Top 5 Bread Product Picks

Here are 5 products I think are great choices in terms of taste, availability, and nutritional value. Numbers 1-4 are all lower carb options to regular bread.  #5 is a good option for those looking for more fiber who don't like the taste/texture of whole wheat bread.

1.  Flatout Wraps
2.  Arnold Select Sandwich Thins
3.  Thomas' Bagel Thins
4.  Joseph's Oat Bran and Whole Wheat Pita Bread
5.  Pepperidge Farm Whole Grain White Bread

Enjoy!

10 Healthy Changes to Make for the New Year

1.  Eat 2-3 servings of fruit each day.
2.  Eat more whole grains.
3.  Schedule in time during the week for relaxing activities.
4.  Take a walk on your lunch break.
5.  Think positively.
6.  Eat a light lunch.
7.  Drink more water.
8.  Eat 2 types of vegetables with dinner.
9.  Call a good friend on the phone.
10. Take the stairs instead of the elevator.

5 Tips to Make Healthy Lifestyle Changes Last

Here are some tips for meeting your healthy New Years resolutions:

Make a list of reasonable and attainable goals
Focus on one goal at a time
Keep food/activity/mood records - try FitDay or MyFitnessPal
Reward yourself for meeting your goals in healthy ways - massage, get your nails done, go hit golf balls
Choose a buddy to help you along the way

Happy New Year!

Top Ten Tips for Healthy Holiday Eating

Question:  I have diabetes.  What can I eat during the holidays?

Answer:  The good news is that even with diabetes, you can partake in holiday meals and treats - you just need to be more aware of portions and which foods affect your blood sugars.

 Here are my best tips for eating healthy during the holidays for both people with diabetes and without:

10.  Never go to an event hungry; eat 3 meals, 3 snacks daily.
9.  Bring a dish that you know is "safe" for you to have - shrimp with cocktail sauce, meat/cheese tray, stuffed mushrooms, fresh veggies, salad, etc.
8.  Mingle; don't hang out around the food table.
7.  Try to plan gatherings that involve activities instead of just eating; maybe get some people to go sliding, skating, or skiing.  Window shopping can also be good exercise during the holidays!
6.  Limit the alcohol.
5.  Stick with more proteins and veggies at meals and appetizers.  Choose where you want to spend your carbs (starches, dessert, fruits, etc.).
4.  Take a walk or help clean up after large meals.
3.  Only eat 1 plateful of food; 1/4 plate protein, 1/4 plate starch, 1/2 plate non-starchy vegetables or salad.
2. Try new lower carb or lower fat versions of your favorite holiday recipes.
1.  Eat some fresh veggies or salad before you go to a party or before your meals.

Have a happy and joyful holiday season!

Prevention of Type 2 Diabetes

Question:  I was recently diagnosed with pre-diabetes.  Could you tell me what questions I should be asking my doctor in order for me to be successful in the prevention of type 2 diabetes?

Answer:  I would ask your doctor if he/she thinks you should be taking any medications to prevent blood sugars and when you should return for another checkup.  Regular exercise, losing weight if you are overweight, and healthy eating can reduce your risk of developing diabetes by up to 58%.  Check to see if your doctor can refer you to a certified diabetes educator and/or registered dietitian for help in making lifestyle changes.

Exercise ideas for fall and winter

Question:  I have prediabetes and have been doing a pretty good job of exercising outdoors during the spring and summer months.  Now that the weather is starting to cool down, I am trying to determine what I can do for physical activity in the colder months.  Suggestions?

Answer:  Glad to see you are looking ahead to the colder months.  Preplanning is always the way to go!

You can still do a lot of walking, jogging, yard work, and biking in the fall - just make sure you dress accordingly! Once the snow and ice come, maybe consider going to a gym or a local park district fitness center where you can exercise indoors.  A local mall is a good place to get some walking in too - go early in the a.m. or later in the evening when there's not as many people shopping.  You can always use indoor exercise equipment at home, too.

Participate in some winter sport activities like skating or skiing.   When it's really cold out get some friends together to shoot hoops, or play indoor racquetball or tennis. Wii video games are also a fun way to fitsome indoor activity in - Wii Fit is specifically designed to give you various forms of exercise.

 It always helps to try to increase your daily activities if you are lacking exercise - park further away at work or when you go shopping and take the stairs instead of the elevator.  Even a few 10-minute increments of activity throughout the day will give you health benefits.

Diabetes and Healthy Tailgating

Question:  My husband has diabetes and this time of year we attend a lot of football games.  Before the game we often will meet up with friends for tailgating parties.  Can you give me some healthy ideas of what we can eat during the tailgate?

Answer:  Here are some ideas for healthier versions of traditional tailgating foods:

Turkey hotdogs or reduced fat beef hotdogs
Chicken or turkey sausages
Turkey burgers or burgers made with ground sirloin - top your burgers with lots of veggies!
Veggie burgers
Healthy Life low carb breads/buns or 100% Whole Wheat Sandwich thins for burgers
Baked chips or pretzels - buy in small individual bags to help with portion control
Fresh salsa or bruschetta for dipping
Veggies (carrots, celery, broccoli, cauliflower, tomatoes, peppers, zucchini, etc.) and lowfat dip
Chili made with beans and ground turkey or sirloin
Air popped or light microwave popcorn
Diet soda, sugar-free flavored waters, flavored seltzer waters

Enjoy the game!

Symtoms of Type 2 Diabetes

Question:  Diabetes runs in my family and I think this puts me at risk.  Could you tell me what are the symptoms of type 2 diabetes?

Answer:  Unfortunately, type 2 diabetes often has no signs or symptoms.  Even if lab work indicates diabetes, a person may not feel any different from usual.  If blood sugars are extremely high over a period of time, a person may start to feel frequent thirst, frequent hunger, lethargy, and may experience more frequent urination. 

If you have a family history, you may be at higher risk for developing type 2 diabetes.  I would recommend regular checkups with your doctor and request that your doctor check your Hemoglobin A1C in addition to a fasting glucose/metabolic panel.  The A1C may be more likely to show postprandial blood sugar spikes which are an earlier sign of the development of type 2 diabetes than an elevated fasting blood sugar. 

Also try to live a healthy lifestyle including regular exercise, healthy food choices and smaller portions, and stress management techniques.  Healthy lifestyle changes may reduce your risk of developing type 2 diabetes by up to 58%.

Diabetes and Baking

Question:  I have type 2 diabetes and love to bake.  When cooking or baking, if I substitute Splenda or Stevia for regular sugar does this make the recipe sugar free?

Answer:  Depending on the recipe the use of Splenda or Stevia may reduce or eliminate the sugar content of a recipe, but there is usually still going to be some carbohydrate in most baked goods.  Some baked goods actually require sugar for a good end product so a sugar/sugar substitute blend may be recommended.  I recommend using recipes from Splenda and Stevia companies to experiment with sugar-free baking.  Most of these recipes will likely contain nutrition information as well. 

Tips to keep junk food out of the house

Question:  I have pre-diabetes and am struggling to eat healthy.  My brother and his family live with me and there are tons of junk food temptations in my kitchen.  I want the entire household to start eating healthy with me, they can all benefit, but they are resistant.  Any suggestions?

Answer:  This is always a tough situation.  No matter what advice I give, it will probably be much easier said than done.  My advise would be to discuss the importance of keeping junk foods out of the house, both for your health and for theirs.  If your brother has young children or teenagers, you can discuss the importance of being a good role model for healthy eating habits for his kids to reduce their risk for prediabetes and type 2 diabetes later on.  Since it is your home, I think you have a right to decide what kind of foods are allowed to enter. 

If this does not go over so well, plan to draw a line and keep a separate area in the cabinets, freezer, and fridge for your foods.  There are lots of healthier treats out there these days that will help to satisfy the cravings for less healthy foods. For ideas, check the http://foodpicker.org/ website.  Fill your area with lots of these healthy treats - I bet you anything they will start raiding your cabinet!

Diabetes and Salt Intake

Question:  If I have diabetes do I have to watch my salt intake?

Answer:  While salt/sodium does not have a direct effect on blood sugars, it can have an effect on blood pressure.  Many people with diabetes also have high blood pressure.  Some people are salt-sensitive meaning that the sodium they consume in their diet will increase their blood pressure.  It is a general recommendation for anyone with diabetes to moderate their intake of sodium.

The American Heart Association recommends a daily sodium intake of no more than 1,500 mg (the amount of sodium in a 6-inch sub sandwich).  I do find that this is very difficult for the average American to try to do.  A more realistic guideline for most people is to keep sodium intake under 2,300 mg per day as recommended by the American Diabetes Association 2010 Standards of Medical Care.

Limit the use of table salt and try to cook more fresh herbs and spices for flavor.   Avoid canned and processed foods as much as possible - fresh foods tend to be much lower in sodium.  Limit fast foods and eating out as many restaurant foods are loaded with salt as a preservative. 

For more information on the benefits of limiting the sodium in your diet, check out the following link:

http://www.nhlbi.nih.gov/hbp/prevent/sodium/sodium.htm

Best Salad Bar Picks

Question:  We have a large salad bar at the work cafeteria that I would like to take advantage of for lunch (especially during the summer).  I'm trying to lose weight and control blood sugar.  Could you give me some tips on what to choose and what to steer clear on at the salad bar?

Answer:  Many of the items on the salad bar are safe and healthy options for people trying to watch their weight and/or control their blood sugars.  Load up on fresh veggies - most of the veggies on the salad bar are going to be low in calories, low in carbs, high in fiber, and full of nutrition and disease-fighting properties.  If they offer darker mixed greens, choose these over iceburg lettuce.

 I usually encourage people eating salads to have some lean protein (chicken, tuna, turkey, or lowfat cottage cheese) along with their salad.  Cheese is also a protein but it's high in calories and saturated fat, so try to keep it limited to 1/4 cup of less if you are going to add it to your salad.

Higher carb items which will affect your blood sugars more include pasta and potato salads, fruit, beans, or dessert items.  One good spoonful (1/2 cup or less) of one of these items along with your veggies and lean protein is probably okay.

Finally, limit the amount of salad dressing that you use.  I encourage people to keep their salad dressing on the side and dip their fork in it before each bite - this makes portion control easier.  Try to choose a lite dressing if possible.  Vinegar tends to be very low in carbs and add great flavor to a salad.  Be cautious with the sweeter dressings like French, Honey Mustard or some of the flavored vinaigrettes which may have up to 15g carb per tablespoon.

Fruit and Pre-Diabetes

Question:  I was diagnosed as having pre-diabetes earlier this year.  Since then I have completely changed my eating habits and become a vegetarian.  I’ve lost weight but want to lose more.  Can you tell me which fruits have a high sugar content?  I am wondering about apples, raisins, bananas, and strawberries.  I already know I need to avoid orange juice. Thanks for your help!

Answer:  Congratulations on making positive changes to your eating habits.  Sugar is one form of carbohydrate.  All carbohydrate breaks down into glucose when digested.  Instead of focusing on sugar content of foods, I encourage my patients to look at total carbohydrate content. 

All fruit is carbohydrate and will have an effect on blood sugars.  The amount of carbohydrate really depends more on portion than the type of fruit.  To give you an idea, a small 4 oz. apple, 1 cup berries, and 1/2 large banana all have  ~15g carb.  Even juice can be included in a healthy meal plan as long as you are careful with the portion.  4 oz. (1/2 cup) of orange juice has ~15g carb.

Be cautious with larger pieces of fruit.  Some apples may weigh close to 16 oz. and contain up to 60g carb. Weigh and measure your fruits if you question the portion and carb content of what you are consuming.

Fruit shrinks when dried.  We tend to consume more of it since it is smaller in size than fresh fruit.  Be cautious with dried fruits, including raisins, as 1/4 cup contains ~30g carb.

Remember, it is still recommended to aim for the recommended 2-3 servings per day of fruits since they provide us with lots of healthy antioxidants and phytochemicals.  Just be more cautious of the portion you are consuming and what other carbs you are consuming at each particular meal or snack.

Prediabetes and weight loss

Question:  I was recently diagnosed with pre-diabetes and was prescribed medication.  I have been following a diet to lose weight but unfortunately in the past few weeks, I have actually gained a few pounds.  When I was eating whatever I wanted without the medication, I stayed the same weight.  In the past, I have exercised at least 3 days a week but after a year of doing this I only lost about 10 pounds.  Do you have any suggestions?

Answer:  10# in the past year is 10# in the right direction - don't be too hard on yourself!  It is possible that the medication you were started on may have weight gain as a side effect even if it is helping to lower your blood sugar - check with your doctor or the pharmacist to see if this may be the case.  It may also be helpful to consult a registered dietitian and/or a personal trainer to help you to achieve better results with weight loss if that is what you are hoping for.

Prediabetes and sugar

Question:  I was recently diagnosed with Pre-Diabetes and was wondering how strict my diet really needs to be?  Does every meal and snack need to be completely sugar and carb free?

Answer:  The best thing to do if you have pre-diabetes is to eat small, frequent meals, make mostly healthy food choices, and step up your daily activity.

 I actually encourage all of my patients with prediabetes, type 1 or type 2 diabetes to make sure they are having some carb everytime they eat.  I have patients focus on total carbohydrate content at meals and snacks.  Sugar is part of the total carb so it does not need to be taken into separate consideration - JUST FOCUS ON TOTAL CARBS.   General guidelines for carbs are 45-60g per meal and 15-30g carb per snack.  Individual needs may vary - it is recommended that you meet with a dietitian to figure out what amounts are best for you.

Is is nearly impossible to have a "sugar-free" diet as even many healthy foods contain natural sugars.  Just try to stick with more healthy food choices like whole grains, fruits, veggies, low-fat dairy products, and lean protein choices.  Save the unhealthy carbs like chips, snack foods, and sweets for special occasions.

Eating out

Question:  On my lunch breaks I go to a sandwich shop.  I usually get a large deluxe sandwich with a side of potato salad or coleslaw.  Now that I have diabetes, I'm trying to modify my lunch order.  Can you make some suggestions of what to order?

Many of the whole sandwiches at sandwich shops these days are 800-1,000 calories by themselves.  The best bet is to order a smaller size sandwich or eat 1/2 of the large deluxe sandwich.  If the portion of potato salad or coleslaw is small it's probably ok to have with the smaller sandwich.  Healthier alternatives might be to have a small side of fruit or a side salad with lowfat dressing.

Try not to eat out too often as healthy choices are often limited and it's easy to overeat.

Diabetes and juice

Question:  I have heard I should avoid fruit juice since I have diabetes.  What about vegetable juices?  Can I have tomato juice and other vegetable juices?

Answer:  Both fruit and vegetable juices are okay to have if you have diabetes.  You need to be more careful with the portion and frequency of fruit juice because it has more carbs than the vegetable juice.  4 oz of fruit juice has ~15g carb and 8 oz. vegetable juice has ~10-15g carb.  Many vegetable juices are higher in sodium, so still be careful of the portion and frequency.  Try to eat more fresh fruits and vegetables to get all the phytochemicals, antioxidants, nutrients, and fiber they provide.

If you are going to drink fruit juice try to stick with unsweetened juices, 100% juice, or consider trying light juices which have sweeteners added to them in place of sugar to lower the carb content some.

 Always check the food label for carb content!

Diabetes and milk

Question:  I have type 2 diabetes and cannot tolerate milk.  What may I substitute for my recommended two milk servings per day?  Would I substitute a carbohydrate or a protein?

Answer:  If you cannot tolerate milk due to lactose-intolerance, consider lactaid milk as a substitute or try using lactase enzyme supplements to help you tolerate foods with lactose better.  Some people who are lactose-intolerant with milk may still tolerate other dairy products such as yogurt - 6-8 oz. yogurt could subsitute for a serving of milk since it has similar carb and protein content and also provides you with a large amount of your daily calcium needs.  Soymilk would also be a good substitute for regular milk as it has a similar amount of carb and protein, and often can be found with calcium added. 

 If you do not tolerate any milk products due to severe intolerance, milk allergy, or choose not to consume dairy for moral or religious reasons, substitute your milk servings with soy milk or another form of healthy carbohydrate (healthy starches, fruit, or beans).   Look for foods that have ~15g carb (1 carb choice or 1 bread/starch/fruit serving) and ~7g protein.  Since dairy products continue to be the best bioavailable source of calcium and vitamin D in the diet, it is also very important in this case to make sure you are getting adequate calcium from other sources in your diet and/or from supplements. 

diabetes and vegetables

Questions:  I have a very big issue when it comes to having diabetes and that is I do not eat vegetables.  I have tried.  I want control my diabetes and be around to raise my young children.  What suggestions do you have to add vegetables to my diet?

Answer:  While it is not an absolute necessity to eat tons of vegetables if you have diabetes, I'm sure all health professionals (including myself) would highly encourage it.  Vegetables are low in calories and  provide us with many disease-fighting antioxidants and phytochemicals, as well as a good dose of fiber which is good for cholesterol and blood sugar levels.  Non-starchy vegetables can also act as a free filler at meals and snacks to help fill you up without adding many extra calories or carbs.

 Usually when I show people who claim to not like a vegetables a list of non-starchy veggies, they can usually pick out at least a few that they are willing to eat.  I like to keep bagged salad mixes and precut/prewashed veggies like carrots, celery, tomatoes, broccoli and cauliflower on hand to add quick salads to lunch and/or dinner.  Maybe consider adding extra veggies into things like pastas, stews, soups, or sandwiches to "hide" the flavor of the veggies with other ingredients. If it's been a while since you've tried certain veggies, consider retrying them as our tastes do change as we get older.

 If you are absolutely opposed to all veggies you can still get some of their nutritional value, antioxidants, and phytochemicals out of vegetable or fruit/vegetable juice combinations and possibly out of dietary supplements.

What does the A1C test mean?

Question:  I was recently told by my doctor I have pre-diabetes and that I need to lose weight, eat right, and get my sugar levels down.  On a 12 hour fast, my glucose level was 73 yet my A1C was 6.1%.  If my glucose is low, why is my A1c still high?  What can I do?

Answer:  The A1C test is an average of blood sugar control over the past 90 days.  It is measured in a percentage which correlates with an estimated average glucose level.  For example,  a person with an A1C of 6.0% has had an estimated average glucose of 126 mg/dL over the past 90 days.  Some people may have a lower blood sugar when they wake up, but may experience spikes in their blood sugars throughout the day due to food intake, stress, meds, etc, resulting in an elevated average.  The fact that your fasting blood glucose is low is a good sign.   Usually post-prandial, or after-meal, numbers are the first numbers to rise when diabetes is starting to develop.  This is likely where you are at and this is a perfect time to make lifestyle changes to prevent the further progression of diabetes.  Research has shown that weight loss, exercise, and healthy eating habits can decrease the risk of diabetes progression up to 58%.