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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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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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Research: why does it matter? The Endia study

October 16, 2014 by helwild Leave a Comment

As the parent of someone with Type 1 diabetes, it can seem that the only organisation in the world doing research into diabetes is the International Charity, Juvenile Diabetes Research Foundation, or as it is more usually known nowadays, the JDRF. For many years, I have ‘walked for the cure’ hoping that one day it would happen. And of course many people connected by Type 1 diabetes, all over the world, are supporting JDRF, working, hoping for the day ‘the cure’ will come.

However, it is good to know that there are many other wonderful organisations undertaking vital research to assist people managing Living with diabetes, and researching possible ‘triggers’, causes, and even treatments, including some that are based right here in Australia.

One of these is a very interesting Australian study known as ENDIA, or “environmental determinants of islet autoimmunity”

We have posted information about this wonderful Australian Study before, but we have many new members who may be unaware of it. One of our Facebook Closed Group ‘Pregnancy and Parenting’ members has asked if we can ‘share’ the links here, hoping to get some more people to commit to the study. Note it is Australia only.

“Hello Helen, I am a member of one of your diabetes closed groups on FB. I have a son who is T1 and has been so since he was 18 months old (he is now 9). Here is a link about the ENDIA study that is being conducted around Australia. We are part of this study and it is about Type 1 diabetes in children. For example, studying what the ‘trigger’ could be for the onset of T1; studying using cord blood to prevent or delay the onset of T1; and studying whether cord blood can be used in assisting T1 children to ‘kick start’ the pancreas. One positive is that being part of this study the storage of cord blood is very cheap. Here is the link, and I hope you do post it, thank you so much”

Thanks to our group member for her story.

Helen

Helen Wilde

Senior Counsellor

Helen has been the parent of someone with diabetes since 1979. She has lived with Type 2 diabetes herself since 2001, and has been a Counsellor with the service since 2002.

www.endia.org.au/about/the-endia-study
The ENDIA study | ENDIA
www.endia.org.au
We are asking women who are pregnant and have Type 1 Diabetes themselves or have a family member with Type 1 Diabetes who would be a first-degree relative of the baby, i.e. the baby’s father or the baby’s older sibling, to consider participating.
The ENDIA study | ENDIAendia.org.auThere is also a Facebook group which you may like to visit, here is the link: https://www.facebook.com/endiastudy?fref=ts

The ENDIA study | ENDIA

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Fancy a beautiful Lunch in a Vineyard winery?

October 9, 2014 by helwild Leave a Comment

LDV 2014 email invitation.pdf - Adobe Reader

Hello.

You already know that www.diabetescounselling.com.au is an Australian Charity, providing free education, support, and counselling to people with diabetes and their families. This means that there are also Volunteers who spend time fund raising throughout the year.

In 2014 we are fortunate to be one of many charities generously supported by Channel 9 Telethon. In late October, we are one of only 6 charities being supported in running a Charity Luncheon, La Dolce Vita, in the beautiful Adelaide Hills.

Celebrating our lives through good food, good company, good wine, in beautiful settings is one of the best aspects of life. This event is an outstanding one, with some of the best food, wine, and scenery that South Australia can offer. It is made extra special knowing that you are supporting 6 diverse charities directly through the opportunities to participate in auctions and raffles on the day, whilst enjoying a gentle ‘wind down’ as 2014 draws to a close.

“La Dolce Vita 2014
Proudly supported by Beyond Bank Australia
Sunday 26th October
It is our pleasure to invite you to La Dolce Vita which, again this year, is being held in the stunning setting of Longview Vineyard.

With fine Italian cuisine and specially selected wines from Longview Vineyard’s cellars being served, you will be treated to a range of mouth-watering taste sensations.
Inspired by the wonderful Italian lifestyle La Dolce Vita promises a lovely relaxing afternoon for you to enjoy with family and friends.

La Dolce Vita is being held:
At: Longview Vineyard, Macclesfield
On: Sunday 26 October 2014
From: 12.30pm to 5pm

(Entrees on the piazza followed by main course, dessert and an auction presented by Michael Pratt … his distinctive style … in the padiglione.)

This year La Dolce Vita is supporting Asthma SA, Blind Sporting Council, Diabetes Counselling Online, The Mary Potter Foundation, PARAQUAD SA, and 5RPH Vision Australia Radio.”

Tickets at $135 per person, or $1300 for a table of 10 are available next to the Diabetes Counselling Online table if you’d like to sit with us! Just email Helen Wilde at [email protected] to purchase tickets from us!

Tickets to La Dolce Vita are limited, but we do have a few remaining at our own table for sale.

Please read the info below from the Channel 9 Telethon office for other booking details. Contact me on [email protected] for more information.

“Tickets at $135 per person or $1,300 per table of 10 can also be booked via the Telethon website or by contacting 8267 0206. Bus transport, which will leave vantage points close to the city, can be booked by contacting Channel 9 Telethon on 8267 0206.
Tickets are strictly limited to 270 guests.”

We look forward to sharing La Dolce Vita 2014 with you.

See you there!

Regards

Helen Wilde

Senior Counsellor

Helen has been a Counsellor with the service since 2003. She has been the parent of someone living with Type 1 diabetes since 1979, and has had type 2 diabetes herself since 2002.

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Understanding cholesterol levels and improving them

October 6, 2014 by Sally 4 Comments

I often see clients who come to me with high cholesterol readings, even though they’re on a cholesterol medication. When we look at the cholesterol breakdown on their blood tests it often helps them to understand how they can make dietary/lifestyle improvements to help with their heart health. This blog intends to break down the various parts of the cholesterol blood test results and give you easy to understand tips in managing the different numbers.

Of course we know that it’s important to manage cholesterol, and especially so for us with diabetes. We know that people with diabetes are 3 to 4 times more likely to develop cardiovascular disease (including heart attack and stroke) than those who do not have diabetes. In addition, around 75% of all people with diabetes die from cardiovascular disease, including heart attack and stroke.

I want to make the clear point that you should NOT make any changes to your medications without checking with your doctor first.

A basic explanation indicates that the total cholesterol number is made up of several smaller components, each that have a ‘healthy target’ range. Primarily these include:

Triglycerides
LDL (the bad cholesterol)
HDL (the good cholesterol)

In a nutshell we want to reduce the triglycerides and LDL numbers and increase the HDL (happy) cholesterol.

Triglycerides

Triglycerides are fairly easy to understand and also fairly easily managed through lifestyle changes. They are a form of fat that results from the breakdown of fats, poor quality carbs and alcohol in the diet and ‘high’ triglycerides are strongly linked with atherosclerosis (or artery plaque) that leads to heart attacks and strokes. This link is made stronger when the HDLs levels are lower and the LDL levels are higher. The tips below will show you how to achieve that.

LDL and HDL

I think this brief Wikipedia explanation works well here to provide the basic idea of how these work together before we move onto the food/lifestyle ways to improve the numbers from our blood test:

“Lipoprotein molecules enable the transportation of lipids (fats), such as cholesterol, phospholipids, and triglycerides, within the water around cells (extracellular fluid), including the bloodstream. Studies have shown that increasing levels of LDL particles (perhaps type-B, i.e. smaller particles, less so than type-A, larger LDL particles) are associated with health problems, including cardiovascular disease.

Although the nickname is simplistic and thus quite misleading, LDL particles (composed of thousands of various molecules) are often called bad cholesterol because they can transport their content of many fat molecules into artery walls, attract macrophages, and thus drive atherosclerosis. In contrast, HDL particles (composed of thousands of various molecules) are frequently referred to as good cholesterol or healthy cholesterol, because they can remove fat molecules from macrophages in the wall of arteries.”

How can we improve our results with diet?

Fortunately there’s been a lot of research conducted in this area, and I’m sure there’ll be much more to come in future. Being evidence-based, following the Australian Dietary Guidelines is always an excellent start. Then it’s all about ensuring there’s more of the good stuff than the bad.

The first three of the five guidelines summarise well how we can improve our dietary cholesterol, as well as our overall health. I’ll cover specifics after this, but feel it’s worth the reminder to read these first three guidelines yourself:

Guideline 1

To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.

Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly.
Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.

Guideline 2

Enjoy a wide variety of nutritious foods from these five food groups every day:

Plenty of vegetables of different types and colours, and legumes/beans
Fruit
Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat

And drink plenty of water.

Guideline 3

Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.

Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips, crisps and other savoury snacks.
Replace high fat foods which contain predominately saturated fats such as butter, cream, cooking margarine, coconut and palm oil with foods which contain predominately polyunsaturated and monounsaturated fats such as oils, spreads, nut butters/pastes and avocado.
Low fat diets are not suitable for children under the age of 2 years.

Limit intake of foods and drinks containing added salt

Read labels to choose lower sodium options among similar foods.
Do not add salt to foods in cooking or at the table.

Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.
If you choose to drink alcohol, limit intake. For women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option.”

And now for some specifics:

1) Consume more of these foods

Plant foods – ensure you get your 5 serves of veg and 2 serves of fruit every day
Fibre – remembering there’s three types. Read up on fibre in a previous blog here.
Oats – full of beta glucans known to improve cholesterol levels. Read up on oats in a previous blog here.
Nuts – one to two 30g handfuls a day of mixed unsalted nuts can make a big difference. Read up on nuts in a previous blog here.
Oily fish and good fats – the omega-3 fats found in deep sea fish have anti-inflammatory properties and have been shown to improve heart health. Read more about the good fats in this previous blog.
Legumes – not enough of us eat enough of these amazing foods! Read more about them here, how to include more of them each day and how they’ll improve your health in so many ways.
Choose plant sterol fortified dairy products. This link from the Dietitians Association of Australia explains more.

2) Consume less of these foods/drinks

Sugar sweetened softdrinks
Processed fruit juice
Alcohol
High glycemic index/poor nutritional quality carbs – read more here to choose better carbs.
Saturated fats
Processed/junk foods

3) And do your best to increase your physical activity levels! The National Physical Activity Guidelines recommends:

Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.
Be active on most, preferably all, days every week.
Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.
Do muscle strengthening activities on at least 2 days each week.

Hoping that’s made understanding how food and lifestyle affects your cholesterol levels a little clearer. Please let me know if you have any questions. 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 list of all Sally’s Diabetes Counselling Online blogs here.

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