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Yoghurt, probiotics and d-health

March 10, 2015 by Sally 2 Comments

With so much fascinating talk about gut microbiata (micro-organisms/bacteria) and health about, I thought it worth a fresh look at yoghurt as part of the dairy serves in our day as it is a great source of these microbiata in our diets. I’m also often asked about which are the best yoghurts from a fat and sugar perspective. Please consult your healthcare team before following the advice here, especially if you’re pregnant, breastfeeding or have a compromised immune system.

We’ll start with a review of why dairy is so important in our diets, then go on to look more closely at probiotics (live organisms/bacteria) and to look at some of the yoghurt choices available on the market, and what to look for when you’re making choices. We’ll finish with some ideas to help us to include more yoghurt in our day.

Last year I wrote a couple of blogs on ‘Dairy and Diabetes’ that I’d really like to remind everyone of, as they included some important messages for our diabetes health.

In the first one, ‘Dairy Foods – health benefits for us with diabetes’ we looked at the dairy and alternatives group in the Healthy Eating Guidelines for Adults brochure. We notice that different genders and ages have significantly different requirements in this important food group. We all need different amounts for different reasons, and for us with diabetes it’s a really important food group for many reasons. Not least, that dairy products have a low-glycemic index. There’s also a great amount of evidence relating to how meeting our dairy serves can contribute to improved wellbeing, with or without diabetes, so pop back and have a read of this one too.

We’re also reminded in the words of the Australian Dietary Guidelines that: “Milk, cheese and yoghurt have various health benefits and are a good source of many nutrients, including calcium, protein, iodine, vitamin A, vitamin D, riboflavin, vitamin B12 and zinc. These foods provide calcium in a readily absorbable and convenient form.”

The Guidelines also remind people with lactose intolerance in relation to yoghurt that: “lactose in yoghurt is already partially broken down by bacteria that thicken the yoghurt, so should be well tolerated”.

The second blog (link above) is about milk comparisons and more ideas for including more dairy in our diet.

Which leads us on nicely to more on yoghurts….

Probiotics – why are they important?

Yoghurt provides similar health benefits that milk does and can have the added benefits of good bacteria or probiotics (eg aBc – La-5 Lactobacillus acidophilus, BB-12 bifidobacterium, Lc-431 Lactobacillus Casei and LCG) which contribute to improved health. Health based on those good bacteria is currently attracting a lot of research into improved immunity, general wellbeing and to improve specific conditions such as Irritable Bowel Syndrome, NAFLD (very relevant for those with type 2 diabetes) and mental health among others. This article provides much more detail if you’d like to read more about probiotics and health/wellbeing.

However, not all yoghurts contain added probiotics, so it’s important to check the label for mention of them, otherwise you may not get the benefits you’re hoping for from them. It’s also worth noting that yoghurts containing probiotics will have a shorter shelf-life as the bacteria deteriorate fairly quickly, so don’t wait around until the yoghurt is on its ‘best by’ date if you’re hoping for the probiotic benefits.

Fat & Sugar in yogurts

With diabetes, and even just in general health, it’s important that we minimise added sugars and keep an eye on the saturated fats in our food products.

The Australian Dietary Guidelines recommends that we choose low-fat dairy products, which means we’re looking for less than 2g/100g saturated fat due to its link with heart health issues, inflammation and increased insulin resistance/decreased insulin production over time. This is particularly important for us with diabetes, and although adding fat to a carbohydrate will lower the glycemic index of the meal, it is just not worth taking the risk with saturated fats. It’s best to try to minimise them in our food choices.. The other aspects of the yoghurt (low GI quality carb and protein) will still help to lower the glycaemic index of the meal without the extra fat.

As to added sugar, we are always looking for as little as possible as an added ingredient. Lactose is a naturally occurring sugar with a low-GI that’s found in dairy foods, so just looking at the amount of sugar in the nutrition information panel may not help us to know whether it has added sugar. Check the ingredients listing first, looking for ‘added’ sources of sugar, like ‘sugar’, honey, palm sugar, maple syrup and other syrups. On the nutrition information panel, look for less than 10g/100g sugars to help watch the added sugars.

If you like the sweeter flavoured yogurts, try adding your own sweetness in the form of fruit, or even a small amount of added sugar, so at least you are in control of the extra sugars. Of course artificially sweetened yogurts are also readily available if you don’t mind the flavour.

Dietitian Connection recently published a comparison table of yoghurts by student dietitian Stacey Beech (thank you Stacey!) which includes information about all the macronutrients (fat, carbohydrate & protein) as well as fibre, calcium, sodium and probiotics. From this list I’ve picked a few ‘better’ examples of brands from that table to try, with a focus on the good bacteria, the low saturated fat, and low added added sugars. My top three favourites are:

The Nestle Ski Soleil (artificially sweetened) range
Vaalia Natural Probiotic Yoghurt (unflavoured)
Pauls All Naturally Tub Set Yoghurt 99.8% Fat Free (also unflavoured)
Jalna Low Fat plain yoghurt

There are other yoghurts on the market that may not have made Stacey’s list, so remember that you want the pack to tell you about the good bacteria (probiotics) it contains, look for less than 2g/100g saturated fat and less than 10g/100g sugar (preferably no added ‘sugar’). This Aldi one is a good example. It’s 2.7g/100g saturated fat, just over our target, but ticks all the other boxes so I’d say that it was worth a try too!

If you’re finding that plain yoghurt is a little bitter for your tastebuds, why not give the lactose free versions a try. These seem sweeter because the added lactase enzyme has split the lactose sugar into its parts, which changes the way it tastes, but with the same health benefits.

Some of the strained Greek yoghurts are also less tart because the whey has been strained off.

Of course you can always make your own, but watch the sugar and fat components in doing that

Multiple uses for yoghurt

For those of you who struggle to meet the recommended dairy serves in your day, yoghurt is an excellent option that can be included multiple times across the day. More than one serve a day is easy to achieve. It works:

At breakfast on top of cereal with fruit
As a snack or dessert choice
As a dressing on your salad (mixed with fresh herbs, lemon juice or vinegar and a teaspoon of grainy mustard)
In place of sour cream on your baked potato (helping to lower the overall GI of the potato)
In place of fats in baking recipes (read this blog by Joan Bailey to learn more)
As dip or accompaniment to Indian curries (example recipe)

How else do you include yoghurt in your day? We’d love to have your comments and suggestions! See the comments box below.

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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Carb Counting Queen: am I really good at Maths, or is it an illusion?

September 5, 2014 by helwild Leave a Comment

I’m always so profoundly moved by what people are so prepared to share with me. Recently I received the following lovely piece of writing from one of the Parents in our ‘Parents of Kids with Diabetes’ group on Facebook. Check out the link if you are the parent, carer or grandparent of someone with diabetes.

Thanks to Maureen Campey for sharing of your thoughts. Fabulous writing Maureen. Yes, the tears come, even if in secret. There are the times we ALL feel like the ‘carb counting Queen’, whether we have a child with diabetes, or have diabetes ourselves! As you say, it helps to be able to see the funny side. I think it also celebrates our confidence in our skills & knowledge, a confidence that we need to stay sane.

“Sometimes I feel sad, but there are times when you just have to laugh at the craziness of life as a mum of a Type 1 child. We were at a friend’s bbq recently and when I came home, I started to write this. Do you feel like this too? I’m happy to share this and just give you a laugh. x

The Carb Counting Queen

I am the carb counting queen. No carb is too complex for my capabilities. This title, it has to be said, was totally uncontested. There was no bloody revolution. There is no pretender to the throne.

A Saturday afternoon bbq? Sure, we’d love to come! Watch me as I glide, seemingly effortlessly, towards the buffet. Greeting friends on either side, they are totally unaware of my inner calculations. Think synchronised swimmer – all smiles above the water, craze of activity below. If karma exists, my maths teacher would be rolling about laughing.

Ok, here we go! Salad, all good: nice and plain. A top ‘filler upper’! Protein, yip: lots of chicken, and sausages. Fine, but wait! Was the chicken marinated? Best stick to sausages! Which carbs though? At least a modicum of healthiness! Bingo! Corn on the cob! One exchange down!

I bet there’s a loaf of bread somewhere, hopefully wholegrain! Always a ‘failsafe’ but so, so boring. Can I check out the pantry without seeming like a crazy lady? Ah look! Potato bake! Now, how did I calculate carbs in that one I made at home? Get the Mobile ‘phone out and have a look. There might be one on the ‘Carb Counter App’ or my faithful knave the ‘Traffic Light Guide’.

Is there a dessert I wonder? Fruit? Maybe iceblocks for the kids? Which brand? Would it be rude to ask? Please let it be at least font size ten on the packaging! So unseemly scrambling about for those newly prescribed glasses.

All that in a ten metre walk! Pass me a glass of bubbly! Now for the rest of the family!”

Maureen Campey

If you have some thoughts you’d like to share about living with diabetes, we’d love to hear from you. Send your writing to: [email protected] OR just write your thoughts after this post in the Comments.

Regards

Helen Wilde

Helen is a Senior Counsellor with www.diabetescounselling.com.au She has been the mother of someone with Type 1 diabetes since 1979, and has lived with Type 2 diabetes herself since 2001.

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While we’re busy making other plans..

August 7, 2014 by helwild 2 Comments

A diagnosis of diabetes brings the ‘C’ word into everyday life: Control. We get bombarded with information, instructions, advice. We’re told to ‘test’, given pieces of paper to go to a clinic or hospital for a variety of even more ‘tests’. We’re monitored, measured, & judged. For some people, this becomes more important than anything else. They become hyper vigilant, testing, checking, measuring, exercising, dieting. Almost everyone diagnosed with diabetes begins their journey like this; driven by fear, anxiety, guilt, the notion of ‘control’ becomes all consuming. For some, this is relatively short lived, and things become all too hard. Those who ‘drop the ball’ early give up, bury their head in the sand, ignore advice, feel hopeless, helpless. Their diabetes remains ‘uncontrolled’. For others, the steady mantra of ‘control’ rules their lives. No matter what they achieve, no matter how ‘good’ their diabetic ‘control’ is, they strive to be ‘better’, to be ‘perfect’. To all intents and purposes, and according to most measures, their diabetes is ‘controlled’. Yet they still feel unsuccessful.

How do we find balance?

Ive been thinking a lot about this lately. Those who have a child diagnosed with diabetes come to this with a rather different perspective. For us, the worry, anxiety, need to achieve control are driven by the primal urge to protect our child. It can be harder for us to let go of the notion of ‘control’ than for the child themselves. After all, our main role in life is to care for our child, to make life the easiest, the best, it can be. We will access the best technology and resources available to us, whether thats a new insulin, a new way of measuring, a new test, an app, a new alarm or monitor, a hypo dog. It can be hard to relinquish that ‘control’ to our child. At what age do we ‘allow’ them to make their own decisions about management? For many of us, the decision is taken out of our hands. Our child will refuse to allow us to administer insulin, conduct tests, record results. They may lie to us, and we have the moral dilemma of respecting their autonomy, their right to privacy, and reconciling that with our parental role to manage their health. In some families, difficult topics are discussed. In others, they are not spoken of, they are ignored. Either way, the hard subjects, sex, death, religion, war, family secrets, unfairness, prejudice, injustice, and overnight hypos, all exist. Our children will learn about them. We do have the right to choose whether or not to speak of them.

We tend to judge ourselves very harshly around these changes in our ‘control’. Yet in the end, the vast majority of children with diabetes grow up to manage their diabetes well, to live good, productive lives, to participate fully in other aspects of life, work, socially, and also often with a strong social conscience, a sense of advocacy and participation in supporting others with diabetes. Through struggle & difficulty many are very compassionate human beings, people to be proud of. In managing our own diabetes, although some Health Care professionals may seem, or indeed be, somewhat judgemental, in the end we are all doing the best we can at the time. There may be ‘scope for improvement’, but judging and blaming have no part in our Mental Health, nor in our Physical Health. We need to find our motivation in self love and in our sense of our own worth. We deserve kindness, and the best we can do.

I think one of the key notions that helps to make this journey survivable is to accept that it is just that- a journey. We travel our road in life, and sure, for everyone, some more than others, there are rough patches, difficulties. The destination is known, we don’t know when, but we do know that ‘all things must pass’. Looking around us while were on that journey is what makes the difference. Taking that holiday in Japan, even though we can’t get an Insurance company to fully insure our insulin pump; walking to the shops in the sunshine, or the rain; playing with our child because it’s fun, not because the exercise will be good for his blood glucose control; taking time out from achieving, controlling, managing, to just simply be. This week I went back to my Yoga class. It’s been 5 years since I saw my teacher, Balbir. In that 5 years she has grown old, but she still has the mesmerising power to transport me during relaxation time to a place of calm and serenity; and the ability to lead me through physical practice which stretches and awakens my body to Life. Taking time to focus on the breath, on Balance, Serenity, and the practice of Mindfulness. Most of all, on Resilience. Building resilience in ourselves, and importantly in our children, helps us and them to live life fully: to achieve a level of mental health that will see our journey through life as a balanced one, a life to feel gratitude for, not a life of self doubt. Yesterday I saw an almond tree in full blossom. It was growing alongside a busy highway. Clearly it had stood there for decades before the road came along, before the construction that rose around it. Yet there it was, in full blossom, old, huge, bursting with optimism and life.

Life is what happens to you while you’re busy making other plans- remember to Notice your Life.

Its a Long Way to go, A Hard Row to Hoe

Helen Wilde

Helen has been the parent of someone with Type 1 diabetes since 1979. She has lived with the diagnosis of Type 2 diabetes herself since 2001. She is a Senior Counsellor with Diabetes Counselling Online. If you are struggling with Control or any aspect of your diabetes you may like to contact our team at

http://www.diabetescounselling.com.au/counselling-request/

carpe diem

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Life..’More than #diabetes’ Ups & Downs

July 28, 2014 by helwild 7 Comments

How much does diabetes dominate your life? It is a health condition which, because it is related to food and exercise, can seem like the most difficult health condition you could possibly have, doesn’t it? And because the symptoms are not always obvious or noticeable, it can seem that if you ignore it, it will just go away, or not be true.That you will ‘get away with it’, if you ignore it, or make a ‘token effort’. Even people with type 1 diabetes can at times feel that they can ‘stretch’ the ‘rules’, not take their insulin, or use insulin to allow themselves to ‘indulge’ in ‘favourite’ foods; or ‘allow’ themselves to ‘run high’ to avoid hypos. The insulin pump combined with the modern blood glucose meters, cgm’s, allows such fine control, approximates more closely than anything else the action of the pancreas in releasing insulin; yet in its very existence such biotechnology is a constant reminder of life with diabetes.

As the parent of a child diagnosed with type 1 diabetes, there were times when it seemed there would never be anything else that mattered in life, other than diabetes. When my daughter grew up & left our home in a tiny rural town to go to the City to study at University, things in some ways got easier; but in other ways, things got harder. I was a young Mum, and I was only 32 years old when my beautiful healthy girl was diagnosed. I was 37 when she left home. It was hard knowing she was 250 km away, and relying on others, who were not me, as her ‘backup’ person. Every night that we slept under the same roof, I got up to sit with her through her hypos. The click of a light switch, or the click of the toaster, would wake me. This continued through her teen years; her pregnancies; her own years mothering babies; travelling with her for Diabetes related professional reasons as colleague, & as her ‘back up person’ for her diabetes management, on trips overseas & interstate ; and on family holidays. Even now, if we are sleeping under the same roof, if I’m sleeping within hearing distance, something wakes me, and I can’t lie in bed knowing she’s out of bed & feeling bad.

I do have other things in my life: work, sport, friends, family: causes to do with the environment and the earth. I have grown tree seedlings for Trees for Life, collected for the Heart foundation, travelled. I’ve volunteered at Film Festivals, Arts Festivals, tutored at the U3A. But beating away like another heartbeat is my daughter’s diabetes. I work and volunteer in Diabetes. I practice Mindfulness. Being her parent will always be a part of who I am. Of course, it is much, much more intense for her. Every minute of every day and night, no respite. I do get to take breaks, she doesn’t.

My life changed 15 years ago. My husband retired, and I got a job in the city, so we moved house. Over the past 15 years, my life has expanded to include assisting my mother in dealing with changes that came about in her life, first with my father’s diagnosis of dementia. In the beginning, I was working in a highly responsible & challenging job. My help was as practical as I could manage, also fitting in supporting both my daughters with pregnancies & babies, toddlers & growing children. With my father’s death, assisting Mum meant helping her manage her own health & living arrangements, & eventually her own dementia.

That time also came to include my own diagnosis of diabetes. Because of my daughter’s diabetes, I came to the diagnosis with a shorter period of ‘denial’ than some experience; and with very little anger. I do feel some negative emotions, of course; but I know that it’s possible to live a good life with diabetes. My fear of diabetes related complications is much less than my fear of dementia.

I hadn’t meant to write about difficult experiences in my life, but yes: they are also part of life, and many of them have nothing to do with diabetes. The past 15 years have included weddings, births, joys: wonderful family Christmases, when Mum played ‘Mother Christmas’ to our large family: visits from overseas relatives, contact through Social media with relatives, friends, strangers. Yes food is pleasure, but there are other pleasures. Exercise is pleasure. Doing things for others is pleasure. Growing things, writing, taking photos, playing with children, doing good work, talking with friends from all over the world, these are all pleasurable.

Life is Good. Life is a river, it flows. Life is truly a journey, with opportunities for rich experiences that include the difficult ones, and the easy ones: spontaneous ones and planned ones. Seize the moment, take opportunities when they arise. Life is more than diabetes: it includes things that are harder, and worse: and things that are easier, & better..Life is for the Living.

Helen Wilde

carpe diem

Helen is a Senior Counsellor with Diabetes Counselling Online. She is also the parent of someone diagnosed with diabetes in 1979. She has lived with type 2 diabetes herself since 2002.

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A fat introduction – blog 1 of a series on fats and diabetes

July 14, 2014 by Sally 2 Comments

I thought it was about time for another blog mini-series and fat is a topic that we see written about a lot so it’s easy to be misled when you’re provided with information that may be influenced by sales and marketing, and ‘fat’ is a huge topic to cover. The benefit of having such topics explained by an Accredited Practising Dietitian is that we’re not trying to sell you anything – just wanting to help you to make the best decisions for your d-health and we base our advice on the best available evidence through scientific research which is constantly being reviewed and updated where appropriate.

As an introduction I’ll remind you that fats are an important part of our diets, as are carbohydrates and proteins (these 3 being the major macronutrients that produce energy) and every cell in our body needs quality fats to protect it, help it communicate with other cells and to allow important biological processes to occur in our bodies. It’s important for us, especially as people with or at risk of diabetes, to understand about the different types of fats, or fatty acids, and choosing the right fats in the right amounts can benefit our wellbeing in many ways. In this blog I’ll explain what the different types of fats are and where they’re found, as well as how much the Australian Dietary Guidelines recommends for people with diabetes.

From a healthy weight perspective, the Australian Dietary Guidelines reminds us that, “When eaten in large amounts, all fats, including healthy fats, can contribute to weight gain. Fat is higher in energy (kilojoules) than any other nutrient and so eating less fat overall is likely to help with weight loss.” So again, it’s all about balance!

Something I found enlightening when learning about foods applies particularly with fats, in that they’re not black and white in the varying types, but more like differing shades of grey. To demonstrate my point, nuts are a perfect example. If you refer to page 2 of this tree nut ready reckoner you can see that every nut has a different amount of all the different types of fat within it. I make this point to reinforce that, as with most things in diabetes, it’s about making healthy choices whenever you can but not worrying too much about small amounts of things that we know we’re better without (such as saturated and trans fats).

Which is a perfect segway to talk about Types of Fats

I think the most straightforward explanation of the different types of fats is found on the Dietitian’s Association of Australia website where they explain:

“There are two main types of fats: saturated fats and unsaturated fats.

Saturated fats

Saturated fats are ‘unhealthy’ fats, and eating greater amounts of saturated fat is linked with an increased risk of heart disease and high blood cholesterol levels. These fats are solid at room temperature and are found in:

Animal-based products:

Dairy foods – such as butter, cream, full fat milk and cheese
Meat – such as fatty cuts of beef, pork and lamb, processed meats like salami, and chicken (especially chicken skin)

Some plant-derived products:

Palm oil
Coconut
Coconut milk and cream
Cooking margarine

Saturated fats are also commonly found in many manufactured and packaged foods such as:

Fatty snack foods
Deep fried take away foods
Cakes
Pastries and pies
Biscuits

Unsaturated fats

Unsaturated fats are ‘healthy’ fats and are an important part of a healthy diet. These fats help reduce the risk of heart disease and lower cholesterol levels (among other health benefits) when they replace saturated fats in the diet.

There are two main types of unsaturated fats: polyunsaturated fats and monounsaturated fats.

Polyunsaturated fats:

omega-3 fats which are found in fish
omega-6 fats which are found in some oils such as safflower and soybean oil, along with some nuts, including brazil nuts.

Monounsaturated fats:

found in olive and canola oil, avocados and some nuts, such as cashews and almonds.

Trans fats

Trans fats are unsaturated fats that have been processed and as a result, behave like saturated fats. Consumption of trans fats increase the levels of ‘bad’ cholesterol and decrease the levels of ‘good’ cholesterol in the body which is a major risk factor for heart disease. It is important to lower the amounts of trans fats you eat to help improve your health.

Trans fats are found in many processed foods, also in butter and some margarines. When buying these products check the labels and choose the varieties that are lower in saturated and trans fats and higher in poly and monounsaturated fats.”

In summary, we should aim to have most of our fat intake from mono- and poly-unsaturated fats.

How much should we have?

You may remember from my blog on label reading that on nutrition information panels we should aim for less than 10g/100g total fat, and less than 2g/100g saturated fats. This is because people with diabetes tend to have higher rates of bad cholesterol, and reducing amounts of saturated fats (and poor quality carbohydrates) is one of the most effective ways of reducing that bad cholesterol.

The Australian Dietary Guidelines advises that in addition to the serves outlined for the five food groups, “an allowance for unsaturated spreads and oils for cooking, or nuts and seeds can be included in the following quantities: 28-40g per day for men less than 70 years of age, and 14-20g per day for women and older men.”

That’s probably enough info for this first blog. If you have specific fat-related questions that you’d like answered in the rest of the fat-series, just comment below and I’ll do my best to answer them for you.

Also remember to see your Accredited Practising Dietitian if you think some personalised advice could be useful, or arrange for an e-consultation with our e-dietitian at Diabetes Counselling Online.

Wishing you a great week! 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.

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