Nutrition 101: Carbohydrates

March 19, 2015 at 11:10 am | Posted in Nutrition | Leave a comment
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By Janelle Langlais
Dietetic Intern

Carbohydrates are the body’s instant source of fuel found in almost everything. Milk, cereal, bread, pasta, soda, juice, candy and sweets all contain carbohydrates, and even fruits, vegetables, nuts and seeds. During digestion, carbohydrates are broken down into sugar molecules used as the body’s main source of fuel. The body stores these sugars in your muscles to provide energy during exercise, and in your liver to provide energy while you are sleeping or fasting. Carbohydrates are essential for proper nutrition; in fact, the Dietary Guidelines for Americans recommends that 45-65% of your diet come from carbohydrates daily.

It’s a common misconception that people with diabetes can’t eat carbohydrates. Everyone can and should eat carbohydrates for proper nutrition, as many options like whole grains, vegetables, fruits, and nuts are nutrient dense (meaning they have a lot of nutrients but few calories). Pairing carbohydrates with foods rich in protein and/or fiber helps the body maintain blood sugar. As protein is the body’s long-lasting fuel, it slows down the digestion process which helps to minimize the effects of carbohydrates on blood sugar. Protein helps make you feel fuller longer, leaving you more satisfied than if you just ate a carbohydrate alone. Fiber also has a similar effects on digestion and “fullness” as it slows down digestion and adds bulk, aiding in maintaining a more stable blood sugar. An apple with peanut butter is a great example of a balanced snack: the apple contains carbohydrates and fiber, and the peanut butter contains lots of protein and a small amount of carbohydrate and heart healthy fat.

Overall, the key is moderation and balance.  Focus on incorporating whole grains, fresh fruits and vegetables into your diet. Opt for whole grain or whole wheat bread or pasta instead of white to increase your protein and fiber intake, creating more of a balanced plate. These foods also contain lots of vitamins and minerals which are essential to a healthy diet. Another thing to remember is to limit sugar-sweetened beverages such as soda and juice, and avoid refined sugars. These sugary drinks and processed foods contain large amounts of sugar and have little nutritional value. Opt for fruit-infused water or diet beverages to decrease your sugar and caloric intake for better health. Lastly, always remember is to be mindful of portion sizes! It is possible to have too much of a good thing, so always read your food labels and follow the serving size.

(Post content reviewed by the MGH Department of Nutrition and Food Services)

Lemon Fish with Carrots and Celery

March 5, 2015 at 11:30 am | Posted in Uncategorized | Leave a comment

The recipe is adapted from Polish cuisine and features fish flavored with lemon and black pepper, served over sautéed carrots and celery. Offer this nutrient-packed recipe hot, as a dinner entrée,or try it cold on a bed of greens.

Ingredients:
4 5 oz portions of scrod or cod (1.25 pounds in total)
3½ cups carrots, shredded (about 5-6 carrots)
1 1/3 cups celery, diced
3½ tbsp canola oil, divided
1¼ tsp lemon juice
¼ tsp kosher salt
black pepper (to taste)
1 lemon, cut into wedges (optional, as garnish)
1 tbsp parsley, chopped (optional, as garnish)

Instructions:
1. Preheat oven to 350º.
2. Cover a baking pan with aluminum foil (allow for foil to hang over the edges of the sheet pan).
3. Place fish on foil and coat fish with 1 tbsp canola oil and lemon juice; season with pepper.
4. Cover fish tightly with aluminum foil (make a few holes in the foil with a fork so that steam can escape).
5. Bake fish for about 15 minutes or until the fish is opaque and flakes easily with a fork. (The internal temperature should be 145°F.)
6. While the fish is baking, sauté celery with 1½ tbsp oil until tender, about 5-10
minutes. Add carrots, 3 tbsp of water and the remaining oil (1 tbsp). Season with ¼ tsp
salt and sauté vegetables for about 20 minutes, or until carrots are tender.
7. Serve fish over vegetables and garnish with lemon wedge and parsley, if desired

Yield: 4 servings (about 4 ounces cooked fish and ½ cup vegetables)

Nutrition Information per Serving:
Calories: 240 • Protein: 27g • Sodium: 375mg • Carbohydrate: 9g • Fiber: 3g • Fat: 11g •
Sat Fat: 1g

Recipe adapted by Agnieszka Szewc, Dietetic Intern

MGH Resources for Quitting Smoking

February 19, 2015 at 1:18 pm | Posted in Uncategorized | Leave a comment

Quitting smoking is one of the best things you can do for your health. If you’re ready to quit, there are a number of resources available that can help you be successful. Members of the Mass General community have access to in-person support and coaching through the MGH Community Health Associates Living TOBACCO-FREE Program. The Program’s multi-lingual coach speaks 5 languages: English, Spanish, Czech, Slovak and Russian. Call 781-485-6210 for more information.

Massachusetts residents can also work with a coach by telephone. Call the free Smokers Helpline: 1-800-QUIT-NOW (1-800-8-Dejalo para Español). The Smokers Helpline also offers interpretation in over 100 languages. Visit makesmokinghistory.org for more information and support resources.

“Mini” Relaxation Exercise

February 5, 2015 at 10:14 am | Posted in Health | Leave a comment
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BetwMeditation pictureeen the snow and problems with public transit, this has been an incredibly stressful two weeks.  The relaxation response is the body’s natural counter to the stress response.  If start feeling stress creeping in, take a few minutes to try this mini relaxation breathing exercise from the Benson-Henry Institute for Mind Body Medicine

INHALE, pause- 1,2,3         EXHALE, pause, 1,2,3

  • After each inhalation, pause and count: 1,2,3 (breath is held in)
  • After each exhalation, pause and count: 1,2,3 (breath is let out)
  • Do this for several breaths.

Winter Skin Care

January 22, 2015 at 1:15 pm | Posted in Health | Leave a comment

The ski resorts have opened for the season, ice skating is back at Frog Pond, and it’s dark at 4:30pm – must be winter in New England.  Another sure sign winter has returned:  itchy skin.  Dry skin (or “winter itch,” as it’s sometimes called) occurs when dry air pulls moisture from the skin, weakening the skin barrier.  The body has difficulty rebuilding the barrier, which in turn leads to itchy skin. Itching leads to scratching which can invite trauma and infection.

To help keep your skin healthy this winter use warm (not hot) water when bathing, and stick to one shower/bath a day (or every other day if possible).  Scented liquid soaps and body washes can be drying; therefore bar soap (such as Dove® for sensitive skin or Cetaphil®) is preferred.  Use your hands to apply soap to the underarms and groin. Avoid loofahs and vigorous scrubbing. Pat dry and apply an emollient which is better absorbed immediately following bathing.

Moisturizers that come in jars are generally recommended as they’re thicker than those that come in a pump bottle. CeraVe®, Cetaphil®, Curel®, Aveeno® and Eucerin® are good moisturizers that can be purchased at any local drugstore and do not require a prescription.  The bottom line is to pick something you like and stick with it!  For dry hands and feet, try applying a thin layer of petroleum jelly and then wear thin cotton gloves & socks to bed, which will help lock in moisture.

Despite the best efforts to keep the skin hydrated and prevent infections, problems can still arise. Contact your healthcare provider right away if you develop painful, hot, red skin which can be accompanied by fever. Another common problem is chronic lower leg swelling (or venous stasis) caused by poor blood return back to the heart. Over time, the legs can become itchy with skin breakdown which puts the individual at greater risk for infection.  If your primary provider cannot manage your skin problems, he or she can refer you to a dermatologist if necessary. We hope these simple tips will keep your skin healthy for 2015!

(Post Content reviewed by Mariko Yasuda, MD –  MGH Department of Dermatology)

Rosemary White Bean Soup

January 8, 2015 at 11:18 am | Posted in Uncategorized | Leave a comment

A quick meal couldn’t be easier—or more balanced. The fiber and protein from the beans will
keep you satisfied, without depriving your taste buds of flavor.  Add a salad to round out your meal.

Ingredients

2-15 oz cans of cannelini, great northern or other white beans
¼ cup 0% Greek yogurt
1 tbsp olive oil
1 tsp red pepper flakes
1 tsp hot sauce, such as Frank’s Red Hot (or to taste)
2 tsp dried rosemary
Black pepper (to taste)

Instructions:

Blend all ingredients in food processor or blender; heat on stovetop or in microwave.

Yield: About 4 servings (1 cup each)

Nutrition Information per Serving:

Calories: 216 • Protein: 14 g • Sodium: 321 mg • Carbohydrate: 35 g • Fiber: 10.5 g
Fat: 3.5 g • Sat Fat: 0.5 g

(Recipe provided by MGH Be Fit)

Recipe: Asian Chicken Lettuce Cups

December 30, 2014 at 10:51 am | Posted in recipes | Leave a comment
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In the mood for Chinese takeout, but want to avoid the extra calories? Try this simple, healthy meal suggestion. If you don’t have a grill pan, you can use a nonstick skillet to cook the chicken.  (Recipe adapted from Cooking Light)

Lettuce Cups

Driving and Diabetes

December 18, 2014 at 11:42 am | Posted in Health | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NPPossessing a driver’s license is a rite of passage in our society.
A driver’s license is seen as a gateway to independence and is a necessity for survival in many instances since many places in the US don’t have adequate public transportation. Driving is such a huge part of our lives, but there are instances when the ability to drive competently is also at issue. The American Diabetes Association (ADA) published a Position Statement on Diabetes and Driving in the 2014 Clinical Practice Recommendations. I would like to summarize the key points of this Position to provide an overview to help both people with diabetes and their health care providers have the best information about driving with diabetes.

The process for identifying drivers with diabetes varies from state to state, depending on what type of vehicle the driver needs to be licensed for. In some states, questions such as “Do you have any medical condition that may interfere with the safe operation of a motor vehicle?” are asked at the initial application for license. These questions may then prompt the need for further medical evaluation. There is no need for a medical examination just because the driver has diabetes. Most often a medical evaluation would be requested when there has been a documented episode of hypoglycemia while driving. Visit the ADA Website for more information on specific rules for each state.

Drivers with diabetes that are commercial drivers in interstate commerce have different rules and follow a set of uniform federal regulations. ALL drivers are subject to an examination every 2 years to update the driver’s ongoing general fitness. Drivers with diabetes managed with diet, exercise, and oral medications do not have any further requirements. Drivers who use insulin often require a more detailed medical evaluation so an exemption to drive and medical certification can be granted. Drivers for commercial motor vehicles, such as school bus drivers and vehicles that transport passengers or hazardous materials are subjected to more strict evaluations that differ state to state.

There are many factors to consider when caring for the driver with diabetes. I want to be clear: a diagnosis of diabetes or the use of oral medications or insulin does not mean that driving ability is compromised. The ADA has determined that the single most significant factor associated with collisions for drivers with diabetes appears to be a recent history of severe hypoglycemia regardless of diabetes type or treatment. The ADA Workgroup on Hypoglycemia defines severe hypoglycemia as an event that disrupts cognitive motor function and requires the assistance of another person to treat the hypoglycemic event.

The plan of assessment and care of the driver with diabetes needs to be individualized. It is important to not only review hypoglycemia awareness, but to also review the other conditions that could interfere with safe driving. These conditions may include decreased visual acuity due to retinopathy or cataracts, neuropathy that diminishes the sensation of the right foot, or sleep apnea which can result in daytime sleepiness. Drivers that have had a hypoglycemic event will need much closer evaluation and education. The driver may need re-education to address issues with mealtimes and dosing of medications (or medications may need to be adjusted altogether), further education about hypoglycemia awareness, and the best methods of treating low blood sugars. Drivers who have had episodes with severe hypoglycemia may also need to perform additional glucometer testing.

People driving for long distances should have a good supply of glucose tablets easily available in the glove compartment or in the console. A supply of snacks such as packages of cheese and peanut butter crackers or nuts should also be stored in the front of the car with the driver and checked before each trip. Drivers who feel hypoglycemia occurring while driving should pull off the road immediately, put on their blinkers, and treat with a fast acting carbohydrate. Do not resume driving until blood sugar values are normalized.

Finally, I advise that all of my patients with diabetes have a medical ID with them at all times. Symptoms of hypoglycemia may appear as if driving under the influence of alcohol or drugs, which can lead to losing precious treatment time if there is an incident where you are unable to identify yourself as having diabetes.  First responders are trained to look for things like a bracelet or necklace, or a card in the wallet.

Healthy Tips for Managing Holiday Stress

December 11, 2014 at 10:49 am | Posted in Health | Leave a comment
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The holidays are a time of fun and excitement, but they can also be a time of added stress.

While stress is a normal part of life, it can have an impact on diabetes management. Stress hormones can raise blood sugar, and prolonged stress weakens the immune system and interferes with healthy self-care routines.

Stay healthy and enjoy the season with these techniques for managing holiday stress:

  • Prioritize – A common cause of holiday stress is trying to do too much at once. Focus on those things that are most important to you, and don’t be afraid to say “no” to taking on new commitments.
  • Take “time out” (Find a distraction) – Take a break and do something to clear your mind. Spend time with or call friends. Engage in some other activity you enjoy (like a favorite hobby).
  • Get Moving – Exercise is a known stress reducer, and sticking with your regular fitness routine can help with maintaining good blood sugar control. Small steps make a difference! Go for a walk, put on a yoga video or dance to a song on the radio.
  • Relax – Mind-body activities like meditation, deep breathing or positive visualizations elicit the relaxation response, the body’s built-in counter to the stress response.

Losing or maintaining a healthy weight is another source of stress for many during the holidays. The added pressures of the holidays can also contribute to emotional or stress eating (eating for reasons other than hunger). Signs of stress eating can be turning to comfort food after a difficult day, or mindlessly munching on snacks to burn off nervous energy. The downside is many comfort foods are high in sugar (which can raise blood sugar), fat, and calories. Distracted snacking makes it easy to take in more calories than expected. Consider preparing some healthy snacks to have accessible.

The techniques above can help with coping with stress eating as well, but if you’re still craving a crunchy snack or Mom’s Mac and Cheese go ahead and have some – just do so mindfully. Keep track of portion size, and eat slowly so you can really enjoy the food’s taste and texture.

It’s not possible to avoid all stress completely, but one final thing to remember is the holiday season (and the stress that comes along with it) is temporary. Slow down and enjoy the best the season has to offer. If you’re still feeling overwhelmed or think you might be experiencing diabetes burnout, talk to your health care provider or a diabetes educator.

(Post content reviewed by the Benson-Henry Institute for Mind Body Medicine)

Easy Weekday Breakfast Ideas

November 28, 2014 at 1:25 pm | Posted in Nutrition, recipes | Leave a comment
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They say breakfast is the most important meal of the day.  Don’t skip breakfast if you’re pressed for time in the morning – instead try one easy breakfast ideas from Janelle Langlais, a dietetic intern with the MGH Department of Nutrition and Food Services.

Turkey, Butternut Squash & Nuts
Serves 1

3/4 cup Butternut squash
¼ cup or 10-15 almonds/walnuts/pecans sliced/chopped
1 tsp. cinnamon (as desired)
1/8th tsp. ginger (as desired)
2-3 oz. Turkey (or chicken) breast

Directions

  1. Combine squash, turkey (or chicken) and spices in a microwave safe dish.
  2. Microwave on high for 1 minute (keep an eye on things).
  3. Add nuts and spices.
  4. Enjoy with ½ cup of skim milk, soy milk or water as desired!

Calories: 365 • Carbs 22g • Protein 29g


Avocado and Egg Sandwich
Serves 1

1 Egg or 2 Egg Whites
2 Slices low-Carb whole wheat bread Or 1 Whole Wheat English Muffin
¼ Avocado sliced or ¼ cup Guacamole
2 slices of tomato
¼ cup spinach
1 slice low-fat cheddar/American cheese

Directions

  1. Microwave egg or egg whites in a microwave-safe dish for 1 minute or until egg is firm. Or conventionally cook egg in a frying pan on stove with Pam or canola oil.
  2. Toast English muffin or bread in toaster/toaster oven.
  3. Top egg with cheese, avocado slices/guacamole, add tomato and spinach.
  4. Enjoy!

Calories: 330 • Carbs 24g • Protein 23g


Blueberry Banana Overnight Oats
Serves 1

1/3 cup oats
2/3 cup Greek yogurt
1/3 cup soy milk, slightly overflowing
1/2 banana (1/3 if it’s particularly large)
1/4 cup blueberries
1/8 cup Granola and/or chopped nuts

Directions

  1. Mash banana and blueberries together in a bowl until blended together. Stir in oats, yogurt, and milk. Cover, and refrigerate overnight.
  2. In the morning, top with granola and/or walnuts, along with fresh berries/bananas, if desired.

Calories: 460 • Carbs 49g • Protein 20g

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