Download April 2014 - Cal

A Better Way to Lend a Hand to
Diabetes Patients
An editorial in a February issue
of American Family Physician
proposed a simple way for
physicians to communicate
treatment priorities for patients
with type 2 diabetes. Their
"hand" illustration re-prioritizes
treatment goals. It conveys
that glycemic control or blood
sugar (BS) control is no longer
the top priority. The new
medical treatment priority
model illustrates that glucose
control is not as important as
smoking cessation, blood
pressure (BP) control, use of
metformin, and lipid control.
Read the full press release at
http://www.medicalnewstoday.c
om/releases/273025.php.
This proposed change of the
treatment goal priorities for
people with diabetes, while it
may be a step in the right
direction, is not optimal. This
revised largely medical/
pharmaceutical approach,
called
"lending a
finger,"
(see the
picture on
this page)
still misses
the two
most
important
priorities
for
reducing
morbidity
and
mortality in
people with
(continued on next page)
4
1
’
l
i
r
p
A
Professional Member Edition
Research
How can we really help diabetes patients?
Practitioner Tips
Plan fun activities that help
your clients build a healthful
lifestyle.
Client and Consumer Education
Handouts: Recipes
and Cooking Tips
1. April Fool Chili
2. Kale Salad
This Month’s Handouts
1. Blood Glucose 101 Part 2
2. Banish the Belly Bulge
3. Sick of Salad?
4. Let’s Talk About Saturated
Fat
Online: Clipart, Calendar,
Recipes, PDF Handouts, Articles,
This Month, Newsletter Archive
The "hand" actua!y missed the two most important factors for improving and reversing insulin resistance while increasing longevity.
type 2 diabetes. It is overly
MD-centric, which may
enable those with type 2
diabetes to believe that they
require prescription drugs to
control not only their BS but
also their BP and blood
lipids.
On the plus side, it’s nice to
see MDs recognize that their
all-too-myopic focus on
controlling BS has too often
done more harm than good
for many people with
diabetes. This focus has led
to unproductive emphasizing
of the diet's glycemic index
(GI) and glycemic load (GL)
as well as a sometimes
obsessive focus on counting
grams of carbohydrate to
control BS. Of course,
counting grams of
carbohydrate is most
counterproductive for those
with type 2 diabetes,
especially if it leads them to
reduce their intake of
high-carbohydrate whole
plant foods. Indeed, even for
type 1 diabetes patients,
where arguably counting
grams of carbohydrate may
have some limited utility, at
least for BS control, a
systematic analysis of the
best data available suggests
it is still pretty close to
useless, even for improving
BS control (1). The
ACCORD studies showed
that aggressively lowering
BS levels with diabetes
medications achieved
increased overall mortality.
As a result of this data, the
American Diabetes
Association apparently has
realized that their
obsessive BS focus was not
all that beneficial for people
with diabetes, especially
those with type 2 diabetes
(2).
From my perspective, this
new proposed "lending a
finger" proposal is not all that
much better than the prior
myopic focus on BS control,
carbohydrate counting, and
glycemic load. Indeed the
"hand" actually missed the
two most important factors
for not only improving and
reversing insulin resistance
(and associated metabolic
ills), but also increasing
longevity in people with type
2 diabetes and the metabolic
syndrome. My "lending a
finger" hand (see the image
on this page) would look like
the two finger peace sign.
Index finger: "Weight loss"
This would be achieved not
by calorie counting but by
changing what people with
type 2 diabetes are told to
©www.foodandhealth.com
eat. Rather than focus on
counting grams of
carbohydrate, patients
should shift their focus
to eating less processed
foods with lower calorie
density and higher fiber
content. That diet would be
composed largely of whole
grains, fruits, and
vegetables, with marked
reductions in salt, sugar-rich
drinks, and fatty animal
products.
Middle finger: "Exercise"
This would consist of at least
one hour of daily aerobic
exercise, with
additional resistance training
2-3 times per week. It would
also discourage long periods
of sitting.
Type 2 diabetes is largely caused by excessive weight gain brought on
by the typical American diet and inactivity.
As shown in the DPPT trail
(see the figure below), those
two lifestyle changes and a
very modest weight loss
reduced insulin resistance
and were far more effective
than metformin for
preventing people with
pre-diabetes from
progressing to type 2
diabetes over several years.
A healthful diet & exercise
program has been shown to
eliminate the need for any
diabetes medication to
control BS in most people
recently diagnosed with type
2 diabetes. A healthful diet
and regular exercise can
also eliminate hypertension
and dyslipidemia in most
people, so there goes the
need for MDs and
pharmaceutical agents to
control BP and blood lipids
too. Once one realizes that
type 2 diabetes is largely
caused by excessive weight
gain brought on by the
typical American diet and
inactivity, the obvious way to
stop and prevent type 2
diabetes is by eliminating the
poor diet and inactivity that
caused the weight gain,
insulin resistance, and
associated metabolic
abnormalities. Sadly, in the
USA, type 2 diabetes is
viewed as a medical problem
when in fact it is caused
largely by poor diet and
©www.foodandhealth.com
lifestyle choices. Improving
the diet and beginning
regular exercise can
dramatically reduce or
eliminate the need for MDs
and pharmaceutical agents
to prevent or treat type 2
diabetes patients who still
have enough beta-cell
function to produce sufficient
insulin, once their insulin
sensitivity is enhanced by a
healthful diet and exercise
program, with a sufficient
loss of abdominal fat stores.
Behavioral/psychology
health professionals playing
a more prominent role to
help with smoking
cessation and with getting
people with insulin
resistance and/or type 2
diabetes to accept that their
disease was largely brought
on by their diet and lifestyle
choices rather than "bad
genes" is a great first step.
Helping patients realize that,
in order to reverse their
illness (or at least to
markedly improve their
health outcomes), they must
accept personal
responsibility for their illness
and then stop the
self-destructive behaviors
that make their disease
worse over time (despite all
the prescription drugs they
take, all the carb counting,
and BS monitoring efforts).
We know that most type 2
diabetics who are
undergoing traditional
medical therapy will
ultimately end up with all
sorts of serious ills such as
neuropathy, failing kidneys,
(which, when they fail means
that patients must spend the
rest of their lives on dialysis),
a markedly elevated risk of
retinal damage, a higher risk
of cataracts destroying their
vision, a marked increase in
dementia, stroke, heart
attack, and heart failure, and
all those unpleasant drug
side effects that undermine
their quality of life.
Bottom Line: It is time to
recognize what causes
diabetes and discourage the
behaviors that promote it. It
is increasingly clear that
adopting a more healthful
diet and lifestyle can help
reverse the disease. So
rather than relying on a
medical approach to control
risk factors with drugs and/or
surgery it would be better for
people with the metabolic
syndrome or type 2 DM to be
encouraged to change what
they eat and become less
sedentary. This is not to say
that drugs and surgeries
have no benefits, but the
medical approach certainly
won't stop the progression of
most of the ills that people
with type 2 diabetes must
deal with sooner or later.
Perhaps it is time for
healthcare providers to stop
©www.foodandhealth.com
being enablers of an
unhealthful
disease-promoting diet and
lifestyle and educate people,
empowering them to reverse
those harmful behaviors.
References:
1. Bell KJ, et al. Efficacy of
carbohydrate counting in
type 1 diabetes: a
systematic review and
meta-analysis. The Lancet
Diabetes & Endocrinology.
doi:10.1016/S2213-8587
(13)70144-X.
2. The Action to Control
Cardiovascular Risk in
Diabetes Study Group.
Effects of intensive
glucose lowering in type 2
diabetes. N Engl J Med.
2008; 358: 2545–2559
By James J. Kenney, PhD,
FACN
Activity Idea: Finding Fiber
This engaging lesson will help
participants learn more about
fiber, its role in health, and its
many benefits. It is excerpted
from the 12 Lessons of Diabetes Program, so if you like what
you see and would like to get
more great ideas, check it out
at http://nutritioneducationsto
re.com/products/-571-72.html.
Assemble a stack of Nutrition
Facts labels. You can cut these
labels off of food packages or
print out the Nutrition Information stamps on any recipes in
the Food and Health database
at http://www.foodandhealth.
com/recipes.php. Whatever
you choose, be sure to label
the Nutrition Facts panel with
the corresponding food so that
participants know what they
are evaluating.
Once your participants have
arrived, hold up a Nutrition
Facts label and show everyone
where they can find the fiber
content of a food. Distribute
piles of labels to groups of students and have each person
hold up a food label, pointing to
the place where fiber is listed.
Correct any mistakes.
Now that everyone knows
where to look to find fiber content, have each group sort their
stack of labels into high- and
low-fiber foods. Circulate
throughout the room and check
the categories.
Review the health benefits of
fiber and discuss the difference
between how much fiber people should consume in a day
and how much fiber they are
actually eating. Discuss fun
ways to incorporate fiber into
meals, reminding students of
the resources they have at
their disposal. You can also arrange the labels for high fiber
foods into a display for future
reference.
Activity Idea: Grab a Lunch
This activity idea is also from
the 12 Lessons of Diabetes
and was originally created to
accompany a few of the lunch
handouts that are featured in a
guide to living healthfully.
Divide the class into groups
and have them brainstorm
ways to pack and store healthful lunch foods. Have each
group come up with a few
ideas for tasty yet balanced
lunches. Review the highlights
of each group’s discussions as
a class.
Bring the groups back together
and have them write down their
recipes, illustrate them, and
post them on a bulletin board
that is titled “Healthful Lunch
Inspiration.” Place the bulletin
board in a highly visible place,
and have participants decorate
it with images of healthful
foods. It can be a great reminder for the coming weeks.
Communicating Food for Health
By Food and Health Communications, Inc.
ISSN 1070-1613 © 2014. All rights reserved.
P.O. Box 271108, Louisville, CO 80027
Phone: 800-462-2352 Fax: 800-433-7435
http://communicatingfoodforhealth.com
1 year, 12 issues of Communicating Food for Health
eNewsletter + eHandouts + online member library for
thousands of articles, recipes, handouts, newsletter archive + license to reproduce for one site + store discount.
• Consultant, one person: 1 year: $89 • 2 years: $145
• Corporate, 6 people: 1 year: $349 • 2 years: $550
Executive Editor
Judy Doherty, PC II
Name: _________________________________________
Title/Company: ___________________________________
Address: _______________________________________
City/State/Zip: ___________________________________
Phone: _________________________________________
E-mail: _________________________________________
__ Check enclosed or __ Charge Visa/MasterCard/AMEX
Card number: ____________________________________
Expiration date: __________________________________
Name on card: ___________________________________
Mail to Food and Health Communications, Inc.
P.O. Box 271108, Louisville, CO 80027;
Phone: 800-462-2352; Fax: 800-433-7435;
[email protected]
Contributing Writers
James J. Kenney, PhD, FACN
Jill Weisenberger, MS, RD, CDE
Victoria Shanta Retelny, RD, LD
Lynn Grieger, RD, CDE, CPT
Stephanie Ronco
Editorial Advisory Board
Alice Henneman, MS, RD
Barbara Hart, MS, RD, LDN
Cheryle Syracuse, MS
James J. Kenney, PhD, FACN
Jill Eisenberg, RDH, MS, RD, CDN
Karla Logston, RN, BS, CDE, CHC
Linda Rankin, PhD, RD, LD, FADA
Stephanie Correnti, BS, RD
Join Communicating Food for Health
The content of Communicating Food for Health
is not intended to provide personal medical
advice; this should be obtained from a qualified
health professional.
©www.foodandhealth.com
A Fun and Delicious April Fool’s Joke
Nutrition Information:
Serves 6. Each serving contains 251 calories, 4 g fat, 1 g
saturated fat, 0 g trans fat, 0
mg cholesterol, 273 mg sodium, 44 g carbohydrate, 13 g
dietary fiber, 6 g sugar, and 12
g protein.
April Fool Chili
Serves: 6 | Serving Size: 1 cup
Ingredients:
1 tablespoon vegetable oil
1 large onion, chopped
4 cloves garlic, chopped
1 large bell pepper, chopped
2 15-oz cans of diced, no-salt-added tomatoes
4 cups water
2 15-oz cans of kidney beans, rinsed and drained
1 16-oz can of solid-pack pumpkin
1/3 cup uncooked brown rice
1 and 1/2 tablespoons chili powder
2 teaspoons ground cumin
Directions:
Heat vegetable oil in a large soup pot or Dutch oven over
medium-high heat. Once the oil is hot, but not smoking,
add the onion, garlic, and bell pepper. Sauté them for 3
minutes.
Add the rest of the ingredients, bring the whole thing to a
boil, then reduce it to a simmer. Cook for 30 minutes.
Brought to you by:
Each serving has 269% DV
vitamin A, 56% DV vitamin C,
13% DV calcium, and 22% DV
iron.
Chef’s Tips:
I call this dish “April Fool
Chili” because no one can ever
guess the secret ingredient:
pumpkin.
Be sure to drain and rinse the
beans thoroughly before adding them to the pot.
Serve this chili with pasta, rice,
or a baked potato.
Garnish with fresh parsley for
one last pop of color.
Did You Know?
Pumpkin is a great source of
vitamin A. One serving of this
dish contains over 200% of the
daily value for vitamin A.
Make Friends with Kale!
Nutrition Information:
Serves 4. Each serving contains 157 calories, 5 g fat, 1 g
saturated fat, 0 g trans fat, 2
mg cholesterol, 213 mg sodium, 27 g carbohydrate, 5 g
dietary fiber, 9 g sugar, and 6 g
protein.
Kale is the Star Salad
Serves: 4 | Serving Size: 2 cups
Ingredients:
1 bunch lacinato kale
6 cups raw baby kale
1 teaspoon olive oil
Juice from 1 lemon
1 cup shredded radishes
1 cup diced apples
1 tablespoon black sesame seeds
2 tablespoons light poppy seed dressing
Directions:
Remove the stems from the lacinato kale and rinse well.
Place the undried lacinato kale in a covered container and
steam lightly in the microwave for 30 seconds to 1 minute. The color will intensify and the leaves will be crisp
tender.
Arrange the lacinato leaves on the plate as pictured. Toss
the baby kale with the olive oil and lemon juice. Put it on
a plate and top with the radishes and apples. Drizzle a
thin ribbon of poppy seed dressing over the greens and
add the black sesame seeds. Serve immediately.
Brought to you by:
Each serving has 464% DV
vitamin A, 320% DV vitamin
C, 23% DV calcium, and 16%
DV iron.
Did You Know?
Kale is high in many different
nutrients. It has tons of antioxidants, which protect your
cells from free radical damage.
One cup of chopped kale has
more vitamin C than an orange.
A single serving of this salad
has 320% of your daily value
of vitamin C.
Kale plants don’t die after the
first frost -- they get sweeter!
Kale is one of the heartiest
leafy greens around and is
grown all over the world.
Kale is a good source of fiber,
manganese, and copper, all of
which are key to good health!
Blood Glucose 101: Part Two
Do I have to give up foods with carbohydrates?
Definitely not. Even if you wanted to, you
could not avoid all carbohydrate because you
would have nothing to eat other than pure
animal protein and fat. Even broccoli, spinach
and peanuts contain carbohydrates.
To live healthfully and to prevent the complications of diabetes, you need fruits, vegetables, whole grains and other foods with carbohydrates.
The key is to learn how much carbohydrate to
have at each meal and snack. A registered
dietitian nutritionist (RDN) can help you with
that. Visit the website of the Academy of Nutrition and Dietetics (eatright.org) to find one
in your area.
How often can I have something with real
sugar?
Real sugar is not taboo. As long as it fits into
your meal plan and you do not exceed the
total amount of carbohydrate that is your goal
for each meal or snack, you can have real
sugar.
Just be sure that it’s not pushing the healthful
foods likes fruits, vegetables, and whole
grains off your plate and out of your diet.
Some people will be able to eat a balanced
diet and enjoy small amounts of real sugar –
say a teaspoon of sugar or honey in coffee or
tea – every day. Others will need to limit sugary treats to just a couple times each week.
What makes blood glucose too low?
Low blood glucose is called hypoglycemia,
and it occurs when your blood glucose falls
below 70 mg/dl.
Many things can cause hypoglycemia, including...
• Skipping a planned meal or snack or eating too little carbohydrate
• Exercising more than usual
• Drinking alcohol, especially if you do not
eat carbohydrate-containing foods at the
same time
• Taking too much diabetes medication
Ask your healthcare provider how to treat
blood glucose lower than 70 mg/dl.
By Jill Weisenberger, MS, RDN, CDE
Brought to you by:
©www.foodandhealth.com
3
Banish the Belly Bulge
aerobic exercise like walking or jogging with
anaerobic exercise like strength training.
Eating for a Svelte Tummy
Belly fat is dangerous fat to carry because it
makes it harder for your body to regulate
blood sugar, blood fats, and blood pressure. Plus, the deeper the fat, the more danger it
poses to your organs and your health over
time. Research has shown that belly fat does
not just hang around your belly without consequences. On the contrary, belly fat is highly
active and secretes both hormones and toxins. It can even elevate LDL (“bad”) cholesterol levels. With all this activity, it should
come as no surprise that belly fat is a big risk
factor for diabetes, heart disease, and certain
cancers.
The good news is that belly fat is highly responsive to lifestyle changes, especially
physical activity. Exercise appears to hit the
abdomen first by shedding belly fat – prior to
shaping up hips or thighs.
So, the first line of defense is movement. The U.S. Department of Health and Human
Services recommends that we get active for
at least 150 minutes per week. That’s about
30 minutes on five days a week. Combine
Want to get rid of that belly fat? Managing
stress is a big factor in reducing belly fat because cortisol, a stress hormone, causes fat
to accumulate around your middle. Also, inflammation is kept at bay with a flatter belly.
So choose foods that fend off stress and inflammation, such as unsaturated fats like
avocado, olive oil, nuts, seeds and fish. Unsaturated, omega-3 fats can reduce internal
stress, as well as inflammation. Omega-3-rich
foods include cold-water fish, like salmon,
halibut, trout, and tuna. Don’t like fish? Then
get an ounce of omega-3 nuts and seeds
everyday – like walnuts, flax, chia, and hemp
seeds.
Protein-rich foods may boost metabolism too,
because it takes a bit more energy to burn
them. Remember, fatty red meats and full-fat
dairy products contain more calories and
saturated fat, which defeats the purpose of
eating protein to get rid of that extra fat. Instead, choose lean protein sources like
chicken or turkey breast, pork loin, buffalo, or
even ostrich meats. Also, choose low-fat
dairy. Better yet – eat more plant-based proteins like beans, legumes, tofu, and whole
grains like quinoa and amaranth. In general,
add more fruits and vegetables to your diet
for lower-calorie, fiber-filled meals and snacks
that will keep your tummy flat and happy!
By Victoria Shanta Retelny, RD, LDN, author
of The Essential Guide to Healthy Healing
Foods.
Brought to you by:
4!
!
!
!
!
!
!
!
!
!
!
© www.foodandhealth.com
Sick of Salad?
Are you tired of eating a salad every day,
even if you vary the vegetables?
Does the thought of going through another
salad bar for a quick meal stop you cold?
There are many ways to enjoy vegetables
without having yet another tossed salad. Try
these four simple and healthful techniques to
enjoy vegetables throughout the year.
1.Use your oven to roast vegetables. This
will bring out a sweeter, caramelized flavor.
Cut carrots, cauliflower,
baby potatoes, eggplant,
zucchini, and butternut
squash into 2-inch
chunks, toss them with a
spritz of olive oil, add
cloves of garlic and onion slices for a deeper
flavor, and spread everything in a single layer in
a foil-lined roasting pan.
Bake in a 400° oven for
30-45 minutes, stirring
halfway through the
cooking time.
2.Use your grill to bring
out a smoky taste in otherwise familiar vegetables. Use a specialized vegetable grill basket to keep smaller
vegetables from slipping through into the
coals. Or put together aluminum foil packets
of mixed vegetables that you slowly heat on
the side of the grill. Encourage everyone to
make their own vegetable kabobs by providing bowls of cherry tomatoes, summer
squash, green or red peppers, mushrooms,
or eggplant.
3.Use a slow cooker for winter squash, ratatouille, or a vegetable chili. Try layering
chunks of your favorite vegetables with
seasonings such as lemon pepper, oregano, basil, or thyme. Top the layers with onion slices and garlic cloves for added flavor,
and cook on low for several hours.
4.Use a 3-tiered bamboo steamer to
quickly heat colorful and flavorful vegetables. Place dense,
longer-cooking vegetables like sweet potatoes
and beets in the bottom
basket over simmering
water, broth or miso.
Cover and let the bottom layer start to cook
while you add cauliflower, green beans, or
broccoli rabe to the
middle layer. Cover and
continue cooking while
placing quick-cooking
vegetables like kale,
spinach, mushrooms,
and onion in the top
layer. Cover and cook
for another 2-3 minutes.
Prepare extra portions of vegetables using
any of these methods to save time later in the
week. They’re even delicious served as cold
leftovers – but you don’t have to call them a
salad.
By Lynn Grieger, RD, CDE, CPT
Brought to you by:
©www.foodandhealth.com
5
Let’s Talk About Saturated Fat
What is Saturated Fat?
lesterol, and high in omega-3 fatty acids
and fiber, as well as low tobacco use.
Saturated fat is found mainly in animal foods,
such as butter, milk and milk products, beef
and pork, chicken skin, and lard. Coconut,
palm and palm kernel oils are also saturated
fats.
Most health experts agree that a diet high in
saturated fat increases your risk of heart disease by raising total cholesterol and LDL
(bad) cholesterol.
• About half of coconut oil’s fatty acids are
medium chain (MC) fatty acids. MC fatty
acids are known to not raise blood cholesterol compared to long chain (LC) fatty acids.
• The problem is, the fatty acid given credit
for coconut oil’s protective effect is lauric
acid, which is longer than most MC fatty
acids, so some consider it to be a LC fatty
acid. Regardless, a few studies have found
that lauric acid improved the ratio of total
cholesterol to HDL (good) cholesterol, but
it also raised LDL (bad) cholesterol.
"
• Furthermore, one study found that a
coconut-oil rich meal damaged blood vessels and altered HDL particles, reducing
their anti-inflammatory properties.
Saturated Fat and the American Diet:
The largest sources of saturated fat in the
American diet are:
1.
2.
3.
4.
Cheese (full-fat)
Pizza
Grain-based desserts (cookies, etc)
Dairy-based desserts (ice cream, milkshakes, etc)
5. Chicken and chicken dishes
6. Sausage, franks, bacon, and ribs
Build a balanced diet that includes foods with
saturated fat only in moderation.
What about Coconut Oil?
By Hollis Bass, MEd, RD, LD
Coconut oil, a saturated fat, is the latest fad
diet food. Its popularity is based on several
claims that don’t hold up under scrutiny:
• A study of Polynesian Islanders found low
rates of heart disease despite a diet naturally rich in coconut meat and coconut oil.
• The study fails to mention the many other
possible reasons for the Islanders’ healthy
hearts, such as a diet low in salt and cho-
Brought to you by:
6!
!
!
!
!
!
!
!
!
!
!
© www.foodandhealth.com