk THERAPEUTIC CONSIDERATIONS Nutrition therapy is a foundational intervention for T2D Goal is to maintain or improve quality of life and nutritional and physiological health HbA1c reductions of 1 – 2% can be achieved with nutrition therapy When other interventions are needed, nutrition therapy can help improve clinical and metabolic outcomes THERAPEUTIC CONSIDERATIONS All nutritional recommendations to patients should take into account ethnocultural factors - cultural foods - dining habits - lifestyles - food preparation techniques - avoided foods and cultural eating practices (fasting, feasting, etc.) WHERE TO START? Identify barriers Understand current nutritional habits and patterns Think about comorbidities How sophisticated does the patient want to get? Account for patient’s favourite foods ENERGY Most patient with T2D are overweight or obese Caloric reduction will likely need to be incorporated into a nutritional plan Even weight loss of 5 – 10% of initial body weight can improve glycemic control, insulin sensitivity, reduce hypertension and dyslipidemia MEAL TIMING More important for people with T1D or those with T2D taking insulin Insulin dosing generally needs to be adjusted for periods of fasting Intermittent fasting can be helpful but requires close monitoring and is generally difficult to do Carbohydrate intake should be spaced throughout the day MACRONUTRIENTS Available evidence is insufficient to recommend any one macronutrient breakdown for patients with T2D Macronutrient distribution will vary depending on the therapeutic diet chosen and the individual needs of the patient General recommendation of 45 – 60% carbohydrates, 10 – 35% protein, 20 – 35% fat MACRONUTRIENTS - CARBS Dietary reference intakes for carbohydrates should be 45% Reducing carbohydrate intake below this threshold tends to result in an increased consumption of saturated fats MACRONUTRIENTS - CARBS Glycemic Index (GI) - an assessment of the quality of carbohydrate- containing foods based on their ability to raise blood glucose Low GI foods have a score of 55 or less Medium GI foods score between 56 and 69 High GI foods have a score of 70 or more DIETARY FIBRE A Low GI diet is quite similar to a high-fibre diet Evidence is greatest for viscous soluble fibres from different plant sources as they slow gastric emptying and delay the absorption of glucose in the small intestine Examples: beta-glucan from oats and barley, mucilage from psyllium, glucomannan from konjac mannan, pectin from dietary pulses, eggplant, okra, and temperate climate fruits (apples, citrus fruits, berries, etc.). ADDED SUGAR Limit or eliminate, especially fructose- containing sugars Limit or eliminate sugar sweetened beverages especially if they account for more than 10% of total daily energy FAT No evidence-based recommendation for percentage of daily total energy consumption Will partly depend on overall dietary recommendations General focus on replacing saturated fats from meat with polyunsaturated fatty acids (PUFAs) Quality of fat has been shown to be more important than quantity PROTEIN General recommendations are 0.8 g per kg body weight Usual intake is 1 – 1.5 g per kg body weight representing 15 – 20% of total energy intake Increase in protein consumption generally recommended with energy-reduced diets unless patient has chronic kidney disease Protein quality is important (plant vs animal) THERAPEUTIC CONSIDERATIONS What is the best therapeutic diet? Many diets have evidence supporting their ability to improve glycemic control The presence or prevention of comorbidities is an important consideration in choice of diet in addition to patient preferences and values MEDITERRANEAN DIET From an evidence-based perspective, the best dietary approach to prevent cardiovascular disease and improve glycemic control Can be modified to account for individual needs (reduced carbohydrate intake, exclusion of alcohol, etc.) DASH AND LOW-SODIUM DIETS Dietary Approaches to Stop Hypertension Good option when the patient is already hypertensive General goal is to reduce sodium and increase potassium intake through dietary emphasis on vegetables, fruits, and low-fat dairy products, and includes whole grains, poultry, fish, and nuts. Smaller amounts of red and processed meat, sweets, sugar- containing beverages, total and saturated fat, and cholesterol, and larger amounts of potassium, calcium, magnesium, dietary fibre, and protein than typical Western diets DASH AND LOW-SODIUM DIETS Some evidence to suggest improvements to glycemic control Much more evidence specifically for reducing blood pressure Possible increased mortality risk if sodium intake is below 1500 mg per day KETOGENIC DIET Good option for improving glycemic control and facilitating weight loss Difficult for long term engagement No evidence that it improves mortality with T2D Conflicting evidence with whether or not it reduces cardiovascular risk SAMPLE QUESTION Which of the following dietary recommendations is the safest and most effective for improving glycemic control in a patient with type 2 diabetes requiring insulin? A. Engage in intermittent fasting with an 8-hour eating window B. Follow a ketogenic diet C. Follow a moderate-carbohydrate diet with regular meal timing D. Follow a low sodium diet consuming no more than 1000 mg per day