Type 2 Diabetes and a Vegetarian/Vegan Diet

1. Type 2 Diabetes and a Vegetarian/Vegan Diet Allison Krippene Sodexo Dietetic Intern December 12, 2012

2. Type 1 Diabetes: the autoimmune destruction of the beta cells of the pancreas leading to absolute insulin deficiency Type 2 Diabetes: Relative insulin deficiency as a result of insulin resistance or deficient insulin secretion Diabetes Mellitus

3. Risk Factors: • Genetics • Geography ( According to Mayoclinic.com the incidence of type 1 diabetes increases as you travel further away from the equator) Treatment: • Exogenous insulin every day Type 1 Diabetes Mellitus

4. Risk Factors: • Genetic and environmental factors, age, overweight/obesity, fat distribution, sedentary lifestyle, race/ethnicity, prediabetes, previous gestational diabetes Treatment: • Regular exercise, weight loss, healthy eating, oral or injectable diabetes medications, insulin Type 2 Diabetes Mellitus

5. Risk Factors: • Age, family history of type 2 diabetes, obesity, race/ethnicity Treatment: • Diet, exercise, insulin Gestational Diabetes Mellitus

6. Diet plays an important role in the prevention and treatment of diabetes Prevention: improve food choices/follow a healthy, balanced diet Treatment: improve food choices, monitor carbohydrate intake, and control portion sizes Diet and Type 2 Diabetes

7. What kind of impact does a vegetarian or vegan diet have on the prevention/treatment of type 2 diabetes? Diet and Type 2 Diabetes

8. Studies show that a vegetarian or vegan diet can decrease the risk of type 2 diabetes, compared to a conventional (omnivore) diet. One recent study on the Seventh-Day Adventists, who follow a vegetarian diet, showed that vegetarians have a 50% lower risk of type 2 diabetes than omnivores. Diet and Type 2 Diabetes

9. Types: • Lacto-vegetarian • Ovo-vegetarian • Lacto-ovo vegetarian • Pesco-vegetarian Vegetarian Diet

10. Excludes all meat, poultry, fish, eggs, and dairy products. Vegan Diet

11. The Benefits: • Reduced saturated fat intake • Changes in intramyocellular lipid • Reduced glycemic index • Increased intake of dietary fiber • Weight loss Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

12. Reduced saturated fat intake: • Decreasing saturated fat intake can increase insulin sensitivity. • Some of the most significant sources of saturated fat include meat and dairy products. Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

13. Changes in intramyocellular lipid: • Intramyocellular lipid accumulation is strongly associated with insulin resistance. • Decreasing fat intake has been shown to decrease intracellular lipid accumulation, leading to better insulin sensitivity. Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

14. Reduced glycemic index (GI): • Low-GI foods tend to produce more gradual rises in blood sugar and insulin levels vs. high GI foods. • Vegetarian/Vegan diets tend to include foods with a lower-GI such as beans, legumes, and nuts. Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

15. Increased intake of dietary fiber: • Consuming large amounts of soluble fiber (found in oats, oat bran, beans, some fruits and vegetables, and psyllium) may help control blood glucose levels after meals by slowing the rate of carbohydrate absorption in the intestine. - Insoluble fiber (sources include whole grains and unpeeled fruits and vegetables) helps prevent constipation and may help prevent weight gain by increasing bulk in the diet, making you feel fuller. Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

16. Weight loss: • Lower intakes of fat and saturated fat and higher intakes of sources of fiber such as whole grains, fruits, and vegetables can help reduce body weight. • Portion control needs to be emphasized. Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

17. Nutrition Considerations: • Vegetarians: iron, zinc, protein, omega-3 fatty acids • Vegans: iron, zinc, protein, omega-3 fatty acids, calcium, vitamin D, vitamin B12 Vegetarian/Vegan Diet and Type 2 Diabetes Prevention/Treatment

18. Conventional Diet: 47-50% carbohydrate, 15-16% protein, 33-35% fat Vegetarian Diet: 60% from carbohydrate, 15% protein, 25% fat Vegan Diet: 75% carbohydrate, 15% protein, 10% fat Macronutrient Intakes

19. When Educating Clients… • Emphasize the importance of carbohydrate counting (vegetarian and vegan diets have a higher intake of carbohydrates) • Consider types of carbohydrates being consumed • Discuss portion sizes (choosemyplate.gov) • Include physical activity goals Type 2 Diabetes Vegetarian/Vegan Nutrition Therapy

20. Keep in mind that vegetarian and vegan diets are extreme dietary patterns that should not be recommended to diabetic patients. • Diabetes can be managed without giving up meat, fish, poultry, dairy and/or eggs. Type 2 Diabetes Vegetarian/Vegan Nutrition Therapy

21. Sample One-Day Menu

22. Austin GL, Ogden LG, O Hill J. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals. American Journal of Clinical Nutrition. 2011; 93: 836-43. Barnard ND, Cohen J, Ferdowsian H, Gloede L, Green A, Jenkins DJA, Turner-McGrievy G. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. American Journal of Clinical Nutrition. 2009; 89: 1588-96. Barnard ND, Cohen J, Jenkins DJA, Katcher H, Turner-McGrievy G. Vegetarian and vegan diets in type 2 diabetes management. Nutrition Reviews. 2009; 67(5): 255-63. References

23. Butler T, Fraser GE, Tonstad S, Yan R. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. American Diabetes Association. 2009; 32(5): 791-96. Costabile G, Giacco R, Rivellese AA. Dietary carbohydrates for diabetes. Current Atherosclerosis Reports. 2012; 14: 563-69. References