A Mediterranean Diet for the Prairies: The Pure Prairie Eating Plan

Mediterranean

Title:  A Mediterranean Diet for the prairies:  The Pure Prairie Eating Plan

Authors:  Catherine B. Chan and Rhonda C. Bell

Introduction:  Healthy eating is a key factor in preventing and treating chronic diseases such as heart disease, stroke, cancer and diabetes.  According to the World Health Organization, good nutrition is one of 4 key factors that could help postpone or avoid 90% of type 2 diabetes and 80% of coronary heart disease.   The Mediterranean Diet has gained popularity as a healthy diet, but evidence gathered through research on Alberta products (canola, flax, barley, pulses, dairy and meats) demonstrates that many Alberta-grown foods have similar nutritional qualities and would be more acceptable and accessible to Albertans.  There is also evidence that, in addition to adequate nutritional quality, food should be accessible, acceptable and available (the 4A Framework) to facilitate healthy eating.  The “Alberta Diet” project was conceived to develop, test and demonstrate the potential health benefits of a dietary pattern based on foods that are commonly grown and consumed in Alberta in a “made in Alberta” menu plan.

The Alberta Diet menu plan integrates knowledge gained through research related to consumer behavior, behavior change, and nutritional quality of dairy, meats, canola, pulses and grains.  A Consensus Conference was held with diabetes experts and patients to exchange knowledge, identify issues, and collaboratively develop recommendations on programs to support improved diet quality for people with type 2 diabetes.  This multi-disciplinary, multi-faceted, iterative approach provided knowledge that formed the basis of a 4-week menu plan with recipes, shopping lists and information about nutritional properties of foods that are grown and readily available in Alberta.  Funding was secured through the Alberta Diabetes Institute (ADI) to test the Alberta Diet concept in a 24-week intervention that measured both quantitative (disease biomarkers) and qualitative (acceptability, accessibility and acceptability) responses of people with type 2 diabetes to the menu plan.  Results from the initial pilot trial produced promising results with significant improvements in blood-sugar control, body mass and levels of “good” (HDL) cholesterol.

With promising outcomes regarding the nutritional adequacy and acceptability of the menu plan, and with encouragement from Alberta agricultural commodity groups and others, we have packaged and re-branded the menu plan as the Pure Prairie Eating Plan (PPEP): Fresh Food, Practical Menus and a Healthy Lifestyle.   PPEP will be available for purchase in mid-November and proceeds from its sale will be used to further research into improving the lifestyle behaviours of Albertans.

How PPEP was developed

The original purpose of the Alberta Diet menu plan was to help people with type 2 diabetes adhere to the nutrition recommendations of the Canadian Diabetes Association by focusing on healthy food choices with a local flavour.  During its development, it was recognized that a diet healthy for people with diabetes is a diet healthy for everyone.  This notion was reinforced in our Consensus Conference with people living with type 2 diabetes, who felt strongly that their diet should not be different from others.

PPEP consists of 28 days of menus including 3 meals and 3 snacks each day, approximately 100 recipes, tips for healthy eating, pantry and grocery lists and other helpful information.  If followed consistently, the menus meet the recommendations of Eating Well with Canada’s Food Guide on a daily basis, and over 1 week averages approximately 2000 kcal/day with macronutrient distribution consistent with health recommendations.  The menus also provide total fibre between 25 and 50 g/day.  In addition, it takes into account the Nutrition Therapy guidelines of the Canadian Diabetes Association in order to make it diabetes-friendly.  The recipes use foods that meet the 4A Framework:  they are nutritionally adequate, locally available, acceptable and accessible to Albertans.  In fact, many of the recipes have been obtained from our provincial agricultural commodity groups:  Alberta Milk, CanolaInfo.org, Alberta Pulse Growers, Alberta Barley as well as Canada Beef.  The recipe ingredients feature many home-grown foods from each food group.  They are quick and easy to make…and tasty!

Our Research Findings

In the first phase of our research, we pilot-tested our menu plan with 15 people with type 2 diabetes who met one-on-one with a program facilitator, and focused on qualitative outcomes such as how participants used the menu plan, what they liked and what they thought could be improved.  In the second phase, we included a 5-week curriculum delivered in a small-group setting with a facilitator and included assessment of hemoglobin A1c as a measure of blood sugar control as well as cardiovascular risk factors such as body mass index, waist circumference and blood pressure.  Nutrient intake was assessed from three-day food records.  Participants were followed up after 3 months.

Key findings

  • In phase 1, most participants liked the menu plan and their A1c decreased by an average of 1%.   However, many were not used to cooking from scratch and cited time as a barrier to using the menu plan more.
  • In phase 1, the benefits of the menu plan included more structure in participants’ diets, increased frequency of snacking, increased awareness of food choices, purchasing healthier foods and better portion control.  Participants were aware of better blood sugar control.
  • Participants were pleased with the variety of food choices and liked the taste of the recipes.  They also liked the flexibility of the menu plan.
  • In Phase 2, a total of 73 participants enrolled and 63 (86%) completed all aspects of the programme, including the 3-month follow-up.  On average, there were decreases in A1c (-1%), body mass index (-0.6 kg/m2) and waist circumference (-2 cm).  Note that a decrease in A1c of 1% is considered to be a clinically relevant improvement in blood sugar control, whereas the changes in weight and waist were relatively small.
  • Analysis of nutrient intakes showed decreases in total energy intake (-127 kcal/day), total fat (-7 g), total sugar (-25 g) and sodium (-469 mg).

The Pure Prairie Eating Plan

PPEP follows the format of the original menu plan.  It has 28 days of menus with accompanying recipes, information about Eating Well with Canada’s Food Guide servings and daily and weekly nutrient analysis.  Tips for making recipes healthier, using different ingredients and ideas for leftovers are sprinkled throughout.  Did You Know? sections highlight the agricultural products grown on the Canadian prairies and their nutritional profiles, as well as research done by our Physical Activity and Nutrition for Diabetes in Alberta (PANDA) team and others.  For people with diabetes, the index contains a section on carbohydrate counting adapted from the tools available through the Canadian Diabetes Association.

PPEP will be available initially as a book via our website www.pureprairie.ca in mid-November and in the near future in e-book format.  The supporting website features sample menus, new recipes, information about our research and links to our sponsors.

Our Sponsors

We would like to acknowledge the financial support of Alberta Livestock and Meat Agency, Alberta Crop Industry Development Fund, Alberta Canola Commission, Alberta Diabetes Institute and Alberta Diabetes Foundation, Alberta Pulse Growers Commission, Alberta Barley Commission, Alberta Wheat Commission, Canada Beef, Alberta Milk and Alberta Potato Growers.