Jack* is an eleven year old boy in my class, who was diagnosed with Type I diabetes when he was 8 years old. I was curious to know about what it meant to him as he is different than us. He tests his blood sugars by himself during break times and as his mum works in the school, after lunch she puts in a needle in his arm to inject insulin. He is otherwise friendly, but at parties, he has food restrictions. One day, I asked him if I could interview him and he was happy. His responses seem rather casual and surprising. I have reproduced the interview below to show what diabetes means from a child`s perspective. So let’s get started. Me: How did you find out you have Diabetes? Jack: I was on holiday and my mum noticed that I was drinking and going to the toilet a lot. Me: How did you react to the diagnosis? Jack: I was scared and upset. Me: How did others react? Jack: They were a bit shocked and confused. Me: Did you know what Diabetes was before the diagnosis? Jack: No Me: What does Diabetes mean to you? Jack: It meant nothing before but now it means a lot. Me: Who are the people involved in caring for you? Jack: Mum, dad, sister and dietitian. Me: What were the symptoms? Jack: Going to the toilet and drinking lots of liquids. Me: How does this affect everyday life? Jack: I now have to be aware if I feel low. Me: Are you treated differently because you have Diabetes? Jack: No not really. Me: Does anything irritate you? Jack: Most of the time I feel normal but it’s having to test that annoys me. Me: How did you adjust to it? Jack: I just kept going and stayed positive. Me: Who would you talk to? Jack: I would talk to a nurse or my parents. Me: How did you understand things about diabetes? Jack: I was talked to and asked if there was anything I couldn’t understand. Me: What do you miss most about the times before you had Diabetes? Jack: Not having to test and take insulin injections. Me: And what have you gained? Jack: Confidence. Jack is rather calm and has accepted diabetes as a part of him. Even tough children can be very sensitive, their understanding of actions may not be as vivid as adults. This means that things like diabetes may not affect them as much as what is expected. He is a bit anxious about the future and the frequent testing irritates him. Although it has become a habit, he wishes that it wasn’t a part of his life. He feels that it differentiates him from others and the feeling of insecurity is still there. Children can feel many things during changes in life. Insensitivity, fear, differentiation, sadness, insecurity or maybe even joy. Whether it is for Diabetes or for another change we all need assistance in guiding our way through different occurrences. Author Rona Bhattacharya is a 10-year-old primary school student in the UK. She is an avid blogger, published author and poet.She is an accomplished dancer and singer.She is also an endurance swimmer and a PADI certified SCUBA diver. She is the Sports Ambassador of her school apart from being academically top of her class. She is very conscious of social issues, has organised multiple fundraisers and is currently swimming 22 miles, the length of the English Channel in the swimming pool for the charity Diabetes UK to raise awareness for children with diabetes. *Name changed to protect identity
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Diabetic or not, a consumer needs to make wise choices about food. Food labels help. Here are my tips. The serving size: Serving sizes are provided in familiar units, such as cups or pieces, followed by the amount of nutrients (carbs, fats, sugar etc.) one serving contains. 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. Ask yourself, "How many servings am I consuming"? - 1/2 serving, 1 serving, or more? Next, check total calories per serving and how many servings you’re really consuming. 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 200kcals and keep away from anything that is more than 350kcal per serving. Per 100g column: The 100ng column is the most frequently used. Use this to compare similar products. .For example, to find a breakfast cereal with the highest fibre content, compare the fibre per 100g of different cereals. Here are some tips to help identify healthier food items based on their nutrient content: Fat: As a general guide, choose foods with less than 10 g total fat per 100 g. Choose milk products with less than 2 g saturated fat per 100 g (e.g. low fat yoghurt has less than 2 g total fat per 100 g and Low fat milk has less than 1g total fat per 100g). Healthy products would be with less than11-13 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. 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 yogurt that have less than 15 g sugar per 100 g. Choose other foods with less than 10 g sugar per 100 g. 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 similar effect on your blood sugar levels. Avoid drinks with more than 2.5 g carbohydrate per 100 g. 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 fiber, protein, calcium, iron, vitamins and other nutrients you need every day. Choose foods with more than 6 g fiber per 100 g. On the other hand avoid excesses of any packaged or processed foods including those items that are “fortified” labeling. Salt/sodium: Choose food with low sodium content i.e., less than 120 mg per 100 g and avoid food that has more than 600 mg per 100 g. % Daily Value: The % Daily Value (DV) / Daily Recommended amount tells you the percentage of each nutrient in a single serving. 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 fibre) seek out foods with a higher % DV — 20% or more. Remember that the information shown in this column of the label is based on 2000 calories a day diet. You may need to consume less or more than 2000 calories depending upon your age, gender, activity level, and whether you’re trying to lose, gain or maintain your weight. 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. 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 supermarket basket read before you eat! Author Pariksha Rao is based in Bengaluru, India. She is a clinical nutritionist, IDF certified diabetes educator, sports nutritionist and a lactation expert, with more than a decade of experience across pharmaceuticals, hospitals and research sectors. Having trained over a 1000 paramedics on personalised patient/ consumer care and counselling, Pariksha believes counselling is a holistic approach to achieve long term behaviour modification by setting mutual, achievable, measurable and realistic short term goals. It comes as a big surprise to the people that I treat; that I’m a big foodie, love to eat out and try different cuisines. Everyone needs a break from eating the same food every day, right? Sticking to a healthy diet doesn't mean you have to avoid dining out. Eating out is not impossible while aspiring to a healthy lifestyle, but making the right choices can be challenging. (For the basics of making healthy food choices at home, visit my last few blogs where I talk about healthy carbs, proteins and fats). For many people, eating healthy is a chore and a bore and this is why people give up. But once you understand your choices, all you need to do is to plan a little ahead to ensure that you can eat out guilt free. Most places are happy to customise your order. Try and find such restaurants and keep a list handy when you want to head out. When possible, eat something healthy at home (or work) before heading out in order to avoid excessive eating there. For example: a fruit or salad or a cup of clear soup. This will help avoid binging as well. When that’s not possible, order a salad or a soup first or start the meal with it in case of a buffet. Choose a clear soup with vegetables and / or chicken rather than a cream based one. While ordering appetisers pick ones that are not deep-fried, like grilled vegetables or cottage cheese or grilled chicken or fish. Another great option is to try something that is steamed, like dumplings or steamed seafood. Keep a check on portions – if the restaurant is serving large portions, order less at a time and share your meals with your companions. If you’re not sure about what is in a dish or the serving size, do ask your server. Many of the restaurants are happy to explain their recipes and portion sizes in details. Avoid alcoholic drinks as far as possible, instead, order fresh lime water without sugar or honey. If you do want to order alcohol, go for a glass of red wine or 30 ml of any hard liquor. For your mains, make sure you order a low fat meal with 2 servings of carbs and 1 portion of protein. (details of calculating portion sizes in my earlier blogs) When not having alcohol, make sure you include at least one portion of healthy carbs, equal portion of protein and have lots of fibre (greens and vegetables) on the side. Choose healthy ingredients : Food Healthier choices Bread Whole wheat/ multi grain bread Rice Steamed brown rice Meats and poultry Avoid red meats and organ meats, pick grilled chicken or fish or a chicken steak Fries Mashed potatoes; grilled sweet potatoes Tortilla Multi grain tortilla Soup Clear soups (no crème) Pasta Whole wheat pasta For example, prefer wholemeal over white pasta and choose sauces with tomato and pesto base. Avoid the cheese filled creamy white sauces as they will make your meal very high in fat. Try and have a salad on the side or get two fistful of veggies added to your pasta and some cubes of grilled chicken, cottage cheese or tofu. Same can be done while ordering pizza. Choose whole grain or multi grain pizza base, loaded with veggies and minimum cheese, a portion of grilled chicken, cottage cheese or tofu and a dash of olive oil. While dinning at (or ordering from) Chinese restaurants specifically ask your server to not add Chinese salt or MSG to your dishes. If you rarely (once in 3 months) dine Chinese, don’t bother. At coffee shops, pick wholemeal or multi grain bread in your sandwich and avoid cheese and mayonnaise. Avoid added cream in your drinks and say no to high sugar add-ons like chocolate or caramel. Ok, so what about desserts? My dining out experience is incomplete without a dessert. Instead of the high fat ice creams and cakes that restaurants tend to serve, I usually pick a low fat ice cream (like a gelato) or a mixed fruit salad or ice candy. The next time you’re ordering dessert, try this - instead of having two portions of carbs in your main have only one and enjoy anyone one of the dessert options above, Guilt Free! Try different combinations at different restaurants and always check your post meal blood sugar and update your food diary (if you’re a diabetic). If your blood sugar is well in control you know that you can indulge in that particular kind of meal and dessert confidently and more often. While travelling, stock up healthy snacking options like nuts, nutrient dense fruits, nutri-bars (pick low sugar, low fat types). Diabetics should stick one portion of fruit as a between meal snack which is either one medium apple, pear, orange or guava or three slices of papaya, pineapple or melon or one medium bowl of pomegranate or any berries. High sugar fruits such as bananas, custard apples, grapes, Sapodilla (Sapota), mangoes should be consumed in half portions sizes (of above). The idea is to avoid high sugar fruits and get more nutrients in from other fruits to keep your blood sugar in control. Oh! And by the way, Avoid Fruit Juices. Period!! Travelling and eating out with friends and family can be an enjoyable experience even for a person with diabetes as long as they choose the right foods and eat moderate quantities. Next blog- Reading food labels Author Pariksha Rao is based in Bengaluru, India. She is a clinical nutritionist, IDF certified diabetes educator, sports nutritionist and a lactation expert, with more than a decade of experience across pharmaceuticals, hospitals and research sectors. Having trained over a 1000 paramedics on personalised patient/ consumer care and counselling, Pariksha believes counselling is a holistic approach to achieve long term behaviour modification by setting mutual, achievable, measurable and realistic short term goals. In the last two blogs I spoke about role of carbs and proteins in diabetes. The third macronutrient is fat. About a decade or so ago, people started developing a ‘fat-phobia’ – it became the ‘BAD’ nutrient and started moving to so called ‘zero fat diets’. Fat is an important component of a healthy diet. It contains essential fatty acids which are vital for nerve function, and is necessary for the absorption of fat-soluble vitamins ( A, D, E, and K). It provides flavour and tenderness to food and gives satiety. This may take some explaining and counselling to change mind sets. Unlike carbohydrates, which are digested fairly quickly, fat takes a longer time thus increasing the blood sugar 4 to 6 hours later. Thus blood glucose look well in range (of the goal) two hours after a high fat meal and shoots up significantly 5 hours later. This is a problem for insulin users. Both the amount and type of fat consumed impacts health. The good fats are generally liquid at room temperature and are mainly found in plant-derived foods. There are two types: Monounsaturated fats (MUFA): found in high amounts in olive oil, canola oil, avocados, and nuts. These are considered the healthiest of all the fats. These fats can withstand very high temperatures and do not turn ugly fast while cooking. Polyunsaturated fats (PUFA): include the omega 6 and omega 3 essential fatty acids. It maybe advisable to cut down on the omega 6s found in safflower, sunflower, corn oil and foods made with these oils (like margarine, mayonnaise, and salad dressings). Omega 3s found in fatty fish (like salmon, mackerel, and tuna), walnuts, flaxseeds, tofu and other soybean products maybe helpful. The bad fats: are generally solid at room temperature and are mainly found in animal products, like butter, meat, whole milk, and cheese. However, some vegetable oils (coconut, palm, and palm kernel oil) are also high in saturated fat. These fats should be limited because they raise blood cholesterol levels. Cholesterol: a fat-like substance found in whole dairy products, liver, egg yolks, and shellfish, red meats etc. The ugly fat: Trans fats are made during hydrogenation, a process that makes unsaturated liquid vegetable oils more solid, saturated, and shelf-stable. Trans fats are found in margarine, vegetable shortening, and many processed foods which list “partially hydrogenated vegetable oil” as an ingredient. These ugly fats affect the cholesterol levels the most. And then there is the invisible fat in food (that cannot be easily seen and is impossible to separate from food, such as butter that has been baked into a cake or the natural oils found in nuts). A visible fat such as olive oil may be absorbed during cooking and become invisible Even though nuts high in MUFA are good,one still needs to be careful! 6 almonds or 4 pecan halves have the same number of calories as 1 teaspoon of oil or butter. Fat Recommendation: Ideal fat consumption would be 4-5 teaspoon of it a day. How to keep a check on that? Sticking to ½ liter (500 ml) of cooking oil per person per month. For a family of four, no more than two litres of cooking oil a month is ideal. 1 teaspoon Oil = 1 tsp butter / peanut butter or 6 pieces of almond or 4 half pecans or 6 pistachios = 5 grams fat Read food labels of fat content in packaged products So what’s the right medium of cooking and how to achieve the above mentioned goal of 4-5 tsp a day? Every cooking oil brand claims to have ‘no cholesterol’. That’s a sham – no plant product has cholesterol so vegetable cooking oils are cholesterol free to begin with. Choose smart - using the best extra virgin olive oil for deep frying is sheer waste as all healthy fatty acids get destroyed in the process. Same olive oil does great things for the heart when used as dressing in your salad. Olive oil, groundnut oil, rice bran oil, mustard oil, canola oil and soybean oil are the best 5 oils available in the market. Rotate these on a monthly basis to get maximum benefits. Here is a ready reckoner to help meet your fat recommendations -
Upcoming Blog- “Eating out, guilt free” Author Pariksha Rao is based in Bengaluru, India. She is a clinical nutritionist, IDF certified diabetes educator, sports nutritionist and a lactation expert, with more than a decade of experience across pharmaceuticals, hospitals and research sectors. Having trained over a 1000 paramedics on personalised patient/ consumer care and counselling, Pariksha believes counselling is a holistic approach to achieve long term behaviour modification by setting mutual, achievable, measurable and realistic short term goals. |
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