Diabetes and Diet

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ASU Professors have studied how changing your diet can help manage the effects of diabetes. Carol Johnston, associate director for the ASU nutrition program for the School of Nutrition and Health Promotion talks about how almonds and vinegar can benefit diabetic health.

José Cárdenas: According to the American Diabetes Association, in 2012 30 million people in the United States were suffering from diabetes. ASU researchers have conducted studies on the effects of diet choices on diabetic health. Joining me to talk more about these studies is Carol Johnston, associate director for the ASU nutrition program for the School of Nutrition And Health Promotion. Doctor, thank you for joining us this evening.

Dr. Carol Johnston: Thank you.

José Cárdenas: I think everybody knows that you eat a more healthy diet and you're better off in either warding off diabetes, which seems to be associated a lot with obesity, or at least controlling it if you have it. You don't see a whole lot about any particular food substance you should be eating that may help. You found that there are some.

Dr. Carol Johnston: Right, and you're absolutely right. Eating a diet that's a little bit lower in carbohydrates or exercising more is pretty much a prescription that patients are given by their doctors that you need to improve your diet, more plant-based foods, and you need to exercise more but we all know that people have trouble adhering to those prescriptions. It's hard to change your diet when you're so used to eating certain ways and people are busy, and it's hard for them to adhere to exercise programs. And so my strategy has been to try to identify simple diet strategies that hopefully people can adhere to for a long term. One of these is vinegar, which is sort of fascinating. It's an interesting food. It's been used medicinally for centuries but this link with diabetic, even though it's been in the lay literature, people have been doing it, it had not been studied scientifically.

José Cárdenas: And the references to in the lay literature, is that why you decided to take a look at it?

Dr. Carol Johnston: Actually, no. I found an obscure reference, it was conducted in a rat, in a rat study showing that vinegar improved their glucose control, the levels of the blood sugar and so I looked on to see what they had done in human and nothing had been done in humans and this study was published in the '80s. And so I just said it's not going to hurt anything to try and so we recruited healthy people, pre-diabetics and diabetics and we had them consume the vinegar at the early stages of their lunch and dinner meals and it worked.

José Cárdenas: What did it show? When you say it worked, what does that mean?

Dr. Carol Johnston: What doctors use is their marker, their main marker for diabetes, a protein in the bloodstream called hemoglobin a1c and that's what doctors use to mark the progression of the disease. And we were able to reduce that significantly with the vinegar. Even though the subjects were taking their diabetic medications, and so the effect of the vinegar was in addition to any effect that the medication had.

José Cárdenas: Could it replace those medications?

Dr. Carol Johnston: I would be very careful. That would be -- you would have to discuss it with your doctor and the doctor would have to monitor your a1c to understand if the vinegar is effective enough to perhaps do that. But the key here might be if you're a healthy individual or you might have prediabetes before they put you on medications, that would be the time to start the vinegar because the vinegar is going to be effective. We saw the same effect in healthy people without diabetic.

José Cárdenas: And, you know, when you say vinegar, people are thinking well why would I do that? And then as your study points out, there's some very easy things to do like a vinaigrette dressing on a salad but what other things could people do and how much vinegar are we talking about, by the way?

Dr. Carol Johnston: Well, the vinegar has to be taken at the start of the meal because it is inhibiting the digestion of your carbohydrates, the starchy carbohydrates, and so that's why it needs to be taken early in the meal. And so you could dilute it in a cup of water, one tablespoon of vinegar in a cup of water or you could use a vinaigrette dressing on a pre-meal salad that you might have to drink it out of the bowl because you know how the dressing is left in the bowl. So it might be just diluting it in a cup of cold water with maybe a little bit of sweetening agent is a good way to do that and you would drink it with the first bites of your meal. That's how our subjects did it in the 12-week trial where we saw this benefit.

José Cárdenas: And you and your colleagues also found another food substance that has similar -- is it as good as vinegar?

Dr. Carol Johnston: This is the almond work and almonds have been known to be good for reducing your risk for heart disease. There's long literature in the science journals about how effective nuts are for reducing your risk for heart disease and there's been a little bit more work recently on diabetes so we took up that. And we decided to use almonds. There's less allergy associated with almonds plus almonds have a very unique nutrient profile. They're rich in a lot of different nutrients that could theoretically help a diabetic. And so we just did a simple study in type two diabetics where for 12 weeks, they ate a handful of almonds every day. Well, five days a week. We said five out of the seven days, to do this. And it did reduce the hemoglobin a1c significantly. And when I say a reduction in hemoglobin a1c, the reduction that we're seeing with vinegar or almonds is the same reduction you would see if you altered your diet and exercised more.

José Cárdenas: Diabetes is a particularly important problem, a significant problem for the Hispanic population. And we've talked about it several times on this show. I don't think we've ever talked about something as simple as this sounds to be. What are doctors doing with this?

Dr. Carol Johnston: I think there might be a little skepticism because it is such a novel, simple concept.

José Cárdenas: Maybe too simple to believe, is that what it is?

Dr. Carol Johnston: Exactly. But theoretically the mechanism, we've identified the mechanism. We know very clear that the vinegar, the acetic acid, the ingredient in the vinegar, is blocking starch digestion. And so it's very clear what the mechanism is. And so it is a simple treatment, it's not -- it's safe, it's inexpensive, and it's widely available. So I definitely recommend people to do this, if they're concerned. Especially if they've been told by their doctor that they have prediabetes. 30% of the population has prediabetes. That's 1 in 3 people. And so this is such a simple thing. It's tasty, you can do so many different things with vinegar to incorporate it into your diet. And the almonds, trade off. You don't just have to do vinegar, you can do almonds some days or you can do both. It's just a simple, tasty dietary solution.

José Cárdenas: It sounds like a good solution and thank you for joining us to talk about it.

Dr. Carol Johnston: My pleasure, thank you.

Carol Johnston:Associate Director, Nutrition Program for the School of Nutrition and Health Promotion at Arizona State University;

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