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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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Fibre is our d-friend

June 16, 2014 by Sally Leave a Comment

I’m sure you’ve all heard about the importance of including good levels of fibre for good digestive health, so I thought it worthwhile to talk through the different types of fibres and how they benefit us as well as what the evidence says about fibre in relation to diabetes and how much we need topped off with some ideas of how you can increase the fibre in your diet for your improved wellbeing. Many of my previous Diabetes Counselling Online blogs have referred to fibre, so I’ll remind you of those along the way and you might like to bookmark them for a re-read.

It’s important to remember from the start that when following a high fibre diet that you drink plenty of fluids (preferably water) and are physically active to help you gain the greatest benefits.

Fibre and Diabetes

Starting with the glycemic index, we should know that including foods higher in fibre will contribute to lowering the glycemic index of the carbohydrates in the meal. You can read more about this topic here and here.

There’s also lots of evidence that you can read about in the Australian Dietary Guidelines about how fibre reduces fat absorption and reduces risk of cardiovascular disease and bowel cancers. All of these are important issues for us with diabetes to consider.

And, of course, if you’re watching your weight, fibre has a lower energy density as it resists digestion so will keep you feeling satisfied for longer too.

Types of Fibre and their roles

Dr Alan Barclay of the Glycemic Index Foundation explains that “dietary fibres come mostly (but not exclusively) from plants and that they are the poorly digested portions that pass through into the large intestine (bowel) and provide much of the bulk in our stools (along with water and bacteria, amongst a few other things).”

There are three main types of dietary fibre: soluble, insoluble and resistant starch. We need a combination of these for good health as they play separate roles.

Soluble fibres attract water and are totally broken down in the large intestine (colon) by good bacteria. They include foods such as whole grains, legumes, psyllium, some fruits, vegetables, nuts and seeds. You can read more here.

Insoluble fibres are the ‘bulking’ fibres that aid regular bowel movements. They are also found in similar foods as the soluble fibres, but wheat bran is also a contributor.

Resistant starch is like fibre in that it is starch that resists digestion in the small intestine and travels through to feed the good bacteria in the colon. Research is indicating how beneficial it is for colon health! It’s found primarily in legumes, pearl barley and brown rice as well as cooked and cooled starches (the process forms a crystalline structure around the starches, causing them to resist digestion) such as potato, pasta and rice. The CSIRO has developed a type of this starch which can be found in some specially formulated breads and cereals (including the BarleyMax range by Goodness Superfoods).

How much do we need?

I usually advise clients to read labels (most labels in Australia include fibre these days) and look for the highest fibre level when you’re comparing products. You can read more about label reading in a previous blog here.

As a guide, breads should be greater than 5g/100g at a minimum.

In total we’re aiming for 28g per day for women and 38g per day for men.

How do we get it?

If you aim to include fibre-rich foods such as wholegrains, legumes, nuts, vegetables and fruit in each of your main meals, and follow the Australian Dietary Guidelines, especially in those 3 food groups, you should easily reach your target. Leaving the edible skins on your fruit and vegetables is also an awesome idea.

I couldn’t do better than share this table from the Grains & Legumes Council website with you to demonstrate how to include more fibre…

(Just click on the picture to enlarge it if it’s too small for you to see clearly)

High fibre recipe ideas

The most basic idea is to modify existing recipes by adding products like legumes and whole grains and nuts and seeds, but here are some high-fibre recipe links that might inspire you to increase your fibre intake.

Cinnamon Chicken with Bean Salad

Apple and Bran Muffins

Mushroom and Lentil Burger

There’s loads more this like this on the Taste.com.au website, as well as my other favourite internet recipe sites including Allrecipes.com.au, the Grains & Legumes Nutrition Council website and the Nuts For Life website.

Some other helpful links for more info on fibre

Dietitians Association of Australia

Grains & Legumes Council

The Better Health Channel, Victoria

Catherine Saxelby’s Foodwatch website

The Australian Healthy Food Guide by dietitian Caitlin Reid

Hoping that’s given you inspiration, understanding and some helpful ideas to include more fibre in you day.

We’d love to hear how you personally get enough in your day, so please share in the comments below.

Wishing you a great day! Sally

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Oats for d-health

June 9, 2014 by Sally Leave a Comment

Oats are an awesome topic for a d-blog as they bring together so many aspects of food in our lives with diabetes including the glycemic index of carbohydrates, the importance of whole grains in our diets, soluble and insoluble fibre, heart health and the chance to talk about more delicious recipes. Not to mention with winter on our doorstep, oats are a wonderful comfort food breakfast for the coming cold mornings – Yes! And this idea follows on well from a recent blog about healthy eating on a budget as oats are definitely a bargain food!

Of course, like with all foods that I talk about individually, I need to make clear that they should be consumed as part of a varied and balanced diet as is demonstrated in the Australian Dietary Guidelines.

I’ll also talk about oats and coeliac disease, since around 10% of us with type 1 get coeliac disease, and I know I was devastated to find out that oats were off my diet when I was diagnosed. Now they’re back, so I’ll speak more of that further down

Glycemic Index

Oats come in various states – groats (the whole oat, just with husk removed), steel cut (the next ‘least’ processed version), oat bran, rolled oats, traditional oats and quick oats – just to name a few. As we often discuss, the less processing that the grain goes through, the lower it’s glycemic index should be as our body has to do the processing itself to break the whole grains down into glucose that our bodies need for fuel. So, when you’re choosing oats try to avoid the ‘quick oats’ which have been chopped smaller for faster cooking, when whole oats actually don’t need much (if any) cooking anyway.

It is also interesting to note that oats are lower in carbohydrates than many other grains. According to Calorie King, they come in at only 58% carbohydrate compared with rice at 79%, wheat at 71%, and quinoa at 64%.

Our D-health

We’ve probably all heard of the cholesterol lowering and glucose ‘slowering’ (I know, I made it up, but you get what I mean lol) abilities of beta-glucans that are found in oats, but oats are packed with a huge range of nutrients that are essential for maintaining health including B-vitamins, minerals (including iron, magnesium, and zinc) plus a whole lot more as well both soluble and insoluble fibre to keep our gut healthy too.

They also contain a plant nutrient that is unique to oats called Avenanthrades which have been demonstrated by research to possess anti-histamine and anti-inflammatory properties, as well as being shown to reduce a process involved in atherosclerosis. All good evidence for us with diabetes to include them in our diet on a regular basis as part of our 3-6 grain serves per day where one serve is a quarter cup of raw oats (17g carb = 1 serve/exchange).

There’s a lot of evidence to demonstrate the heart health benefits of oats, and I’m sure there’ll be more to come!

Oats and coeliac disease

Coeliac Australia says on their website that “FSANZ defines wheat, rye, barley and oats as gluten containing grains, as all four grains have been shown to trigger a reaction in those with coeliac disease.

“Many gluten free or pure oat products are now being imported to Australia. It is important to note that this means that the product is only free of contamination from wheat, rye or barley crops during the harvesting, processing or packaging of the product. The product has not had the gluten extracted or been genetically modified to be gluten free.

“It is recommended by the Medical Advisory Committee (MAC) for Coeliac Australia that despite the extensive medical research done in relation to oats and coeliac disease, oats should be excluded from a gluten free diet until the research is more conclusive and definitive.”

However, if you’ve been strictly gluten free for over a year and have fully recovered any previous damage, then it’s possible to do an ‘oat challenge’ using uncontaminated oats including 50g oats a day for 3 months with a pre- and post- biopsy to determine if oats are likely to cause you villi damage/inflammation.

Having diabetes, my doctor encouraged me to do this to help with the inclusion of more low-GI grains in my diet, and I would encourage the same of other people with diabetes who miss oats in their diet.

Notice I said ‘uncontaminated’ oats? From a coeliac perspective it’s important with all ‘gluten free’ grains to ensure they’ve been processed/packaged in a gluten free facility. Two I know of here in Australia are Freedom Foods and Carman’s Fine Foods. If you know of any others, please comment in the space below, thanks

Recipes

The obvious way to eat oats is to include them in your breakfast as porridge, muesli or in a smoothie, but there are so many other delicious ways to use them.

One of my favourite snacks used to be this Lowan recipe for oatbran and apple muffins as they were so easy to make and turned out perfectly every time, remembering I’m not a baker lol With both oat bran and apple, the GI of these would definitely be low. I just used a little less sugar – if you like it sweet you could use some sweetener in place of some of the sugar. I also choose to use light olive oil rather than vegetable oil (from an inflammation perspective).

I also like the look of this oat crumble topped pears with yogurt recipe which is likely to have a low-GI, but go easy on the sugar/maple syrup. Perhaps try some Agave syrup with its low GI instead?

And as far as savoury goes, they’re ideal to add to casseroles and soups. And how delicious does this recipe for lamb rissoles with tabouli and hummus sound? Yummo!

This roasted pumpkin crumble also looks like a top low-GI idea, especially good for those vegetarians amongst us!

And if you’re after more info on oats, Accredited Practising Dietitian/Nutritionist Catherine Saxelby wrote a blog on oats with more detail on the types of oats and her own favourite recipes that you can read here. And here’s a website that has a listing of all the nutrients if you’re interested.

Please share your favourite oaty recipes in the comments below! Sally

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How to manage d-lunches ‘on the road’

June 2, 2014 by Sally 3 Comments

Delicious snacks can fit easily into Guideline 3 with a little help from your friends <3

Quite a few of our readers have indicated that they find having a nutritious lunch to suit their diabetes requirements in their busy lives a tricky thing to deal with. Hopefully this blog will help with some practical ideas that you can implement whether you’re a truck driver, a shop owner, a school teacher, an office worker or even a shift worker.

Of course if you have ideas of your own that work, we’d love to have you add them at the bottom of the blog to help others too.

Benefits of taking your own

Making and taking your own lunches is not only financially and nutritionally rewarding, it can actually save you time (spent going to buy your lunch that could be better spent enjoying some exercise) and the effort involved really isn’t much. Also it’s easier to know you’re eating well when you are in control of the ingredients and the portion size.

I timed myself making a cheese and mixed leaf salad from a frozen loaf of bread the other day. It took only 3 minutes, which included slicing the cheese, packing it in a sandwich box and putting away the mess. An apple was the perfect accompaniment to it

Other easy lunch ideas may include:

the leftovers from last night’s dinner
pre-made soups or vegetable and legume laden casseroles

frittata made with veggies and legumes

salad mixed with your choice of tinned fish, meat, or tinned legumes

wholegrain sandwich with cheese or another protein source (such as egg, a slice of meat, a tin of tuna) and mixed salad (such as cucumber, onion, tomato and mixed leaves)

What should your lunch consist of?

Carbohydrates: Our lunches need to contain a low-GI carb source to keep our blood glucose levels steady. Read more here for other benefits of low-GI carbohydrates. These might include wholegrain bread, breadroll or wrap, tinned legumes (baked beans or 4 bean mix are easy options), cooked Basmati rice or quinoa or Rice Plus for a bit of variety.

Protein: The protein element provides us with many essential nutrients as well as helping us to keep our hunger satisfied for longer. A previous blog on this topic will help you to know how much to aim for and the reasons for it. This might include left over cold meats from dinner, a tin of tuna/salmon, cheese (for your dairy benefit too) or vegetarian proteins such as nut butters, hummous or tofu.

Vegetables: Remembering that we’re aiming for 5-6 vegetable serves per day which is quite a lot to achieve in one sitting, getting a serve or two in with your lunch can benefit you in so many ways. Keeping a bag of mixed salad leaves handy with tomatoes, carrots and celery can make adding a serve to a sandwich, or using the salad as the basis for your meal a very easy job. This is where soups really shine too as vegetable-based soups tick nearly all the boxes for a perfect lunch, especially with the colder weather approach. Leftover roasted vegetables are an awesome and delicious option too.

Fruit: Having a piece of fruit with your lunch will provide you with more of those wonderful plant based nutrients to keep your brain and body functioning in top order. Remember that we’re aiming for two pieces a day, so if you struggle to reach that, lunchtime is good time to slip a piece in to your day.

Dairy: If you’re not meeting your dairy needs each day (see previous blog on dairy) then having a glass of milk (you can get individual sized UHT milks to save refrigeration) or a yogurt if you’re not already having cheese with your lunch, can be a top way to add this food group.

Food Safety is very important for lunches

Read the previous blog on Food Safety, and remember to pay particular attention to foods like dairy foods (yogurt, milk and cheese), meats, cooked grains (like rice, quinoa and pasta) and prepared salads.

Some ideas to help keep these foods safe include the use of:

insulated containers with ice bricks
a thermos to keep soups and casseroles hot
keeping a frozen water bottle in your lunchbox to minimise bacterial growth
tinned food that you can open when you’re ready to each (tuna, sweet corn, baked beans)

What if I get stuck with no other option than to buy lunch?

Sometimes, despite best efforts to be organised and take your own, there will be situations where you need to buy lunch. A great tip here is to find supermarkets or stores where possible in preference to takeaways, bakeries, service stations or pubs. It’s easy to find the makings of your homemade sandwich in a supermarket and you’ll still have the portion control and financial benefits of taking lunch from home. A grainy bread roll, some cold meat from the deli and a small bag of mixed leaves makes an easy sandwich.

And if there are no supermarkets or stores and you do need to visit a takeaway, bakery, service station or pub, they usually do have a healthier option such as a grainy sandwiches (you could ask for no or minimal spread) and healthy fillings. It’s really worth the effort to avoid those pies, chips, battered foods and high-GI carbs wherever you can.

Where can I find ideas to suit what I need?

Nutrition Australia has a helpful webpage with more ideas for healthy lunchboxes for busy adults that you may like to view, as does Taste.com.au and ninemsn.com.au.

Making an appointment with an Accredited Practising Dietitian for personalised advice about how you can find lunches to suit you that are healthy for your diabetes and convenient for your lifestyle is an awesome idea. You can find one near you by clicking here.

If you’re unable to arrange that for any reason, Diabetes Counselling Online can arrange for Australian’s to have a free e-consultation with a dietitian just by registering here.

As mentioned at the top, if you have lunch ideas that work for a busy person we would love to hear about them as a comment below the blog.

Hoping it’s helped you with some ideas to improve the quality of your work day lunch breaks. Sally

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After the #party’s over: #guilt #regret #acceptance

April 18, 2014 by helwild Leave a Comment

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So, the Moveable Feast of Eostre, the goddess of spring fertility, is upon us once again. It’s Easter. We have a full moon, rabbits & chickens, chocolate & sweet fruit buns with a cross baked into the top. For some religions, there are other, more sombre & deeply significant symbols associated with this part of our annual calendar. For most of us, there are 4 days off work, at a time of year when the moon is full, when the day & the night are almost of equal length, with the equinox falling just under 4 weeks before Eostre in 2014, on March 20th. The weather is generally pretty ‘liveable’, whatever hemisphere of this bounteous Earth we are living in.

The stage is set for a time of rest & relaxation, of time with family & friends, of contemplation, & of feasting. In our Northern hemisphere heritage & tradition, even though we are now living in the Southern hemisphere, the annual cycle away from the darkness & deprivation of winter means it’s time to make special purchases of foods that we normally reserve for special occasions: weddings, parties, birthdays, anniversaries. Some observe religious abstinence of some food for part of this time; but all spend at least part of this time feasting.

For about 38 years, our Easter has involved spending time with our extended family. In the early days, these Easter gatherings were held at our house in a small inland country town. We actually sent out invitations, & at first our brothers & sisters & our own parents came, bringing children, the occasional great grandparent, & the occasional dog. We needed caravans & tents for everyone to be able to sleep under cover, & occasionally the bathroom & septic tank struggled to cope. Luckily we were only a short walk from the Public utilities. The cousins bonded for life.

Later, once we acquired our scruffy little fibro beach shack, all the growing cousins brought friends; girlfriends, boyfriends. Meals were mostly eaten outside, huddled away from the sea breezes in a cold year, or gloriously somnolent in sunshine in a warm year. That’s the thing about Easter: it’s a Moveable Feast, so the weather can be like the end of summer; or it can be like the beginning of winter; or even both. We still needed a caravan or a tent some years, but bunks, sofa beds, mattresses on the floor, two showers & an outdoor hose, & two toilets helped a great deal. The septic tank needed regular emptying.

I remember a lot of laughter from those years. For most of those 38 years we were at the beach shack, & our time was taken up with sandcastles, swimming, searching rock pools for little crabs, midnight Jetty fishing excursions, sailing, rowing in a kayak or canoe. Food was abundant of course, as were leftovers. We played cards with gum nuts for stakes, Coon can, Pontoon, snap.

Nowadays our eldest daughter brings her family & we spend about 5 days at the shack. This year, because of the school holidays & other plans our family holiday ended on Good Friday. Traffic on the road to Adelaide was building up, & so they left before lunch today.

Our party this year included a full eclipse of the Moon, two red moons in a row, sunsets & dawns that were peacefully beautiful. Oh & the beginnings of a mouse plague. We swam in the sea, laughed, played games, built sandcastles & lego cities. We spotted our resident gecko, still skittering about inside the shack. We put down mouse bait, & threw out one little corpse. We enjoyed the fun of a 5 year old who wakes bursting with energy at 6.30 a.m. & wants to play baby pelicans (learning to fly & land) baby galahs, or baby seagulls. We enjoyed the seriousness of a tall 15 year old, who wants to share his thoughts & opinions about a myriad of topics. Both children are bursting with the joy of life.

Sure, we did enjoy some great, simple, homecooked meals. We didn’t buy takeaway. We didn’t eat chocolate. We didn’t have any chocolate with us. There are 3 people with diabetes in our party, & we aren’t that fussed about chocolate anymore. After the party’s over, what happens? There are the mechanics to be gone through: cleaning up, working out what to do with leftovers, perhaps extra sheets & towels to wash, if you’ve had house guests as we’ve had. But there is no time to waste on regret, guilt, or ‘shouldn’t haves’. The motto of ‘Acceptance‘, ‘going with the flow’, is the mantra that my daughter repeated many times over the past 5 days. ‘Don’t sweat the small stuff’ in life, whether it’s about food, children’s behaviour, TV programmes, the timing of how a day runs on holiday. It’s OK to change your mind, & also to accept that in many cases whatever decision you make is just fine. Managing diabetes is organised, stressful. Reducing stress can be as simple as letting go of the ‘need’ to be the one who manages, who seeks to ensure that everything is covered. It’s actually OK for things on holiday to not be tightly planned & organised.

Technically,our party is over for this year. Last night I was woken from sleep at 1 a.m. by the sound of young girls laughing out the front. Now I hear the sound of other people’s holiday long weekend just starting. People have arrived, having made a long drive from somewhere. My elderly neighbour on one side is from the Adelaide Hills, & he is having a Prawn feast with his extended family, including a new great grandchild. His elderly red dog is resting outside in the shade. On the other side, the young family of the second son is cooking up a Sausage sizzle. Their dog is a middleaged lab, all protective when he needs to be, & all tail waggingly friendly when he doesn’t. Everywhere I hear children playing, birds calling, wind, the sound of the sea on the shore. Out the front, two little boys aged about 9 are walking past, wearing shorts & fleecy jackets.

We have decided to stay on a little. I have been very unwell, & am still moving more slowly than usual.There is a lot to do. We have no need to rush back to the city, where our daily lives are. And it’s still so beautiful here. Our original plan was to head back today, but slowly our plan evolved into a different one. Acceptance includes being flexible, open to what life brings.

happiness comes from letting go of guilt

carpe diem

Helen

Helen Wilde is a Senior Counsellor with Diabetes Counselling Online. She has been the parent of a person with diabetes since 1979, and has lived with Type 2 diabetes herself since 2001.

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