Garden, Take 1

This year we decided to forgo the CSA we have belonged to for the past two years. The reason? We've finally gone as local as local can get and planted our own vegetable garden! My husband and I have been wanting to grow something more than tomatoes for quite a while, but the summer always seemed to slip away. And with our CSA, we always had plenty of local, organic vegetables. However, this year we were determined to make it on our own.

[Don't get me wrong: I loved our CSA. But it was a bit far for us to travel (opposite side of the county) and I felt that now that I have an honest-to-goodness yard, it should be used for more than growing patchy grass.]

In our garden we planted: broccoli, cabbage, collards, eggplant, cucumbers, romaine and red leaf lettuce, bell peppers and tomatoes. I'm looking forward to eating my first salad completely from the garden! I'm already planning for next year. I'd love to include some squash and potatoes...mmm.

CSA stands for Community Supported Agriculture. Basically, a farmer will sell shares of his or her crops to consumers for the growing season. Instead of grocery shopping, you receive distributions of crops once a week or so, depending on your CSA arrangement. By doing this, the consumer shares in the risks inherent to farming - there are no guarantees.  Farmers feed us, after all - why should they be the only ones taking on the risk? This arrangement benefits both consumer and farmer alike. The farmer has a steady income and can plan for future seasons. The consumer receives a greater quantity of vegetables when the crop prospers and a lesser quantity when it doesn't.  For example, last year's late blight decimated the tomato crop, and we received virtually no tomatoes. In contrast, the year before had us nearly sick of tomatoes they were so plentiful. (Sick of tomatoes? I know, it sounds impossible...but trust me, I couldn't use them fast enough!)

In closing, let me say how great our CSA was/is. We belonged to Restoration Farm located in Old Bethpage, NY. The farm is beautiful and the growers, Caroline and Dan, are amazing. I highly recommend it if you live in Nassau County or even western Suffolk County. The farm is on the grounds of Old Bethpage Village Restoration, a recreation of a mid-19th-century American village. The majority of the buildings are genuine - they were moved to the site from their previous locations and arranged to represent a typical rural Long Island farm village of that time period. Each season the village holds Civil War reenactments, the Long Island agricultural fair and other events. Both the farm and the village are fantastic places to visit if you are in the area.

Have we Traded Trans Fat for Saturated Fat?

According to an article published this week in the New England Journal of Medicine, the answer is no. Read the article here.  The investigation was conducted by a researcher from Harvard Medical School and the Center for Science in the Public Interest (CSPI), one of my favorite organizations and publisher of the Nutrition Action Healthletter.

Trans fats have similar characteristics to saturated fats. With the trans fat labeling requirement in effect since 2006, and the NYC ban on trans fats, many were concerned that manufacturers and chefs would simply replace the trans fat in their products and recipes with saturated fat. If this were the case, would we really be accomplishing anything to improve our overall health?

The researchers conducted two evaluations of 83 reformulated supermarket and restaurant foods (from 1993-2006 and 2008-2009) and discovered that the majority of reformulated foods had less than 0.5g trans fat per serving (the level at which a manufacturer can claim "0g trans fat") and the average amount of saturated fat was " lower, unchanged, or only slightly higher (<0.5 g per serving) than before reformulation."

Keep in mind there are thousands and thousands of products out there and this analysis only closely examined 83 reformulated products...but I still hope this is an indicator of things moving in the right direction - or at least not a wrong one.

Gluten Intolerance?

Here is a question I recently received from FOODPICKER.org:

Jan A. asks: I have type 2 diabetes and just found out I have gluten intolerance.  I haven’t been able to figure out what I can eat.  I have been leaving grains out of my diet.  What should I do?

Answer:  I am so glad to answer this question, as gluten has become a hot issue lately! First, I would like to explain that gluten is not inherently a poison. Gluten is a protein found in wheat. Gluten is strong and stringy, and is responsible for bread's ability to rise without breaking apart and collapsing. You cannot make yeast-rising bread with flour that does not contain gluten.

Gluten contains two fractions, gliadin and glutenin, both of which evoke an autoimmune response in people with Celiac disease. Celiac is an autoimmune disease resulting in an inflammatory condition in the small intestine. The protein fractions of barley and rye (hordeins and secalins, respectively) are closely related to those in gluten, and will also initiate autoimmune activity (although oats are gluten free, they have been suspect in the past due to contamination during processing). People with Celiac disease must eliminate all sources of wheat, barley and rye - and their derivatives - completely from their diets or risk serious damage to their GI tract and a host of other issues.  There is no established threshold for immune response initiation, so complete elimination is paramount.

It is possible that a larger number of people than previously thought are sensitive to gluten. Type 1 diabetes (another autoimmune condition) has been linked to Celiac disease with increasing frequency. However, while there are specific antibody and biopsy tests to help diagnose Celiac disease, tests for gluten sensitivity are generally unreliable. The easiest thing to do is to try a gluten-elimination diet and see if whatever symptoms you are experiencing improve.

Avoiding gluten sounds simple but is actually quite tricky, as gluten is ubiquitous in the average American diet. Keep in mind that "wheat-free" does not mean "gluten-free" and there are many non-food products that must be avoided.

For example, sources of gluten include:

• Bread, pasta and any products made from barley, rye, wheat and any of their derivatives, including  kamut, triticale, spelt, graham, semolina and durum.
• Vinegars made from fermented wheat, rye or barley (malt vinegar)
• Beer, made from fermented barley 
• Soy sauce, made from fermented wheat or barley 
• Gravies, sauces, jellies thickened with flour or starch
• Emulsifiers in some toothpastes contain gluten
• Modified food starch, found in many packaged foods and processed cheeses (and even Twizzlers!)
• Hydrolyzed or Texturized vegetable protein, may use wheat, rye or barley proteins
• Dextrin 
• Malt syrup and malt flavoring (derived from barley; found in some soy and rice milk products)
• Vegetable gum
• Glue on envelopes 
• Prescription and OTC medications may contain wheat starch as a filler
• Lipstick may also contain wheat starch as a dispersing agent/filler
• Natural and artificial flavorings - may contain gluten.

Here is an even more comprehensive list of gluten-containing foods and ingredients.

Ok, so at this point you are probably wondering: “is there anything I can eat?” The answer is yes! 

Naturally gluten-free foods include:

• Fruits
• Vegetables
• Meat, poultry, seafood
• Beans and legumes
• Gluten-Free Grains  (corn, quinoa, rice, oats, millet, amaranth, teff, buckwheat, soybeans, arrowroot)
• Dairy (milk, yogurt and most cheeses)
• Oils and fats 
• Alcohol, except beer

Quinoa is a favorite of mine – it cooks in half the time it takes to make brown rice and is the highest grain source of protein. A gluten-free diet requires you to ‘think outside the box,’ especially in terms of breakfast foods. Why not have a scrambled egg with some quinoa and a piece of fruit?  For lunch, you can create delicious and hearty salads with lettuce, veggies and beans. Top it off with a dressing of olive oil and lemon juice (instead of vinegar). When dining out, be sure to ask your server about dishes with sauces, breading and cream soups (may be roux-based and contain flour). When in doubt, stick to simple, fresh foods and ask for dishes without sauces or gravies.

At home, be aware of possible cross-contamination with foods containing gluten. Wash cutting boards and utensils thoroughly. Use squeeze bottles of condiments whenever possible to avoid contaminating the condiment jar by inserting a utensil that previously contacted gluten-containing foods. Bread crumbs may stick to the insides of toasters (or the toaster oven rack) and may contaminate gluten-free items. Of course, always read the ingredients list when buying packaged food!

There are many gluten-free products out there (breads, cookies, snack bars, etc.). These products may come in handy at times, but are not necessary. Focus on naturally gluten-free foods, especially since many gluten-free products are highly processed and have a higher fat content.

At this point, you may notice that following a gluten-free diet also eliminates many sources of whole grains. For this reason, I do no generally advise anyone to follow a gluten-free diet unless there is a particular reason for doing so – i.e. symptoms related to suspected gluten sensitivity, wheat allergy or a diagnosis of Celiac disease. "Gluten-free" does not automatically mean "healthy." But with some experimentation and practice, it is possible to eat a delicious and healthful gluten-free diet. 

Good luck!

Tolerable Upper Limit for Fructose?

Couldn't have said it better:
http://blog.nutritiondata.com/ndblog/2010/04/fructose-poison-or-nutrient-or-both.html

Sugarless Candy (and sugar alcohols)

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

Jeff W. asks:  My doctor recently diagnosed me with type 2 diabetes.  I know it is important to watch my sugar intake.  Is sugarless candy really sugarless?

Answer:  While sugarless candy will not contain sugar, be aware that it may contain other sources of carbohydrate. All carbohydrates will affect blood sugar, be it candy, potatoes or bread.  (Really, all food will affect blood sugar, but carbohydrates have the greatest effect.) In the past, people diagnosed with diabetes were told they were not allowed to eat sugar. This is no longer true. People with diabetes can eat any foods but must pay closer attention to portion sizes and combination of foods.

Candy sweetened with sugar is a source of concentrated carbohydrate. You may choose to substitute with sugarless candy, but be sure to read the label and note the amount of carbohydrate in each serving - and the serving size! I would also suggest reading the ingredients listing and noting which artificial sweetener is used in the product.

Sugarless candy is often sweetened with sugar alcohols. The names of sugar alcohols usually end in -ol; some common ones are sorbitol, maltitol, xylitol, mannitol and lactitol. Sugar alcohols are metabolized differently than sugar, so they will not raise you blood glucose quite as much as sugar and they have slightly fewer calories. However, ingestion of large amounts of sugar alcohols may cause diarrhea. This occurs because sugar alcohols are usually not fully digested. The presence of undigested carbohydrate in the intestine alters the osmotic pressure, thus causing water to be drawn into the intestine, resulting in diarrhea. This reaction to sugar alcohols varies from person to person, so keep this in mind when trying out sugarless candy made with sugar alcohols.

Everyone is different -  sugarless candy may affect your blood glucose differently than someone else with type 2 diabetes. As with incorporating any new food into your diet, the only way to know for sure is to try a small amount and test your blood glucose.

Reversing diabetes?

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

Tammy S. asks: My 45 year-old husband was diagnosed with type 2 diabetes a few months ago.  Is it true that you can reverse diabetes?

Answer:  Confusion abounds regarding whether or not type 2 diabetes can be reversed! The short answer is no. Diabetes is a chronic condition that cannot be cured - it can, however, be managed. There is a distinct difference.

Type 2 diabetes occurs when the pancreas either does not produce enough insulin, or the body's cells do not respond to insulin properly (insulin resistance). In either case, the not enough glucose is moved from the bloodstream into the body's tissues, and you are left with high blood glucose levels.

Let's look at an example: 2 hours after a meal, blood glucose should be below 140 mg/dl. When your blood glucose is over 140 for longer than 2 hours, other constituents of blood are skewed: triglyceride levels increase, fibrinogen (used in clotting) decreases. Over time (in terms of years) this will increase your chances of damaging the tiny blood vessels in eyes, kidneys and nerves - leading to a host of other problems.

A person without diabetes can eat chocolate cake or a salad for lunch - in either case, 2 hours after a meal his/her blood glucose will be below 140 (probably more like 120). The pancreas will compensate depending on what is eaten. In a person with type 2 diabetes, like your husband, eating chocolate cake for lunch (and nothing else) puts a huge glucose load on his bloodstream. His pancreas kicks into overdrive to compensate, but it just can't keep up. Two hours later his pancreas is still trying to clear all the blood of the sugar from lunch. It's like using a spork to eat soup - it sort of works, but is not totally efficient! Now, if your husband had eaten a salad and maybe some broiled fish or chicken followed by a smaller portion of chocolate cake, his blood glucose might be within a normal range 2 hours later.

Does that mean his diabetes is cured? No! If he goes back to eating cake for lunch, his diabetes manifests again.

However, diabetes complications should not be considered manifest destiny! This does not mean that you cannot live a healthy, long life with diabetes. Treatment of type 2 diabetes includes a healthful diet, physical activity, blood sugar monitoring and medication. 

The most successful person with type 2 diabetes takes control of their treatment by:

• testing blood sugar as recommended
• following a meal plan to control blood sugar
• exercising on a regular basis
• taking medications as prescribed
• maintaining a healthy body weight (or losing weight, if needed)
• visiting healthcare providers on a regular basis - endocrinologist, dietitian, CDE, etc.)

Possible diabetes? Fasting glucose question

Below is a question I recently received from FOODPICKER.org

Susan D. asks: My fasting glucose number was 127.  Does this sound like pre-diabetes or diabetes?  What should I do to control by blood sugar?

Answer:  Diabetes is usually diagnosed if your blood glucose level exceeds 125 mg/dL during a fasting plasma glucose test. This test is usually conducted on more than one occasion to confirm the diagnosis. Three types of blood tests are to diagnose diabetes: 

• A Fasting plasma glucose test measures your blood glucose after fasting (not eating anything) for at least 8 hours. 
  
  
• An oral glucose tolerance test also starts with you in the fasted state, then you drink a glucose-containing beverage and your blood glucose levels are monitored for 2 hours afterwards.
  
  
• A random (or casual) plasma glucose test measures blood glucose at any point in time, without regard to when you last ate. 

Here is some more information regarding diabetes diagnosis from the NIH's National Diabetes Informational Clearinghouse. Since a blood glucose of 127 mg/dL is just above the cutoff, your doctor will likely repeat the fasting test or have you complete an oral glucose tolerance test before officially diagnosing you.

If your diagnosis of diabetes is confirmed, you should speak to your doctor regarding treatment. Generally, this involves blood glucose monitoring, oral medications, exercise and diet changes. Most notably, you will need to take care to spread carbohydrates evenly throughout the day. This may seem overwhelming, but there is a lot of help available! Often the best way to get started is by attending a diabetes education class or making an appointment with a Certified Diabetes Educator or Registered Dietitian. Check out this post from a few weeks ago for some more ideas in finding help. 

Send your questions to diabetes@foodpicker.org or directly to me at jjznutrition@gmail.com

Prediabetes, weight loss and fruits & vegetables

Here is a question I recently received from FOODPICKER.org:

Bob R.: I have pre-diabetes and am trying to lose weight.  How many servings of fruit and veggies should I have each day?

Answer: Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. It's great that you have already decided to take the first step to better health! According to the American Diabetes Association losing as little as 5-10% of your body weight (approximately 10-15lbs), along with engaging in regular activity, may help you delay or prevent the development of type 2 diabetes.

In general, adults should consume about 3 cups of vegetables and 2 cups of fruit everyday.  But what counts as a cup? This may be confusing. In general, 1 cup of raw or cooked vegetables or 2 cups of raw leafy greens should be considered 1 cup of vegetables. For fruits, 1 cup of chopped fruit or ½ cup of dried fruit can be considered 1 cup. Here is a handy vegetable chart and a handy fruit chart from MyPyramid.gov that should help clear things up a bit.

You'll notice that both vegetable juices and fruit juices are also on the MyPyramid charts. In terms of watching your blood glucose levels, juices have two major strikes against them: they contain little to no fiber, and are a concentrated source of sugars. Drink juices in moderation! Also be sure to look out for starchy vegetables like potatoes, corn and peas. Starchy vegetables are much higher in carbohydrate than their non-starchy or cruciferous counterparts. Go for vegetables like broccoli, kale, lettuce, cabbage, cauliflower, chard, bok choy and bell peppers. Check out http://www.choosemyplate.gov/  for menu planning tips and to track and assess your food intake. Also visit FruitsandVeggiesMoreMatters.org for recipe ideas.

Don't forget that regular, moderate exercise is an important part of a healthy lifestyle. You don't have to join a gym - try walking for 30 minutes, 5 days a week. It will make a difference.

New Type 2? Think there's nothing to eat?

Question of the week from FOODPICKER.org:

Susan A.: I was diagnosed with type 2 diabetes last month.  I’m having difficulty understanding how many carbs and sugar I can have each day.  I’m finding that nearly everything contains carbs and sugar!  Can you help me with this?
 
Answer: Asking for help is the first step in learning diabetes self-management. You might start by asking your endocrinologist or primary care doctor to refer you any classes in your area. Also please refer to last week's question & answer for help in finding a Certified Diabetes Educator (CDE) or Registered Dietitian (RD) to work with you. For newly diagnosed persons, I highly recommend personalized sessions with a CDE or RD. It will be very helpful in starting you off on the right track to great diabetes self-care and good long-term health.

There are 2 main meal planning methods taught to people with diabetes: carbohydrate counting and the exchange system.  I find carb counting a much easier method to learn and teach, but you may find you like exchanges better. Be sure to ask about these two methods so you can discover which will work better for you.

In general, the body needs a minimum of 130 grams of carbohydrate each day. Carbohydrates are not the enemy here - your body runs on carbohydrate and needs adequate amounts to survive! For someone with diabetes, the issue is that the body cannot handle a large amount of carbohydrate at one time. It is important for you to spread carbohydrates throughout the day. You will find it easier to do this (and easier to maintain blood glucose control) if you eat several smaller meals and snacks instead of only 2 or 3 meals per day.

For example, say you are aiming for approximately 150 - 160g of carbohydrate per day. You could divide as follows:

• Breakfast: 25 -30g
• Snack: 15 - 20g
• Lunch: 30 - 45g
• Snack: 15 - 20g
• Dinner: 30 - 45g
• Snack: 15g

This type of breakdown of grams/carb per meal is typical in the carb counting method of meal planning.

When reading food labels, the "Total Carbohydrate" amount is the most important one to consider (sugar is included in the "Total Carbohydrate" amount). For foods without labels (the best type to eat!), you can try searching the USDA's nutrient database or FOODPICKER.org. You can also track and assess your diet for free with USDA's SuperTracker.

In general, the faster your blood glucose rises, the higher it is likely go. You'll want to concentrate on carbohydrates that take longer to digest. This includes carbohydrate choices with lots of naturally-occurring fiber: whole grains (brown rice, quinoa), whole fruits (not fruit juices) and non-starchy vegetables (broccoli, lettuce, spinach, green beans, peppers, tomatoes, etc.).

There are a few common starchy vegetables to look out for: corn, peas, white potatoes and sweet potatoes. While nutritious, these veggies are more concentrated sources of carbohydrates. Enjoy them in smaller portions than you would non-starchy vegetables. Low-fat dairy products (milk & yogurt) are also nutritious carbohydrate choices, but be sure to check the "Total Carbohydrate" amount, especially on fruit-flavored yogurts. Some are loaded with added sugars, which will drastically increase the amount of total carbohydrate. 

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

Diabetes Education Help

Question of the week from FOODPICKER.org

Nancy M. asks: "I am trying to find a class for our grandson. He is 19 and has a part-time job but no insurance. He just found out last week that he is a type 1 diabetes after losing a lot of weight and his blood sugar was 523. He is on insulin but needs to go to a class to manage his diabetes without going hungry. Where do we start? Any suggestions would help us a lot."

Answer: Learning you or someone you love has diabetes can turn your world upside-down, but know that help is available and you are not alone! There are many resources to check, even without medical insurance. Diabetes cannot be cured, but it can be managed. People with diabetes can enjoy healthy, long life filled with delicious foods - but education is the first step. It is extremely important for your grandson to start taking an active role in his health right away.

First, where was your grandson diagnosed? I would check with the doctor, healthcare provider or clinic that actually made the diagnosis. Also check with other other local hospitals and clinics. It is very likely they have many resources already in place for people just like your grandson.

Second, your best bet would be to find a certified diabetes educator in your area. You can locate a diabetes educator through the American Association of Diabetes Educators. A certified diabetes educator (CDE) is a healthcare professional with additional training and specialized knowledge in diabetes self-management education. A variety of healthcare professionals may also be CDEs - doctors, nurses, registered dietitians, pharmacists, etc.

Another resource is the American Dietetic Association, through which you can find a registered dietitian (RD) in your area. Registered dietitians are food and nutrition experts. An RD will assess your grandson's nutritional needs, work with him to provide knowledge and facilitate lifestyle changes that fit within his current work schedule and activity level.

Note that both websites above will generate a list of providers, from there you can contact the individual diabetes educator or registered dietitan to see what s/he offers in terms of classes, one-on-one education sessions, and find out about cost. Some RDs and CDEs work alone, some are part of a larger healthcare facility or network of facilities.

Also, be sure to check out the American Diabetes Association for more resources and information on diabetes basics, lifestyle and events.  Finally, you might also want to tell your grandson to check your state Department of Health's website. For example, New York State DOH has a diabetes page filled with information and available resources.

Good luck!