Snacking and Diabetes

Question of the Week from FOODPICKER.org:

Tom R. asks: "I have been diagnosed with type 2 diabetes. During the day at work I eat very little, but in the evenings and weekends, I can't seem to stay out of the kitchen. Do you have any suggestions to control my snacking in the evenings and weekends?"

Answer: Before I offer some snacking tips, we should take a step back to examine your food pattern. Not eating much during the day sets yourself up for two problems: 1) unstable blood glucose levels and 2) excessive eating/snacking later in the day. Unfortunately, many popular snack foods are loaded with carbohydrates and fat, and contain very few nutrients and fiber, e.g. potato chips, corn chips, pretzels, etc.

It is especially important for people with diabetes to eat small meals throughout the day to keep blood glucose and energy levels stable. If you are not used to eating breakfast or lunch, I would suggest starting with something small, like a piece of whole grain bread with natural peanut butter. Plan to bring some healthy snacks with you to work. Some examples include:

• Almonds, walnuts or other nuts - plain or lightly salted
  
• Low-fat string cheese
• Hard boiled egg
• Apple or piece of fruit
• Hummus with carrot and celery sticks
• Greek yogurt - much lower in sugar and higher in protein than regular yogurt!
  
• Light or plain microwave popped corn

I think you'll find that slowing altering your eating pattern to include several small meals spread throughout the day will help with both issues I mentioned.

However, I do have some suggestions for snacking at home. First, when you find yourself hankering for a snack, take a few minutes to decide if you are really hungry or if you just "want" something - there may be a difference. If you aren't sure, start with some unsweetened, flavored seltzer water, sugar-free gum or herbal tea and then see how you feel.

I also suggest altering the availability of snack foods in your home - get rid of it or don't buy it! As I mentioned, most typical snack foods have few nutrients and they are designed to be tasty and leave you wanting more. They are hard for anyone to resist. Until you establish new habits, it is easiest to simply not have it available. Unless you live alone, this may take some family negotiations - see if you can limit the amount available if not everyone is on board.

Instead of chips or candy, have low-calorie, high fiber items around such as popped corn (you can make it and flavor it yourself on the stovetop or in the microwave) and fresh crunchy veggies (carrots, celery, broccoli), which are satisfying to chew. If you absolutely need to have something sweet, frozen grapes make a great treat, or you can try some sugar-free jello or a piece of high-quality dark chocolate (70% cocoa) - you'd be surprised at how satisfying a small piece can be. Good luck!

Question of the Week: Sugar Substitutes and Diabetes

Here is this week's question from FOODPICKER.org:

Q: What is the best sugar substitute to use for baking and daily use for diabetics?

A: These days, you have a choice of many sugar substitutes, unlike years ago when people with diabetes were stuck with saccharin. There are many more available today: Aspartame (NutraSweet or Equal), acesulfame potassium (Sunett and Sweet One), saccharin (Sweet'n Low), sucralose (Splenda), rebaudioside A (also called rebiana or reb-A, which is derived from the stevia plant) and various sugar alcohols (maltitol, xylitol, erythritol and many more). Truvia, a new sweetener on the market, is a combination of erythritol and rebiana.

If by "daily use" you mean for use in coffee or tea, the choice is really up to your tastebuds. However, please know that some artificial sweeteners do contain a small amount of carbohydrate. When used in moderation, these sweeteners should not hugely impact your blood glucose - but only you will know how it affects you when you check your blood glucose levels. Please be aware that sugar alcohols are not absorbed in the small intestine, and may cause gas or diarrhea - proceed with caution until you know how they affect you.

Since most sugar substitutes are many times sweeter than sugar, this creates volume and texture problems when making baked goods. However, there are some good options out there: Splenda and Truvia make a crystalline product which measures out the same as sugar, cup-for-cup. I would check each manufacturer's website for information on use in baking and recipe ideas.

While you may lower the carbohydrate content of baked goods by using a sugar substitute instead of sugar, be aware that flour is itself a source of carbohydrate. Just keep this in mind when planning your meals, and you can find a way to have some treats while also managing your blood glucose levels.

A final, personal note:

It is a myth that people with diabetes must buy special "diabetic" food (or supplements) and cannot have sweets. People with diabetes can eat a healthful diet of real foods - yes, treats too - just like everyone else should! The difference is in the planning and combination of foods, which is why it is essential for people with diabetes to meet with a Registered Dietitian (RD) or Certified Diabetes Educator (CDE) to formulate a meal plan.

Artificial sweeteners are often a hot-button issue. I respect the choice to use them, but I am not a huge fan of any of them. Our palates are quite malleable and, given the opportunity, will adjust to varying levels of tastes. Artificial sweeteners undermine this process by keeping the palate used to a heightened level of sweetness. I usually advise slowly cutting back on sugar and/or sugar substitutes bit by bit - try it, you might be surprised at what you can adapt to!

Ever wonder why you don't see those 'drink milk/eat dairy to lose weight' ads anymore?

Yeah, me too. I recently discovered why: it is no longer legal to make this claim. Oh, there are ways around it, sure - now the message is only implied in advertisements, not explicitly stated. In class last week, we examined what used to be the most oft-cited research to support the claim that dairy foods aid weight loss. Let's take a look at:

Zemel MB, Thompson W, Milstead A, Morris K, Campbell, P. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obesity Research 2004;12:582-590

This was a randomized, placebo-controlled trial (a very strong study design) that sought to determine the effects of increasing dietary calcium (read: dairy products) during caloric restriction in humans. In other words, does dairy or calcium help weight loss? The trial lasted 24 weeks. The subjects were healthy, obese men and women between the ages of 18 and 60. 34 women and 7 men started the trial (n=41), and 27 women and 5 men actually completed the trial (n=32).

Subjects were randomized into 3 diet groups: high dairy diet (providing 1200-1300mg calcium), calcium-supplemented diet (approx 500mg calcium from food + 800mg from a supplement), and control diet (identical diet to calcium-supplemented diet, except with a placebo supplement). All 3 diets were designed to create a 500kcal/day deficit.

Main outcomes included overall change in body weight, total fat loss (as measured by a DXA scan), fat loss from trunk region (measured by waist circumference and DXA scan). All of this seems well and good. Strong study design, monitoring with reliable tests...the authors even state on p. 584 that "all subjects maintained complete daily diet diaries throughout the study, and compliance was assessed by weekly subject interview, review of the diet diary, and pill counts." Impressive! Too bad they don't report this data. We have no idea what the subjects were actually doing.

Now, for the results: As expected, all subjects lost some weight. For overall body weight (which is the only outcome I will discuss here, for the sake of time and space, and the space-time continuum): the control group lost 6.4 +/- 2.5% of their body weight. The calcium-supplemented group lost 8.6 +/- 1.1%, and the high-dairy group lost 10.9 +/- 1.6% of their body weight. Ok, the high dairy group lost the most weight. Seems like the end of the story, right? I'll get back to that in a minute.

I shouldn't forget to mention some limitations of this study: small sample size (only 32 completers), mostly women, we have no idea exactly what they were consuming during the study because even though it was assessed, those data were not reported.

Now, the lead author of this research wrote a diet book, The Calcium Key, in which he states that study after study has "proven" that low-fat dairy foods work wonders for weight loss, and that you can "increase the amount of weight lost by 70%."

Hmm...

Sure, the control group lost 6.4% of their body weight compared to the 10.9% lost by people on the high-dairy diet. This is an increase of 70%, but what does it actually mean? The control group lost 6.6 kg (14.5 lbs) during the 24 weeks, the calcium-supplemented group lost 8.6kg (18.9 lbs) and the high-dairy group lost approximately 11 kg (24.2 lbs) in 24 weeks. Wow! 1 pound per week!

Remember that all subjects were supposedly eating a diet with a 500kcal/day deficit - this should promote a healthy weight loss of 1 lb per week, no matter how much dairy or calcium one consumes (3500 kcal = 1 lb; 500 kcal x 7 days = 3500 kcal). Perhaps the high-dairy group subjects were simply more compliant with the diet? Again, data not reported, so we don't know.

I hardly think this one study showing us that we can increase weight loss from 2/3 lb per week to a 1 lb per week is grounds for the dairy council plastering posters everywhere (well, they used to be everywhere). Oh, and this research was supported by the National Dairy Council. Not surprising.

What is surprising are the economics and conflicts of interest in this research (i.e. the lead author's employer holds a patent on the claim that dairy consumption improves weight loss!) check out this post from Parke Wilde, who teaches U.S. Food Policy at the Friedman School of Nutrition Science and Policy at Tufts University.

Question of the Week from FOODPICKER.org

Here is a question I received from FOODPICKER.org:

"I have type 2 diabetes and high blood pressure. Someone suggested I try “Original No Salt” which is Sodium-free instead of salt. Is it a safe alternative for my use?"

A: "Original No Salt" does not contain sodium, and thus is safe to use if you have hypertension, also known as high blood pressure. There is a direct link between sodium intake and an increase in blood pressure, which is why you are told to lower the sodium in your diet.

Products such as "Original No Salt" are good alternatives to table salt, but there are many other ways to flavor your food. You might try herbs (fresh herbs are particularly flavorful), spices, pepper, lemon and lime juice. Mrs Dash is a brand of salt-free herb flavor mixes, but you can easily create your own herb mix at home for a fraction of the cost - just buy your favorite herbs and mix together in a jar. Here are some other seasoning ideas from the American Heart Association.

You should also be aware that the majority of sodium in our diet comes from processed foods - NOT from salt added during cooking or at the table. Processed foods are loaded with sodium! Be sure to check both the serving size and the sodium content of any food you buy with a Nutrition Facts label. Foods particularly high in sodium include anything canned (soups, beans and vegetables), lunch meats, sausage, salami and cheese. Sodium content will vary from brand-to-brand, so be sure to do some comparing.

By making simple substitutions, you can dramatically reduce the sodium you eat: buy frozen or fresh vegetables instead of canned. Buy dehydrated beans (in bags) and cook your own, or rinse canned beans before eating.

You may also be interested in learning about the DASH (Dietary Approaches to Stop Hypertension) diet plan which has been shown to lower blood pressure. The DASH diet focuses on plenty of fresh vegetables, fruits, low fat dairy, whole grains, nuts and lean meats. This diet would also be appropriate for someone with type 2 diabetes. You can learn more about the DASH diet here and here is a brochure (pdf)

Do you know someone with diabetes? They can send their questions to: diabetes@foodpicker.org

Check out: www.FoodPicker.org for Diabetes Nutrition Education

I just became a nutrition editor at www.foodpicker.org - a website designed to help people with diabetes make better food choices.

I became particularly interested in counseling people with diabetes while I was a dietetic intern at the fabulous Naomi Berrie Diabetes Center in Manhattan.

In the United States, 24 million people have diabetes and an estimate 57 million have pre-diabetes. There is a direct correlation between what a person with diabetes eats and their blood glucose levels. The risk for health complications increases the longer blood glucose remains uncontrolled. Do you know what well-controlled diabetes is a risk factor for?

Nothing!

My hope in joining this project at www.foodpicker.org is to provide a credible discussion of nutrition and diabetes-related topics. I will be posting about these, in addition to my usual favorite: how health and nutrition research is distorted by the media.

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