Dealing with Diabetes During COVID-19

According to the Centers for Disease Control (CDC), people with type 1 diabetes, type 2 diabetes or gestational diabetes have increased risk of severe illness from COVID-19.  As you’re aware, being obese (often a co-morbidity with type 2 diabetes) elevates the risk of becoming severely ill from COVID-19.  Visit the CDC Coronavirus website for the latest news.  With this new factor in mind, providing education and support for people with diabetes, as well as those at risk, takes on increased importance.

Weight management: During the pandemic, there is anecdotal evidence about the “quarantine-15,” a term to describe weight gained during the lockdown period.  For those who are overweight, losing just 5% of body weight can improve blood sugars and other diabetes outcomes.  Although this risk of weight gain isn’t limited to those with diabetes or pre-diabetes, keeping a healthy weight takes on greater importance. The same dietary guidance applies now as always– macronutrient percentage recommendations should be personalized and whether it be a Mediterranean, low-carb, vegetarian diet or another choice that your client follows, including lots of non-starchy vegetables, minimizing added sugars and refined grains and choosing whole, minimally processed foods – such as almonds – are the key tenets to healthy eating with diabetes. When it comes to snacking, including options that are high in fiber and protein to provide sustained energy can help people feel satisfied and help steady blood sugar.  With filling snacks, the chance of boredom eating is less likely too, which in turn, can help with weight maintenance. You’ll find 6 grams of plant protein and 4 grams of filling fiber in every healthy handful of almonds.

Staying motivated: Your patients and clients are at home more now and doing a lot of their own cooking. People with diabetes, given their increased risk, may have taken additional steps to protect themselves by avoiding unnecessary public outings, including shopping as frequently as they used to.  Education about stocking a healthy pantry by choosing foods with a longer shelf is something consumers are more interested in now than ever before. Sharing easy-to-make recipes with staple ingredients reimagined is a great way to provide a variety of options so meals and snacks don’t become repetitive.  Being at home so much makes it’s easy to graze all day. Work with clients on planning ahead and make the snacks they eat count by focusing on snacks that are high in fiber and protein to provide long-lasting energy to help tide them over between meals.  Greek yogurt topped with fruit and sliced almonds, spicy beef jerky, baby carrots with red pepper hummus or apple slices spread with almond butter are just a few delicious options!

FNCE Thank You

Thanks to everyone who stopped by our booth at FNCE to say hello and check out all of our offerings. We loved seeing you! If you missed us, be sure to check out our handouts that you can download for use with your patients and clients, and check out our Diet and Skin Health webinar (providing 1 hour CPE).  Reminder that our booth – like all of FNCE – is still open until June 2021 so you can still stop by and check us out if you registered for the meeting. And for those who couldn’t make it to FNCE, we have a very limited number of tins still available. Click here to order. Please note that we can only send one tin per person and to US addresses only. While the virtual meeting and connecting at our booth was fun, we are really looking forward to seeing you at FNCE in person next year in New Orleans! 

RESEARCH UPDATE:  A Look at Diabetes and Depression

A newly published prospective randomized control trial, conducted at Soochow University in Suzhou, China, investigated the effect of a low carb diet with almonds versus a low fat diet with no almonds on measures of depression, gut microbiota and HbA1c.¹  The research was funded by Suzhou Science and Technology Project (China). 

During the 3-month study, 45 participants, with an average age of 72, followed either a low-fat diet (control; n=23) or a low carbohydrate-almond diet (n=22). The low-carb almond group substituted 56 grams of almonds (2 ounces) for 150 grams of a carbohydrate-rich staple food.

Both groups were instructed on how to follow their assigned diet and record a food diary; the almond group also completed an almond adherence record.  Total calories were similar between the two diets:

• The low carb with almonds diet consisted of 40% carbohydrate, 38% fat and 22% protein
• The low fat diet consisted of 59% carbohydrate, 25% fat and 16% protein

Outcome parameters were measured at the start of the study and included blood samples to gauge HbA1c and fasting GLP-1 (glucagon-like peptide) concentration; depression scores using a validated assessment; body weight and height measurements; and determination of alpha-diversity of the gut microbiota through fecal samples.

At the 3-month conclusion of the study, these same parameters were measured again.  Specific findings included:

• Depression scores among those in the low carb-almond group decreased significantly (p<0.01) vs. no change in the low fat diet group
• HbA1c levels decreased in both groups, but the low-carb-almond diet followers had a larger reduction compared to the low fat diet followers (p<0.01)
• The low carb- almond group saw improvements in BMI and weight loss (p<0.05) by the end of the study, while no changes were seen in the low fat diet group. 
• The alpha-diversity of the gut microbiota increased significantly in both groups, but the low carb-almond group saw an increase in specific bacteria that affect GLP-1 secretion.
• While there was no statistically significant change in GLP-1 concentrations for either group over the course of the study, it was higher in the low carb-almond diet group than in the low fat diet group by the end of the study. 

In previous studies, the impact of low carbohydrate diets on depression scores has been inconsistent. The researchers hypothesize that the improvements seen in the group consuming the low carb-almond diet may have been due to the food used to replace carbohydrate – in this case, almonds. Almonds provide “dietary fiber, polyphenols and unsaturated fatty acids, that may be protective against the development of depression,”  according to the researchers.

People with type 2 diabetes do not make enough of the hormone glucagon-like peptide (GLP-1) receptor agonists, which are released from the intestines after eating to reduce blood glucose levels, among other things. To explore the potential mechanisms of the improvement in GLP-1 concentration, the researchers compared the composition of the gut microbiota between the two groups:

• Measures of Roseburia and Ruminococcus in the low carb-almond diet group were significantly higher than those in the low fat diet group by the end of the study.  Roseburia and Ruminococcus produce short-chain fatty acids, which may have helped maintain GLP-1 levels.
• Compared to the start of the study, harmful Bacteroides decreased significantly in the low carb- almond group at three months.

The researchers note, “The results show that an almond low carb diet could regulate the gut bacteria. Improvement of depression score in the almond low carb diet may be through modulating of the microbiome-gut-brain.”  Studies report that depressed people have a higher population of potentially-harmful Bacteroidetes species in the gut.

Limitations of this study should be noted, and include:

• The study was conducted in a population of type 2 diabetes patients with and without depression, which could limit the effect of the low-carbohydrate almond diet
• Changes in depression status were not monitored during the three-month intervention, only measured at the end of the study
• Further studies of patients with diabetes with clinical depression are warranted

Click here to view the full study.

Helpful Resources

Diabetes and your Diet

Healthy Snacking Guide