Mindfulness is increasingly being used for eating habits and diabetes management. The results of a study in which mindful eating was trialled in a group of individuals with type 2 diabetes found that eating mindfully, or consuming food in response to physical cues of hunger and fullness, is just as effective as adhering to standard nutrition-based guidelines in reducing weight and blood sugar levels in adults with Type 2 diabetes. In this study, individuals were coached in the art of mindful eating through group sessions spanning over 3 months. This encouraged participants to become aware of their thoughts and body prior to eating by taking a few moments to assess their level of hunger, thus helping to make conscious choices about food consumption, as well as stopping eating once they were full. Results in this group were compared with a control group who were not instructed in mindful eating, but were given standard nutritional advice as per conventional diabetes education programmes. Both interventions led to improvements in weight (the standard and mindful approaches led to losses of about 3 and 1.5 kg respectively). There was also a reduction in the marker, which measures overall blood sugar control (HbA1c) from 0.7 and 0.8 per cent in the standard and mindful group respectively. A valuable outcome of this study is choice. People with diabetes have a choice when it comes to eating a healthy diet, as both interventions were equally effective. Coping with dietary lifestyle changes that seem “restrictive” or “prescriptive” can be an emotional blow for people with diabetes and may affect their compliance to treatment. However, if they can make informed choices and find mindful meditation more appealing this could be a more meaningful approach for them as it encourages “inner wisdom” towards eating. In my experience in practice, people who confess to over-eating are happy to also admit that it is largely down to habit and not being fully aware of what they are eating, why they are eating it and are not in tune with what their body really needs. Whether people are binge eating or following a highly restrictive diet, in both scenarios it they have usually lost connection to when they are hungry or full. Mindful eating heals this disconnection between the body and mind because our relationship with food is often a reflection of our emotional well being. Living with diabetes can be emotionally challenging so instead restricting or over eating as a coping mechanism to block negative feelings there are healthier ways of managing emotions such as mindful breathing to let go of anxiety. There is no need to manage emotions through food choices but learn to embrace and tolerate negative emotions, as uncomfortable as they may be, without pushing them away or stuffing them down with food. This improves the whole experience of living with diabetes and the art of eating. Author Mita Mistry LicAc MBAcC is a Mindfulness Coach, Acupuncturist, Columnist based in Leamington Spa, UK. She is a recognised expert in holistic healthcare modalities, specialising in helping to ease the mental and emotional side effects of chronic conditions whilst empowering people to reach their optimum health and well being goals.
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Diabetes can affect anyone at any age. The World Health Organisation estimates that over 382 million people worldwide including 4.05 million people in the UK have diabetes. Of this, 3.5 million diagnosed are adults and there are around 549,000 people with undiagnosed Type 2 diabetes. The NHS spends over £10 billion annually on diabetes, 80% of which is on complications of the condition. These figures highlight there are number of issues around diabetes management and in particular support for people having to live and cope with the condition. Mindfulness is a technique of self-awareness through observing moment-to-moment thoughts, emotions and physical sensations in our body. Although the foundations of it are rooted in ancient traditions of meditation, mindfulness is gaining popularity in clinical settings . There is now scientific evidence of its usefulness in the management of diabetes especially with regards to blood sugar control. Mindfulness has been shown to positively impact a number of issues in the management of diabetes, physically, mentally and emotionally. Physically it helps in regulating blood glucose levels, blood pressure, aiding sleep, improving glycaemic control to easing back pain. Mentally and emotionally, mindfulness is a secret ingredient because in 40-60% of people with diabetes there is an increased risk of diagnosed and undiagnosed mental health problems, which adversely impacts compliance with agreed management and consequently diabetes outcomes. The National Audit Office concluded that 22,000 people were dying from preventable diabetes related causes so it is critically important these people receive emotional and behavioral support. This support is crucial from the moment a person receives an initial diabetes diagnosis. According to NICE (NICE, 2005) when a person is first diagnosed with diabetes, they will often go through similar psychological stages as that of bereavement - disbelief, denial, anger and depression. Mindfulness helps to break this cycle by helping the person to accept their condition and embrace the change. Equally, living and coping with any chronic condition including diabetes is just as emotionally upsetting as the initial diagnosis because it requires changes to lifestyle. As humans, we are creatures of comfort; the fear of the unknown, the loss of an old lifestyle or embracing change causes stress, anxiety, feeling frustration, guilt, anger or sadness all of which are completely normal. Sadly 1 in 2 patients do not comply with treatment and whether that is “denial” of the change or to “avoid negative emotions” remains personal to each individual but either way it is serious and can lead to complications, and perhaps ultimately grave consequences. However, by exploring the impact of having a chronic condition or facing the inner emotional battles of diabetes, mindfulness can help people break these negative cycles to focus their awareness on successfully feeling empowered to control the condition rather than it control them. This is especially effective in the areas of diet and nutrition, exercise, sleep, stress and medication, all of which are critical success factors in managing diabetes so that people with the condition and their loved ones can live a full content life. Author Mita Mistry LicAc MBAcC is a Mindfulness Coach, Acupuncturist, Columnist based in Leamington Spa, UK. She is a recognised expert in holistic healthcare modalities, specialising in helping to ease the mental and emotional side effects of chronic conditions whilst empowering people to reach their optimum health and well being goals. ,Last year I accompanied my daughter to a birthday party. As the birthday girl was getting ready to cut the cake, I saw another girl in a corner,forlorn and detached. Later on I learnt that it was my friend`s 15 year old daughter Tina. She had Type I diabetes. Though I knew the family for three years I did not know that they were struggling with Tina`s diabetes since she was five. My friend asked me not to mention this to anyone as she was not prepared to take the gossip and pity that would follow. She kept blaming herself for ignoring the early signs. “Few months before her diagnosis I had started noticing things like shakiness before meals and frequent bathroom trips, but the paediatrician dismissed our concerns”. Then the symptoms started to intensify – “Tina developed an insatiable thirst and started wetting her bed frequently, something she hadn’t done since she was a toddler. We sought a second opinion and soon after she was diagnosed and treatment started. She was now on insulin." Managing Tina`s diabetes required major adjustments for the entire family. “Our routine has changed completely. We don’t have any flexibility anymore. Initially Tina was scared of sleeping or even dozing off for fear of wetting her bed. We had to wake her up in the early hours of the morning everyday to check her blood sugar levels. At least she used to listen to us then, now she’s in her teens and it’s been tough for all of us”. "Soon began school and that was a whole new challenge. Some days we barely made it to bed without losing it altogether." "Now, at 15 like most teenagers Tina has a mind of her own and it is a real struggle as far as diet and insulin is concerned. Last week she threatened to inject the whole insulin pen if I didn’t let her stay out late with her friends.” Tina had become the number one priority at home and everything else took a back seat. “I’ve developed chronic sleep deprivation from waking up in the middle of the night to check Tina’s blood sugar.” She also suffered periods of anxiety and depression leading to disharmony in the family. Last summer I was able to convince both her parents and Tina to join a diabetes teen social support network. After meeting other parents with diabetic children, they could discuss their issues facing them and find relevant and practical advice and support from peers. With the help of a diabetes educator, Tina gradually learned to manage her meals and match them with the insulin doses. With counselling, she also learned to manage her daily life without her condition affecting her studies and social life. I met my friend over coffee today and saw Tina sneakily tucking into a piece of cake “I can be naughty sometimes....” Tina’s parents are confident that she will be able to be independent and manage her condition on her own. "Will she have a good career? Can she have children?" Mothers will always be mothers. Author Pariksha Rao is based in Bengaluru, India. She is an award-winning IDF certified diabetes educator, clinical and 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. 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
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. In my last blog I mentioned that carb intake should be 2 exchanges in every major meal a day. The most common answer to this recommendation is “this is too less...I am going to starve” or “I will feel hungry again within an hour”. That’s where proteins come to the rescue... The right amount of protein intake in every meal reduces hunger and improves satiety but limits muscle mass loss. Patients with diabetes lose around 1 pound of their muscle mass every year as they age, and eating a diet lower in protein is one of the biggest contributing factors. The body uses more energy to digest protein than it does to digest fat or carbs thus preventing a steady and fast rise in blood glucose level and helps achieve weight loss long-term. Proteins to the rescue …… again Rice based meals in moderate proportions is fine if accompanied by a healthy proportion of legumes or lean cuts (without skin) of chicken or fish, if such a meal is planned with other fibre rich nutrients like green leafy and non-starchy vegetables. Proteins are made of different amino acids. Some of these are called "essential" because they are necessary and cannot be made by the body. We need to obtain them from our diet. Complete proteins contain ample amounts of all the essential amino acids and are found in fish, poultry, cheese, eggs, and milk. Incomplete proteins do not contain all of the essential amino acid like protein in grains, legumes, and vegetables. Although, it might seem like meat eaters are better off than vegetarians, it’s not necessarily true. Even though it is important to consume the essential amino acids, it is not necessary to get them only from animal sources. Good news for vegetarians...There is a dietary strategy called mutual supplementation in which you combine complementary partially complete protein food to supply adequate amounts of all the essential amino acids. For example - beans and brown rice are both quite rich in protein, each lacks one or more of the essential amino acids. However, when beans are combined with brown rice the result is equivalent to a complete protein that can substitute chicken or meat. Unlike most beans, soybean products (such as tofu and soymilk) are complete proteins. They contain the essential amino acids. Tofu, soy flour, soy-based meat substitutes, soy cheese, and many other soy products are healthy ways to make a meatless diet ‘nutrient complete’. Some more combinations that can be tried are: Thick lentil soup with a serving of almonds on the side; kidney beans/pinto beans in a corn tortilla; whole-grain pasta tossed with peas; bean soup with whole grain crackers; corn tortillas with beans and rice, soy curry and rice; milk and oats. How much protein do I need in a day? It is preferable to calculate daily protein intake for people with diabetes as grams per kilogram of body weight and not as a fixed percentage of total energy intake. People with diabetes should not reduce protein intake to less than 1 g/kg of body weight, while protein intake of 0.8–1 g/kg (of body weight) should be recommended for people with diabetes and chronic kidney disease. Try the following options to meet your recommended protein intake:
What was your protein intake yesterday? As I mentioned, you need 1 gram/ kg body weight of protein (if you weigh 65 kilograms you need 65 grams of protein / day). If 1 cup milk/ 2 egg whites/ 1 fist size piece of lean chicken or fish/ 1 med bowl of legumes and pulses/ 1 med bowl of thick yoghurt each will give us approximately 7 grams of protein, can you calculate the amount of protein that you consumed yesterday? Leave the amount of your yesterdays’ protein intake as a comment for me... Upcoming Blog - “Fats: The good, the bad and the ugly” 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. According to recent WHO report, the prevalence of diabetes in adults worldwide will rise to 380 million in the year 2025. With an all time high obesity and diabetes, the need of the hour is to address the core issues and enable patients to take charge of their own lives. In this series of blogs I shall be talking about the four main pillars of diabetes management – Diet, Exercise, Medication and Monitoring. Beginning with diet, I shall cover Carbohydrates, Proteins, Fats, eating out options and reading food labels. In my practice one of the most common reactions to a diagnosis of diabetes is ‘Oh! I’ve never eaten much of sugar, rice, sweets or potatoes etc; and yet I have this disease. Now I can’t eat any of the food that I love.’ This feeling of deprivation is further compounded by societal interference leading to dejection and confusion. Unscientific remedies are tried, which offset any attempts at blood sugar control. People with diabetes often make wrong assumptions about the reasons for diabetes occurrence and its management. This stems from denial, having to make changes to control it and needing the support of family and friends to combat this life altering and potentially life threatening disease. It is important that patients understand how to control their diabetes through simple and small lifestyle modifications on a daily basis. Diabetes education regarding diet, exercise, medication and monitoring is imperative. The most important dietary rule of Diabetes: There is NO “Diabetic Diet”. It is vital to understand that healthy eating isn't about deprivation or denial. Having diabetes need simply translate into eating a variety of foods in moderate amounts and sticking to regular mealtimes. This means choosing a diet that is balanced in all macro-nutrients like carbohydrate, protein, healthy fats and all essential vitamins and minerals. There is no “diabetic diet” as such. It’s a diet that is nutritionally adequate, tasty and individualised, that even people without diabetes may follow to stay healthy. It is important for a person with diabetes to know which foods will raise their blood sugar to what extent. Carbohydrates contribute the most to blood sugar levels. Carbohydrates (‘carbs’) are the sugars, starches and fibres found in fruits, grains, vegetables and milk products. There are two types: simple and complex. Whole grains like wheat, oats, barley, pearl millet, whole fruits and vegetables, brown and red rice are all good sources of complex carbs. All these food items when processed into finer grain size and products become simple to digest and increase blood sugar quickly.Bread, cookies, candy, juices, cola, sugar, honey, jaggery are some sources of simple carbs. Monitoring carbs is the key in achieving glycemic control. Both the amount and type in food influence blood glucose levels. While emphasis should be on increased complex (high fiber) carbs, excess amount of even complex carbs in a meal could lead to high blood sugar.The amount of carbs that maybe consumed is based on multiple factors including activity and medication. This should be constant and ‘binge’ eating is to be avoided. Eating very low carb diet is detrimental and the recommended range is 45–65%of total calories. So, restricting total carbs to <130 g/day (approximately 6 cereal exchanges/ day) could impair the functioning of brain and heart and lead to hypoglycemia (low blood sugar). Despite the person`s wishes, families find it difficult to follow a restrictive carb plan and I have often seen such rigid approaches contributing to disordered eating behaviour. (Cereal Exchange: an exchange can be understood as 1 palm sized tortilla, 1 medium sized bowl of brown rice, 1 fistful of pasta, 1 palm sized chapatti, 1 medium bowl of broken wheat or oats porridge, 1 slice (3 X 3 inch) of whole wheat bread.) Carbs are a must in every major meal especially after alcohol consumption to regulate sugar levels and avoid hypoglycemia. Different methods may be used to estimate the carb content of meals like:
So what is needed is to understand what food item is a source of healthy complex carbs, and have minimum 6 exchanges per day (2 cereal exchanges/ meal) and keep in between snacks protein rich. Upcoming Blog - “Proteins to the rescue” Author - Pariksha Rao is based in Bengaluru, Imdia. 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. “The big talent is persistence”. Octavia E. Butler It is always extremely difficult to ascertain why human behaviour does not correspond with agreed recommendations from a healthcare provider, whether it is in following diet, exercise, lifestyle changes or taking medications. In diabetes, approximately half are not able to do so, resulting in poor control of diabetes. This has far reaching consequences - increased heart attacks, stroke, amputations, kidney and eye problems, along with economic implications. The ability of physicians to recognize non adherence is poor, and interventions to improve adherence have had mixed results. A number of reasons have been suggested and it is probably combinations of these factors that are responsible. Majority of diabetics are on multiple medications and complex regimes due to many coexisting conditions. Some are forgetful, or miss doses due to being preoccupied with other more pressing activities. Some are unable to tolerate or have side effects like hypoglycemia and weight gain. Sometimes people with high blood glucose levels have difficulty in reading labels and this should be kept in mind. The perception of benefits of treatment can also have a significant effect on adherence. People have their own assumptions about their risks of complications and side effects, which leads to reduced adherence to treatment. There is also a considerable resistance to injectable medications. Some of the reasons are injection phobia, negative impact on work, permanent need for insulin, inconvenience, not believing insulin was necessary, hypoglycemia, less flexibility and feeling of failure. People adhere well when the treatment regimen makes sense to them, when it seems effective, when they believe the benefits exceed the inconvenience, when they feel they have the ability to succeed at the regimen, and when their environment supports regimen-related behaviours. A very oft reported problem is that communication between the patient and the provider is not adequate and this barrier leads to misunderstandings. As diabetes is a long journey, adherence is influenced by the changing situations in a person`s life. Various life`s events influence human behaviour, either good or bad, may result is deviation from set practices and result in poor adherence. Though numerous methods have been tried, there is not one simple solution. The first and foremost is to win the confidence of patients by improved two way communication with a non-judgemental approach. Reduced treatment complexity, regimen coordination with daily life (eg, meals, waking, bedtime, brushing teeth, etc), fixed-dose combinations and decreased frequency of administration of medications are important. Weight gain and hypoglycaemia are important issues, which must be discussed in details and pre-emptive advice must be given. Diabetes is associated with multiple psychological problems, some of which may not be clinically apparent. This has a bearing on adherence. Social support influences the ability to adjust to and live with illness and patient adherence. Assistance and support from friends and family have been implicated in promoting patient adherence by encouraging optimism and self-esteem, buffering the stresses of being ill, reducing patient depression, improving sick role behaviour and giving practical assistance. The presence of close others may result in the direct or indirect control of behaviour and facilitating adherence. However, a non-supportive relationship maybe toxic and have an opposite effect.
A collaborative approach to care augments adherence. People who have difficulty maintaining adequate adherence need more intensive strategies than do patients who have less difficulty with adherence, a more forgiving medication regimen, or both. A useful approach could be to create a social strategy with involvement of medical, lifestyle and mental health experts to empathise, motivate and provide continuous guidance. Regular monitoring of blood sugar levels using cloud services and forthwith action which is pragmatic and with person involvement bolsters confidence. Importantly, people should have help and guidance at hand and should have people to speak to. This can be done remotely using video link, text messaging and chat using mobile health. As travel takes up a lot of time and is inconvenient, this can be done from a place of choice of both the provider and the patient. Other new technologies such as reminders through mobiles and pillboxes may be needed to help patients who have the most difficulty meeting the goals of a regimen. Medication apps represent a possible strategy that can be recommended to non-adherent patients and incorporate into their practice. It is important to make the person believe that whatever strategy is used, people with good diabetes self-care behaviours can attain excellent control. |
AuthorsDebashis Archives
December 2016
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