Online Health Chat with Andrea Dunn, RD, LD, CDE

Tuesday, November 17, 2015

Description

If you have type 2 diabetes, you can improve your health and lower your risk of heart disease or stroke:

  • Eat foods like fruits, vegetables, beans and whole grains as part of your carbohydrate budget.
  • Eat foods made with less salt, saturated fat and trans fat.
  • Be active 30 minutes or more each day.
  • Stay at or get to a healthy weight by being active and eating the right amounts of healthy foods.
  • Stop smoking.
  • Take medicines the way your doctor tells you.
  • Ask your doctor about taking medicine to protect your heart, such as aspirin or a statin.
  • Ask for help if you feel down or have trouble with stress.
  • Ask your family and friends to help you take care of your heart and your diabetes.

About the Speaker:

Andrea Dunn, RD, LD, CDE, is a registered dietitian and certified diabetes educator with the Center for Human Nutrition. She focuses patient counseling on diabetes management and prevention, weight reduction and cholesterol/blood pressure management. She takes an individualized approach to each patient’s lifestyle, learning needs and readiness to change.

Andrea completed her undergraduate degree at Notre Dame College of Ohio and her internship at Miami Valley Hospital in Dayton. She has volunteered for more than 10 years with the Academy of Nutrition and Dietetics’ Diabetes Care and Education Dietetic Practice Group, serving in a chair role for three years. She is currently on the advisory board for Heart Advisor Newsletter and an associate editor for Diabetes Spectrum. Andrea has been a certified diabetes educator for the past 15 years.


Let’s Chat About Healthy Eating with Diabetes


Holiday Eating

heidi: Last year, I was newly diagnosed with type 2 diabetes and was afraid to eat over the holidays. Since then, I have learned more about food and my blood sugars. I have lost 10 pounds and exercise regularly. I don't want to avoid all my favorite foods this year on Thanksgiving. What should I focus on?

Andrea_Dunn,_RD,_LD,_CDE: Focus on the reason for the holiday – being thankful! Beyond that, enjoy what you eat. Plan ahead for the situation you are going to be in (at home, at a restaurant, eating two holiday meals at two different homes). There is no one way to address holidays. You might want to decide ahead of time on which foods might be special for that meal (Aunt Betsy's stuffing and Cousin Jo's pumpkin pie) and not eat the foods you can have at other times (mashed potatoes, white bread rolls, ice cream). Be careful not to get caught up in other people's overeating drama. Enjoy what you eat without guilt. Balance what you eat with moderation and exercise/activity. And as much as possible, stick to your sleep and medication schedule.


Specific Foods

McNeill: I use a few different sugar substitutes, depending on what I am eating or drinking. One of my friends has diabetes, and she uses sugar instead. Should I switch to sugar?

Andrea_Dunn,_RD,_LD,_CDE: It is nice to have choices among non-nutritive sweeteners, but you certainly don't have to use any of them if you don't want to. They are very low in calories, if they even have any calories at all. Every gram of sugar has 4 calories, so a teaspoon of sugar (one level measuring teaspoon) has 4 grams of sugar and 16 calories. Just be a minimalist if you are using sugar and do count is as part of your total carbohydrate budget if you are counting carbs.

r903: When I was diagnosed with diabetes, my doctor told me to follow a low-carb, high- fiber diet. What can I eat?

Andrea_Dunn,_RD,_LD,_CDE: The style of eating for someone with diabetes can be any number of heart healthy eating patterns. Perhaps your doctor was talking about eating less added sugar and processed foods, and choosing more whole grains, vegetables, fruits and nuts/seeds/beans (higher fiber foods)? This certainly would offer you more vitamins/minerals and antioxidants and still give your diet plenty of variety.

sinaihospital: I have had type 2 diabetes since 2009. What foods must I eat and what foods must I not eat for my type 2 diabetes? Thank for your advice.

Andrea_Dunn,_RD,_LD,_CDE: There is no one diet for diabetes. But a style of eating for diabetes should be heart healthy, as diabetes can increase your risk of heart disease and stroke. Instead of focusing on what you can/can't eat, think about the foods you like to eat. Are most of them plant-based? For example, whole grains, vegetables and fruit? Next, look at your other risk factors. Are you at a healthy weight? Is your blood pressure in goal range? Are your cholesterol/lipid numbers in goal range? How about your blood sugars? Are you exercising regularly? All these factors are important in long term treatment of your diabetes. For more information on diet, get a yearly update from your registered dietitian.

MelliG: My doctor said it would be OK if I had an occasional alcoholic drink, but I've had friends that said alcohol can cause low blood sugars. What do I need to know?

Andrea_Dunn,_RD,_LD,_CDE: Moderate alcohol consumption is usually defined as one drink/day or less for adult women and two drinks/day or less for adult men. To reduce any risk of hypoglycemia (low blood sugar) for those who might be using insulin or secretagogues, have your alcoholic drink with food, not on an empty stomach. Monitoring your blood sugar more frequently may also reassure you that your blood sugar level is within goal range.

Shelli: Here is my question. A good example of this is Cool Whip. The carb total in the original is lower than the carb total in the sugar free. Which should I eat and why?

Andrea_Dunn,_RD,_LD,_CDE: Hopefully, you are not eating much of either one. They are a condiment. So, I would say choose the one you like by taste, but be mindful of the serving size and enjoy the food. Or use an aerosol whipped dairy choice, which may only have 1 gram of carbohydrate and 1 gram of fat.

Peppy: Is bitter melon useful in treating blood sugar spikes after meals?

Andrea_Dunn,_RD,_LD,_CDE: Several small studies have looked at the bitter melon, which is a fruit looking somewhat like a cucumber, and its effect on blood sugars for those who have diabetes. However, at this time, the American Diabetes Association does not recommend the use of any herbal products due to lack of evidence.


Discussing Diets

uca2120: What is a good diet for someone who has diabetes?

Andrea_Dunn,_RD,_LD,_CDE: There is not one style of eating for diabetes. A healthy way to eat could be:

  • Vegan diet
  • Vegetarian diet
  • Mediterranean diet
  • DASH diet
  • Low-fat diet or moderate-carbohydrate diet
  • Moderate carbohydrate diet

casi: Is there some easy, quick way to calculate what a meal consists of regarding carbs, protein, etc.?

Andrea_Dunn,_RD,_LD,_CDE: Some people use the meal "choices" approach . If you look at food according to food groups, then knowing how many choices from each food group to have each day can be a quick and easy way to assess what you eat. You can see a registered dietitian to have this planned out for you. If you know your calorie needs, you can look at http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf in appendix 7 for dietary patterns and food choices by calorie needs.

LJJ: Is there a guideline for the percent of carbs, proteins and fats, as well as grams of fiber for a meal or the entire day?

Andrea_Dunn,_RD,_LD,_CDE: There is no one diet for diabetes nor is there an ideal percentage of carbs, protein or fats. Regarding fiber, the guidelines for those with diabetes are no different than other people. Try for at least 14 grams of fiber/1000 calories or roughly 28 grams or more if you need 2000 calories.

casi: Somewhere there must be a chart or something with the ideal percentage of carbs, protein and fats that we can easily use. A list/plan would be much easier to use to get a handle on this.

Andrea_Dunn,_RD,_LD,_CDE: These percentages will vary depending upon the type/style of eating your follow. For example, a vegan or vegetarian style of eating is going to be higher in percent of carbs than an animal-based, protein style of eating. At this time, the American Diabetes Association recommends these percentages be based on your individual needs, considering your glucose, lipid, blood pressure and weight goals.

derosy: I notice the diets recommended contain fruit, vegetables and whole grains, but when I look at the amount of carbs in foods like beans, apples, oranges, peaches and Shredded Wheat and Grape Nuts cereal, there are a ton of carbs in these foods. So what's up?

Andrea_Dunn,_RD,_LD,_CDE: You are correct. A style of eating heart healthy, and higher in fiber, in based on foods that contain carbohydrates. These foods are nutrient-dense and not very processed.


Medical Matters

Jack_in_Florida: I take three metformin (500) per day. How should I time them? With meals? Two with breakfast, one with dinner? Does it make any difference? I seem to tolerate them well.

Andrea_Dunn,_RD,_LD,_CDE: I will refer you back to your prescribing physician for your dosage times. For most people, taking the metformin with meals decreases any stomach/intestinal issues that may occur, especially when first taking metformin. (Intolerances may include diarrhea or increased gas/bloating.)

gm3: Do patients with diabetes have worse outcomes after coronary artery bypass graft surgery (CABG) than heart patients without diabetes? Also, does diabetes damage the tiny blood vessels that supply oxygen and nutrients to the nerves in your legs, kidneys and eyes?

Andrea_Dunn,_RD,_LD,_CDE: These are very good questions to ask of your cardiologist and primary care doctor. Some of the variables include the length of time that you have had diabetes, how well managed your diabetes is and your genetic profile. Yes, uncontrolled diabetes can damage the blood vessels and nerves that service the legs, kidneys and eyes.

dannmcN: My doctor has me on a fixed insulin plan (x amount of insulin before each meal, three times/day). But even giving myself insulin before each meal, I find that my blood sugars are still out of goal range. What am I doing wrong?

Andrea_Dunn,_RD,_LD,_CDE: When you are on a fixed insulin plan, you need to also eat similar amounts of carbohydrates from meal to meal. We call it a consistent carbohydrate style of eating. Just as you "consistently'' take your insulin, you need to be consistent with the amount of carbohydrate you have at each meal (not eat the same food but similar amounts of carbs) or you will get varying results (high or low blood sugars depending on the amount of carbs). A registered dietitian, certified diabetes educator or your health care provider can give you more information about this plan.

Peppy: Discuss the statin and certain blood pressure medications linked to the onset of diabetes. It is real for many of us, and we don't want diabetes too. Thank you.

Andrea_Dunn,_RD,_LD,_CDE: You are correct. There are some medications (certain statins, hydrochorothyazide, beta-blockers) that may precipitate higher than normal blood glucose or be risk factors for developing diabetes. That does not mean you should stop these medications on your own. Look at the other risk factors you have for developing diabetes, and work on those you can control – weight, exercise, choosing healthy foods.


Curious Complications

gatorfrog: Hello. I have type 2 diabetes. Back in 2011, I had my large intestine removed, subtotal colectomy. Since then, I have a very hard time digesting food, especially meats, even fish. This causes me to have a bit of a hard time keeping my blood levels even. What can I do to get more protein into my diet? Thank you for any help.

Andrea_Dunn,_RD,_LD,_CDE: It sounds like you have two separate issues, the blood glucose levels and inadequate protein intake. Due to the complexity of your surgery and possibility you could have malnutrition, I recommend you follow up individually with a registered dietitian who is also a certified diabetes educator or specializes in diabetes.

eatveggies: For several years, my A1c level has been 6.2, but my fasting (12-hour fasting) glucose level is always normal (usually in the 80s, highest once was 92). I'm a 69-year-old female, and my weight is normal and stable (124 lbs., 5'4"). I exercise almost daily, walking or treadmill. I eat a very low fat, vegetarian diet and only whole grains. Any dietary advice?

Andrea_Dunn,_RD,_LD,_CDE: My first question to you would be, are you anemic? If yes, then the actual blood glucose number will be more accurate than the A1c average. If you are not anemic, then the A1c elevation in the pre-diabetes range (5.7-6.4) may be reflective of after meal rises in your blood glucose. Have you ever monitored your blood glucose two hours after a meal or snack? Monitoring at that time will show you how what you ate effected your blood sugars (goal of 180 or less two hours after a meal if you have diabetes. Otherwise, people without diabetes seldom spike higher than 140).


Dealing with Prediabetes

jfks: Would it be prudent to follow a diabetes diet for those of us who are pre-diabetic (over 100)?

Andrea_Dunn,_RD,_LD,_CDE: Actually, the recommendations are a bit different. The prediabetes recommendations are based on the Diabetes Prevention Program, which focused on five percent to seven percent weight loss and 150 minutes or more of moderate-intense exercise/week. This was a National Institute of Health study, and all of the information is available online. The focus of the weight loss was a low-fat style of eating. As has been mentioned today, the "diabetes diet" is actually a individualized heart healthy diet, using portion control to achieve/maintain a healthy weight. In this concept, yes, this would also help with prediabetes.


Seeking Further Facts

Higline: I've seen a registered dietitian and attended the diabetes classes my local hospital offers. I would like to read more and keep up on diabetes. Any suggestions?

Andrea_Dunn,_RD,_LD,_CDE: Have you checked out the new launch of "Eat Well, America!" by the American Diabetes Association for National Diabetes Month? See it at www.diabetesforecast.org/landing-pages/adm/ for shopping, cooking, eating and meal planning ideas.

LJJ: Thank you. All of the links and feedback are very helpful.


Closing

That is all the time we have for questions today. Thank you, Andrea, for taking time to discuss healthy eating and diabetes.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.

Andrea_Dunn,_RD,_LD,_CDE: According to the Centers for Disease Control and Prevention, approximately 9.3percent of the US population (29.1 million) is affected by diabetes (that’s one out of every 11 people). And 86 million Americans aged 20 years or older have prediabetes. Chances are, someone you know has or will develop type 2 diabetes. Strategies for all people with diabetes should be choices that are heart healthy: not gaining weight if you are overweight, including regular exercise and following a high-fiber style of eating that is low is added sugars and avoiding trans fats.

Knowing what foods contain carbohydrates, and choosing the nutrient-dense high fiber foods whenever possible over the processed foods that are higher in sodium, fat and sugars can help with blood sugar management. For most people, this includes eating moderate portions of foods at meals and snacks.

There is not one style of eating for diabetes. A healthy way to eat could be:

  • Vegan diet
  • Vegetarian diet
  • Mediterranean diet
  • DASH diet
  • Low-fat diet or moderate-carbohydrate diet
  • Moderate carbohydrate diet

Eating healthfully through the holidays can certainly be a challenge. Focusing on non-food holiday treasures (family and friends) can certainly help target the reasons for celebrating the holidays in the first place and take the focus off overeating. Eat mindfully this holiday season. Enjoy what you eat. Strive for moderation and not overeating.


For Appointments

To make an appointment with Andrea Dunn, RD, LD, CDE, or any of the other specialists in our Digestive Disease and Surgery Institute, Center for Human Nutrition at Cleveland Clinic, please call 216.444.3046 or toll-free at 800.223.2273, ext. 43046, or visit us online at www.clevelandclinic.org/nutrition.

To register for one of our Diabetes Education classes, or to speak with a Cleveland Clinic diabetes care specialist, please call 216.444.6568.


For More Information

Cleveland Clinic Digestive Disease and Surgery Institute

Cleveland Clinic’s Digestive Disease and Surgery Institute (DDSI) offers patients the most advanced, safest and proven medical and surgical treatments primarily focused on disorders related to the gastrointestinal tract.

Part of the DDSI, the Center for Human Nutrition provides evaluation, education and treatment to people who have disease-related nutrition problems. Additionally, the Center is involved with a multitude of programs to promote health and wellness. Both of these efforts are driven by a dedicated team of registered dietitians, dietetic technicians, nurses, pharmacists, physicians and surgeons who work together to provide comprehensive support for patients with specialized nutrition needs.

The Digestive Disease and Surgery Institute has been ranked second in the nation by U.S. News & World Report’s Best Hospitals Survey since 2003 and first in Ohio since 1990.

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