From the Desk of The Nutty Nutritionist

Archive for the ‘Diabetes’ Category

Power Up, Peeps!

In Autoimmune disease, Diabetes, Fighting Cancer, Managing cholesterol, Wellness on October 23, 2011 at 10:47 PM
As a dietitian who specializes in chronic disease management, I spend the majority of my time helping people prevent or manage conditions such as diabetes, high cholesterol, high blood pressure, cancer, and autoimmune disorders (scleroderma, lupus, rheumatoid arthritis, etc).  Of course, the dietary suggestions I make for each client are based on his or her individual health needs and taste preferences.  However, there are specific fruits, vegetables, and herbs that I consider “power” foods and encourage everyone to eat them on a regular basis, regardless of health status.  My judgments are based on a food’s ability to lower blood sugar, cholesterol or blood pressure; provide antioxidants for heart disease and cancer prevention; and/or as act as anti-inflammatory agents, important for taming autoimmune disease, and preventing heart disease and diabetes.  I will share my so-called “power foods” and suggested serving sizes with you now.  It will be impossible for the average person to include all 15 of these foods on a daily basis, but aiming for 3-5 times per week for each will certainly “power up” your nutritional status and help you thwart disease.
 
Vegetables
 
1.  Sweet potato/Yam:  easier on blood sugar than a white potato and helps lower cholesterol due to its high soluble fiber content; great source of carotenoids and other antioxidants for eye health, heart health, and cancer prevention; anti-inflammatory properties for those with autoimmune conditions.  Serving size: 1 cup.  
 
2. Dark green leafy vegetables: such as spinach, kale, arugula, collards, mustard greens.  Contain potent antioxidant and anti-inflammatory properties for heart health, autoimmunity, and cancer prevention; excellent source of potassium to help lower blood pressure.  Serving size:  the more, the better.  Caveat:  be careful if on blood thinning medication, as these are high in vitamin K.
 
3.  Cooked tomato products:  such as tomato/vegetable juice, spaghetti sauce, tomato soup, pizza sauce.  Contain potent antioxidant and anti-inflammatory properties for heart health, cancer prevention, and autoimmune modulation; excellent source of lycopene for men’s prostate health; rich in potassium for lowering blood pressure (especially if no salt added during processing).  Serving size:  1/2-1 cup.
 
4.  Broccoli:  exceptional source of cancer-fighting compounds; anti-inflammatory benefits good for heart and autoimmune conditions.  Easy on blood sugar.  Serving size:  1 cup.  Substitute: Brussels sprouts, cauliflower, Bok choy, or other cruciferous vegetables.
 
5.  Starchy beans:  such as kidney beans, black beans, red beans, white beans, garbanzo beans, etc.  Excellent source of soluble fiber which is easier on blood sugar and helps lower LDL cholesterol; many varieties are rich in potassium for lowering blood pressure.   Antioxidant properties.  Serving size:  1/3 cup.  
 
Power fruits:
 
1.  Avocado:  YES!  IT’S A FRUIT!  Rich in monounsaturated fat, known to fight inflammation and raise healthy HDL cholesterol.   Serving size:  1/8-1/4 medium size.  Caveat:  high in calories, so don’t consume a whole avocado every day or your body will take on the shape of an avocado…
 
2.  Cherries:  potent source of antioxidants and anti-inflammatory properties, great for heart health, joint pain, and autoimmune conditons;  2 tbsp cherry juice daily can ease arthritis pain.  Serving:  12-20 fresh cherries or 1/4 cup dried cherries (2 Tbsp. dried with diabetes).  Caveat:  can raise blood sugar if you have diabetes, so watch portion size.
 
3.  Blueberries:  highest antioxidant/anti-inflammatory power for cancer prevention, heart disease, brain health, and autoimmunity.  Serving:  3/4 cup  fresh/frozen or 1/4 dried blueberries (2 Tbsp dried with diabetes).
  
4.  Apples: excellent source of soluble fiber for lowering LDL cholesterol; potent antioxidant/anti-inflammatory properties for heart health, cancer prevention, and easing autoimmune flare-ups.  Serving size:  “an apple a day keeps the doctor away”, but you knew that already, right?  Caveat:  organic is best, as conventionally grown apples have high pesticide residues.
 
5.  Kiwi:  excellent source of vitamin C, particularly important during “cold and flu season”; rich in potassium for lowering blood pressure; contains papain, a natural enzyme that can aid protein digestion for those with digestive disorders; high fiber makes it easier on blood sugar and speeds intestinal transit for optimal colon health and for those with autoimmune-related intestinal motility issues.  Serving:  1-2 medium kiwis.   
 
Power herbs/spices:
 
1.  Cinnamon:  potent anti-oxidant/anti-inflammatory properties for cancer and autoimmune conditions; helps lower blood sugar.  Serving:  1/4-1/2 tsp. daily, added to coffee, tea, oatmeal, yogurt, etc.
 
2.  Basil:  potent antioxidant/anti-inflammatory for heart health, cancer prevention, autoimmunity.  Serving:  add liberally to salads, sauces, meats, side dishes.  Fresh or dried.  Acceptable substitute:  oregano or rosemary.
 
3.  Tumeric (curcumin):  loaded with antioxidants and anti-inflammation properties  for heart, cancer, autoimmunity;  Serving:  1/8-1/4 tsp  Substitute:  cumin, curry
 
4.  Fresh Garlic:  cooked lightly to release antioxidant/anti-inflammatory components, excellent for fighting inflammation, lowering cholesterol, and cancer prevention.  Serving:  1-2 cloves.  Caveat:  may need to hand out nose plugs…
 
5.  Paprika:  potent antioxidant/anti-inflammatory properties, for the same reasons as other herbs listed above.  Excellent topper for chicken and fish.  Serving: 1/8-1/4 tsp.  
 
As I have said time and again, it is always best to eat real, wholesome foods rather than to rely on pills and supplements to give your body what it needs to look and feel well.  Taking so-called fruit or vegetable pills or powders will not provide the same benefits.  Add these powerful foods to your shopping list this week and be on your way to feeling your best!
 
 
 
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Sorting Out The Sweeteners

In Diabetes, Trends, Wellness on September 21, 2011 at 4:07 PM

A friend asked for my opinion regarding a recent Yahoo! Health article entitled “The 4 Best and 3 Worst Sweeteners to Have in Your Kitchen”.  The article names Aspartame, Sucralose, and Agave as the “bad guys” and Stevia, Sugar Alcohols, Honey, and Molasses as the “good guys”.   Oh boy.  Glad I have the opportunity to clear the air on this one…

I agree that artificial, non-caloric sweeteners such as Aspartame (Equal), Sucralose (Splenda), and Saccharin (Sweet & Low) are bad news and should be avoided whenever possible, especially when you are pregnant.  The good news is that these sweeteners are 100 times sweeter than sugar, so it is easy to just use a small amount, if you must have it.  (i.e. you refuse to eat your oatmeal unless you can sweeten it up a bit…), and it will not add calories or raise your blood sugar.  In my opinion, getting a little bit of regular sugar is always a safer option than consuming artificial derivatives, but since regular sugar can mess with your blood sugar, I draw the line here for people suffering from reactive hypoglyemia or diabetes.  If you have blood sugar problems, you should avoid all forms of sugar as much as possible, and a small amount of aspartame or sucralose will not cause bodily harm.  The cancer scares on the Internet are ridiculous, as we are not consuming large amounts of these sweeteners on a daily basis.   Since the artificial sweeteners are so concentrated sweet, you aren’t getting that much from most food products.   People with diabetes have a lot more to lose by overconsuming sugar than they do from getting some blood-sugar-friendly artificial sweetener on occasion.   A reasonable limit on artifically sweetened foods would be consuming a 6 oz. container of “light” yogurt and a can of diet soda daily.  If you drink a 6-pack of diet soda a day, you definitely should cut back, for many many reasons, which I am not going to discuss here…

I also believe, in agreement with the Yahoo! article, that agave should be limited as well.  Because it is naturally-derived sweetener does not mean it is good for us, contrary to popular belief.  It is still a form of sugar and will add calories and raise blood sugar.  Agave syrup is being added to more and more foods and beverages these days, claiming health benefits.  Oh phooey.   But here is a fun factoid:  did you know agave is fermented to produce tequila?  Let’s limit our agave intake to a tequila shot or two, shall we?  (just trying to lighten the mood here…HA!)

I disagree with the author of the Yahoo! article and am not convinced that Stevia is a safe alternative to sugar.  While it is true that Stevia will not raise our blood sugar or add padding to our hips and thighs, similar to the other non-caloric sweeteners mentioned above, it too should be consumed in moderation.  Yes, it is a naturally-derived plant component, but plants produce toxins to defend against its predators.  Could this chemical compound really be a toxin used by the Stevia plant to fend off critters?  I’m not trying to scare anybody here.  I just haven’t seen any long term research supporting it’s safety.  Personally I find the aftertaste quite offensive and avoid it completely.  But I find the aftertaste of all non-sugar sweeteners unsavory,  so that just might be me and my inherited taste sensitivities.   So, in short, Stevia should not be consumed with anything and everything.  We cannot assume it is safe at this point. 

Sugar alcohols are OK in small amounts (like in gum) but skip the low carb junk foods that are loaded with it, such as many “sports bars”, Atkins Diet branded foods, and brands catering to the needs (??) of people with diabetes.  So called “diabetic friendly” chocolate, cookies, ice cream, and pies sweetened with sugar alcohols are NOT health foods, and are just as capable of raising your blood sugar as all baked goods can.  Plus, the resulting diarrhea is no fun and keeps us from absorbing the vitamins from foods. 

Honey is the sweetener I use, but only in moderation, as it is still a source of calories and will raise blood sugar.  I add it to plain Greek yogurt on occasion, and that’s about it.  The advantages mentioned in the article regarding honey’s antioxidant content and such is true, but from a teaspoon or tablespoon serving size, it doesn’t begin to amount to what you would get from eating a diet rich in brightly colored fruits and vegetables.

Finally, it is funny how molasses is mentioned as a good guy.  It is still very sweet, just like other sugars, and high in calories.  While it is true that Blackstrap molasses is a rich source of vitamin K, which may sound healthy, those taking blood-thinning medications , such as Coumadin (warfarin), will need to count this sweetener into their total vitamin K intake, as vitamin K promotes blood clotting and will render these meds less effective.  This can be dangerous for someone with a history of blood clots, heart attack, or TIA/stroke.  Again, not trying to scare anybody, just advising you to be mindful.

For more information (and my professional opinion) regarding sugar and other carbohydrates, check out the archives under the “Diabetes” category, as I have written extensively on this topic.

Live well.  Be well.

Curtailing the Carbs

In Diabetes on April 30, 2011 at 1:18 PM

If you have concerns about managing your blood sugar either now or in the future, hopefully you have read the previous postings outlining the lifestyle modifications recommended for preventing, delaying, or managing type 2 diabetes.  This posting is an update on the previous article entitled “Meal Planning for Controlling Blood Sugar”, as I have continued to receive questions regarding the suggested dietary changes:  Which foods contain carbohydrate? How much can I have? Do I have to avoid “carbs” completely? What about whole grains? Can I ever eat dessert again?  These are all very relevant questions.  What you eat, when you eat, and how much you eat have everything to do with how high or low your blood sugars will go.  Moderation is the name of the game.  You do not have to completely give up anything, unless you choose to do so.  However, to best manage your blood sugars, your portions will likely need to be smaller than what you are used to eating.

Carbohydrate-containing foods, in the form of sugar and starch, are responsible for raising your blood sugar after a meal.  Therefore, in order to prevent a dramatic rise in blood sugar, it is imperative that you limit the amount of carbohydrate you eat at one time.  Spreading your “carbs” out throughout the day, in small, evenly-spaced doses, is the best way to keep your blood sugar steady over time.  Even if you don’t already have diabetes, eating large portions of starchy and/or sugary foods can lead to an undesirable chain of events:  first, a significant rise in blood sugar occurs; then the pancreas pumps out loads of insulin to cover the surge (assuming your body can still make enough insulin); this flush of insulin can make your blood sugar crash quickly, leading to those infamous “carb cravings” in the effort to raise the blood sugar back up. So, back to the candy bowl, cookie jar, or potato chip bag you go…often without even thinking.  This vicious cycle can repeat itself over and over and over again—certainly not beneficial for your blood sugar, poor over-worked pancreas, or waistline. 

The above-mentioned scenario is most certainly not a good cycle for someone at risk for diabetes, and is potentially dangerous for someone who has already been diagnosed with the disease.  If your pancreas cannot keep up with the demand for insulin, then your blood sugar remains high for an extended period of time after meals.  Long-term elevations in blood sugar can damage blood vessels throughout the body, possibly leading to a heart attack, stroke, blindness, kidney failure, foot problems, and/or nerve damage.  My goal as a diabetes educator is to help people prevent these complications.   Eating less carbohydrate limits the rise in blood sugar, thereby reducing the body’s exposure to high levels of damaging sugar, pure and simple.  You can protect your body too by following the guidelines below.

I teach my clients a skill known as “carbohydrate counting”, which allows them to determine the amount of carbohydrate they eat throughout the day.  This is a meal planning strategy intended to help them understand how their food choices affect their blood sugar level.  This is not a specific “diet”, per se.  Even if you don’t have diabetes, limiting your carbohydrate intake can be a helpful adjunct for everyday weight management as well.

To review, foods containing carbohydrate include grains, breads, cereals, dried beans, starchy vegetables, milk, yogurt, fruit, juices, sweets, and desserts.  For carbohydrate counting purposes, a “serving” worth of carbohydrate is equivalent to 15 grams.  Therefore, serving sizes are based on however much of a food it takes to equal 15 grams of carbohydrate.  Here are some examples of single servings (15 grams) worth of carbohydrate: a slice of bread, 1/3 cup of cooked pasta or rice, 1/2 cup corn, 1 cup milk, 1 small fresh fruit, 1 tbsp. sugar or honey, 2 Oreo cookies, or a handful of pretzels or potato chips.  Time to drag out those measuring cups and spoons again!  These portions are based on the “Exchange Lists for Meal Planning” developed by the American Diabetes Association and American Dietetic Association. (For a more detailed list, visit www.diabetes.org or www.eatright.org.) 

Contrary to popular belief, the same rules apply to whole grain carbohydrates: 1/3 cup of brown rice has the same amount of carbohydrate as 1/3 cup white rice.   The presence of fiber makes the brown rice a better choice for your blood sugar, as it digests more slowly than the refined rice, but you still have to limit portions.  It is smart to avoid refined “white” starches as much as possible, but choosing 100% whole grains is not a license to overeat them.  Refer to the chapter entitled “Popular Nutrition Myths” to gain more insight into the media and marketing hype surrounding whole grains.

It is important to realize that you don’t have to limit yourself to only one serving of carbohydrate every time you eat. That would be a very difficult plan to follow for a lifetime.  The goal is to budget your carbohydrates and stay within a reasonable range to allow you to control your blood sugars as well as your weight.  In my experience, most women manage their blood sugars by limiting themselves to 2-3 servings of carbohydrate per meal, or 30-45 grams, and 1 serving of carbohydrate per snack, or 15-20 gramsMost men do well by limiting their carbohydrate intake to 3-4 servings of carbohydrate per meal, or 45-60 grams, and 1-2 servings per snack, or 15-30 gramsHealthy snacks are encouraged if you go longer than 3-4 hours between meals, to help curb appetite and keep blood sugar levels steady. 

For processed food items, counting carbs is a breeze by locating the ”Total Carbohydrate” information available on the label.  Just be sure you verify the serving size at the top to make sure you recognize the serving size for which the information applies. If you don’t have a food label available, there are many handy resource books that provide carbohydrate information.  If you need a review on label reading, refer to the chapter entitled “Making Sense of Food Labels”.   I don’t think I could completely give up Oreo cookies if I had diabetes—I would want the option to have a couple cookies at least every once in a while.  Looking at the label, I see that 2 Oreo cookies have 15 grams of carbohydrate.  That is equal to one serving.  Therefore, I could incorporate two cookies in as a snack between meals or make them part of a meal by limiting the other sources of carbohydrate eaten at the same time.  It’s all about strategy.  You don’t have to completely give up desserts, just be careful to limit the portion size to keep your blood sugar from going haywire.  You would need a minimum of 4 people sharing some of those restaurant-sized desserts!

I urge you to measure your typical portions of starchy and sugary foods in order to get a sense of how much carbohydrate you usually eat.  Then you can make a plan to cut back accordingly.  For example, let’s say you typically serve yourself 2 cups of cooked pasta, which is equal to 90 grams of carbohydrate (1/3 cup pasta contains 15 grams of carb).  Your blood sugar, as well as your hips and thighs, will suffer from this big old mound of pasta.  If a slice or two of garlic bread will accompany this meal as well, you are looking at 105-120 grams total carb.  Yowzah! And this is not even counting the carbohydrate in the pasta sauce… My suggestion?  Cut your portion of pasta in half, eliminate the bread entirely, and add a large salad instead.  Concerned you will starve to death?  As you have heard me say time and again, this is highly unlikely, as you will be eating again tomorrow.  The salad will help your belly fill up without harming your blood sugar. Yes, this will likely involve a dramatic change in behavior for most people, but your body will thank you for the effort. 

If measuring portions is simply not in your DNA, I encourage you to at least try rearranging your plate. The typical American meal would include a half plate full of meat, half plate of starch, and then a teeny tiny portion of vegetable, if any.  A healthier distribution would consist of a half plate full of non-starchy vegetables, with the remaining half divided among lean meat and starch.  Starchy vegetables, such as potatoes, corn, and peas count as starch here…sorry.  For the “meat and potato” men out there, you have a choice: eat only a half plate of food or start loading it with veggies.  I suggest the latter.  The goal is to limit calories, carbohydrate, and fat, while still eating a full plate of food. 

Get started by paying attention to the amount of carbohydrate you eat throughout the day.  When you recognize the types of foods you tend to overeat, set a plan to cut these portions back.  You don’t need to change everything immediately.  Begin the process by becoming more aware of your personal food choices and typical portion sizes.  Keeping a food diary may prove helpful by reminding you to measure portions and help recognize areas for change. 

Any further questions regarding diabetes management, don’t hesistate to ask!

Sample Meal Plan for Men with Diabetes

In Diabetes on March 12, 2011 at 12:54 PM

This posting is the fourth installment in a series on diabetes prevention/ management.  Please refer to the introductory articles entitled “Delaying or Preventing Type 2 Diabetes” and “Meal Planning for Controlling Blood Sugar” to gain an understanding of the logistics behind the meal plan presented here.   This sample meal plan is also appropriate for a man trying to lose weight and lower his risk of developing type 2 diabetes. 

Below is an example of a 2000 calorie, carbohydrate-controlled meal plan that can help the “average” man get started with modest weight loss and managing blood sugars.  Each of the three meals is designed to contain between 400-500 calories, with 3-4 servings worth of carbohydrate, or 45-60 grams.  Each snack has between 150-200 calories, with 1-2 servings of carbohydrate, or 15-30 grams.  Eating every 3-4 hours is a highly effective way to limit portion sizes of carbohydrate-containing foods, while managing appetite at the same time.  You don’t need to eat 6 times a day to succeed with weight and blood sugar control.  The example provided assumes a person wakes early and has about 5-6 hours between meals (i.e.  7 AM, 12 PM, and 6 PM), thereby necessitating small snacks between the main meals.

Breakfast       (before 9AM is ideal)                         

2 slices 100% whole wheat bread or English muffin

1-2 Tbsp. natural peanut butter or 1-2 eggs/egg substitute  

 1 cup skim milk or 1 cup of fresh fruit

 OR

1 cup plain cooked oatmeal  (can use noncaloric sweeteners as desired)

1/2 banana or 1/2 cup berries

2 Tbsp. chopped nuts  

 Morning Snack                                           

 whole grain granola bar

OR

small fruit

piece of “light” string cheese

Lunch                                                            

2 slices 100% whole wheat bread or 12″ whole grain tortilla/lavash

3-4 ounces of turkey, chicken, or tuna with 2 Tbsp. lite mayo

1-2 cups raw green, yellow, and orange vegetables

small piece of fruit

OR   (if eating on the run)

6″ Subway sandwich with turkey, chicken or ham

small bag of baked potato chips

Afternoon Snack                                        

small handful of unsalted nuts

OR

1/2 cup trail mix

Dinner                                                          

4-6 ounces chicken, fish, lean beef or pork

1 cup brown rice, potato, or whole wheat pasta

2-3 cups non-starchy vegetables or green salad

1 Tbsp. light tub margarine or 2 Tbsp. light dressing

 OR                                                                                                                                                                 

1 1/2 cups casserole or combination meal (such as stew or lasagna)

2-3 cups non-starchy vegetables or green salad

Evening Snack w/protein                        

 small fruit 

 3/4 cup low fat cottage cheese

OR

6 100% whole wheat crackers (such as Triscuits)

1-2 slice of low fat cheese or 1-2 Tbsp. natural peanut butter

If you have any further questions regarding diabetes management, don’t hesitate to ask!

Sample Meal Plan for Women with Diabetes

In Diabetes on March 12, 2011 at 12:39 PM

This posting is the third installment in a series on diabetes prevention/ management.  Please refer to the introductory articles entitled “Delaying or Preventing Type 2 Diabetes” and “Meal Planning for Controlling Blood Sugar” to gain an understanding of the logistics behind the meal plan presented here.   This sample meal plan is also appropriate to follow if you are trying to lose weight and lower your risk for developing diabetes. 

Below is an example of a 1500 calorie, carbohydrate-controlled meal plan that can help the “average” woman get started with modest weight loss and managing blood sugars.  Each of the three meals is designed to contain between 300-400 calories, with 2-3 servings worth of carbohydrate, or 30-45 grams.  Each snack has between 100-150 calories, with 1 serving of carbohydrate, or 15-20 grams.  Eating every 3-4 hours is a highly effective way to limit portion sizes of carbohydrate-containing foods, while managing appetite at the same time.  You don’t need to eat 6 times a day to succeed with weight and blood sugar control.  The example provided assumes a person wakes early and has about 5-6 hours between meals (i.e.  7 AM, 12 PM, and 6 PM), thereby necessitating small snacks between the main meals.

Breakfast       (before 9AM is ideal)                         

 1-2 slices 100% whole wheat bread or English muffin

 1 Tbsp. natural peanut butter or 1 egg  

 1 cup skim milk or 1 cup of fresh fruit

 OR

1 cup plain cooked oatmeal  (can use noncaloric sweeteners as desired)

1/2 banana or 1/2 cup berries

2 Tbsp. chopped nuts  

 Morning Snack                                           

 6 oz. plain or “light” yogurt

OR

small fruit

piece of “light” string cheese

Lunch                                                            

1-2 slices 100% whole wheat bread or 6″ whole grain tortilla/lavash

2-3 ounces of turkey, chicken, or tuna

1-2 cups raw green, yellow, and orange vegetables

small piece of fruit

OR

 1 cup bean soup

3 (or more) cups salad greens with 2-3 oz. grilled chicken

2 Tbsp. oil-based “light” dressing

4 whole grain crisp breads (crackers)

Afternoon Snack                                        

1/4 cup unsalted nuts

OR

“100 calorie” snack pack (if desiring a junk food…)

Dinner                                                          

2-3 ounces chicken, fish, lean beef or pork

2/3 cup brown rice, potato, or whole wheat pasta

1-2 cups non-starchy vegetables or green salad

1 Tbsp. light tub margarine or 2 Tbsp. light dressing

 OR                                                                                                                                                                 

1 cup casserole or combination meal (such as stew or lasagna)

1-2 cups non-starchy vegetables or green salad

Evening Snack w/protein                        

 small fruit 

 1/4 cup low fat cottage cheese

OR

5 100% whole wheat crackers (such as Triscuits)

slice of low fat cheese or 1 Tbsp. natural peanut butter

An example for men, containing 2000 calories, will be outlined in the next entry.

Meal Planning for Controlling Blood Sugar

In Diabetes on March 11, 2011 at 11:00 AM

If you have concerns about controlling your blood sugar either now or in the future, hopefully you have read my previous article outlining the lifestyle modifications recommended for preventing, delaying, or managing type 2 diabetes.  As promised, I will now share the basics of meal planning with you, to help get you on your “weigh” towards controlling blood sugar through reduced carbohydrate intake.

If you recall from the previous article, carbohydrate-containing foods, in the form of sugars and starch, are responsible for raising your blood sugar after a meal.  Therefore, in order to prevent a dramatic rise in blood sugar, it is imperative that you limit the amount of carbohydrate you eat at one time.  Spreading your “carbs” out throughout the day, in small, evenly-spaced doses, is the best way to keep your blood sugar more steady over time.  Eating too much at one meal or snack can cause an undesirable chain of events:  1.  a significant rise in blood sugar  2.  the pancreas is forced to pump out substantial amounts of insulin to cover the surge  3.  the flush of insulin may result in a subsequent blood sugar crash  4.  the drop in blood sugar induces “carb cravings”  5.  back to the candy bowl, cookie jar, or potato chip bag you go… 

The above-mentioned scenario is most certainly not a good cycle for someone at risk for diabetes, and is potentially dangerous for someone who has already been diagnosed with diabetes.  If your pancreas cannot keep up with the demand, then your blood sugar stays elevated for an extended period of time after meals.  These extended periods of time during which your blood sugar remains elevated is when most of the damage occurs to blood vessels throughout the body.  Damage from long-term blood sugar exposure results in the unfortunate diabetic complications of blindness, kidney failure, foot problems, nerve problems, and heart attacks/strokes.  My goal as a diabetes educator is to help people PREVENT these complications.   Eating less carbohydrate prevents dramatic surges in blood sugar, thereby reducing the body’s exposure to high levels of sugar, pure and simple.  You can do it too by following the guidelines below.

I teach my clients a skill known as “carbohydrate counting”, which allows them to plan the amount of carbohydrate to eat throughout the day.  This is a meal planning tool intended to help them understand how their food choices affect their blood sugar level.  This is not a specific “diet”, per se.  Even if you don’t have diabetes, limiting your carbohydrate intake can be a helpful tool for general weight management too.

To review, foods containing carbohydrate include grains, breads, cereals, dried beans, starchy vegetables, milk, yogurt, fruit, juices, sweets, and desserts.  For carbohydrate counting purposes, a “serving” worth of carbohydrate is equivalent to 15 grams.  Therefore, serving sizes are based on however much of a food it takes to equal 15 grams of carbohydrate.  Here are some examples of single servings (15 grams) worth of carbohydrate:

1 oz. of bread (typically one slice)

1/4 of a large bagel

6 inch tortilla 

1/2 of a 6-inch pita bread

1/3 cup of cooked pasta or rice

3/4 cup unsweetened dry cereal

1/2 cup cooked cereal, such as oatmeal

3 cups of popcorn

small potato or 1/2 cup mashed/hashed potato 

1/2 cup corn, peas, lima beans

1 cup acorn or butternut squash

1 cup milk

6 oz. plain yogurt or “light” yogurt (with artificial sweeteners)

1 small fresh fruit (like those “kid size” apples advertised these days)

1 cup cubed mixed fresh fruit (including melon, berries, grapes, cherries, etc.)

1/2 cup canned fruit (without juice or heavy syrup)

1/2 cup fruit juice

2 tbsp. raisins (or dried cherries, blueberries, cranberries)

1/4 cup larger dried fruit (such as apricots, prunes)

1 tbsp. sugar or honey

3/4 oz. starchy snack food (typically a handful) such as pretzels or chips

To precisely count your carbohydrates, you MUST measure your portions!

If you look at the food label on processed food items, “total carbohydrate”  is always listed on the label.  To count the carbohydrate, make sure you first look at the serving size listed at the top of the Nutrition Facts panel, so that you know what serving size to which the information applies.  (you can refer to a previous posting on reading food labels from my January 2010 archives should you need a review)   For example, let’s say you want to eat a packet of maple & brown sugar oatmeal for breakfast.  You look at the label and see the serving size is “1 packet”.  (never assume serving size, ALWAYS double check before you interpret the numbers)  When you scroll down the label to “total carb”, you see it is equal to 33 grams.  Underneath the total carb you will  find fiber and sugar listed as well .  These two values are included in the total carb.  The sugars listed do not differentiate between natural or added sugars.  The good news is that fiber can be subtracted away from the total carb, as fiber is not digested and converted to glucose.  You notice this oatmeal has 2 grams of fiber.  Therefore, you can subtract 2 grams away from the 33 grams to get a net carbohydrate of 31 grams.  Since 15 grams worth of carb is equal to one serving, you are essentially getting 2 servings worth of carbohydrate from one packet of this oatmeal. 

You are probably thinking right now…”Are you kidding me? I can only eat a 1/2 packet of this oatmeal since that is equal to one 15 gram serving?”  Or, “I only get to eat one slice of bread when I have a sandwich?”  The answer to these questions is a resounding “NO!!!”  You don’t have to limit yourself to only one serving of carbohydrate every time you eat.  That would be a very difficult plan to follow for a lifetime.  The goal is to “budget” your carbohydrates and stay within a reasonable range to allow you to control your blood sugars as well as your weight.

Most women will control their blood sugar with a limit of 2-3 servings of carbohydrate per meal (30-45 grams) and 1 serving of carbohydrate per snack (15-20 grams).  Most men will control blood sugar with a limit of 3-4 servings of carbohydrate per meal (45-60 grams) and 1-2 servings per snack (15-30 grams).  Healthy snacks are encouraged if you go longer than 3-4 hours between meals, to help curb appetite and keep blood sugar levels steady.  Using these guidelines, every time you sit down for a meal,  measure your portions of carbohydrate foods and compare your portion to the serving on the food label to calculate the amount of carbohydrate you have on your plate.  (or you can use the many available resource books that provide you with carbohydrate counts if you don’t have a food label available)  If you served yourself 2 cups of cooked pasta, that is equal to 90 grams of carbohydrate (1/3 cup pasta is 15 grams of carb) .  Obviously, this indicates your blood sugar is in for a wild ride if you end up eating this much.  Cut your portion back so that you do not exceed 45-60 grams for the entire meal.  If a slice of garlic toast is included with this pasta, you are heading for trouble.  Eliminate the bread, cut back on pasta, and add a large salad to help fill you up instead.  Yes, this does involve a dramatic change in portion sizes for many people, but your long-term health is well worth the sacrifice!

To help ease this transition, it is often helpful to build your plate in the following manner:

1/4 of your plate for starchy foods, such a potato, rice, pasta, corn

1/4 of your plate for unbreaded, lean meat (breading will contribute to your carb count)

1/2 of your plate loaded with non-starchy vegetables such as broccoli, cauliflower, asparagus, green beans, etc.

You still end up with a full plate of food, just the proportions are different.  Add a green salad on the side, and you end up filling your belly more, without adding additional carbohydrate (as long as you don’t have any carb sources in your salad from dressing, croutons, etc…)  The typical American diet would include a half plate of meat, half plate of starch, and then a teeny tiny portion of vegetable, if any.

Get started today by paying attention to the amount of carbohydrate you eat throughout the day.  When you recognize the types of foods you tend to overeat, set a plan to cut these portions back.  You don’t need to start eating “perfectly” by tomorrow.  Begin the process by becoming more aware of your personal food choices and typical portion sizes.  Keeping a food diary may prove helpful by reminding you to measure portions and help recognize areas for change.  My next blog entry will include a sample calorie and carbohydrate controlled meal plan to help you on your way!

Cheers!

Preventing or Delaying Type 2 Diabetes

In Diabetes on March 9, 2011 at 4:06 PM

Since starting this blog for my family and friends 14 months ago,  I have been asked a wide variety of nutritional and health management questions:   ranging from the most common health-related issues of weight control and cholesterol management, to more specialty niche areas, such as athletic performance and the gluten-free diet.  With over one million people ages 20 years and older being diagnosed with type 2 diabetes every year, I knew it was just a matter of time before I was asked to blog about the prevention and management of this very prevalent disease.  As a certified diabetes educator, I have been serving a growing population of clients recently diagnosed with diabetes over the past 5-10 years.  The good news is that type 2 diabetes (formerly referred to as “adult onset diabetes”) can be prevented, or at least well managed, with healthy eating and lifestyle practices.  If you have a family history of type 2 diabetes, have had gestational diabetes during one or more pregnancies, or have been informed by your doctor that you have “metabolic syndrome”, you are at significantly increased risk of developing type 2 diabetes in the future.   If you already have pre-diabetes (formerly referred to as “borderline diabetes”), as indicated by a fasting blood sugar level of 100-125 mg/dL, you can reverse the progression to full-blown diabetes by losing weight, changing your eating habits, and exercising regularly.

It is always easiest to follow specific lifestyle recommendations when you have a clear understanding of why you need to adopt them.  So, the science geek inside me is going to come out for a bit and explain what goes wrong in the body prior to the development of diabetes… put your thinking caps on!

Type 2 diabetes occurs when the body fails to regulate sugar levels in the blood.  Insulin is a hormone produced by the pancreas that helps remove excess blood sugar from the bloodstream by transferring it into body cells.  A condition known as “insulin resistance” usually exists for many years prior to the diagnosis of type 2 diabetes.   During this insulin resistance phase, the body cells are not as receptive to the action of insulin, so the pancreas is forced to crank out ever-increasing amounts of insulin in order to successfully transfer sugar out of the bloodstream.   (here’s a simplified visual:  insulin is knocking on the door, with sugar molecules in hand, but the body cells refuse to open the door, so the pancreas feels compelled to send a large “army” of insulin to pound it down!)   While insulin resistance can be hereditary, it is most certainly caused by being overweight and leading a sedentary lifestyle.   Therefore, it is critical to adopt lifestyle behaviors that help your body become more “insulin sensitive” and prevent the further deterioration of the body’s ability to produce insulin and regulate blood sugar levels.  When you are insulin sensitive, your pancreas doesn’t need to work so hard to put the sugar away.  This is a good thing.  You don’t want your pancreas to wear out any faster than necessary… that’s when you need to start taking external sources of insulin.  The primary goals of all diet and exercise recommendations for someone newly diagnosed with type 2 diabetes is to not only control blood sugar levels, but also to preserve the pancreas’ ability to produce insulin.

Changing your diet, exercise, and lifestyle habits can go a long way towards fighting metabolic syndrome, pre-diabetes, and decreasing your chance of developing type 2 diabetes in the future:

1.  Eat smaller, more frequent meals.   No meal skipping.  Skipping meals leads to increased risk of overeating later in the day.  Large meals lead to greater increases in blood sugar, thereby requiring the pancreas to produce larger amounts of insulin.  This puts undue stress on your pancreas, making it more likely to wear out one day.

2.  Limit your intake of carbohydrate-containing foods.  Foods that contain carbohydrate include grains, such as pasta, rice, bread, cereal; starchy vegetables, such as potato, corn, peas, and lima beans; dried beans, such as kidney, black, pinto, and lentils; fruits; milk and yogurt; sugary beverages, such as fruit juice, lemonade, and soda; sweets and desserts.  All carbohydrates, whether in the form of sugar or starch, turn into glucose through the digestive process.  Glucose is the form of sugar that travels in your blood stream.  The more carbs you eat at one time, the higher your blood glucose levels will go.  Sugars and refined (white) grains raise your blood sugar the fastest and should be avoided as much as possible.  100% whole grains digest more slowly, allowing your body to process the sugar at a more reasonable pace, but the total portion sizes still need to be limited.  Ideally, you should limit portions of potato, rice, and pasta to a small-fist size (approximately 1 cup), which would not fill up more than 1/4 of a 9-inch plate.  Gone are the days of piling your plate full of pasta or a bed of rice…  There is no need to avoid carbohydrates all together, just be mindful of portions and set limits.

3.  Non-starchy vegetables contain small amounts of carbohydrate but will generally not affect your blood sugar.  Feel free to load your plate full of salad and other leafy greens, broccoli, cauliflower, asparagus, green beans, bell peppers, zucchini, etc.  This allows you to fill your belly with minimal calories and minimal carbohydrate.

4.  Maintain a healthy weight.  Even if you are significantly overweight, losing just 5-10% of your current body weight can help you become more insulin sensitive.  (i.e.  10-20 pounds for a 200 pound person)

5.  Exercise regularly, using a combination of cardiovascular and muscle-strengthening exercises.  Physical activity moves sugar out of your blood stream and transfers it to the exercising muscles, which burn sugar for energy.  The more muscles you move, and the longer you move them, the more your blood sugar is lowered to a healthy level.  This lowering effect on your blood sugar can last up to 24 hours, so daily exercise is best for lowering blood sugar naturally.  (Exercise essentially acts like a shot of insulin!)  Well-worked muscles are very metabolically active and help increase insulin sensitivity too. 

6.  Adopt daily stress management techniques such as exercise, yoga, meditation, and/or getting enough sleep.  Circulating stress hormones, such as cortisol and adrenaline, increase blood sugar levels and make the pancreas work harder to produce the insulin required to cover these blood sugar surges.  The relaxation response from stress-busting activities helps blood sugar levels return to normal naturally.  A very compelling reason to get to bed earlier tonight…

By applying these changes to your diet and exercise habits, you will be significantly decreasing your chances of developng type 2 diabetes, or well on your way to managing any current blood sugar issues.   Should you have any additional questions, don’t hesitate to ask.  I plan to follow up this entry with some easy meal planning ideas to help get you on your way, so stay tuned!

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