1. A Colorful Way to Prevent Diabetes: A “Berry” Good Idea April J. Stull, PhD, RD Botanical Research Center Pennington Biomedical Research Center Louisiana State University System

2. Diabetes Fighting Diabetes Blueberry Defeating Diabetes

3. Outline Diabetes Dietary Supplements Blueberries –Literature Review –PBRC human research Study

4. Obesity and Diabetes Trends Among U.S. Adults Obesity (BMI ≥30 kg/m 2 ) Diabetes 1994 2000 2007 No Data 26.0% No Data 9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

5. Interventions Used to Delay the Progression to Type 2 Diabetes Diet Modification Physical Activity Medication Complementary and Alternative Medicines (CAM)??

6. 10 Most Common CAM Therapies (2007) Percent Barnes, PM et al., National Health Interview Survey, 2007

7. Botanical Dietary Supplement Is a plant or plant part dietary supplement valued for its medicinal or therapeutic properties, flavor, and/or scent Dietary Supplement –Is intended to supplement the diet –Contains one or more dietary ingredients –Is intended to be taken by mouth as pill, capsule, tablet, or liquid –Is labeled on the front panel as being a dietary supplement

8. Botanical Dietary Supplements Products made from botanicals that are used to maintain or improve health may be called: –Botanical products –Herbal products –Phytomedicines

9. Out-of-Pocket Costs for CAM Among US Adults, 2007 Botanical Dietary Supplements Yoga, Tai, Chi, Qigong Classes Relaxation Techniques Homeopathic Medicine Practitioner Costs Total Costs: $33.9 billion Nahin RL et al., National Health Interview Survey, 2007 $11.9 billion 43.7% 14.8 billion

10. Botanical Dietary Supplement “BLUEBERRIES”

11. U.S. Blueberry Consumption Per Person United States Highbush Blueberry Council; Available at www.blueberry.org 70% consumption increase from years 1997 to 2007

12. Blueberries Are Everywhere!!!

13. Blueberries Blueberries provide health benefits for many different conditions / diseases –Heart –Vision –Cancer –Diabetes

14. Antioxidant Activity USDA, ORAC of Selected Foods, 2007

15. Definitions Glucose (blood sugar) –Sugar in the blood that is used for energy Insulin –A hormone that controls the amount of glucose in the blood –Produced from the pancreas

16. Definitions Insulin sensitivity –Insulin efficiently moves glucose from the bloodstream to the cells in the body –Cells inside the body respond to the action of insulin Insulin resistance –Insulin has difficulty moving glucose from the bloodstream to the cells in the body –Cells inside the body DO NOT fully respond to the action of insulin

17. Blueberries as a Therapy for Type 2 Diabetes Literature Review –Blueberries are a folk remedy in Canada for treatment of diabetes (Martineau LC et al., Phytomedicine, 2006) –Blueberries have been found to: Reduce blood glucose concentrations in rats and humans (Abidov M et al, 2006 ; DeFuria J et al, 2009) Increase glucose uptake in muscle and fat cells (Vuong T et al, 2006) Protect against obesity in rats (DeFuria J et al, 2009)

18. Humm…. Can blueberries improve pre- diabetes and prevent diabetes in humans?

19. PBRC Blueberry Research Study Primary Objective –To evaluate the effect of blueberries on improving the ability of insulin to work in pre- diabetic individuals Hypothesis –Dietary supplementation with blueberry smoothies will result in an increase in the ability of insulin to work in pre-diabetic individuals

20. Study Design Baseline Blueberry Smoothie Placebo Smoothie Screening Insulin Sensitivity Test 1 2 3 4 5 6 7 8 9 10 End Visits (Weeks) * Randomized * Started consuming smoothies Insulin Sensitivity Test Measures the ability of insulin to move glucose (or blood sugar) from the bloodstream to the cells

21. Study Design Weeks Study Parameters12345678910 Randomization Blood Pressure/Body Weight Blood and Urine Samples Physical, Heart Function, and Body Fat Exam Oral Glucose Tolerance Test Insulin sensitivity Test Nutritional Assessments Food Frequency Questionnaire 3-Day Food Records Fruit/Wine Questionnaire Smoothie Taste/Ratings Test Smoothie Pick-up

22. Nutritional Value of Smoothies Nutritional Value (per 16oz)BlueberryPlacebo Energy, kcal 239234 Carbohydrate, g 48.548.6 Fiber, g 4.24.3 Protein, g 11.911.1 Fat, g 0.08 Saturated Fat, g 0.05 Each participant consumed two 16oz smoothies per day (Total 32oz) Blueberries provided (per 16oz smoothie): 80 kcal, 20g carbohydrates, 4g fiber, 0.8g protein, 0g fat Vitamins and minerals: calcium, magnesium, phosphorous, potassium, folate, vitamin C, A, E, and K

23. 16 oz Blueberry Smoothie = 1 cup of blueberries

24. 23 1314 Characteristics of The Study Participants

25. The Ability of Insulin to Work in All Participants From Beginning to End of Study 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

26. Blueberries Improved the Ability of Insulin to Work ∆ insulin Sensitivity = ability of insulin to work from week 0 to week 6

27. Consuming Blueberries Did Not Affect: Food intake Body weight %Body fat

28. Conclusions Blueberry smoothies improved the ability of insulin to work in pre-diabetic individuals The blueberry smoothie did not affect body weight and energy intake Yummy…

29. Future Research 2 nd Blueberry Study Evaluate the effects of blueberries on high blood pressure and heart health *****will start RECRUITING soon!***** We need your help!!

30. For More Information About Blueberries United States Highbush Blueberry Council http://www.blueberry.org Blue Harvest Farms http://www.blueharvestfarms.com Nutrition Information http://www.lsuagcenter.com/en/food_health/nutrition http://www.lsuagcenter.com http://www.lsuagcenter.com/en/food_health/nutrition http://redstickfarmersmarket.org http://www.herbsociety.org

31. Thank You

32. Acknowledgements William Cefalu, MD William Johnson, Ph.D Catherine Champagne, PhD, RD, LDN Katherine Lastor, RD, LDN PBRC inpatient and outpatient unit staff Metabolic kitchen staff PBRC Botanicals Research Center United States Highbush Blueberry Council Cefalu’s Lab Participants