The Pure Prairie Eating Plan: A Mediterranean Diet for the... Written by Catherine B. Chan, PhD and Rhonda C. Bell,... How was PPEP Developed? Introduction

December 2013
The Pure Prairie Eating Plan: A Mediterranean Diet for the Prairies
Written by Catherine B. Chan, PhD and Rhonda C. Bell, PhD
Introduction
Key Messages
•
The Pure Prairie Eating
Plan (PPEP) is a four week
structured menu plan for a
well-balanced diet, initially
developed for people with
type 2 diabetes.
•
PPEP emphasizes foods
that are locally grown or
produced, readily available
and acceptable to people
living on the prairies.
•
PPEP provides supporting
resources such as recipes,
weekly grocery lists and
cooking tips to make it very
practical.
•
Initial research findings
indicate that following
PPEP results in good
blood-sugar control
and improvements in
cardiovascular risk and
nutrient intakes. 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 four key factors that could
help postpone or avoid ninety per
cent of the cases of type 2 diabetes
and up to eighty per cent of the
cases of coronary heart disease.1
The Mediterranean Diet has gained
popularity as one approach to a
healthy diet2, but evidence gathered
through research on Alberta
products (canola, flax, barley,
pulses, berries, dairy and meat)
demonstrates that many Albertagrown foods have similar nutritional
qualities and would be acceptable
and more accessible to Albertans.3-7
Evidence also exists that, in addition
to providing adequate nutritional
quality, food should be accessible,
acceptable and available (the 4A
Framework) to facilitate healthy
eating.8-10 The Pure Prairie Eating
Plan (PPEP) 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.
How was PPEP Developed?
PPEP was first developed as a
nutritional approach to be used in
a set of practically-oriented studies
designed to help people with type
2 diabetes improve their adoption
and adherence to physical activity
and eating patterns that match
treatment recommendations from
the Canadian Diabetes Association
(CDA). Initial studies conducted
by the Physical Activity and
Nutrition for Diabetes in Alberta
(PANDA) team examined the
barriers to adhering to a healthy,
diabetes-friendly diet, according
to diabetes patients and diabetes
educators. Next, a consensus
conference was held with diabetes
experts and patients to facilitate
knowledge exchange, identify
issues and collaboratively develop
recommendations for programs
that they believed would support
long-term adherence to a high
quality, healthy diet among
people with diabetes.11,12 This
multi-disciplinary, multi-faceted,
collaborative approach provided
the framework for PPEP.
Originally, PPEP was called “The
Alberta Diet” as a play on “The
Mediterranean Diet”, but it was
re-branded to reflect planning as
an important component of this
approach to facilitate a healthy
diet and to recognize the rich
diversity of healthy food choices
available in the Canadian Prairies.
PPEP integrates knowledge
across several areas of research:
consumer behavior, behavior
change and the nutritional quality
of dairy, meat, canola, pulses and
grains.
What is PPEP?
PPEP is a structured menu plan
that outlines 28 days of healthy
food choices for three meals and
three snacks per day in portion
sizes and a dietary pattern that
meets Canada’s Food Guide
and the Nutrition Therapy
recommendations from the
CDA. It emphasizes foods that
are locally grown or produced,
readily available and acceptable to
people living on the prairies. See
Figure 1 for a sample menu plan.
PPEP also contains approximately
100 recipes, tips for healthy
eating, pantry and grocery lists
and other helpful information
about the foods described.
When followed, the menus
average approximately 2000
kcal/day with a macronutrient
distribution consistent with
health recommendations. The
menus provide between 25 and
50 grams of total fibre per day.
The recipes are for foods that
meet the 4A Framework: they
are nutritionally adequate,
locally available, acceptable and
accessible to Albertans. All are
quick, tasty and easy to prepare.
Many of the recipes have been
obtained from our provincial
agricultural commodity groups:
Alberta Milk, Alberta Canola
Commission, Alberta Pulse
Growers, Alberta Barley as well as
Canada Beef and Dairy Farmers
of Canada. Additional recipes
were developed specifically
for the guide by well-known
cookbook author and chef,
Nancy Hughes. Along with Dr.’s
Chan and Bell, many bright and
enthusiastic nutrition students at
the University of Alberta helped
to define and refine PPEP.
Research Studies Using
PPEP
In the first set of implementation
and evaluation studies, PPEP was
pilot-tested for 12 weeks with 15
people with type 2 diabetes. Each
participant met one-on-one with a
program facilitator who oriented
them to PPEP and evaluated the
following:
• how participants used the
menu plan,
• what participants liked about
the PPEP concept, meals,
snacks and format,
for Health Educators
• what they thought could be
improved,
• biological markers of diabetes
control and cardiovascular
risk.
Results from this first study
produced promising results
summarized below:13
• Participants implemented
PPEP in different ways. For
example, some adhered
rigorously to the menus and
did all cooking from scratch,
while others used the menus
as a guide to their dietary
pattern. They liked the
flexibility of the menu plan.
• All participants liked the
PPEP concept and approach.
Participants followed PPEP
~5 days/week and about 60%
of them continued to follow
PPEP 8 weeks after the study
had concluded.
• Participants were pleased with
the variety of food choices and
liked the taste of the recipes.
• Many were not used to
cooking from scratch and cited
time as a barrier to using the
menu plan more.
• The benefits of PPEP that
participants described
included:
₋₋ more structure in their
diets,
₋₋ increased frequency of
snacking,
₋₋ increased awareness of
food choices,
₋₋ aided purchasing of
healthier foods,
₋₋ better portion control.
• Blood-sugar control
(measured as A1c) improved
by 1%; body weight and levels
of “good” (HDL) cholesterol
2
also improved. These effects
were clinically and statistically
significant.
Next, funding was secured
through the Alberta Diabetes
Institute to conduct a 24-week
intervention with a larger group
of participants with type 2
diabetes. The revised version
of PPEP was paired with a fiveweek curriculum that emphasized
building practical skills in food
selection and food preparation.
The PPEP and curriculum were
delivered in a small group setting
with a facilitator. Quantitative
markers of diabetes control (A1c)
and cardiovascular risk (body
mass index, waist circumference
and blood pressure) along
with three-day food records
were collected. A total of 73
participants enrolled and 63
(86%) completed all aspects
of the program. On average,
there were decreases in A1c
(-1%), body mass index (-0.6 kg/
m2) and waist circumference
(-2 cm).14 Analysis of nutrient
intakes showed decreases in total
energy intake (-127 kcal/day),
total fat (-7 g/day), total sugar
(-25 g/day) and sodium (-469 mg/
day).14 All of these findings were
statistically significant. Additional
information about PPEP and
Figure 1: A Sample Menu Plan from PPEP
Week 1, Day 1
Meal
Ingredients Per Serving
Canada’s Food Guide
Servings
Breakfast
Breakfast Parfait
1 serving Breakfast Parfait
1 cup (250 ml) coffee/tea
2 Tbsp (30 ml)1% milk (optional)
1 tsp (5 ml) granulated sugar (optional)
2 Vegetables and Fruit
1 Grain Products
1 Milk and Alternatives
Morning Snack
Fresh Raspberry
Muffin with Roasted
Almonds
1 Fresh Raspberry Muffin
1 tsp (5 ml) non-hydrogenated magarine
1 Tbsp (15 ml) roasted almonds
1 Grain Products
1/4 Meat and Alternatives
1 Oils and Fats
Lunch
Tuna Caesar
Sandwich
1 Tuna Caesar Sandwich
1 cup (250 ml) 1% milk
1/2 cup (125 ml) peaches (in water)
2 1/2 Vegetables and
Fruit
2 Grain Products
1 Meat and Alternatives
1 Milk and Alternatives
1 Oils and Fats
Afternoon Snack
Five Minute
Hummus & Crackers
1 serving Five Minute Hummus
6 whole wheat Melba toast
1/4 cup (60 ml) chopped tomatoes
1/2 Vegetables and Fruit
1 1/2 Grain Products
1/2 Meat and Alternatives
Dinner
Roasted Apple Pork
Tenderloin with
Roasted Potatoes
1 serving Roasted Apple Pork Tenderloin
2/3 cup (150 ml) roasted potatoes
1/2 cup (125 ml) green beans
1 small whole grain dinner roll
1 tsp (5 ml) non-hydrogenated margarine
1/2 cup (125 ml)1% milk
2 Vegetables and Fruit
1 Grain Products
1 1/2 Meat and
Alternatives
1/2 Milk and Alternatives
1 Oils and Fats
Evening Snack
Cinnamon Raisin
Toast
1 slice toasted raisin bread
1 tsp (5 ml) each margarine, cinnamon
1/2 cup (125 ml) 1% milk
1 Grain Products
1/2 Milk and Alternatives
1 Oils and Fats
Total Servings
7 Vegetables and Fruit
7 1/2 Grain Products
3 1/4 Meat and
Alternatives
3 Milk and Alternatives
4 Oils and Fats
Good to Know
Nutrition facts of
the day
Adjusting today’s menu
Calories: 2350
Fat: 59 g
Saturated fat: 14 g
Carbohydrate: 334 g
Fibre: 46 g
Protein: 132 g
To cut about 200 calories:
• have only 1/2 cup (125 ml) of yogurt at breakfast (saves 50 kcal)
• omit margarine at morning snack and dinner (saves 70 kcal)
• make an open faced sandwich for lunch (saves 70 kcal)
To add about 200 calories:
• have 2 Tbsp (30 ml) almonds at morning snack (adds 100 kcal)
• drink 1 cup of milk with your dinner (adds 100 kcal)
Calorie intakes for PPEP average 2000 kcal/day over each week.
3
for Health Educators
curriculum acceptability,
accessibility and acceptability was
also collected and is still being
analyzed.
for purchase late in December
2013. Proceeds from its sale will
be used to further research into
improving the lifestyle behaviours
of Albertans.
The Evolution of PPEP
PPEP will be available initially as
a book via our website
www.pureprairie.ca and in
e-book format in the near future.
The supporting website features
sample menus, new recipes,
information about our research
and links to our sponsors.
While the original purpose of
PPEP was to help people with
type 2 diabetes adhere to the
nutrition recommendations of the
Canadian Diabetes Association,
it is clear that a healthy diet for
people with diabetes is a healthy
diet for everyone. This concept
was reinforced in the consensus
conference. People living with
type 2 diabetes and members of
the expert panel felt strongly that
a “diabetes diet” is not and should
not be different from the diets of
others.
The promising and positive
outcomes regarding the
acceptability of the menu plan
and improvements in health,
along with the encouragement
we’ve received from a number of
Alberta agricultural commodity
groups, led us to make the Pure
Prairie Eating Plan (PPEP):
Fresh Food, Practical Menus
and a Healthy Lifestyle, widely
available. PPEP will be available
About the Authors
Rhonda Bell and Catherine Chan
are professors of human nutrition
at the University of Alberta.
They are both members of the
Physical Activity and Nutrition
for Diabetes in Alberta (PANDA)
research team.
Our Sponsors
We would like to acknowledge
the financial support of
Alberta Livestock and Meat
Agency, Alberta Crop Industry
Development Fund, Alberta
Canola Producers 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.
Archived issues of our newsletter can be
found on our website.
The team of Alberta Milk registered dietitians are:
Jaclyn Chute, RD
Lee Finell, MHSA, RD
Colinda Hunter, RD
Cindy Thorvaldson, MSc, RD
Nutrition File® is a free quarterly research newsletter for health educators, funded
by the dairy producers of Alberta. If you are a new reader and would like to add
your name to our distribution list, please contact Alberta Milk at [email protected]
albertamilk.com or phone 1-877-361-1231.
for Health Educators
4
A Recipe from PPEP: Chickpea and Feta Bulgur Salad Serves 4 – Serving Size: 1 ½ cups (375 ml) This recipe, featuring whole grains, pulses, veggies and cheese, can be served for lunch by itself or as a side‐dish at dinner. Developed for PPEP by chef Nancy Hughes. Ingredients 2 cups (500 ml) water 1/2 cup (125 ml) finely chopped fresh mint 1 cup (250 ml) dry bulgur 3 Tbsp (45 ml) cider vinegar 1 medium cucumber, diced 2 Tbsp (30 ml) canola oil 1/2 of a 16 ounce (450 ml) can chickpeas, rinsed and 2 medium garlic cloves, minced drained 1/2 tsp (2 ml) salt 1/2 cup (125 ml) diced red onion 2 oz (60 g) feta cheese, crumbled 1/2 cup (125 ml) finely chopped fresh flat leaf parsley Directions 1. Bring the water to a boil in a medium saucepan over high heat. Add the bulgur, reduce the heat to medium‐low, cover and simmer 12 minutes or until most of the water has been absorbed. 2. Meanwhile, combine the remaining ingredients, except the cheese in a large bowl. 3. Drain the bulgur in a fine mesh sieve and run under cold water to cool quickly. Shake off excess liquid and add to the cucumber mixture. Stir until well mixed. 4. Add the cheese and stir until just mixed. Let stand 10 minutes to absorb flavours. Nutrition Information – per serving 308 kcal 11 g fat 3 g saturated fat 44 g carbohydrate 11 g fibre 11 g protein Eating Well with Canada’s Food Guide servings 1.5 Vegetables and Fruit 1.5 Grain Products 0.5 Milk and Alternatives 0.5 Meat and Alternatives