Test your food knowledge!

Screen Shot 2015-02-08 at 1.29.29 PMStill more to learn about healthy food choices

Working at home, I try not to miss Oprah when Dr. Oz makes an appearance, usually it’s a Tuesday and usually I’m procrastinating. Last week Dr. Oz and David Zinczenko, editor-in-chief of Men’s Health magazine were helping overweight teens better understand calories, fat, how much one needs to eat, serving size, etc. Safe to say, it was a good lesson for us grown-ups too. 

Mid-way thru the program the doctors gave Oprah and the audience a quiz comparing two foods/meals, many of which are in Zinczenko’s new book,Eat This Not That For Kids. Which of the two meals/foods below they asked are healthier based on calorie, fat and sugar content. Guess what? Most of the audience, including moi, failed miserably. 

1. Turkey bacon or regular bacon? Answer: Regular bacon. Both turkey bacon and regular have the same amount of calories and fat, but turkey bacon has a ton more sodium. Why? To make it taste like regular bacon!

2. A multi-grain bagel with low fat cream cheese or a glazed donut? Answer: Glazed donut. The multi-grain bagel and cream cheese have 500 calories compared to the donut’s 180 calories. And don’t be fooled — the multi-grain bagel is refined carbohydrate. Just because it’s got a variety of grains doesn’t mean they’re whole grains, and when it comes to bagels, they’re not.

3. Bacon and eggs or French Toast sticks? Answer: Bacon and eggs. It’s got 250 calories compared to the toast sticks 400 calories! 

Enough to say, even when you think you’re pretty smart about eating healthy, you can still be fooled. Zinczenko’s book has many more of these shocking food comparisons and I think it’s just as apt we adults learn this as kids. 

One of the few questions I actually answered correctly is don’t skip breakfast! Most people who do consume 450 more calories/day.

Grappling with food on the road and a sunny Christmas in Sydney

opera house

I can’t complain about a vacation that’s taking me from Queenstown, New Zealand, to Sydney, where we are now, to Singapore, Tokyo and San Francisco before I arrive home. Yet one thing that’s tough, beside the jet lag and time zone changes and more frequent blood sugar testing, is eating almost all your meals at restaurants where you can’t control your food, let alone half the time knowing what it is–well that will come in Singapore. 

Then real life comes flying in to the idyllic lull. Just today a friend back home sent me this article from theNew York Times about how low GI foods (non-starchy, non-sweet foods that raise blood sugar less and more slowly) are better for diabetics than the highly touted whole grain diet. In other words, your blood sugar will rise less and more gradually if you trade in your whole grain bread for nuts, beans and certain high-fiber crackers. 

I’ve known this for quite some time having tested my blood sugar about a zillion times to see my reaction to different foods. So, for me, every day (when I’m not traveling around the world) begins with slow-cooking steel cut oatmeal, to which I add ground flax seeds, cinnamon, low fat yogurt and peanut butter. If I eat bread or ordinary cereal my blood sugar goes off the charts. 

Luckily here in Sydney we’re staying with friends so I’ve stocked the larder with my healthy foods and gotten the expected grimace when I offer to share my yogurt and peanut butter combo. I still don’t know why Danon hasn’t produced such a flavor but no one seems to share my enthusiasm for it. So yesterday my day began with my usual oatmeal and then I had a salad with toasted almonds some raw broccoli, a few slices of ham and a spoonful of hummous for lunch and most nights here it’s fish and greens, since my friends are healthy eaters too, and there’s nothing Bruce can’t sear on the Barbie and make delicious. Of course, Singapore and Tokyo will prove to be problematic again because most dishes are rice-based. And so I will need to stick to grilled meats, miso soup and sashimi. God knows when I first lived in Tokyo 20 years ago the rice was always my menace.

But, back to Sydney. Soon we’re off to the ferry for a 15 minute ride over to the city to buy some Christmas gifts. Still having a little trouble reconciling Christmas carols with bright sunshine and 80 F temps. Guess I’ll just have to force myself to get used to it. 

 

Test your carbohydrate knowledge

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Since it’s Columbus Day and Columbus was in search of spices (or so I think I remember) it seems fitting to have a little food quiz today. 

Whether you use the Exchange System or Carbohydrate Counting to measure your meds against your carb intake, here’s a little quiz by virtue of Accu Check and their cute, bite-size refrigerator magnets to see if you know your carbs.

Before you look at the answers posted on the graphics to the right (and if you already did come back tomorrow and try this again. If you’re my age you won’t remember what you just saw), ask yourself how many exchanges or carbs you think are in the foods below:

1. 1 small apple

2. 1 large baked potato

3. 1/2 cup cooked broccoli, same as 1 cup raw

4. 1 cheeseburger with bun

5. 1 cup of French Fries

Since I still have 15 more magnets, I imagine we may go through this exercise again in the near future with different foods.

By the way, I got these magnets at the American Association of Diabetes Educators conference this summer, so I can’t tell you whether they’re available anywhere. But I imagine if you’d like a set, it couldn’t hurt to contact Accu-Chek and find out.

4 sides of my diabetes teepee

I walked out of my weekly grocery shop the other day looking at my cash receipt and it struck me: this is why at 55 years old (yes, you know that now) and 36 years living with diabetes, I’m in the shape I am. This list is how I eat, and it’s one of the sides that forms my diabetes Teepee: half my diet is vegetables, then whole grains, fruits, fish, low-fat dairy, nuts, dark chocolate and red wine. Yes, there’s a cup or two of coffee a day and the odd treats, but my basic diet never wavers and hasn’t for nearly the last decade. And, I’ve learned to love it. There is no sense of sacrifice here.

My daily hour walk constitutes the second side upon which my diabetes house leans and the third is being responsible with my medication: testing, calculating and correcting. At times a pain in the royal butt, ’tis true, but I prefer to know where I am most of the time to keep myself on course. 

The fourth side of my teepee is more like a small deck–and that’s managing my mind. When it all gets too much, when I can’t bear the little red dots all over my abdomen, when I resent I have them because I’ve taken so many injections for so many years, when I’m merely walking to meet a friend or from the subway and I’m going low–before my thoughts scramble completely–I think, “Why do I have to live like this???” And then I just accept that I do, and that I can handle this.

I can’t say it’s ever fun, I can’t say there aren’t times I don’t throw a pity-party (usually I’m the only guest) because I work like a dog maintaining my health on top of the work the rest of my life takes. But I can say at 55 almost everyone I know has something: cancer, parkinsons, obesity, aphasia, and I wouldn’t trade “mine” for “theirs.” Over the years, diabetes has helped me become even healthier than I would have been without it–and not many people with an illness can say that. Look, it’s written all over my grocery receipt.

Want to lose weight and get healthy? Nutrient-dense foods.

Are you ready to Eat to Live?

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Maybe he’s just another hawker wanting to sell books or sit next to Oprah, or maybe he’s got it right. Joel Furhman is a doctor and up and coming weight loss healthy eating guru. I’m now reading one of his earlier books, Eat to Live, from 2003 and here’s his proposition in a nutshell: Make the overwhelming bulk of your diet nutrient-dense foods and you’ll avoid disease, particularly heart disease and cancer, your diabetes’ symptoms may go away if you’re type 2, your blood pressure and cholesterol will lower and you’ll lose weight and maintain a “normal” body weight. Furhman says most of our weight, ills and diseases come from our (profit-making-big-business) unhealthy American diet which is high in fat, refined carbohydrates and calories and low in nutrient-dense foods, leaving us hungry, unsatisfied, fat and unhealthy.

Further, our most recent mania to control portions is like putting a band-aid on a levy that’s bursting; limiting our portions of non-nutritive food may cut some calories but it still leaves us nutritionally deficient with over stimulated appetites. He says if you have type 2 diabetes you can eradicate insulin resistance using his eating plan, if you have type 1 you can dramatically lower your insulin requirement. And I believe him. It seems common sense to me that the over-processed, packaged, chemically-formulated and steroid-pumped, refined junk we eat causes weight gain and disease.

Furhman just hates the food pyramid the U.S. Department of Agriculture rolls out each year and proposes one of his own. Drum roll please: our personal food pyramid’s bottom, the foundation of our diet, should be built on vegetables and leafy greens, then fruit, beans and legumes, whole grains, with the top of the house giving us a trickle of non-fat diary, animal protein and healthy fats derived from foods like nuts and avocado. If you think you’ve heard this a million times, his USP (unique selling proposition) is he rates foods according to their nutrient density. Something by the way is going to soon make an appearance in supermarkets. But what I found compelling was Furhman’s forceful argument, continue to eat unhealthy foods and your sickening yourself every day, want to truly “fortify” yourself against disease? Do it with food, not drugs. Highlights from his book:

1. Olive oil is not the miracle drug we all thought, 97% of its fat will go straight to your hips so use it limitedly.

2. Leafy greens like salad greens and green vegetables are 1/2 protein, 1/4 carbs and 1/4 fat. Who knew? You don’t need to eat a side of beef to get enough protein if you’re eating lots of veggies.

3. If you’re eating a diet rich in fresh fruits and veggies you’re getting enough water. 8 glasses a day, fugedabout it, 3 is plenty!

4. Furhman agrees, don’t be fooled be foods that say “fortefied.” A spray of folic acid won’t do it.

5. Animal protein whether white, as in chicken or red, as in beef is equally disease causing. Fish is better but even fish should only be eaten 2xweek and mercury-free.

6. Don’t worry about getting the right mix of veggies and beans etc. on your plate to get your protein covered, eat this healthy way and you will.

Mind you, always, any significant change in your eating plan may create a change in your blood sugars, which means a change in your medication–and I guarantee you if you follow this plan you will definitely need less medicine, whether you’re on orals or insulin. So, be alert and discuss this with your health care provider. If you have a condition like kidney disease you may not be able to eat enough veggies, fruits, nuts and legumes for this to work for you, so please don’t undertake this without consulting with a professional. Also if you have vitamin or mineral deficiencies talk with a professional before making any dietary changes.

You might call this a super-charged slightly left of center vegetarian eating plan, but many vegetarians rely on refined carbs and saturated fats like pasta, crackers, pretzels and cheese, which are not nutrient-dense, whereas this plan is mostly vegetables, fruits and beans. Whole grains, healthy fats and animal protein are parceled out according to your weight loss goals.

Of course, restaurants and social outings are harder to maneuver than home cooking, so he proposes using outings as a time when you indulge a little. If you’re living in this century, time is the other nasty. Who has much time to shop and prepare vegetarian meals? Furhman offers recipes, but darn, somebody’s got to make them. I mostly do the simplest thing: steam an assortment of fresh veggies every night for dinner, lunch is a spinach salad with beans, left over veggies from the night before and a little feta cheese. Breakfast is steel cut oats.

If you want to really get healthier and drop some pounds read the book, try the diet and see what you think. Wouldn’t it be remarkable to shed those 20 pounds forever, really feel full and satisfied, and watch your health transform, including your energy and outlook?

End note: I will be away this week at the American Association of Diabetes Educators annual conference in Washington D.C. I am not an educator or any other type of medical professional, merely a lay person interested in knowing what educators are learning, talking about, being taught, where their struggles are with patients, what they see for the future and will let you know.

Why insulin can contribute to making you fat

UnknownA good rag for news & reflection

I write a monthly column for DiabetesHealth Magazine. It’s my personal opinions and experiences about living with diabetes. Of course Scott King, the publisher, likes to say it’s my, “rants and raves.” My articles also appear on their regular web site blasts. 

Yesterday their web blast featured an extremely understandable and easy reading article about the carb/fat debate, The “Fat-Free Fallacy:” Is It Obesity’s Great Enabler? 

I could condense the article here, but it’s better you read the whole thing. Don’t let the length of the article scare you, it reads fast. 

I will give you, however, my 3-bullet take away: 1) Glucose not used by the body is turned into fat by insulin, so unused carbs make you fatter than fat 2) Never skip your insulin, instead lower your carb intake. And, since you have to have three things in a list 3) The food pyramid will likely make you fatter since carbs form its foundation. 

You can take all this with a grain of salt, but I’d say pay more attention to the results you’re getting from your diet and then draw your own conclusions.

ADA’s new nutrition guidelines

I read this article about two weeks ago in the online newsletter, that I receive weekly, DiabetesInControl. It’s about the ADA’s new guidelines for nutrition. I’ve reprinted it in its entirety for those of you who want to know the entire text. DiabetesInControl is a free newsletter, you can subscribe here, written largely for diabetes medical professionals containing mostly studies and first findings, but has some interesting news for the layman regarding where research is going and what organizations are doing. What I also enjoy is Dr. Richard Bernstein’s monthly live 60 minute tele-conference where he answers patient’s questions.

What I found particularly interesting about the ADA’s new guidelines is they’re beginning to get on the bandwagon with almost everyone else noting that carbohydrates are the food group that need to be controlled regarding raised blood sugar, and they even come pretty close to admitting that they aren’t counseling people to follow stricter guidelines because people probably can’t do it. You’ll get to that part when below John P. Bantle and his ADA colleagues say, “and changes individuals with diabetes are willing and able to make.” 

Of course I think if your blood sugar or triglycerides or cholesterol isn’t where it should be, and you are not one of the people whom the ADA lumps into the above group, then you should probably apply stricter guidelines to yourself than you’ll read here. What I do find encouraging, on the other hand, is their statement that, “nutrition counseling should be tailored to the personal needs of the individual.” Here, I feel they’re looking at the whole person, their particular medical record, support systems and environment. 

Article: The American Diabetes Association (ADA) has updated its guidelines regarding medical nutrition therapy (MNT), including the use of low-carbohydrate diets to prevent diabetes, manage existing diabetes, and prevent or slow the rate of development of diabetes complications. The revised position statement, which is published in the January issue of Diabetes Care, updates those from 2002 and 2004, presenting evidence-based data published since 2000 and grading of recommendations according to the level of evidence available, based on the ADA evidence-grading system.

John P. Bantle, and colleagues from the ADA write,  “The goal of these recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions.”  “This requires the use of the best available scientific evidence while taking into account treatment goals, strategies to attain such goals, and changes individuals with diabetes are willing and able to make. Achieving nutrition-related goals requires a coordinated team effort that includes the person with diabetes and involves him or her in the decision-making process.”

In addition to listing major nutritional recommendations and interventions for diabetes, the updated position statement stresses the importance of monitoring metabolic parameters, including glucose and glycated hemoglobin levels, lipids, blood pressure, body weight, and renal function, during therapy. Such monitoring will help evaluate the need for changes in MNT and thereby optimize outcomes. The authors note that many aspects of MNT require additional research.

Some of the specific recommendations include the following:

Individuals with prediabetes or diabetes should receive individualized MNT, preferably administered by a registered dietitian knowledgeable about the components of diabetes MNT (B).

Nutrition counseling should be tailored to the personal needs of the individual with prediabetes or diabetes and his or her willingness and ability to make changes (E).

Modest weight loss in overweight and obese insulin-resistant individuals has been shown to improve insulin resistance and is therefore recommended for all such individuals who have or are at risk for diabetes (A).

In the short-term (up to 1 year), either low-carbohydrate or low-fat, energy-restricted diets may be effective for weight loss (A).

Patients receiving low-carbohydrate diets should undergo monitoring of lipid profiles, renal function, and protein intake (in patients with nephropathy), and have adjustment of hypoglycemic therapy as needed (E).

Physical activity and behavior modification aid in weight loss and are most helpful in maintaining weight loss (B).

When combined with lifestyle modification, weight loss medications may help achieve a 5% to 10% weight loss and may be considered for overweight and obese individuals with type 2 diabetes (B).

For some patients with type 2 diabetes and a body mass index of 35 kg/m2 or more, bariatric surgery can markedly improve glycemia (B).

Primary prevention for individuals at high risk of developing type 2 diabetes should include structured programs targeting lifestyle changes, with dietary strategies of decreasing energy and dietary fat intakes. Goals should include moderate weight loss (7% body weight), regular physical activity (150 minutes/week) (A), dietary fiber intake of 14 g/1000 kcal, and whole grains comprising half of total grain intake (B).

Intake of low-glycemic index foods that are rich in fiber and other vital nutrients should be encouraged (E), both for the general population and for those with diabetes.

Data do not support recommending alcohol consumption to individuals at risk for diabetes (B).

Secondary prevention, or controlling diabetes, should include a healthy dietary pattern emphasizing carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk (B).

A key strategy for achieving glycemic control is to monitor carbohydrate by counting, exchanges, or experienced-based estimation (A). Use of glycemic index and load may be modestly beneficial vs considering only total carbohydrate (B).

Sucrose-containing foods should be limited but can be substituted for other carbohydrates or covered with insulin or other glucose-lowering medications (A). Glucose alcohols and nonnutritive sweeteners are safe within daily US Food and Drug Administration intake levels (A).

Saturated fat should be limited to less than 7% of total energy (A), and trans fat should be minimized (E). In individuals with diabetes, dietary cholesterol should not exceed 200 mg/day (E).

At least 2 servings of fish per week (except for commercially fried fish) are recommended for n-3 polyunsaturated fatty acids (B).

Protein should not be used to treat acute or prevent nighttime hypoglycemia (A). High-protein diets are not recommended for weight loss (E).

If adults with diabetes choose to use alcohol, intake should be restricted to 1 drink per day or less for women and 2 drinks per day or less for men (E) and consumed with food (E).

Practice Pearls

Previous research has suggested that MNT can reduce glycated hemoglobin levels by approximately 1% for patients with type 1 diabetes and 1% to 2% for patients with type 2 diabetes.

The current guidelines do not recommend low-glycemic index or high-protein diets for the routine treatment of patients with diabetes. Moreover, most patients with diabetes should not routinely receive supplements or vitamins.

The ADA has issued practice guidelines for screening, diagnostic, and treatment interventions that are known or believed to improve health outcomes of patients with diabetes. Each recommendation is graded by the ADA as A, B, C, or E to indicate the level of supporting evidence.

Diabetes Care. 2008;31(Suppl 1):S61-S78.

The debate goes on: carbs in or carbs out?

Screen Shot 2015-02-08 at 4.09.19 PMTreat carbs like special treats

A friend, and fellow A1c Champion, saw author, Gary Taubes, talk about his new book Good Calories, Bad Calories, a month ago on Good Morning America and sent this email around, “Taubes says that exercise makes us hungry for carbohydrates, not lean, and that carbohydrates cause insulin secretion which creates fat.”  One of her email recipients, who is a Ph.D and medical specialist, wrote back: ‘There is still a lot that we don’t know but for me eating less and moving more has led to my weight reduction. I could have dieted on birthday cake as long as I did not eat more cake calories than I spent.’

It’s a constant debate in this country: What’s the magic formula for losing weight, fast – and easy. The second battle ground, and especially for us d-people, is are carbs good or bad? To me, the answer to both is simple: eat less, move more and since carbs raise your blood sugar, if you want to lower it eat less carbs. Why is that such a difficult notion? Seems crystal clear to me and trust me I’m no rocket scientist.

Around the same time my friend’s email went around, a wicked debate was playing out on DiabetesHealth’s web site. Hope Warshaw, MMSc, RD, CDE, BC-ADM, and diabetes educator, wrote five articles on carbs, Don’t Want to Go Low Carb or Vegan, that garnered more comments than I’ve ever seen in response to an article, and a rebuttal article by Richard D. Feinman, PhD, Professor of Biochemistry and Director of the Nutrition and Metabolism at State University of New York Downstate Medical Center.

In a big nutshell Feinman said, “I’m astonished that experts encourage people with diabetes to eat carbohydrates and then “cover” them with insulin. Why would anyone, (let alone doctors who advocate it every day), recommend a diet that requires more medication?” Are they all in bed with pharma companies? Sorry, that last question is my own.

“It strikes me as odd that what most experts know about metabolism – diabetes is, after all, a metabolic disease,” said Feinman, “they learned in medical school from somebody like me. The first thing we teach medical students is that there is no biological requirement for carbohydrate. It is true that your brain needs glucose, but glucose can be supplied by the process of gluconeogenesis; that is, glucose can be made from other things, notably protein. This is a normal process: when you wake up in the morning, between thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose. And, all of the metabolic syndrome ills – high triglycerides, low HDL, hypertension and obesity – are improved by low carbohydrate diets. If we had been describing a drug,” Feinman goes on to say, “everybody would have rushed out to buy stock in our pharmaceutical company.”

I can’t comment on the metabolic workings, but being like most diabetics I can share with you what I experienced when I changed my diet several years ago to low carb. I read Dr. Richard Bernstein’s book, Diabetes Solution, and for the first time read someone advocating getting rid of carbs to control blood sugar. Dr. Bernstein advocates next to no carbs in a diabetic diet.

Himself a diabetic for more than 50 years, Bernstein claims he has reversed many of his early complications and gotten his blood sugar under tight control by virtually eliminating carbs. Less carbs means you’ll be taking less insulin and by taking less insulin, Bernstein claims, your insulin will be better absorbed, there’ll be less variability in its time and efficacy and greater predictability with your blood sugars. Let’s just say after I read his book, I was encouraged and inspired to try his “solution,” so I pretty much vacuumed the carbs out of my diet. “Vacuumed” in the sense that I cut way, way back. I essentially eliminated refined carbs: white bread, white potatoes, rice, pasta, sweets, muffins, starchy veggies. The result? My sugars indeed dropped, were consistently lower, my insulin doses dropped, and maybe best of all I was no longer chasing high blood sugars. You know the ones that come from refined carbs where you just can’t seem to knock them down all day. My Lantus dose went from 20 to 12.5 units and my mealtime Humalog was all but cut in half before each meal. The results were so dramatic and made life so much easier, I have not in five years gone back to my old ways. I do have to add the caveat that we’re all different and your body may not respond the same as mine.

It’s common sense, though, that the less carbs you eat the less your blood sugar will rise and the less medication you’ll need. I don’t understand how anyone can argue the logic in that. If we’re still being given diets with substantial carbs in them it’s probably because the American Diabetes Association (ADA) and powers that be think the average diabetic will never stand for, and won’t be able to, cut the carbs. Not unlike why the ADA’s A1c recommendation is as high as 7 – which correlates with 170 on your meter – even though we’re advised to stay in a target range of 80 – 120. Something sound fishy?

For those interested, here’s my routine that keeps my sugars low. My one carb meal is breakfast. I figure it’s healthy, high fiber, it’s satisfying, and since I walk in the morning, the blood sugar rise gets leveled out. Every morning I make a bowl of slow-cooked, steel cut oatmeal. I know many people who make a batch a week and freeze portions, but I like the morning ritual. I actually eat less than a whole serving and make up the difference with a dollop of low fat plain yogurt or cottage cheese and a tablespoon of peanut or almond butter. Also I add flax seed and cinnamon. For this treat, and like Jerry on Seinfeld I could eat breakfast for any meal, I need 3.5 units of Humalog or 3 if I’m taking my hour walk around my local park. Lunch is generally a spinach salad with feta cheese, tomatoes, beans, left over veggies, or a spinach/feta omelet. For that I need .5 – 1 unit, and dinner is typically fish or chicken, vegetables and beans. If I’m having a glass or two of wine with this dinner I don’t need any insulin – alcohol for most people lowers their blood sugar, unless you’re drinking Strawberry Margaritas and Singapore Slings.

A few months ago I interviewed a fellow type 1 who had had an islet cell transplant, two actually. For 18 months afterward she was insulin-free. Unfortunately, as for most islet cell transplant recipients, if not all, her new cells began to fail and she had to add some insulin back to keep her blood sugars in range. She told me, though, she’s on a very small dose — 14 units total daily. My daily dose is about 18 units and none of my beta cells work. Seems argument enough for me that you can keep your insulin, or meds, at a minimum by sweeping most of the carbs out of your diet.

I should tell you in full disclosure my diet is not carb-free – and alas, I am not perfect. When out to dinner I often nibble on the bread and love it dripping with olive oil. Thank God someone decided that’s healthy. I indulge in an order of fried calamari or crab cakes from time to time, and if dessert comes to the table I’ll stick my fork in like everyone else for a taste. But without question, the less carbs I eat the less insulin I need, and for me the control I get and the way I feel is worth it.

If you’re curious about a lower carb diet, give it a try. First hook up a hoover to your pantry and suck out all the chips, pretzels, rice and muffin mixes. Second, while experimenting, test, test, test. Third, see if your blood sugars and meds don’t drop. Fourth, reward yourself with some high cocoa dark chocolate — Lindt’s 85% Excellence chocolate bar has only 8 carbs per serving! Good luck.