Ask the Nutritionist Chat Archive 2/5/08 - American Diabetes Association (via Mowser)

Ask the Nutritionist Archive, Tuesday, February 5, 2008

The American Diabetes Association is pleased to present ADA Live! - a series of live Q&A sessions on topics related to diabetes and healthy living.

During this chat Stephanie A. Dunbar, MPH, RD, ADA Director of Nutrition and Clinical Affairs, discussed and answered questions on heart healthy eating.

This live event is designed to provide conversation around healthy eating. The information provided is for informational purposes only and is not meant to substitute for the advice of your dietitian or physician. We hope your questions have been answered and we look forward to serving you again in the future. If you have a medical emergency dial 911 for immediate help.

Editor`s Note: The American Diabetes Association`s moderators retain editorial control over ADA Live discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

ADA_Moderator: Welcome to ADA Live!

Today our guest is Stephanie A. Dunbar, MPH, RD, ADA Director of Nutrition and Clinical Affairs, will discuss and answer your questions on heart healthy eating

Thanks for coming today Stephanie.

Stephanie_Dunbar: Thanks, it's so nice to be here.

Shepherd__TX: Is diet used in the management of diabetes?

Stephanie_Dunbar: Absolutely. What you eat is key for managing diabetes. There are a lot of things to balance with your diet - monitoring carbohydrate and cutting back on "bad fats" to lower your risk of heart disease at the same time. To keep blood glucose levels in check, you have to have a balance between the carbohydrates that you eat, how much exercise you do and any medications you take that lower blood glucose levels. But that is not all you need to worry about. The most common complication of diabetes is heart attack and stroke. Most people think it is eye or kidney problems - but that isn`t true. So you always want to do what you can to reduce your risk factors for heart disease. This includes eating a healthy diet, exercising daily, and trying to lose weight if you need to.

Newark__NJ: Why should I worry about my cholesterol levels?

Stephanie_Dunbar: People with diabetes are at very high risk for heart attacks and strokes because of their diabetes. Some researchers say that just having diabetes is like having had a heart attack! That is how serious heart disease is for people with diabetes. High LDL cholesterol and triglyceride levels and low HDL levels are risk factors for heart disease. This mix of cholesterol problems are very common in people with diabetes. But there are things you can do to lower your risk. Following a diet that is low in saturated and trans fat as well as high in fiber will help to lower your risk. Daily exercise is also very important. At least 30 minutes of exercise like walking will help to lower your risk.

Burlington__VT: My sister told me I should cut back on fat so my bad cholesterol will be better. Is that true? I only worry about the carbs I`m eating.

Stephanie_Dunbar: Your sister is right. For improving cholesterol levels, you want to cut back on the "bad fats" - saturated, trans fat and cholesterol. You can cut back on saturated fats by choosing lean meats and non-fat dairy products. Also cut back on trans fats by avoiding baked products like cookies, cakes and some crackers, as well as margarine and shortening. On the things to eat to improve your cholesterol numbers - increase the non-starchy vegetables you eat. Fill at least 1/2 your plate with salad, brocolli, spinach and other veggies. Include healthy fats - like nuts and vegetable oils for cooking instead of butter or margarine. Eat fish 2-3 times a week. When you eat starchy foods, make them count - choose whole grains like brown rice, whole wheat pasta and oatmeal. Another great food to include are legumes and dried beans - like pinto or black beans. Beans are loaded with fiber. And if you want a sweet taste, reach for fruit instead of candy or white-flour based cookies and cakes.

Indianapolis__Indiana: My wife (65) and I (66) are both overweight pre-diabetics, and desire to lose weight and reduce our risk for diabetes, but do not know anything about what to do or how to do it. ADA is sending us some tips and recipes, but we want to obtain any other info that will aid us in eating right and exercising the correct way. Is there any info available we can get free or at a low cost? We are at the low end of Social Security.

Stephanie_Dunbar: We have a new publication that is free by calling the ADA call center at 1-800-342-2383 (1-800-Diabetes). It is called, "What Can I Eat? The Diabetes Guide to Healthy Food Choices." It has 28 pages of information about food and exercise. I recommend it for everyone who has or is at risk for diabetes.

Delft__The_Netherlands: My cholesterol levels are low, even very low. I reduce sodium use reasonably by replacing it as much as possible with other condiments. I eat two buttered slices of 6 grains bread with Dutch cheese or meat for breakfast and lunch. For dinner I eat 2 medium potatoes, 2 veggies and grilled fish or meat. I do NOT eat any snacks, nor any sugar in tea or coffee. And still I am obese, i.e. 82 kilos for my 5`4. What do you recommend? BTW, One in a while (more or less in a week) I drink ONE glass of wine or a French cognac. My blood sugars are excellent.

Stephanie_Dunbar: I would recommend you write down a detailed list of everything you at and how much you eat for a few days. For example, how much butter on the toast, how many ounces of cheese or meat and are there any toppings on the potato? You can use the information on food labels to total up the calories. You may be eating more calories than you realize. After keeping the record, you can take a look at when you may be able to cut back on portions. Another important factor is exercise. Try to include at least 30 minutes of exercise every day. If you are doing that, try to increase to 60 minutes per day.

Greenwich__CT: Why do alcohol, beer, and wine not count as carbohydrates?

Stephanie_Dunbar: It depends on the type of alcohol as to how you count it. Distilled spirits like vodka - does not contain enough carb. to raise blood glucose levels; however beer does (12 oz of regular counts as about 15 grams of carb. Also, any mixers need to be counted. All alcohol contains calories, but the actual alcohol in the drink doesn`t affect blood glucose levels directly. A cautionary note: advice has changed about alcohol over the past few years. People with diabetes should eat when drinking alcohol and not cut back on their food intake because alcohol can cause hypoglycemia up to 12 or more hours after drinking. Also, quantity is very important - no more than 1 drink for a woman or 2 for a man is the guideline.

Oswego__IL: With things that were previously off-limits now being OK because they are "good fat" how much is to much of that kind of food, i.e. peanut butter and avocado.

Stephanie_Dunbar: I can`t answer your exact question because how much of the good fats you can eat will vary from person to person depending on what else they eat, how much they weigh, etc. Including the "good fats" is important. But remember, you don`t want to just add them to your diet, you want to use them to replace the saturated and trans fats. So for example, instead of cheese and meat on a salad, you can sprinkle some almonds, olives and add a few slices of avocado. Use a vinagrette salad dressing which is usually lower in calories and saturated fats. For breakfast, you can try using peanut butter on a slice of whole grain toast instead of using butter or cream cheese. For cooking, use liquid vegetable oils whenever possible. When you need a solid shortening for baking, try one of the trans-free margarines. I`ve had great success with using these in place of butter or margarine in baked products.

Atlantis__Florida: What type of snack food can a diabetic have in the afternoon that won`t set off a high glucose number when taking a sample before evening meal?

Stephanie_Dunbar: If you are having high blood glucose levels before your evening meal, it should like you need some type of change in your plan. With many of the newer medications and insulins, you don`t have to have a snack anymore in the afternoon to prevent hypoglycemia. If you are taking medication, make sure you know when it works to lower blood glucose as to whether you need an afternoon snack. If you want a snack, but want to avoid the typical options that are higher in carbohydrate, you can try having a small handful of nuts, or some raw vegetables with either a tablespoon of salad dressing or hummus for dipping. You can also try a small can of tomato or vegetable juice. All of the above ideas are heart healthy. If you are looking for something sweet without calories or carbohydrate, try a sugar-free popsicles or sugar-free jello. Other foods that contain no more than 5 grams of carbohydrate are 1 cup of popcorn or 2 saltine-type crackers.

Cleveland__OH: I am type 2 diabetic. I was wondering is it unhealthy to eat salmon everyday, i notice in some pink salmon the cholesterol is high, can i raise my cholesterol by eating salmon everyday?

Stephanie_Dunbar: Salmon is actually a type of fish that is good for your heart! Salmon, as well as other fatty fish like mackerel, sardines, and herring contains omega-3 fatty acids. Salmon has about 50-75 mg of cholesterol in a 3 ounce portion, so it is not excessive. This is about the same as for 3 ounes of chicken breast meat. The benefit of the fish is great because of the omega-3 fatty acids. So compared to other types of meat or poultry, fish is a healthier choice. The only problem with eating salmon every day is that some types can contain mercury. The ADA recommends that everyone with diabetes eat 2-3 servings of fish per week. YOu can find out more about eating fish and mercury levels at the EPA website http://www.fda.gov/oc/opacom/hottopics/mercury/backgrounder.html

Atlantis__Florida: My physician has added the following supplements to my medications: Homosistine Modulator, cinnamon, folic acid, fish oil and chromium picolinate. I know that they have some beifit, but are they really necessary. Also he has suggested Vitamin B6, B12 why not a good multivitimin?

Stephanie_Dunbar: Most people do not need to take all of these supplements unless they have some type of deficiency. The best source of vitamins and minerals is food. If you have any concerns about whether you are getting enough, taking a multivitamin is a good insurance plan.

Dallas__TX: My doctor gave me an 1800 calorie ADA diet to follow. It has a week of menus, but I don`t know what to eat after that. Can you help me?

Stephanie_Dunbar: ADA stopped recommending the "ADA Diet" well over 10 years ago. We recognize that there is not one certain way to eat that will meet everyone`s needs. While the menus can be helpful to get you started, after a while, boredom takes over, and as you`ve found - you don`t know what to eat. Now ADA recommends that each person have an individualized meal plan tailor-fit with their food preference ansd schedule that helps them meet their goals for blood glucose,cholesterol and blood pressure - as well as weight management. Some people carb count and have a set allowance for carbohydrates. some use a simple method called the Plate Method tha tputs an emphasis on proportion control especially for starches, fruit, meat and dairy. Others use the exchange lists, but have the options of choosing their foods instead of following a pre-printed sheet. I would suggest calling our 1-800-DIABETES call center to get additional resources for meal planning.

Centreville__VA: I have been adding about a tablespoon of ground flax seeds to my Bran flakes or All Bran in the morning. A serving size is 2 tablespoons which is equal to 60 calories. How much ground flax seeds are necessary to get the benefit of the omega-3 oil, without adding too many calories?

Stephanie_Dunbar: For beneficial health effects from flax comes from the alpha-linolenic acid or ALA. ALA is also found in walnuts and canola oil. ALA is a precursor to the types of fatty acids that you find in fatty fish such as salmon and tuna. Most of the health benefits studied from omega-3 fatty acids have come from studies using fish or fish oils. Eating 2-3 servings of fish per week supply the beneficial amount of omega-3 fish oils. Recommendations for ALA is about 1.5-3.0 g/day. One tablespoon of ground flax seed contains about 1.6 g. of ALA and is 30 calories.

hondrigata1: I use ground flax seeds in my cereal. A serving is 2 tablespoons which is equal to 60 calories. How much flax seed should I have to get the full benefit?

Stephanie_Dunbar: I just answered another question about flax seed. I think my answer above will answer your question as well.

Joplin__MO: I am a 50 years old male and was just diagnosed 2 weeks ago with type 2 diabetes. Doc said to get more exercise, stay away from sugar and other carbohydrates, and eat a low-fat diet. He said diabetics die from heart disease but not from diabetes. It seems like I can`t eat anything! I`m sick of tuna fish and water.

Stephanie_Dunbar: Much of the advice you received is good, it just doesn't make sense without a few more details to put it into perspective. Getting more exercise is important for helping to lower blood glucose levels and to strengthen your heart. No getting around it - at least 30 minutes per day is essential. For the advice on carbohydrate, you want to cut down on the processed carbs such as white bread and rolls, white pasta and instead, choose whole grain foods such as whole wheat bread, whole wheat pasta and brown rice. But that's not all, you need to keep track of how much you eat and limit your portions of starchy foods. The easiest way to get started with knowing how much carbohydrate to eat - is to limit starchy foods including potatoes, peas and corn to 1/4 of your plate. This leaves 1/2 your plate for non-starchy vegetables that are low in carbohydrate and 1/4 of your plate for lean meats, chicken without the skin or fish. You can use some fats, but choose those that are low in saturated and trans fats. In terms of the advice for cutting back on sugar, this is good for everyone. Americans eat way to much sugar. It has "invaded" our food supply and is not just in cookies and cakes anymore. Sugar does not cause diabetes, but it simply provides excess calories and carbohydrate . . and no one needs those!

katikat_s_mom: What are some low carb foods that are heart healthy?

Stephanie_Dunber: I think we answered a similar question about snacks that wouldn't raise blood glucose levels before dinner. I'd suggest 1 ounce or less of nuts or seeds - like sunflower seeds, non-starchy vegetables with an oil-based salad dressing dip, or even celery with a small amount of peanut butter.

Oklahoma_City__OK: Will fiber help lower my cholesterol?

Stephanie_Dunbar: There are health benefits to fiber, one of which may be lower cholesterol levels. Most Americans get less than Â½ the fiber they need in a day for optimal health.

There are health benefits to fiber, one of which may be lower cholesterol levels. Most Americans get less than Â½ the fiber they need in a day for optimal health. Most women need at least 25 grams of fiber, and men need about 35. It calculates out to 14 grams of fiber per 1,000 calories. Most American get about 12 grams of fiber total. That is not enough for good health! There are many foods that are great sources of fiber and may help lower cholesterol levels as part of an overall diet that is low is saturated fat and cholesterol. Here are some quick ways to add fiber to your diet without. Choosing this combination of foods would give you most of the fiber you need in only about 75 grams of total carbohydrate. Eat Â½ cup of beans per day - in soup, on salads, or as your starchy vegetable for a meal for about 7 grams of fiber Eat a piece of fruit for snack 2 grams Eat at least 1 cup of of non-starchy vegetables with both lunch and dinner for about 8 grams. Eat Â½ cup of oatmeal with 3/4 cup of blueberries for about 5 grams. Eat 1 ounce of walnuts or almonds for 1 gram.

Most women need at least 25 grams of fiber, and men need about 35. It calculates out to 14 grams of fiber per 1,000 calories. Most American get about 12 grams of fiber total. That is not enough for good health!

There are many foods that are great sources of fiber and may help lower cholesterol levels as part of an overall diet that is low is saturated fat and cholesterol. Here are some quick ways to add fiber to your diet without. Choosing this combination of foods would give you most of the fiber you need in only about 75 grams of total carbohydrate.

Eat Â½ cup of beans per day - in soup, on salads, or as your starchy vegetable for a meal for about 7 grams of fiber

Eat a piece of fruit for snack 2 grams

Eat at least 1 cup of of non-starchy vegetables with both lunch and dinner for about 8 grams.

Boston__Mass_: I have high blood pressure and am trying to cut back on sodium. Most of the special low sodium foods cost more. What should I do because I can't afford the higher cost foods?

Stephanie_Dunbar: You are right that there are a lot of lower sodium foods on the market, but sometimes they cost more. It's important for everyone to watch their sodium intake, not just people with high blood pressure. ADA recommends that everyone with diabetes - whether they have high blood pressure or not eat <2300 mg of sodium per day. It's easy to find a can of soup that has that much! So you do have to be careful. Fresh fruits and vegetables, meats and unprocessed grains, like rice or whole oats, don't have added sodium. Most other foods do. If you try to generalize it, the more processed a food, the more sodium. Here are a few tips for cutting back on sodium: Cut back on processed meats and cheeses. Make sandwiches from meat that you have leftover from dinner. Canned foods can be loaded with sodium. If you are using canned vegetables, do not cook them in the water from the can. Dump them out, rinse the vegetables well, and warm them in fresh water. This will significantly reduce the sodium. Frozen vegetables are often lower in sodium, but you do have to read the labels. Those vegetables in sauces will usually be higher. Watchout for condiments and dressings. These are often high in sodium in well, so use just small amounts. And of course, avoid adding salt to foods when you are cooking or at the table. Just 1 teaspoon of salt has 2300 mg of sodium.

Fresh fruits and vegetables, meats and unprocessed grains, like rice or whole oats, don't have added sodium. Most other foods do. If you try to generalize it, the more processed a food, the more sodium. Here are a few tips for cutting back on sodium:

ADA_Moderator: We're close to the end of our time here today. Do you have any thoughts you'd like to leave us with Stephanie?

Stephanie Dunbar: The key take home points are that caring for your heart and reducing your risk for heart disease is an integral part of managing diabetes. Key tips to remember:

The key take home points are that caring for your heart and reducing your risk for heart disease is an integral part of managing diabetes. Key tips to remember: Reduce the unhealthy fats - saturated and trans Increase the healthy fats - polyunsaturated and monounsaturated fats from vegetable oils, nuts, seeds, olive, soy products, avocados Include omega-3 fatty acids from fish and vegetable sources such as canola oil, flax seed and walnuts Increase your fiber intake - include beans and vegetables every day. Choose whole grains and fruits as well to round out your carbohydrate choices Choose lean meats and non-fat dairy. Cut back on the junk foods that have added sugars, fats and calories. And don't forget about trying to achieve a healthy weight if you need to and exercising every day.

Reduce the unhealthy fats - saturated and trans

Increase the healthy fats - polyunsaturated and monounsaturated fats from vegetable oils, nuts, seeds, olive, soy products, avocados

Include omega-3 fatty acids from fish and vegetable sources such as canola oil, flax seed and walnuts

Increase your fiber intake - include beans and vegetables every day. Choose whole grains and fruits as well to round out your carbohydrate choices

Choose lean meats and non-fat dairy.

Cut back on the junk foods that have added sugars, fats and calories.

And don't forget about trying to achieve a healthy weight if you need to and exercising every day.

ADA_Moderator:

That's it for today. Thanks so much for taking the time to be here Stephanie.

Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.

Keep up to date with all the ADA Live events and reference the archives here.

We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid Pharmacists and diabetes experts, will discuss and answer your questions on all aspects of diabetes at 1:00 p.m. EDT Thursday, February 7, 2008. See you then.

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