By: Sue Cotey and Andrea Harris, RNs
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You probably know that eating too much sugar and fat increases your risk of getting type 2 diabetes. But research increasingly shows that a food you might not expect — meat — can dramatically raise your chances as well.
Your body needs protein. But if you have diabetes or a risk of diabetes it’s wise to cut back on your meat intake to improve your health.
- A Diabetes Link to Meat
- Do different nuts have different health benefits for people with diabetes?
- Nuts and cholesterol
- Nuts and the glycemic index (GI)
- Nuts and heart disease
- How many calories are in nuts?
- On the whole, are nuts good for people with diabetes?
- Why People with Type 2 Diabetes Should Eat Tree Nuts
- Foods that spike a patient’s blood glucose are not what you think
- Bagel vs. donut
- Starchy potatoes
- Sticky white rice
- Fiber to the rescue
- What is the best milk for people with diabetes?
A growing body of research
A recent study from the Journal of the American Medical Association examined the deaths of nearly 700,000 people in 2012 from heart disease, stroke and type 2 diabetes.
They found that nearly 50 percent of the deaths were related to poor nutritional choices. For people who already had diabetes, their risk of death increased if they consumed more processed meats.
Another study released this spring from researchers in Finland analyzed the diets of more than 2,300 middle-aged men, ages 42 to 60. At the outset, none of the participants had type 2 diabetes. In the follow-up, after 19 years 432 participants did.
Researchers found that those who ate more animal protein and less plant protein had a 35 percent greater risk of getting diabetes. This included any kind of meat — processed and unprocessed red meat, white meats and variety meats, which include organ meats such as tongue or liver.
The study concluded that choosing plant and egg proteins may help prevent type 2 diabetes.
And a final study out of Harvard University found that people who ate a single serving of red meat each day had a 19 percent higher risk of getting type 2 diabetes than those who didn’t. An even smaller-sized serving of processed red meat, such as one hot dog or two slices of bacon, increased the risk to 51 percent.
This study concluded that choosing whole grains, nuts, low-fat dairy, fish and poultry instead of red meat lowers your risk of diabetes.
What’s the trouble with meat?
The exact reason why meat — particularly red meat and processed meat — is problematic isn’t known. But researchers believe there are three main components that increase diabetes risk:
- Sodium, which increases blood pressure, can cause insulin resistance.
- Nitrites in processed meats may increase insulin resistance and impair pancreatic function.
- Heme iron found in red meat can cause cell damage and chronic inflammation.
Making a change for better health
If you are at increased risk for getting diabetes or already have it, small changes matter.
If you eat a lot of red meat, try to cut back. And replacing some meat-based protein with eggs or plant-based protein is your best option. For example, you can get one ounce of protein from:
- One egg
- ¼ cup of cooked beans or peas
- ¼ cup of tofu
- 2 tablespoons of hummus
- 1 tablespoon of peanut or almond butter
The fact is, you only need a small amount of protein each day: 5 ounces daily for women and 6 ounces for men. And older adults need even less protein in their diet.
The Finnish study estimated that replacing just 5 grams of animal protein with plant protein each day would reduce your risk of diabetes by 18 percent.
The next time you are planning a meal or eating out make some small adjustments. Try choosing a 5-ounce steak instead of a 10-ounce serving. Also, opting for the chicken or fish instead of a rib eye can help keep your risk down.
Or, better yet, look for plant-based protein options in new recipes or on the menu at your favorite restaurants.
A Diabetes Link to Meat
Red-meat consumption is already linked to higher levels of colorectal cancer and cardiovascular disease (atherosclerosis, heart disease, and stroke). Now researchers from Harvard School of Public Health (HSPH) have added an increased risk of type 2 (adult onset) diabetes to that list. The incurable illness occurs when the body’s ability to control blood glucose levels by means of insulin secretion becomes impaired, either because of “insulin resistance” (when insulin fails to trigger effective glucose uptake by muscle or other tissues), or because production of insulin by beta cells in the pancreas declines.
The HSPH investigators, led by professor of epidemiology Frank Hu and research fellow An Pan, analyzed data from three longitudinal studies of male and female healthcare professionals who were followed for 14 to 28 years. After adjusting for other risk factors, the researchers found that a daily serving of red meat no larger than a deck of cards increased the risk of adult-onset diabetes by 19 percent. Processed red meat proved much worse: a daily serving half that size—one hot dog, or two slices of bacon, for example—was associated with a 51 percent increase in risk. (The average 10-year risk of getting diabetes for U.S. adults is around 10 percent.)
Why is red meat harmful? “Saturated fat, which can lead to cardiovascular disease, is really just the beginning of the story,” explains Hu. Even though it is “difficult to pinpoint one compound or ingredient” as mechanistically linked to diabetes risk, three components of red meat—sodium, nitrites, and iron—are probably involved. Sodium is well known to increase blood pressure, but it also causes insulin resistance; nitrites and nitrates have also been shown to increase insulin resistance and to impair the function of the pancreatic beta cells. Iron, although an essential mineral, can cause beta-cell damage in individuals with hereditary hemochromatosis (a disorder in which the gastrointestinal tract absorbs too much iron), and heme iron—the readily absorbable type found in meat—at high levels can lead to oxidative stress (and cell damage) and systemic, chronic inflammation in some people.
The study found that substituting other foods—such as whole grains, nuts, low-fat dairy, fish, and poultry (listed in order of effectiveness)—for meat substantially lowered diabetes risk. (Beans were not part of the study because consumption levels are so low, but Hu says that the benefits would likely be similar to consumption of other plant-based foods.) The findings of the group, which included Stare professor of nutrition Walter Willett and Brigham professor of women’s health JoAnn Manson, agree with the advice presented in a “Healthy Eating Plate” (HSPH’s answer to the U.S. government’s MyPlate dietary guidance), on which meat and dairy products are not even represented visually. The Healthy Eating Plate emphasizes vegetables, fruits, whole grains, and healthy proteins such as those listed in Hu’s study; recommends avoiding processed meats entirely; and shows a glass of water, rather than a glass of milk, beside the plate. “We don’t need to remove red meat from the diet entirely,” says Hu. “Americans just need to move meat from the center of the plate to the side of the plate.”
Nuts provide a number of benefits for people with diabetes. Studies suggest that nuts may even decrease the risk of type 2 diabetes
A study published in the Journal of the American College of Nutrition found that “nut consumption was associated with a decreased prevalence of selected risk factors for cardiovascular disease , type 2 diabetes, and metabolic syndrome
This page explores the various benefits of nuts for people with type 2 diabetes.
Do different nuts have different health benefits for people with diabetes?
Yes. Some nuts have benefits that others don’t.
- Almonds contain a lot of nutrients, particularly vitamin E
- Walnuts contain healthy omega-3 fatty acids
- Cashews offers lots of magnesium
- Almonds, peanuts, and pistachios all reduce ‘bad’ cholesterol
Almost all nuts offer something good for people with diabetes. Salted nuts, however, should be avoided. Excessive salt consumption is consistently linked to an increased risk of heart disease.
Nuts and cholesterol
One of the most prominent characteristics of nuts for people with diabetes is their effect on cholesterol levels. Avoiding high cholesterol levels is essential for people with diabetes, because exposure to high blood glucose levels increases the risk of the arteries narrowing.
Almonds, peanuts, and pistachios all reduce “bad” cholesterol very effectively. “Bad” cholesterol refers to small, dense particles of low-density lipoprotein (LDL), too much of which can clog the arteries.
Almonds, walnuts, pistachios, pecans, and hazelnuts reduce “bad” cholesterol by increasing levels of high-density-lipoprotein (HDL), or ‘good’ cholesterol. HDL clears out ‘bad’ cholesterol, thus reducing the risk of heart disease
Nuts and the glycemic index (GI)
The glycemic index measures the speed at which your body absorbs carbohydrates All foods are ranked on the glycemic index. Nuts are low on the glycemic index, which means your body absorbs the carbohydrates slowly.
In 2007, a study in Metabolism found that adding almonds to white bread and eating nuts with pasta slowed the rate of carbohydrate absorption (although that doesn’t mean eating white bread is a good idea – you can get the same benefits from having whole grain bread, without the effect on blood glucose levels). As a result, the participants’ blood sugar levels rose much more slowly.
Nuts and heart disease
People with diabetes have a significantly increased likelihood of developing heart disease. As many as 80 per cent of people with diabetes will die from a heart-related health problem, it is predicted.
Many nuts have a positive effect on heart health, reducing the risk of cardiovascular health problems and making them a great option for people with diabetes.
Almonds and walnuts, which contain a lot of vitamin E, also inhibit the development of plaque that can narrow and clog the arteries. Walnuts also have a lot of Omega-3 fatty acids, which is a kind of unsaturated fat most commonly found in fish. Omega-3 fatty acids increase levels of “good” cholesterol.
Many nuts contain an amino acid known as L-arginine, which strengthens the walls of the artery and makes them more flexible. People with strong, flexible arteries are less likely to suffer from poor blood flow.
How many calories are in nuts?
100g of almonds contains 576 calories , which is a lot for people with diabetes. It is therefore recommended that people with type 2 diabetes who would like to lose weight limit their consumption of nuts somewhat.
On the whole, are nuts good for people with diabetes?
Yes, but the effects vary depending on the kind of nut. Most of them offer some kind of benefit, from cardiovascular health to Omega-3 oils. The best advice, then, is to incorporate a generous amount of nuts into your diet, and make sure you get a variety.
The most important nuts for people with diabetes are probably the ones that improve cardiovascular health: almonds, walnuts, and pistachios, namely. If you only incorporate a few nuts into your diet, choose these ones. But be sure to avoid the salted varieties.
Why People with Type 2 Diabetes Should Eat Tree Nuts
The science behind a tree nut’s ability to improve your heart health is actually the result of their positive impact on your blood pressure, your body’s ability to metabolize dietary fat, your blood sugar levels, your body’s overall inflammation levels, and the well-being of your blood vessels.
Reducing your risk of these health issues helps reduce your risk of metabolic syndrome.
Metabolic syndrome is characterized by five risk factors that increase the likelihood of developing heart disease, type 2 diabetes, and having a stroke.
The five risk factors include:
- increased blood pressure (greater than 130/85 mm Hg)
- high blood sugar levels (insulin resistance)
- excess fat around the waist
- high triglyceride levels
- low levels of good cholesterol, or HDL
For patients already living with type 2 diabetes, the risk of developing heart disease or having a stroke is high. Taking steps to reduce your risk of metabolic syndrome means reducing your risk of these additional conditions.
Metabolic syndrome is diagnosed based on the combined five assessments of your waist circumference, fasting blood triglycerides, cholesterol levels, blood pressure, and fasting blood sugar levels.
If your doctor is prescribing regular exercise, quitting smoking, and weight loss, then a daily serving of tree nuts should help, too.
“Tree nuts have shown consistently in research to reduce the inflammation markers for heart disease and diabetes, and they help to increase high-density lipoproteins that protect your heart,” Elisabeth Almekinder, RN, BA, CDE, a freelancer writer who specializes in diabetes and other health issues, told Healthline.
High-density lipoproteins are a combination of cholesterol, triglycerides, and proteins, explained Almekinder, also a member of The Diabetes Council.
Lipoproteins play a critical role in the absorption and transportation of dietary fats in your small intestine. They also transport beneficial cholesterol and triglycerides from your liver to other parts of your body.
Despite the health concerns surrounding cholesterol and triglycerides, your body does need certain amounts of both in order to produce certain hormones and bile in the liver. Cholesterol is also a key building block for basic human tissue such as skin and cartilage.
Nuts are a gold mine when it comes to healthy fats.
The dietary fat in nuts is primarily monounsaturated, which is known for its ability to help lower cholesterol and protect your heart, according to the Mayo Clinic.
Foods that spike a patient’s blood glucose are not what you think
When providing nutrition advice to patients with prediabetes, the foods that can increase blood glucose levels are often not what you think. Identifying those foods are key to helping patients take the right step toward healthier eating.
The AMA Ed Hub™—your center for personalized learning from sources you trust—offers CME on a broad range of topics, including Nutrition Science for Health and Longevity: What Every Physician Needs to Know, to help physicians begin an effective nutrition conversation with patients. The four-hour, self-paced course is developed and hosted by the Gaples Institute for Integrative Cardiology, a nonprofit focused on enhancing the role of nutrition and lifestyle in health care, and is distributed in collaboration with the AMA Ed Hub.
How to talk with your patients about nutrition
Most people know that eating sugar-filled candies can cause blood glucose levels to rise, which for those predisposed, can create a greater risk for prediabetes. However, foods don’t have to taste sweet to spike blood sugar levels.
“It’s well understood that if you eat something sweet, like a brownie your blood glucose will bump, so no one is surprised when that happens,” said Stephen Devries, MD, a cardiologist and executive director of the Gaples Institute. “But many patients are unaware that starchy foods, many without a trace of sweetness, can bump blood glucose levels even more.”
Bagel vs. donut
Donuts are filled with added sugar and fat-no one mistakes them for a healthy food choice. But sometimes, well-meaning replacement foods can have unintended consequences.
“Patients with reason to be concerned about their blood sugar usually understand that sugary foods like donuts are poor choices,” said Dr. Devries. “In an effort to lower their sugar, they may swap a breakfast donut for something less sweet, like a bagel. But many patients don’t realize that starchy foods can cause blood sugar to soar even higher than sweet ones.”
The explanation is that starch is metabolized by the body into glucose. Because the bagel has a greater mass of carbohydrate than the donut, it leads to a higher release of glucose into the blood stream referred to as the “glycemic load.”
However, the conclusion is definitely not to encourage patients to eat more donuts. Instead, “the importance of comparing glycemic loads is to demonstrate that patients need to take care to limit not only sugary foods like donuts, but to also reduce their intake of starchy foods that can also spike sugar levels,” said Dr. Devries.
“Skip the donuts and bagels for breakfast, better to opt for oatmeal and fruit for breakfast,” he added.
“Potatoes are a vegetable, but the health value of all vegetables are not interchangeable. White potatoes in particular have a very high glycemic load. As a result, a baked white potato can also raise blood sugar even more than a glazed donut.”
Interestingly, potatoes chilled when eaten have a lower glycemic load than when served warm. A good alternative to potatoes as a side dish are beans or cauliflower rice, a popular culinary newcomer. The glycemic load is much lower, and cauliflower includes several key nutrients.
Sticky white rice
Even though it is not sweet, sticky white rice is another food that can deceptively bump blood sugar. Devoid of the fibrous outer bran and nutrient filled germ layers, white rice is mostly starch with a correspondingly high glycemic load.
A better choice is brown rice, a whole grain with more fiber than white rice and a lower glycemic load. Other whole grain alternatives to white rice are barley and farro.
“Whole grains are absolutely preferred over refined, but shouldn’t be consumed in unlimited quantities said Dr. Devries. “Large amounts of even whole grains, including brown rice can still spike blood glucose levels.”
Fiber to the rescue
As described in the Gaples Institute nutrition course, dietary fiber, especially the soluble type, reduces the amount of sugar absorbed from the digestive tract. Good sources of dietary soluble fiber include oats, beans, apples, citrus fruits, and nuts.
AMA members are eligible for a 20 percent discount on the Gaples Institute’s CME modules. Contact the Unified Service Center for the discount code at (800) 262-3211 or . AMA PRA Category 1 Credit™ is available.
What is the best milk for people with diabetes?
Share on PinterestThe types of milk recommended for diabetes will vary depending on their carbohydrate requirements.
The “best” milk for a person with diabetes depends on the flavors they prefer, the rest of their daily diet, and their overall daily carbohydrate intake.
For example, if a person aims to reduce their carbohydrate intake as much as possible, almond and flax milk contains nearly zero carbohydrates.
All cow’s milk does contain carbohydrates, and it is important for people with diabetes to factor this into their carbohydrate counts. However, skim milk can be a lower- fat, lower-calorie option for people who are not lactose intolerant and prefer cow’s milk.
Lower-fat foods and beverages like skimmed milk might result in a higher blood sugar level due to faster absorption. Glucose monitoring might therefore be helpful to determine if and what kind of cow milk is best.
Milk and type 2 diabetes risk
Several scientific studies have attempted to find a link between drinking milk and a reduced risk for type 2 diabetes.
A 2011 study in the Journal of Nutrition examined 82,000 women who had already finished menopause and, at the start of the study, had not received a diagnosis of diabetes. Over the course of 8 years, the researchers measured the participants’ intake of dairy products, including milk and yogurt.
They concluded the following:
“A diet high in low-fat dairy products is associated with lower diabetes risk in postmenopausal women, particularly those who are obese.”
Another study from 2011, published in the American Journal of Clinical Nutrition, tracked the relationship between dairy consumption during adolescence and their risk for type 2 diabetes as an adult.
The researchers concluded that consuming more dairy products during adolescence were associated with a reduced risk of type 2 diabetes.
The researchers also found that the adolescents with the higher dairy intake and lower prevalence of diabetes later in adulthood also had a lower intake of sugar-sweetened beverages and trans-fats, a lower glycemic load, and consumed less red and processed meats.
Whether or not the resulting lower diabetes risk was due to the dairy itself or the many other lifestyle factors, including consistent dairy intake into adulthood, necessitates more research.
A 2014 study, conducted by researchers in Sweden, found that a higher intake of high-fat dairy products, including butter, yogurt, milk, cream, and cheese, was associated with a lower risk of diabetes.
The researchers examined the effects of different saturated fats and concluded that a diet rich in the types of saturated fat found in dairy had a protective effect against type 2 diabetes.
They also found a link between an increased risk of developing the condition and a diet rich in saturated fats from meat.
Selecting a type of milk might involve different considerations for people who already have type 2 diabetes. They might focus more on controlling carbohydrate intake than fat intake.
However, these studies raise the point that not all fats are harmful to health, including those found in milk.
People with type 2 diabetes know to avoid certain carbohydrates that raise blood sugar levels. Counting carbohydrates is as easy as checking the nutrition label on foods for grams of sugar. But carbohydrates are not the only nutrient that affects blood sugar levels. Despite being sugar-free, proteins can influence — either positively or negatively — insulin secretion and glucose production as well. However, nutrition labels offer little help when it comes to understanding the impact of proteins, because it is not the grams of protein that matter but the protein source.
In a new peer-reviewed paper, California Dairy Research Foundation Executive Director Gonca Pasin, Ph.D., and nutrition scientist Kevin B. Comerford, Ph.D., report that milk and other dairy foods are the only animal proteins to consistently show beneficial effects on glucose production and insulin secretion.
To understand why dairy has different effects than beef, pork, or poultry, the authors suggest looking beyond nutrition labels and into the food matrix. Although it sounds like something out of a sci-fi movie, the food matrix approach simply means considering the complexity of food rather than looking at one particular nutrient. And milk is a very complex food.
Compare a glass of milk with one ounce of beef; both come from a cow, and both provide about the same amount of protein. But once consumed, some major differences between these protein sources become apparent. A cut of beef comes from muscle tissue and is made up of structural proteins. In stark contrast, milk evolved to be a food source for developing offspring and contains proteins with immunological, hormonal, and nutritional functions. As a result, milk contains unique types of proteins that are more biologically active in the human body than those from animal tissue.
“Not all protein sources are created equal in their abilities to modulate insulin secretion and insulin sensitivity,” explain the authors.
One protein group that appears to have a particularly strong influence on insulin production is whey. Perhaps best known for its role in promoting muscle growth, milk’s unique whey protein has demonstrated effects on insulin secretion. Indeed, the same branched-chain amino acids from whey proteins that play a role in stimulating protein synthesis in muscle tissue also stimulate the pancreas to produce insulin.
In addition, whey proteins can positively influence insulin sensitivity. The authors report on a study that found milk consumption in subjects with type 2 diabetes resulted in a five-fold greater increase in insulin response than would be expected based on its glucose response. What could explain this discrepancy? One suggestion is that the amino acid chains from whey proteins interact with chemical and hormonal signals from fat cells. In type 2 diabetics, these signals prevent insulin from moving glucose from the bloodstream and into the cells. However, whey proteins may interfere with these signals, allowing the insulin to effectively do its job.
Despite having unique proteins, dairy is often lumped in with other animal proteins in long-term prospective cohort studies that investigate the association between diet and risk of developing type 2 diabetes. These studies find that compared to plant proteins, animal proteins are associated with a higher risk of developing type 2 diabetes, and thus recommend replacing animal proteins — including dairy — with plant proteins.
But as the authors explain, “Studies that ignore the vastly heterogeneous nature of large food groups and simply assess plant protein versus animal protein will undoubtedly miss critical caveats underlying the unique relationships between different protein sources and type 2 diabetes risk.”
Indeed, when protein type is assessed individually, dairy proteins have the same lower risk association as plant proteins. The epidemiological evidence repeatedly finds that a higher intake of dairy foods, including milk, cheese, and yogurt, reduces the risk of developing type 2 diabetes.
Importantly, it is unlikely that whey protein is working alone. Calcium, magnesium, and even the presence of probiotics in fermented dairy products may add to or work synergistically with whey protein to positively influence blood glucose regulation. Hence, the emphasis on the food matrix approach—we consume food, not nutrients, which requires looking at all of the components to assess potential health benefits.
The authors believe that given the interaction between the ingredients in the foods we eat, and the way our bodies metabolize glucose and produce insulin, dietary choices can be highly effective in managing type 2 diabetes. But, they also warn that, “a person’s age, activity level, body composition, hormone levels, genetics, gut microbiota, and lifestyle factors all play a huge role in how a person reacts to different foods and dietary patterns. Therefore, not all people will benefit the same from the same dietary intervention.”
They also recommend moving away from population-based nutritional research to more personalized approaches. With 30 million Americans currently diagnosed with type 2 diabetes, and tens of millions more at risk for developing the disease, this personalized approach may be quite challenging. Because diabetes is the seventh leading cause of death in the United States, research into the influence of dairy on diabetes is a worthwhile challenge to accept.
— “Emerging Evidence for the Importance of Dietary Protein Source on Glucoregulatory Markers and Type 2 Diabetes: Different Effects of Dairy, Meat, Fish, Egg, and Plant Protein Foods,” by Kevin B. Comerford and Gonca Pasin, was published in Nutrients 2016, 8(8), 446; doi:10.3390/nu8080446
— About the California Dairy Research Foundation (CDRF):
The CDRF is an independent non-profit organization that leads and delivers research and science-based programs towards a more innovative and sustainable California and U.S. dairy industry. For more information about the CDRF and the research it supports, visit http://www.cdrf.org.
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