By Brooks Kent
The following was the keynote address delivered at the annual seminar of the Diabetes Action Network, on July 3, 2000, as part of the annual convention of the National Federation of the Blind, held in Atlanta, Georgia.
I'm Brooks Kent. As President of the Atlanta Association of Diabetes Educators, I'd like to welcome you to our city. I 'm a nutritionist and dietitian by trade. It's a fantastic career for somebody whose passion is food! Food is one of the ways that we celebrate life. In the beginning, when babies cry, we feed them. Throughout life, we celebrate all of our holidays around food. At the end, when someone dies, we take food to the family. What happens when we are told that we have to change the very way that we eat that many of the foods we most enjoy are limited to us?
It' s hard to make the changes that are so necessary for our health. Fortunately, many of the recommendations for people with diabetes have changed. We no longer ban sugar from the diet. It isn t the poison that we once thought it was. We know that, with careful planning, all foods can fit. The latest dietary guidelines have been produced and released. These are known as THE DIETARY GUIDELINES FOR AMERICANS 2000. Notice that they are not just for people with diabetes or with chronic heart disease. They are for all Americans, in order to make us healthier and stronger, and better able to enjoy the lives we lead.
Tonight, I m going to go over these brand new dietary guidelines. Has anybody here seen them? Have you noticed how they have changed? I think these guidelines make a good basis for all of us as we learn how we can eat a healthy diet. I m sure there will be questions you ll want to ask as we go along.
The first guideline concerns weight. Uncle Sam actually wants you to take out the tape measure and measure your waist. Anything over 35 inches for women and 40 inches for men is considered a risk factor. How many of us can say that we re under those figures? Did you know that it's the first 10 or 20 pounds that will make the biggest difference? When I first started diabetes education, I d constantly encourage people all the time about "getting down to your ideal body weight." We now know that getting rid of that little abdominal pouch, just a few of those extra pounds around the middle, will take us a lot closer to our blood glucose targets.
The second guideline addresses physical activity. How are you doing with that? Are you physically active? Are you doing pretty well? Do you know how much exercise is recommended as good, physical activity? Actually, the recommendation is 30 minutes daily, of moderate physical activity. But what does the word "moderate" mean? "30 minutes of moderate activity" actually means something like walking two miles in 30 minutes. Have you ever tried to do that? That s pretty intense! So it's going to take some effort on everybody s part to get out and do a little more exercise.
For those of you who find it difficult to exercise outside, that s okay. There are plenty of exercises that can be done in a chair. Would you like to try a few right now? The first thing I m going to ask you to do is put your hands on your shoulders. Now, lift them up as high as you can go. Stretch those fingers out. Now, curl your fingers in. Go back down to touch your shoulders. Let s do it to the count of ten. We ll go up on one, down on two. Ready? One, two, three, four, five, six, seven, eight, nine, ten.
How do you feel now? Do you feel any better? Just that little bit of exercise gets your heart pumping, doesn t it! Remember that following the guideline for exercise is something that we all need to do. We know that exercising is vital for our health.
How many of you are familiar with the food guide pyramid? Did you know there is a different one for diabetes? It differs in several ways from the one for the general public? One example is cheese, which is normally listed in the dairy group with milk and yogurt. On the diabetes pyramid it is now in the meat group. This is because cheese doesn t have very much carbohydrate. When you have diabetes, cheese acts more like a meat than like a dairy product. The beans which are typically in the meat group are very high in carbohydrates, so we ve moved them over to the starch and grains group. And what about potatoes, corn, peas, and the winter squashes like hubbard, acorn and butternut squashes? Those indeed are vegetables, but we group them as starchy vegetables because of their starch content.
Now, somebody tell me where to put a tomato? I'm sure you made an A in biology if you said tomatoes were fruit; but, when you have diabetes, you count your tomato as a vegetable.
Another way to use the pyramid is as a guide for the number of servings for a day. For instance, for people with diabetes, the number of servings for grains, starches and beans is six servings or more. For members of the general public, it goes as high as eleven servings , which would be appropriate for a 2800 calorie diet -- a little high for most of us. Most women, especially those desiring weight loss, need somewhere around 1600 calories each day.
Did anyone hear about the report that was published a month ago, on the effect of fiber in managing your diabetes? For a long time, we've thought fiber was a major player in controlling diabetes and now the research substantiates it. Any time you add fiber to your diet, it is beneficial. This does not mean your white rice is off limits ( you re only going to get two more grams of fiber if you use brown rice instead), but we d like for you to increase the fiber intake in your diet at every opportunity. Adding fiber is something you want to do very slowly, while incorporating extra water. Do not try to do it all at once.
Now, let me give you a list of words to look for on labels, words that should be first on the list of ingredients you look for. These are words like brown rice, bulgur (a cracked wheat), also look for graham flour, whole grain corn, oatmeal, popcorn, pearl barley, whole oats, rye or whole wheat.
We have excellent evidence now this will help all of us. There was a study published by the American Dietetic Association in 1998, the DASH Diet Study. The "Dash" diet actually stands for "dietary approaches to stop hypertension." Most people who have diabetes are also at very great risk for hypertension, so one of the things we d like you to do is to find other ways of controlling your blood pressure. The DASH Study indicates one of the best ways is to eat eight to ten servings of fruits and vegetables every day. That s right! Eight to ten! Along with that, we d like you to eat two servings of low-fat dairy products. Now, that s a lot of fruits and vegetables. How many fruits do you think I could include in that, if I am helping you with your diabetes? Not a whole bunch! So, you ll have to eat lots and lots of vegetables. We ve also found that all of those fruits, vegetables and dairy products can decrease your blood pressure as much as we could with medication. it's pretty impressive how your diet can make that much difference.
How many of you were out in the Atlanta heat today? Here, it's not a good idea to take chicken salad on a picnic. Just make sure you keep things clean, make sure your food is properly refrigerated and that you keep your food safe.
One of the things about low-fat and low-carbohydrate foods is that they protect our kidneys as well as our hearts and arteries. I have a particular passion for protecting people s hearts! I don t want you all to have the same heart problems I have, so I d like to see you all decrease the amount of fatty foods in your diets, and increase the number of beans and legumes that you include. This can be tasty as well as healthy.
We all know, but we need to remember, that sugar is not now considered to be the poison it used to be for people who have diabetes. On the other hand, sugar can present a problem, because it is a very concentrated form of starch or carbohydrate. What's more, it fills us up, and keeps us from eating foods that are much more nutritious, that would benefit us. It's important to moderate the amount of sugar you consume. Did you know that for the general population soda pop is the number one source of added sugar? That is followed by sweets and candies, cookies and cakes, fruit drinks and fruit "ades." I can t tell you how many kids think that these fruitopias are the way to go!
Again, the main purpose of this guideline is to combat hypertension; but there are also a lot of other things about salt we really don t understand. We think there may be some problems with salt we don t even know about yet. While not everyone who has diabetes is salt sensitive, you are much more likely to be "salt-sensitive" if you have diabetes. In Japan, where they have a very healthy diet, we find a much higher incidence of stomach cancer, and we think it has something to do with their high intake of sodium. A high intake of sodium is also a contributing factor to the formation of kidney stones. There are lots of reasons to watch the amount of salt you have in your diet.
There s that wimpy word, moderation, again! Moderation means one drink per day for women and two drinks per day for men. We know a healthy diet can be had which includes alcohol, and some studies have shown that alcohol may actually lower the incidence of cardiac disease for people who have diabetes. However if it's one drink per day for women and two drinks per day for men I don t want ya ll to save up all your drinks for Saturday night!
The new dietary guidelines are now available to everyone. There is a lot of other information in them besides the ten guidelines I have shared tonight. Actually, it is a 39-page booklet, which can be obtained by calling (202) 418-2312. it's also on the Internet through the U.S. Department of Agriculture. Let me give you that website also. It is www.usda.gov/cnpp. Or, you can just go to the USDA web site and ask for "dietary guidelines," and the search box will take you there.
Isn' t it true that when you use canned tomatoes in cooking the serving amount is different than when you use fresh tomatoes?
Actually, when we use tomatoes or anything that is pre- cooked, we should decrease the portion size. If you take a fresh tomato, it would take almost the entire tomato to give you one serving of the same vegetable, raw. What happens when you cook the tomato or the vegetable? It shrinks as it cooks. Are you still getting the same amount of tomato or onion, for example? A smaller quantity will give you the same amount in the serving size. So, we ask that you cut back on the amount in your servings of cooked vegetables.
In that same vein, what about your green leafies? I have a question for all of you. Green, leafy vegetables, are they "free foods"? No, they are not free foods. We do have to consider them as part of the daily diet. We can add a green, leafy vegetable to any meal or snack without having to worry about it, but it does contain carbohydrate, and has to be counted.
What about catsup?
Catsup has both sugar and salt. Catsup labels will tell you there are between four and five grams of carbohydrate in each tablespoon, which would mean one tablespoonful is a free food. Beyond that, however, if you are a six-packet catsup person, you ve just added two carbs to your diet.
Can you say something about Splenda?
Splenda (sucralose) is a wonderful, new artificial sweetener, on sale mid-September. I tasted it at the American Dietetic Association meeting last year. It has been approved for pregnancy as well as all types of diabetes. Anyway, it tastes just like sugar, and it can be used in cooking, which you can t do with the aspartame products. Some people don t like Sweet n Low, which we have been using for cooking. Splenda can be used in cooking and it is teaspoon for teaspoon at the same ratio as you would use sugar. You can also bake with it. You have to order it and I will give you the phone number to use. It is (800) 777-5363. it's a wonderful sweetener, and it's going to add a lot of choices for a lot of people.
There' s been a lot of publicity about testing of aspartame.
The artificial sweeteners have probably been tested more than anything else that we put in our mouths. They' ve gone through many, many clinical trials to determine their effects on people. There are so many things going around about these artificial sweeteners right now but I would say that moderation is the word for all of these things. I have heard a lot of negative things about aspartame, but none of them have been supported through scientific evidence or research. Aspartame was checked very, very carefully before it was released onto the market and approved for use. It is considered to be a safe product. If you are hesitant about using aspartame then choose another sweetener. Remember, though, that it does give you a lot of flexibility that you might not have otherwise. It gives you the satisfaction of having some sweetness in some products that you might not otherwise be able to enjoy.
Don t try to cook with it, though. Has anyone ever tasted a diet soda after it has been left outside in the sun all day at the filling station? Isn' t it horrible? That is because aspartame is made from protein, and protein "denatures," breaks down, with heat.
I live in Indiana and it's been a test market for Splenda.
Yes, Splenda is in some things that are on the market right now such as Log Cabin Syrup and in the reduced-calorie, Ocean Spray Cranberry Juice Cocktail.
I think someone also asked about fructose, the product called "Fifty/Fifty." What is fructose? It' s a sugar made from fruit. It' s the same thing that we get in orange juice. I d be very cautious about using Fifty/Fifty. I normally teach people to look at the total number of carbohydrates rather than just the amount of sugar that is contained in a food product. If you just look at the amount of sugar included, it can be very deceiving. After all, a carbohydrate is either a starch or a sugar. Our bodies don t care where the sugar comes from. They don t care if it's from a sugar or a starch. By looking at the total carbohydrate count, the amount of starch and sugar in your diet is already figured for you.
I teach everyone I instruct how to count carbohydrates. It is a very simple thing to do. All you have to do is know the amount of carbohydrates in the amount of food you are eating. If you are on an insulin pump, it's the only way that we can teach you to manage your diabetes. To use the pump effectively, you have to learn carbohydrate counting. Anyone who has been using the EXCHANGE LIST to manage their diabetes can easily learn to count carbohydrates. All you need to know is how much carbohydrate you are getting in each meal, and keep that consistent throughout the day. If you are on insulin, you obviously can have a little more flexibility in how much Regular or Humalog insulin to inject, by counting carbohydrates. If you are not on insulin, carb counting is an excellent way to control your diabetes with diet.
Carbohydrate counting is very simple and you can easily fit it into your meal plan. All of the starches and sugars that you want to include in your diet can be included if you don t overdo the carbohydrate intake at any one particular time. How many of you are doing carbohydrate counting? For those of you that have not learned to do it, I would suggest you talk to somebody on your diabetes management team. It will give you the freedom to eat a lot of foods you thought were off limits.
Someone asked me about eating rice bran. The bran from the rice, or any grain, is where the fiber is found. Any time you can add more fiber to your diet, it will improve your blood sugar control. Another form of bran would be something like Metamucil. Again, you want to be very careful and increase your intake of fiber slowly. You want to drink lots of water. Don t overdo it. You ll have a lot fewer friends if you go at it too hard.
One more thing about carbohydrate counting. Most people who are trying to control their diabetes with diet do not have a problem with what they eat. Rather, they have a problem with how much they eat. That is what makes the difference.
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