Synthesis of Disease Reports
Today in America, 23 million people have been diagnosed with diabetes. This number does not reflect a differentiation between Type I and Type II Diabetes, the CDC states 90-95% of the 23 million of these people have Type II Diabetes (2009). Type II Diabetes is a chronic, progressive disease in which insulin is not utilized or produced correctly by the cells in the body. The Academy of Nutrition and Dietetics recommends that those with diabetes follow a balanced diet including all food groups, with emphasis on non-starchy vegetables, complex carbohydrates, lean portions of animal protein, low-fat dairy options. All while incorporating a moderate intensity exercise program per week (2014). The American Diabetes Association has set regulatory ranges for a healthy blood glucose levels. This ranges from 80-130 mg/dL (fasting) or less than 180 mg/dL postprandial, or managing HbA1c values around 7. (2009)
For diabetic diet recommendations, RDN’s suggest a meal containing 45-60 grams of carbohydrate (Denny 2015). Many patients are taught carbohydrate counting in order to make those choices easier throughout the day. One carbohydrate exchange or one carbohydrate serving is between 15-20 grams. Carbohydrate choices should include fibrous vegetables, complex grains, and low-glycemic index options. In making these choices, the Type II Diabetic should focus on the quality of the carbohydrate they are consuming. Another portion of the diabetic diet is the addition of healthy, plant-based fats and quality proteins. Feinman concluded, “protein and fat are known to induce satiety and to reduce hunger-inducing blood sugar swings (2014).” In order to decrease a quick spike in blood glucose, individuals should consume their carbohydrates with a good source of protein and fat. This will help alleviate a dramatic increase in postprandial blood sugar levels. Plant-derived sources of fat and protein are vital for neurological functions, optical health, central nervous system health. One plant-based fat that is particularly beneficial to the human diet is omega-3 fatty acids which can be found in the nuts and chia seeds included in Betsy’s Nut Butters. An excellent example of a diet that proved beneficial for the Type II Diabetic patient is the Mediterranean diet. Esposito (2017) concluded that following this diet may improve glycemic control, reduce cardiovascular risk factors, and improve the glucose-insulin homeostasis in the body.
After initial diagnosis of Type II Diabetes patients can be left with their world flipped upside down. Everything they thought they knew about food and lifestyle habits is in question and health professionals are throwing numerous suggestions at them in order to aid in improving their health. Research indicates that some diabetics may feel restricted in their for choices, and socially isolated in their food choices. Maisharah (2011) found that despite the knowing how important it is to remain compliant with the prescribed diet, the National Health Interview Survey found that only around 60% of diabetics complied with their recommended diet. Positive coaching by health professionals and support systems such as encouragement to eat healthy foods as opposed to just telling them the things they can not eat. Our focus for the recipe development was to aid in the isolation and limitations of a diabetic diet by focusing on an item most diabetics feel like they can no longer enjoy; dessert.
We decided on diabetes because we knew it would be a challenge to come up with a healthy dessert choice for the millions of Americans affected by this disease state. We decided to make a pumpkin peanut butter swirl ice cream. In this recipe we focused on making a dessert option that was simple to make and around one carbohydrate exchange. The final recipe resulted in a portion controlled, ½ carbohydrate choice tasty pumpkin peanut butter swirl popsicle, that is also vegan, dairy free, and gluten-free.
Through this immersive learning project, our class had the fortunate opportunity to work with a successful alumna of Ball State University and Registered Dietitian Nutritionist, Betsy Opyt. Betsy’s successful gourmet nut butter business has flourished due to her great marketing, unique flavors, and high-end ingredients. She uses ingredients that are flavorful and benefit the body. The peanut butter is low in saturated fat, contains no trans fats, and provides a variety of mono- and polyunsaturated fats. The addition of chia seeds boosts the butter with a great source of fiber, helping with digestion and pushing the carbs and sugars through the body, and giving a crunchy texture. The sweetness is from honey, demerara sugar, and organic stevia leaf extract. The stevia leaf extract has a minimal blood-glucose raising effect in our population, but more importantly in the individual diagnosed with any form of diabetes.
A reflection on the research and development process.
We knew from the beginning that we wanted to research diabetes because of its current prevalence in the United States and the projected growth. We began brainstorming different types of food that patients with diabetes typically find restrictive or prohibited and found that dessert fits into those categories. Our group broke into two different paths: one experimenting with a peanut butter cupcake recipe and the other with a pumpkin peanut butter ice cream recipe. Both recipes were tailored to a Type 2 Diabetic patient utilizing a sugar substitute and Betsy’s Best Peanut Butter.
Lab week 1: Deciding on a recipe
Peanut Butter Blossom Cakes
First, we combined the flour and baking powder in a small bowl and set aside for later use. In the mixing bowl, we mixed Betsy's Best Peanut Butter until it was smooth. Slowly, we added the Splenda, a tablespoon at a time, keeping the consistency of the product smooth. An egg and vanilla were added and mixed until fully combined. Lastly, the flour and baking powder mix was added 1/4 cup at a time to prevent an overload of ingredients in the mixer.
After all the ingredients were mixed, we did a taste test to test how Betsy's Best Peanut Butter enhances the flavor of the batter. The batter had a very sticky consistency and was very thick. A strong peanut butter flavor was present as well as a cinnamon flavor. Though the taste was delicious, the texture and consistency of the batter would be a problem in the baking process.
The online recipe stated it would yield about 20 cakes (cupcakes) but we were only able to fill 5 cupcakes on a 6 cupcake pan. They were baked for five minutes at 375 degrees Fahrenheit. The online recipe stated to bake for 8-10 minutes but we checked after 5 minutes and added 2 minutes due to doughiness of the cupcakes. Again, we checked the cupcakes after the 2 minutes and added an additional 3 minutes which fully baked the cupcakes for a total of 10 minutes of bake time. We let the cupcakes cool until they were able to be tested. To our surprise, the cakes were bland in flavor and moistness. More peanut flavor could be added to. As for the moisture, water could have been added to the mix base to make it less thick and sticky.
The ice cream recipe went through many different trials. Our first obstacle was the texture. When it was first made, it had a slushy texture and froze like a rock. It was impossible to scoop, even when left on a counter at room temperature for 15 minutes. It was incredibly crystallized and had a poor mouthfeel due to the lack of fat, but still had a pleasant flavor. We next decided to try adding a cornstarch slurry to the soy milk in order to introduce a stabilizer and thickener in the following weeks. Due to the early success of this recipe, we chose to develop it further to create a product that went above and beyond our expectation.
Lab 2: Slurry Development
The slurry was made to create a creamy consistency and a better mouthfeel. We put two cups of soy milk into a pan and brought to a boil. Once it was boiling we added the slurry to the soy milk, which was made from two tablespoons cornstarch and two tablespoons of coconut milk. The mixture was brought back to a boil and whisked for seven minutes until it thickened. Once it was at the appropriate viscosity, the contents were immediately cooled in an ice bath. In this week we added the peanut butter to the ice cream batter. While the texture was improved the flavor was not as good as when we swirled the peanut butter through the ice cream after freezing. We decided to allow the flavors to compliment each other instead of combining them.
Lab 3: Temperature Considerations
In this lab we worked on tinkering with the temperature, we added a ¼ teaspoon salt to try to lower the freezing temperature of the ice cream. This did not improve the freezing consistency, it made our soft serve melt even faster at room temperature and still froze solid like a brick in the freezer. This is when we decided to focus on portion control and freezing surface area - the next lab we will experiment with popsicle molds. For the swirl, we decided to thin out the peanut butter to allow smoother ribbons when swirled throughout the ice cream/popsicle.
Lab 4: Popsicle Poppin 
This lab we made portion controlled popsicles. We were thrilled with how well these came out. The ⅓ cup portioned popsicle had only 90 calories and ended up being only ½ of a carbohydrate choice - all while tasting scrumptious and we finally got the texture issues figured out!
This project was a tremendous opportunity to experience research and development as undergraduate students. It evolved very quickly over a short period of time, but this drove everyone’s competitive nature.The room was buzzing with energy when the judging portion of the lab began. All of the groups were frantically trying to finish our recipes as the telecommunication group was filming the commotion. As the time for the judgment neared, all of the groups were anxiously awaiting the judge’s arrival. Everyone was thrilled to meet our project’s partner and successful alumna, Betsy Opyt. While the judging was quicker than expected, it was thorough and exhilarating. Hearing feedback from our professors and Betsy about our popsicles and ice cream was reassuring and validated the hard work we put into creating it. During the shift to listening to each team’s presentations, the wave of relief could be felt through the class. Each team gave informative presentations that sold their recipes and why they should win. Our team was thrilled to hear that we had been chosen to represent Ball State and Betsy’s Best Nut Butter at the Food and Nutrition Conference and Expo. We all had an absolute blast working with Betsy at her booth and showing off our hard work.
Due to the sugar alternatives and few ingredients, our product is very low in carbs and sugar. This ice cream is a one carb option for diabetic patients. Our carb count is actually so low that the patient can eat double the serving size and still be consuming a healthy amount of carbohydrates. Not only are diabetics able to eat a dessert but feel they are eating something healthy and in their carbohydrate range.
Personal Stories Relating to Diabetes
Sydney Mattern
I have a close friend who is a Type 1 diabetic and I often worry about her health. She doesn’t really understand how food plays a role in her health. She knows that if she eats a lot of sugar or carbohydrates she’s going to need to dose herself higher. She isn’t concerned about her future health. Sometimes she will wake up in the middle of the night and feels super low and she fixes it by eating a ton of candy and then falling back to sleep. I’m worried that she might not wake up one day. It’s really hard for her though because we all love ice cream and desserts so she wants to be able to hang out with us and do what we do. She doesn’t want to just watch us eat dessert. That was one reason I was so excited to do an ice cream recipe because now she can eat like we do without the negative health effects.
Sara Kruszynski
Sara Kruszynski
From my family’s history of Type II Diabetes, I can speak on my perspective of my father’s diagnosis and current state of overall health. My father has had diabetes for 25 years now. He has been to a variety of physicians, on numerous medications, has dieted countless times, and has lost his sense of taste and smell due to diabetic neuropathy in culmination with his medications. It has been not only physically, but psychologically tumultuous for him and our entire family. It is difficult for us to understand what exactly he is going through, but there has been a snowball effect as a result of his loss of senses. He no longer has a desire to eat so he’ll go without; he started losing weight due to undernourishment which caused his blood sugars to improve, but he is fatigued due to the lack of nutrients in his diet. The diagnosis of diabetes has worn on him greatly and the psychological implications of being diagnosed with a chronic disease are certainly detrimental. Although my father lost his sense of taste and smell, one way to combat some of the psychological barriers of Type II Diabetes is making foods or food alternatives Type II friendly. Having sugar-free and low carbohydrate options available at restaurants, ice cream parlors, and fast-food establishments could help lift some of the burdens of living with this disease state. It would help the Type II individual feel included in the process of socialization and would not feel like a burden or as if they were placing a limitation on what could be accomplished.
Kailey Adkins
Diabetes was close to my heart because I watched my grandfather struggle to manage his all of my life. My grandfather was diagnosed with diabetes over 20 years ago and had to do treatment and monitoring every day. To make it even more challenging my grandmother is a fantastic cook and baker. She loved to fill the house with pies, cookies, candies, and homemade breads. This made eating socially with the family a bit of a challenge for my grandfather. I remember when my grandmother discovered Splenda for baking and both of their lives changed for the better. While my grandfather still needed to monitor his intake and dose insulin appropriately - he was able to more safely join the table at family meals. My grandfather passed away a little over a year ago from pancreatic cancer, after a lifetime of struggling to manage his Type II Diabetes. If our recipe developed in this class can make the lives of anyone better, I like to think it would have been his.
Kyleigh Snavely
Kailey Adkins
Diabetes was close to my heart because I watched my grandfather struggle to manage his all of my life. My grandfather was diagnosed with diabetes over 20 years ago and had to do treatment and monitoring every day. To make it even more challenging my grandmother is a fantastic cook and baker. She loved to fill the house with pies, cookies, candies, and homemade breads. This made eating socially with the family a bit of a challenge for my grandfather. I remember when my grandmother discovered Splenda for baking and both of their lives changed for the better. While my grandfather still needed to monitor his intake and dose insulin appropriately - he was able to more safely join the table at family meals. My grandfather passed away a little over a year ago from pancreatic cancer, after a lifetime of struggling to manage his Type II Diabetes. If our recipe developed in this class can make the lives of anyone better, I like to think it would have been his.
Kyleigh Snavely
I have two members of my family with Type II Diabetes. They both love to dive into the desserts at family gatherings with no hesitations regarding carbohydrates. Study nutrition and how it affects our bodies has made me realize the importance of food control and diabetes management. I have had several conversations about what they do to better their health but it comes down to whether or not there are healthy alternatives for them to enjoy. Not many people at our gathering take into account or work to accommodate these individuals. When our group decided to focus on Type II Diabetes, and more specifically a dessert, I couldn’t help but be super excited. The Pumpkin Peanut Butter Swirl Popsicles are easy to make and store in the fridge during our family events. I will definitely be making these for Thanksgiving and Christmas. Not only will I make them but talk with my family about the significance of balancing the right carbs with delicious flavors.
References
Academy of Nutrition and Dietetics. (2015, November 4). The Lowdown on Diabetes. Retrieved
from http://www.eatright.org/resource/health/diseases-and-conditions/diabetes/the-
lowdown-on-diabetes
Academy of Nutrition and Dietetics. (September 2017). Position of the Academy of Nutrition
and Dietetics: the role of medical nutrition therapy and 2 registered dietitian nutritionists in the treatment and prevention of prediabetes and type 2 diabetes. Academy of Nutrition and Dietetics. Retrieved from:https://www.eatrightpro.org/~/ media/eatrightpro%20files/practice/position%20and%20practice%20papers/final_revised_draft_position_paper_mnt_diabetes.ashx
Allison, K. C., Crow, S. J., Reeves, R. R., West, D. S., Foreyt, J. P., DiLillo, V. G., Wadden, T.
A.,... The Eating Disorders Subgroup of the Look AHEAD Research Group. (2007). Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity, 15(5), 1287-1293. doi:10.1038/oby.2007.150
American Diabetes Association. Nutrition recommendations and interventions for diabetes: a
position statement of the American Diabetes Association. (2008). Diabetes Care, 31(1),
S61+. Retrieved from http://go.galegroup.com/ps/i.do?p=HRCA&sw=w&u=munc 80314&v=2.1&it=r&id=GALE%7CA173646080&sid=summon&asid=aebf7664071aac5a71320d9624b9f690
*Anderson, R. A., Zhan, Z., Luo, R., Guo, X., Guo, Q., ..., Stoecker, B. J., (2016) Cinnamon
extract lowers glucose, insulin and cholesterol in people with elevated serum glucose,
Journal of Traditional and Complementary Medicine, 6(4), 332-336, ISSN 2225-4110,
doi.org/10.1016/j.jtcme.2015.03.005
* Blevins, S. M., Leyva, M. J., Brown, J., Wright, J., & al, e. (2007). Effect of cinnamon on glucose
and lipid levels in non-insulin-dependent type 2 diabetes. Diabetes Care, 30, 2236-2237. Retrieved from https://search-proquest-com.proxy.bsu.edu/docview/223022200?pq-origsite=summon&https://search.proquest.com/nursing/advanced?accountid=8483
*Camilleri, M., Bharucha, A. E., & Farrugia, G. (2011). Epidemiology, Mechanisms and
Management of Diabetic Gastroparesis. Clinical Gastroenterology and Hepatology : The
Official Clinical Practice Journal of the American Gastroenterological Association, 9(1),
5–e7. doi.org/10.1016/j.cgh.2010.09.022
Center for Disease Control, US Department of Health and Human Services. (July 2017).
National diabetes statistics report, 2017 estimates of diabetes and its burden in the United States. Retrieved from: https://www.cdc.gov/diabetes/pdfs/data /statistics/national-diabetes-statistics-report.pdf
Consumption of Nuts Is Associated with a Lower Risk of Cardiovascular Disease in
Women with Type 2 Diabetes. The Journal of Nutrition, 139(7), 1333–1338.
doi.org/10.3945/jn.108.103622
*Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., ...Yancy, W. S., Jr. (2013, November). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care, 36(11), 3821+. Retrieved from http://go.galegroup.com/ps/i.do?p=HRCA&sw=w&u=munc80314&v=2.1&it=r&id=GALE%7CA350334725&sid=summon&asid=3db44e126819c34157f53f00891f6c5e
*Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., . . . Worm, N. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition, 31(1), 1-13. doi:http://dx.doi.org/10.1016/j.nut.2014.06.011
*Davis, P. A., and Yokoyama, W. (2011, September). Cinnamon intake lowers fasting blood
glucose: meta-analysis. Journal of Medicinal Food, 14 (9). Retrieved September 10, 2017.
Dekker, J. and de Groot, V. (September 2016). Psychological adjustment to chronic disease and
rehabilitation – an exploration, Disability and Rehabilitation, DOI:
10.1080/09638288.2016.1247469
Denny, S. (Ed.). (2014, November 17). Diabetes and diet. Eat Right. Academy of Nutrition and
Dietetics. Retrieved from http://www.eatright.org/resource/health/diseases-and-conditions/diabetes/diabetes-and-diet
Denny, Sharon. (July 2015). Carbohydrates--part of a healthful diabetes diet. Retrieved from:
http://www.eatright.org/resource/health/diseases-and conditions/diabetes/ carbohydrates-part-of-a-healthful-diabetes-diet
Denny, S. (Ed.). (2016, August 12). Treating diabetes with medical nutrition therapy. Academy
of Nutrition and Dietetics. Retrieved from http://www.eatright.org/resource/health/ diseases-and-conditions/diabetes/treating-diabetes-with-medical-nutrition-therapy
*Esposito, K., Maiorino, M.I., Bellastella, G., Panagiotakos, D.B., Giugliano, D., Endocrine (2017).
56(1) 27 Healthy Concepts Food Company, LLC (2017).
https://betsysbest.com/collections/shop/products/peanut-butter-
*Khoshbaten, M., Madad, L., Baladast, M., Mohammadi, M., & Aliasgarzadeh, A. (2011).
Gastrointestinal signs and symptoms among persons with diabetes mellitus.
Gastroenterology and Hepatology From Bed to Bench, 4(4), 219–223. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017431/
Kohn, J. (Ed). (2015, April 30). Eating right with diabetes. Eat Right, Academy of Nutrition and
Dietetics. Retrieved from http://www.eatright.org/resource/health/diseases-and-conditions/diabetes/eating-right-with-diabetes
Li, T. Y., Brennan, A. M., Wedick, N. M., Mantzoros, C., Rifai, N., & Hu, F. B. (2009). Regular
*Maisharah, S., Bahari, M. B., Gillani, S.W., (2011). Pilot Study on Barriers Influencing
Compliance towards Dietary Intake in Diabetic Patients. Journal of Pharmaceutical
Sciences and Research. 3(7)
Martins, M. R., Ambrosio, A. C. T., Nery, M., Aquino, R. d. C., & Queiroz, M. S. (2014).
Assessment guidance of carbohydrate counting method in patients with type 2 diabetes
mellitus. Primary Care Diabetes, 8(1), 39.
*Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. (2008, January). Diabetes Care, 31(1), S61+. Retrieved from http://go.galegroup.com/ps/i.do?p=HRCA&sw=w&u=munc80314&v=2.1&it=r&id=GALE%7CA173646080&sid=summon&asid=aebf7664071aac5a71320d9624b9f690
*Parker, A. R., Byham-Gray, L., Denmark, R., Winkle, R. J. (2014). The Effect of Medical Nutrition
Therapy by a Registered Dietitian Nutritionist in Patients with Prediabetes Participating
in Randomized Controlled Clinical Trials. Journal of the Academy of Nutrition and
Dietetics, 114(4) 1739-1748
*Saslow, L. R., Kim, S., Daubenmier, J. J., Moskowitz, J. T., Phinney, S. D., Goldman, V., . . .
Hecht, F. M. (2014). A randomized pilot trial of a moderate carbohydrate diet compared
to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes
mellitus or prediabetes. PLoS One, 9(4) doi:http://dx.doi.org.proxy.bsu.edu/10.1371/journal.pone.0091027
*Salas-Salvado, J., Martinez-Gonzalez, M. A., Bullo, M., Ros, E. (2011) The role of the diet in
the prevention of type 2 diabetes. Nutrition Metabolism and Cardiovascular Diseases,
21, B32-B48. doi:10.1016/j.numecd.2011.03.009
Sawyer, L., Gale, E. A. M. (2008, November). Diet, delusion and diabetes. Diabetologia, 52(1),
1-7. Retrieved from https://link.springer.com/article/10.1007%2Fs00125-008-1203-9
*Stephens, P., Rook, K. S., Franks, M. M., Khan, C., & Iida, M. (2010). Spouses use of social
control to improve diabetic patients' dietary adherence. Families, Systems & Health, 28(3), 199+. Retrieved from http://go.galegroup.com.proxy.bsu.edu/ps /i.do?p=HRCA&sw=w&u=munc80314&v=2.1&it=r&id=GALE%7CA239529674&sid=summon&asid=8730aa665d4bbd45e5db324b2688df41
Wolfman, T. (Ed.). (2016, November 1). Understanding diabetes. Eat Right. Academy of
Nutrition and Dietetics. Retrieved from http://www.eatright.org/resource/ health/diseases-and-conditions/diabetes/understanding-diabetes
*Wu, J., Micha, R., Imamura, F., Pan, A., Biggs, M., Ajaz, O., . . . Mozaffarian, D. (2012).
Omega-3 fatty acids and incident type 2 diabetes: A systematic review and meta-analysis.
Comments
Post a Comment