Living with Diabetes

Diabetes. What is this?

Chances are you have heard of this disease.  Maybe you have an uncle that has diabetes because he let his diet and lifestyle get out of hand. You may have seen a coworker poking his/her finger just to draw blood and test it on a handheld machine before they eat lunch.  Or maybe you heard the Liberty Medical commercial and chuckled every time Wilford Brimley mentioned "Diabeetus."  My experience with diabetes came when I was about 16 years old and my father was diagnosed with type 1 diabetes (unusual but true). So what is diabetes? And how is their life any different from yours?

Simply put, diabetes is a medical condition where the pancreas (as pictured) does not make insulin or the body does not use insulin correctly.  To break the definition down a little further, insulin is a hormone that the body uses to convert the foods you eat into energy.  As you eat, the carbohydrate foods (listed below) are broken down into a single sugar molecule called glucose.  Glucose is absorbed into the bloodstream where it flows freely until insulin “unlocks” an opening in the cell wall, so it can be used as energy your body needs to function correctly.  When insulin is not made by the pancreas or cannot be used correctly, the glucose stays in the bloodstream which not only neglects your cells from energy but can cause damage to your blood vessels, eyes, nerves, or kidneys.  In some instances, it can lead to death.  When there is a large amount of glucose roaming in the blood stream it is known as hyperglycemia.

 

 

Foods that contain carbohydrates:

·         Grains

·         Cereals

·         Pasta

·         Fruits

·         Vegetables

·         Milk/yogurt

·         Beans

·         Sweets/sugar

 

When you have diabetes, the body does not discriminate against carbohydrates.  A carb is a carb no matter if it is a piece of candy or piece of fruit. When someone has diabetes they have to watch how many carbohydrate foods they eat and not just avoid sweets, as many of us assume.  When my father was first diagnosed with type 1 diabetes we, his family, thought “oh he can eat candy as long as it is sugar-free” or “he can eat whatever as long as it is not cake or ice-cream.” But neither of these statements are 100% correct.  The American Diabetes Association explains this into further detail:

*Myth: People with diabetes can't eat sweets or chocolate.

*Fact: There are no “off limits” foods for people with diabetes just like for someone without diabetes.  If eaten with a healthy meal plan and blood sugar is not too high, sweets or chocolate may be included.  The key to sweets or chocolate is portion control. These foods contain higher amounts of carbohydrates so if consumed on special occasions or in a small amounts, these foods are acceptable.

*Myth: People with diabetes should eat special diabetic foods.

*Fact: A suggested meal plan for someone with diabetes is in the same ballpark as a healthy diet suggested to any other individual – lean protein, whole grains, fruits and vegetables (non-starchy), healthy fats while limiting saturated and trans fat, and limit salt and sugar.  Diabetic foods or sugar-free foods usually have no benefit while they may increase blood glucose, cost more, and contain sugar alcohols which may cause a laxative effect.

 

There are many different ways to determine what kind of carbohydrate foods to eat or how many the individual should eat.  This includes carbohydrate counting, glycemic index, exchange list, or just an overall healthy diet based on MyPlate.

 

 

Type I vs. Type II

The two main types of diabetes are type 1 diabetes and type 2.  The biggest difference in the two conditions has to do with the insulin in the body. 

Listed below are the differences between type I and type II diabetes:

Type I	Type II
Previously known as “juvenile diabetes”
Only about 5 % of diabetic cases	Most common
The pancreas does not make insulin	The pancreas makes insulin but it is not used correctly in the body – “insulin resistant”
Insulin shots are required	Most cases do not have to take insulin shots --
Cannot be reversed	Can be reversed if caught early and diet/lifestyle is corrected
Usually diagnosed before the age of 40	Usually diagnosed after the age of 45
Symptoms develop rapidly (days/weeks)	Symptoms develop slowly (years)
Risk Factors: disease of Pancreas, infection or illness	Risk Factors: Obesity, insulin resistance, ethnicity, high blood pressure, sedentary lifestyle, age

 

Diabetes Complications

·         Diabetic Ketoacidosis (ketosis): a severe condition where hyperglycemia (high blood glucose/sugar) causes an accumulation of ketones in the blood and urine. – may lead to death

·         Cardiovascular disease

·         Retinopathy (eye damage)

·         Neuropathy (nerve damage) – may lead to amputation

·         Nephropathy (kidney damage)

o   In 2011, 49,677 people of all ages began treatment for kidney failure due to diabetes.

o    In 2011, a total of 228,924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant.

·         Coma

 

Both types of diabetes may lead to these complications, but the most severe form of diabetes is when the pancreas completely stops making insulin – type I and later stages of type II diabetes.  Maintaining a consistent blood glucose level is left up to the individual.  Education on diet, insulin, exercise, hyper and hypoglycemia symptoms, handling emergencies, coping, and even pregnancy are crucial at this point.

With everything mentioned above with diet and complications, one would think managing their diabetes should be a priority.  Well, what if you had a child with type I diabetes and their life depended on insulin shots? Would you do everything in your power to keep them healthy?  A recent study published in the Journal of the Academy of Nutrition & Dietetics brought this idea to reality.

Within this questionnaire, parents not only mentioned how specific foods can affect their child’s blood glucose levels but expressed the “importance of not restricting their child’s diet” (276). These parents found a barrier when it came to other siblings without type I diabetes, school events, parties, or play dates, or when the child refused to eat what was offered at mealtime.  The parents talked about others being allow to eat specific foods (high carbohydrate) and not wanting their child to feel “left out.”  Another parent mentioned they would rather have their child eat a food higher in carbohydrates then not eat at all or fight with them to get them to eat the meal provided.

 

After learning about how important carbohydrates can be to an individual with diabetes or how untreated diabetes can be a risk factor to many other conditions, how strict do you think you would be if you were a parent of a child with diabetes?

 

Main Article

Patton, S.R., Clements, M.A., George, K., Goggin, K. (2016). ”I don’t want them to feel different”: A mixed methods study of parents’ beliefs and dietary management strategies for their young children with type I diabetes mellitus. Journal of the Academy of the Academy of Nutrition and Dietetics, 116(2). 272-281. Doi:10.2016/j.jand.2015.06.377.

 
 

Resources for readers

Guide to Raising a Child with Diabetes

http://www.shopdiabetes.org/548-ADA-Guide-to-Raising-a-Child-with-Diabetes-3rd-Edition.aspx?loc=type1&source=dorg

Sports and Rec

http://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-life/sports-recreation.html

Everyday life Links

http://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-life/

Fiber: Are We Getting Enough?

Source: http://smartypantsvitamins.com/the-difference-between-soluble-and-insoluble-fiber/

As kids, we all heard the song “Beans, beans, the magical fruit, the more you eat…” well…you know the rest. While the song is catchy and causes kids to go into fits of laughter, it can be confusing because who thinks of beans as a fruit? Technically they may be considered a fruit, but for nutrition purposes we consider them legumes. The song does hold true, though, because beans contain fiber, which helps keep you regular. It is a component of our diet we actually need more of instead of less. According to the Dietary Guidelines for Americans 2015, fiber is under consumed and is of public health concern. This is likely due to the health implications that a lack of fiber in the diet can present. There are two types of fiber, and while many of you are thinking soluble and insoluble, I’m actually talking about dietary and functional. Dietary fiber is fiber that occurs naturally in whole foods, such as fruits and vegetables, whereas functional fiber is isolated and added to foods to increase fiber intake.

In the February issue of the Academy of Nutrition and Dietetics (AND) Journal, the question of the month asks, “Is dietary fiber considered an essential nutrient?” To answer that question, we must first determine the definition of a nutrient. Nutrients are chemical substances obtained from food and used in the body to provide energy, structural materials, and regulating agents to support growth, maintenance, and repair of the body’s tissues. Fiber is not absorbed, doesn’t provide energy, and therefore, isn’t a nutrient, much less an essential nutrient. It is, however, an essential component to a healthy diet. While fiber is generally thought of as an agent to keep you regular, it can provide much more than constipation relief.

Fiber assists in preventing

·  Weight gain-foods high in fiber make you fuller, especially when combined with adequate amounts of water, which can reduce your overall caloric intake.
·      Diabetes-Soluble fiber turns into a gel after absorbing water and slows the rate at which sugar enters the bloodstream.
·      Heart disease-Studies have shown that fiber consumption can impact cholesterol levels, reducing the risk of heart disease.
·      Digestive problems-Fiber keeps things moving in the gastrointestinal tract and can prevent or relieve constipation.

The recommended amount of fiber for women is 25g/day and 38g/day for men. For men and women over the age of 50, the recommended fiber intake is 30g and 21g, respectively. Yet, the average American consumes only 14-15 grams of fiber a day. Why do you think that is? If we were following the MyPlate guidelines, we would probably be meeting the suggested fiber needs. But we all know that with the fast paced lives that numerous Americans live, many rely on quick, cheap foods that are generally highly processed and calorie dense. Most of these foods, as we know, contain little to no fiber.

So how do we get more fiber in our diet? Fiber can be found in plant foods, such as fruits, vegetables, legumes, and whole grains.

Foods naturally high in fiber include:

·      1 cup raspberries (8g)
·      ½ cup black beans (7.5g)
·      ½ avocado (~7g)
·      1 medium pear (5g)
·      ½ cup lentils (8g)
·      1 cup whole wheat pasta (6g)

“But, what about supplements?” you ask. Studies show that supplements and functional fiber may not have the same effect as eating foods that are naturally rich in fiber. Those that reach their fiber goals through whole foods rather than supplements or fortified foods are consuming more fruits, vegetables, beans, nuts and whole grains. So not only are they obtaining valuable amounts of fiber, they are also likely meeting their needs for other various nutrients, which is why fiber intake is a good indicator of our diet quality. If we are lacking in fiber, we’re probably lacking in other nutrients, as well.

I encourage you to evaluate your fiber intake. It is easy to fall short in that category when we are not making an active attempt to fulfill that need. SuperTracker is a great tool to utilize for fiber content, among various other nutritional requirements, as many sources of dietary fiber do not have a nutrition label.

For those that need to increase their fiber intake, do so gradually. Increasing fiber dramatically can cause stomach issues, including bloating, cramping, and gas. To reap the benefits from fiber and to alleviate any discomfort, it is suggested that fiber be consumed with plenty of water.

How much fiber are you getting in your daily diet? Could you benefit from increasing your consumption of fiber-rich foods?

Main article:

Kohn, J.B. (2016). Is dietary fiber considered an essential nutrient? Journal of the Academy of Nutrition and Dietetics, 116(2), 360. doi:10.1016/j.jand.2015.12.004

Integrative Medicine

Over the past decade (if not longer), there has been some buzz about something called “integrative medicine” (or IM for short).  Many assume that IM is something that only “hippies” would take seriously, so you may have never taken it into consideration with your own health. Yet contrary to this belief, there has been a steady increase of interest in IM from the medical community and more studies are conducted every year on its effectiveness and safety.

So what is integrative medicine?  You may also recognize IM under one of its many aliases, such as complementary therapies, alternative medicine, or holistic health. Essentially, IM combines conventional medicine and alternative medicine. It not only addresses the specific disease or illness, but also incorporates other less “mainstream” aspects of medicine such as the psychological, social, and spiritual aspects of health. IM treats the symptoms along with the other underlying causes and effects of the disease as an individual state.  In other words, IM focuses on the whole picture (thus the term holistic, meaning “the interconnectivity of all of the parts that cannot be separated”).  IM also creates a therapeutic bond between patient and the health care team--something that can be sorely lacking in modern medicine. https://nccih.nih.gov/health/integrative-health

One example of the growing interest in this field is how the Mayo Clinic incorporated a complementary and integrative medicine program within their department of medicine in 2001. Duke University has an ever growing IM department that incorporates research into its program. Yale School of Medicine has incorporated an IM curriculum. Even the National Institute of Health (NIH) has created the National Center for Complementary and Integrative Health (NCCIH).  

In addition to the burgeoning inclusion of IM curriculum into medical schools, the Academy of Nutrition and Dietetics (AND) has taken an interest in creating standardized curriculum for nutrition programs as well. With all of these credible programs and organizations taking an interest in IM, maybe it’s time to remove the “stigma” from IM and start treating it a bit more seriously.

The National Center for Complementary and Integrative Health (NCCIH) states that the use of IM has grown within care settings across the nation, including hospitals, hospices, and military health facilities. Some of the most common integrative medicine approaches include:

• Natural products (herbs, vitamins, minerals and probiotics)
• Herbs Fact Sheet: https://nccih.nih.gov/health/herbsataglance.htm
• Supplement Fact Sheet: https://ods.od.nih.gov/factsheets/list-all/
• Use wisely: https://nccih.nih.gov/health/supplements/wiseuse.htm
• Yoga
• https://nccih.nih.gov/health/yoga/introduction.htm#hed5
• Tai chi
• https://nccih.nih.gov/health/taichi/introduction.htm#use
• Meditation
• https://nccih.nih.gov/health/meditation/overview.htm#hed3
• Massage
• https://nccih.nih.gov/health/massage/massageintroduction.htm#hed3
• Chiropractic
• https://nccih.nih.gov/health/chiropractic/introduction.htm#hed5
• Acupuncture
• https://www.nlm.nih.gov/medlineplus/acupuncture.html

Now, since this is a blog is written by a dietetic intern and future nutrition professional,  it’s crucial that I show the evidence to back up this topic (i.e. the scientific approach to show the importance of increased IM education).  In 2002, a Complementary and Alternative Medicine (CAM) Task Force was designated by the Academy of Nutrition and Dietetics (AND). The objective of the CAM Task Force was to design measurable educational competencies for dietetic practitioners. They created recommendations for incorporating integrative medicine into dietetic education for nutrition college students and nutrition professionals.

Three years after the CAM Task Force was created, they conducted a survey in 2005. They discovered that integrative medicine education existed in curriculum, but it was inconsistent in content. It was made clear that dietetic educators must include integrative medicine into their curricula so future registered dietitian nutritionists (RDN) can be better prepared and ready to provide proper guidance to their clients and patients. The registered dietitian nutritionist must be competent and confident in all fields of nutrition, and the field of integrative medicine is no different.  

More recently (August of 2014), the Academy of Nutrition and Dietetics produced a survey that was geared towards the dietetic approach of integrative medicine. The purpose of the survey was to identify how  many dietitians incorporated some sort of integrative medicine into their counseling and education, what type of integrative medicine used, and how much education they received on integrative medicine.  

The survey found the most confident and commonly utilized approaches to integrative medicine were vitamin and mineral dietary supplements, functional foods, probiotics, and fatty acids. The survey also revealed that the minimal use of integrative medicine within the dietetics field is due to a lack of education. Educators in didactic programs for dietetics claimed that less than two hours were spent on lectures based on integrative medicine. However, those same educators agreed on the importance of integrative medicine education in curriculum was crucial. It concluded the main reason for the lack of integrative medicine education was time.

The survey also revealed an agreement amongst RDNs that the Accreditation Council for Education in Nutrition and Dietetics (ACEND) should incorporate a standardized curriculum for competencies in didactic programs for dietetics, internships for dietitians, and offer board certification as a specialist in integrative medicine.  

Ok, so enough fancy, technical research and science talk!  What does this mean for you??  Whether you’re a nutrition student, an RDN, or just an interested individual, IM can (and most likely does) play a role in your life whether you realize it or not!

For the (soon-to-be or established) RDN, it is important to keep one thing in mind: you may or may not decide to have a background or education in IM, but you will be asked questions about vitamins, mineral, supplements, and other IM practices from your clients and patients. No matter your personal beliefs about IM, it is crucial that you can provide the correct information to your client or patient. Like most medical treatments, research is ever growing and evolving, so it is imperative we stay up to date with the most recent findings so we can provide the most accurate and appropriate information and guidance. To see what scientific studies have shown to be effective and safe, reliable sources can be found at nccih.nih.gov

For those that are not in the nutrition field ,but have a genuine interest in expanding or practicing IM, here are a few words of advice:

• Always talk to your health care providers before starting any integrative medicine. Especially dietary or herbal products. You do NOT want an interaction with other medications you may be taking.
• Even though you are a patient or client, you too can stay up to date on scientific studies. It will help when deciding which IM approaches may work best for you. The website nccih.nih.gov is an amazing resource that allows you to search all kinds of different IM practices and the most recent scientific support. Please make sure that your information is coming from a credible source and not a post on Facebook. I have provided a couple of other resourceful links at the bottom of this post.  
• Be careful when choosing a complementary health practitioner.  Do your research here to to find someone with credentials but be careful, there is no standardized system for credentialing complementary health practitioners. It varies from state to state, so do your research! Maybe your family doctor or other health care provider could give you a recommendation?
• Remember: IM is not just about taking supplements!
• There are many, proven and encouraging studies that tout the benefits of yoga, acupuncture, massage, and natural products. Use the links that were provided above, below each category.

Integrative medicine has been around for millennia, and is not going anywhere.  It’s time to get get on board!

Main Article:

Augustine, M. B., Swift, K. M., Harris, S. R., Anderson, E. J., & Hand, R. K. (2016). Integrative Medicine: Education, Perceived KNowledge, Attitudes, and Practice among Academy of Nutrition and Dietetics Members. Journal of the Academy of Nutrition & Dietetics, 116(2), 319-329. doi: 10.1016/j.jand.2015.08.015

Other References and Resourceful Links:

https://nccih.nih.gov/health/decisions/consideringcam.htm

http://www.mayoclinic.org/alternative-medicine/ART-20046087?p=1