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D-discussion on ‘That Sugar Film’

March 23, 2015 by Sally 2 Comments

Last week I attended the Newcastle premiere of ‘That Sugar Film’, with Damon Gameau as the star. I was there because I was invited to participate afterwards as the ‘nutrition expert’ in the 30 minute Q&A with the audience, numbering 640. I thought my experience worth talking about as, although the film is doing an awesome job at raising awareness of how much sugar is in the foods we eat, it’s really important that people understand that eating well is not all about fearing or avoiding one nutrient (in this case, sugar). I believe that achieving optimum health through eating a well balanced diet, consisting of a variety of real foods, mostly plants, is the most important message to take away from this experience, and I hope that is what I communicated to the audience as a panel member.

In ‘That Sugar Film’ Damon Gameau performs an experiment on just himself. Bearing in mind that we’re all different, and, importantly, that this wasn’t a clinical trial, Damon’s self experiment can form a good reminder to us on some key points of understanding about how added sugars in foods can play havoc with our wellbeing in various ways. Damon has written a blog himself explaining what ‘added sugars’ actually means. He explains, as I have previously done, how and why the term ‘added sugars’ does not include the naturally occurring sugars in fruits and dairy. Natural sugars such as these, and other carbohydrates, including whole grains and legumes, also provide essential nutrients for wellbeing. I encourage you to read his blog on this subject (link above) as it provides a well balanced view.

The Dietitians Association of Australia (DAA), of which I am a member, supports the recommendations of the Australian Dietary Guidelines (ADG) about limiting the intake of foods and drinks containing added sugars. Examples are: confectionery; sugar-sweetened soft drinks and cordials; fruit drinks; vitamin waters; energy drinks; and sports drinks. The DAA believes a healthy, balanced diet involves eating appropriate amounts of a wide variety of nutritious foods, while occasionally being able to enjoy small amounts of ‘discretionary choices’. It’s about taking a balanced approach that is sustainable over the long term.

On that note, remember my recent blog chatting about Dr Rosemary Stanton’s talk on ‘Why so many controversies?’ Here, Dr Stanton reminds us that junk food, containing free sugars, poor quality fats, and high levels of sodium, currently accounts for 36% of the energy intake of adults, and greater than 40% of children’s energy intake. Those are scary figures. Those figures are worth considering when choosing foods and drinks, as are the points about added sugars in ‘That Sugar Film’. Making healthy choices is really about being mindful of what is in the foods we’re eating, choosing to buy and eat fresh foods, learning to read labels, and remembering to eat with moderation.

For us with diabetes, I found this experience to be a really good reminder to be mindful in our food choices. We can consider if we could make a healthier choice where there are options. This is not always possible, so remembering that ‘a little of what you like does you good’, if you make the decision to eat something from our ‘discretionary’ list, then it’s not worth feeling guilty about. Enjoy that choice, try to make it a small amount, and eat slowly and mindfully.

Nourishment and Enjoyment

It is important to appreciate that we eat food for more reasons that just getting the nutrients we need for good health. Eating is also a social activity and most celebrations are based around eating (think weddings, funerals, get-togethers and more). It’s about learning the balance between nourishment and enjoyment.

As APD Dr Joanna McMillan reminds us, it’s important to take pleasure in what you’re eating because that’s the only way you’ll do it for the long term. This is such an important message for us all to remember, especially when we have diabetes because it really is every meal for the rest of our lives. As we often say, ‘it’s all about moderation’ and trying where possible to make healthier choices.

Accredited Nutritionist Catherine Saxelby also reinforces these ideas in her blog on this film where she says, “On a more serious note, I believe the film goes overboard on the need to quit sugar. Are we not capable of moderation? Does it have to be total exclusion?”

Nutrition is a developing science

There is a lot to learn about food and how it affects us. As the dietitian for Diabetes Counselling Online I’ve written over 60 blogs on diabetes and food for Diabetes Counselling Online in an effort to help people with any type of diabetes to get a clear understanding of the nutritional value and health benefits of the food and drinks we choose. There are many more more topics to cover.

I’m constantly reminding people to aim to choose ‘real foods’ from the 5 food groups in the Australian Dietary Guidelines. These guidelines (released in 2013) were developed by real experts who reviewed over 55,000 scientific journal articles. They then translated that evidence into meaningful dietary advice, while reflecting a commitment to best practice standards in health guideline development. This amazing work was done to help all Australians to make better decisions about the foods we choose, to minimise risk of many long term health conditions.

Nutrition science is constantly developing and there are still many discoveries to be made. This is why dietitians constantly study to keep up to date with the latest research so the advice we provide in our medical nutrition therapy is providing you with the safest and most practical advice available.

Some processed foods aren’t all bad

Another point worth making is that ‘That Sugar Film’ demonstrates the large amounts of sugars that can be found in processed foods. It tells us that if you took all the foods off a shelf in a supermarket that contained added sugar, there’d only be about 20% of the foods left there. So this is an exercise for us in learning to read labels, as well as us understanding how to make informed choices of the foods that are there.

Some of these processed foods that are referred to in the film are baked beans, containing the equiv of 1 tsp of sugar per serve. Using baked beans as an example, the beans themselves are highly nutritious and 1 tsp sugar is in the sauce, which also contains nutrients such as lycopene that we need to obtain from cooked tomatoes. That 1 teaspoon of sugar is not enough to spike your BGLs and baked beans do have a low glycemic index, so they’re a good option for us when we need a meal in a hurry.

There are also other processed foods such as tinned and frozen vegetables, some breakfast cereals, some grainy breads and dairy products that as a dietitian I regularly encourage people to use. If these products weren’t being recommended, then chances are that people might inadvertently choose something less nutritious in an effort to have a little less sugar. Learning to label read is so important here. Some of the healthier, lower GI breakfast cereals are really convenient options in our busy lives, as well as containing important nutrients that we need for wellbeing, despite containing some added sugars.

Have you seen it?

If you haven’t seen ‘That Sugar Film’ yet, I encourage a viewing as it will help you to reflect on your own intake of ‘added sugars’, and perhaps help you to understand more about yourself and the food you eat. Just remember to come back and re-read here, so you can refresh your memory about the points I have made in this blog so you’re seeing a balanced perspective.

In the words of Michael Pollan: “Eat food. Not too much. Mostly plants.” This is reinforced by the words of Associate Professor and APD Tim Crowe, “Because there are thousands of natural chemicals present in foods, there is no single food that should be called a ‘superfood’. Instead, think ‘superdiets’ that contain plenty of different plant-based foods as the best way to eat for good health.”

Please feel free to ask questions either in the space provided following this blog, or on our closed Facebook group ‘Diabetes and Food – let’s celebrate it!”. I believe food really should be celebrated, not feared.

Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), 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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D-thoughts on snacking

January 26, 2015 by Sally Leave a Comment

Happy Australia Day! And what good timing for a blog on snacking! It must be the ‘most asked’ question I get as a dietitian: “What are the best snacks for people with diabetes?”

It’s not really a black and white question as the answer depends on your personal diabetes requirements, your personal tastes, your ability to be mindful in your choices and your knowledge of healthy eating in general. So this blog aims to help you to be mindful in making snacking decisions.

We encourage you to choose foods that are higher in nutrients to add to your overall wellbeing, rather than ‘discretionary choices’ which everybody, diabetic or not, is encouraged to limit. It’s especially the case for us with diabetes… but it doesn’t mean missing out on delicious flavours!

Priority One

Your first priority needs to be your overall diabetes goals. Are you getting all the nutrients from your diet that you need for wellbeing? Are you needing to watch your weight? Is matching your food intake to your body’s ability to process carbs an issue for you?

A perfect segue to our Australian Dietary Guidelines… Are you actually meeting the quantities recommended in the 5 main food groups across your day?

In an ideal world we would choose snacks that are included in the foods that we are recommended to enjoy each day. In these examples I’m referring to the ‘Healthy Eating for Adults’ brochure, but there’s also a Healthy Eating for Children brochure for those thinking about their children with diabetes. In both cases, the actual food group listings are on page 2.

Each of the food groups has snacking potential, so there’s always plenty to choose from.

In the ‘Vegetables and legumes/beans’ group you can always find a low-carb snack if that’s what you’re after. Whether it’s raw veg to nibble on, celery with nut butter, blanched asparagus spears when they’re in season, tasty tiny tomatoes that burst with flavour in your mouth, hummous dip with veggie sticks, or even leftover cold roasted non-starchies or ratatouille (recipe in the files section of the closed ‘Diabetes and Food – let’s celebrate it!’ Facebook group). There are always options in this group of foods if one of them will meet what you’re looking for…

Next group down and a great one for those wanting something to satisfy a sweetness craving is the ‘Fruit’ group. With diabetes we are recommended to aim for about 2 serves per day, eaten at different times. However, some fruits are really low in carbohydrate, so we can have more of these without upsetting our glycemic control. Some of those include berries, passionfruit and kiwifruit. But still watch your quantities. If you want to know how much fruit will contain 15g of carbohydrate, take a look at www.calorieking.com.au , search for the fruit you are looking at, and adjust quantities to get to the 1 carb serve number.

In the ‘Grain (cereal) foods’ group, it’s easy to calculate whether you’re going to meet your daily recommended amount. Often for people with diabetes this is a group that people actually tend to be low in. Instead of choosing a ‘discretionary item’, swapping in a low-GI high fibre grain snack such a piece of heavily grained toast with a topping to suit your taste can be a great option to satisfy your hunger and keep your BGLs stable. Or even a small bowl of your high-fibre cereal. Of course these options all contain carbs, but they are all much more nutritious than a cracker or sweet biscuit.

In the ‘Protein’ group, snacking options are easy to find, but it’s important to remember to try not to exceed the guidelines in terms of serve sizes and number of serves recommendations. This is because protein contains energy (or calories/kilojoules) that will cause weight gain if you have too much, although they shouldn’t upset your glycemic control. I recommend having a read of this blog on Protein : written earlier, if you’d like more info. The perfect snack from within this group for us with diabetes is really a handful of nuts, as the evidence behind inclusion of nuts in our diet is quite outstanding. Read more about nuts in this blog.

And last, but not least, is the ‘Dairy and/or alternatives’ group. I wrote a couple of blogs about dairy and diabetes as it’s such an important food group for us with diabetes. Here’s a link to the first one and the second one that contain more great ideas for snacking. My favourite snacking recommendations to help meet the nutritional guidelines are a low-fat yogurt (low sugar too if you’re watching your carb intake closely) or plain low-fat greek yogurt with berries mixed in. Or a low-fat milk based smoothie made on frozen berries, with a couple of teaspoons of chia seeds added for extra fibre. Even a cup of milk based coffee can do the trick… These should work well to satisfy hunger and provide you with the nutrients this group is known for.

Priority Two

Your second priority, also a very important one, is to ask yourself what do you actually feel like eating and why? Sometimes snacking can become a habit. People say “I have a sweet tooth and NEED a biscuit or cake”. (or whatever) This is important too, because if you deprive yourself of what you really want (or feel you need) all the time, then your craving will only grow bigger and you’ll end up overdoing it and regretting it later. Not a good thing, but happens all too often. If you can enjoy a small amount of what you feel you “need”, being mindful of enjoying every mouthful, savouring the textures and flavours that you’ve wanted so badly, then you’re in a better place to return to your ‘healthier’ options on a regular basis.

Do I really need to snack?

If you’re medicated for your diabetes, and are putting yourself at risk of a hypo if you don’t snack, then you should snack as you’ve been advised by your medical diabetes team. If in this case you’d rather not be snacking as you’re just not hungry, then you should talk to your d-team and arrange to have the medication adjusted so that you don’t need to snack.

For those of you where snacking has just become a habit, it’s worth thinking twice to see if you really are hungry before you just head for a snack. Is it out of habit or because you’re bored? Sometimes a drink of water will satisfy that ‘hunger’ feeling, which may actually be your body telling you that you’re dehydrated. If you’re bored, take the opportunity to go for a walk, call a friend, do something off your household chores list, read a book, or engage in your hobby.

If you are constantly actually hungry, it may be worth your while to visit an Accredited Practising Dietitian to see how your meal plan can be adjusted to help avoid that happening. Being hungry is not good or necessary for you to manage your diabetes and weight well.

More ideas?

In the Diabetes Counselling Online closed Facebook groups ‘Diabetes and Food – let’s celebrate it!’ and ‘Diabetes Weight Matters’ we’ve asked the members what their favourite snacks are and have created a document up in the files section of the groups. I think I still need to finalise the weight matters file, but it’ll be there soon. These are member ideas, not necessarily dietitian approved, so please use this blog as a thought process in helping to make your snacking decisions right for you.

Also in the current issue (February 2015) of the Australian Healthy Food Guide they’re running a feature relevant to this blog that you may find helpful. It’s entitled “Your Treat Foods Toolkit” and explains “why those ‘naughty’ treat foods are discretionary, and how they can fit into a healthy diet.” It’s written by an Accredited Practicing Dietitian, Brooke Longfield and can be found on page 34. Although not related specifically to diabetes, you’ll find it helpful for portion sizes and understanding more about ‘discretionary’ foods.

Happy snacking! Sally

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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!

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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