Elderly and Diabetes

Elderly and Diabetes

About 50% of people with diabetes are aged 65 years and above.

Living with diabetes, while it can be effectively managed, can be tough at times. Every day brings with it new challenges that you must overcome. As one gets older this becomes tougher and specific age related complications require diligence and care to properly mitigate. Through all this, it is important to remember that it is tough, not impossible.

My mother has Type 2 diabetes, but she won’t eat. My father gets up and snacks in the middle of the night. My mom complains of going in a hypo (low blood sugar phase) just to eat sweets that she craves.   I often hear these and other gripes from my patients’ care givers (mostly their kids) all the time.

Older people with Diabetes face higher risks of such complications as heart attacks, kidney disease and blindness; they’re more likely than other seniors to wind up in nursing homes.

But we need to relax a little and keep reminding ourselves that when it comes to the elderly, quality of life is much more important than those (almost sacred) numbers that pop up on the glucometer.

How to Read Food Labels

How to Read Food Labels

While in a grocery store, how many times do you look at the nutrition facts label and try to make sense of all that information? or think about how a particular packaged product is going to affect your health in the short and long term…

Diabetic or not, as a consumer, one needs to make wise choices about the food one eats. This is where food labels come in. They help us make informed decisions towards choosing good nutrition and health. Knowing how to read food labels also assures that we achieve our goal of healthy eating.

While reading labels it’s important to pay attention to:

The serving size: Serving sizes are standardized to make it easier to compare similar products; they are provided in familiar units, such as cups or pieces, followed by the amount of nutrients (carbs, fats, sugar etc.) that that serving would provide you, usually in grams or ounces. The size of the serving on the food package influences the number of calories and all the nutrient amounts listed on the top part of the label, so one needs to know how many servings are there are in the food package. Then ask yourself, “How many servings am I consuming”? – 1/2 serving, 1 serving, or more. For example, one serving may be half a can of soda, a quarter of a cookie, half a chocolate bar or 100 grams (5 tablespoons) of cereal etc.

This information can be misleading since in most cases you may end up consuming more than the serving size (who has just one cookie….really!) mentioned on the label while believing that you only ate the sugars or fat of a single serving.

Next, check total calories per serving and how many servings you’re really consuming if you eat the whole package. If you double the servings you eat, you double the calories and nutrients.  Choose products that are low to moderate in calories per serving i.e., 50 to 200 kcals and avoid, like the plague, anything that is more than 350 kcal per serving.

Per 100g column: The 100g column is the most frequently used.  Use this to compare similar products or to select foods based on specific guidelines. For example, to find a breakfast cereal with the highest fiber content, compare the fiber per 100g of different cereals. The following guidelines will help identify healthier food items based on their nutrient content:

Fat: As a general guide, choose foods with less than 10g total fat per 100g. Choose milk products with less than 2g saturated fat per 100 g (e.g. low fat yoghurt has less than 2g total fat per 100g and Low fat milk has less than 1g total fat per 100g). Healthy products would be with less than 11-13 grams of saturated fat, as little trans fat as possible and low in cholesterol. When the Nutrition Facts label says a food contains “0 g” of trans fat, but includes “partially hydrogenated oil” in the ingredient list, it means the food contains trans fat, but less than 0.5 grams of trans fat per serving. So, if you eat more than one serving, you would be consuming substantial quantities of this ugly fat. So avoid any food product that contains trans fat.

An important thing to remember is that trans fat quantities are usually measured in the raw material by the manufacturers, which is deceptive, because raw materials for processed foods may not contain trans fat by themselves, but the cooking process (such as baking) may convert the benign fats into trans fat. In a perfect world, all nutrient information on a label would be mentioned post processing, but we’re not that lucky.

Sugar:  Pick up low sugar breakfast cereal and yoghurt that have less than 15g sugar per 100g. Choose other foods with less than 10g sugar per 100g.

Sugar goes by many names in labels, many of which you may not recognize. So look out for cane sugar, invert sugar, corn sweetener, dextran, molasses, malt syrup, maltose, evaporated cane juice, high fructose corn syrup, honey, rice syrup, agave nectar, maple syrup etc in the list of ingredients. All of these are basically sugar and therefore will have the same effect on your blood sugar levels.

Avoid drinks with more than 2.5g carbohydrate per 100g. Don’t hate me for saying this but your daily can of soda or carbonated beverage is out the window! (Including the “Zero calories” ones).

When buying packaged food pick up items with nutrients such as: dietary fibre, protein, calcium, iron, vitamins and other nutrients you need every day. Choose foods with more than 6g fibre per 100g. On the other hand avoid excesses of any packaged or processed foods including those items that are “fortified” labelling.

Salt/sodium:  Choose food with low sodium content i.e., less than 120mg per 100g and avoid food that has more than 600mg per 100g.

% Daily Value:  The % Daily Value (DV) tells you the percentage of each nutrient in a single serving, in terms of the daily recommended amount. As a guide, if you want to consume less of a nutrient (such as saturated fat or sodium), choose foods with a lower % DV — 5 percent or less. If you want to consume more of a nutrient (such as fiber) seek out foods with a higher % DV — 20% or more.
Remember that the information shown in this column of the label is based on 2,000 calories a day diet. You may need to consume less or more than 2,000 calories depending upon your age, gender, activity level, and whether you’re trying to lose, gain or maintain your weight.

The bottom line is that the more manufacturers reduce the sinful ingredients from the processed food items, the worse it tends to taste. For example – Higher fiber in a cookie will make it soggy so it needs more fat to make it crisp. Oats was a tough sell till fruity and sugary flavors were introduced. Also, if you’re anything like me, the zero calorie sweetener never really tastes the same as sugar, does it?!!As long as food choices of consumers are based primarily on taste and labeling laws open to manipulation, manufacturers will continue to walk the tight rope of selling their products versus complete transparency.

Look at the list of Ingredients.

A good rule of thumb is to scan the first three ingredients, because they are the largest part of what you’re eating.

All food packages include a list of ingredients but they are not always found as part of the nutrition information panel. Ingredients are listed in order of quantity from largest to smallest. Sugar, fat and salt are often listed in the ingredient list under different names.  Therefore, healthier ingredients can be listed at the top, and sugar (by any other name…is still sugar) further down. So a product loaded with sugar, doesn’t necessarily show it as one of the top ingredients.

If the first ingredients include refined grains, some sort of sugar or hydrogenated oils, you can be pretty sure that the product is unhealthy. Instead, try to choose items that have whole foods listed as the first three ingredients.

Another good rule of thumb is if the ingredients list is longer than 2–3 lines, you can assume that the product is highly processed.

If you or someone in your family has food allergies to gluten, lactose, nuts etc, food labels are your first step in avoiding potentially serious situations.

So, before you drop a package in your grocery basket read it before you eat it!

Stay Hydrated this Summer!

Stay Hydrated this Summer!

With so many activities on your plate with summer holidays beginning, whether it heading off to a nice beach, cycling, road trips, it’s easy to get well into your day without realizing that you’ve barely had anything to drink.  It’s important to remember that our hydration needs change and become more urgent as the mercury rises.

People with diabetes need to be extra careful when it comes to replenishing their fluids in summer. If our blood glucose levels are higher than they should be for prolonged periods of time, our kidneys will attempt to remove some of the excess glucose from the blood and excrete this as urine. Which means water is escaping our bodies faster than it’s being replenished. Increasing thirst in a person with diabetes, therefore, is often as sign of high blood glucose levels.

The amount of water you need to drink depends on your weight, body composition, how much you eat, and activity levels. The average adult men need about 3 liters and women about 2.2 to 2.5 liters.  It’s always best to listen to one’s body signals as our brains are highly attuned to our needs. Notice when you’re thirsty or fatigued, as these can be signs of mild dehydration. Also pay attention to the color of your urine. Your urine should be clear, not yellow or orange which is sign of dehydration. If you’re outside lounging near the pool or working outdoors, carry a water bottle and keep sipping. Thirst is also often mistaken by people for hunger. A good way to avoid eating when you actually need water is to drink up when you feel cravings and observe if they go away, especially if you’ve eaten less than 2 hrs earlier.

About 20% of your fluid is taken in via the foods you eat.  Fruits and veggies typically have high water content.  If you exercise or sweat during the day, you’ll need to replace that water with at least an additional 1-3 cups.

Try these tips and stay hydrated:

  • Start your day with a Glass of water, it will help detoxify your system too
  • Carry your water bottle to work and place it right in front of you on your desk
  • If you have a 16 oz / 1 ltr water bottle, make it a goal to refill your water bottle at least three times throughout the day
  • Add fruits and vegetables with high water content to your diet. These include cabbage, spinach, squash, watermelon, citrus, cantaloupe and strawberries
  • Add flavor to your water: add few slices of lemon/ orange, few leaves of mint; crushed ginger, strawberries, cucumber etc.
  • Stay away from juices (you definitely don’t need that extra sugar!)
  • Make sure to drink fluids during exercise, especially if you’re exercising outdoors or in a hot climate
  • Coconut water has always been popular, and for good reason – it’s a naturally occurring electrolyte drink.  It’s similar to our own blood and is absorbed more quickly than water through our intestinal walls, which means faster recovery!  It’s also low in sugar and contains amino acids, vitamins and antioxidants
  • Have buttermilk or smoothies (without additional sugar)
  • If you’re flying this summer, remember, an airplane cabin is a low-humidity environment, which can leave you dehydrated and more susceptible to jet lag
  • Eat a balanced diet to get all the essential electrolytes from your diet
  • Avoid low sodium salt unless prescribed by your doctor – sweating leads to sodium depletion
  • Limit tea and coffee intake to 2 cups a day as they contain large amounts of caffeine which are diuretics i.e., increase urinary output. Avoid alcohol and sodas for the same reason.

 So, what’s your favorite way to stay hydrated and energized this summer?

Food Safety and Hygiene

Food Safety and Hygiene

Last week I had a very interesting discussion with my client when I told him to peel the skin of apples before he eats it. His eyes popped out saying  ‘what kind of a nutritionist says throw away the peel that is a good source of fiber?’ In return I asked him what is he planning to give his body more?, Safe nutrition or germs, pesticides, wax and colors? And for fiber you can increase the quantity of fruits and vegetables instead of putting your health at risk.

My choice would certainly be organic food grown in a ‘perfect world’….or If  I grow them myself in my kitchen garden. But do I have time? NO…

So here is the deal. I try and buy apples, grapes, peaches, strawberries, greens, celery, nectarines, bell peppers, cucumbers, potatoes and tomatoes from organic store as these fruits and vegetables tend to carry a lot of pesticides on their skin. And rest of the vegetables I buy from any store. Organic or not, if I didn’t grow the produce myself or get it from family friends who are trusted farmers, I always make sure to carefully wash all produce that we eat. This is especially important with non-organic produce, but I even wash organic store-bought produce as well.

Homemade fruit and vegetable washes are effective at removing residue from produce and also help preserve the fridge-life of these foods since bacteria that may cause decay is removed. To be most effective, different vegetables call for different methods of washing, but three simple and inexpensive recipes will clean virtually every type of produce.

How to Wash Most Fruits & Vegetables:  

For most produce with a skin place the fruits and veggies in a large bow filled with water and add 1 cup of white vinegar OR apple cider vinegar. Let soak for up to an hour, scrub gently and rinse. Dry fully before returning to the fridge.

How to Wash Lettuces & Greens:

Lettuces and greens are more delicate and more difficult to wash. They also are more likely to contain insects or other little visitors. For greens, dissolve 2 tablespoons of salt in 2 cups of water and add the juice of one lemon. Spray this on the greens, let sit for about a minute, and then add them to a sink of diluted vinegar water. Soak for about 15 minutes, rinse in cool water and dry completely or use a salad spinner helps before putting in the fridge.

How to Wash Berries:

Berries are perhaps the most difficult to clean because they are so delicate and take on the flavour of anything they come in contact with (vinegar flavoured blueberries on pancakes or ice crème, anyone?). Try diluted fresh lemon juice to clean berries.  Mix 2 cups of water with 1/2 cup fresh lemon juice and spray on the berries and then soak in fresh water for about 15 minutes. Dry completely before storing in the fridge!

Other tips that one must follow to prevent health related risks:

  • Cooking and serving utensils to be of stainless steel. Ceramic layered cooking utensils can be used to cut down the quantity of cooking oil in food.
  • Avoid Teflon and any other chemical non-stick coatings. Teflon is a coating manufactured using perfluorooctanoic acid (PFOA), which is considered “a likely human carcinogen.” When heated, cookware coated with Teflon and other synthetic non-stick surfaces emits fumes that can potentially sicken people.  Over heating of non-stick pans and any scratching or chipping of the materials can cause these chemicals to be released.
  • Avoid plastic whenever possible when it comes to food and beverage.  Hard plastics can contain BPA. If you must use plastic in the kitchen:
  • Choose BPA-Free, PVC-free plastic
  • Do not heat in the microwave (“microwave-safe” only means that the plastic won’t actually melt – the extreme heat of the oven will increase transference of chemicals).
  • Do not store fatty, greasy or acidic foods in plastic.
  • Do not use scratched, badly worn or cloudy plastics for your food and beverages.
  • Hand-wash plastics to avoid wear and tear.
  • Avoid hard plastic melamine dishes.  They are made by combining the chemical melamine with formaldehyde (which is considered a known human carcinogen.
  • Use caution with aluminium cookware.  Aluminium is a soft, highly reactive metal and can migrate in measurable amounts into food when used for cooking. Aluminium has been linked to brain disorders as well as behavioural abnormalities and is considered a toxic substance.
  • Store perishable and non- perishable food items separately.
  • All raw material procured needs to be checked for expiry date mentioned on it and before opening the packet to prevent food poisoning.
  • Refrigerate or freeze perishables, prepared food and leftovers within 2 hours. Do not leave them sitting out at room temperature.
  • Never place food on the same plate or cutting board that previously held raw meat, poultry or seafood unless the cutting board has been thoroughly washed.
  • Always thaw frozen food in the refrigerator. Never defrost food at room temperature on the countertop.

I am sure all of us are concerned about what we eat is safe. So, if you have more tips on washing fruits and vegetables please share!