Health, Nutrition

Diabetes and A Healthy Microbiome

By Christina Badaracco, Dietetic Intern 

What Is the Microbiome?

The human microbiome includes all the bacteria, both good and bad, that live in our organs. There are actually about 10 times as many bacterial cells in the body as human cells! Bacteria play many important roles in keeping us healthy, such as protecting us from invading bad bacteria and breaking down (or fermenting) the fiber in foods like vegetables that our own bodies can’t digest.

Our microbiome includes many different types of bacteria, and more diversity is typically a sign of good health. Many diseases, such as diabetes, can reduce the diversity in our gut and create environments that are better for bacteria that produce substances that cause inflammation or other harmful effects.  In this figure you can see many of the things that cause the microbiome to become imbalanced (such as taking antibiotics or poor diet) and some of the health problems that might result.  The microbiome is such an important factor in our health that the National Institutes of Health have launched two versions of the Human Microbiome Project, granting hundreds of millions of dollars into research about the connection between changes in the human microbiome and disease.

Is there a Link Between the Microbiome and Type 2 Diabetes?

Type 2 diabetes can be caused by genetics as well as diet and lifestyle.  Eating a healthy diet (one with lots of fiber-filled fruits and veggies and low in sugar and saturated fat) and exercising regularly can help keep your microbiome healthy and might help reduce the risk of developing diabetes.  The short-chain fatty acids that good gut bacteria produce when breaking down fiber can increase your body’s metabolism and how quickly glucose in the blood is used up, which can help manage blood sugar.  A recent study showed that a diet rich in fiber could improve diabetes management because it produces the short-chain fatty acids the cells of our gut lining need to be healthy.  Fiber also reduces inflammation and keeps you feeling full, which helps with managing portion sizes and keep blood sugar steady after meals. The types of bacteria in the gut also shifted to the species that love a high-fiber diet, promoting health long into the future.

How Can I Feed a Healthy Gut Microbiome?

  • Eating a diet rich in fiber keeps your good bacteria happy. They break down molecules like cellulose found in fruits, vegetables, and whole grains.
  • Limit high-sugar and high-fat meals. Bad bacteria thrive when we eat a high-sugar and high-animal fat diet. Try to limit foods like sodas, candy, large servings of fast foods, sugary baked goods, red and processed meats.
  • Try to eat some foods with probiotics. Foods that are already broken down (or fermented) contain good bacteria that can colonize and thrive in our guts. As a bonus for people with diabetes, these bacteria have already broken down some of the glucose for you! Some examples of fermented foods include:
    • Dairy: cheese or yogurt
    • Bread: sourdough
    • Grains: injera (found in Ethiopian cuisine), idli (found in Indian cuisine), atole (found in Mexican cuisine)
    • Vegetables: sauerkraut, fermented pickles, curtido (found in Salvadoran cuisine) kimchi (found in Korean cuisine) and tempeh and miso (found in Japanese cuisine)
  • Your healthcare provider many suggest taking a probiotic supplement to increase your good gut bacteria, particularly if you have recently taken antibiotics.
Post content reviewed by Melanie Pearsall, RD, CDE
Nutrition

Asparagus Chickpea Quinoa Salad with Lemon Vinaigrette

Celebrate spring with this salad recipe from the MGH Be Fit program.  Leftovers work well for a quick lunch—just keep the dressing separate and add before eating, so the greens don’t wilt.  You can also add a hard-boiled egg to further increase the protein in this recipe.

Ingredients

For the lemon vinaigrette
¼ cup lemon juice
½ cup olive oil
2½ teaspoons Dijon mustard
Kosher salt and black pepper, to taste

For the salad
1 cup uncooked quinoa, rinsed and drained
1 bunch asparagus (15 to 20 spears), cut into 1-inch pieces
1 tablespoon olive oil
1 (14-ounce) can chickpeas, rinsed and drained
3 large handfuls of arugula
2 scallions, thinly sliced
½ cup crumbled feta cheese

Instructions:
To make the vinaigrette:
Place all ingredients in a small jar with a lid and shake until thoroughly combined (or whisk together in a small bowl). Taste vinaigrette; add salt and pepper as needed.

To make the salad:
In a medium saucepan over medium heat, combine the quinoa with 2 cups of water. Bring to a boil, then cover and lower the heat to a simmer. Cook for 15 minutes or until the quinoa is tender. Let sit for 5 minutes then fluff with a fork. (If your quinoa still has water in it simply strain it out.) Set aside until ready to assemble the salad.
While the quinoa is cooking, sauté asparagus in olive oil in a medium skillet over medium heat until cooked through, about 7 minutes.

To assemble the salad:
Combine the cooked quinoa with asparagus, chickpeas, arugula, and scallions. Top with vinaigrette and feta cheese.

Yield: 6 servings

Nutrition Information per Serving:
Calories: 390 • Protein: 10g • Sodium: 240mg • Carbohydrate: 31g • Fiber: 7g •
Fat: 26g • Sat Fat: 5g

Recipe adapted from Two Peas & Their Pod
Nutrition

Eat Balanced by Pairing Your Carbs with Protein

By Lisa Keovongsa
Dietetic Intern

There is a common misconception that once a person is diagnosed with diabetes they need to cut out all carbs. This is not the case! Carbohydrates are very important because they serve as the main fuel source for the body and give the brain and muscles the energy needed to carry out daily activities. Carbs, protein, and fat all play essential roles and can be incorporated into your meals and snacks to keep you feeling your best. Also, eating carbs with protein at every meal will help manage your blood sugar and help your body best utilize the nutrients in your food.

Carbohydrate Foods
Many foods with carbohydrates raise blood sugar.  Eating carbohydrate with a protein or fat can keep your blood sugar steady.  Foods with carbohydrates include:

 Starchy vegetables*/legumes:  Pumpkin, squash, all potatoes, yucca, beans, corn

Dairy: Milk, yogurt

Grains: Breads, pastas, tortillas, rice, crackers/snack chips, cereals, quinoa

Fruit: Apples, oranges, pears, bananas, mangoes

*Non-starchy vegetables have fewer carbohydrates.  Examples of non-starchy vegetables include: Carrots, lettuce, broccoli, cabbage, tomatoes, any leafy green, cucumbers

Protein Foods
There are many options when it comes to eating protein. These foods include meats, poultry, eggs, fish, cheese, cottage cheese, nuts, nut butter, and tofu.

Why do we need to eat protein with carbs?
During digestion, the food we eat gets broken down into simple sugars that are delivered to our muscles and liver through the bloodstream.  Insulin is the “key” that “unlocks the gate” for sugar to leave the blood and enter the cells. When someone with diabetes eats large portions of carbohydrate-rich foods, too much sugar is released into the blood stream and, because there’s either not enough insulin or they have insulin resistance, their body is unable to use this sugar for energy effectively.  This can cause high blood sugar, which, if it happens consistently over time, can lead to complications.  Proteins (and fats) take longer to digest than carbs, so eating protein along with the carb slows down digestion in the stomach and absorption in the intestines. This will help slow the rate of sugar entering the bloodstream, keeping blood sugars steady and preventing blood sugar spikes (and crashes).  Check your blood sugars 2 hours after a meal to see the effects.

Snack Ideas
Pair one item from the protein list with an item on the carbs list to make a balanced snack that will keep your blood sugar in check:

Protein                                                 Carbs

Handful of nuts                                 Whole fruit (apple, ½ banana)

1 cup Greek yogurt                           5 Whole wheat crackers

2 Deli turkey slices                           1 whole grain tortilla

1 oz beef jerky                                  1 oz whole wheat pretzels

Hard-boiled egg                                1 cup regular yogurt

½ cup cottage cheese                       ¼ cup granola

1 tbsp Peanut butter                        3 cups popcorn

2 Tbsp Hummus                               ½ cup dried fruit

1 oz cheese                                       1 cup raw vegetables

Post content reviewed by Melanie Pearsall, RD, CDE
Health, Nutrition

Insulin: Get to know me!

By Meredith Kimmish
Dietetic Intern

If you or a loved one is currently living with Type 2 Diabetes, understanding the insulin regimen your healthcare provider has prescribed may be intimidating or difficult to understand. If you sometimes wonder Why am I taking this?; When should I take this?;  or Am I doing this right? you are not alone! Many people living with diabetes use different types of insulin, inject at different times of the day, and have various eating habits. But what does this all mean to you?

First let’s learn the basics on insulin:

  • There are different types of insulin depending on how fast they work, peak times, and how long they last
  • Insulin comes in different strengths and not everyone takes the same dosage
  • Insulin cannot be taken as a pill.  It breaks down before it can be absorbed by the body. That is why it must be injected

Now that we know the basics, let’s look at the 3 features of insulin:

  • Onset– the length of time it takes for insulin to reach the bloodstream and begins its job to lower blood sugars.
  • Peak time– Time during which insulin is working at its full strength to lower blood sugar levels.
  • Duration– How long insulin lasts to lower blood sugar levels.

What Insulin are you currently taking?

  • Rapid acting– Insulins such as Humalog and Novolog have a short onset and are taken with meals (either shortly before, during or right after)
  • Intermediate acting– Insulin such as NPH has a longer onset and duration than rapid acting, so it works between meals
  • Long-Acting- Insulin such as Lantus has the longest onset time and lowers blood glucose evenly throughout the day.
  • Mixed dose– NPH insulin may be mixed with a rapid acting insulin. Mixed dose is usually only used for people with a simple insulin treatment plan.

Check with your healthcare provider and/or CDE if you have any questions about your insulin.  They will work with you on the best time to take your medications.

Checking your Blood Glucose
Insulin needs are based off many factors such as body weight, food intake, physical activity, use of certain drugs, and physical or mental stress. These factors may differ day to day, therefore It is important to check your blood glucose levels regularly. Keeping a log of your blood sugar checks is a great way to help you learn how food, exercise and activity, and stress can affect your blood sugar levels. If you see that your blood sugars are too high or too low for several days, this may be a sign that you need to change your insulin regimen.

Eating Patterns and Meal Planning
Studies have shown that having meal plans and preparations ahead of time can help manage your diabetes. Remember, there is not a standard diabetes meal plan, so create one that works best for you and your lifestyle with long term goal setting.  Having scattered meal periods throughout the day can throw your blood sugar out of whack.  Creating a regular schedule for healthy meal and snack times can help manage your blood sugars by coordinating your insulin regimen with meal times.

If you would like to schedule an appointment with a registered dietitian from Massachusetts General Hospital, call the Outpatient Nutrition Counseling at 617-726-2779.

 Post content reviewed by MGH Pharmacist and Melanie Pearsall, RD, CDE
Guest Post, Health, Nutrition

College Eating- Healthy Lifestyle Living on a Budget

By Ellie

Moving off to college and living on your own for the first time can be a major adjustment. Personally, the biggest adjustment I found was learning how to cook for and feed myself on a regular basis around classes and other activities. Through my experiences in college and living on my own, I’ve acquired a few tips and tricks when it comes to cooking, including tips about cooking for only one person, eating healthy, and eating inexpensively.

Cooking for One

One of the more prominent challenges when it comes to living on your own is adapting recipes – whether they’re from websites, apps or even good ole’ fashioned cook books — that make 4-6 servings for one person. My first tip is embracing freezer meals. By freezing leftovers, you can cook recipes without having to adjust to fit your serving size, and you have future quick and easy meals readily available. All you must do is heat them up! Personally, I’ve found this very helpful with dishes such as lasagna, soups, breakfast sandwiches, muffins, quesadillas, and casseroles.

Another freezer tip you can use is instead of freezing whole meals you can freeze pre-cut ingredients so that they won’t go bad, and they’re ready to use whenever you need them. I’ve found this helpful in: soon to expire fruits that can be used for smoothies; leftover vegetables such as onions, carrots, and celery; and even products like cheese or breads. I use this most often when I need to cut a recipe in half (or even quarters) to fit my serving size.  If I’m left with three-quarters of an onion in my fridge, I’ll cut it up, bag it, and freeze it for future recipes.

Eating Healthy and Inexpensively

A common myth is that it’s cheaper to eat unhealthy foods than healthy foods. Eating healthy doesn’t have to be expensive.  You can save a lot of money by eating out as little as possible and doing more home cooking.   As you do more grocery shopping, you’ll learn that vegetables, grains and beans are much cheaper and more accessible than meat.  I’ve also found that shopping is easier if I plan out what weekly meals I will be cooking at the beginning of the week and decide what ingredients I need before I get to the store.  This way, I’m not making trips to the grocery store every two days or buying things I don’t need that then go to waste. When shopping, be sure to stick to foods that will give you the most nutrients, like brown rice instead of white rice, whole-wheat bread products, and stay away from processed ingredients/foods that are high in sugar. When shopping for produce, you can save a lot of money by buying fruit and vegetables that are in season or on sale in bulk and freezing what you don’t use.

Lastly, many people don’t like to cook at home because they don’t have a lot of cooking experience or confidence. Some would-be cooks don’t know where to find recipes, or they don’t know how to cook for their own food preferences or dietary needs.  There are many great websites, beginner’s cookbooks, and apps with hundreds of delicious recipes and easy to follow, step-by-step instructions for those who are new to the kitchen. These will help you be inspired to eat at home more, which will save you money and help you eat healthier.

Overall, cooking is an individual process. There are going to be ideas that work for you and ideas that don’t.  This will be mostly dictated by personal preferences and needs. The most important thing is to be constant in cooking at home and cooking with quality ingredients.

Post content reviewed by Melanie Pearsall, RD, CDE
Nutrition

A Beginner’s Guide to Meal Planning

Is cooking more meals at home one of your goals for this year?  Great!  Now the next question:  where to start?  Standing in front of the fridge at dinnertime hoping to find some inspiration might work for some, but if cooking at home is new for you it’s probably a good idea to adopt a habit of meal planning.  Essentially, meal planning helps answer the question “what’s for dinner?” for the whole week.  If done regularly, it can help reduce some of the stress of cooking weeknight dinners and save money.  Begin your meal planning practice with these tips:

Plan:  Set aside time to devote to meal planning.  The weekend is usually a good option as you can plan your meals for the following week.  Decide how many meals you will need to prepare, choose your recipes and make a grocery list.

Shop sales/shop in season:  Read through grocery store flyers and plan your menu around what’s on sale.  Fruits and veggies are less expensive (and more flavorful) in season.  Also, look for opportunities to use the same ingredient(s) in more than one recipe.

Stay organized: Get a calendar and fill in the menu for the week.  Keep it someplace you can see it easily (like on your refrigerator).  Save all your recipes in one place so you can find them easily.  If you find recipes online, a Pinterest board may be a good option.

Prep ingredients:  Do as much of the prep work as possible ahead of time.  This is another reason it’s helpful to do your meal planning over the weekend.  Chopping the veggies you need for each recipe or making a big batch of quinoa on Sunday saves time during the week.

Use leftovers:  Practice “cook once, serve twice” when possible.  Make extra servings and bring some for lunch the next day.  Soups and chili can also be frozen for later (just thaw and reheat).

Have a backup plan:  There’s always the chance something unexpected will happen to throw off your plans.  Keep a couple of simple recipes on hand to fall back on in a pinch.

If you’re just starting to cook more at home, start small.  Maybe plan for one or two meals a week.  As you gain more confidence in the kitchen, you’ll be able to do more.  Remember, there’s no right or wrong way to do meal planning.  The most important part is finding a system that works for you and that you can stick with.

Post content reviewed by Melanie Pearsall, RD, CDE

 

Nutrition

Healthy Holidays: Adapting the “Balanced Plate” for Holiday Eating

balanced plateThe Holidays are often filled with rich foods that may not seem to fit into a balanced plate. But, with the proper portions and a few healthy tweaks, you can confidently create a balanced holiday plate without giving up your favorite dishes.

Many traditional holiday foods have a lot of starches and fat, so it’s important to keep in mind the balanced plate when eating during the holidays. Here are some tips to make your holiday eating a breeze!

PROTEIN: 1 palm-sized portion Protein

Make it work: 1 palm-sized portion of white meat turkey, ham, fish, or any other lean protein

Turkey and ham are traditional holiday proteins.  Try to eat more white meat rather than dark meat as this is a leaner source of protein. No matter your choice of holiday protein source, keep your portion to the size of your palm to fulfill your protein needs.

STARCH: 1 fist-sized portion starch

Make it work:  Usually a fist size of starch is recommended, but choosing smaller (½ fist-sized) portions of your favorite starches will allow you to have more options on your plate.  For instance:  ½ fist-sized portion of stuffing AND a ½ a fist-sized portion of mashed potatoes.

Starches can definitely be tricky with all of the options during the holidays. Holiday starches include stuffing, mashed potatoes, sweet potatoes, and dinner rolls.  These tips can help to decrease the carbohydrates and help save room in your balanced plate for some dessert!

Swap 1: Switch out traditional mashed potatoes for mashed cauliflower.  Mashed cauliflower has about 5 times LESS carbohydrates than mashed potatoes. If cauliflower isn’t for you, stick to a small portion size of mashed potatoes and use skim milk instead of cream.

Mashed Cauliflower

Swap 2: Add extra non-starchy vegetables to stuffing to decrease the carbohydrates per serving.

Carrot Mushroom Stuffing

VEGETABLES: 2 fist-sized portions veggies

Make it work: 2 fist-sized portions of non-starchy vegetable side dishes (such as green beans, broccoli, Brussels sprouts, salad, etc.)

Remember that half of the balanced plate should be filled with non-starchy vegetables. Try to avoid dishes with a lot of cheese, butter, or cream and instead choose roasted, sautéed, or raw vegetables.  There are many recipes online with healthier versions of traditional side dishes such as the Healthy Green Bean Casserole recipe below!

Healthy Green Bean Casserole

Roasted Broccoli with Lemon & Parmesan

FRUIT: 1 cup or 1 small piece of fruit

Make it work: Incorporate fruit in a festive way into your holiday meal. Add in any of your favorite seasonal fruits to make a festive, colorful side dish.

Winter Fruit Salad

Beverages

Stick to water as a beverage and save room for all the other delicious things on the plate! Starting the meal off with some lemon water will help you stay hydrated and able to enjoy the entire meal. Be mindful of alcohol, especially holiday drinks like eggnog! These drinks contain a lot of added sugar and fat.  Try switching to healthier versions or other fun beverages with very little added sugar.

Dessert  

There are many recipes out there for lighter versions of holiday desserts.  If you have a family favorite recipe, try searching online for some easy swaps to make sure you can have your pie, and eat it too!

These simple tips can ensure that holiday eating doesn’t wreak havoc on your progress towards a more healthy life! By making a few changes, you can still have all the traditional holiday foods while following the balanced plate guidelines.

Have a happy & healthy holiday season!

Content reviewed by MGH Department of Nutrition and Food Services