Diabetes, COVID-19

and More –

The Diet Connection

Caroline Trapp, DNPDirector of Diabetes Education & Care

Physicians Committee for Responsible Medicine

NMDOH 11/20/20

Common Problems for our Senior Citizens

– What Do They Have in Common?

• Type 2 Diabetes

• Heart Disease

• Alzheimer’s Disease

• COVID-19

CERTAIN DIET PATTERNS HAVE AN IMPACT

• SAD Diet linked to higher rates of diabetes, heart disease, Alzheimer’s Disease

• Plant-based diet linked to lower rates of diabetes, heart disease and Alzheimer’s Disease

COVID-19

New York COVID-19 Patients

Obesity41.7%

Diabetes33.8%

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes

among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020 April 22 [Epub

ahead of print].

Hypertension

56.6%

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020 April 22 [Epub ahead of print].

12 New York

area hospitals

5,700 COVID-19

patients

Health Issues Can Make COVID-19 Worse

COVID-19 Severe DiseasePrevalence in Hospitalized Patients

Under-weight

0%

Over-weight

29%

Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a

designated hosptial in Shenzhen, China. Diab Care. 2020;43:1392-8.

Normal-

weight

19%

Obese

39%

Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China.

Diab Care. 2020;43:1392-8.

COVID-19 Severe Disease in China

Prevalence in Hospitalized Patients

Covid-19 Mortality in People with Diabetes

Diabetes

No Diabetes

7.8%

2.7%

Zhu L, She ZG, Cheng X, et al. Association of blood glucose control andoutcomes in patients with COVID-19 and pre-existing type 2 diabetes.Cell Metab. 2020;31:1-10. June 2, 2020.

COVID-19 Death Rates

Zhu L, She ZG, Cheng X, et al. Association of blood glucose control and outcomes in patients

with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31:1-10. June 2, 2020.

COVID-19 Mortality in People with Diabetes

0

5

10

Poor Control

11%

Good Control

1%

Zhu L, She ZG, Cheng X, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020;31:1-10. June 2, 2020.

Dramatic Lessons about

Nutrition

• Norway

• U.S.

• Okinawa

Norway During World War II

What has changed?

Estimated Per Capita Sweetener Consumption

(Pounds per capita)

1909: 123.9 lb

2012:181.5 lb

2004: 201.5 lb

U.S. Per Capita Meat Intake (lb)

Source: US Department of Agriculture, Economic Research Service,

https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/. Accessed

October 4, 2018.

1909: 10.4 lb

2012:56.6 lb

2006: 60.9 lb

U.S. Per Capita Chicken Intake (lb)

Source: US Department of Agriculture, Economic Research Service,, https://www.ers.usda.gov/data-products/food-

availability-per-capita-data-system/. Accessed October 5, 2018.

1909: 3.8 lb

2012:33.5 lb

1960:8.3 lb

U.S. Per Capita Cheese Intake (lb)

Source: US Department of Agriculture, Economic Research Service,

https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/. Accessed October 5, 2018.

Much of what I was taught

about nutrition was wrong…

Which people live the longest?

Why?

Okinawa Longevity Diet

An Educator Gets Educated

Weight loss, better blood sugar, better blood pressure, off medication, less joint pain, more energy.

Before Now

What is a Plant-Based Diet?

BreakfastOatmeal with cinnamon& raisins, coffee with soy milkbanana

Protein = ~17 grams

LunchBean burrito, Steamed broccoliApple

Protein = ~ 20 grams

DinnerWhole wheat pasta marinara,minestrone soup, whole wheat breadOrange

Protein = ~30 grams

Total Protein = ~67 gramsFiber = ~ 40 grams

Fiber is Filling

Fiber tells the brain you’re full.

Approved June, 2017:

RESOLVED, That our American Medical Association hereby calls on US hospitals to improve the health of patients, staff, and visitors by

(1) providing a variety of healthful food, including plant-based meals and meals that are low in fat, sodium, and added sugars,

(2) eliminating processed meats from menus, and

(3) providing and promoting healthful beverages.

Chickpea and BeanThe Plant Powered Couple

Chickpea and BeanThe Plant Powered Couple

Kim & Marc Ramirez

Plant-Based Eating:

The Power Plate

Good nutrition has never been

more important.

Your work has never been more

important.

Documentaries - For More Inspiration: …

Check Out These Resources:

• Chickpeaandbean.com

• NativePowerPlate.org

• ByAnyGreensNecessary.com/starterguide

On your iPhone or Android

Free Phone App – Meal Plans, Recipes,

Grocery Lists, Celebrity Videos

Cartoon used with permission of Dan Piraro

Caroline Trapp

ctrapp@pcrm.org

COMPLETE NUTRITION

Caroline Trapp, DNP

Director of Diabetes Education & Care, Physicians Committee

NUTRITION BASICS

1. Eat whole plant foods2. Avoid animal products3. Minimize oils 4.Take vitamin B12,

consider vitamin D

FRUITS

FRUIT: MYTH VS. FACT

Myth: Sugar in fruit is bad for you.

Fact: Sweet fruits are superfoods

Myth: I have diabetes, so I can’t have fruit.

Fact: Fruit is good for people with

diabetes

Du H, Li L, Bennett D, et al. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PloS Medicine. Published online April 11 2017

FRUIT: THE ULTIMATE FAST FOOD

Wash and eat:

• Bananas

• Blueberries

• Grapes

• Raspberries

• Strawberries

• Pears & apples

• Peaches & plums

5-Minute prep:

• Melons

• Kiwis

• Mangoes

• Pineapple

• Oranges & citrus

• Kiwis

• Pomegranates

Du H, Li L, Bennett D, et al. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PloS Medicine. Published online April 11 2017

WHOLE GRAINS

• Oats

• Corn (including

popcorn)

• Brown Rice

• Quinoa

• Buckwheat

• Amaranth

• Sorghum

• Millet

• Wheat (cracked wheat,

wheat berries, durum,

bulgur)

• Wheat varieties (spelt,

kamut, farro)

• Barley

• Rye

* Yellow = gluten free grains

WHAT ARE MY OPTIONS?

WHAT’S A WHOLE GRAIN?

Image: https://wholegrainscouncil.org/what-whole-grain

• Reduced risk of disease:

– Stroke

– Type 2 diabetes

– Heart disease

– Colon cancer

– High blood pressure

– Lower cholesterol

Jonnalagadda, S., Harnack, L., Liu, R., McKeown, N., Seal, C., Liu, S., & Fahey, G. (n.d). Putting the Whole Grain Puzzle Together: Health Benefits Associated with Whole Grains Summary of American Society for Nutrition 2010 Satellite Symposium. Journal Of Nutrition, 141(5), 1011S-1022S.

WHAT CAN WHOLE GRAINS DO

FOR YOU?

VEGETABLES

WHAT CAN

VEGGIES DO?

Help lower BPRich in folate for moodHelp you stay regularFill you upImprove bone densityReduce cancer risk

• Eat all the colors of the

rainbow

• Raw and cooked

VARY YOUR VEGGIES

Images: www.Veggie-Quest.com https://dinnerthendessert.com/rainbow-roasted-vegetables/

• Start meals with a salad

• Have a green smoothie

at breakfast

• Stir baby spinach into

soups or pasta dishes

• Snack on veggies while

you cook

INCLUDE THEM AT EVERY MEAL

LEGUMES

LEG-WHAT?

• Rich in protein, iron, fiber

• Control hunger and blood sugar—

even the day after you eat them!

• Lower cholesterol

• Make it easy to “go”

• Feed good gut flora

BEANS ARE SUPERFOODS

Nilsson A, Johansson E, Ekström L, Björck I. Effects of a brown beans evening meal on metabolic risk markers and appetite regulating hormones at a subsequent standardized breakfast: a randomized cross-over study. PLoS ONE. 2013;8:e59985. WinhamDM, Hutchins AM. Baked bean consumption reduces serum cholesterol in hypercholesterolemic adults. Nutrition Research. 2007;7:380-386.

• Hearty chili

• Tasty taco, burrito,

enchilada filling

• Veggie burgers

• Salad topper

• Healthy chip dip or

sandwich spread

• Black bean brownies!

IDEAS FOR ENJOYING BEANS

5 Pro Tips

1. Start with ½ cup of beans at a time.

2. Soak dry beans 8-12 hours before cooking.

3. Drain the soak water; cook in fresh water.

4. Rinse canned/cooked beans.

5. Eat separately from fruit.

WHAT ABOUT GAS?

This Photo by Unknown Author is licensed under CC BY-NC

SPECIFIC

NUTRIENTS

WHERE DO YOU GET YOUR

PROTEIN?

Protein

Protein Protein

Protein

BreakfastOatmeal with cinnamon& raisins, coffee with soy milkbanana

Protein = ~17 grams

LunchBean burrito, Steamed broccoli

Protein = ~ 20 grams

DinnerWhole wheat pasta marinara,minestrone soup, whole wheat bread

Protein = ~30 grams

Total Protein = ~67 grams

HIGH-PROTEIN PLANT

FOODS

• B12 supplement required on a plant-

based diet

• Recommended for everyone 50+ or

on certain medications

• For nerve and blood health

• RDA: 2.4 mcg/day

• Supplement: 100 mcg/day or per your

healthcare provider

VITAMIN B12

IRON

• RDA for adults:

– Men 19+ / Women 51+ years: 8 mg/day

– Women 19-50 years: 18 mg/day

• Vegetarians consume as much or more iron

than non-vegetarians.

• Plant-based iron is safer.

• Vitamin C boosts iron absorption.

• Good sources: Beans, greens, whole grains

Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.

CALCIUM

RDA for adults:

• 19-50 years: 1,000 mg/day

• 51+ years: 1,200 mg/day

Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. (2011).British Dietetic Association. Food fact sheet: calcium. https://www.bda.uk.com/foodfacts/Calcium.pdf. Published July 2017. Accessed April 25, 2018.

CALCIUM IN BEANS AND

GREENS(MILLIGRAMS PER CUP)

Black beans 103 Broccoli 94

Great northern beans121 Collards 358

Navy beans 128 Kale 94

Soybeans 175 Mustard greens150

Tofu 512 (Spinach 244)

White beans 161 (Swiss chard 102)

HOW MUCH CALCIUM IS

ABSORBED?

Brussels Sprouts 64%

Mustard Greens 58%

Broccoli 53%

Kale 40-59%

Fortified Orange Juice 36-38%

Milk (for comparison) 32%

Weaver CM, Plawecki KL. Am J Clin Nutr 1994;59(suppl):1238S-41S.Heaney RP, Weaver CM. Am J Clin Nutr 1990;51:656-7.

WHAT ABOUT GETTING

CALCIUM FROM DAIRY?

• Higher intake of dairy linked to:

– Bone and hip fractures

– Premature death

– Heart disease

– Some cancers

Michaelsson, K., Wolk, A., Langenskiold, S., Basu, S., Warensjo Lemming, E., Melhus, H., & Byberg, L. (2014). Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ, 349(oct27 1), g6015–g6015. https://doi.org/10.1136/bmj.g6015

Aune, D., Navarro Rosenblatt, D. A., Chan, D. S., Vieira, A. R., Vieira, R., Greenwood, D. C., … Norat, T. (2015). Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. The American Journal of Clinical Nutrition, 101(1), 87–117. https://doi.org/10.3945/ajcn.113.067157

IODINE

• RDA for adults: 150 mcg

• Good sources: Iodized salt, vegan sushi,

sea vegetables (e.g. nori, kombu, dulse)

– Sea vegetables may provide too much

• Vegan women of childbearing age

recommended to supplement 150 mcg/d

• Tips:

– When using salt at home, use iodized.

– Eat vegan sushi or sea veggies a few

times per week.

Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.

VITAMIN D

• RDA for adults:

–19-70 years: 600 IU/day

–71+ years: 800 IU/day

• Some recommend 1,000-2,000 IU

Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. (2011).National Institutes of Health Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Updated March 2, 2018. Accessed April 26, 2018. Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.

VITAMIN D

• Sources: Sun, supplements, fortified

foods

• Two types: D2 and D3

–Equivalent when taken by mouth

• Deficiency → osteomalacia,

osteoporosis

Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. (2011).National Institutes of Health Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Updated March 2, 2018. Accessed April 26, 2018. Melina et al. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116:1970-1980.

The major cause of the most common

chronic diseases is diet. (WHO, 2003).

7 out of 10 deaths in the U.S. are from

chronic diseases that can be prevented

through proper nutrition and other lifestyle

changes (Kung, et al., 2008).

x x x x x x x

TAKE-HOME POINTS

1. Eat whole plant foods: Fruits, veggies, whole grains, beans

2. Avoid animal products3. Minimize oils4.Take B12 (and vitamin

D if needed)