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

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2005, 2010, 2015* Dietary Guidelines Recommend The 2015 DGA states that healthy eating patterns, including low‐fat or fat‐free dairy 3 Daily Servings of Dairy foods, are associated with reduced risk for Foods several chronic diseases, including cardiovascular disease (strong evidence) and for Those >9 years 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 “ … the amount of many potential alternatives to provide Three sufficient calcium would servings of provide too many milk calories and/ or be a provide large amount to the same consume daily .” level of nutrients “ … bioavailability of the found in calcium in vegetable these products has not been foods 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 Americans* consume, on average, <2 cup equivalents of dairy foods/ day. Adding j ust one more dairy serving a day could help close the gap. National Dairy Council. NHANES 2011-2014. *(2+ y) 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

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 HIGH BLOOD PRESSURE TYPE 2 DIABETES (includes heart attack and stroke) Total dairy* and cheese Total dairy is associated with Total dairy, yogurt and cheese consumption is associated with lower risk for hypertension (high- consumption is associated with lower risk for stroke (moderate quality evidence) lower risk for T2D (moderate- to quality evidence) high-quality evidence) Cheese and yogurt consumption Total dairy, cheese and yogurt is not associated with higher risk A meta-analysis found eating consumption is not associated for hypertension (moderate- to approximately 3 ounces of with higher risk for CVD high-quality evidence) yogurt (80 g) per day, compared (moderate- to high-quality evidence) to none, is associated with Clinical trials continue to lower risk for T2D Total dairy, cheese and yogurt investigate how dairy products, consumption is not associated including low-fat dairy products, with higher risk for coronary might contribute to a healthy artery disease (moderate- to high- blood pressure in different quality evidence) populations *Dairy foods in these studies are whole, reduced fat, low-fat and fat-free milk, cheese and yogurt OPTIONAL Link to infographic: https:/ / www.nationaldairycouncil.org/ content/ 2019/ dairy-foods-key-for-supporting-health Drouin-Chartier JP. S ystematic Review of the Associat ion between Dairy Product Consumption and Risk of Cardiovascular-Related Clinical Outcomes. Adv Nutr 2016

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 outhbeach, Zone  Low fat  Ornish, TLC, Engine 2  Elimination/ Food group restrictive  Whole 30, Paleo  Magic foods  Cabbage S oup, 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

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

Paleo Late Paleolithic Contemporary Dietary Era Diet Paleo Diet 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 0.94) ( I 2 = 48.81, p = 0.03). 0.89 (0.84– Figure. (a) Total dairy products (b) whole milk (c) yogurt and type 2 diabetes RRs for Reference- Tian et al. 2017. Dietary Protein Consumption and the highest vs. the lowest intake in all subj ects. The RR of each study is represented the Risk of Type 2 Diabetes: A S ystematic Review and Meta- by a square, 95% CI are represented by the horizontal lines, and the diamond Analysis of Cohort S tudies. Nut rient s . represents the estimate and its 95% CI.

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 KETO MACRONUTRIENTS Fat Protein Carb  History- 1 st used in 1921 to treat epilepsy 10%  Extremely low carbohydrate diet  Purpose- Force the body to use ketones for energy instead of blood glucose 30% 60%

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