Category: Diet and nutrition

Posted on

Weight Loss in Diabetes

There is a known connection between obesity and Type 2 diabetes. It is known that the obesity epidemic is driving the Type 2 Diabetes epidemic world wide. There is strong evidence that modest weight loss can delay the progression from pre-diabetes to type 2 diabetes (1,2,3).  Weight loss in diabetes is beneficial in managing type 2 diabetes. Why lose weight question, for many type 2 diabetics is an important one to get their diabetes under control.
Studies have shown that reduction in calories lead to a reduction in A1C of 0.3% to 2.0% in adults with type 2 diabetes, leads to reduction in medication doses and improvement in quality of life (1). Maintaining weight loss is challenging (4) but offers long-term benefits. For example, maintaining weight loss for 5 years is associated with sustained improvements in A1C and cholesterol levels (5). Weight loss in diabetes can be attained with lifestyle programs that offer a 500–750 calorie energy deficit or offer 1,200–1,500 calorie for women and 1,500–1,800 calorie for men. For many obese individuals with type 2 diabetes, losing >5% can produce beneficial outcomes in sugar control, cholesterol, and blood pressure, and sustained weight loss of ≥7% is optimal (4).

Definition of Obesity

Body Mass Index, or BMI, is used as a screening tool for overweight or obesity.
• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to <25, it falls within the normal.
• If your BMI is 25.0 to <30, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.
To calculate BMI, see the Adult BMI Calculator or determine BMI by finding your height and weight in this BMI Index Chart.

How does Obesity Lead to Type 2 Diabetes?

Increase weight leads to increase fat (adiposity), increase adiposity leads to insulin resistance which eventually will lead to diabetes.
To have weight loss in diabetes, there are three modalities: bariatric surgery, weight loss medications (pharmaceuticals) and energy deficit. A combination of any of the three modalities with behavior modification can help patients achieve weight loss.

Bariatric surgery

Bariatric surgery is indicated for patients with a BMI equal or greater than 40 or a BMI equal or greater than 35 with co-morbidities such as diabetes. The two most popular types of bariatric surgery are Roux-en-Y gastric bypass and Gastric sleeve surgery also known as vertical sleeve gastrectomy. Gastric sleeve is more popular because the number of side effects are less than with the Roux-en-Y bypass but is not as effective.

Weight loss Medications (Pharmaceuticals)

Prescription weight loss drugs: Belviq, Contrave, Saxenda, phentermine, and Qsymia. Over the counter you can find orlistat. Lifestyle intervention plus pharmacotherapy intervention lead to better response to calorie restriction. For patients on weight loss medications see an increase magnitude of response, average percentage of weight loss is greater. Overall pharmaceuticals can help extend weight loss sustained response. SEQUEL study data showed amount of weight loss group on pharmaceutical treatment lead to greater weight loss more than the placebo group.

Who can benefit from the use of Pharmaceuticals for weight loss?
Patients who report early hunger shortly after eating, patients who tend to have more than one plate of food to feel full, Patients with persistent food thoughts, strong emotional response to food or eating, and less than robust response to dietary plan. For some, pharmaceuticals can be use indefinitely or in maintenance can be use when needed.

Calorie Restriction

Type 2 diabetes is potentially reversible via an 8-week, very low-calorie diet followed by careful weight management for up to 6 months, new research shows. The findings were published online March 21, 2016 in Diabetes Care by Dr Sarah Steven of Newcastle University, United Kingdom, and colleagues.

The best weight loss response was seen in Younger age patients, in those with shorter duration of diabetes and not on insulin. STAMPEDE trial followed 150 patients with a BMI of 27-43 1 for five years 1 out of 3 patients were in remission after 5 years after bariatric surgery. Look AHEAD and DIRECT trial achieve 50% remission on an average weight loss of 10 kgs.
Calorie restriction paired with exercise provides patients with type 2 diabetes with a plan to lose weight and control blood sugars. Before starting any exercise, program consult your Primary care physician.
Lifestyle is always recommended to manage diabetes, for some patients with type 2 diabetes it may not be enough. Pharmaceuticals and bariatric surgery are other tools that can help. For patients who are morbidly obese bariatric surgery maybe the best alternative. Talk to your Primary Care Physician to find out what they recommend for you.
Weight loss in type 2 diabetes can lead to remission or well control diabetes at the levels of prediabetes leading to decrease complications from diabetes. Make weight loss part of your diabetes action plan.

References
  1. https://jandonline.org/article/S2212-2672(17)30333-7/abstract
  2. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002095
  3. http://annals.org/aim/fullarticle/2395729
  4. https://jandonline.org/article/S2212-2672(15)00259-2/fulltext
  5. http://drc.bmj.com/content/5/1/e000259
Posted on

In Diabetes, think lower carbs

Lower Carbohydrate diet

My advice in diabetes, think lower carbs. Eating fewer carbohydrates with every meal is one of the most important changes in your diet that you can make to control blood sugars. Eating fewer carbohydrates sounds restrictive but meals can be made tasty and think about the benefits that come with it.

How many carbohydrates should you eat per day

While reducing carbohydrates will help with blood sugars, it is a very personal journey to find what foods work for you. Based on a 2500 calorie per day diet, I would recommend 100-150 gm of carbohydrate per day. If you want to lose weight reduce not only your calorie intake but also your carbohydrate intake down 75-110 per day.

Is there a diet that is better for diabetes?

The best diet is the one that works for you, your goals and activity. Everyone is different, the diet that works for you might not work for someone else, and vice versa. If you are trying to build strength and muscles, you shouldn’t follow the same diet as when you are trying to lose weight.
In the same way, someone who runs every day has different dietary requirements than someone who sits in an office all day and doesn’t exercise.

Moderate carbs

The general recommendation for a non-diabetic person is to get 40-60% of their daily calories from carbs. If you eat 2,000 calories a day, that’s between 200 and 300 grams of carbs a day.
For people with diabetes, this is generally too many carbs, but for people with diabetes that exercise a lot and/or are trying to build muscle mass 30-50% might be better than low carb.
One possible problem is that if you do not maintain the high level of exercise your blood sugars can go out of control easily.

Low carbs

There is no clear definition of exactly what a “low carb” means, low carb can be approximately 50-90 grams of complex carbs a day (not including vegetables). Patients with diabetes go this low when they want to slim down, like when wanting to drop a few pounds.

The benefits of lower carbs

The benefits of lower carbs are not surprising, Carbs raise blood sugars far more than fat and protein do. Limit the amount of carbs to get blood sugars under control, to use less insulin, avoid weight gain and avoiding the complications of diabetes.
Eating less carbs is one of the most important changes patients with diabetes can make. Lower carbs can make their blood sugars steady and will help avoid the roller coaster ups and downs that come with eating a high carb diet. For patient s with Type 2 diabetes this should be the first approach to manage high blood sugars effectively. For type 1 diabetes is the best way to manage it along with insulin.
Eating fewer carbs will lead to less insulin and less oral medications use. Eating just one low carb meal per day can make a difference, especially if it is the largest meal of the day. Reduce carbs slowly and be patient, it takes your body about 2-3 weeks to get used to it.
Other benefits are lower cholesterol, lower triglycerides, lower weight, and reduction in cardiovascular disease. For a place to start healthy eating refer to the plate method. Combine lower carbs with lean protein and good fats, to see low or no blood sugar fluctuations after meals.

The negatives of low carbs

Low carb is great for weight loss and can help with blood sugar control, but it also decreases your metabolism and energy levels. If you live an active lifestyle (and especially if you do resistance training), the moderate carb diet provides you with the energy you need to fuel your workouts, while still allowing for great blood sugar control.

The no-carb (ketogenic) diet

The theory behind the ketogenic diet is that by consuming almost no carbs (less than 5% of your total calories), your body will start converting fat into fatty acids and ketones.

Benefits of no-carb

Ketones can replace glucose as your body’s main energy source, meaning that your body mainly relies on fat for energy. In theory, this should make it very easy to lose excess body fat if you limit your calorie intake at the same time. By eating almost no carbs, you also, in theory, need very little insulin, making blood sugar control easier.

The negatives of no-carb

For most insulin dependent patients their insulin sensitivity fluctuates. Since he theory is that fat is released more slowly into the bloodstream than complex or refined carbs, there should be no blood sugar fluctuations. Insulin resistance is based on the amount of fat you have specially in your abdomen, for those with little or no fat the increase in fat intake can lead to fluctuations in insulin needs.
Many patients also experience weight gained from the increase fat intake. For patients with type 2 diabetes wanting to lose weight this maybe an alternative for a short term. Long term will lead to little energy level and can induce patients to end up eating more because they feel hungry all the time.

As I wrote in the beginning, what the optimal diet depends on your goals.

Posted on

Healthy Habits

You have decided to become healthier, but big changes make you anxious?

Not sure where to start, do I have to exercise 5 to 7 days right from the start? I’m a big proponent of making small changes, keeping those changes to a small number like 1 to 2 goals at a time. Depending on what areas, you think you need to improve, you can choose from the following list to get started:

Self-Care:

• Practicing stress reduction or deep breathing
• laughing or socializing
• using mindfulness or meditation
• attending a financial wellness seminar

Rest & Recover:

• Stretching
• taking a yoga class
• getting 7-9 hours of sleep
• taking time for yourself
• getting a chair massage (self-massage counts, too!).

Movement:

• Taking the stairs instead of the elevator
• going for a walk
• biking or walking to work
• taking an onsite yoga class
• running a race
• going to the gym

Nutrition:

• Eating a fruit or vegetable

• drinking water

• bringing lunch from home

• sharing a healthy snack with coworkers

Small changes will add up and make a big difference to your health. Changing your habits is a process that involves several stages. Sometimes it takes a while before changes become new habits. Healthier habits may protect you from serious health problems like high blood pressure or diabetes. If you continue these habits for a while, they may become part of your daily routine.

The four stages of changing a health behavior are:

• contemplation
• preparation
• action
• maintenance

If you started to make some changes, it is a good idea to set health goals. Review what worked, what didn’t work, and can you make changes to make sure you can accomplish that goal. Measuring progress is important to make sure your changes are yielding the results you wanted.
Changes are hard but small changes or steps can help overcome the anxiety that comes with big changes. Keeping motivated can also be a barrier, change your routine and reward yourself whenever you reach a goal. Healthy Habits become even more important for patients with chronic disease like hypertension and diabetes.

Patients with chronic disease states like hypertension or diabetes, should consult with your Primary Care Doctor before starting any kind of exercise program. More information can be found online at the American Diabetes Association for patients with diabetes or Pre-diabetes. Certified Diabetes Educators can help patients with diabetes get blood sugars under control, set health goals and develop a diabetes plan. For patients with chronic disease Ambulatory Care Pharmacist and Community Pharmacist are a great resource to help you get your health to goal.

Posted on

Can I Eat Eggs?

Eggs are a good source of protein, but they have dietary cholesterol. The cholesterol we eat does not necessarily raise blood cholesterol for most people. Our bodies make all the cholesterol we need, we do not need dietary cholesterol. What has a big impact on cholesterol is the amount of fat you eat.  For patients with cardiovascular disease or cardiovascular risk lowering dietary cholesterol is important.

What is Cholesterol?

Cholesterol is a type of fat in the body. Cholesterol helps form the lining (membrane) of the body’s cells and it plays a role in hormone production. Two subtypes of cholesterol we care a lot about are:

HDL (the “good” cholesterol) and LDL (the “bad” cholesterol).

  • LDL can get trapped in the lining of the artery. Over time, leading to a heart attack or stroke.
  • HDL’s job is to help remove LDL from the body.

Can I eat eggs or not?

Yes, but in the right way. If you regularly have an egg, reduce saturated fat in other areas of your diet.  Eating moderate amounts of eggs will have little impact on blood cholesterol for most people.
However, if you are adding a lot of saturated fat (bad fat), such as preparing eggs with butter, cheese, bacon, sausage, or eating excessive amounts of eggs a day, you are going to run into issues.
Are there other satisfying breakfast or snack choices that won’t impact cholesterol? Absolutely! Oatmeal, low-fat plain yogurt, egg whites, fruit with modest amounts of nuts, avocado and whole wheat toast, or peanut butter on whole wheat toast are excellent choices. But taste preferences, cultural differences, allergies, and time constraints make some of these challenging.

Reasons to Choose Eggs

• Good source of complete protein. If you don’t eat much red meat or high-fat dairy, eggs are a good addition to the diet. At seven grams of protein per whole egg, it’s a more efficient, readily absorbed protein option (more so than beans or lentils).
• Keep you fuller for longer and are satisfying! The fat and protein content of eggs will keep you fuller longer, prevent overeating later compared to options like bagels, toast, cold cereal, pancakes, or waffles.
• Eggs won’t raise blood sugar. This is a big for patients with diabetes, especially those who don’t eat much poultry or fish. While lentils and beans have protein, they are primarily carbohydrate (which raises blood sugar).
• Easy to prepare. They take a few minutes to cook. Hard-boiled eggs make meal and snack time simple.
Overall, yes, eggs can raise your cholesterol but not as much as saturated fat. It’s about your dietary balance in general.
Eggs can be part of your diet if you don’t over due the amount of fats you eat, egg whites are also a healthy alternative. For patients with diabetes one egg per day is OK to eat but should refrain from frying or adding a lot of butter and cheese. For patients with diabetes there is no diabetic diet, we recommend a healthy diet low in starchy carbohydrates. Using the plate method can help make sure you get enough protein in your diet.

Posted on

Trying to Eat Well but…

Many patients report overeating in the evening time or often given into cravings when trying to change the way they eat. For many, the day hours seem to pass by without a problem either because they don’t feel hungry, or when they eat, they eat healthily. When the sun sets, or they set foot in their house that’s when food has a new power. Many believe there’s something wrong with them or they “don’t have any self-control.” Truth is, that’s rarely the case. Here are the three most common situations: I see in the clinic:

Define “eating well.” Often when people try to improve what they eat, they reduce the types and amount of food they are allowed – especially if they are trying to “make up” for last night. This results in an underfed body and an unsatisfied mind. An underfed body is a hungry body – hormones like ghrelin increase making you feel like a bottomless, insatiable pit.

Ignoring hunger cues / skipped meals. It’s easy to ignore your hunger when you’re busy doing projects or distracted. Hunger catches up with you when your mind is finally winding down at the end of the day. As a result, food has greater power and gets more attention.

Relaxation. We all need a way to release the emotional pressure of life. For many, food is a convenient way to relax. If you pair the need to relax with an underfed body, the desire to eat becomes so great, it feels humanly impossible to resist eating beyond the point of physical need.

Here’s are a few tips so you can try to find your own balance:
• Recognize hunger cues and intensity – eat before you are starving. For most eating every 3-4 hours is a normal rhythm
• Eat balanced meals that leave you satisfied – that includes fruits/vegetables, protein, AND grains (carbs are not the enemy). Don’t forget healthy fats! It is great for satisfaction.
• Rest and stress – just because stress is “normal” in your life, doesn’t mean your mind and body don’t physically react. Our minds and bodies need rest – whether that means a break from the office or getting enough sleep. Without a balance of each, the desire for food and fuel increases.
• Identify stress outlets – Consider additional outlets for relaxation such as socializing, laughing, drawing, yoga, walking, meditation, petting a dog, reading, knitting…that way food isn’t the only option.
Nutrition is a challenging topic. While food helps our physical body, eating is also emotional, social, and cultural. Food isn’t often about willpower or decision-making. Rather it’s about balancing our human needs.

Picture by Deanna Marie Velasquez

Posted on

Diabetes Plate Method

The Diabetes Plate Method is a simple way to plan meals. Using the plate method “formula” encourages you to eat more healthy food and fewer unhealthy foods.

The Diabetes Plate Method helps you control portion sizes of starchy, carbohydrate-containing foods that have the most impact on blood glucose levels. It focuses on eating more non-starchy vegetables, which are low in carbohydrate and calories and high in vitamins, minerals, and fiber.

You can use the plate method for your specific health and nutrition goals including weight loss or maintenance, blood glucose management, and simple good nutrition. The plate method is also a useful tool for people with prediabetes and for those who simply want a healthy approach to eating.

Start by filling half your plate with non-starchy vegetables. Then fill one-quarter of your plate with whole grain or starchy foods and the remaining quarter with lean protein foods. The Diabetes Plate Method includes fruit and low-fat dairy on the side but is optional if you are trying to lose weight.

Healthful fats, which can be used in any section of the plate for food preparation or as condiments, are also key ingredients. The best part about the Diabetes Plate Method? It doesn’t require a lot of math and you can use it almost anywhere.

To create your own plate:

http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/#seven

The following healthy plate reflects the healthy fats that were omitted, thank you for the comments:

Healthy Eating Plate

Posted on

Why We​ Overeat

Your brain is wired to make you eat more, first with cues such as the size of your plate, and the effects of sugar and fat on what’s known as the pleasure center of your brain. Eating is fun—especially when common foods are enhanced to tempt your taste buds. Willpower takes effort and it needs to be all day long. A study found that people who put fruit on their kitchen counter weighed 13 pounds less, on average than those who did not have visible fruit. And those with soda on the counter weighed 24 to 26 pounds more than those who had a soda-free counter.

Trick your brain into thinking you’re eating more by using an 8-inch plate. Your 3 ounces of pasta on an 8-inch plate looks like a full serving. But when it’s on a 10-inch plate, it looks like an appetizer size, so you end up adding more. A specific color that will help you not to overeat, is blue. The contrasting the color of your plate with the color of the food can lead you to eat about 30 percent more than if the plate is blue.

Food served from the stovetop encouraged people to eat 25 to 30 percent less than the same food served family-style at the table. People who ate while reading, watching TV or playing games were more likely to consume as much as 25 percent more food than if they were not distracted, according to a 2013 study published in The American Journal of Clinical Nutrition.

Creating a calming environment that encourages you to slow down and pay attention to your food can help decrease the amount of food consumed. Bright lights can push you to eat faster and eat more. Fast, loud music will prompt you to eat more food. Use calming and quiet background music, pay attention to what you’re eating.

Use tongs instead of a serving spoon. According to a 2011 study published in the journal Judgment and Decision Making, it’s harder to grab food with tongs, which means you put less on your plate. Dine with one friend, and you’ll likely consume about 35 percent more food than if you ate alone.

Your server’s appearance can influence how much you eat. If your waiter is overweight, you’re three times more likely to order dessert and alcohol than if you have an average-weight waiter. The reason? Comparing yourself to someone who is larger gives you a “license to eat. As many as 92 percents of restaurants exceeded recommended daily calories in a single meal. The average entrée plate is around 1,500 calories, and that doesn’t include the drinks, the appetizers, the sides, or the desserts.

The reason foods such as potato chips and ice cream tempt you. Humans are programmed to like sugar, fat, and salt. Our hunter-gatherer ancestors needed a lot of calories to survive, so our brains are hardwired to seek out high-calorie foods. It also doesn’t help that most of our foods and flavors have been enhanced by companies to hit this perfect balance of sugar, salt, and fat called “the bliss point”. Our foods have been modified so much many cannot and should not be call real food. While taste alone won’t cause you to overeat, high-sugar snacks might. There is evidence that foods with a lot of sugar can trigger an addictive-like pattern of eating, making you more likely to binge.

Your brain may pressure you to overeat, but you can push back.

  1. Don’t put fruits and veggies in your refrigerator’s crisper drawer. Cut them up, and place them in an easy-to-see spot in your fridge so your family is more likely to grab them.
  2. Ask your server to box up half or two-thirds of your meal before it ever touches your plate.
  3. At the grocery store, walk down the healthy aisles first.
  4. Use tall, slender glasses for beverages other than water. The tall glasses look fuller.
Posted on

Low Carb Bread

For most of us, eating bread is part of our daily routine, for diabetes patients a healthy low carb diet seems to work best to control blood sugars. A lot of my patients’ report having a hard time finding low carbohydrate breads, a search was launched on the web to see if I could find products that are low carb but also taste good.
My first find was Diabetes Daily site, to my surprise they listed Joseph’s High Fiber Plus Pita Bread which I have tried and is not bad. Next The diet doctor site offers recipes for low carb breads that you can try. Linda’s diet delights site also mentions low carb bread alternatives, some are the same as Diabetes Daily, but she also has some that are different. Unfortunately, I have not been able to find many of the products mention but would love to hear from those of you have tried the low carb breads listed in the sites above or any of the low carb bread recipes.

Posted on

Is Eating Vegan Healthy?

A few years ago, one of my patients asked me if I knew anything about Forks over knives. She reported she saw a cardiologist to get cleared for surgery, he told her he would not clear her but encouraged her to see the documentary Forks over Knives and to follow the diet. The patient was very stressing over the fact she could not get the surgery, she told me that the cardiologist encouraged her to eat a vegan diet. Vegans abstain from eating any animal products while vegetarians do not eat animal meat but still eat eggs, cheese, milk.  The Forks over Knife documentary and book explores the claim that all deteriorating diseases can be control, even reverse by not eating animal based and processed foods.

Most people become vegan to avoid animal cruelty products and wanting to be healthier. But is a vegan diet Healthy? Around 2.5 percent of people in the United States (U.S.) are vegans, according to a 2016 poll. Here are some facts about the vegan diet:

The vegan diet contains only plant-based foods. All protein, vitamins, and minerals must come from non-animal sources, so food choice and preparation are important. Tofu, tempeh, and mushrooms are three of the many alternatives than can provide the nutrients found in meat. A vegan diet can help to protect bone and heart health, and lower the risk of cancer.  Supplements are recommended to replace levels of certain nutrients abundant in meat, such as vitamin B12.

Animal fats have been linked to various cancers, diabetes, rheumatoid arthritis, hypertension, heart disease, and a range of illnesses and conditions. Animal sources are likely to account for 13 of the top 15 sources of cholesterol-raising fats in the U.S.  Not eating meat reduces the overall risk of mortality.

The following are likely to be in short supply on a vegan diet, but alternatives are available.

  • Vitamin B12: Vitamin-B12 fortified plant foods, such as fortified soy, seaweed, cereals, and nutritional yeast can supplement intake.
  • Iron: Dried beans and dark leafy greens may be better sources of iron than meat on a per-calorie basis. Using a cast-iron skillet to prepare a meal is a good way to absorb more iron into the food.
  • Calcium: Eat more tofu, tahini, and green, leafy vegetables.
  • Vitamin D: Regularly consuming more vitamin-D fortified foods and spending time in the sun can boost vitamin D levels.
  • Omega-3 fatty acids such as DHA and ALA: Omega-3 fatty acids, such as fish oil, are vital for cardiovascular health, eye function, and brain function. Though EPA, another type of omega-3, can’t be obtained with a vegan diet, ALA and DHA can be found in ground flaxseed, walnuts, canola oil, soy products, and hemp beverages.
  • Zinc: Whole grains, legumes, and soy products are rich in zinc.

My patient followed the diet and lost around 20 lbs., reported feeling better, got off most of her medications and could get her surgery. The patient was not able to stick with the diet for more than 18 months, and has since started to eat meat again. While eating vegan can be healthy, making sure to get vitamin B12, iron, calcium, vitamin D, omega 3 acids and zinc; is important.