A fortune cookie I found on the ladies’ locker room floor one day this summer
So, today is my last day in Pediatrics, and I’ve definitely learned a lot. For starters, I learned that I was right about not wanting to work in Peds. It takes a certain kind of person to love working with kids, and I am not that certain kind. However, I also learned a whole bunch of interesting nutritional practices that really opened my eyes to what a fascinating and strange and precarious thing the still-developing human body is.
Pediatrics has also made me rethink whether I really want to do OB nutrition or become a lactation consultant after all. And by that, I mean that I kind of want to run the hell in the other direction. However, through working with gestational diabetes patients as well as diabetic kids, I’ve learned that I love doing diabetes education even in those populations, so becoming a Certified Diabetes Educator (CDE) is high on my list of things I want to do once I’m an RD. I was also shocked that, heavy as it can be, I actually really liked working in the ICU and with neurology patients on modified-texture diets. Who knew?
So far, this internship has been even more amazing than I could have possibly imagined. I can’t believe I only have a couple months left! When I went back to school in 2009, I had this vague idea that well, yeah, I’d be in a hospital seeing patients, but my experience has exceeded my expectations. Wow, that’s a lot of “ex” in one sentence. Just to throw one more in, I’m just going to add that I’m so happy I didn’t listen to the ex-boyfriend who tried to talk me out of going back to school all those years ago because I didn’t ask him first.
So, um, yeah. Cheers to doing what feels right—and also to learning what you don’t want!
Oh, and cheers to the weekend!
Have you ever been surprised to find out you were or were not interested in something? Any good weekend plans?
During my diabetes rotation, I was struck by how many people thought they weren’t supposed to eat carbs—at all! Many others believed that they were forbidden from consuming sweet treats ever again (not that that stopped many folks) and even healthy foods like bananas because of the high sugar content. It was during this rotation that I really started to learn how to explain the concept of “in moderation.”
The thing is, everyone needs carbohydrates, and while it is important to limit carbs (especially refined carbs) when you have diabetes, they still have their place in the diet. The trick is to space them out over the course of the day to keep blood sugar levels stable—and to check your blood sugar at regular intervals. Grains, fruit, vegetables (especially the starchy veggies) and dairy all contain some form of carbohydrate, whether it’s glucose, fructose or lactose, so creating meals and snacks that combine these foods with protein helps keep you going without experiencing sharp peaks or dips in blood glucose levels.
As explained in a recent article in the Chicago Tribune, Amy Campbell, manager of the clinical education programs at Joslin Diabetes Center, a research organization affiliated with Harvard Medical School, nutritionally dense carbs such as veggies and whole grains are a great choice, as they offer more vitamins, minerals and fiber than their refined counterparts. Fruits and dairy products such as milk and yogurt are also nutritious options. Most diabetics should consume between 30 and 60 grams of carbohydrate per meal (about 2-4 servings) and between 15 and 30 at a snack.
What does that look like on the plate? This is the handout we give out at the hospital to many of our patients, including those with diabetes.
When it comes to making room for a treat, there are a few ways to do so. Forgoing a less exciting carb at dinner to make room for a small portion dessert is one way to have your cake and eat it too when you have diabetes. Exercise is another, as it can lower blood glucose levels for many hours afterwards. Just make sure to check your blood sugar and adjust your insulin as needed.
Do you have diabetes or know anyone who has it? How do you make room for treats?
Last night, I dreamed mostly in Spanish. No big deal for some folks, but I don’t speak a lick of Spanish. I can follow a little, but that’s about it. However, in the past few weeks, I’ve had to get comfortable working with an interpreter or using a telephone interpreter service to communicate with patients who don’t speak English.
I’m starting to remember little things, but let’s not kid ourselves—I couldn’t go to Madrid and expect to get by asking people on the street if they can tell me what a carbohydrate is or whether protein raises their blood sugar or what time to take which insulin. “Show me how to get the air out of the needle” would only get me into trouble.
Educating patients on carbohydrate counting and giving examples of healthy meals has also put me in touch with the fact that what a healthy meal looks like varies across cultures. A recent article in Today’s Dietitian looked at the best breakfast options from around the globe, sizing up typical morning meals from countries such as Turkey, Israel, Costa Rica, China, Vietnam, and Venezuela. The article also includes recipes for arepas and queso blanco.
Those of you who’ve been following me a while know I’m a big fan of oatmeal for breakfast, though the summer months find me craving smoothies and yogurt bowls in the morning. It may be cold as balls in NYC today, but the warmer temps are coming…
What’s your favorite healthy breakfast?
Earlier this week, British science journal Nature published a commentary called “The Toxic Truth About Sugar“, in which authors Robert Lustig, Laura Schmidt and Claire Brindis (all researchers at the University of California medical center in San Francisco) argue that “added sweeteners pose dangers to health that justify controlling them like alcohol.”
The paper details some of the specific ways in which increased sugar consumption has been linked to a rise in obesity and related non-communicable diseases such as diabetes, cancer and heart disease. It also goes into the ways in which sugar’s effects on the body can be similar to those of alcohol (by acting on the brain, for example, to encourage further consumption). By using alcohol and tobacco as two other substances that have been linked to disease and are now regulated, the authors make a case for doing the same with sugars. Continue reading
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Tagged cancer, corn, diabetes, heart disease, Marion Nestle, media, obesity, other blogs, research, robert lustig, sugar
Don't wait 'til you have diabetes, y'all. Find out your blood sugar levels.
You know your cholesterol levels, so why not your blood glucose levels too?
Type 2 diabetes was recently thrust into the public eye when Paula Deen announced she has been living with the disease for 3 years. However, something we hear about far less frequently is prediabetes.
The CDC estimates that some 79 million Americans over the age of 20 have prediabetes, which is defined as consistently elevated blood glucose levels (fasting blood glucose of 100 – 125 mg/dL or A1C of 5.7% – 6.4%) that are not quite high enough to qualify for a diagnosis of diabetes. That may not sound like such a big deal, but it can significantly up your risk of cardiovascular disease and other long-term damage in addition to paving the way to full-blown diabetes.
The good news is that if you find out your numbers put you in the prediabetic range (many doctors say “borderline high”—ask for specific numbers), you can do something about it. Getting blood glucose levels under control is key, and many people are able to do that through a healthier diet and exercise. Your doctor may also prescribe a drug such as Metformin to help lower blood glucose levels.
Don’t wait until you’re diagnosed with Type 2 Diabetes. Speak with your care provider at your next appointment about your blood sugar levels and how to keep or get it into a healthy range.
You can read more about diabetes and prediabetes here.
This morning on the TODAY Show, Paula Deen announced that she has Type 2 Diabetes. Here’s a link to the video
In the interview, the Food Network star defends the high-cal Southern cooking she is famous for and emphasizes that she supports “eating in moderation.” She also encourages people to see their doctor, get tested, and get on a good regimen to manage the disease if they do have it.
Deen, who found out she has diabetes three years ago, is now a spokesperson for a drug called Victoza, and just released a new program, Diabetes in a New Light. It gives the thing a bit of a creepy PR glow, but I’m glad to see at least a little bit of info about lightening up recipes without sacrificing taste, even if Deen is mostly hawking a diabetes drug.
Let’s not kid ourselves, here—expecting Paula Deen to start endorsing, like, steamed veggies and fish and talking about diabetes exchanges just wouldn’t be realistic. While I have plenty of my own thoughts about the high-cal dishes she prepares on her show and the well-established links between diet and diabetes, I’m also vaguely nauseated at the way people seem to be relishing this, as if the woman’s being brought to justice or something.
What do you think about Paula Deen’s announcement?
image courtesy of NIH
Does anyone else find it ironic (or telling) that the United States, which is oh-so-focused on waistlines—or more specifically, its inhabitants’ expanding middles—should keep identifying “belts” of disease? We’ve got the Diabetes Belt and the Stroke Belt, and now it appears that people living in the 11 states spanning from Louisiana to Virginia are also at an increased risk for sepsis, a severe illness in which bacteria overwhelm the bloodstream.
“In 2010, we examined death rates from sepsis across the United States,” said Dr. Henry Wang, associate professor and vice chair for research in the University of Alabama at Birmingham (UAB) department of emergency medicine. “Laying it out on a map, we saw that the states with highest sepsis mortality formed a cluster in the Southeast United States, closely mirroring the appearance of the Stroke Belt.”
Researches felt that possible causes for the cluster may be related include health behaviors, diet and environment and air pollution as well as genetics and pre-existing medical conditions (like Diabetes, perhaps?). They hope it will lead to more research and strides toward preventing sepsis.
When I showed him the article, Chris said, “Maybe the belt is too tight.” Very funny. Not necessarily untrue, though.
Researchers recently identified the U.S. Southeast, already called the “Stroke Belt” as the region with the highest diabetes rate. While most states showed a diabetes rate of about 8.5 percent, close to 12 percent of people in parts of 15 states including Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas ,Virginia, West Virginia and the entire state of Mississippi had the disease. Continue reading
According to a new report by the Centers for Disease Control, Diabetes may affect as many as 1 in 3 Americans by 2050. Currently, 1 in 10 people in the U.S. have been diagnosed with the disease, which is the leading cause of adult blindness, kidney failure, and limb amputation. It also contributes to heart attacks and strokes. Talk about a good time!
I belong to a group called Food Picker, which helps users select foods that are appropriate for diabetics, as determined by RDs and nutrition students. I covered the vegetarian section a while back, posting healthy options to the database.
Every week, members are sent a question from a reader and we can respond on our own blog. I found this week’s question of particular interest…
From: Linda V. (e-mail not disclosed for privacy)
Subject: tips for potluck?
I attend a monthly book club with friends that includes a dinner potluck in which everyone contributes a dish. I have type 2 diabetes and I struggle with what to eat at the potluck. Could you offer me some tips?
I love potluck dinners. Aside from being economical, they’re also a great chance to get to know people by striking up conversations about the dishes they bring. However, if you have special dietary needs, not knowing what’s going to be available can be intimidating. Here are a few tips to make potlucks less daunting:
- If you know some of the other people who will be attending, give them a call or send around an email to find out what others are thinking of bringing. This can help you plan ahead.
- If you have no idea what will be available until you get there, take a look at all the offerings before piling stuff on your plate.
- Fill half the plate with vegetables, a quarter with a grain, and a quarter with protein.
- Bring something you know you can eat. For example, a salad that includes greens, fresh or roasted vegetables, and some kind of protein like beans makes a great balanced dish you can feel good about filling your plate with.
- If there’s a dessert you know you want, make room for it. Skip starchy sides if there’s a treat you want to indulge in. Keeping portions small also helps.
Also, don’t be afraid to talk to friends about your concerns. It’s likely they have been through similar situations and would be happy to help you!