Emerging Trends in Nutrition: Understanding Today’s Popular Diets as they Relate to Diabetes Jennifer Sygo, M.Sc., RD Registered Dietitian and Sports Nutritionist, Cleveland Clinic Canada Nutrition Columnist, National Post Author, “Unmasking Superfoods” (HarperCollins Canada 2014)
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Emerging Trends in Nutrition: Understanding Today's Popular Diets as they Relate to Diabetes
Presentation by Jennifer Sygo (MSc, RD) at the Diabetes Perspectives... Ages and Stages Symposium (September 29, 2014)
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Emerging Trends in Nutrition: Understanding Today’s Popular Diets as they
Relate to Diabetes
Jennifer Sygo, M.Sc., RD Registered Dietitian and Sports Nutritionist, Cleveland Clinic Canada
Nutrition Columnist, National Post Author, “Unmasking Superfoods” (HarperCollins Canada 2014)
…as recently as 10 years ago…
1Moore et al, Cochrane Database Syst Rev. 2004;CD004097.
…and 6 years ago…
1Nield et al, Cochrane Database Syst Rev. 2008;CD005102.
Times have changed…
• Now have numerous contenders: low carb, low GI, Mediterranean, Paleo, vegetarian/vegan
…all suggest some benefit vs. standard diet recommendations and/or typical Western diet
How about low-carb?
• Can be low carb, high protein, or low carb, high fat (LCHF)
• Composition varies, but typically: – Reduce from ~275 g/day intake (based on 2000
kcal/day and 55% of calories from CHO) – To “lower CHO” (120 g/day or 40% kcal = Zone) – Or “low CHO” as low as 20 g CHO/day (induction
phase of Atkins)
Compare: 20-25 g CHO = ½ cup cooked pasta, 1/3 bagel, 1 slice bread, 1/3 cup cooked rice, 1 banana, 1 cup fruit juice
Low-carb vs. other diets in type 2 DM
Samaha, Haimoto, Davis, Iqbal compared to low fat Westman, Wolever-1 compared to low GI Elhayany-1 compared to Mediterranean Stern compared to high CHO
Ajala, Am J Clin Nutr. 2013 (97):505.
What about ketogenic diets?
• Duke study (2008): LCHF ketogenic diet vs. cutting kcal by 500/day (low GI) in type 2 DM for 6 months:1
• LCHF lost 24.5 lbs vs. 15.2 lbs in low GI; • HbA1C -1.5% vs. -0.5%; • 92% vs. 62% reduced or eliminated diabetic meds
• Yamada (2014): LCHF (keto or not) vs. kcal-controlled in type 2 DM for 6 months2
Glucose tolerance improved more in Paleo diet, even independent of wt loss; Paleo diet consumed 1380 kcal vs. 1809 MJ/d, but felt equally full; appetite hormones improved more in Paleo
Diabetes diet Decr. wt, WC, 3-month blood sugar, TG, diastolic BP; Increased HDL in Paleo vs. Diabetes Diet
Frassetto et al (2009)
9 nonobese, sedentary, healthy
10 d. Eucaloric Paleo diet
None Total cholesterol (-0.8 mmol/L), LDL chol (-0.7 mmol/L), TG (-0.3 mmol/L) all improved
Paleo Diet: the Jonsson Study (2009)
• Pilot cross-over study comparing ad libitum “Diabetes Diet” of vegetables, root vegetables, whole grain breads and cereals, fruits/berries; lower fat and higher monounsaturated fat; vs. “Paleo”: lean meat, fish, fruit, vegetables, eggs, nuts in 13 type 2 diabetics on medication
Why the Confusion? “As a long-time subscriber, here’s what I think. I love the nutritionist’s column. It’s always interesting, though I know a couple of months later she’ll totally rescind everything she said before. Very funny.” The next time you read something about nutrition that seems contradictory, keep a few of these points in mind: 1. Nutrition, like all aspects of science and medicine, is an evolving area of
study. 2. It is difficult to assess the impact of a single nutrient on our health. 3. The endpoints of nutrition research can be difficult to define. 4. The findings of one study are exactly that. Bias is an inherent risk in all
research. Multiple studies need to be conducted by different research groups to determine whether a single finding is valid.
5. The findings of a study do not necessarily translate across the entire population.
Why the Confusion? Despite the confusion, there are some “truths” that have evolved, e.g.:
• Food is more complex and more valuable than individual nutrients. And, by extension, diets based on nutrient-dense whole foods are increasingly being shown to be the most healthful.
• There is a U-shaped curve for many, if not most aspects of nutrition.
• The placebo effect is strong. • We tend to create our own narratives about health (and
life) that influence the way we interpret things we read, hear and experience (“confirmation bias”).
• There is more to nutrition than nutrition.
The Bottom Line
If in doubt, eat your vegetables. Everything else is controversial.