Nutrition News march2006
By Barbara Quinn, MS, RD, CDE
March 2006

Glycemic Index: What We Need to Know

Glycemic Index (GI) ranks an individual food on a scale of 1 to 100 based on how a standard 50-gram dose of that food causes blood glucose levels to rise within 2 hours when compared to white bread or glucose, which are given a glycemic index of 100. Low GI foods cause smaller rises in blood glucose levels and high GI foods cause higher rises.

Simple, huh? No one else thinks so, either. Glycemic Index may add some benefits to diabetes control, but it’s not a perfect system. Here’s why:

GI does not measure how quickly blood glucose levels increase, only how high they rise. Turns out that blood glucose levels tend to peak at about the same time, regardless of the food source.

GI of food varies according to degree of ripeness (a ripe banana has a higher GI than an under ripe banana), if it is cooked or raw (raw carrots have a lower GI than boiled carrots), and how it is processed (plain boiled macaroni has a lower GI than boxed macaroni and cheese).
GI varies if a food is eaten alone or with other foods. For example, white bread (high GI) eaten with peanut butter (low GI) produces a moderate GI response.
Individual foods affect blood glucose levels differently from day to day and person to person.

Glycemic Load (GL) is another method for predicting how foods will affect blood glucose levels. GL takes into account the amount of carbohydrate in a food as well as the glycemic index. For example, jam has a high GI, based on a 50-gram portion. But if you eat just 1 teaspoon (or 5 grams) of jam, the glycemic load is much less and produces a smaller rise in blood glucose levels.

Bottom line:

Glycemic Index (GI) and Glycemic Load (GL) both attempt to measure Glycemic Response: How YOUR body responds to the foods YOU eat
Both GI and GL can help you fine-tune your diabetes control.
Don’t forget: Total carbohydrates still count in predicting how a meal or snack will affect your blood glucose levels.

Nutrition News january2006
By Barbara Quinn, MS, RD, CDE
January 2006

Trans fats and Whole grains in the New Year

Besides watching those carbs this year, here are two other food ingredients that can help make or break your health goals for 2006:

Trans fats

As of January 1, we have one more tool to help make better choices when we buy food. The US Food and Drug Administration now requires trans fats on Nutrition Facts food labels.

What’s the big deal? Trans fats are the big brothers of saturated fats---the two bad boys in our diet that contribute to heart disease. Saturated fats raise good and bad cholesterol…not good. Trans fats raise bad cholesterol and lower good cholesterol…really not good.

If you have diabetes, you are at a high risk for heart disease. Your goal for 2006: Select food items with the lowest combined total amount of saturated and trans fat.

Whole grains

Yeah, yeah, we know that whole grain foods are good for us. But why are they important to people with diabetes? According to the 2005 Dietary Guidelines for Americans, at least 3 servings (or 3 ounces) of whole grain foods a day may reduce one’s risk for heart disease by 20 to 30 percent*

Whole grains are just that---the whole germ, endosperm and bran of a grain seed. Bran is the coarse outer layer where most of the fiber, B-vitamins, protein and minerals such as copper, iron, zinc, and magnesium reside. Beneath the bran lies the endosperm, where the seed stores starch (carbohydrates), protein and more B-vitamins. Farther inside the seed lies the germ---a major storehouse for healthful fats, antioxidants and minerals.

If you have diabetes, you still need to “count” the total carbohydrates in whole grains to control your blood glucose levels. But you also reap the benefits of numerous other nutrients as well.

Happy Healthful New Year!

*References: Whole grain foods and heart disease, J.Am.Coll.Nutr. 2000, 19:291S-299S. Whole grain intake in the Iowa Women’s Health Stud, Am. J. Clin. Nutr. 1998, 68: 248-257. Whole grains and coronary heart disease. Am. J. Clin.Nutr, 1999,70:412-419.

Nutrition News november2005
By Barbara Quinn, MS, RD, CDE
November 2005

ABC’s of Diabetes Control

As we approach the holiday season, remember that diabetes is controlled by more than just eating fewer sweets. Experts urge us to know our ABC’s: A1C, blood pressure, and cholesterol. Here’s why:

A1C is a simple blood test that indicates your average blood glucose levels over the past 2 to 3 months. An A1C level greater than 7 percent means your diabetes is not in good control.

Nutritionally, you can lower A1C values by eating smaller portions of foods that contain carbohydrates (sugars and starches), such as bread stuffing, potatoes and pumpkin pie. Large meals cause a surge of blood sugars that dangerously increase A1C levels. Space your intake of carbohydrate foods (fruit is a carbohydrate, too!) throughout the day.

Blood Pressure control helps prevent kidney disease, heart disease and stroke---major risks for people with diabetes. Your goal? Less than 130/80.

Nutrition strategies to lower blood pressure involve more than tossing the salt shaker. Our bodies rely on adequate intakes of potassium, calcium, and magnesium to regulate blood pressure. Foods that include these nutrients include fruits, vegetables, whole grain breads and cereals, dairy foods, nuts and legumes.

Cholesterol. People with diabetes are twice as likely to die of heart disease as people without diabetes. A yearly blood test that reveals your total cholesterol level plus the good (HDL), the bad (LDL) and the ugly (triglycerides) will also provide clues as to how you can change your diet.

For example, a high LDL indicates a need to reduce the amount of saturated and trans fats in your diet. A high triglyceride level can be treated with a diet lower in carbohydrates and alcohol and higher in omega-3 fats from fish, walnuts and other sources.

A gentle reminder if you are carrying extra weight into the holiday season: The most effective way to reduce A1C, blood pressure and blood cholesterol levels is to lose some of that extra poundage.

Nutrition News september2005
By Barbara Quinn, MS, RD, CDE
September 2005

Monumental Insights About Diabetes

Under the watchful eye of Abraham Lincoln and Thomas Jefferson, I joined several thousand colleagues in Washington, DC last month for our annual meeting of the American Association of Diabetes Educators (AADE). Our theme: “Monumental opportunities…Diabetes Educators in Action.” Here are some highlights:

· “Inside the Beltway, outside the Beltway” is said to be a popular weight loss phrase in Washington, according to “President Bush” (or someone who looked a lot like him);

· We live in an “obesigenic” society---our excess weight a result of our bodies doing exactly what they are programmed to do when food is plentiful and physical activity is limited;

· Virtually unheard of a generation ago, 25% of the children now diagnosed with diabetes are type 2 rather than type 1. The reason? Our increasing epidemic of obesity in children that leads to metabolic syndrome---a precursor to type 2 diabetes.

· We know that increased physical activity improves blood glucose control, weight, blood pressure and energy. We know we “should” eat healthy foods, watch portion sizes, cook more and only eat when we are hungry. Why don’t we?

· Research that won the 2002 Nobel prize found that the decisions we make in life are primarily based on emotions (how we feel) rather than intellect (what we know).

· Pull out a sheet of paper and graph how your weight has changed over time. Plug in what was happening in your life during times of weight gain or weight loss. This will help you understand the emotional situations that trigger your health habits.

· Diabetes and alcohol do NOT mix with pregnancy or if you have any of these complications: Hepatitis C or other liver disease, pancreatitis, high blood triglycerides, or severe neuropathy.

· Calories still count. The most effective long-term diet to control diabetes and reduce its complications is carbohydrate-controlled, low in saturated fat and high in fiber.

Nutrition News july2005
By Barbara Quinn, MS, RD, CDE
July 2005

Latest Perk on Coffee and Type 2 Diabetes

For most of us, life without coffee would be…rough. But does coffee have any benefit other than getting our eyes open in the morning? Surprisingly, several epidemiological studies over the past three years found a lower risk for type 2 diabetes in people who drank higher amounts of coffee. (Journal of the American Medical Association, July 6, 2005).

Specifically, data pooled from several studies found that people who drank 4 to 6 cups of coffee per day had a 28% lower risk of diabetes when compared with people who drank less than two cups a day. Those who drank more than 6 cups of coffee a day had a 35% lower risk. Moreover, the association held true for men and women, obese and normal weight persons. Confounding factors such as smoking history, physical activity and alcohol consumption were not related to the results in several studies.

How can this be? Caffeine alone can increase blood sugar levels and worsen insulin sensitivity---risk factors for type 2 diabetes. Coffee contains more than caffeine, however. Other substances in coffee may be the grounds for its positive effect:

Chlorogenic acid: an antioxidant substance shown to reduce blood glucose levels in animal studies.
Quinides: by-products of chlorogenic acid that improve insulin sensitivity in animal studies.
Magnesium: a nutrient that helps the body use carbohydrates for energy. Magnesium deficiency has been linked to insulin resistance and increased risk for type 2 diabetes in children and adults. (Diabetes Care, Volume 28, Number 5, May 2005.)

Still, we still have more questions than answers:

What’s “a cup”? A standard cup of coffee in the United States is 8 ounces, double the size of a typical serving in Europe (which is generally twice as strong).
Regular or decaf? Although most studies looked at the intake of caffeinated coffee, two studies on decaffeinated coffee found the same association between higher intakes and lower risk of type 2 diabetes.
Filtered or boiled? Drip-filtered coffee (versus boiled) appears to be most beneficial on LDL cholesterol levels and risk for type 2 diabetes.
Cream or sugar? Cream or milk added to coffee or tea was not associated with the risk for type 2 diabetes. One study did find an association between sugar in coffee and lower insulin sensitivity---a risk factor for type 2 diabetes.

A word of caution: Studies that look at “associations” do not prove cause and effect. People in prison, for example, tend to have more tattoos. That does not mean everyone with a tattoo will end up in prison. Until human intervention studies give us more information, don’t rely too strongly on your Starbuck’s to lower your risk for type 2 diabetes.

Nutrition News may2005
By Barbara Quinn, MS, RD, CDE
May 2005

My Pyramid for Diabetes

Is the newly revised “MyPyramid…Steps to a Healthier You,” relevant to people with diabetes? Let’s take a look:

The United States Department of Agriculture’s new “MyPyramid” eating plan is based on the 2005 Dietary Guidelines for Americans. These guidelines were formulated from scientific evidence that shows a pattern of eating that can reduce the risk for chronic diseases such as diabetes, heart disease and cancer.

Not surprisingly, then, the suggested eating patterns and exercise guidelines featured at www.mypyramid.gov fit well with current recommendations for diabetes. Just make sure you balance carbohydrates (sugar and starch-containing foods) at meals and snacks.

Engage in regular physical activity and reduce sedentary activities. Translation: Get off your duff and get at least 30 minutes of exercise every day.
Make at least half of the total grains you eat “whole” grains. Examples: brown rice, buckwheat, bulgur, oatmeal, wild rice, whole wheat bread and crackers.
Unless you are highly active and eat more than 2400 calories a day, limit your daily intake of grains to 4 to 7 ounces.
Eat 2 to 3 cups of dark-green, orange, and other non-starchy vegetables like broccoli, carrots, tomatoes, spinach, and romaine lettuce each day.
Limit starchy vegetables like potatoes, corn, and green peas to 2 to 3 cups per week.
Limit fruit to 1 to 2 cups a day and go easy on juice.
Consume 3 cups of fat-free or low-fat milk, yogurt or cheese each day.
Choose low fat meats and cheese.
Choose fish, nuts, seeds and vegetable oils that are rich in polyunsaturated and monounsaturated fatty acids.
Choose and prepare foods and beverages with little added sugars.

Sounds good to me!

Nutrition News march 2005
March 2005
By Barbara Quinn, MS, RD, CDE

Questions about Stevia

What is Stevia?

Stevia (stevioside) is extracted from the leaves of Stevia Rebaudiana Bertoni---a plant indigenous to South America. Natives call it “sweet herb” or “herb of sugar” because of the sweet taste its leaves impart to foods and beverages.

Is it safe?

Stevia has been used as a commercial sweetener in Japan and Brazil for more than 20 years. Not so in the United States…or Canada…or the European Union, however. These countries conclude there are still “unresolved concerns” about the safety of Stevia as a food additive.

In particular, the US Food and Drug Administration states there is not enough evidence for Stevia to be approved as a non-nutritive sweetener. Studies on rats have shown that high doses of Stevia may negatively affect reproductive organs. Other animal studies have created concern that large amounts of Stevia may promote cancer-causing substances or interfere with the conversion of carbohydrates to energy.

That is why Stevia is only marketed in the United States as a “dietary supplement” a designation over which the FDA has little control.

Should you use Stevia if you have diabetes?

Until more evidence comes forth, you will need to draw you own conclusions:

A recent study on patients with type 2 diabetes showed that 1 gram of Stevia a day helped lower blood glucose levels.
To date, no allergic reactions to Stevia have been reported.
Some studies have shown Stevia to have a blood pressure lowering effect.
Moderation is the key. No ill effects have been reported when Stevia is used in moderate amounts.

Sources: Metabolism, Vol 53, No. 1, January, 2004, pp. 73-76. Other information is referenced in the Position paper from the American Dietetic Association "Use of nutritive and nonnutritive sweeteners," accessible through www.eatright.org and search for Position Papers.

Nutrition News january2005
January 2005
By Barbara Quinn, MS, RD, CDE

Ways To Prevent Type 2 Diabetes

The bad news: Diabetes is one of the most costly and burdensome chronic diseases of our time.

The good news: According to current research, type 2 diabetes may be prevented or delayed when certain lifestyle goals are achieved:

Lose weight if you are overweight. Being overweight greatly increases your chances of developing type 2 diabetes. A weight loss of just 5 to 7 percent significantly reduces your risk.

Eat no more than 30 percent of your total daily calories from fat. Here’s how to calculate: Divide the number of calories you eat each day by 30. That will give your approximate daily fat allowance in grams. For example, if you eat 1500 calories a day, your total daily fat allowance is 50 grams. (Fat grams are listed on food labels.)

Limit your intake of saturated fat to no more than 10 percent of your total calories. That’s about 15 to 20 grams a day if you eat between 1500 to 2000 calories a day. You can find saturated fat (in grams) on food labels as well.

Eat more dietary fiber. Since fiber is only found in plant foods, this is a smart way to get more fresh fruit, vegetables, whole grain cereals and breads, beans and legumes into your diet. The goal: 15 grams of fiber for each 1000 calories you eat.

Exercise at least 150 minutes each week. Thirty minutes a day, five days a week is a reasonable goal.

Lifestyle changes can stop or slow the progression of a serious disease. That’s the most encouraging news of all.

Nutrition News
November 2004
By Barbara Quinn, MS, RD, CDE

Tips To Handle Holiday Meals

Cranberry sauce. Mashed potatoes and dressing with gravy. Pumpkin pie and Christmas fudge. Welcome to the carbohydrate- and fat-packed holiday season. Before you are tempted to drop your diet plan like a hot roll with butter, consider these ideas to glide through the holidays with your diabetes under control:

Adjust recipes. Instead of butter, try whipping the potatoes with fat-free half and half. Make your favorite holiday desserts with one of the new “sugar-plus-sugar-substitute“products. Made for baking, these products contain half the carbs and calories of regular sugar.

Count carbohydrates. Carbohydrate counting can help you control your diabetes whether you take insulin, oral medications, or manage your diabetes with diet and exercise. Here’s how it works: Count each 15 grams of carbs in your meal as one “carb choice.” Each of these food portions contains approximately 15 grams of carbohydrates (1 carb choice): 1-ounce dinner roll or slice of bread; ½ cup dressing or mashed potatoes, 1/3 cup cranberry sauce, 1/12 of a pumpkin pie.

Know your carb limits. A reasonable goal for most people with diabetes is no more than 45 to 60 grams of carbohydrate (3 to 4 “carb choices”) per meal. Then you can determine if you have room for pumpkin pie.

Pace yourself. The key to good control is to limit the total number of carbohydrates you eat at one time. Wait an hour or two after a holiday meal to enjoy a small amount of dessert.

Practice portion control. Even with heavy holiday meals, you can still choose to eat smaller portions. That’s the easiest way to cut extra carbohydrates and fat.

Happy Holidays!

Nutrition News
September 2004
By Barbara Quinn, MS, RD, CDE

Diabetes Equals Heart Disease?

Diet recommendations

Consider these statistics:

Atherosclerosis (a diseased heart) is the cause of death for almost 7 of every 10 people with diabetes.
More than half of the people who are newly diagnosed with diabetes already have heart disease.

It is now clear that diabetes is not just a “sugar” issue. If you have diabetes, you are at high risk for heart disease.

What’s the treatment? “TLC---Therapeutic Lifestyle Changes” that involve diet, exercise and weight loss remain the primary treatments for diabetes and heart disease.

Choose healthful carbohydrates. Whole grain breads, cereals, and fresh fruit. And monitor the size of your portions. (Just one measuring cup of pasta affects your blood sugars like two slices of bread.)
Keep company with good fats. Olive and canola oils and other plant-based fats such as nuts and avocados are rich in monounsaturated fats---the type that hearts adore.
Avoid “bad” saturated and trans fats. These types of fat encourage the proliferation of bad LDL cholesterol in your blood. Read labels carefully. Some “low carb” products are loaded with saturated fat.
Eat a wide variety of fruits and vegetables each day. These foods contain the nutrients and antioxidant substances that help control the “inflammation” process that now describes heart disease.
Exercise. 150 or more minutes each week can help control blood glucose levels and cut your risk of heart disease.
Lose weight if you are overweight. Blood glucose, cholesterol, and blood pressure can all go down significantly with just a 7 percent weight loss. (That’s just 14 pounds for a person who weighs 200 pounds.)

Barbara Quinn is a registered dietitian and certified diabetes educator in Carmel, California. Your questions and comments are encouraged.

Nutrition News
July 2004
By Barbara Quinn, MS, RD, CDE

Carbs that Count

It’s true. Too many carbohydrates can cause high rises in blood sugar levels, especially if you have diabetes. Most nutrition professionals advise you to “count” the number of carbohydrates you consume each time you eat. Question is, What counts? Here’s a list of what to look for (in order of importance) to help guide you through your next label-reading adventure:

Serving size: The MOST important part of the Nutrition Facts label. All the nutrition information is based on this serving amount.
Total carbohydrates: The combined amount of all sugars and starches in one serving. Blood sugar levels rise in response to the “total” amount of carbohydrates consumed at one time.
Dietary fiber: Carbohydrates that your body cannot digest or absorb that provide numerous health benefits. Foods high in dietary fiber are often called “complex carbohydrates.”
Saturated fat: If you have diabetes, this type of fat is bad news for your heart. Unfortunately, many of the new “low carb” products are saturated in saturated fat.
Ingredients: This is where you will likely find sugar alcohols: listed---foods that end with “-ol” like mannitol and sorbitol. Sugar alcohols contribute about half the carbs as other sugars and starches.
“Net carbs” “Net carb effect” ‘Impact carb” Anyone’s guess what these terms mean; they have not yet been defined by the US Food and Drug Administration.

What carbs count when you are trying to control your blood sugars? Try this not-so-simple calculation (in grams):

Total carbohydrates – Dietary fiber - (Sugar alcohols divided by 2) = “Carbs that count”

Barbara Quinn is a registered dietitian and certified diabetes educator in Carmel, California. Your questions and comments are encouraged.

Nutrition News
May 2004
By Barbara Quinn, MS, RD, CDE

How to Decipher a Food Label

Long gone are the days when people with diabetes were told, “You can’t eat sugar.” Now we know that all carbohydrates---sugars and starches---can affect blood sugar levels. Sounds simple enough…until you look at a food label. Here are some helpful hints:

1. Total carbohydrate. The total combined grams of sugar, starch, and fiber in one serving of a product. This is the most important number to look at if you have diabetes.

2. Dietary Fiber. The portion of the total carbohydrate that is not digested and therefore does not affect your blood glucose levels. Foods high in fiber can help control diabetes and lower your risk for heart disease and even some types of cancer.

3. Sugars. How much of the total carbohydrate in a product comes from sugar. This includes natural sugars such as fructose in fruit or lactose in milk as well as sugars that are “added” to a product.

4. Sugar alcohols. Sorbitol, mannitol and other “-ol” ingredients are found in many low carbohydrate products. In general, sugar alcohols contain about half the amount of carbs per gram as other sugars. Caution: Large doses of sugar alcohols can cause diarrhea.

5. “Net carbs” is a term not defined or approved by the US Food and Drug Administration---the agency that oversees the Nutrition Facts label. Some food manufacturers have arrived at this arbitrary term by subtracting out the grams of fiber and sugar alcohols from the total carbohydrates.

6. Saturated fat. In the frenzy to remove carbohydrates from foods, many products contain more than a fair share of “bad” saturated fat---a known heart stopper. Look for products with no more than 1 or 2 grams of saturated fat per serving.

Barbara Quinn is a registered dietitian and certified diabetes educator in Carmel, California. Your questions and comments are encouraged.