Summary of a seminar by Dr Rosemary Stanton on plant based eating

Dr Kate Marsh and Dr Rosemary Stanton

Last week I went to a presentation called Paleo versus Plant based diets. I really wanted to share some of the information I was reminded of there with you. Upfront I’d like to make clear that I’m not sharing these to make you feel bad or guilty, so please don’t go there! Just to help you to reconsider and be mindful of what you put in your mouth due to the effect on your overall wellbeing as well as your diabetes management.

There were three key speakers. Dr Kate Marsh (a member of the Diabetes Counselling Online board) who is passionate about plant-based diets, Dr Rosemary Stanton who is probably the most well-known dietitian in Australia and Brenda Davis, a Canadian Registered Dietitian. The day wasn’t about diabetes, but they made several key points that I thought worth sharing with you related to improving your wellbeing by eating more plants. This doesn’t necessarily mean going vegetarian or vegan, but just cutting down on the animal-based foods.

Dr Kate Marsh showed us the evidence of how plant-based eating can improve diabetes management, and help people to avoid chronic disease in general.

Brenda Davis made direct nutrient comparisons between the Paleo and plant based diets, in many cases demonstrating how close the modern Paleo diet was to a vegan diet. But in this blog, I don’t want to discuss the Paleo diet as a ‘diet’ is not sustainable and although it has some strengths it’s not suitable to recommend on a population based level such as this blog. If you’re interested in this for your own health, I recommend a personalised consultation with your Accredited Practising Dietitian as some aspects of it may be dangerous for people with diabetes, especially in the longer term.

Instead I want to focus on Dr Rosemary Stanton’s presentation which was entitled ‘Why so many controversies?’ because it’s really a common sense (and of course evidence-based) approach to healthy eating. The changes she suggests are not too hard to try and really make sense when you think about.

Dr Stanton is a great advocate of the Australian Dietary Guidelines due to the enormous amount of research (over 55,000 pieces of peer reviewed published scientific research) and work by a committee of leading experts in the field of nutrition, public health, industry and consumer issues, and overseen by the Council of NHMRC that went into it to ensure that the Australian population would have not only the right amount of energy (calories/kilojoules) to maintain a healthy weight, but also would have the vitamins and minerals needed to keep us well and to help prevent chronic disease.

She began by explaining how we get so many mixed messages through the media and how important it is to check on advice that you read, as many of the people who talk about nutrition aren’t university trained experts in the field even though they may have passion on their side. Then she got to the part that I really wanted to share with you about own diets.

Dr Stanton explained that in comparison with Australian consumption patterns when the guidelines were being reviewed, the evidence suggests that we need to eat more:

  • Vegetables and legumes/beans – a variety of different coloured vegetables
  • Fruits
  • Whole grain (cereal) foods such as wholegrain breakfast cereals and wholemeal bread
  • Milk, yoghurt, cheese – preferably reduced fat varieties (except for children under 2 years)
  • Fish, seafood, poultry, eggs, nuts and seeds, and legumes/beans
  • Red meat (young women only)

There were also many areas as population that we could do with eating less of, and most of these related to our diabetes health such as:

  • Refined grain (cereal) foods such as white bread and low fibre cereals (these will spike our BGLs without providing our nutrient requirements)
  • High and medium fat milk, yoghurt and cheese (let’s stick with low fat to avoid the saturated fats and extra energy that we don’t need)
  • Red meats (adult males only)
  • Energy-dense and/or nutrient-poor foods and drinks which are high in saturated fat, added sugars, added salt and/or alcohol, such as sugar sweetened drinks, fried foods, hot chips, many take-away foods, cakes and biscuits, chocolate and confectionery and crisps.

Dr Stanton made the point quite strongly that although the foods in that last bullet point are referred to as ‘discretionary’ items in the guidelines, really it’s just ‘junk’ food and we’re better off without it and taking any extra energy needed from the main food groups of the guidelines themselves. This idea was explained further in the Diabetes Counselling Online blog I wrote on Snacking.

She talked about how our Modern Western diets currently emphasis:

  • foods and drink high in added fat, sugar, and salt
  • highly processed grains
  • meat dominates dinner
  • vegetables are only an accompaniment (often chips)
  • fruit juice preferred to fruit
  • full and medium fat milk, cheese, sweet yogurt , ice cream
  • alcohol (with or without food)

And if you think about this it’s just so true! For those of us who are not vegetarian, if you ask us what we’re having for dinner, the answer is ALWAYS a meat-based one. It’s just the way we’ve learned to think about our meals – maybe it’s time to consider this, recognise that it’s not doing us any good, and try to improve what we’ve in the past.

Dr Stanton suggested that the main changes needed are:

  • much more vegetables and legumes
  • more fruit
  • include nuts and seeds
  • far less junk (currently 36% of adult’s and >40% of children’s calorie/kJ intake)

Do many of you try to include ‘Meat Free Monday’? Here’s a link to a website dedicated to this idea with recipes from some of the top chefs that you might like to take a look at.

If you start to enjoy some of these, you might see how you can move closer to a plant-based diet without comprising on your enjoyment of the meals you’re eating. It doesn’t mean you have to give up your favourite steak – just try cutting down the size of it and increase the vegetable sides, or your pizza night – make it at home with healthier toppings, or even your night off cooking nights – by having frozen pre-prepared meals that you’ve made a batch of earlier.

Have you read my Diabetes Counselling Online blog called ‘Learning to Love Legumes’? It’s full of some great ideas and those legumes will provide you with more than enough protein to keep your tummy satisfied hunger-wise and those tastebuds happy too.

Dr Stanton’s ‘Take Home’ messages were a great reminder to us all when there is just so much conflicting information available via the internet. She says:

  • education is important and ongoing
  • get information from trusted sources (NHMRC), without a conflict of interest
  • don’t trust Dr Google
  • be sceptical of those with something to sell
  • with scientific papers, read the whole paper, not just the newspaper headlines or blog comments

And what sensible advice that is!!

I’d like to finish up this blog by sharing one of Brenda Davis’s presentation slides. She finished her talk on Paleo vs Plant-based diets by explaining about the longest living people in the world, those that live in the Blue Zone, and a quick rundown on what keeps them so healthy. Could you adopt some of these ideas into your own life?

Paleo vs Vegan diets Blue Zones Longevity Diet 1 Brenda Davis 2015
Blue Zones Longevity Diet – Brenda Davis 2015 – Please click on the image to make it larger

Hoping this has helped you to consider some positive changes you can make to your own diet. 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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Juggling Wellness and Diabetes

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I’m writing this personal kind of blog on a Saturday. I love Saturdays. They encompass lots of things I love to do which all contribute to my wellbeing. This morning I was out on my run and because it’s Saturday and lovely Spring weather lots of my neighbours were also out and about. Nearly everyone I ‘ran’ into made the comment about how well I looked. I had at least 3 such comments this morning and they inspired me to share with you what I believe to be the key to being well with diabetes, or what works for me anyway.

This is important to me because I have diabetes and I’m turning 50 next year, so I know that if I don’t focus on being well myself I’m in a higher risk group to lose my wellness that is so important to me. I want to do all I can to hold onto it for as long as I can, so I can enjoy more of this wonderful life. I’m also passionate about helping others to be well too to the best of their ability, so here goes!

Sleep

Every Saturday I get to sleep in. Yay! To catch up on a few hours I may have missed through the busy-ness of my week. Time to give my body a chance to repair and relax. I usually get to sleep in until around 8am, which is a big improvement on my 6-6.30am starts on other days of the week. The only thing that stops me from doing this is waking early with a hypo, but this morning my BGLs behaved themselves. :) This week I found an awesome article in The Conversation on the importance of sleep which I encourage you to read. It’s just so important for our wellbeing, and especially so for us with diabetes.

Eating Well

As a dietitian you would know that I am particularly passionate on this topic! This is the only topic in today’s blog that I’m qualified to talk about as a health professional, and it’s such an important one! The Australian Dietary Guidelines that we follow actually makes the comment, “Diet is arguably the single most important behavioural risk factor that can be improved to have a significant impact on health.” It is something that I think about, read up on and focus on every day.

Today I started with my fibre rich, low-GI and high nutrient breakfast, a combination of two cereals that enjoy eating together topped with skim milk. I had a banana for morning tea and a delicious bowl of vegetable and low-GI carb rich Minestrone soup. This afternoon I’ll probably have a snack of a handful of nuts and another piece of fruit. We have a delicious lean meat and vegetable rich stir-fry planned which we’ll serve with plain Basmati rice, and I’ve marked out my favourite Black Cherry yogurt for dessert.

Minestrone

I know that I’m getting the nutrients I need to be well each day, and I’m sure it must also reflect in my outward appearance when I’m out on my run, makeup free in my daggy running shorts too lol

Regular Exercise

Nice segway to the exercise! Also lots of evidence here to support wellbeing, reducing inflammation, improving mental health and keeping our BGLs more stable. You may know that I’m a golfer. I try to play 18 holes in a comp twice a week, and 9 holes if I have time as a break in my day on a Friday. On the days I’m not golfing I do my best to get in at least the minimum recommended 30 minutes of moderate physical activity. Usually I try for 45 minutes. Since I’ve been doing this I have noticed a big improvement in the stability of my glycemic control as my fitness has improved. It’s so worth the effort even when you don’t really feel like it!

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Family Time/Love

I’m incredibly fortunate to have so much love and support from my family, but I guess it works both ways in that I also love and support them! I believe that love and giving love is an important part of wellbeing. We hug each other a lot in our household, and in the wider family too. Have you hugged someone today and told them you love them?

Family

Being sociable

Although I was out on my run, I enjoy stopping along the way on a Saturday as I have more time available to me to chat with my lovely neighbours in the suburb I live in. I chat with the children, and the parents, and the older people, and the neighbours who are my friends. To me this is important as I feel loved within my community too, and I know that I’m helping some of these people to feel loved too <3

Hard Work

I enjoy working. It keeps my brain active. It gives me a purpose and keeps me inspired each day to stay well and make the most of my life. The lovely Helen Wilde called me a workaholic this week, which made me think. You know I probably am a workaholic, but that’s because I love what I do and it makes me happy to help other people to be well. But I honestly try very hard to keep a balance with the other important factors in my life.

For those of you who are lucky to be retired or not have to ‘work’ as such I would encourage some kind of volunteer role as it can really be so rewarding and contribute to your wellness. We have some awesome volunteers who help us out at Diabetes Counselling Online. You can read more about our team and some of our ambassadors here. They’re so important in making our charitable organisation what it is.

Keeping the Balance

Of course, being Saturday, I also have household chores to do, preparation cooking for the week ahead, and I might even fit in a quiet hour of reading a book. It’s always a good day, and means I really relax and enjoy myself on my day of rest (and golf) Sunday. :)

If you try to imagine all these aspects (including any others you may have yourself) as a number of balls that you’re juggling, I believe that remaining well is all about keeping a balance amongst them. Sometimes you need to drop one ball to keep the others going smoothly, but don’t forget it and go back to collect it as soon as you can. I don’t see diabetes as one of those balls – it’s just part of me and often influences how I manage some of those balls/aspects.

Hopefully some of this will inspire you to focus on keeping your balls in the juggle, and know where you can make some positive changes to improve your own wellness. Diabetes Counselling Online actually has a whole section on the website on Diabetes & Wellbeing. Check it out!

You know we’re here to help. With love, 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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Discussion on low carb diets

Australian Guide to healthy eating poster

By popular demand through a thread in our Facebook group Diabetes and Food – let’s celebrate it!, this topic deserves a blog to help explain some of the ‘stuff we hear’ around carbohydrates and type 2 diabetes. I’d also encourage people with type 1 diabetes to read this though, because some of the points made are also relevant for us! Up front I will remind you that everyone has individual requirements and should see an Accredited Practising Dietitian for a personalised consultation, so this is a ‘general guide’ only.

Firstly we need to understand what ‘low’ means in such a context as in my experience as an Accredited Practising Dietitian, people tend to associate ‘low’ with ‘virtually no’ carbohydrate. We’ll also look at some of the evidence that shows that ‘low’ carb diets can help with glucose control in type 2s, and why when drugs (other than metformin or SGLT2-inhibitors) are introduced it’s important to ensure more (quality) carb intakes as advised by your health professionals. And lastly (but certainly not leastly) we’ll review how, based on the Australian Dietary Guidelines, it’s possible to have a nutritionally balanced diet while watching your carb intake.

What does ‘low’ carbohydrate mean?

If you ask some people what they think ‘low carb’ means, you may hear that it’s about cutting carbohydrates out as much as possible. Straight up as a dietitian my alarm bells ring as carbs feature in all five of the food groups that we need for nutrients to ensure our wellbeing: vegetables (starchy vegetables like potato, sweet potato and corn), fruit, dairy, protein (when the likes of legumes are included, and especially in vegetarian diets) and of course, the important grain/cereal foods.

The American Diabetes Association defines a low-carb diet as 130g of carb per day. Does that surprise you?? The ‘trick’ with low carb diets is therefore to know how to choose your carbs wisely so that you’re still meeting your nutrient requirements, and also to know what to replace that carb energy with (remembering that carbs, proteins and fats make up our daily energy intake) so you don’t get too hungry and be encouraged to ‘cheat’.

Remembering that there’s 15g of carbohydrate in an ‘exchange’ or ‘serve’ that gives us close to 9 carb serves across the day.

If you’re on medication that helps your body to produce more insulin, or you’re providing insulin yourself on a fixed dose then this idea is dangerous to your health so please speak to your health professionals before making any changes to your diet.

Some benefits of lower carbohydrate diets

Of course we know that all carbohydrates break down to glucose which is the fuel needed by our bodies, but in modern diets often too much (and poor quality) of this ‘fuel’ is provided which can cause stress to our organs and worsen our diabetes control. So understanding the benefits of a lower carbohydrate diet can help us to stick with it for longer and balance the rest of our diets more easily.

Some of those benefits may include:

  • Lower incidence of high blood glucose levels (hyperglycemia)
  • Lower amounts of medications need to control hyperglycemia
  • 130g/day is a sustainable amount, meaning it’s easier to stick to in the longer term
  • Putting your pancreas under less stress to produce insulin, thereby helping it to keep working for longer
  • By ensuring your 130g/day is nutritious and low-GI carb you may also improve your blood fat levels (cholesterol/triglycerides) which will lower your risk of cardiovascular disease
  • It doesn’t necessarily lead to weight loss – that depends on your total energy intake.

How do you manage it best?

Again I will mention how important having a personalised consultation with your Accredited Practising Dietitian is because everyone is different in many ways. Here I will make suggestions that I hope will help to get your head around combining the idea of low carb into your daily routine while still meeting the nutritional requirements as outlined in the Australian Dietary Guidelines foundation diet (see page 2).

In a nutshell, it’s about only choosing your carb sources from the 5 food groups and balancing that out with quality proteins and healthy fats. I encourage you to re-read the previous blogs I’ve written on those topics as highlighted.

Remembering that 130g/day equates to close to 9 carb exchanges/serves, your day might start to look a bit like this:

Breakfast: ¼ cup of raw rolled oats (1 serve carb) served with 125ml light milk (half a serve), a small banana (85g – 1 carb serve) and a tablespoon of LSA mix (for extra fibre/protein) = 2.5 serves total

Morning Tea: A 100g tub of low-fat yogurt = 1 serve total

Lunch: A sandwich made on wholegrain bread (the grainer the better – 2 serves) made with a protein serve and as much non-starchy veg as you can handle, either on the sandwich or as a side, using half an avocado as the spread (for your good fats), and a piece of fruit such as an apple or pear (both good low-GI fruits – 1 serve) = 3 serves total

Afternoon Tea: A 30g handful of mixed unsalted nuts = not worth counting carb-wise

Dinner: Remembering the balanced plate being one quarter carb, one quarter protein and half non-starchy vegetables, this works with so many meals. Aim for your carb serve to = 2 serves total

Supper: You’ve still got half a carb serve up your sleeve. I would encourage something like half a slice of grainy toast with peanut butter on it to give you the energy to get you through the night, but half a serve of low-fat dairy would also work well, or even a couple of squares of dark chocolate if you fancied it = 0.5 serves total

In this example you can see that we’ve incorporated 9 carb serves/exchanges and yet have included quality carbs at every meal.

Some final tips

  • Remember to include protein and some non-starchy veg with every meal.
  • Rice and pasta can be problematic a serve size is so small. Something I recommend that works for many people is to include the carb serves in the form of legumes (lentils, chickpeas, kidney beans, etc) in the pasta sauce and use low-carb alternatives such as those made from konjac root, or make pasta/rice out of vegetables such as grated zucchini or carrot or cauliflower. I sometimes serve my pasta sauces on mashed cannellini beans and frozen spinach (warmed of course!) and find it’s very satisfying.
  • Don’t forget to exercise! If the point of minimising your carbs is to control your BGLs, then even as little as ten minutes exercise after meals can make a fantastic difference to your readings. Do some self-experimenting about how much your BGLs drop after say 10, 20 or 30 minutes walking after meals, and then if you want to include more quality carbohydrates in some meals, you’ll know how to manage better.

I hope this has proved useful for you, and that you have a better understanding of how a low-carb (130g/day) might help with your diabetes control. Of course please ask any questions below and I’ll be happy to address them for you.

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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Closing the GI loop – quality + quantity of carbohydrates

This is the third in a blog series on Mondays across World Diabetes Month on the Glycemic Index (GI). We started with one on the benefits of low-GI carbohydrates which happily surprised many us.

Then last Monday we talked about ways to make the change, including tips and tricks, so that you can do that.

So this third blog is designed to close the loop on understanding the glycemic index by explaining about Glycemic Load (GL) which combines the quantity and quality of carbohydrate foods to help us make the most of our carbohydrate intake. The GL is calculated by multiplying the GI of a food item with it’s carbohydrate quantity.

For those of you with type 2 diabetes particularly, this should be really helpful in working out how much of various carbohydrate types you should be including. In saying that, please do not change your eating habits without checking with your D-team of health professionals as medications and other issues can alter what YOU need in the way of carbohydrates.

When we talk about the quality of carbohydrates, it’s not only the GI but also the nutritional quality of the carbohydrate that should be taken into consideration. For example, some fruits that are high in nutrients have a high GI rating, and some starches that have a lower GI rating, such as longer grain rices, have little nutritional benefit. With or without diabetes, we should aim to make every mouthful be chocked full of nutrients to help us maintain our wellness.

Another numbering system of carbohydrate foods, this GL stuff could get a little overwhelming. So we don’t want to overcomplicate matters. Put simply, ass with the glycemic index, the lower you go the more you can eat without upsetting your BGLs and insulin levels. But when you look at the research that backs it up, it’s certainly worth considering.

In 2008 Australian researchers published a paper that lists 1000 foods and their GI & GL called “International tables of glycemic index and glycemic load values: 2008” (by Fiona S. Atkinson, Kaye Foster-Powell, and Jennie C. Brand-Miller in the December 2008 issue of Diabetes Care, Vol. 31, number 12, pages 2281-2283). Since that table was published there has been a significant amount of further research published to demonstrate the benefits for general improved glycemic control in various populations and for health conditions such as cardiovascular disease for diets with a lower glycemic load.

As a broad guideline we should think about a GL of 100 per day being a reasonable number to aim for. Carbohydrate foods with a GL less than 10 should be your first choice for carbs. Foods that fall between 10 and 20 on the GL scale have a moderate effect on your BGLs, and those greater than 20 will cause both BGL and insulin spikes.

If you’re interested in having a go at working out your Glycemic Load, Harvard Health Publications published a table ‘Glycemic index and glycemic load for 100+ foods’ that came from the research paper by our Australian researchers in Diabetes Care, and is freely available to anyone wishing to try.

Using breakfast as an example from that list, if I have 30g of museli (GI=66, GL=16) with 250ml of skim milk (GI=32, GL=4), then my breakfast Glycemic Load will be 16+4=20.

Why don’t you give it a go for an average one of your days to see if you fit below the 100 mark?? You wouldn’ t need to do it every day, but a one off workout might be an eye opener for you.

Good luck :)

 

 

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