Nutrition

Why pair carbohydrates with protein or fat?

By Lindsay Boland, dietetic intern

Blood sugar spikes
Changes in blood sugar levels over time 

Carbohydrates are the body’s primary source of fuel. When we eat carbohydrates, they are broken down into glucose (sugar) which gets absorbed through the small intestine into the bloodstream. Normally when sugar enters the bloodstream, insulin moves the sugar into our cells to where it is either used for immediate energy or stored for energy to be used later.

When you have diabetes, this process may take a little bit longer either because the body doesn’t make enough insulin or can’t use the insulin it makes properly. This leaves sugar hanging out in the blood stream for longer than it should. Therefore, when carbohydrates are consumed in large quantities, it often causes a spike in blood sugar.  Sometimes it may be necessary to take medications or insulin to help move the sugar out of the blood and into the cells.

The good news is we can help prevent these spikes in blood sugar by pairing certain foods together. Protein, fat and fiber require a little more work to be broken down than carbohydrates. This means these foods stay in our stomachs longer and take more time to enter the bloodstream. Pairing carbohydrate foods with a source of protein or fat and some fiber helps slow the absorption of the sugars into the bloodstream. This helps us maintain more steady blood sugar levels throughout the day, which allows our body to use these sugars appropriately for energy.

Snack examples:

CARBOHYDRATE PROTEIN/FAT
1 Medium Apple 1 Tbsp Peanut Butter
5 Whole Grain Crackers 1-2 Hardboiled Eggs
1 Cup Grapes 1oz Cheese
¾ Cup Berries 6-8oz Plain Greek Yogurt
2 Tbsp Dried Fruit 12-15 Almonds
Post content reviewed by Melanie Pearsall, RD, CDE

 

 

 

recipes

Meatball Mummy Crescent Bites

trick or treat ghostCelebrate Halloween with this festive appetizer recipe from the Pediatric Diabetes Clinic

Kitchen Tools:

Knife or Pizza Cutter
Parchment paper
Large cookie sheet

Ingredients:
1 can (8 oz) refrigerated crescent dinner rolls
20 frozen cooked turkey meatballs, thawed
Ketchup or mustard
Marinara sauce (1 oz or 2 tablespoons = 4 gm Carb)

Directions:
Heat oven to 375 degrees Fahrenheit. Put piece of parchment paper on work surface (counter).  Unroll dough onto parchment paper, press out perforations to make one sealed large rectangle.  Cut into 4 small rectangles with knife or pizza cutter

Using knife or pizza cutter, cut each rectangle into 10 strips. You will have 40 strips of dough after all 4 small rectangles cut.

Wrap 2 strips of dough around each meatball to look like “bandages”.

Separate “bandages” near one end to show meatball “face”. Place wrapped meatballs on ungreased large cookie sheet.

Bake 13 to 17 minutes or until dough is light golden brown and meatballs are hot. With ketchup or mustard, draw “eyes” on mummy bites.

Serve warm with marinara sauce if desired.

Prep time: 15 min lTotal time: 30 minutes l Makes: 20 servings l Serving Size: 1 meatball l Carbs per serving: 7 grams

Recipe amended from Pillsbury.com/recipes
Nutrition, recipes

Be Fit Basics : Mango Black Bean Salad

This easy salad recipe from the MGH Be Fit Program is a great use of the leftover grain from last night’s dinner. If you don’t have a cooked grain, substitute fresh or frozen corn kernels instead.  If you can’t find fresh mango, look for frozen cubed mango in the freezer section of your grocery store.  Dislike cilantro? Substitute another green herb, like parsley.

Ingredients:
1 mango, chopped and peeled (or about 1½ to 1¾ cups)
½ cup thinly sliced green onions (scallions), the white and green parts
½ cup cooked grain (use leftover rice, quinoa, etc.) or corn kernels
¼ cup finely chopped cilantro
2 tbsp fresh tomato salsa (or diced tomato)
1-15 ounce can low- sodium black beans, rinsed and drained
juice of 1 lime
2 tbsp olive oil
½ tsp salt (or to taste)
¼ tsp black pepper

Instructions:
In a large bowl, combine all ingredients and toss gently to mix.

Yield:  Serves 6

Nutrition Information per Serving (about 2/3 cup – nutrition information calculated with brown rice):  Calories:  160 • Protein:  5g • Sodium:  250mg
Carbohydrate: 27g • Fiber:5g • Fat: 5g • Sat Fat:1g

Recipe adapted from Cooking Light.  Originally posted on mghbefit.com
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
Health

Standards of Medical Care in Diabetes 2018

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NPThe American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people with diabetes. Beginning in 2018 the ADA will publish updates online as they become available if new evidence or regulatory changes require immediate incorporation. The new recommendations include the areas of cardiovascular health, health technology, screening , and patient centered care. These standards are meant to provide general treatment goals for people with diabetes. They are not meant to replace clinical judgment. I am going to briefly review some of the changes this year.  A more detailed explanation of the standards can be found here.  Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.

Section 1: Improving Care and Promoting Health in Populations

Care for people with diabetes includes assessing for financial resources, access to care, stability of housing situation, ability to access healthy food, and medication use.  Additional support for diabetes self-management can come from community health workers, navigators (who help “navigate” health insurance and claims), and lay health coaches who help with self-management.

Section 2: Classification and Diagnosis of Diabetes

Certain medical diagnoses can make A1c test results less accurate. People with conditions that affect red blood cells, such as sickle cell anemia, may get an incorrect result. It is important to use other methods to test for diagnosis and control of diabetes such as fasting and postprandial (after meal) glucose levels.

Section 3: Comprehensive Medical Evaluation and Assessment of Comorbidities

Pancreatitis is now listed as a comorbid condition (another condition a person can have along with diabetes).

Serum testosterone should be checked in men with symptoms of hypogonadism.

Section 4: Lifestyle Management and Section 6: Glycemic Targets

Both sections address the ADA recommendations for using technology to help with diabetes management.  This could include teleconference, text messages, or email. The use of continuous glucose monitoring (CGM) for people with Type 1 Diabetes should start at age 18.

Section 8: Pharmacologic Approaches to Glycemic Treatment

Recent study data has shown that all patients newly diagnosed with diabetes should be following strict lifestyle changes and start metformin. People with heart disease should consider additional medication(s) that may reduce cardiovascular events/mortality.

Section 9: Cardiovascular Disease and Risk Management

People with hypertension (high blood pressure) and diabetes should monitor their home readings to help to identify white coat hypertension and to improve medication management and following directions for taking medications. The ADA defines hypertension as blood pressure of 140 or greater /90 or greater.

Lipid management recommendations were changed to group risk in two broad categories: with heart disease and without.

Section 11: Older Adults

It is very important to individualize medical therapy in older adults to achieve the best results without any adverse reactions, such as hypoglycemia. A1c target should be adjusted for age and other medical conditio

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