Diabetes SA's Annual Food and Health Seminar 'Mediterranean Magic' was held on Saturday 21 February 2015 at the Adelaide Convention Centre in their brand new Panorama Rooms. After the opening by General Manager, Fiona Benton, the 400 guests (approx.) were informed of all of the benefits of enjoying a Mediterranean eating pattern through including legumes and nuts every day by Dr Alison Coates, from the University of South Australia. At morning tea time, guests were invited to enjoy tasting some of the Mediterranean foods through mini sweet potato, button mushroom and spinach frittatas, mini chicken, tabouleh and hummus wraps and diced fruit with vanilla bean yoghurt. Guests were also treated by the Australian Mushroom Growers Association with a very tasty mushroom, rice and quinoa salad, which everyone seemed to enjoy! After morning tea, Glenn Cardwell, an Accredited Practising Dietitian from Perth, entertained the crowd and discussed the many benefits of consuming vegetables and most importantly, consuming mushrooms as part of your five serves of vegetables every day. Then to show guests how easy it is to embed the Mediterranean style of eating into every day meals, Danielle (Health Promotions Officer) and Dayna (Dietitian) from Diabetes SA conducted a cooking demonstration where they made rice paper salad rolls and berry and yoghurt parfaits. Feedback from the seminar was very positive and the venue was beautiful with stunning views of the river and Adelaide Oval. Thank you to all who attended and organised the seminar, making it a great success. http://www.diabetessa.com.au/latest-news/annual-food-and-health-seminar-mediterranean-magic.html

1. Health benefits of legumes and nuts-
a Mediterranean style of eating
Alison Coates, PhD, RNutr
Alliance for
Research in Exercise
Nutrition and Activity
www.ibnuts.com/
www.theblackdogyogablog.com

2. Secrets of the Mediterranean diet
www.msccruisesusa.com
Traditional Mediterranean
food pattern associated with
reduced risk of developing
Type 2 diabetes
BMJ 2008; 336: 1348–1351.

4. • Olive oil
• Oily fish
• Fruit and vegetables
• Wine in moderation
• Legumes
• Nuts

5. Legumes
Nuts
and
Legumes

6. What is a serve of legumes
When incorporated as a 1 vegetable serving
• 1/2 cup (75g) of cooked beans, peas, lentils, chickpeas
When incorporated as a 1 meat serving
• 1 cup (150g) of cooked beans, peas, lentils, chickpeas
http://thumbs.dreamsti me.com/z/placa- vazia- com-as-er vilhas- verdes-na-for ma-de-um- ponto-de-
interroga%C3%A7%C3%A3o-38054987.jpg
Note: Dietary pulses = dried leguminous seeds
www.goodreads.com

7. How many Australians
consume legumes?
Source: Grains & Legumes Nutrition Council. Secondary Analysis of the 2011 – 2012 Australian Health Survey. Unpublished: 2014.
Only 7.9% of Australians consumed legume foods
at least one day of the Australian Health survey.
Adult consumers reported eating
~ 100g (2/3 cup cooked legumes) / day
www.glnc.org.au

8. Common types of legumes
www.realsimple.com/food-recipes/shopping.../common-types-beans
Black beans Pinto beans Kidney beans Cannellini beans Lima beans
Chickpeas Black eyed peas Lentils

9. Favourite legumes in Australia
• Number of consumers by legume type
Source: Grains & Legumes Nutrition Council. 2014 Australian Grains and Legumes Consumption and Attitudinal Report. Unpublished: 2014.
10% 7% 7% 5%
Baked beans
(navy beans)
Chickpeas Lentils Kidney beans
www.watties.co.nz
www.123rf.com/photo_26400745
www.listentolena.com
www.livestrong.com

10. Helping Beans Run Out of Gas
www.cartoonstock.com

11. Pictures from http://www.americanbean.org/
Scientists discover
how to make beans
less explosive
Increasing fermentation with
TWO strains of healthy bacteria
have been found to be the key to
making beans flatulence-free.
Granito et al (2003). Journal of the Science of Food and Agriculture. Volume 83, Issue 10, p 1004–1009.
http://magazinedown.com/upimg/201004/04/040248531599.jpeg

12. • Legumes have low energy density
• ~330-450kJ/100g
• Legumes are nutrient-rich foods
• High in protein, low in fat and
cholesterol-free
• Legumes are low GI
• Rich in fibre (1/2 cup provides
~30% daily need)
• Legumes are good sources of
vitamins and minerals
• Rich in Iron, Potassium, Folate,
phosphorous, zinc and magnesium
What makes legumes so good?
www.favoriterun.com/blog/?p=373

13. Protein and fibre content…
…help with appetite regulation
www.healthmeup.com

14. Energy intake increases with
higher energy density
Kral TVE, Roe LS, Rolls BJ. Am J Clin Nutr 2004;79:962– 8.

15. Lower energy density and increased vegetable
intake can limit total energy consumption
Rolls BJ, Roe LS, Meengs JS. J Am Diet Assoc 2004;104:1570–6.
People could
eat the pasta
meal until they
felt full
kJ/g
1.38 2.80 5.56
No
difference
in hunger
ratings

16. Red Lentils Chickpeas Kidney beans
Amount of
water/ 1 cup
of legumes
3 cups 3 cups 3 cups
Quick
preparation
method
(no soaking needed)
Rinse
Bring to boil and
simmer for 30-45
minutes
Rinse
Bring to boil and
simmer for 45-60
minutes
Rinse
Bring to boil and
simmer for 55-70
minutes
Traditional
preparation
method
Use quick
preparation
method
- no soaking
required
Soak 6-8 hours
Drain
Fresh water and
bring to boil then
simmer for 20-30
minutes
Soak 6-8 hours
Drain
Fresh water and
bring to boil then
simmer for 30-40
minutes
Tips for preparing legumes
www.glnc.org.au/legumes/legumes-cooking-tips/

17. Simple recipes to incorporate legumes into your diet
Black bean and corn Mexican salad

18. www.eatforhealth.gov.au/eating-well/healthy-recipes/vegie-lentil-soup
Lentil and vegetable soup

19. • Eat a diet containing 50-60% energy from
carbohydrate mainly from
• whole grains and legumes
• fruit
• vegetables
• low-fat milk
• Legumes have a lesser effect on blood glucose than
most other carbohydrate-containing foods.

20. http://www.carineresear ch.com.au/

21. • People with Type 2
diabetes ate 3 different
meals in a cross-over
study design
• Glucose and insulin
responses to the mixed
meals were measured
• Meals were matched on
carbohydrate, fat, protein
and water
Schafer et al (2003) Am J Clin Nutr;78:99-103
How carbohydrate type
alters blood glucose response

22. Mixed meal with peas and
potatoes ( )
Mixed meal with potatoes ( )
Mixed meal with peas ( )
Mixed meal with peas ( )
Mixed meal with peas and
potatoes ( )
Mixed meal with potatoes ( )
Schafer et al (2003) Am J Clin Nutr;78:99-103

23. Larger glucose and
insulin responses when
higher GI foods are
incorporated into a
mixed meal
Schafer et al (2003) Am J Clin Nutr;78:99-103
Peas reduce the
glycaemic response
http://www.gourmetsleuth.com/images/default-source/dictionary/green-split-peas-jpg.jpg?sfvrsn=3

24. Sievenpiper et al. (2009). Diabetologia; 52: 1479–1495.
Legumes alone
(11 trials)
Legumes in
low-GI diets
(19 trials)
Legumes in high
fibre diets
(11 trials)
Fasting blood
glucose
-0.82
(-1.36, -0.27)
No significant
change
−0.32
(−0.49, −0.15)
Long term glucose
regulation (HbA1C)
No significant
change
−0.28
(−0.42, −0.14)
−0.27
(−0.45, −0.09)
meta-analysis of 39 trials
Legumes improve markers of
longer-term glycaemic control
standardised mean differences (95% Cis)

25. Eating legumes lowers bad cholesterol
Median
amount
eaten
130 g/day
Evidence
from 26
studies using
• Beans
• Chickpeas
• Lentils
• Peas
Ha et al (2014) CMAJ.186(8), E252-E262

26. Can legumes assist with weight loss?
• A diet high in legumes can help reduce weight gain
• Significant weight loss is achievable with energy
controlled diets that are high in legumes.
• Currently there are no long term clinical trials
examining the effect of increased legume intake on
weight status.
http://getsuperhealthy.com/weight-loss-tips-for-diabetics/

27. Good nutrition linked to better
brain function
http://doutissima.com.br/2014/10/27/nutricao-e-dia-dia-entenda-importancia-de-alimentar-se-na-hora-certa-14659476/

28. Legumes can
boost brain power
www.contenido.com.

29. More vegetables, fruit, grains and legumes
-decreased odds of disease
+better cognitive function
Van Dam et al (2002). Ann. Intern. Med. 2002, 136, 201–209.
http://smokefree.gov/sites/default/files/fruit.jpg
42, 504 male health
professionals
40 to 75 years of age
12 years follow-up
clipart

30. Higher intakes of vegetables and legumes
were associated with less cognitive decline
5691 elderly Chinese people followed over 3 years
(Chinese Longitudinal Health Longevity Study)
Chen et al J. Nutr. Health Aging 2012, 16, 549–552
Always ate Always ate
Reduced
risk of
cognitive
decline
34%
OR: 0.66;
95% CI: 0.58, 0.75
22%
OR: 0.78;
95% CI: 0.64, 0.96
http://www.dreamstime.com/royalty-free-stock-photo-fresh-vegetables-image6745465
(Adjusted model)
www.goodreads.com

31. Are there clinical trials that
have tested whether legume
consumption improves cognition?
http://www.flyingtheflag.eu/getattachment/367d3d7c-8e41-43c3-b1d7-98dcdf4d733a/Watch-This-Space.aspx?maxsidesize=500
Department of Innovation
Energy and Mines

32. http://www.dreamstime.com/royalty-free-stock-images-lentils-word-image16054729
http://www.kaivac.com/prodimages/Low_cost.jpg
https://omni4health.files.wordpress.com/2014/12/0804healthbreakfast.jpg
Quick and easy
to prepare
http://thumbs.dreamstime.com/z/word-legumes-written-lentils-19806547.jpg
www.kaibizzen.com
www.simplyshrinkingofficial.blogspot.com.au/
www.crevarchiropractic.com

33. Secrets of the Mediterranean diet
www.tripadvisor.com

34. What is a serve of nuts ?
30g in a handful
Nuts for life

35. Nut consumption in Australia
Australians on average consume 1 serve (~30g) per week
~16% of people ate nut or nut products on the day of the AHS
www.glossophilia.org/?p=7704

36. • Nuts are energy dense foods
~2200-3000 kJ/100g
• Nuts are nutrient-rich foods
• High in protein, MUFA and PUFA
• Nuts are low GI
• Rich in fibre
• Nuts contain antioxidants
• Vit E, polyphenols
• Nuts have healthy electrolytes
• Low in Na+, Rich in K+ and Mg2+
What makes nuts so good?
Coates AM, et al. Edible nuts and metabolic health. Curr Opin Lipidol. 2007; 18(1):25–30.
Nuts for life

37. Simple and healthy nut recipes

38. PhysiciansHealthStudy
21,454men 40-84years
began1982-dietquestionnairein1983
17yearfollow-up-201suddendeaths
Albert CM. Arch Intern Med 2002;162:1382-1387
Frequency of nut consumption
Relative Risk
<1/mth 1-3/mth 1/wk >2/wk
Coronary Heart
Disease
1.0 0.89
(0.9-1.2)
0.90
(0. 9-1.0)
0.7
(0.5-0.9)
Sudden Death 1.0 0.98
(0.7-1.4)
0.85
(0.6-1.3)
0.64
(0.4-1.0)
clipart

39. NursesHealthStudy
86,016womenaged34-59years
began1976-dietQuestionnairein1980
14yearfollow-up-1255majorCHDevents
Frequency of nut consumption
Hu FB. BMJ 1999;317:1341-1345
Relative Risk
Almost
never
1-3/mth
to 1/wk
2-4/wk >5/wk
Coronary Heart
Disease
1.0 0.91
(0.8-1.0)
0.78
(0.6-0.9)
0.66
(0.47-0.93)
Fatal Coronary
Heart Disease
1.0 0.76
(0.6-0.9)
0.60
(0.4-0.96)
0.60
(0.3-1.1)
clipart

40. Regular nut consumption linked to
reduced risk of diabetes
Ros et al. Nutrients 2010, 2, 652-682

41. Josse et al (2007) Metabolism Clinical and Experimental 56, 400– 404
Addition of nuts improves blood glucose response
• Similar effects also seen with mixed nuts and pistachios

42. Replacing carbohydrate with nuts improves HbA1C
• 3 month parallel study in 117 people with type 2 diabetes
• Supplements provided ~2000 KJ
75g (mixed nuts)
Jenkins et al (2011) Diabetes Care;34(8):1706-11
38g (mixed nuts) + ½ muffin
-0.21%
absolute
HbA1c units
FDA
considers
>0.3%

43. -35
-25
-15
-5
5
15
T-Chol LDL-C HDL-C TGs
%Changefrombaseline
pecans (72g/d) 4 wks almonds(66g/d) 6 wks almond oil (35g/d)
hazelnuts(40g/d) 4 wks walnuts (56g/d) 6 wks macadamia (40-90g/d) 4 wks
pistachio(20% calories) 3wks
Overall improvement of blood lipid profiles
with regular consumption of tree nuts
Rajaram et al J Nutr. 2001,131(9):2275-9; Hyson et al. J Nutr. 2002, 132(4):703-7;
Mercanligil et al. Eur J Clin Nutr. 2007, 61(2):212-20; Zambon et al Ann Intern Med. 2000, 4;132(7):538-46;
Garg et al. J Nutr. 2003,133(4):1060-3; Edwards et al J Am Coll Nutr. 1999 Jun;18(3):229-32.

44. But doesn’t eating high fat foods
cause weight gain?
The good news....nut-eaters weigh less.
Nuts for life

45. 8865 Men aged 23-54 years began 1999 - diet questionnaire in 2005
Frequency of nut consumption (50g serve)
Bes-Rastrollo et al, Obesity 2007;15:107-116.
Almost
never
1-3/mth
to 1/mth
1/wk >2/wk P for
trend
nut consumption
(g/d)
<3.3 3.3-7.0 7.1- 21.3 21.4
Relative risk 1.00 0.93 0.94 0.61 <0.001
adjusting for age, gender, smoking, leisure time physical activity
Frequent nut consumption linked to less weight gain
clipart

46. Mediterranean diet with nuts
and weight loss
• 191 participants (77 men and 114 women)
Lasa et al (2014) Eur J Clin Nutr. 68(7):767-72
• Mediterranean diets supplemented with either olive oil or nuts reduced
total body weight to the same extent as low-fat diet.
*
*
*
*
* *

47. + almonds
– almonds
Week
Weight
(kg)
Nuts can enhance weight loss in people with insulin
resistance or diabetes on a low calorie diet (LCD)
Wien et al. Int J Obes Relat Metab Disord. 2003;27(11):1365-72
Both diets reduced insulin resistance
Almond-LCD:-66%
CHO-LCD:-35% (P<0.0001)

48. Circulatory function is altered in diabetes
endothelium
Reyes-Soffer et al (2010) Metabolism Clinical and Experimental 59 :1365–1371
preventing-a-heart-attack.com
heart.org
Arginine is important for
maintaining healthy blood vessels

49. Arginine Content of Nuts (g/100g)
0
0.5
1
1.5
2
2.5
3
3.5B
eef
Peanuts
A
lm
onds
W
alnuts
B
razilsH
azelnuts
C
ashew
sPistachios
M
acadam
ias
Pecans
mg

50. Ros et al Circulation 2004;109:1609
Blood vessel function improves after
4 weeks of consuming walnuts
Similar improvements
also found with
hazelnuts and almonds
healthfitnessrevolution.com/wp-content/uploads/2013/07/almonds.jpgwww.nuthealth.org/assets/Uploads/hazelnuts.jpg

51. Nuts can also
boost brain power
www.contenido.com.

52. Regular nut consumption associated
with better cognition
• Higher long-term total nut intake was associated with
better average cognitive status1
• Reduced incidence of cognitive decline when the Mediterranean
dietary pattern (with nuts as a key component) is adhered to2
• Possibly linked to nutrients found in nuts -MUFA + vitamin E3,4
2Lourida et al. (2013) Epidemiology; 24: 479–4891O'Brien, et al. (2014). J Nutr Health Aging; 18(5): p. 496-502.
3Naqvi et al (2011) J Am Geriatr Soc; 59(5): p. 837-43. 4Morris et al. (2002) Arch Neurol, 2002. 59(7): p. 1125-32.
www.thecommissioni
ngelf.net/

53. Walnuts improve brain function
Significant improvements in aspects of brain function
- Correct coding and retrieval of information
Pribis et al (2012) Br J Nutr;107(9):1393-401
University students consuming 60g ground walnuts/d for 8 weeks
www.blog.discount-supplements.co.uk/blog/wp-content/uploads/walnut.jpg

54. Nut consumption for vascular health
and cognitive function
Cognitive decline
Depression
Neuro-degenerative
disorders
impaired
blood flow
heart.org
Barbour et al (2014). Nutr Res Rev;27(1):131-58.
+
www.glossophilia.org/?p=7704

55. Study Design
Baseline Week 12 Week 24
Peanut Phase
Habitual Diet
Nut-free Phase
Peanut Phase
Habitual Diet
Nut-free Phase
Randomised cross-over
84g/d56g/d
www.nuts.com/nuts/peanuts/
www.nuts.com/nuts/peanuts/
www.nuts.com/nuts/peanuts/

56. Transcranial doppler sonography (TCD)
dilation of
cerebral
arteries
↑ blood flow
middle
cerebral
artery
Cerebral
vasodilator
responsiveness
(CVR)
CO₂ breathed
(hypercapnia)
X3

57. Increased responsiveness
of brain blood vessels
20
22
24
26
28
30
L R
% CVR
Nut free diet
Peanut
*
* Denotes p<0.05
6% greater
*
9% greater
Barbour, J.A., et al. 2014; presented at 2014 NSA meeting

58. 0
5
10
15
20
25
RAVLT
recall
RAVLT
delayed
recall
RAVLT
target
Stroop Initial letter Excluded
letter
Coding Symbol
search
*
% Difference
peanut-control (SE)
*
* Denotes p < 0.05
Improvements in cognitive function
Processing speedVerbal fluency
(Executive function)
Barbour, J.A., et al. 2014; presented at 2014 NSA meeting

59. Why Legumes + Nuts?
• great source of healthy nutrients
• favourably influence blood lipids
• help to reduce or control body weight
• help to control blood glucose
• emerging evidence for maintaining cognitive
function
• should be part of your daily diet
but avoid the salt!!!
http://echolife.files.wordpress.com/2010/07/macadamia_nuts.jpg
www. ocbicycleco.com/2011/10/11/eat-your-vegetables/

60. Where to find more information
www.glnc.org.au/ www.nutsforlife.com.au/

61. Acknowledgements
Funding source: Australian Research Council Linkage Grant
(LP100200597) in partnership with the Peanut Company of Australia.
Associate Professor Alison Coates
alison.coates@unisa.edu.au