Nutrition, Uncategorized

Who Knew Carbohydrates Could Be So Simple – or Complex?

By Shannon Evins
Dietetic Intern

With various medications, glucose tests, and protocols to follow, diabetes can seem an overwhelming subject to master. Doctors, nurses, dietitians, and other health professionals start throwing numbers and words like carbohydrates and glucose at you and telling you what you should and should not eat. By now, most people know that carbohydrates are at the center of what affects blood sugar. To get to the root of the problem and simplify the concept, it is important to understand the different kinds of carbohydrates. They can be split into two main groups: simple or complex.

Simple carbohydrates are the things you normally think of when someone mentions high blood sugar – candy, cakes, cookies, pies, pastries, etc. They are called simple because they are easy for your body to digest and so spike your blood sugar quickly. It is best to avoid or watch the portion size of simple carbohydrates. Here are some other simple carbohydrates that people often overlook although they have the same effect as table sugar on your body: brown sugar, honey, molasses, maple syrup, corn syrup, jams/jellies, fruit juice, and soda.

Complex carbohydrates, on the other hand, take longer to break down which means a slower release of energy and less of a spike in your blood sugar. They also often have a higher content of fiber and nutrients, so everyone, not just people with diabetes, should focus on eating complex carbohydrates. Common complex carbohydrates include whole-grain items (whole-wheat bread, whole-grain cereal, brown rice, whole-wheat pasta, etc.), corn, beans, lentils, peas, potatoes, winter squashes or pumpkin, and whole fruits.

To better understand the concept of simple versus complex carbohydrates, let’s go back to the days of arts and crafts and imagine carbohydrates this way: say you have some beads and string and want to make a necklace. You have to add the beads one-by-one to the string in order to make the necklace. Each bead represents a sugar molecule. Simple carbohydrates are the equivalent of just two beads on that string. It would take you no time at all to add those beads to the string. Complex carbohydrates, however, have several more beads on the string, meaning it would take longer to put together. Similarly, your body is doing this for digestion but in reverse – each bead is being removed from the string, meaning each sugar molecule is being broken down and digested. It takes only a short amount of time for your body to digest two molecules versus several.

Overall, carbohydrates are very important for bodily functions because they are the main fuel source for your body. Just remember that it is best to eat them as part of a balanced meal with a fat or protein source and vegetables in order to stabilize blood sugar. Simple (or complex) enough?

(Post content reviewed by MGH Department of Nutrition and Food Services)
Health, Uncategorized

Another “Mini”Relaxation Exercise

Meditation picture

The holiday season is “the most wonderful time of the year.”  It’s also the time of year many feel the most stressed! The relaxation response is the body’s natural counter to the stress response.  If you’re feeling holiday stress starting to creep 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.
Uncategorized

Prediabetes

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

What is prediabetes? Does it become diabetes? How is it diagnosed? How can it be treated? Do medications work? I feel like I have more and more patients asking me these questions and with recent statistics stating that over 54 million people in the US have prediabetes, I’m probably right. Prediabetes is a condition where the blood sugar is elevated but not so elevated that it’s diabetes. It typically does not have any symptoms, but there are instances where people might have symptoms of problems commonly associated with diabetes, such as retina changes or neuropathy. Some people may have a change in their skin called acanthosis nigricans. This means that the skin is darker in color in places like the armpit, behind the neck, or on the elbows, knees or knuckles.

Prediabetes is diagnosed with the same blood tests as those used to diagnose diabetes but the result parameters are different. Prediabetes is diagnosed when the A1C is between 5.7% and 6.4%; fasting glucose is between 100mg/dl and 125mg/dl; or when the 2 hour oral glucose tolerance test is between 140mg/dl and 199mg/dl. People that have a positive test are advised to have the test rechecked every 1 to 2 years to monitor for type 2 diabetes.

The cause of prediabetes is not known but it is thought that genetics may play a part and that there is increased insulin resistance. Much like with diabetes, there are established risk factors for the development of prediabetes. These risk factors include: age; positive family history; being of African American, Asian, Pacific Indian, and Hispanic ethnicity; overweight (especially with an increased abdominal girth); being sedentary; and PCOS (polycystic ovarian syndrome). A diagnosis of prediabetes does not mean an automatic progression to type 2 diabetes, but many people will progress to diabetes within 10 years of initial diagnosis.

There are many things that can be done to improve your health and possibly help the blood sugar values revert to normal range. There are some instances where metformin (Glucophage), a medication commonly used to treat type 2 diabetes, may be started, but that is an individual decision between the patient and their health care provider. The mainstay of treatment consists of lifestyle changes. For example: eating smaller portions, avoiding sugary beverages and fried foods, and walking most days of the week for 30 minutes at a moderate pace. I always tell my patients that they don’t have to join a gym or run a marathon, but they do have to move a little bit more each day. Remember, walking is the least costly form of exercise and will yield great benefits for your physical and mental health. I hope I have provided answers to your questions and some healthful tips to try and incorporate into your daily life. Now, I think I’ll take my own advice and leave the laptop behind so I can go take a walk in this gorgeous sunshine.

Uncategorized

Potato Basil Frittata

A frittata (similar to an omelet) can effortlessly transition from brunch to a quick weeknight dinner, being both elegant and easy.  Add a side salad to round out your meal.

Ingredients:
2 tbsp olive oil
4 red potatoes, peel left on, cubed
8 extra large eggs
¼ cup low fat milk or soymilk
½ cup basil, chopped
1/3 cup scallions, chopped
¼ cup grated pecorino romano or parmigiano reggiano cheese
3 ounces goat cheese, sliced into rounds
Pinch of salt and pepper

Instructions:
Heat a sauté pan on medium heat and then add olive oil. Add cubed potatoes and sauté, stirring occasionally, until potatoes are tender when pierced with a fork (about 15 minutes). Meanwhile in a separate bowl, whisk the eggs; then stir milk, basil, scallions, grated cheese, and salt and pepper into eggs. Turn on oven broiler.

Pour the egg mixture over the potatoes and cook on medium low heat for 3-5 minutes,
occasionally running a rubber spatula around the edges of the frittata to loosen. Frittata is ready for the broiler when eggs around the edge of the pan start to set, but the middle is still loose.

Top frittata with goat cheese rounds and place under the broiler for about 3 minutes or until eggs are set throughout. Run your spatula along the sides and bottom of the frittata to loosen from the pan and place on large plate or platter.

Yield: 8 servings

Nutrition Information per Serving:
Calories: 273 • Protein: 15g • Sodium: 327g • Carbohydrate: 18g • Fiber: 2g
Fat: 15.5g • Sat Fat: 6g

Uncategorized

Standards of Medical Care in Diabetes 2015

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people with diabetes. They were formally called Clinical Practice Recommendations but are now referred to as Standards of Medical Care in Diabetes. I would like to acknowledge that Dr. Deborah Wexler from the Diabetes Center at MGH is a member of the Professional Practice Group of the ADA, Glycemic Group Subchair. This group edits the Standards of Care and reviews ADA Position Statements.

These standards are meant to provide general treatment goals for patients with diabetes. They are not meant to replace clinical judgment. I am going to briefly review some of the changes this year; visit the American Diabetes Association website for a more detailed explanation of the standards. Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.

The ADA determined that the following themes were to be considered by clinicians, policymakers, and patient advocates at all times:

  1. Patient-Centeredness – These recommendations are a guide to care and must be adapted to each patient’s individual needs. There is no “one size fits all” in the care of diabetes.
  2. Diabetes Across the Life Span – People with Type 1 and Type 2 Diabetes are not only increasing in number, but are also living longer. There are few clinical trials that address the needs of this population, so it’s important that all health care team members communicate well to be sure the best care is provided.
  3. Advocacy for People with Diabetes – Living with diabetes is challenging. It’s important for all of us in this field to act as educators for our patients and the community. This is the best way to avoid issues of discrimination. The ADA has published position papers on diabetes and employment, diabetes and driving, and diabetes and correctional institutions, to name a few.

Standards Review of Changes

S2: Classification and Diagnosis of Diabetes – Screening of overweight Asian adults with another risk factor should be considered at a BMI of 23 or greater. All other overweight patients with another risk factor should be screened at a BMI of 25 or greater.

S4: Foundations of Care/Education – The ADA supports diabetes self-management education (DSME) for all patients with pre-diabetes and diabetes. This model has better health outcomes as well as possibly resulting in cost savings.

S4: Foundations of Care/Physical Activity – It’s important to be as active as possible. Sitting for more than 90 minutes at a time should be avoided.

S4: Foundations of Care/Smoking Cessation – E-cigarettes are not supported by evidence based research as a good alternative to tobacco products.

S4: Foundation of Care/Immunizations – All patients with diabetes need to be vaccinated annually for influenza. Hepatitis B immunizations should be provided for people ages 19-59 and there is consideration of this being done across the lifespan. Pneumococcal vaccination is also important. These recommendations are based upon the Centers of Disease Control (CDC) recommendations:

  • People over the age of 2 should receive the PPSV23 vaccine.
  • Adults who are 65 or older and HAVE NOT been vaccinated should receive the PCV13 vaccine and the PPSV23 vaccine 6-12 months after the initial vaccine.
  • Adults who are 65 or older and HAVE received PPSV23 should receive a follow up within 12 months of the PCV13 vaccine.

S6: Glycemic Targets – Pre-meal targets have been changed from 70-130 mg/dL to 80-130 mg/dL to better avoid episodes of hypoglycemia.

S7: Approaches to Glycemic Treatment – The algorithm for medication management of diabetes has been updated to include the newest medications available for the treatment of diabetes. Lifestyle changes including healthy eating, weight control, activity, and education are still extremely important in all management strategies for diabetes.

S8: Cardiovascular Disease and Risk Management – The goal for patients with hypertension is now <140/<90. It is also perfectly acceptable for this goal to be changed to meet individual needs. The goals for lipid management have also been changed to focus more on each person’s individual risk and to keep the LDL <100. Again, this goal may be altered to meet the need of each individual.

S9: Microvascular Complications and Foot Care – Feet should be examined at each office visit if there is a history of deformity, ulcer, or decreased sensation.

S11: Children and Adolescents – An A1c level of 7.5% or lower are acceptable.

S12: Management of Diabetes in Pregnancy – This is a new chapter that provides guidance for the care during pregnancy from pre-conception across the lifespan.

It is important to remember that these standards are not the final say in how to care for people with diabetes. Always talk with your health care team about what is the best treatment for YOU.

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Uncategorized

Lemon Fish with Carrots and Celery

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