WEBVTT
00:00:00.160 --> 00:00:08.800
When a patient is diagnosed with prediabetes or diabetes, the education often becomes all about sugar and carbohydrates.
00:00:08.960 --> 00:00:16.079
And while those things absolutely matter, I sometimes wonder if we're focusing on the wrong things.
00:00:16.399 --> 00:00:18.800
Welcome back to the Exam Room Nutrition Podcast.
00:00:18.960 --> 00:00:20.640
I'm your host, Colleen Sloan.
00:00:20.719 --> 00:00:28.320
I'm a physician assistant and registered dietitian, and we're continuing our special four-part avocados in practice miniseries.
00:00:28.480 --> 00:00:31.600
This is brought to you by Avocados Love One Today.
00:00:31.839 --> 00:00:38.000
In today's episode, we're talking about what may be getting overlooked in the Diabetes Nutrition Conversation.
00:00:38.240 --> 00:00:51.439
Joining me again is Patricia Bannon, registered dietitian and nutrition expert to discuss glycemic load, diet quality, and the characteristics of foods that may support healthy blood sugar management and diabetes risk reduction.
00:00:51.679 --> 00:00:53.920
Patricia, this is such an important conversation.
00:00:54.000 --> 00:00:56.079
I'm so excited to discuss it with you today.
00:00:56.240 --> 00:00:57.840
It's great to be back, calling.
00:00:58.640 --> 00:01:11.200
So when someone is newly diagnosed with prediabetes or type 2 diabetes, because the education is very similar there, what are some of the first things that tend to come up in terms of nutrition advice that you're seeing amongst your colleagues?
00:01:11.439 --> 00:01:16.480
Yeah, so the conversation often starts with, you know, limit sugar and carbohydrates.
00:01:16.560 --> 00:01:24.000
They're told to cut back on sweets, refined grains, carbs more broadly, but it gets back to what we were talking about in our earlier episode.
00:01:24.159 --> 00:01:25.519
Then what do I eat?
00:01:25.680 --> 00:01:27.840
You know, they may also be told to lose weight.
00:01:27.920 --> 00:01:37.519
And, you know, weight loss could be beneficial for some people in terms of blood sugar management, but we also know leading with the scale is never appropriate or helpful, right?
00:01:37.760 --> 00:01:52.480
So I think to broaden the conversation, help our patients by helping them include fiber, helping them include healthy fats, protein, as well as a holistic look at movement and sleep and also how those foods are combined.
00:01:52.640 --> 00:02:01.840
So the goal isn't to eliminate carbs, but really to choose healthier carbs that have more fiber in them is going to help steady that blood sugar response.
00:02:02.000 --> 00:02:10.800
And avocados can fit here into this approach because they provide fiber and healthy unsaturated fats and they're naturally sugar-free.
00:02:11.120 --> 00:02:12.240
Yes, I love that.
00:02:12.400 --> 00:02:19.840
Now, we've previously talked about food swaps and why it's really important to educate our patients on what they can substitute it with.
00:02:20.000 --> 00:02:30.159
But I would really like to get practical here and help us understand and give us some ideas of how we can shift that conversation towards what they can add that will actually support metabolic health.
00:02:30.400 --> 00:02:33.680
Yeah, so I think the first thing is exactly that the reframing, right?
00:02:33.919 --> 00:02:36.479
Reframing the conversation to what they can add.
00:02:36.639 --> 00:02:41.199
It's gonna make it positive and actionable and give them a sense of autonomy.
00:02:41.439 --> 00:02:48.800
So encouraging vegetables, beans, whole grains, nuts, seeds, lean proteins, and healthy fats such as avocado.
00:02:49.039 --> 00:02:53.360
Pairing foods is also really important when we're looking at carbohydrate-containing foods.
00:02:53.439 --> 00:03:02.400
So pairing them with fiber, protein, and healthy fats can help slow digestion and support a more gradual rise in blood sugar.
00:03:02.560 --> 00:03:11.360
So what that pairing might look like is instead of just telling your patient to avoid toast, it might be pairing whole grain toast with an avocado and an egg.
00:03:11.520 --> 00:03:15.520
It might be pairing rice and beans with vegetables and avocado.
00:03:16.240 --> 00:03:19.120
Food pairing is one of my favorite strategies.
00:03:19.280 --> 00:03:19.759
I love it.
00:03:19.919 --> 00:03:21.360
I think it's so effective.
00:03:21.520 --> 00:03:28.800
And it helps patients keep some of their favorite foods on the plate, like we've talked about previously, about keeping that satisfaction and satiety.
00:03:29.120 --> 00:03:31.599
I love that avocados are a great food to pair with.
00:03:31.759 --> 00:03:41.199
Now, Patricia, we hear a lot about glycemic index and glycemic load when we're talking about diabetes or like a diabetic diet, like what we learned way back in school.
00:03:41.439 --> 00:03:49.360
But I would love if you can explain to us the difference between those two and if you think that we might be able to incorporate that in overall dietary patterns.
00:03:49.599 --> 00:03:59.280
Yeah, so the glycemic index, it ranks carbohydrate-containing foods on how quickly they raise blood sugar compared to a reference food, which is generally glucose.
00:03:59.439 --> 00:04:07.199
Now, the glycemic load reflects both the quality and the quantity of the carbohydrate on their potential impact on blood sugar.
00:04:07.360 --> 00:04:09.439
So a nice example of this is watermelon.
00:04:09.520 --> 00:04:15.759
Okay, so watermelon is a relatively high glycemic index, but it has a low glycemic load.
00:04:15.840 --> 00:04:19.199
And that's because per serving it doesn't have that many carbohydrates.
00:04:19.279 --> 00:04:20.480
It's mostly water.
00:04:20.720 --> 00:04:23.920
So it's a great guide, but it is just a guide.
00:04:24.000 --> 00:04:30.720
There's many other things that can influence this, such as portion size, food combination, and cooking methods also matter.
00:04:30.879 --> 00:04:34.879
And there's an interesting study on avocados and glycemic load.
00:04:34.959 --> 00:04:38.399
This was a study supported by the Avocado Nutrition Center.
00:04:38.480 --> 00:04:44.000
And it was a secondary analysis of the HAT study, the habitual diet and avocado trial.
00:04:44.160 --> 00:04:47.360
This was one we talked about in our weight management episode.
00:04:47.519 --> 00:04:51.519
And it's the most extensive avocado clinical trial of its kind.
00:04:51.680 --> 00:04:58.720
And in this secondary analysis, it included 961 adults with elevated waste circumference.
00:04:58.879 --> 00:05:10.560
And the participants who added one avocado a day for six months reduced the glycemic load of their overall diet by nearly 14 points compared to the control group.
00:05:10.720 --> 00:05:13.839
And what I love about this is they weren't instructed to do anything else.
00:05:14.000 --> 00:05:17.279
They weren't instructed to reduce calories or carbohydrates.
00:05:17.439 --> 00:05:23.839
So a lot of the work I do is on helping people create microhabits, you know, these small shifts with big results.
00:05:23.920 --> 00:05:26.160
So what I like here is this is a great example of that.
00:05:26.319 --> 00:05:34.319
Just by adding an avocado a day is an example of a nutrient-dense food that may help shift the overall dietary pattern.
00:05:34.959 --> 00:05:38.560
Okay, Patricia, I'm a fan of habit stacking too.
00:05:38.720 --> 00:05:39.279
I love that.
00:05:39.439 --> 00:05:48.639
And I actually never thought about bringing avocados into, you know, a meal or something you already enjoy because you're already consuming, you know, that food that you like.
00:05:48.800 --> 00:05:52.879
So I love making food choices and healthier options easier.
00:05:52.959 --> 00:05:55.040
And that's one really, really great way.
00:05:55.279 --> 00:06:06.240
Now, I want to understand a little bit about research and what it tells us about the relationship between overall diet quality and diabetes risk, because I think this is important and it's not talked about enough.
00:06:06.560 --> 00:06:07.120
Absolutely.
00:06:07.279 --> 00:06:17.279
So the first thing is that diabetes risk is influenced by many factors, including genetics, body composition, physical activity, sleep, and then, of course, overall diet quality.
00:06:17.439 --> 00:06:21.279
So when it comes to overall diet quality, it's really those patterns that matter.
00:06:21.439 --> 00:06:27.920
You know, the patterns of having minimally processed foods, fiber, healthy fats, vegetables, lean proteins.
00:06:28.000 --> 00:06:37.920
And avocados is one of my favorite foods to recommend for people with prediabetes because it can help improve overall diet quality while providing fiber and healthy fats.
00:06:38.079 --> 00:06:40.800
So there's two studies that really bring this to life.
00:06:40.879 --> 00:06:44.240
And these were studies that were supported by the Avocado Nutrition Center.
00:06:44.319 --> 00:06:51.839
And there are two observational studies in Hispanic and Latino populations that provide additional, although not causal, evidence.
00:06:52.000 --> 00:07:02.240
So one analysis of more than 14,000 Hispanic adults with type 2 diabetes linked avocado intake with a lower average blood sugar and better insulin response.
00:07:02.399 --> 00:07:06.000
So, in terms of diabetes management, that's really interesting.
00:07:06.160 --> 00:07:21.839
And then the other study of more than 6,000 Hispanic adults associated regular avocado intake over a six-year period with a 28% lower diabetes risk and a 31% lower risk among those with prediabetes.
00:07:22.079 --> 00:07:34.319
And of course, these can't be generalized to a larger, more diverse population, but it's really adding to the growing body of evidence in terms of blood sugar control, diabetes, and how avocados can really help benefit people.
00:07:34.560 --> 00:07:40.879
Okay, Patricia, you know I love the science, but I love even more is making that science practical for our patients.
00:07:41.040 --> 00:07:49.360
So we've talked about this in previous episodes, but I would like to hear some ways that avocados can actually be brought into meals that support blood sugar management.
00:07:49.680 --> 00:07:50.079
Yes.
00:07:50.240 --> 00:07:52.079
So pairing it is really key.
00:07:52.240 --> 00:07:56.879
Pairing the avocado with other sources of fiber foods and protein.
00:07:57.040 --> 00:07:58.800
I use this example a lot, right?
00:07:58.879 --> 00:08:02.000
That whole grain toast with avocado and an egg.
00:08:02.160 --> 00:08:08.959
And one thing I haven't mentioned yet is avocados can work great in frozen desserts, such as frozen yogurt bark or ice cream.
00:08:09.120 --> 00:08:11.600
You know, it's rich, it has a creamy texture.
00:08:11.759 --> 00:08:14.000
It's really a satisfying dessert option.
00:08:14.160 --> 00:08:20.240
And there's actually in the show notes, there's gonna be a link to a no-sugar added avocado banana dairy-free ice cream.
00:08:20.480 --> 00:08:22.079
I love this ice cream, by the way.
00:08:22.160 --> 00:08:23.600
I'm like a smoothie fan.
00:08:23.680 --> 00:08:25.839
So when I saw this, I loved it.
00:08:25.920 --> 00:08:31.519
So definitely grab the link in the show notes because this is gonna be so helpful for some of your patients who maybe have a sweet tooth.
00:08:31.600 --> 00:08:42.720
And again, like we've talked about throughout this entire series, we don't just want to tell them what they have to avoid and restrict, really bringing in foods that are nutritious, beneficial, but also taste good too.
00:08:42.799 --> 00:08:47.039
So they have that element of pleasure and enjoyment while working on their health.
00:08:47.279 --> 00:08:49.519
Patricia, this has been an incredible episode.
00:08:49.600 --> 00:08:55.279
Thank you so much for sharing all of this information and thank you to Avocados Love One Today for sponsoring this series.
00:08:55.440 --> 00:09:00.080
As I mentioned, all of the research and that delicious recipe will be linked in the show notes.
00:09:00.159 --> 00:09:10.960
And be sure to come back tomorrow as we are wrapping up our avocados in practice mini series with one of my favorite topics feeding kids and families, from first foods to family meals.
00:09:11.120 --> 00:09:12.399
I hope you'll join us.
00:00:00.160 --> 00:00:08.800
When a patient is diagnosed with prediabetes or diabetes, the education often becomes all about sugar and carbohydrates.
00:00:08.960 --> 00:00:16.079
And while those things absolutely matter, I sometimes wonder if we're focusing on the wrong things.
00:00:16.399 --> 00:00:18.800
Welcome back to the Exam Room Nutrition Podcast.
00:00:18.960 --> 00:00:20.640
I'm your host, Colleen Sloan.
00:00:20.719 --> 00:00:28.320
I'm a physician assistant and registered dietitian, and we're continuing our special four-part avocados in practice miniseries.
00:00:28.480 --> 00:00:31.600
This is brought to you by Avocados Love One Today.
00:00:31.839 --> 00:00:38.000
In today's episode, we're talking about what may be getting overlooked in the Diabetes Nutrition Conversation.
00:00:38.240 --> 00:00:51.439
Joining me again is Patricia Bannon, registered dietitian and nutrition expert to discuss glycemic load, diet quality, and the characteristics of foods that may support healthy blood sugar management and diabetes risk reduction.
00:00:51.679 --> 00:00:53.920
Patricia, this is such an important conversation.
00:00:54.000 --> 00:00:56.079
I'm so excited to discuss it with you today.
00:00:56.240 --> 00:00:57.840
It's great to be back, calling.
00:00:58.640 --> 00:01:11.200
So when someone is newly diagnosed with prediabetes or type 2 diabetes, because the education is very similar there, what are some of the first things that tend to come up in terms of nutrition advice that you're seeing amongst your colleagues?
00:01:11.439 --> 00:01:16.480
Yeah, so the conversation often starts with, you know, limit sugar and carbohydrates.
00:01:16.560 --> 00:01:24.000
They're told to cut back on sweets, refined grains, carbs more broadly, but it gets back to what we were talking about in our earlier episode.
00:01:24.159 --> 00:01:25.519
Then what do I eat?
00:01:25.680 --> 00:01:27.840
You know, they may also be told to lose weight.
00:01:27.920 --> 00:01:37.519
And, you know, weight loss could be beneficial for some people in terms of blood sugar management, but we also know leading with the scale is never appropriate or helpful, right?
00:01:37.760 --> 00:01:52.480
So I think to broaden the conversation, help our patients by helping them include fiber, helping them include healthy fats, protein, as well as a holistic look at movement and sleep and also how those foods are combined.
00:01:52.640 --> 00:02:01.840
So the goal isn't to eliminate carbs, but really to choose healthier carbs that have more fiber in them is going to help steady that blood sugar response.
00:02:02.000 --> 00:02:10.800
And avocados can fit here into this approach because they provide fiber and healthy unsaturated fats and they're naturally sugar-free.
00:02:11.120 --> 00:02:12.240
Yes, I love that.
00:02:12.400 --> 00:02:19.840
Now, we've previously talked about food swaps and why it's really important to educate our patients on what they can substitute it with.
00:02:20.000 --> 00:02:30.159
But I would really like to get practical here and help us understand and give us some ideas of how we can shift that conversation towards what they can add that will actually support metabolic health.
00:02:30.400 --> 00:02:33.680
Yeah, so I think the first thing is exactly that the reframing, right?
00:02:33.919 --> 00:02:36.479
Reframing the conversation to what they can add.
00:02:36.639 --> 00:02:41.199
It's gonna make it positive and actionable and give them a sense of autonomy.
00:02:41.439 --> 00:02:48.800
So encouraging vegetables, beans, whole grains, nuts, seeds, lean proteins, and healthy fats such as avocado.
00:02:49.039 --> 00:02:53.360
Pairing foods is also really important when we're looking at carbohydrate-containing foods.
00:02:53.439 --> 00:03:02.400
So pairing them with fiber, protein, and healthy fats can help slow digestion and support a more gradual rise in blood sugar.
00:03:02.560 --> 00:03:11.360
So what that pairing might look like is instead of just telling your patient to avoid toast, it might be pairing whole grain toast with an avocado and an egg.
00:03:11.520 --> 00:03:15.520
It might be pairing rice and beans with vegetables and avocado.
00:03:16.240 --> 00:03:19.120
Food pairing is one of my favorite strategies.
00:03:19.280 --> 00:03:19.759
I love it.
00:03:19.919 --> 00:03:21.360
I think it's so effective.
00:03:21.520 --> 00:03:28.800
And it helps patients keep some of their favorite foods on the plate, like we've talked about previously, about keeping that satisfaction and satiety.
00:03:29.120 --> 00:03:31.599
I love that avocados are a great food to pair with.
00:03:31.759 --> 00:03:41.199
Now, Patricia, we hear a lot about glycemic index and glycemic load when we're talking about diabetes or like a diabetic diet, like what we learned way back in school.
00:03:41.439 --> 00:03:49.360
But I would love if you can explain to us the difference between those two and if you think that we might be able to incorporate that in overall dietary patterns.
00:03:49.599 --> 00:03:59.280
Yeah, so the glycemic index, it ranks carbohydrate-containing foods on how quickly they raise blood sugar compared to a reference food, which is generally glucose.
00:03:59.439 --> 00:04:07.199
Now, the glycemic load reflects both the quality and the quantity of the carbohydrate on their potential impact on blood sugar.
00:04:07.360 --> 00:04:09.439
So a nice example of this is watermelon.
00:04:09.520 --> 00:04:15.759
Okay, so watermelon is a relatively high glycemic index, but it has a low glycemic load.
00:04:15.840 --> 00:04:19.199
And that's because per serving it doesn't have that many carbohydrates.
00:04:19.279 --> 00:04:20.480
It's mostly water.
00:04:20.720 --> 00:04:23.920
So it's a great guide, but it is just a guide.
00:04:24.000 --> 00:04:30.720
There's many other things that can influence this, such as portion size, food combination, and cooking methods also matter.
00:04:30.879 --> 00:04:34.879
And there's an interesting study on avocados and glycemic load.
00:04:34.959 --> 00:04:38.399
This was a study supported by the Avocado Nutrition Center.
00:04:38.480 --> 00:04:44.000
And it was a secondary analysis of the HAT study, the habitual diet and avocado trial.
00:04:44.160 --> 00:04:47.360
This was one we talked about in our weight management episode.
00:04:47.519 --> 00:04:51.519
And it's the most extensive avocado clinical trial of its kind.
00:04:51.680 --> 00:04:58.720
And in this secondary analysis, it included 961 adults with elevated waste circumference.
00:04:58.879 --> 00:05:10.560
And the participants who added one avocado a day for six months reduced the glycemic load of their overall diet by nearly 14 points compared to the control group.
00:05:10.720 --> 00:05:13.839
And what I love about this is they weren't instructed to do anything else.
00:05:14.000 --> 00:05:17.279
They weren't instructed to reduce calories or carbohydrates.
00:05:17.439 --> 00:05:23.839
So a lot of the work I do is on helping people create microhabits, you know, these small shifts with big results.
00:05:23.920 --> 00:05:26.160
So what I like here is this is a great example of that.
00:05:26.319 --> 00:05:34.319
Just by adding an avocado a day is an example of a nutrient-dense food that may help shift the overall dietary pattern.
00:05:34.959 --> 00:05:38.560
Okay, Patricia, I'm a fan of habit stacking too.
00:05:38.720 --> 00:05:39.279
I love that.
00:05:39.439 --> 00:05:48.639
And I actually never thought about bringing avocados into, you know, a meal or something you already enjoy because you're already consuming, you know, that food that you like.
00:05:48.800 --> 00:05:52.879
So I love making food choices and healthier options easier.
00:05:52.959 --> 00:05:55.040
And that's one really, really great way.
00:05:55.279 --> 00:06:06.240
Now, I want to understand a little bit about research and what it tells us about the relationship between overall diet quality and diabetes risk, because I think this is important and it's not talked about enough.
00:06:06.560 --> 00:06:07.120
Absolutely.
00:06:07.279 --> 00:06:17.279
So the first thing is that diabetes risk is influenced by many factors, including genetics, body composition, physical activity, sleep, and then, of course, overall diet quality.
00:06:17.439 --> 00:06:21.279
So when it comes to overall diet quality, it's really those patterns that matter.
00:06:21.439 --> 00:06:27.920
You know, the patterns of having minimally processed foods, fiber, healthy fats, vegetables, lean proteins.
00:06:28.000 --> 00:06:37.920
And avocados is one of my favorite foods to recommend for people with prediabetes because it can help improve overall diet quality while providing fiber and healthy fats.
00:06:38.079 --> 00:06:40.800
So there's two studies that really bring this to life.
00:06:40.879 --> 00:06:44.240
And these were studies that were supported by the Avocado Nutrition Center.
00:06:44.319 --> 00:06:51.839
And there are two observational studies in Hispanic and Latino populations that provide additional, although not causal, evidence.
00:06:52.000 --> 00:07:02.240
So one analysis of more than 14,000 Hispanic adults with type 2 diabetes linked avocado intake with a lower average blood sugar and better insulin response.
00:07:02.399 --> 00:07:06.000
So, in terms of diabetes management, that's really interesting.
00:07:06.160 --> 00:07:21.839
And then the other study of more than 6,000 Hispanic adults associated regular avocado intake over a six-year period with a 28% lower diabetes risk and a 31% lower risk among those with prediabetes.
00:07:22.079 --> 00:07:34.319
And of course, these can't be generalized to a larger, more diverse population, but it's really adding to the growing body of evidence in terms of blood sugar control, diabetes, and how avocados can really help benefit people.
00:07:34.560 --> 00:07:40.879
Okay, Patricia, you know I love the science, but I love even more is making that science practical for our patients.
00:07:41.040 --> 00:07:49.360
So we've talked about this in previous episodes, but I would like to hear some ways that avocados can actually be brought into meals that support blood sugar management.
00:07:49.680 --> 00:07:50.079
Yes.
00:07:50.240 --> 00:07:52.079
So pairing it is really key.
00:07:52.240 --> 00:07:56.879
Pairing the avocado with other sources of fiber foods and protein.
00:07:57.040 --> 00:07:58.800
I use this example a lot, right?
00:07:58.879 --> 00:08:02.000
That whole grain toast with avocado and an egg.
00:08:02.160 --> 00:08:08.959
And one thing I haven't mentioned yet is avocados can work great in frozen desserts, such as frozen yogurt bark or ice cream.
00:08:09.120 --> 00:08:11.600
You know, it's rich, it has a creamy texture.
00:08:11.759 --> 00:08:14.000
It's really a satisfying dessert option.
00:08:14.160 --> 00:08:20.240
And there's actually in the show notes, there's gonna be a link to a no-sugar added avocado banana dairy-free ice cream.
00:08:20.480 --> 00:08:22.079
I love this ice cream, by the way.
00:08:22.160 --> 00:08:23.600
I'm like a smoothie fan.
00:08:23.680 --> 00:08:25.839
So when I saw this, I loved it.
00:08:25.920 --> 00:08:31.519
So definitely grab the link in the show notes because this is gonna be so helpful for some of your patients who maybe have a sweet tooth.
00:08:31.600 --> 00:08:42.720
And again, like we've talked about throughout this entire series, we don't just want to tell them what they have to avoid and restrict, really bringing in foods that are nutritious, beneficial, but also taste good too.
00:08:42.799 --> 00:08:47.039
So they have that element of pleasure and enjoyment while working on their health.
00:08:47.279 --> 00:08:49.519
Patricia, this has been an incredible episode.
00:08:49.600 --> 00:08:55.279
Thank you so much for sharing all of this information and thank you to Avocados Love One Today for sponsoring this series.
00:08:55.440 --> 00:09:00.080
As I mentioned, all of the research and that delicious recipe will be linked in the show notes.
00:09:00.159 --> 00:09:10.960
And be sure to come back tomorrow as we are wrapping up our avocados in practice mini series with one of my favorite topics feeding kids and families, from first foods to family meals.
00:09:11.120 --> 00:09:12.399
I hope you'll join us.
