Personalized Nutrition- Is the Future Here Yet?

August 10, 2017 at 8:21 am | Posted in Nutrition | Leave a comment
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By Robert Dunn, Dietetic Intern

Is the secret to a perfect diet hidden in your own body?

Personalized nutrition is a modern approach to nutrition that aims to prescribe specific diets based on biomarkers. Biomarkers are substances that provide information on a person’s condition, and can be used to measure disease risk. By assessing their impact on nutrition, medical professionals may be able to precisely determine the best diet for improving a person’s health.

The role of personalized nutrition is evolving quickly. Many researchers are optimistic that it may provide a breakthrough in the treatment of certain diseases. One of the diseases being closely studied is diabetes, a condition that affects over 29 million people in the United States. Additionally, over 80 million people are estimated to have prediabetes, putting them at risk for developing diabetes later in life. Diet and lifestyle have always been important for diabetes management, and personalized nutrition may soon play a key role in this process.

Researchers in Denmark recently published a study on personalized nutrition in diabetes treatment. Their goal was to determine the most effective weight loss diet for people that were diabetic, pre-diabetic, or neither (healthy group). To do so, they divided patients from prior weight loss studies into those groups based on two biomarkers: fasting insulin and fasting blood glucose. Once the patients were assigned groups, the researchers could then compare weight loss data to determine if any diet had a particularly strong effect on any specific group.

After comparing the data, several trends became clear. Patients in the diabetic group lost more weight on a low-carbohydrate diet that was high in plant-based fats like olive oil. Meanwhile, the healthy group was more successful with a low fat, high-carbohydrate diet. Finally, pre-diabetic patients who followed a diet high in fiber (fruits, vegetables, whole grains) lost more weight than those who followed a control diet. Based on these results, the researchers concluded that biomarkers like fasting blood sugar could be helpful in planning diet interventions for patients with either diabetes or pre-diabetes.

The results of this study seem promising, and may offer insight into weight loss strategies for people with diabetes or pre-diabetes. However, personalized nutrition is an emerging area of research and it is important we don’t make conclusions based on limited evidence. The study’s authors stated that next steps include “research to explore additional biomarkers…which may help to more effectively customize the right diet for specific individuals.”

In the meantime, people with diabetes and pre-diabetes should be encouraged to optimize their nutrition and physical activity. Nutrition counseling with qualified professionals has been shown to improve the health of people with these conditions. Anyone interested nutrition for diabetes management should consider meeting with a Registered Dietitian (RD).  Registered Dietitians are nutrition experts who help people of all backgrounds use diet to meet their medical needs.

To schedule an appointment with an RD from Massachusetts General Hospital, contact the Department of Nutrition and Food Services by calling 617-726-2779.

Content reviewed by Melanie Pearsall, RD, LDN, CDE

Prediabetes

June 18, 2015 at 2:30 pm | Posted in Uncategorized | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

What is prediabetes? Does it become diabetes? How is it diagnosed? How can it be treated? Do medications work? I feel like I have more and more patients asking me these questions and with recent statistics stating that over 54 million people in the US have prediabetes, I’m probably right. Prediabetes is a condition where the blood sugar is elevated but not so elevated that it’s diabetes. It typically does not have any symptoms, but there are instances where people might have symptoms of problems commonly associated with diabetes, such as retina changes or neuropathy. Some people may have a change in their skin called acanthosis nigricans. This means that the skin is darker in color in places like the armpit, behind the neck, or on the elbows, knees or knuckles.

Prediabetes is diagnosed with the same blood tests as those used to diagnose diabetes but the result parameters are different. Prediabetes is diagnosed when the A1C is between 5.7% and 6.4%; fasting glucose is between 100mg/dl and 125mg/dl; or when the 2 hour oral glucose tolerance test is between 140mg/dl and 199mg/dl. People that have a positive test are advised to have the test rechecked every 1 to 2 years to monitor for type 2 diabetes.

The cause of prediabetes is not known but it is thought that genetics may play a part and that there is increased insulin resistance. Much like with diabetes, there are established risk factors for the development of prediabetes. These risk factors include: age; positive family history; being of African American, Asian, Pacific Indian, and Hispanic ethnicity; overweight (especially with an increased abdominal girth); being sedentary; and PCOS (polycystic ovarian syndrome). A diagnosis of prediabetes does not mean an automatic progression to type 2 diabetes, but many people will progress to diabetes within 10 years of initial diagnosis.

There are many things that can be done to improve your health and possibly help the blood sugar values revert to normal range. There are some instances where metformin (Glucophage), a medication commonly used to treat type 2 diabetes, may be started, but that is an individual decision between the patient and their health care provider. The mainstay of treatment consists of lifestyle changes. For example: eating smaller portions, avoiding sugary beverages and fried foods, and walking most days of the week for 30 minutes at a moderate pace. I always tell my patients that they don’t have to join a gym or run a marathon, but they do have to move a little bit more each day. Remember, walking is the least costly form of exercise and will yield great benefits for your physical and mental health. I hope I have provided answers to your questions and some healthful tips to try and incorporate into your daily life. Now, I think I’ll take my own advice and leave the laptop behind so I can go take a walk in this gorgeous sunshine.

2013 ADA Clinical Practice Recommendations (Part 1)

February 21, 2013 at 1:00 pm | Posted in Health | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen W

Every year the multidisciplinary Professional Practice Committee of the American Diabetes Association (ADA) publishes a set of guidelines and recommendations on the diagnosis and treatment of diabetes for both adults and children. These standards guide us in how and when to screen for, diagnose and treat diabetes; how to monitor for complications; and how to educate patients in their self-management strategies.

These standards of care provide concrete data about goals of treatment, but they are not meant to be the only approach to care. Rather, they provide a guideline for the care of a person with diabetes;  providers rely on their best clinical judgment for each individual they care for and adapt the guidelines as needed.  Last year I did a review of the ADA Guidelines along with the specific updates published (you can refer to that post here). This year there were 12 revisions published which I will highlight this week and next. Please remember that these are guidelines— always review your personal health care plan with your health care provider(s).

Screening for Type 1 Diabetes

Type 1 Diabetes is generally diagnosed with an acute presentation of hyperglycemia and even ketoacidosis. There is no evidence that screening the general population for Type 1 Diabetes is helpful, but there is valid evidence that measuring islet autoantibodies in relatives of people with Type 1 Diabetes will identify at-risk individuals. Those identified can be referred to clinical studies where they can learn about their potential for developing Type 1 Diabetes and what symptoms to watch for.  Lifestyle education would also be provided and more frequent screening instituted.

Prevention/Delay of Type 2 Diabetes

There are several random controlled studies showing that people at high risk for developing Type 2 Diabetes can decrease their rate of onset with certain interventions. These interventions may include lifestyle changes and even medication in some instances. ADA supports formal education for people with impaired glucose tolerance and an A1C between 5.7 and 6.4%. People who fall into this category also need to be monitored annually for their blood sugar values and assessed for cardiovascular risk factors (obesity, hypertension, and high cholesterol).

Glucose Monitoring

I think one of the most important things we do as diabetes providers is helping people learn how to monitor their blood sugars at home and follow these patterns for better control. However, there has been some discussion in the literature about the clinical utility and expense for self-monitoring of blood glucose (SMBG) in people who aren’t on aggressive insulin or not on insulin at all. ADA has approached this issue by stating that frequency and timing of SMBG should be decided on an individual basis based on the person’s needs and goals for treatment. People using MDI or an insulin pump need frequent SMBG to assess for control and monitor for hypoglycemia. People using less frequent insulin or non-insulin therapies may check SMBG on a more variable schedule that should be determined with the health care provider. It’s also important to review testing technique at times to be sure the results are accurate.

DSME and Support Groups

ADA has always advocated for education and support for people with diabetes, and now is supporting formal education for pre-diabetic patients. ADA supports third-party payer reimbursement for both these services.

Hypoglycemia

Hypoglycemia awareness and management should be frequently reviewed with patients. The self-management plan should always be re-evaluated if there have been one (1) or more episodes of severe hypoglycemia (inability to handle the episode on your own).  People with severe hypoglycemia or hypoglycemia unawareness may need the targets for glycemic control raised. People with declining cognition need to be assessed frequently for hypoglycemia by their providers and family members.  Adjustments in their glycemic management plan will also need to be made.

To view the full set of Clinical Practice Recommendations for 2013, click here.


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