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Living Well with Diabetes Newsletter
August 2016

Palm Beach Diabetes and Endocrine Specialists
1515 N. Flagler Drive, Suite 430 West Palm Beach, FL 33401

The Sweet Taste of Summer Fruit!

By: Director of education – Jessica Cook MS, RD, LD, CDE

With Summer in full effect, many of us are enjoying the delicious taste of Summer Fruit. Berries, melon, mangoes, cherries, apricots, plums, peaches, nectarines, figs, grapefruit are all in season and there are certainly many to choose from. However, if you are managing your blood sugar, it may be a challenge to control portions of fruit to prevent large blood sugar spikes. Here are a few helpful hints:

Watch portion sizes of fruit: 1 portion = 15 grams carbohydrates

Carbohydrate Amount
1 ¼ cup
15 grams
Other Berries
¾ cup
15 grams
1 cup
15 grams
Nectarine, Peach, Plum, apricots
1 small or half large
15 grams
15 grams
Figs (fresh)
½ cup
15 grams

• Limit your servings to 2 per day. Fruit is a healthy, low calorie, high fiber food choice, but should be limited in consumption due to sugar content. Two servings of fruit per day are enough to give you the nutrients from the food without dramatically increasing blood sugar levels.

• Do not eat fruit right before bed. Fruit raises blood glucose levels, therefore consuming right before bed can possibly elevate blood glucose levels making it more difficult to sleep and/ or increasing fasting blood glucose levels the following morning. Consuming high carbohydrate foods at night also do not give the body opportunity to use these carbs for fuel since most people are not physically active before bed, as well leading to elevated blood glucose levels. Avoid eating anything two hours before sleeping and if snacking after dinner, reach for nuts or seeds, veggies, hard-boiled egg or low fat cheese to satisfy hunger.
• Do not drink fruit in the form of juice. Fruit juices lack fiber, which helps to slow down blood sugar spikes, and are more concentrated than fresh fruit. Therefore drinking fruit in the form of juice will lead to a quick increase of sugar in the bloodstream, which is very dangerous in people with diabetes. Fruit juice (4oz.) should only be consumed in an episode of hypoglycemia (blood glucose levels under 70mgdL) occurs.
• Limit dried fruits. Dried fruit is very concentrated in sugar and calories. Consuming only two tablespoons of fruit equals 15g of sugar and 75 calories, which is a small portion of food. Dried fruit delivers a quick increase in blood sugar, which again is not optimal for diabetes, so beware of trail mixes and granola bars packed with dried fruits. Fresh fruit is always best.
• Combine it with protein. Adding lean protein to snacks not only helps to increase satiety, but also minimizes blood sugar spiking. Proteins take longer to digest than carbohydrates, therefore combining carbs with protein create a slower blood sugar spike and also help you consume less carbs for that meal or snack. Perfect examples would be half an apple with 1 Tbsp. natural peanut butter, 5 whole grain crackers with 1 slice low fat cheese or 6oz. plain non fat Greek yogurt with ½ cup berries.

Thank you for taking time to read our Living Well with Diabetes August 2016 Newsletter.

The Olympics of Food

By: Rosemarie Steinsapir MS, RD, LD, CDE

The huge volume of work that embodies the Dietary Guidelines for Americans, as developed by the USDA and intended for use by professionals, stresses the approach to good health through the careful consideration of scientifically based protocols for food intakes. These include recommendations for each specific macronutrient and several micronutrients. The Guidelines address physical exercise, food trends in our current society and the needs of age and sex-specific groups.

According to the Dietary Guidelines for Americans 2015 (as the continuum from 2005, and 2010 and 2013), the current recommendations are a diet consisting of 45-65% carbohydrate, protein intake of 15-20%, and fat intake of 25-30%, with saturated fat not exceeding 10% and added sugars not exceeding 10%. The percentage is calculated on the total calories required for the day, which is based on, height, weight, sex and age.

In 2013, the American Dietetic Association concluded that there was no specific amount of carbohydrate that represented an ideal percentage. Further, (in at least one study) the low carbohydrate diet of less than 130 grams per day appeared to preserve/improve renal function in moderately obese persons with Type 2 diabetes. (1)

These new parameters for carbohydrate leave room for debate in the overall interpretation for meal planning. When carbohydrate is reduced in the diet, what food is going replace it? Which carbohydrate should we eliminate and how are we defining carbohydrate? The starch? The fruit? The milk? Are we recommending high protein and high fat diets for diabetes patients? Even the proponents of low-carb diets are recommending individualization of diets. (2)

Dietitians have learned to manipulate these parameters into meal plans that meet the nutritional needs of their patients. What has not changed is: the inclusion in meal plans of wholesome healthy foods comprising a variety of foods in limited portion sizes, which meets the patient’s uncultured eating pattern and nutritional requirements (including appropriate calories!)

The Guidelines also suggested limits on fats, Trans fats, added sugars, and sodium. And, these are just the macronutrients of food!

The vitamins and minerals in food make up the micronutrients. The following nutrients earned special attention and correspond to chronic disease states in our society: calcium, potassium, Vitamin D, Dietary Fiber, and alcohol. The relationship between food and health is considered to be a strong one, which has received government-wide attention. As we approach 2020, the guidelines are expected to shift and pick up more recommendations on food trends we currently see in our population. For example, we might expect to see a tighter rein on processed carbohydrate foods.

In the early 20th century, the focus for nutrition was the gathering and naming of nutrients that were both useful and required for life. This era saw the discovery of many vitamins and minerals that cured long existing and known states of disease: scurvy, rickets, and pellagra. As we round the corner into the 21st century, we have learned one thing absolutely: stay tuned because it’s almost time to change and rethink our approach again!

• Tirosh A, Golan R, Harman-Boehm I, et al. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care. 2013;36(8):2225-2232.
(2) Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31(1):1-13.
Come join us for our Free Diabetes Support group
Thursday September 22nd
5:30 -7:00 P.M.
Wellington Reserve Plaza
1041 State Rd. 7, Suite 1
Wellington, FL 33414

Healthy Snacks will Be Served!

Dr. Geetanjali Kale and Registered Dietitian Jessica Cook will discuss:
• Healthy activity with diabetes
• Signs and symptoms of hypoglycemia during activity
• Benefits of physical activity of diabetes
• Benefits of yoga and diabetes
• Medication reduction with activity
Sponsored by: 
Palm Beach Diabetes & Endocrine Specialists

Call 561-659-6336 Ext. 8012 for reservations Today!

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