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Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian


Despite greater awareness about diabetes in recent years, a recent study found that nearly three in 10 Americans have the disease but don't know it. The findings also showed that among those who were diagnosed with diabetes, a significant percentage weren't meeting goals to control their blood sugar and blood pressure or lower their LDL cholesterol.

This Thursday, Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will discuss why eating healthy is a key component of diabetes management and prevention. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus; those unable to attend the event can watch a live webcast of the discussion.

In the final installment of our two-part Q&A with Kenny, she offers tips to avoid overindulging on sugary treats during the holidays, explains why you should consider limiting your consumption of red meat, and outlines the benefits of a vegetarian diet.

Many of us have a hard time refraining from indulging in high-calorie foods during the holidays. What’s your advice to those trying to make healthy choices during holiday season?

The holidays don’t have to be a stressful or trying time for patients with diabetes. Patients can adhere to a few simple strategies to help prevent weight gain and hyperglycemia. Some people will find it beneficial to eat a nutritious snack, particularly one that is high in fiber, and to drink lots of water in advance of a holiday party, rather than arriving hungry.

Buffet tables and appetizer trays can be problematic. Count toothpicks and stop snacking when you reach a certain number of toothpicks in your pocket. It is always a good idea to find the smallest plate available, when there are options, so as to reduce portions. Another tip is to limit alcohol intake; not only will this itself reduce liquid calories, but it will help individuals to make smarter choices. Substitute sparkling mineral water with lemon or lime. Eat lots of veggies at snack tables. Avoid calorie and sugar-dense sweets, or limit to one.

The most important aspect is to devise a plan in advance of a holiday gathering, and stick to it. Set your predetermined limits. Spontaneous choices will tend to be less healthy ones. Finally, if you are going to indulge a bit more, try to take a brisk walk afterwards to help reduce the glycemic impact of your meal.

Previous research has shown that decreasing your red meat consumption can lower your type 2 diabetes risk. Why does eating red meat influence a person’s diabetes risk? 

A study published in the Journal of the American Medical Association last year found an association of higher-diabetes risk with increased intake of red meat (about 30 percent higher with average increased red meat intake of ½ serving daily, adjusted for weight and BMI), and the converse, a lower risk in those who decreased their red meat consumption over a four-year period in the subsequent four years (14 percent reduction in diabetes risk by reducing consumption by more than ½ red meat serving daily over the baseline measure, some of which was mediated by reduced BMI with lower red meat intake).

This data was based on food questionnaires, and was a compilation from three prospective cohort studies involving almost 150,000 men and women. One of these cohorts, the Women’s Health Study, showed a 28 percent increased risk of developing diabetes in women in the highest quintile of red meat intake.  On further analysis, this seemed to be largely mediated by higher intake of processed meats such as hot dogs and bacon. Note that these studies do show an association, but not clear causation in terms of red meat and diabetes risk.

One theory of causality proposed is that compounds such as nitrates and nitrites added in meat processing  (sandwich meats, hot dogs, bacon), can be converted to “N-Nitrosamines”, which are thought to be toxic to the pancreas insulin-secreting beta cells. Thus, eating a bologna sandwich may be different in risk than eating grass-fed organic beef. But we don’t have enough data at this time to be clear on this.  Regardless of the nitrate content, red meat is still high in saturated fats, and this in and of itself is associated with higher cardiovascular disease risk. Additionally, higher red meat intake was associated with more weight gain and higher BMI in this analysis.

Is a vegetarian diet more preventative than other types of diets?

Vegetarian diets may be helpful in preventing diabetes, and in reducing hyperglycemia in diabetic patients. This is likely due to the high-fiber content of most vegetarian diets, which blunts the post-meal rise in glucose level, and also to the early satiety that a diet high in fiber promotes. Additionally, most studies show that the typical vegetarian diet is lower in calories than a non-vegetarian diet, and vegetarians consequently have a lower BMI on average than other individuals.

Many of the components of a typical vegetarian diet are also associated with lower cholesterol and a reduced rate of cardiovascular disease. For example, it is known that foods like nuts, oats, barley, plant sterols, and soy protein help to lower LDL cholesterol. Since cardiac disease is the number cause of mortality for diabetics, any diet that can accomplish a goal of both controlling sugar and reducing heart disease must be promoted. A vegetarian diet may also help diabetic patients with kidney disease. A diet high in animal protein may contribute to hyperfiltration in the kidneys, and may hasten diabetic kidney damage; by elimination of animal protein this may result in renal protection with a vegetarian diet. Finally, a vegetarian diet rich in fruits and vegetables is packed with phytonutrients with antioxidant potential.

Most data on the relative benefits of vegetarian diets come from long term cohort studies, one of the largest of which was the Seventh Day Adventist Study Cohort in California. This was a group of more than 20,000 individuals studied for over 20 years. In this group it was shown that vegetarians had a lower rate of diabetes, and a lower rate of cardiovascular disease and total mortality compared to non-vegetarians. Similar results were found in European cohort studies. In terms of randomized trials, a trial done at George Washington University in 2003 showed that a vegetarian diet compared to a conventional ADA diet, proved better at helping diabetics reduce their A1c level (-.4 vs 0.01) with equivalent drops in weight at the end of the study period. This was interesting because it showed that there were putative benefits to a vegetarian diet in diabetic patients compared to other diets, independent of their weight loss effect.

Previously: Examining the role of exercise in managing and preventing diabetes, Diabetes self-management program helps at-risk teens and their families make healthier choices, Stanford preventive-medicine expert: Lay off the meat, get out the sneaks, New evidence for a direct sugar-to-diabetes link, Examining how diet soft drinks impact your health and Sugar – it’s everywhere
Photo by Michigan Municipal League

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