Event Closed! LIVE Event with Experts from Renowned Joslin Diabetes Center

By RachelChavez Latest Reply 2014-01-23 20:03:03 -0600
Started 2014-01-20 14:41:47 -0600

**Event Closed**
Welcome to our first ever LIVE event! As this is our first event, we’re excited that you’re here to experience this adventure with us as we go! Our experts today are Melinda Maryniuk who is a Registered Dietitian and Director of Clinical Education Programs, and Nora Saul who is Manager of Nutrition Services at Joslin Diabetes Center. We’ve collected and prepared a few questions to get us started using feedback from our members. Today’s topic is “What do I need to know about my diabetic diet?”

Here’s how it will work. John will pose a question to our experts. Our experts will then reply to that question with their response. If you would like to chime in, or get further clarification, simply click the ‘reply’ button underneath our experts’ response or other members’ response. Remember, the page won’t refresh automatically, so make sure you click refresh occasionally to see the latest posts.

So let’s get started!

58 replies

John Crowley
John Crowley 2014-01-23 19:57:02 -0600 Report

Thanks to everyone who helped. Sorry about some of our technical glitches with time stamps and such. We're now finished up. And hopefully we'll do this again regularly. Especially thanks to Melinda and Nora!

TopazDee 2014-01-23 19:55:28 -0600 Report

On the cinnamon theme I always drink mango and cinnamon tea should I find this beneficial to my diabetes ?

John Crowley
John Crowley 2014-01-23 19:59:15 -0600 Report

Well based on the study quoted below, it sounds like the cinnamon can help. The study looked at doses between 1 and 6 grams.

John Crowley
John Crowley 2014-01-23 19:48:22 -0600 Report

OK, I'll throw out one more: We occasionally have disagreements arise in the community over starchy foods. Some feel that potatoes, white flour, and pasta must be completely avoided. Others feel that starches can be worked into a diabetic meal plan. What’s your position? What limitations would you set?

nora2 2014-01-23 19:52:40 -0600 Report

Starches provide a source of energy; many are low fat, low saturated fat and are a source of B vitamins. The potato is also a great source of vitamin C and potassium. Starches also add flavor and variety to the diet. Of course, all carbohydrates will raise blood glucose, and some such as white flour, are high glycemic index. As long as people control portions and choose lower glycemic index carbohydrates overall, starches certainly have a seat at the table and a place on the plate.

Melinda, RD
Melinda, RD 2014-01-23 19:54:12 -0600 Report

Of course, choosing higher fiber and lower glycemic index carbs such as brown rice, whole wheat breads and cereals and legumes are good choices not only for your glucose levels - but for nutrition as well.

TopazDee 2014-01-23 19:45:45 -0600 Report

Sorry John can't get the gist of conversation as everything appearing jumbled on my screen and timed as anything between 8 & 5 hrs ago, is there a better link you could advise me to get a better way of linking in I am on emails at the moment?

John Crowley
John Crowley 2014-01-23 19:36:36 -0600 Report

Are there any supplements that you recommend for people with diabetes? What does the research say regarding some of the “natural” treatments we hear a lot about like cinnamon?

nora2 2014-01-23 19:38:23 -0600 Report

We recommend the same healthy diet options for people with diabetes as for the general public, whole grains, lean proteins, low-fat dairy, legumes, fruits/vegetables and healthy fats. Although there are many supplements and herbal products that have an effect on blood glucose; there isn’t a solid body of research evidence showing that any vitamin or herbal supplement is consistently effective in treating high blood glucose levels or curing diabetes. However, there are some supplements that have some research studies to support their use and are not harmful, if taken in reasonable quantities.
Cinnamon is one of them. A recent meta-analysis of studies found that cinnamon helped people reduced their fasting numbers, although it didn’t have an effect on A1C. So sprinkling a teaspoon of cinnamon on your cereal in the morning or into your yogurt may add something beyond flavor to your morning repast.

Chris Clement
Chris Clement 2014-01-23 19:42:33 -0600 Report

how much cinnamon would be needed in order to make a difference? would a sprinkle do much? Is there a specific type of cinnamon? I seem to remember there are different kinds..

nora2 2014-01-23 19:48:02 -0600 Report

Hi Brizeater, Yes, cassia cinnamon is the type (it is the kind we use in the United States) and the studies used between 1 and 6 grams of cinnamon. There didn't seem to be much difference between using 1 and 6 grams so using 1 gram is probably a good bet. One gram is about 1 teaspoon.

John Crowley
John Crowley 2014-01-23 19:40:00 -0600 Report

Anyone have any follow up questions about supplements?

Melinda, RD
Melinda, RD 2014-01-23 19:41:23 -0600 Report

I might add a comment about another popular supplement. Alpha-lipoic acid is an antioxidant that has been shown to have a modest affect reducing the pain of a neuropathy, a complication of diabetes. However, clinical trials have not shown any impact on blood glucose levels or eye disease.
If you choose to use any supplements, talk with your health care provider. Supplements can interact with medications so it is important your providers know what you are taking. Both the government’s Office of Dietary Supplements.
http://ods/od.nih/gov and the National Center for Complementary and Alternative Medicine http://nccam.nih.gov/health/diabetes/supplements are wonderful resources to check into before starting a dietary supplement Of course, if you decide to take a supplement it is important to continue to take your prescribed medication as well.

John Crowley
John Crowley 2014-01-23 19:28:00 -0600 Report

Question 3: We hear a lot about gluten-free diets these days. How would a person with diabetes know if they have a gluten intolerance or even Celiac disease?

nora2 2014-01-23 19:29:56 -0600 Report

Celiac would be suspected if a person has diarrhea or abdominal pain and is losing weight. However, people with celiac can also have mild symptoms such as fatigue and iron deficiency anemia or just difficulty gaining weight. People with type 1 diabetes are at higher risk of developing celiac disease because both of the diseases are immune related. Up to 10 percent of children with type 1 diabetes are diagnosed with celiac. However, celiac is less common in those with type 2 diabetes. The first step to find out if you have celiac disease is to get a blood test. There are a number of antibodies for celiac disease that can identify people who are gluten sensitive. Antibodies are proteins that the body makes to fight bacteria, but sometimes our immune system misfires and makes antibodies against harmless agents such as gluten.
There are three antibody tests that are commonly used to check for celiac disease:
• anti-tissue transglutaminase (tTG) antibodies
• endomysial antibodies (EMA)
• deamidated gliadin peptide (DGP) antibodies
The first two are very sensitive for celiac, the DGP antibody isn’t as specific, but is a good test to monitor how effective treatment is. The gold standard to diagnosis celiac is an intestinal biopsy.
The important thing to remember is to get tested before you start at gluten free diet. If you remove gluten from your diet and take the test, it can come back negative even if you have celiac disease.
In addition to celiac disease, some people have gluten sensitivity. Their intestinal cells aren’t damaged but they have the same functional problems as those with celiac disease. Unfortunately there isn’t a test for gluten sensitivity.

John Crowley
John Crowley 2014-01-23 19:31:22 -0600 Report

Related to the gluten-free topic, how do you feel about eliminating entire categories of food: lactose, wheat, corn, soy, etc.? Are there potential benefits?

Melinda, RD
Melinda, RD 2014-01-23 19:32:21 -0600 Report

There are no benefits to eliminating an entire category of food—unless you have a medical reason to do so. People who don’t have the enzyme lactase to digest milk, need to omit lactose containing foods. The same goes for gluten containing products (such as wheat and soy). While elimination diets are popular – there are no proven benefits except for those where it is medically necessary!

John Crowley
John Crowley 2014-01-23 19:17:07 -0600 Report

So for question number 2: There are a number of “trendy” diets out there that make claims about helping people with diabetes. Specifically, what do you think of the Paleo diet? What diets do you recommend, if any?

Melinda, RD
Melinda, RD 2014-01-23 19:23:06 -0600 Report

The premise of the Paleo diet is that we have developed a series of chronic disease such as diabetes because of all the processed foods we eat. The Paleo diet recommends eating the way we did before agriculture was introduced, i.e. a diet of fruits, vegetables and meats without dairy, grains or legumes. While the Paleo diet is low in carbohydrate, high in fiber and low in sodium; it also eliminates two complete food groups that may lead to some nutrient inadequacies such as calcium, vitamin D and some of the B vitamins. Dependent on your choice of meats, the diet can be excessive in saturated fats. It can also be quite difficult to follow for the long-term. If you choose to follow a Paleo type diet, you should consider a multivitamin and calcium supplement. A vitamin D supplement would also be in order if you don’t spend adequate time in the sun.

jigsaw 2014-01-23 19:52:46 -0600 Report

I heard that not all brands of supplements are equal. I've also heard that some supplements could be harmful if a professional is not approached for guidance. Example, some multivitamins use an artificial vitamin E, while others use natural vitamin E. Shouldn't we use caution with brand names as well as professional guidance with supplements?

Melinda, RD
Melinda, RD 2014-01-23 19:40:21 -0600 Report

We would recommend both the DASH and Weight Watchers Diets. They are both healthy and can be followed long-term.

SamsLady 2014-01-23 19:15:38 -0600 Report

So about exercising when limited?

Melinda, RD
Melinda, RD 2014-01-23 19:21:53 -0600 Report

Are you asking how you can do more exercise when you are limited with what you can do? What is really important is to just keep moving in whatever way you can! If you're unable to walk - put on some music and do "chair exercises" - moving your arms and legs as you can.

John Crowley
John Crowley 2014-01-23 19:04:09 -0600 Report

As we all know, eating healthy with diabetes comes down to making good decisions over and over again. Do you have any “rules of thumb” that you could give to us that can help when we’re making decisions? (For example, how many grams of carbs per meal is a good target?)

nora2 2014-01-23 19:11:58 -0600 Report

Since you asked for some “rules of thumb” – let’s start with some “hand-y” tips –
• Your hand is a good reference point for how much to eat. Aim for your serving size of meat to be about the size of the palm of your hand.
• Look at the 4 fingers on your hand. For men aim for 4 servings of carb per meal (or 60 grams) and for women – a bit less… 3 servings (45 grams)
• The tip of your thumb – represents just a small serving of a heart-healthy fat, for example, a tablespoon of olive oil.
• If you make a fist – that is about one cup….or about 2 servings (30 grams) of most carbs. Pasta and rice is even more concentrated in carbohydrate – so a one cup serving of those would be 3 servings or 45 grams.
Here are some other tips to help make meal planning a little easier:
• Each time you have a meal or a snack – include a fruit or a vegetable. Make it automatic. And keep things in handy, easy-to-grab servings so you’re likely to do it. Clementines, small packs of carrots, sliced cucumbers, 4 dried apricots are good choices.
• Put a lot of colors on your plate. The more colorful – the more likely you’re including different fruits and vegetables.
• Write down what you’re going to eat ahead of time. You’ll be more likely to stick to your plan – if you really plan ahead (and commit it to writing!)

jigsaw 2014-01-23 19:28:09 -0600 Report

Since we are all at different stages of diabetes ( insulin resistance, insulin production etc.) do you recommend adjusting carb intake downward when blood glucose is still high? Would you suggest medication instead? This is assuming one is doing a reasonable amount of exercise and using 60 grams to begin with.

Melinda, RD
Melinda, RD 2014-01-23 19:40:26 -0600 Report

There is no exact level of carb that people need to eat - but, yes, you may find that bringing carb down can be helpful. Most Americans eat 45-50% of the calories from carb, so bringing it down to 40% (in other words, a little less than usual) may be helpful. There is no evidence that VERY low carb diets are helpful (meaning - omitting most all carbohydrates).

RachelChavez 2014-01-23 19:13:35 -0600 Report

Great! Can you give some basic guidelines for carbs?

Melinda, RD
Melinda, RD 2014-01-23 19:16:04 -0600 Report

The level of carb that is recommended should be customized for you based on your weight, activity level, and medication plan. Until you see a dietitian, aim for about 45 to 60 grams of carb per meal if you’re a man and 30-45 grams of carb per meal if you’re a woman. If you eat snacks, aim for between 15 to 30 grams carb per snack.

jigsaw 2014-01-23 19:38:05 -0600 Report

Thankyou! That is definitely helpful as are most of the answers that I am seeing! This is really amazing!

John Crowley
John Crowley 2014-01-23 19:00:56 -0600 Report

Hi, everyone! We're very excited to have Melinda and Nora here with us from Joslin. Welcome.

Melinda, RD
Melinda, RD 2014-01-23 19:06:51 -0600 Report

Hi out there! We'd love to hear your questions!

jigsaw 2014-01-23 19:31:53 -0600 Report

Since we are all at different stages of diabetes ( insulin resistance, insulin production etc.) do you recommend adjusting carb intake downward when blood glucose is still high? Would you suggest medication instead? This is assuming one is doing a reasonable amount of exercise and using 60 grams to begin with.

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