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Exercise Physiologist & Diabetes

December 3, 2014 by Imagine_David Leave a Comment

So often we nit-pick at our meal plans thinking that what we eat is the problem with our blood glucose levels.

In fact our meal plan may be perfect …. but ….. our blood glucose level may not be.

For people with type 2 diabetes, more energy spent on designing & participating in a safe & effective exercise program might be the answer.

Do you have an Accredited Exercise Physiologists (AEP) on your team?

Accredited exercise physiologists (AEPs) hold a four-year university degree and are allied health professionals who specialise in the delivery of exercise for the prevention and management of chronic diseases and injuries.

AEPs provide support for clients with conditions such as cardiovascular disease, diabetes, osteoporosis, mental health problems, cancer, arthritis, pulmonary disease and more.

AEPs are eligible to register with Medicare Australia, the Department of Veterans’ Affairs and WorkCover and are recognised by most private health insurers.

********For more information about how you can access an AEP via Medicare go HERE *********

**A safe exercise plan can help with many different health problems, not just diabetes**

AEPs work in:

private clinics
hospitals
occupational rehabilitation companies
employment agencies
gymnasiums
GP super clinics
research institutes.

You might see an AEP to help you:

create a safe and effective diabetes self care exercise plan to enhance your diabetes self management
If you have pre-diabetes – create a safe and effective exercise plan to reduce your risk, or delay, the start of type 2 diabetes
overcome persisting pain caused by injury or overuse
improve your heart health
rehabilitate following a cardiac event
improve your recovery following cancer treatment
improve your general health and wellbeing.

AEPs also provide training in safe manual handling; perform functional assessments; carry out sub-maximal and maximal fitness tests; perform body composition tests and musculoskeletal assessments; and provide lifestyle education to help people manage their health conditions.

In Australia, we have the unique situation where we’re working backwards.

We have the existing resources and infrastructure including the specialised workforce of Exercise Physiologists and the Medicare subsidies which enable Australians to access these services, but we need to significantly increase our activity levels as 70% of Australians are not active enough.

Accredited Exercise Physiologists are allied health professionals, providing exercise and lifestyle therapies for the prevention and management of chronic disease, injury and disability.

**Safe and effective exercise planning is best done by the AEP**

AEP vs. Personal Trainers

Accredited Exercise Physiologists (AEPs) are not Personal Trainers.

AEPs are allied-health professionals with Medicare Provider numbers and are trained members of the health and medical sector. Fitness professionals (e.g. personal trainers) are members of the sport and recreation sector.

Personal Trainer

The Personal Fitness Trainer Qualification (Certificate 4) may be completed in less than 6 weeks of training.
Qualified and insured to design and deliver fitness programs to persons of low risk only (i.e. “apparently healthy populations”).

Accredited Exercise Physiologist (AEP)

Allied Health Provider
4 Year University Degree qualified and accredited with ESSA.
Specialise in graded exercise therapy and lifestyle interventions for persons at risk of developing, or with existing chronic and complex medical conditions and injuries (i.e. ‘specific populations’).

**Safe and effective exercise can assist with the maintenance of a good quality of life**

Questions to ask your AEP

How much experience do you have in helping people living with diabetes create safe and effective diabetes self care exercise plans?
What do you need from me to give me the safest advice?
Will you work with me and my other health care professionals e.g. diabetes educator , dietitian, doctors to enable everybody to understand the plan and to guide me safely with this plan? Can you write the plans and advice for me so that I can show my other health care professionals what we are doing?

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

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A fresh look at The Christmas Meal

December 1, 2014 by Sally Leave a Comment

My family celebrated Christmas Day a month early this year because we’ll all be in different parts of the world on 25^th December, and we value our annual family get together. I thought it was a good opportunity to remind you how easy it is to provide a delicious and nutritious lunch, especially for us in Australia with the hot weather, that won’t disrupt your usual diabetes routine too much whilst still enjoying your Christmas celebrations. I’ve also included a few of our family recipes for your enjoyment.

Ours was held at my brother’s home in Sydney. We had 20 family members expected, including 7 children under the age of 14. Our Christmas foods tradition follows a Red, White and Green theme to look Christmassy. My Mum is the organiser and she delegates one dish to each of the family groups, so not all the preparation and cooking is left to one person (although you’ll notice that she does more than her own fair share!). Sharing that load really does minimise the stress often associated with these large family gatherings.

The basic idea is to include more plant-based foods, and provide a treat or two that you save for these such special occasions.

We arrived to bowls of pistachio nuts – perfect as each nut must be opened first, thereby minimising overeating potential – and olives. Perfect with a glass of bubbly to get us all in the mood for our Christmas feast ahead!

First course are the cold green and red soups.

I made the green zucchini soup which is so easy (6 zucchini, 1 onion lightly sautéed. Add 1 litre chicken stock, one chopped potato and some fresh dried tarragon with salt and pepper to taste. Simmer for 15 mins or until potato is cooked through. Allow to cool. Blend and refrigerate).

One of my Sister-in-laws made the red tomato gazpacho which is just pureed tomatoes with an onion/ lemon juice flavour added, plus diced cucumber and ham (from the main event).

Both these soups are very popular across the whole family. The children tend to love the zucchini soup the best. I like to indulge in a small bowl of both so I can enjoy both yummy flavours.

Buffet in the kitchen.

Our centre piece is a whole ham that my Mum makes a glaze for and bakes. It’s served at room temperature as there usually no room in the fridge, and that’s where the salt comes into its own as a preservative until there’s room to get it into the refrigerator.

Of course, the ham in your meal could be replaced with any protein source that you and your family enjoy including the traditional favourites of turkey and seafood.

Traditionally we’ve had cold baby potatoes tossed in fresh herbs and olive oil for our carb salad (excellent for resistant starch and glycemic management), however this year Mum found a recipe for a quinoa and cannellini bean salad that was also full of fresh herbs. It was very delicious, but also more work than the potatoes.

Then the non-starchy salads – we have a tomato salad, a green avocado salad and asparagus with parmesan, so there are plenty of plant foods to fill up on.

This year Mum found an unusual tomato recipe that had pomegranate seeds and lots of fresh herbs. Again it was very delicious but I think she underestimated how long it would take to dice up all those coloured tomatoes. It was flavoured with lots of chopped garlic, fresh herbs and olive oil. Usually we do sliced beefsteak tomatoes with mozzarella cheese and fresh basil leaves on top, drizzled with extra virgin olive oil. I don’t think you can beat that one for simplicity and flavour!

Desserts

We don’t really enjoy the richness of the traditional Christmas desserts in our family. This year another of my Sister-in-laws and one of my Aunts were asked to bring a dessert with no guidelines so we ended up with a pavlova topped with lovely fresh fruit, and a light lemon ricotta cheesecake that my Sister-in-Law found on a blog called ‘Marley & Lockyer’ with you as it’s so easy and suitable for us with diabetes.

We served ours with low-fat icecream, but you could also use low-fat Greek yogurt rather than cream.

For those of you who really enjoy the Christmas puddings and mince pies, the December 2014 issue of Australian Healthy Food Guide magazine included a feature called ’10 of the best Christmas treats – enjoy your favourite sweets for fewer kJs!’ which I encourage you to read. In there they rate the ‘Best Mince Pie’ as a bite-size Woolworths Free From Gluten Fruit Mince Bit as a ‘real taste of Christmas’ for only 522kJ (125cal).

Reminders

I hope you found some healthy inspirations here for your Christmas main meal. I’d remind you to have a read of the blog I wrote for Diabetes Counselling Online entitled ‘Five tips for managing diabetes at events where food choices are likely to be poor’ and remember these tips when you’re at your own Christmas food celebration.

I’d also encourage others of you to share your own healthy and special favourite Christmas dishes in the comments below please!

Wishing you all compliments of the season with a reminder about enjoying everything in moderation, except the love and goodwill that we can all enjoy in excess across the Christmas season. Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

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Breakfast with diabetes

November 17, 2014 by Sally 13 Comments

Many people have been asking me about their breakfast choices lately, so hopefully this blog will help to answer some of your own breakfast questions. They usually want to know how to choose a good breakfast cereal, how much of it to have to keep them feeling satisfied til morning tea without disrupting their blood glucose results too much, what they can have instead of cereal that is quick and easy and still healthy and how to enjoy a breakfast out without tipping the scales too much.

Before starting though I’d like to remind you to not make any changes to your current diabetes routine without first checking with your own health care professionals. These are meant as general guidelines only.

Why do we need it?

As people with diabetes, breakfast is important to us for several reasons:

It helps to get our blood glucose levels of to nice level start, especially when we include a moderate amount of low-GI carbs
It helps us to manage our appetite better as the day progresses, especially so we don’t end up very hungry and tempted to make poor choices
It fuels our brain so we can mentally function better and cope better with the curve-balls that diabetes can throw at us
It helps to reduce insulin resistance by providing us with the low-GI energy that our bodies need to function better

What should be in it?

A good starting place is a reminder that with each meal we should include low-GI carb sources, preferably 2 carbohydrate serves as a minimum, and a protein serve to ensure we have the slow release of glucose to keep our brain fuelled for peak performance and our tummies happy so we don’t crave poor food choices by morning tea. Extra fibre also doesn’t go astray.

How to choose a good breakfast cereal?

If you recall our earlier blog on label reading, when reading cereal packet labels we should be looking for whole grains, nuts and fruit with little or no added sugar or oil in the ingredients listing if possible. Ideally we’d like the fibre to be at around the 10-15g/100g level, but if it isn’t then extra can be added in the form of bran, psyllium or chia seeds to boost it.

Remember too that if you have nuts included in your cereal it may fall outside of the total fat value of 10g/100g, saturated fat 2g/100g targets that we aim for, but as long as there are no other fats listed then all the fat is from the nuts so it’s okay.

So if you’ve got the whole grains and the nuts and the dried fruit and the low-fat milk or plain yogurt for added protein and low-GI carb, you should find all the reasons listed above satisfied for the importance of your breakfast.

How much of it should I have?

Certainly an important consideration as too much could upset your glycemic control, rather than helping it, and could also contribute to unwanted weight gain.

Everyone is different and the answer will depend on your activity levels, on your hunger and of course on your diabetes management objectives.

This is where it’s important to check with your own d-team, preferably an Accredited Practising Dietitian, about how much is right for you.

What can I have instead of cereal?

So many clients I see tell me they don’t like cereal, and that’s fine. We all have different tastes. There are many other breakfast options that are suitable for people with diabetes.

Multigrain toast and muffins with an egg or baked beans for added protein and extra veggies to help you meet your 5 veggie serves are awesome. Avocado and fresh tomato on toast (no need for a spread) is also a great way to get started. And peanut butter works on toast to give you the extra protein serve to keep you feeling fuller for longer.

Fruit smoothies also work well for those of you who struggle to eat in the mornings.

Cooked breakfasts are also wonderful when you have a little more time, and including veggies in there is a great idea.

I actually really like the ideas included in this blog by one of our Diabetes Counselling Online Facebook group members, Dr Lyndal Parker Newlyn: The Beauty of Breakfast that also talks about why it’s so important to get into this healthy habit.

What about eating out for breakfast?

Eating out can work well if you remember the diabetes basics about low-fat, low sodium and whole grains.

Choose meals like a bircher museli with fresh fruit and plain yogurt, or spinach, mushrooms and tomatoes on multigrain toast, or served with baked beans for that low GI carb with protein included.

And enjoy a coffee made on low-fat milk for the good low-GI carb and protein hit.

Traditional breakfast ideas that should be reviewed for better diabetes management

The first thing that springs to mind is fruit juice. Traditionally many Australians enjoy a glass of juice with their breakfast. With diabetes it’s not an ideal option when you consider that we’re aiming for two pieces of fruit per day and a glass of juice provides the carb energy of closer to 4 pieces of fruit without the fibre.
Avoid crumpets – yes, even the wholemeal ones. Not only do they have a high glycemic index but they’re also high in sodium (sodium bicarbonate is used to make the holes) and most people like to have butter or margarine on them which adds unneeded extra fats.
Doubling up – Some of my clients tell me they have both cereal and toast, and unless you’re having a half serve of each, you probably don’t need to have both. This is where many of my clients see a rise in their BGL readings 2 hours after breakfast, when basically they’ve just had too much for their system to manage.

What do you eat for your diabetes breakfast?

Please share below what your favourite breakfast ideas are, in case they spark someone’s tastebuds into action. We have different tastes, so the more ideas we can share the better!

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Making 2&5 easy

November 3, 2014 by Sally Leave a Comment

We’re all so busy these days. How on Earth are we meant to able to consider our health and getting enough fruit and vegetables (our 2&5) into the meals we eat?

Often I see clients who, when I take their diet histories, they don’t even start to consider foods like fruit and vegetables until so late in the day that it’s actually too late to get enough of those important plant nutrients. Or when they’re doing it they find them so unappealing that there’s no incentive to make them want to eat more.

In this blog I hope to help you find it easier to get them all in and enjoy them, which in turn will help you to improve your own wellbeing, diabetes health, mental health, heart health and so much more!

The Australian Dietary Guidelines tells us:

“There are many nutritional, societal, culinary and environmental reasons to ensure that vegetables, including legumes/beans, and fruit are a major component of Australian dietary patterns. These foods are nutrient dense, relatively low in energy (kilojoules) and are good sources of minerals and vitamins (such as magnesium, vitamin C and folate), dietary fibre and a range of phytochemicals including carotenoids. Many of the sub-components of foods and their relationships have not been studied in detail, and it is expected that other sub-components – and their biological effects – are still to be discovered.”

From a diabetes point of view, they’ll help improve our immune system, mental health, good cholesterol, bowel health and help with weight management (just to name a few benefits!).

Perhaps a good start would be to look at ideas to include them in your meals across the day, and then provide you with some easy recipes – some of my personal favourites, and I encourage you to share your personal favourites below too in case they inspire someone else to enjoy more of these wonderful foods.

A good starting point is to know what the guideline is and how much a serve is. This snip from the Australian Dietary Guidelines for Adults brochure provides a pretty clear picture.

One of my best tips is to break up the intake of these foods across the day so that you’re not left with large amounts required at the end. Personally I aim to get 2-3 serves of vegetables at lunchtime and another 2-3 for dinner, and I one of my fruit serves at breakfast and one as a snack later in the day. But there are no rules about this. Here are some ideas that might help you.

Breakfast

Weekday breakfasts usually need to be fast to prepare and eat. So a bowl of high fibre cereal with a serve of fruit is one easy way to get you off to a good start. Think bananas, strawberries, blueberries. A milk based smoothie also works well here, as does multigrain toast with peanut butter and a squashed banana.

On weekends with a little more time, why not wilt some baby spinach leaves and panfry mushrooms and tomato, served on toast with an egg. Remembering that one medium sized tomato equals a serve, and half a cup of cooked veg (the mushrooms and wilted spinach) is another serve, you’re off to a great start with two vegetable serves already under your belt.

Lunch

I love lunchtimes in my office. I take the various ingredients to build my favourite salad and set aside an hour to build and eat it while I check my email and Facebook. My salads include mixed leaves, baby tomatoes (various colours if they’re available), Lebanese cucumber, onion, half a cup of 4 bean mix and a quarter of an avocado. That gives me around 3 vegetable serves and I salivate over every mouthful.

Of course leftover are also a top idea for lunch, especially ones high in vegetable ingredient, and can be served with baby spinach leaves to lift them.

And if you’re in a massive hurry and can only have time to make a sandwich, pile on the salad and take some extra veg in a box to nibble on with your sandwich. I just adore the flavour in the grape or Perino tomatoes, and cooked and cooled asparagus (in season at the moment) are such a treat flavourwise – I even enjoy it raw!

Dinner

A good place to start here is to remember the plate model, in that half your plate should be non-starchy veg or salad.

I’ll provide ideas below on some yummy ways you can make this happen. It is definitely the easiest meal to get those extra serves in, so 2-3 shouldn’t be a challenge at all.

Snacks

Of course a piece of fruit is an excellent snack, remembering you’re aiming for 2 per day, so if you’ve had one with your breakfast you only need one later in the day too. For us with diabetes they’re better off eaten at separate times to keep our BGLs more stable.

Five easy ideas to enjoy your vegetables

Simply steamed or microwaved to an ‘al-dente’ texture (ie not overcooked) mixed vegetables of your choice such as broccoli, zucchini, green beans and peas. Dress with the juice of a lemon, a finely chopped clove of garlic, extra virgin olive oil (equal amount to the lemon juice) and salt and pepper to taste. Delicious!
Start with a tin of tomatoes and add flavours such as garlic, anchovies and chilli. Then just add your choice of veggies and simmer in the sauce for 5 minutes or until they’re an al-dente texture (not overcooked). Tasty!
Take a bowl and add a huge variety of vegetables such as mushrooms, cherry tomatoes, capsicum, zucchini, pumpkin, beans, whole garlic cloves, onion and toss them in some extra virgin olive oil with fresh or dried oregano and salt and pepper to taste. Tip them into a baking tray lined with baking paper (for easy washing up) and roast at 180 degrees Celsius for about 30 mins. Also wonderful with crumbled feta cheese tossed through at the end, and delicious cold the next day for leftover lunches!
Soups and stews are such an obvious choice for those who find it hard to enjoy their veggies as all you need to do is add a whole load of mixed veggies into a large pot, cover with stock, simmer for 20-30 minutes and blend with your desired flavourings. How easy is that?!
Last but not least, if you have left over steamed vegetables it’s so easy to reinvigorate them by adding them into a mix of a few beaten eggs and some cheese and a few extra fresh herbs, baked for 30 mins at 180 degrees to make a frittata that will ‘Wow’ your guests. Also fabulous for next day lunches to help get your vegetable serves in. Yummo!

That’s probably enough to cover in this blog. I’ve give you quite a lot to consider. As mentioned, we’d love you to share your favourite ways of enjoying vegetables, and let’s talk about them more in our Diabetes Counselling Online groups such as Diabetes and Food – let’s celebrate it!, Diabetes Weight Matters and Men Living with Diabetes among others.

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Learning to Love Legumes

October 20, 2014 by Sally 1 Comment

When you were a child, were legumes amongst the foods that you really disliked the flavour/texture of? Do you still avoid them?

Just recently I’ve had a few clients telling me that they just can’t stand legumes, and when I dig a bit deeper it’s usually not such a dire ‘hate’ as they imagined. So I thought we’d look at the various types with yummy ways to include them and have a closer look at their fibre and carb/GI levels.

In our last Diabetes Counselling Online blog about legumes entitled ‘Legumes Rock’ we found out that:

“Legumes are truly amazing plants. They are high in all three types of fibre (soluble, insoluble and resistant starch), they are high in protein and low-glycemic carbohydrates so keep your appetite satisfied for longer, and they are incredibly versatile and inexpensive. They’re also full of vitamins, minerals and plant chemicals. Once you start a healthy habit of including them every day, you won’t want to stop.”

So when I ask these clients, “what is it about them that you dislike?”, some say it’s the texture, some say it’s how they look, some say “they’re too dry”. And in every case we’re able to help by making suggestions to try them that might avoid the ‘issue’ they seem to have.

What’s your issue?

When you consider that they’re budget friendly (especially when you buy the dried varieties that take just a little more preparation) and can sit in your pantry for a long time (especially the tinned varieties), they allow you to have on hand the makings of many easy and delicious recipes.

This table comes from the Grains & Legumes Nutrition Council website, and I thought it helps to demonstrate this point.

Do you ever wonder “what can I add to this salad to make it more interesting or to add the low-GI carb that I need, or to add the protein/fibre that I need, or even just to make it into a one-pot meal?”? Half a tin (per person) of 80c (Coles own brand price) legumes of your choice could well be the answer.

Learning to love them

If it’s been a while, why not give this a try?

Taking a single creamy coloured cannellini bean from a tin and squeezing it between your fingers, see how the smooth and delicate outer casing protects the bean’s shape and also keeps your fingers clean. The velvety inside squishes with hardly any pressure and shows you how easy these are to mash. Warmed through and smashed together with the velvety richness of extra virgin olive oil the flavours remind me of holidays in Italy.

A great option is to consider replacing mashed potato or rice with them. Fresh herbs also compliment the flavours wonderfully.

Types and descriptions and good ways to use them

The Grains and Legumes Council explains: “Legumes (also known as pulses) include all forms of beans and peas – dried, canned, cooked and frozen. Among the well known legumes are butter beans, haricot (navy) beans, cannellini beans, red kidney beans, adzuki beans, black-eyed beans, soybeans, chickpeas, faba bean, field pea, lentils, lupin, mung bean and peanuts.”

A comparison

This table looks at some of the more popular types so you can see how good they are, remembering that any number under 55 means it’s low-GI.

Type	GI rating	Carb/100g	Protein/100g	Fibre/100g
Cannellini beans	31	12.2	6.2	6.4
Chick peas	38	13.3	6.3	4.7
Lentils	42	9.5	6.8	3.7
Red kidney beans	36	14.1	6.6	6.5
Baked beans	40	11.8	4.6	4.8
Field peas (or split peas)	25	6.7	6.6	3.9

The data for this table was taken from the Sydney University GI website, and CalorieKing.com.au.

This comparison demonstrates that the variety of legumes all have similar excellent values from a diabetes point of view. Therefore, depending on your tastes, you could try them in many different ways and know that they’ll be helping your health.

Some simple ideas to try

Cannellini beans – delightfully soft and creamy
- add half a tin to your omelette or frittata
- mash as a side with olive oil instead of mashed potato or rice
- add to salads
- whizz into a dip with garlic, lemon, olive oil and other yummies
Chick peas – slightly firmer texture providing a soft, nutty crunch
- try them as hummus for your snacks
- roast them to produce a crunchy snack with added spices for more flavour
- add them to salads, casseroles and soups
Lentils – small in size but they bring so much unassuming value to
- curries
- soups
- dahl (a simply prepared stew based around lentils and other split legumes)
Red kidney beans – the colour makes them appealing to add variety
- often used in Mexican dishes such as Chilli con carne and tacos
- great in salads, casseroles and soups
Baked beans – such an easy staple in any pantry
- perfect on a slice of multigrain toast (watching the carb serves) with an egg on top
- even straight out of the tin if you’re pushed for time and inspiration
Field peas (or split peas) – cooks down to a pulp-like texture
- traditionally cooked in soups to add a thickened, creamy texture such as in pea and ham soup.

To finish up I encourage you to look at this resource that is provided by the Grains and Legumes Council called ‘Legumes – tips and tricks to enjoy them more often’, and remind you that for the health benefits to take effect you should be aiming to have a serve (75g or half a cup of cooked) of a variety of different legumes at least four times per week.

If you’d like to know more and have links to some recipes and other ideas, take another look at the first blog on this topic ‘Legumes Rock’.

Hoping I’ve inspired you to give a few of these varieties a try, especially if it’s because you did have an aversion when you were a child. Perhaps it was the way they were prepared, or even just ‘the idea’ of them. As an adult with more mature taste buds it’s definitely time for a re-try. Enjoy!

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a list of all Sally’s Diabetes Counselling Online blogs here.

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