November In-Review

November is Diabetes Awareness Month.  My last blog was all about knowing your numbers.  You can read about it here.  I can't stress to you enough about knowing your numbers, it really is the first step in prevention.  Going to the doctor can be daunting, but it's more important to know where your numbers are at (for diabetes, heart disease, that's why they're called check-ups!) and concurrently make changes to improve your health.  I hear a lot of people that say, "I'm just going to eat what I want and enjoy life."  My response always to them is that the food I eat not only is healthy BUT also tastes good, why else would I be eating it? 

The truth is you need to start where you are at and implement one change at a time.  It really is that simple.  Make too many changes all at once?  Odds are you'll slip back into your old habits.  Our goal is to implement healthy habits for life.  

Thanksgiving was this past week.  The holidays are here and amongst us!  I helped contribute to an article for work about "Eating Healthy for the Holidays".  It's been thought that many people gain more weight than they really do over the holidays.  However, the weight that people do gain - between 1-2 pounds - is often times not lost.  So over the years gaining 1-2 pounds each year can really add up.  You can read more about my tips in the article here, about how to prevent this weight gain.  Keep in mind that the holidays are a time to spend with family and friends and while food is often times the focus, try finding alternative activities to do that aren't solely focused on food - pick a fun activity/exercise to do together - museum, park, play, beach (it is currently 81° here in the MIA).

The holidays can be stressful - lots of activities that require time management, financial stress, and it also involves spending time with loved ones, which let's be honest can be stressful, so exercise is helpful for staying active as well as having an outlet for stress.  It's a win win!    

The CDC released a report that stated that 1 in 10 Americans are eating the recommended amount of fruits and vegetables needed daily:  1 1/2 cups of fruit and 2-3 cups of vegetables (depending on age and gender).  1 in 10?  I'd like to think we're doing better as a country, but when they release studies like this it only validates my job that much more.  I believe there are a number of reasons why people are not getting the recommended amount and one is definitely lack of access (and affordability).  We have to do better and have kale on sale for "2 for $3" or else people are buying the chips that are the same price.  Additionally I believe people don't always know how to cook their vegetables and if people don't know how to cook them, then they definitely aren't eating them (don't get me started on how little restaurants offer them as well.  It's like a mission to get a salad with dinner without having to pay SO much extra!)  It's the common theme I keep repeating on the blog - start where you are at.  If you are eating little to no vegetables, start including a salad at meals.  It might be the simplest way to begin to include vegetables and it doesn't require cooking.  From there?  keep finding ways to try and experiment with a new vegetable.  Just whatever you do, don't start juicing or making smoothies - I need you to chew your food - juicing and smoothies might just be the worst trend ever.  Read about it here.

4 Salads 4 Different Ways - Change the nut, cheese, and fruit and you've got a different tasting salad!

I've shared about this before on the blog, but for those new to reading my blog I've challenged myself to make everything homemade (for the most part).  From homemade marshmallows to homemade pestos, I'm making everything homemade.  The one area though that still is not completely homemade - bread/crackers/pie crusts, etc.  I've dabbled in making bread before and it isn't too difficult (yes it takes time and patience) but it's definitely something that with more practice starts to come easier.  I knew I needed to get back into the swing of making more homemade breads (bread does freeze, so there's really no excuse)! 

I've seen so much recently about sourdough starters, I figured if I'm making things homemade, I might as well try to start literally from the ground up.  I wanted the challenge to see if I could really get a starter going.  The craziest part of it all?  It literally is just water and flour.  The fermentation happens all on it's own over time and with a little feeding.  Now for background knowledge, I do happen to kill all things green (plants), so I was a little worried that I'd be able to get the starter going and then it would just fizzle.  I've been reading Artisan Sourdough Made Simple by The Clever Carrot to help give me guidance and while I'm only into week 2, so far so good!  I should probably read a little more into her tips, but once I got the starter past week one and I made my first loaf I felt accomplished.  Into week two now and I have had an issue with "hooch" aka I need to feed my starter.  Again, I should read more of her tips.  I am not an expert, yet.  But it has inspired me to get a Dutch-oven - probably should've already had one at this point in my cooking career, but I opted to make a bread in a 9x5 pan this week.  I didn't realize the bigger the pot the more air there is for the bread to breathe, hence why my 1st loaf was quite small.  And if I'm investing, I should probably get a bread cutter, because if I'm baking bread I might as well have a cute design on the top.  You know I'm right.

While November is coming to a close, Diabetes Awareness Month isn't just the month of November.  I worked for 3 and a half years with an emphasis in diabetes.  Now more than ever we have to create awareness through education because the stats are staggering - it's estimated that 1 in 3 people by 2050 will have Type 2 diabetes.  Yes, awareness needs to be spread.   

Type 1 Diabetes does not always get as much attention as Type 2 Diabetes does as it doesn't effect as many people.  It is a chronic autoimmune condition characterized by a pancreas that is not able to produce insulin, a hormone that's necessary for vital life functions.   The condition is often misunderstood by many and those that have been given the diagnosis are left to deal with the diagnosis.  I've counseled many patients with Type 1 Diabetes on how to carb count, basal/bolus insulin therapy, CGMs, etc.  But the one thing I often felt at a loss in how to help - was in dealing with the diagnosis.  If you know someone that has recently been diagnosed with Type 1 Diabetes, have them read this article.  If you are someone living with Diabetes and have had a hard time dealing with the diagnosis, read this article.  And if you are someone that doesn't know anything about Type 1 Diabetes, read this article.  It will forever change your life.  I know it did mine.

Click to read article here.

#ThisIsDiabetes

November is Diabetes Awareness Month®.  The theme this year from the American Diabetes Association is #ThisIsDiabetes - "Whether you're living with diabetes, caring for someone who is, or you're fighting to stop it, there's a hero in you.  One in 11 Americans has diabetes.  So put on your cape and take a stand."  It's a month to draw awareness to the disease as well as to call attention to those at risk.

I taught a class last week called "Dining Out and Diabetes" in Spanish, "Comer Afuera y la Diabetes".  Ironically no one in class had diabetes, so I shifted my focus of class to discuss what diabetes was and more so how to prevent it (what I prefer anyways).  One lady in class mentioned she was too scared to go in and have her levels checked.  She kept asking a lot of questions but yet didn't know what her numbers were.  Bottom line she's like so many others out there:

Approximately 84 million American adults - more than 1 out of 3 - have prediabetes.  Of those with prediabetes, 90% don't know they have it. 

To me that's a staggering statistic and the reason why we have National Diabetes Awareness Month®.  Experts say a "diabetes tsunami" is coming our way.  Why are the numbers SO high?  One of the main reasons is that  ⅔ of adults (and  ⅓ of children) are overweight or obese, not to mention we're couch potatoes - binge watching TV is the new norm, sadly.  Type 2 diabetes develops because the body is resistant to insulin.  Insulin acts like a key that allows sugar to enter the cells, where it can be burned for fuel or stored for later.  However, in some people, the key struggles to open the lock.

This puts the pancreas into overdrive - to compensate for this insulin resistance the beta cells have to pump out more insulin just to keep up.  Over the years the beta cells wear out.  When this occurs this is when the blood sugar levels fall into the "diabetes" range.  Americans are headed towards this breaking point because of a couple of reasons:  we're gaining weight at alarming rates (due to portion sizes, sugary beverages, and less exercise) and because of age.  Beta-cell failure occurs more rapidly with age.  

I read an article this week that discussed this issue - of needing to know your numbers, yet doctors are not communicating how important it is to make a change once you've been diagnosed with prediabetes.  "Prediabetes doesn't trigger much of a fuss in the doctor's office.  A lot of healthcare professionals see the numbers are in the prediabetic range and simply tell the patient that their numbers are high.  They should go home and exercise and eat less."  Many patients I saw (at my previous job that were referred by their primary care doctors) had NO idea what their numbers were and and/or why they were even being referred - many knew they needed to lose weight, but stated they had NO idea of their blood sugar levels.  Now in the doctors' defense the patients may have been told this, but in the education/prevention world we call this the "Charlie Brown effect".  They get their diagnosis and then all they heard was "whaa whaa whaa whaa".  The truth is you're going to have some doctors that are more proactive than others.  I encouraged all my patients to be their own advocates and one, know their numbers and what they mean, and two take preventative action with their nutrition.  One other good piece of advice is to see a specialist if your numbers are in the prediabetes range, an endocrinologist.  They specialize in endocrine disorders.  If you have heart disease you see a cardiologist - so why wouldn't you see an endocrinologist if you have prediabetes?  Back to the numbers and what they mean:

If you have a fasting blood sugar drawn (eight-hour fast) and the numbers fall in between 100 - 125 mg/dL this signals that you have an irregularity in your blood sugar levels, impaired glucose tolerance.  A diagnosis is not made from one blood sugar level, however, you should have your A1c level checked.  The A1c level is a 3-month average of your blood sugar levels.  This will give a better picture of what is going on (as well as the ability to diagnosis if your blood sugar levels are normal, prediabetic, or diabetic).  If the A1c level falls in between 5.7 - 6.4% this is considered prediabetes.  6.5% and higher is diabetes.  This is the first place I start with patients, in understanding their numbers.  Diabetes works on a continuum - it cannot be reversed (contrary to what people may say), however it can be controlled.  The first step is knowing your numbers and if they are in a range of concern, begin to make changes in order to offset/prevent developing diabetes.  

How can we lower the risk of developing type 2 diabetes?  How can we help control type 2 diabetes if one already has it?  There was a whole study focused solely on preventing type 2 diabetes - Diabetes Prevention Program.  Here's what the findings said along with other helpful tips to help prevent diabetes:

-The best way to dodge diabetes is to lose weight (or not gain) extra pounds.  Losing 7-10% of your current weight can cut your chances of developing type 2 diabetes in half.

-Do at least 30 minutes of brisk walking or other aerobic exercise every day.  Include strength training two or three times a week as well.  Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose.  Limit the time you spend sitting at work, at home, or in between.  

-Limit sweets, especially sugar-sweetened drinks.  The sugar you sip may add flab more than the sugar you chew.  Liquid calories don’t seem to lead to satiety and it’s easy to take in a large amount, easily.  Think your drink! 

-Fill up half your plate with vegetables and only a quarter with (preferably whole) grains.  Whole grains don’t have a magical nutrient that fights diabetes and improves health.  It’s the entire package – elements intact and working together – that’s important.  The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose.  This leads to lower, slower increases in blood sugar and insulin.  As a result, they stress the body’s insulin-making machinery less, and may help prevent type 2 diabetes. 

I also wrote a whole blog post last time about how to choose healthier carbohydrates - they're not all created equal.  Read about it here.

-Replace saturated fat and trans fats with unsaturated fats to lower the risk of heart disease.  The unsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.  Trans fats do just the opposite.  Trans fats are found in many margarines, packaged baked goods, fried foods in fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. 

Baptist Health South Florida, my current employer, is finishing up a year-long program that implemented the Diabetes Prevention Program - education, support, changing lifestyle habits - all in an effort to prevent Type 2 diabetes.  We'll be starting another program in January.  If you or someone you know has prediabetes and is looking for help and support and is ready to implement change, comment below so I can refer you to get signed up for the program!  You must live in Miami.  A year might sound like a long time, but it takes time to implement change and undo habits that you've had for a lifetime, all in an effort to help prevent diabetes.  It'll literally be a life-changing program.

The bottom line and the good news about diabetes:  you're not destined to get diabetes if you practice prevention.  Keep your weight - and especially your waist - under control, and spend more time on your feet than on your seat!

The key to healthy eating is balancing your plate - protein/carbohydrate/healthy fats - and aiming to include LOTS of non-starchy veggies to fill you up with fiber!  Delish, healthy food!