1. How to implement your Research diet- Protocol 1061 Stanford GCRC Nutrition Core

2. Your Research Diet is based on:  Diet Recommendations for insulin resistance/pre-diabetes…..

3. Pre-Diabetes/Insulin Resistance Recommendations:  Lose Weight  Decrease Carbohydrate… and choose better carbs  Lean protein foods in small portions  Replace saturated fats and refined carbs with unsaturated fats

4. 1 st Phase- Introduce the “right mix”  After your SSPG we will ask you to start counting the servings of carbohydrate, fat and protein you eat each day

5. Your Research Diet Composition:

6. You will have a daily allowance of:  Carbohydrate Choices Starches, Breads, Fruit, milk, starchy vegetables…  Lean Protein Skinless poultry, lean beef, pork and seafood  Unsaturated Fats Oils, nuts & seeds, mayo, avocado

7. Carbohydrate-rich Foods: Breads and Grains  Fruits and Starchy vegetables  Milk and Yogurt

8. Where are the Carbs? 0-870Pro 500Fat 025Veg 0-8815Milk 0015Fruit 0-1315Starch G FATG PROG CHOFood Group

9. What is a “CHO” serving ? A portion of food that contains 15 grams of carbohydrate ½ cupCorn/Peas/Beans Pasta/potatoes(cooked) ½ small 1 ozBagel 1 slice (1 oz)Bread ⅓ cupRice (cooked) 1 serving:STARCHES: ⅓ cup

10.  1 cup rice = 3 CHO servings or 45 grams CHO  2 corn tortillas = 2 CHO or 30 grams CHO

11. 30 grams CHO 2 carbs 60 grams CHO 4 carbs

12. 15 gram CHO Serving of Fruit 1 (3½ oz)Kiwi 2 Tbsp.Raisins 1¼ cup whole berriesStrawberries ½ (4 oz)Pear, large 4 ozOrange Juice 1 small (4 oz)Apple 1 small (4 oz)Banana

13. Typical Apple: >7 oz = 30 grams CHO

14. One Serving of Milk 15 grams CHO Plain or “light” yogurt

15. Carbohydrates and Food Labels…..

16. How to Count bag: 3.5 servings with 17g CHO per serving: 17x3.5 60 g CHO = 4 CHO 25 g Fat = 5 FATS Read label for total carbohydrate… not sugar

17.  Portions Matter! This Bagel is “sugar-free” but contains 50% more carbohydrate than this candy bar! 4 oz Bagel = 4 CHO 22 grams total Carb = 1.5 CHO *14 grams fat = 3 FAT *mostly saturated fat – so need to limit!

18. Lean Proteins: 1 oz = 1 PRO  Skinless poultry  Seafood  Very lean beef and pork  Very low fat cheese ≤ 3 grams fat per oz

19.  3 oz of lean meat is the size of a deck of cards

20. Your meal plan does not include high fat meats…. 6 oz steak-filet mignon: 520 kcals 37 grams fat 15 grams sat fat 6 oz skinless chicken breast: 280 kcals 6 grams fat 1.7 grams sat fat Each of these counts as 6 protein choices But if you choose the steak- you get double the calories and 6 times the fat- mostly saturated!

21. Other Protein foods….  1 egg = 1 PRO  ¼ cup low-fat cottage cheese = 1 PRO  ¼ cup canned tuna = 1 PRO *Note- beans, milk and yogurt contain protein- but for your diet- count them as carbs *Nuts and seeds also have some protein but for this study will count as fats

22. Unsaturated Fats and Oils… Olives Nuts and Seeds Mayonnaise and Salad Dressings Liquid oils olive, canola Avocado

23. Unsaturated FatServing Size Vegetable oils (canola, olive, corn, etc) 1 teaspoon Regular mayonnaise or margarine 1 teaspoon Light mayonnaise or margarine 1 Tbsp Sunflower seeds1 Tbsp Almonds/cashews6 ea Walnuts/pecans4 halves peanuts10 ea Large olives (black or green) 8-10 avocado2 Tbsp (1 oz) 5 grams of Fat = 1 fat serving Note: ¼ cup nuts = 4 fat servings

24. How much saturated fat is okay…?  Aim for no more than 10-15 grams of saturated fat per day…. You can’t eat regular cheese and meet this goal

25. 5 grams fat or 1 teaspoon oil = 1 fat FoodPortion = to 1 serving Olives10 large Vegetable oil canola, olive, safflower 1 teaspoon avocado1/8 or 2 Tbsp mashed almonds6 each peanuts10 each Sunflower seeds1 Tbsp Regular mayo1 teaspoon

26. Limit foods with Saturated Fat……

27. Finding Saturated Fat on Food Labels In one ounce of cheddar cheese 6 of the 9 fat grams are saturated

28. How would you count this… 6 grams fat ~ 1 FAT 42 grams carbs~ 3 CHO 10 g Protein ~ 1 PRO

29. 2 slices pizza: ~ 12 grams saturated fat Turkey sub NO cheese Light mayo 1 gram saturated fat 2 slices large pepperoni pizza: ~45 grams carbs (3CHO) ~30 grams *fat (6 fat) ~25 grams protein (3 ½ pro) *fat is mostly saturated sandwich roll ~ 3 CHO Lean turkey ~ 2 PRO Lettuce/tomato/pickle “free” 2 teaspoons mayo = 2 fat

30. Quarter Pounder with Cheese: 12 grams sat fat Regular Hamburger NO cheese: 3.5 grams sat fat Count as 2 CHO for bun 2 -3 protein for burger

31. What does this diet look like? 40-45% CHO 15-20% Protein 35-45% Good Fat

32. Breakfast ½ cup Bran Flakes 4 oz 1% lowfat Milk ¾ cup fresh Blueberries 8 Walnut Halves Lunch Turkey/Avocado Sandwich: 2 slices Whole Grain Bread 2 oz lean deli Turkey breast 2 slices avocado Tomato/Lettuce 1 teaspoon Mayonnaise 1 Fresh Orange Snack ¼ cup roasted almonds Dinner 3 oz Salmon ½ cup black beans 1 Cup mixed salad greens 2 teaspoons olive oil 1 cup steamed asparagus Snack 6 oz “light “yogurt 1 cup Fresh Strawberries 1525 kcals 40% FAT (6% SFA) 41% CHO 19% PRO 37 g Fiber

33. How do I tally my daily foods… CHO2+1Whole Wheat English Muffin + small peach PRO Fat31.5 Tbsp Peanut Butter “Free”Tomato slices Daily Goal: Daily Tally: CHO:10lll Pro:7 Fat:11lll

34. Free Foods!  Non-caloric beverages (diet soda, Mineral water, coffee, tea, etc  Seasonings, lemon, lime, vinegar  Non-starchy vegetables: greens, cabbage, broccoli, zucchini, green beans, onions, peppers, artichokes…  Broth  Sugar-free gelatin  Artificial sweetener

35. Your diet schedule….  Start maintenance diet on SSPG visit  Start weight loss diet day of IVGTT (Also start injections this day)  Weekly f/u visits during 1 st month of injections/weight loss  Every two week f/u visits for remaining 12 weeks on diet  After 16 weeks of weight loss- wt. maintenance resumes with no more dietitian visits

36. Reminders….  Don’t change your normal activity level  Inject your study drug before a meal that contains at least 250 calories  Record all your foods… even from the “free-food” list