What diet does and why it matters to primary care Jennifer - - PowerPoint PPT Presentation

What diet does and why it matters to primary care

Jennifer Brunelli, MS , RD, LDN Carolina Panthers S ports Dietitian Manager/ Owner, S ports RDpro LLC

MyPlate

2005, 2010, 2015* Dietary Guidelines Recommend 3 Daily Servings of Dairy Foods for Those >9 years

• The 2015 DGA states that healthy eating

patterns, including low‐fat or fat‐free dairy foods, are associated with reduced risk for several chronic diseases, including cardiovascular disease (strong evidence) and type 2 diabetes (moderate evidence). Research has also linked dairy intake to improved bone health, especially in children and adolescents.

3 Servings of Milk Deliver a Unique Nutrient Package

Three servings of milk provide the same level of nutrients found in these foods “ … the amount of many potential alternatives to provide sufficient calcium would provide too many calories and/ or be a large amount to consume daily.” “ … bioavailability of the calcium in vegetable products has not been addressed and could pose a concern.”

2015 Dietary Guidelines Advisory Committee

• Report. Appendix E3.6

https://www.nationaldairycouncil.org/content/2018/three-servings-of-milk-deliver-a-unique-nutrient-package

Visit nationaldairycouncil.org for flashcards on cow’s milk and dairy alternative beverages

https://www.nationaldairycouncil.org/content/2018/how-milk- compares-to-various-plant-based-alternative-beverages

Nearly 9 in 10 Americans Fall Short on Dairy Recommendations

2015-2020 Dietary Guidelines for Americans Dietary Intakes Compared to Recommendations. Percent of US Population Ages 1 & Older Who Are Below, At or Above Each Dietary Goal

Americans* consume,

• n average, <2 cup

equivalents of dairy foods/ day. Adding j ust

• ne more dairy

serving a day could help close the gap.

National Dairy Council. NHANES 2011-2014. *(2+ y)

EATING DAIRY FOODS IS NOT LINKED TO HIGHER RISK FOR KEY CHRONIC DISEASES and in some cases may be linked to lower risk, according to a review of 20+ studies. CVD

(includes heart attack and stroke)

Total dairy* and cheese consumption is associated with lower risk for stroke (moderate

quality evidence)

Total dairy, cheese and yogurt consumption is not associated with higher risk for CVD

(moderate- to high-quality evidence)

Total dairy, cheese and yogurt consumption is not associated with higher risk for coronary artery disease (moderate- to high-

quality evidence)

HIGH BLOOD PRESSURE Total dairy is associated with lower risk for hypertension (high-

quality evidence)

Cheese and yogurt consumption is not associated with higher risk for hypertension (moderate- to

high-quality evidence)

Clinical trials continue to investigate how dairy products, including low-fat dairy products, might contribute to a healthy blood pressure in different populations TYPE 2 DIABETES Total dairy, yogurt and cheese consumption is associated with lower risk for T2D (moderate- to

high-quality evidence)

A meta-analysis found eating approximately 3 ounces of yogurt (80 g) per day, compared to none, is associated with lower risk for T2D

Drouin-Chartier JP. S ystematic Review of the Associat ion between Dairy Product Consumption and Risk of Cardiovascular-Related Clinical Outcomes. Adv Nutr 2016

*Dairy foods in these studies are whole, reduced fat, low-fat and fat-free milk, cheese and yogurt Link to infographic: https:/ / www.nationaldairycouncil.org/ content/ 2019/ dairy-foods-key-for-supporting-health

OPTIONAL

Plant-based in Perspective

2015-2020 Dietary Guidelines For Americans Dietary Patterns are Plant-Based and Incorporate Animal Foods

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

Fad Diets

 How to spot a fad diet:

 Promise a quick fix  Claims that sound too good to be true  Dramatic statements that are refuted by reputable

scientific organizations

 Lists of "good" and "bad" foods  Recommendations made to help sell a product  Elimination of one or more of the five food groups (fruits, vegetables,

grains, protein, and dairy)

Types of Fad Diets

 Low carbohydrate

 Keto, Atkins, S

• uthbeach, Zone

 Low fat

 Ornish, TLC, Engine 2

 Elimination/ Food group restrictive

 Whole 30, Paleo

 Magic foods

 Cabbage S

• up, Grapefruit Diet

Paleo

 Paleolithic diet

 Emphasizes- lean meat, fish,

shellfish, fruit, vegetables, eggs, nuts, and seeds

 Excludes- grains, legumes,

cereals, dairy, processed foods, refined sugars and added salt

Paleo

Image source: Jen Christ iansen (S cient ific American)

Paleo

Late Paleolithic Era Diet Contemporary Paleo Diet Dietary Guidelines for Americans Protein (% ) 34% 38% 10-35% Carbohydrate (% ) 45% 23% 45-65% Fat (% ) 21% 39% 20-35% Calcium (mg) 1580 628 1000

Adapted from: Berggren et al. 2018. Nutrition and Health Info S heet: The Paleo Diet- For Health Professionals.

Paleo

 Benefits

 Includes nutrient-dense whole fresh foods and encourages limiting highly

processed foods containing added salt, sugar, and unhealthy fats

 No long-term research to support

 Limitations

 Limitation of grains and dairy - limits key nutrients like fiber, vitamin D,

calcium, thiamin, riboflavin and iron.

 Limitation of salt and dairy - increases one’s risk for developing iodine

deficiency

Paleo

Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. European Journal of Clinical Nutrition (2015) 69, 944– 948; doi:10.1038/ ej cn.2015.39

Type 2 Diabetes

 Dairy

 A meta-analysis showed association

between total dairy product consumption and the risk of T2DM.

 The summary RR and 95%

CI for high vs. low total dairy product consumption was 0.89 (0.84– 0.94) (I2 = 48.81, p = 0.03).

• Figure. (a) Total dairy products (b) whole milk (c) yogurt and type 2 diabetes RRs for

the highest vs. the lowest intake in all subj ects. The RR of each study is represented by a square, 95% CI are represented by the horizontal lines, and the diamond represents the estimate and its 95% CI.

Reference- Tian et al. 2017. Dietary Protein Consumption and the Risk of Type 2 Diabetes: A S ystematic Review and Meta- Analysis of Cohort S

• tudies. Nut rient s.

Type 2 Diabetes

 Whole Grains

 A higher intake of wholegrain is

associated with a lower risk of T2DM, as well as an improvement of its maj or risk factors (overweight/ obesity, plasma glucose regulation, postprandial hyperinsulinemia, and insulin resistance)

S chematic outline of plausible mechanisms of action by which wholegrain could influence glucose homeostasis and T2DM risk development. PYY: peptide YY; CCK: cholecystokinin; GIP: gastric inhibitory peptide; GLP-1: glucagon like peptide 1; FF

• A. Free fatty acids; TG triglycerides; and S

CF A: short chain fatty acids, ↓ decrease, ↑ increase.

Reference- Della Pepa, Giuseppe et al. “ Wholegrain Intake and Risk of Type 2 Diabetes: Evidence from Epidemiological and Intervention S tudies.” Nut rient s vol. 10,9 1288. 12 S

• ep. 2018, doi:10.3390/ nu10091288

Ketogenic Diet

 History- 1st used in 1921 to treat epilepsy  Extremely low carbohydrate diet  Purpose- Force the body to use ketones for energy

instead of blood glucose

60% 30% 10%

KETO MACRONUTRIENTS

Fat Protein Carb

Ketogenic Diet

Ketogenic Diet



S hort-term side effects- nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu



Long-term side effects- hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies



Complications often lead to emergency room visits and admissions for dehydration, electrolyte disturbances, and hypoglycemia



Long-term compliance = low

Ketogenic Diet

 Does it work?

 Useful for some people with uncontrolled epilepsy  Current Research - cancer and diabetic populations  Obesity

 Meta-analysis conducted by Bueno et al. (2013)- ket ogenic diet was associated with < 1 kg of

additional weight loss over high-carbohydrate, low-fat strategies

 Meta-analysis conducted by Hall et al. (2016)- energy expenditure and fat loss was greater

with low-fat diets compared with ketogenic diets  Concern for general population - high fat content combined with restrictions on

nutrient-rich fruits, vegetables and grains

 Meta-analysis conducted by Aune el al. (2016)- whole grain intake was associated with a

dose-dependent reduction in risk of coronary heart disease, cardiovascular disease, total cancer, and all-cause mortality

Ketogenic Diet



S eidelmann, S ara B et al. 2018. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. The Lancet Public Health, Volume 3, Issue 9, e419 - e428

Whole 30



A popular 30-day nutrition challenge created by Doug and Melissa Hartwig and promoted on their website (whole30.com) and through their several best-selling books



Elimination Diet



Allowed- Meat, S eafood, Eggs, Fruits, Vegetables, Natural fats, Herbs, S pices, S easonings



Eliminates- S ugar, Alcohol, Grains, Legumes, Dairy, Carrageenan, MS G, S ulfites, Baked Goods, Junk Food, Treats (even with approved ingredients)

Whole 30

 Unanswered Questions

 No short or long term studies  Why 30 days?  How should people shift diet after 30 days?  Long-term effect of categorizing foods as good vs bad

Intermittent Fasting

 Any period of voluntary food

restriction

 Protocols are varied and might

include:

 Religious fasting  Time restricted feeding  S

cheduled days of extreme caloric restriction followed by normal or high calorie days

Intermittent Fasting

 Research

 Has not demonstrated that alternate-day fasting regimens produce superior weight

loss in comparison to standard, continuous calorie restriction weight-loss plans

 There are considerable observational data on various forms of religious fasting

 S

uggest that these regimens result in transitory weight loss

 Mixed impacts on other biomarkers

 Data are lacking regarding the impacts of intermittent fasting on other health

behaviors, such as diet, sleep, and physical activity

 There are limited data linking intermittent fasting regimens with clinical outcomes

(diabetes, cardiovascular disease, cancer, or other chronic diseases, such as Alzheimer's disease)

Intermittent Fasting

 Future S

tudies Needed:

 Modified fasting regimens appear to promote weight loss and may improve

metabolic health

 Insufficient data to determine the optimal fasting regimen:  Length of the fasting interval  Number of fasting days per week  Degree of energy restriction needed on fasting days  Recommendations for dietary behavior on nonfasting days

 Large-scale randomized trials of intermittent fasting regimens in free-living

adults are needed

 S

tudies should examine effects on not only weight, but also body composition

Within Day Energy Balance

Within Day Energy Balance

From Deutz R, Benardot D, Martin D, Cody MM. Relationship between energy deficits and body composition in elite female gymnasts and runners. Med S ci S port s Exerc.2000;32(3):659– 68.

Effects of Dieting

 Negative Health Effect- increased risk of heart disease  Negative impact on metabolism  Missing key nutrients

 Example- calcium

 Increased risk for osteoporosis, stress fracture, and broken bones

 Can lead to eating disorders

How to counsel patients

 Determine the nutrition and obesity prevention and treatment

messages you have the time and skill to provide to your patients

 Recognize the difference between advising patients on the basics and

the in-depth counseling provided by an RDN

 An RDN has the knowledge and skills needed to help individuals make

changes that can affect outcomes

 Know when to refer to RDN

 Could be one of the most important ways that health care professionals

help patients learn about, implement and sustain behavior changes

Questions?