Medical Nutrition Therapy Options for Adults Living with Diabetes. Jane Eyre Schuster, RD, LD, CDE Legacy Health Diabetes and Nutrition Services

Transcription

1 Medical Nutrition Therapy Options for Adults Living with Diabetes Jane Eyre Schuster, RD, LD, CDE Legacy Health Diabetes and Nutrition Services

2 Objectives Discuss Medical Nutrition Therapy considerations in the treatment of adults living with type 2 diabetes Compare and contrast various eating patterns used in the treatment for diabetes

3 Disclosures I, Jane Eyre Schuster, RD, LD, CDE have no relevant financial or nonfinancial relationships in the products or services described, reviewed, evaluated or compared in this presentation. October 26, 2018 LEGACY HEALTH 3

4 Diabetes Self-Management Education and Support Services Patient centered care Evidence-based Individualized to meet the needs of the person, including language and culture Delivered by trained and competent individuals (educators) who are quality assured Delivered in group or individual settings Supports the person and their family in developing attitudes, beliefs, knowledge, and skills to self-manage diabetes Available to patients at critical times (i.e., at diagnosis, annually, when complications arise, and when transitions occur) Includes monitoring of patient progress, including health status, quality of life 10/26/2018 LEGACY HEALTH 4

5 Medical Nutrition Therapy (MNT) To help people adopt heathy eating patterns To help manage good blood glucose and cardiovascular risk to reduce common diabetes related complications To help preserve quality of life and the pleasure of food No one right way optimize carbohydrates, proteins or fats Focus on individualized eating plans with foods shown to have health benefits Avoid foods that have established harm Involves comprehensive nutrition assessment with consideration of comorbidities Assesses and aids in designing individualized meal patterns that include food preferences, food allergies, eating habits and cultural background 10/26/2018 LEGACY HEALTH 5

6 Diabetes Dietitian Intervention Effects of food on blood glucose levels Carbohydrate, protein and fat sources Individualized meal planning Resources for making healthy food choices Understand portion sizes Navigate food label reading Plan and prepare meals Best times to eat to match their diabetes medications Able to address additional nutritionally related issues Renal, CVD, HTN, Lipids, Cancer, GI issues, etc Ongoing nutrition requirements over the lifetime 10/26/2018 LEGACY HEALTH 6

7 Eating Patterns Which is best? Mediterranean Dash (Dietary Approaches to Stop Hypertension ) Low Carbohydrate Low Glycemic Index High Protein Carbohydrate Controlled Low Fat Nonsurgical Energy restriction for weight loss Meal Replacements Surgical Weight loss intervention??? 10/26/2018 LEGACY HEALTH 7

8 Mediterranean Diet Pros includes fruits, vegetables, whole grains, beans, moderate intake of wine and lean meats and low intake of processed foods Promotes heart health High in Monounsaturated fats - olives, olive oil, avocados, nuts and seeds, High in cancer-fighting antioxidants Promotes regular physical activity Cons Does not state exact servings amounts/day, rather the macronutrient distribution Uses terms like: low to moderate intake, abundance and often which can be confusing Moderate wine intake vs use of certain medications, high triglycerides or pancreatitis Physical activity and calorie totals not addressed specifically Less processed foods = less sodium 10/26/2018 LEGACY HEALTH 8

9 DASH Diet (Dietary Approaches to Stop Hypertension) Pros includes fruits, vegetables, whole grains, beans, lean meats and plant based fats, low-fat free dairy Free and available access no expensive or hard-to-find foods Provided specific calorie levels for weight loss and maintenance Proven health benefits in heart health Promotes regular physical activity Cons Not specifically for weight loss No pre-package foods Can provide up to 55% of calories from carbohydrates too high? Limited research on it s effects on diabetes Less processed foods = less sodium Is designed to be an eating program for life by including cooking and shopping 10/26/2018 LEGACY HEALTH 9

10 Low Carbohydrate Pros Weight loss in a short time Helps with satiety due to protein and fat intake Improves blood glucose control Has positive effects on HDL cholesterol and triglycerides Decrease in adipose tissue Decrease food intake and body weight Have to pay attention to food choices Cons % carbohydrate recommendation varies from <26%-45% of total calories Calorie restrictions vary all you want to very restricted Decreased fiber intake can promote constipation May require supplements to replace what is missing Sustainability? Little to no effect on LDL cholesterol and total cholesterol 10/26/2018 LEGACY HEALTH 10

11 Low Glycemic Index Diet Pros Quick and easy references Good way to ID how individual foods effect blood glucose Can decrease blood glucose, insulin response and maybe inflammation Cons The rating is only for individual foods. As the food ripens or if it is paired with protein or fat it can affect the GI ranking. Misleading if you consider the GI rank to mean that a food is healthy if it is low. GI number is only really valid if the food is eaten alone. Helps you feel full longer = more weight loss 10/26/2018 LEGACY HEALTH 11

12 High Protein Diets Pros Targets metabolic targets of satiety may be more important than low carbohydrate Immediate weight loss Cons Initial weight loss is temporary due to water loss Can effect mood, energy Improves cholesterol Improved satiety Often the fat choices are mostly saturated fats which may lead to higher LDL levels Sustainability? Improved blood glucose Inflexible rules Easy to find foods to eat Have to pay attention to food choices 10/26/2018 LEGACY HEALTH 12

13 Carbohydrate Controlled Diet Pros Consistent intake over the day Portions matter Cons Provides plenty of fiber, vitamins and minerals Provides structure to the day. For some, can be more confusing Takes practice and discipline Helps with insulin administration No I can t have rules Stabilizes blood glucose Addresses heart health 10/26/2018 LEGACY HEALTH 13

14 What is the right answer? What is the goal of the patient? Any eating pattern is most effective when starting where the patient s eating patterns are Eating pattern that is sustainable Family support is critical Meets the nutrition status and comorbidity issues, such as renal disease Has physical and emotional support along the way 10/26/2018 LEGACY HEALTH 14

15 Consensus recommendation* All people with type 2 diabetes should be offered access to ongoing DSMES programs An individualized program of Medical Nutrition Therapy (MNT) should be offered to all patients. All overweight/obese patients should be advised of the health benefits of weight loss and encouraged to engage in a program of intensive lifestyle management, which may include food substitution. Management of hyperglycemia in type 2 diabetes, A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 10/26/2018 LEGACY HEALTH 15

16 Thank you!

17 References: o American Diabetes Association (2018) 4. Lifestyle management: standards of medical care in diabetes Diabetes Care 41:S38 S50. o Beck J, Greenwood DA, Blanton L et al (2017) 2017 national standards for diabetes self-management education and support. Diabetes Educ 43: o Shai I, Schwarzfuchs D, Henkin Y et al (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359: o Esposito K, Maiorino MI, Ciotola M et al (2009) Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med 151: /26/2018 LEGACY HEALTH 17

18 References: o Esposito K, Maiorino MI, Petrizzo M et al (2014) The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care 37: o American Association of Diabetes Educators (2018) Addressing Obesity in Diabetes an AADE practice paper, August /26/2018 LEGACY HEALTH 18