5 Strategies to Prevent Diabetes

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

Diabetes is a health problem that has greatly increased over the past 20 years.  More and more people are diagnosed with Type 2 Diabetes each year, and an estimated 25% of people with the disease don’t even know they have it.  Type 2 Diabetes occurs when your blood glucose is consistently higher than it should be, either because your pancreas is not producing enough insulin or your cells aren’t able to respond to insulin’s signals. 

In addition to the increases in Type 2 Diabetes, another 1 in 3 people have prediabetes, or blood glucose higher than normal but not high enough to be diagnosed with diabetes.¹ People with diabetes and prediabetes are at a higher risk for heart disease, stroke, vision loss, and amputations, and they pay almost twice as much in healthcare costs as people without diabetes.¹ The good news is that both prediabetes and Type 2 Diabetes are preventable.  There are several dietary and lifestyle changes you can make today to help reduce your risk for diabetes, keep your blood glucose within a healthy range, and reverse the progression of the disease even if you already have prediabetes or Type 2 Diabetes.

1.  Maintain a healthy body weight. 

People who are overweight and obese are more likely to develop Type 2 Diabetes.  Although the exact relationship between weight gain and diabetes is unclear, researchers believe that excess fat tissue produces signals that cause cells to become insulin-resistant.  At the same time, it's likely that obesity causes the pancreas to produce so much insulin in response to high blood glucose that the pancreas becomes damaged and is eventually not able to produce enough insulin.² Either way, studies have shown that blood glucose levels improve when people who are overweight or obese lose just 7% of their initial weight.³ To find out how much weight you would need to lose to reduce your risk for diabetes, simply multiply your weight in pounds by 0.07.

2. Be physically active.

All adults should get at least 150 minutes of moderate-intensity physical activity every week, or about 30 minutes every day.  During exercise your cells take glucose from your blood to use for energy, leading to an immediate drop in blood glucose and improving blood glucose levels throughout the rest of the day.  One study found that people who engaged in 45 minutes of high-intensity exercise experienced high blood glucose levels about 2 hours per day less than sedentary people.  Even taking a 15-minute walk after a meal can help by causing a short-term drop in blood glucose, but may not lead to the same long-term blood glucose control that vigorous exercise can cause.⁴ It’s important to note that you should check your blood glucose levels before and after exercise if you are already taking diabetes medication because combining that medication with exercise can cause your blood sugar to fall dangerously low. 

3. Choose foods with a low glycemic index.

A food’s glycemic index is an estimate of how that food will impact your blood glucose levels after you eat it.  In general, foods with a high glycemic index are made up of refined carbohydrates and sugar, which are digested and absorbed quickly and do not include much protein, fat or fiber.  Some foods with a high glycemic index include white bread, sugar-sweetened drinks, sweetened breakfast cereals, cookies, and cakes.   

Foods with a low glycemic index tend to be higher in fiber or protein, so they take longer to digest and therefore cause your blood glucose to rise more slowly. Whole grains, fruits, vegetables, nuts, and legumes are all carbohydrate-rich foods that tend to have lower glycemic indexes.  The fiber in whole grains may be especially helpful for reducing the risk of Type 2 Diabetes.³ Protein and fat do not impact blood glucose, and since they slow digestion adding them to a meal will decrease the meal’s overall glycemic index.

4. Eat yogurt.

Although overall dairy intake is not associated with Type 2 Diabetes, people who eat yogurt are less likely to develop the disease.  One study of nearly 195,000 people found that eating one serving of yogurt per day is associated with a 4% lower risk of developing Type 2 Diabetes.  People still saw this benefit regardless of whether the yogurt was plain, flavored, full fat, or low fat.⁵   

One possible reason for this is yogurt’s high magnesium content.  Studies have shown that people who do not eat enough magnesium are at a higher risk for diabetes,³ and increasing magnesium intake by 100 mg per day can decrease that risk by 15%.⁶ Taking magnesium supplements alone has not been shown to help prevent Type 2 Diabetes, so there could be some other benefit to eating whole foods that are naturally high in magnesium.  Instead of relying on supplements, meet your daily need for magnesium with foods like yogurt, as well as whole grains and leafy vegetables, which are also high in fiber.

5. Eat less red meat.

Both processed and unprocessed red meats are associated with the development of Type 2 Diabetes.^3,7 There are lots of possible explanations for this relationship.  Red meat is high in heme-iron, a pro-oxidant that can damage pancreatic cells.  Red meat also tends to contain nitrites, which your body converts into nitrosamines that are toxic to the pancreas.  Eating a lot of red meat is also linked with future weight gain, which could independently lead to Type 2 Diabetes.  Try substituting poultry, fish, beans, or low-fat dairy for one serving of red meat to reduce your risk for Type 2 Diabetes.⁷

Overall, the keys for diabetes prevention are not much different from the recommendations for a healthy lifestyle.  Engaging in regular physical activity, choosing whole grains and fiber-rich fruits and vegetables, limiting sugary foods and drinks, and replacing a few servings of red meat each week with lean protein or yogurt will help you reduce your risk for many other diseases as well as Type 2 Diabetes.

References:

1.         CDC Features - Diabetes Latest. http://www.cdc.gov/Features/diabetesfactsheet/. Accessed January 20, 2017.

2.         Eckel RH, Kahn SE, Ferrannini E, et al. Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized? Diabetes Care. 2011;34(6):1424-1430. doi:10.2337/dc11-0447.

3.         Association AD. 4. Prevention or Delay of Type 2 Diabetes. Diabetes Care. 2016;39(Supplement 1):S36-S38. doi:10.2337/dc16-S007.

4.         Dijk J-W van, Venema M, Mechelen W van, Stehouwer CDA, Hartgens F, Loon LJC van. Effect of Moderate-Intensity Exercise Versus Activities of Daily Living on 24-Hour Blood Glucose Homeostasis in Male Patients With Type 2 Diabetes. Diabetes Care. 2013;36(11):3448-3453. doi:10.2337/dc12-2620.

5.         Chen M, Sun Q, Giovannucci E, et al. Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. BMC Med. 2014;12:215. doi:10.1186/s12916-014-0215-1.

6.         Office of Dietary Supplements - Magnesium. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/. Accessed January 20, 2017.

7.         Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011;94(4):1088-1096. doi:10.3945/ajcn.111.018978.

Recipe Review: Spinach & Pearl Barley Risotto

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

Prep time: 30 minutes

Cooking time: 15 minutes

Ingredients:

1 Tbsp vegetable oil

2 small red onions, chopped

2 cloves garlic, minced

1 cup pearl barley

3 1/3 cups vegetable stock

1 pint cherry tomatoes, halved

7 oz fresh spinach or 4 cooked beets

2 oz coriander

1 Tbsp lemon juice

1 15-oz can garbanzo beans, drained and rinsed

Instructions:

1.     Add oil, onions, and garlic to a large sauté pan and cook over medium heat until onions have softened.  Add all of the pearl barley and stir around the pan for about a minute, or until the barley starts to become translucent.  Add the stock one ladle-full at a time, stirring until the barley absorbs the stock before adding another, until about 1 ½ cups of stock remain.

2.     Pour the remaining stock into the pan, cover, reduce heat to medium-low, and allow the barley to cook for 15 minutes.  Stir occasionally.

3.     While the barley cooks, put the spinach or cooked beets into a blender or food processor and puree until smooth.  If no blender is available, chop spinach or beets finely.

4.     When the barley is cooked and the liquid has been absorbed, add the puree along with the halved cherry tomatoes, garbanzo beans, lemon zest, and coriander.

5.     Serve warm.

Yield: 6 Servings

Nutrient Facts:

275 calories, 10 g protein, 51 g carbohydrate, 5 g fat, 10 g fiber

92 mg calcium, 633 mg potassium, 584 mg sodium, 4 mg iron, 83 mg magnesium

169 mcg vitamin A, 20 mg vitamin C, 1 mg vitamin E, 162 mcg vitamin K, 145 mcg folate

This risotto was quick, flavorful, and satisfying.  I made a few changes to the original recipe and was very happy with the result.  The original recipe says to roast the tomatoes in the oven while the barley cooks, but I wanted to make the meal a little simpler.  Cutting the tomatoes in half and adding them directly to the risotto allowed them to cook a little and also helped the flavor of the tomatoes blend with the rest of the dish.  This was a great way to still include cooked tomatoes without having to worry about them burning in the oven while I concentrated on the barley.

I also modified the recipe by adding garbanzo beans.  Usually a risotto might be served as a side dish to accompany chicken or fish, but I wanted to make this a one-pot meal.  Using garbanzo beans increased the risotto’s protein and fiber content.  It also added a little depth to the meal’s flavor, and the softer texture of the beans complemented the chewiness of the barley.  These changes ultimately streamlined my cooking process because I didn’t have to turn on my oven or make a side dish to serve as a protein source.

The last modification I made was to chop the spinach by hand and add it earlier in the cooking process since I didn’t have the means to puree it.  This didn’t appear to change the texture or flavor of the dish, but I believe it did change the color.  Cooking the spinach for longer made it come out a duller green, and the color might have been brighter and more interesting if I had pureed the spinach and added it after the barley was cooked instead.  If you plan to serve the dish to children who would be excited by a brightly colored meal, I would recommend adding the spinach at the end so the color stays vibrant.

Although I had never cooked with barley before making this dish, it is definitely going to become a staple in my kitchen.  People have been depending on barley for a long time.  In 1324, the King of England declared an inch to be equal to “three grains of barley, dry and round, placed end to end lengthwise.”¹ Barley is similar to rice because it is a small, hard grain that has to be cooked in water or broth before you can eat it, but whole grain barley (also known as hulled barley) has more protein and fiber than brown rice.  Hulled barley has also been shown to help with blood sugar control because it is high in the soluble fiber beta-glucan.  Unfortunately, pearl barley is not a whole grain.  You could easily substitute hulled barley to get more fiber out of this meal, but you might end up cooking it for 15-20 minutes longer.   In the grocery store, you can find barley either in the bulk section or in the rice aisle.

Overall, this was a wonderful dinner.  It was a great way for me to learn how to cook barley, and I will be enjoying the leftovers for a few days!

Recipe Source: http://www.honestlyhealthyfood.com/blogs/honestly-healthy-food/17968997-spinach-pearl-barley-risotto

References:

1.         Barley – February Grain of the Month | The Whole Grains Council. http://wholegrainscouncil.org/whole-grains-101/easy-ways-enjoy-whole-grains/grain-month-calendar/barley-%E2%80%93-february-grain-month. Accessed January 13, 2017.

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Recipe Review: Curried Yellow Split Pea Soup with Spinach

Submitted By Amy Sercel MS RD CD

Edited By Marcia Bristow MS RDN CSSD CD

Prep Time: 20 minutes

Cooking Time: 45 minutes

Ingredients:

2 tsp vegetable oil

1 cup onion, chopped

1 clove garlic, chopped

1 ½ tsp fresh ginger, finely chopped

½ tsp ground cumin

½ tsp curry powder

¼ tsp turmeric

¼ tsp ground coriander

¼ tsp cayenne

2 cups dried split yellow peas

1 ½ cups fresh spinach, shredded

½ tsp salt

Instructions:

1.     In a large soup pot, heat oil over medium heat.  Add onion and garlic and cook until soft, 3-5 minutes.

2.     Add ginger, cumin, curry powder, turmeric, coriander, and cayenne.  Cook, stirring, 1 minute to toast the spices. 

3.     Add the split peas and 8 cups of water.  Bring to a boil over high heat.  Reduce heat to medium-low, cover, and simmer until split peas are soft, about 45 minutes.

4.     Add spinach and salt.  Cook until spinach wilts, about 1-2 minutes.  Soup will thicken upon standing.  Add additional water to thin as desired.

Yield: 8 servings

Nutrient Facts:

203 calories, 12 g protein, 31 g carbohydrate, 4 g fat, 12 g fiber

37 mg calcium, 581 mg potassium, 156 mg sodium, 2 mg iron, 59 mg magnesium

39 mcg vitamin A, 5 mg vitamin C, 1 mg vitamin E, 45 mg vitamin K, 106 mcg folate

This recipe is quick, easy, and excellent for a cold winter night!  It is flavorful and satisfying but low in calories and fat, making it a great option if you are looking to keep your energy intake low.  My family found it delicious – everyone asked me for a copy of the recipe!  I doubled the amount each spice, but you could definitely use less if you prefer a milder meal.  You could also consider personalizing the soup by adding some cauliflower, bell peppers, mushrooms, winter squash, or kale about halfway through the step of simmering the split peas.  I recommend doing this if you’re thinking of making this a one-pot dinner, since the original recipe doesn’t call for many vegetables.

You don’t have to plan very far ahead to make this recipe.  Depending on how stocked your spice cabinet is, you probably have almost all of the ingredients in your pantry already, and you’ll only have to chop the onion, garlic, ginger, and spinach.  I would suggest chopping the garlic, onion, and ginger before you start cooking so you can sauté everything immediately without worrying that it will burn while you are chopping the next ingredient.  Once you add water the soup needs to simmer for about 45 minutes, which will allow you plenty of time to chop the spinach, prepare a side dish or just relax before eating. 

I served this dish with brown rice and steamed broccoli to give the meal some extra color and texture.  My family loved the way the brown rice complemented the soup.  The rice also boosts the meal’s protein content a little, providing the essential amino acids that are missing from the split peas to create a complete protein.

If you aren’t used to cooking with yellow split peas, you can find them in the same aisle as canned beans in your grocery store.  Yellow split peas are a relatively inexpensive and nutritious source of protein.  They’re high in folate, a vitamin that helps keep your immune system strong and your heart healthy.  They’re also high in fructans, a type of fiber that promotes the growth of healthy gut bacteria.  Overall, this is a nourishing meal that is sure to become a go-to on those busy days when you aren’t sure what to have for dinner.

Recipe Source: http://www.food.com/recipe/curried-yellow-split-pea-soup-with-spinach-206923

Exercise to Lose Weight? Maybe Not

Submitted By: Amy Sercel MS RD CD

Edited By: Marcia Bristow MS RDN CSSD CD

Often when people have a goal of losing some weight, their first strategy will be to work out more often.  It’s possible that you’ve even tried this in the past.  If so, you might have noticed that exercising more does not always result in the weight loss you want, or may lead to a slight weight gain.¹

The truth is that exercise alone isn’t enough to achieve significant weight loss.  In order to lose weight you need to burn more calories than you eat, which creates something called an energy deficit.  As a general rule, you need a deficit of 500-1,000 calories each day to achieve a healthy weight loss of 1-2 pounds per week.  Unfortunately, the number of calories you will burn through exercise is affected by your age, gender, ethnic background, body mass index, and genetics, so it’s hard to estimate how much exercise you need in order to create enough of an energy deficit to lose weight.²

It’s common to overestimate the number of calories you burn during exercise and underestimate the calories you eat.  Some foods are surprisingly high in calories, and you might not burn as many calories through exercise as you think.  If you weigh 150 pounds, here are some activities you would need to do to burn off different foods:^3,4

• Walk briskly for 30 minutes to burn off a 12-oz beer with 150 calories
• Swim for 1 hour to burn off a bagel and cream cheese with 450 calories
• Run 4 miles to burn off a 16-ounce mocha latte with 400 calories
• Lift weights for 1 hour to burn off 2 tablespoons of Nutella with 200 calories
• Row for 45 minutes to burn off a medium serving of French fries with 365 calories

In addition to taking a longer than you realize to burn off the calories you eat, it’s also possible that your body will make up for the calories you burn through exercise by slowing your metabolism or producing hormones that make you feel more hungry.  In one study, 35 people exercised long enough to burn 500 calories per day for five days each week.  While in theory everyone in the study should have lost weight, half of the participants either didn’t lose weight or gained weight.  These participants reported feeling hungrier than usual and ended up eating an average of 270 calories per day more than they did before starting the program.⁵ Other studies suggest that the number of calories you will burn through exercise levels off as you get more active because your metabolism slows down in response to your increased activity level.^6,7 

Although exercising alone might not be the most effective way to lose weight, it can certainly contribute to the energy deficit needed for weight loss, and there are many other reasons to be active.  Regular physical activity can help prevent further weight gain, and can also reduce your risk of heart disease, diabetes, and some cancers.  It will also help you maintain your balance and muscle mass as you get older and can help keep your mind sharp.⁸ If you are looking to lose weight, create an energy deficit by filling up on low-calorie fruits and vegetables and choosing smaller portions.  Make an appointment with a Registered Dietitian to learn how many calories you should eat every day, develop strategies to make dietary changes that will work for you and set realistic physical activity goals.  This way, you will form healthy habits that will help you lose weight and maintain your weight loss.

References:

1. Liebman B. You should exercise to lose weight, right? NutritionAction.com. November 2016. http://www.nutritionaction.com/daily/exercise-for-health/exercise-to-lose-weight/?mqsc=E3859437&utm_source=WhatCountsEmail&utm_medium=Nutrition_Action_Daily_TipsNutrition%20Action%20Daily&utm_campaign=2016.11.25%20Exercise%20for%20Health. Accessed November 25, 2016.

2. Thomas DM, Kyle TK, Stanford FC. The gap between expectations and reality of exercise-induced weight loss is associated with discouragement. Prev Med. 2015;81:357-360. doi:10.1016/j.ypmed.2015.10.001.

3. Publications HH. Calories burned in 30 minutes for people of three different weights. Harvard Health. http://www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-and-routine-activities. Accessed December 13, 2016.

4. Food Nutrition Chart, Food Calorie Chart, Whats Cooking America. https://whatscookingamerica.net/NutritionalChart.htm. Accessed December 13, 2016.

5. King NA, Hopkins M, Caudwell P, Stubbs RJ, Blundell JE. Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss. Int J Obes. 2007;32(1):177-184. doi:10.1038/sj.ijo.0803712.

6. Pontzer H, Durazo-Arvizu R, Dugas LR, et al. Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans. Curr Biol. 2016;26(3):410-417. doi:10.1016/j.cub.2015.12.046.

7. Byrne NM, Wood RE, Schutz Y, Hills AP. Does metabolic compensation explain the majority of less-than-expected weight loss in obese adults during a short-term severe diet and exercise intervention? Int J Obes. 2012;36(11):1472-1478. doi:10.1038/ijo.2012.109.

8. Physical Activity for Everyone: Guidelines: Adults | DNPAO | CDC. http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html. Accessed June 14, 2015.

Recipe Review: Butternut Squash White Bean Stew

Submitted By Amy Sercel MS RD CD

Edited By Marcia Bristow MS RDN CSSD CD

Prep time: 30 minutes

Cooking time: 35 minutes

Ingredients:

2 T olive oil

1 c slivered onion

¾ c sliced celery

3 c mushrooms, halved

4 c butternut squash, peeled and cubed

1 14-ounce can diced tomatoes

1 clove garlic, pressed

2 c water

2 T tomato paste

¾ tsp dried rosemary

½ tsp coarse salt

1 pinch black pepper

2 15-oz cans Great Northern beans, rinsed and drained

Chopped fresh parsley to garnish

Instructions:

1.     Heat oil in a large pot over medium-high heat.  Add onion, celery, and mushrooms.  Cook until vegetables start to brown, about 8 minutes.

2.     Stir in squash, tomatoes, garlic, water, tomato paste, rosemary, salt, and pepper and mix well.  Cover and bring to a simmer.  Reduce heat and simmer until squash is tender, about 25 minutes.

3.     Uncover, stir in beans and simmer until stew consistency, about 10 minutes.  Sprinkle with parsley, if desired.

Yield: 8 servings (1 ½ cups each)

Nutrient Facts:

247 calories; 14 g protein; 42 g carbohydrate; 4 g fat; 11 g fiber

163 mg calcium; 1245 mg potassium; 338 mg sodium; 5 mg iron; 108 mg magnesium

388 mg vitamin A; 25 mg vitamin C; 3 mg vitamin E; 13 mcg vitamin K; 129 mcg folate

My family thought this stew was delicious – the flavors blended together and complemented each other nicely.  As an added bonus, you might already have some of the ingredients in your pantry, and can stock up on the canned items to keep on hand for those busy nights when you aren’t sure what to make for dinner.

While you will spend about 30 minutes chopping the vegetables, you will have plenty of time to clean up the kitchen, prepare side dishes, or just relax in the 35 minutes it will take for the stew to simmer.  The most time-consuming part was peeling and cutting the butternut squash.  If you want, you can avoid this step by using pre-cut butternut squash from the produce section of your grocery store.

One of the best things about this dish is the fact that you can easily customize it to your tastes.  I left out the celery because of a food allergy and used additional mushrooms instead.  I also used tomatoes canned with basil, which gave the stew some extra flavor, and might consider adding a few tablespoons of fresh basil next time.  If you like spicy dishes, you could add some paprika or a chopped jalapeño pepper for an extra kick.  You could also sprinkle a little cheese on top for a savory touch.

This recipe is so satisfying and flavorful that you might not notice it’s both gluten-free and vegan.  The high fiber content in the squash, mushrooms, and beans will keep you full for a long time after eating and could help reduce your cholesterol levels.  Great Northern beans contain a lot of iron, which you will absorb more easily because of the vitamin C in the butternut squash.  The soup also contains about 25% of your daily need for potassium, an electrolyte that most people don’t get enough of.  Having adequate potassium in your diet can help keep your heart healthy and reduce your blood pressure. 

I ate this with steamed broccoli and garlic bread, but it could also pair well with a green salad, baked chicken, or a sandwich.  No matter how you serve it, this stew is sure to please even the toughest critic!

Recipe Source: http://relish.com/recipes/butternut-squash-white-bean-stew/