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Objective: Vinegar consumption studies have demonstrated possible therapeutic effects in reducing HbA1c and postprandial glycemia. The purpose of the study was to closely examine the effects of a commercial vinegar drink on daily fluctuations in fasting glucose concentrations and postprandial glycemia, and on HbA1c, in individuals at risk for Type

Objective: Vinegar consumption studies have demonstrated possible therapeutic effects in reducing HbA1c and postprandial glycemia. The purpose of the study was to closely examine the effects of a commercial vinegar drink on daily fluctuations in fasting glucose concentrations and postprandial glycemia, and on HbA1c, in individuals at risk for Type 2 Diabetes Mellitus (T2D). Design: Thirteen women and one man (21-62 y; mean, 46.0±3.9 y) participated in this 12-week parallel-arm trial. Participants were recruited from a campus community and were healthy and not diabetic by self-report. Participants were not prescribed oral hypoglycemic medications or insulin; other medications were allowed if use was stable for > 3 months. Subjects were randomized to one of two groups: VIN (8 ounces vinegar drink providing 1.5 g acetic acid) or CON (1 vinegar pill providing 0.04 g acetic acid). Treatments were taken twice daily immediately prior to the lunch and dinner meals. Venous blood samples were drawn at trial weeks 0 and 12 to measure insulin, fasting glucose, and HbA1c. Subjects recorded fasting glucose and 2-h postprandial glycemia concentrations daily using a glucometer. Results: The VIN group showed significant reductions in fasting capillary blood glucose concentrations (p=0.05) that were immediate and sustained throughout the duration of the study. The VIN group had reductions in 2-h postprandial glucose (mean change of −7.6±6.8 mg/dL over the 12-week trial), but this value was not significantly different than that for the CON group (mean change of 3.3±5.3 mg/dL over the 12-week trial, p=0.232). HbA1c did not significantly change (p=0.702), but the reduction in HbA1c in the VIN group, −0.14±0.1%, may have physiological relevance. Conclusions: Significant reductions in HbA1c were not observed after daily consumption of a vinegar drink containing 1.5 g acetic acid in non-diabetic individuals. However, the vinegar drink did significantly reduce fasting capillary blood glucose concentrations in these individuals as compared to a vinegar pill containing 0.04 g acetic acid. These results support a therapeutic effect for vinegar in T2D prevention and progression, specifically in high-risk populations.
ContributorsQuagliano, Samantha (Author) / Johnston, Carol (Thesis advisor) / Appel, Christy (Committee member) / Dixon, Kathleen (Committee member) / Arizona State University (Publisher)
Created2013
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Dietary protein is known to increase postprandial thermogenesis more so than carbohydrates or fats, probably related to the fact that amino acids have no immediate form of storage in the body and can become toxic if not readily incorporated into body tissues or excreted. It is also well documented that

Dietary protein is known to increase postprandial thermogenesis more so than carbohydrates or fats, probably related to the fact that amino acids have no immediate form of storage in the body and can become toxic if not readily incorporated into body tissues or excreted. It is also well documented that subjects report greater satiety on high- versus low-protein diets and that subject compliance tends to be greater on high-protein diets, thus contributing to their popularity. What is not as well known is how a high-protein diet affects resting metabolic rate over time, and what is even less well known is if resting metabolic rate changes significantly when a person consuming an omnivorous diet suddenly adopts a vegetarian one. This pilot study sought to determine whether subjects adopting a vegetarian diet would report decreased satiety or demonstrate a decreased metabolic rate due to a change in protein intake and possible increase in carbohydrates. Further, this study sought to validate a new device called the SenseWear Armband (SWA) to determine if it might be sensitive enough to detect subtle changes in metabolic rate related to diet. Subjects were tested twice on all variables, at baseline and post-test. Independent and related samples tests revealed no significant differences between or within groups for any variable at any time point in the study. The SWA had a strong positive correlation to the Oxycon Mobile metabolic cart but due to a lack of change in metabolic rate, its sensitivity was undetermined. These data do not support the theory that adopting a vegetarian diet results in a long-term change in metabolic rate.
ContributorsMoore, Amy (Author) / Johnston, Carol (Thesis advisor) / Appel, Christy (Thesis advisor) / Gaesser, Glenn (Committee member) / Arizona State University (Publisher)
Created2012
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In 2002, a scientifically derived food guide pyramid for vegetarians, the Modified Food Guide for Lacto-ovo-vegetarians and Vegans was published and well received. Now that 10 years have passed, new scientific literature regarding the bioavailability of the nutrients of key concern in vegetarian diets has been published, and the graphical

In 2002, a scientifically derived food guide pyramid for vegetarians, the Modified Food Guide for Lacto-ovo-vegetarians and Vegans was published and well received. Now that 10 years have passed, new scientific literature regarding the bioavailability of the nutrients of key concern in vegetarian diets has been published, and the graphical format of the nation's food guide has evolved from a pyramid shape into a circular plate. The objective of this research was to examine the post-2002 literature regarding the bioavailability of key nutrients in vegetarian diets; to use this information to update the recommendations made in the 2002 Modified Food Guide Pyramid for Lacto-ovo-vegetarians and Vegans; and to adapt this revised food plan to the new USDA MyPlate format. This process involved reviewing the scientific literature to determine if the DRIs for the nutrients of key concern in vegetarian diets are adequate for the vegetarian population and using this information to develop new recommendations for vegetarians if necessary, analyzing the nutrient content of representative foods in different food groups, reconfiguring the food groups so that foods with like nutrient components were grouped together, determining the number of servings of each food group required to meet vegetarians' nutrient requirements at three caloric levels, and developing sample menus. A circular plate graphic, the Vegetarian Plate, was designed to illustrate the recommendations of this updated food guide. This updated, scientifically derived food guide provides a sound base for diet planning for lacto-ovo-vegetarians and vegans. Further research is needed to assess the Vegetarian Plate's adequacy for children, pregnant and lactating women, athletes, and individuals with medical conditions or chronic diseases.
ContributorsFladell, Lauren (Author) / Johnston, Carol (Thesis advisor) / Vaughan, Linda (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2013
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Background. Research suggests that non-O blood types are at an increased risk of thrombosis and related health complications in cardiovascular disease (CVD). This is due in part to higher concentrations of von Willebrand factor (VWF), an important factor involved in blood clotting. Objective. The purpose of this study was to

Background. Research suggests that non-O blood types are at an increased risk of thrombosis and related health complications in cardiovascular disease (CVD). This is due in part to higher concentrations of von Willebrand factor (VWF), an important factor involved in blood clotting. Objective. The purpose of this study was to examine the effects of a vegetarian-like diet on blood coagulation and other health parameters in adults with type A blood compared to type O blood over a four week intervention. Given the lack of previous research on blood type and diet, it was hypothesized that no difference in blood coagulation would be observed. Design. This study was a randomized, parallel arm, dietary intervention using healthy, omnivorous adults with blood types A and O. A total of 39 subjects completed the study. Subjects were randomized into two groups: a vegetarian-like diet group made up of 12 type As and 12 type Os and an omnivorous control diet group made up of 11 type As and 12 type Os. At weeks 0 and 4, fasting blood was drawn and analyzed for prothrombin time (PT), activated partial thromboplastin time (APTT), von Willebrand factor (VWF), total cholesterol, LDL, HDL, triglycerides, and CRP. In addition, subjects were weighed and filled out a FFQ at weeks 0 and 4. Results. After adhering to a vegetarian-like diet for four weeks, type Os had a significant increase in PT (+0.24±0.32 sec/ p=0.050), whereas type As saw no significant change. There was a trend of weight loss for type Os in the vegetarian-like diet group (-1.8±2.6 lb/ p=0.092) and significant weight loss for type As (-0.9±2.1 lb/ p=0.037). Both blood types O and A experienced significant decreases in BMI (-0.3±0.4/ p=0.092 and -0.2±0.3/ p=0.037, respectively). No change was seen in APTT, VWF, total cholesterol, LDL, HDL, triglycerides, or CRP. Conclusion. Type Os saw an increase in PT, perhaps indicating a reduction in risk of thrombosis and its related health complications. Type As were less responsive to the dietary intervention and may require more rigid dietary guidelines or a longer time on such a diet to see the benefits.
ContributorsBrown, Jennifer (Author) / Johnston, Carol (Thesis advisor) / Martin, Keith (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2013
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The unpleasant bitter taste found in many nutritious vegetables may deter people from consuming a healthy diet. We investigated individual differences in taste perception and whether these differences influence the effectiveness of bitterness masking. To test whether phenylthiocarbamide (PTC) `supertasters' also taste salt and sugar with greater intensity, as suggested

The unpleasant bitter taste found in many nutritious vegetables may deter people from consuming a healthy diet. We investigated individual differences in taste perception and whether these differences influence the effectiveness of bitterness masking. To test whether phenylthiocarbamide (PTC) `supertasters' also taste salt and sugar with greater intensity, as suggested by Bartoshuk and colleagues (2004), we infused strips of paper with salt water or sugar water. The bitterness rating of the PTC strip had a significant positive linear relationship with ratings of both the intensity of sweet and salt, but the effect sizes were very low, suggesting that the PTC strip does not give a complete picture of tasting ability. Next we investigated whether various seasonings could mask the bitter taste of vegetables and whether this varied with tasting ability. We found that sugar decreased bitterness and lemon decreased liking for vegetables of varying degrees of bitterness. The results did not differ by ability to taste any of the flavors. Therefore, even though there are remarkable individual differences in taste perception, sugar can be used to improve the initial palatability of vegetables and increase their acceptance and consumption.
ContributorsWilkie, Lynn Melissa (Author) / Phillips, Elizabeth D. (Thesis advisor) / Cohen, Adam (Committee member) / Johnston, Carol (Committee member) / Arizona State University (Publisher)
Created2012
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Many people with or at risk for diabetes have difficulty maintaining normal postprandial blood glucose levels (120-140 mg/dl). Research has shown that vinegar decreases postprandial glycemia. The purpose of this study was to examine a possible mechanism by which vinegar decreases postprandial glycemia, particularly the effect of vinegar ingestion on

Many people with or at risk for diabetes have difficulty maintaining normal postprandial blood glucose levels (120-140 mg/dl). Research has shown that vinegar decreases postprandial glycemia. The purpose of this study was to examine a possible mechanism by which vinegar decreases postprandial glycemia, particularly the effect of vinegar ingestion on gut fermentation. In this parallel arm randomized control trial, the effects of daily ingestion of vinegar on gut fermentation markers were observed among adults at risk for type 2 diabetes in Phoenix, Arizona. Subjects (n=14) were randomly assigned to treatments consisting of a vinegar drink (1.5g acetic acid) or a placebo (2 vinegar pills containing 40mg acetic acid each). All participants were required to consume the vinegar drink (16 oz) or 2 placebo pills every day for 12 weeks. At week 12, participants filled out a questionnaire to report gastrointestinal (GI) symptoms and three consecutive breath samples were taken from each subject to measure fasting breath hydrogen (BH2) with a breath analyzer. Fasting BH2 measures for the vinegar drink group (16.1+11.8 ppm) were significantly different than those from the pill group (3.6+1.4) with a partial eta squared of 0.39 (p=0.023). After adjusting for age as a confounding factor (r=0.406) and removing an outlier, fasting BH2 measures for the vinegar drink group (4.3+1.1 ppm) were still significantly different than those from the pill group (3.6+1.4) with a partial eta squared of 0.35 (p=0.045). Participants in both groups reported mild changes in GI symptoms. In conclusion, adults at risk for type 2 diabetes that consume 2 tablespoons of vinegar a day may have increased gut fermentation compared to those who do not consume vinegar.
ContributorsWhite, Serena (Author) / Johnston, Carol (Thesis advisor) / Appel, Christy (Committee member) / Martin, Keith (Committee member) / Arizona State University (Publisher)
Created2013
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ABSTRACT This randomized, controlled, double-blind crossover study examined the effects of a preprandial, 20g oral dose of apple cider vinegar (ACV) on colonic fermentation and glycemia in a normal population, with the ultimate intention of identifying the mechanisms by which vinegar has been shown to reduce postprandial glycemia and insulinemia.

ABSTRACT This randomized, controlled, double-blind crossover study examined the effects of a preprandial, 20g oral dose of apple cider vinegar (ACV) on colonic fermentation and glycemia in a normal population, with the ultimate intention of identifying the mechanisms by which vinegar has been shown to reduce postprandial glycemia and insulinemia. Fifteen male and female subjects were recruited, ages 20-60y, who had no prior history of gastrointestinal (GI) disease or resections impacting normal GI function, were non-smokers, were non-vegetarian/vegan, were not taking any medications known to alter (glucose) metabolism, and were free of chronic disease including diabetes. Subjects were instructed to avoid exercise, alcohol and smoking the day prior to their trials and to consume a standardized, high-carbohydrate dinner meal the eve prior. There was a one-week washout period per subject between appointments. Breath hydrogen, serum insulin and capillary glucose were assessed over 3 hours after a high-starch breakfast meal to evaluate the impact of preprandial supplementation with ACV or placebo (water). Findings confirmed the antiglycemic effects of ACV as documented in previous studies, with significantly lower mean blood glucose concentrations observed during ACV treatment compared to the placebo at 30 min (p=0.003) and 60 min (p=0.005), and significantly higher mean blood glucose concentrations at 180 min (p=0.045) postprandial. No significant differences in insulin concentrations between treatments. No significant differences were found between treatments (p>0.05) for breath hydrogen; however, a trend was observed between the treatments at 180 min postprandial where breath hydrogen concentration was visually perceived as being higher with ACV treatment compared to the placebo. Therefore, this study failed to support the hypothesis that preprandial ACV ingestion produces a higher rate of colonic fermentation within a 3 hour time period following a high-carbohydrate meal. Due to variations in experiment duration noted in other literature, an additional study of similar nature with an expanded specimen collections period, well beyond 3 hours, is warranted.
ContributorsMedved, Emily M (Author) / Johnston, Carol (Thesis advisor) / Sweazea, Karen (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2012
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Diabetes is the 7th leading cause of death globally. In 2018, 34.2 million Americans had type 2 diabetes. Many symptoms of diabetes are similar to those of scurvy or vitamin C deficiency. Vitamin C marginality and inadequacy are more prevalent in Type 2 Diabetes/prediabetes than with normal glucose tolerance. Intracellular

Diabetes is the 7th leading cause of death globally. In 2018, 34.2 million Americans had type 2 diabetes. Many symptoms of diabetes are similar to those of scurvy or vitamin C deficiency. Vitamin C marginality and inadequacy are more prevalent in Type 2 Diabetes/prediabetes than with normal glucose tolerance. Intracellular vitamin C inadequacy is suspected due to competition between dehydroascorbic acid and glucose at GLUT 1 and 3 cellular receptors. Erythrocyte osmotic fragility is noted in Gulo -/- knockout mice unable to synthesize endogenous vitamin C. The ascorbate deficient red blood cells presented with low cytoskeletal B-spectrin, spherocyte appearance, and impaired deformability. This cross-sectional study investigated the relationships between diabetes status, erythrocyte osmotic fragility, and serum vitamin C status. Participants were aged 18-65, non-smoking, reported no unresolved health complications, and denied prior vitamin C supplementation. Those with T2D indicated diagnosis of >1 year. All participants provided written informed consent and the study was approved by the local Institutional Review Board in January 2021. Participants provided one fasted blood sample. Erythrocyte osmotic fragility was measured via UV/Vis spectrophotometry with various concentrations of sodium chloride (0.85% - 0.10%) to induce osmotic stress. In addition, plasma was extracted and mixed 1:1 with 10% (w/v) metaphosphoric acid in 2 mmol/L disodium EDTA and centrifuged. The supernatant was stored at -80°C until analysis with isocratic reverse-phase UV-HPLC separation. Participant characteristics did not differ significantly between groups apart from age (p< 0.01) and HbA1c (p=0.002). Data are presented for adults with T2D (n=14; 36% female; 55.5±8.2 y; 31.5±9.0 kg/m2; HbA1c: 7.4±1.9%; plasma vitamin C: 36.0±12.2 uM) and without T2D (n=16; 69% female; 38.7±13.5 y; 26.8±6.6 kg/m2; A1c: 5.4±0.3%; plasma vitamin C: 34.8±10.9uM). Erythrocyte osmotic fragility was significantly elevated (+4.4% hemolysis) in adults without T2D at 0.35% saline (p=0.039). Greater VC status (>30 uM) was associated with lower hemolysis at 0.35% NaCl (p=0.031). Erythrocyte osmotic stability was linked to greater vitamin C intake at 0.20% saline in those without T2D (p =0.019). In this pilot study, vitamin C status did not differ significantly by diabetes status. Vitamin C status was directly linked to erythrocyte osmotic stability in adults without T2D.
ContributorsLundy, Ciara Cheyanne (Author) / Johnston, Carol (Thesis advisor) / Sweazea, Karen (Committee member) / Alexon, Christy (Committee member) / Arizona State University (Publisher)
Created2022
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Plant-based eaters are known to reap nutritional benefits due to their dietchoice, but it is important to evaluate dietary differences that may put them at a disadvantage compared to omnivores. Stark differences exist in daily intakes of protein between vegans and omnivores, which may lead to several risks including decreased

Plant-based eaters are known to reap nutritional benefits due to their dietchoice, but it is important to evaluate dietary differences that may put them at a disadvantage compared to omnivores. Stark differences exist in daily intakes of protein between vegans and omnivores, which may lead to several risks including decreased strength and bone density. The purpose of this study was to analyze the differences in protein intake, lean mass, strength, and bone density in vegans versus omnivores in order to support the argument for an increased recommended daily allowance (RDA) for protein for plant-based eaters. Participants in this study were assigned to groups based on omnivorous (n = 25) or vegan (n = 19) dietary pattern. Nineteen matched pairs were created based on age and BMI. Data was collected at a single lab visit and included health history and physical activity readiness questionnaires, 24-hr food recall, and anthropometric measures. Bone mineral density (BMD) was measured using DEXA and strength was assessed using hand and Biodex dynamometers. Statistical analyses were conducted using independent samples t-tests and Pearson’s correlation tests to evaluate differences in body composition, bone density, strength, and dietary intake between the two groups with significance set at p.05. Differences were seen in daily calorie (p=.007), protein (p<.001), fat (p<.001), and fiber (p=.009) intake. Lean mass (p=.282) and bone density (p=.651) were not different between groups, but lower body strength was different (p=.008). There was a correlation between lower body strength and protein intake (p<.001), and lean mass was correlated with lower body strength (p<.001), grip strength (p<.001), and bone density (p<.001), but not i LBM (p=0.158). Correlations were also observed between BMD and lower body strength (p=.004). These data suggest that there is a significant difference between protein intake in vegans versus omnivores, which appears to have a positive association with strength. BMD also has a positive association with strength as well as lean mass. Cumulatively, the results suggest that it may be beneficial for vegans to increase daily protein intake.
ContributorsNadalet, Camila R (Author) / Johnston, Carol (Thesis advisor) / Shepard, Christina (Committee member) / Hooshmand, Shirin (Committee member) / Arizona State University (Publisher)
Created2023
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Background: Vegan and vegetarian diets have gained in popularity in recent years. Stated reasons for this include some possible health benefits and concerns of animal welfare. Though considered to be nutritionally adequate, questions remain over whether current protein recommendations of 0.8 g/kg/d are sufficient to maintain body processes and growth.

Background: Vegan and vegetarian diets have gained in popularity in recent years. Stated reasons for this include some possible health benefits and concerns of animal welfare. Though considered to be nutritionally adequate, questions remain over whether current protein recommendations of 0.8 g/kg/d are sufficient to maintain body processes and growth. Protein is unique in that it is the only macronutrient that contains nitrogen. Its status can be determined through nitrogen balance analysis of the urine if protein content of the diet is known. Nitrogen balance is considered the gold standard for determining protein intake requirements. A negative balance indicates a catabolic state, whereas a positive nitrogen balance is seen during anabolism. In healthy people, nitrogen equilibrium is desired under normal circumstances. This equilibrium reflects the net synthesis and breakdown of proteins. While nitrogen balance techniques have been used for decades, currently, there are no known studies measuring nitrogen balance and protein intake in strict vegans. Methods: Twenty vegan, inactive, male participants were recruited and received a 5-day eucaloric diet with a known protein content held constant at 0.8 g/kg/d. On day five, 24-hour urine was collected by participants and aliquoted for future analysis. Nitrogen content of the urine was determined through photometric assay and compared to the known nitrogen content of the diet to calculate nitrogen balance status. Results: Mean absolute nitrogen balance (-1.38 ± 1.22 g/d, effect size = -1.13) was significantly lower than zero (equilibrium) (p < .001). Mean relative nitrogen balance (-18.60 ± 16.96 mg/kg/d, effect size = -1.10) was significantly lower than zero (p < .001). There were no correlations seen between nitrogen balance and age, years as vegan, or fat- free mass. Conclusion: Consuming 0.8 g/kg/d of protein is insufficient to produce nitrogen balance in long-term vegans.
ContributorsBartholomae, Eric (Author) / Johnston, Carol (Thesis advisor) / Sweazea, Karen (Committee member) / Wharton, Christopher (Committee member) / Lee, Chong (Committee member) / Kressler, Jochen (Committee member) / Arizona State University (Publisher)
Created2022