The Mended Hearts, Inc.
Hearts of Jersey Chapter #179

April 2009

March Meeting, Riverview

We ate our heart-healthy wraps, fruit salad and crunchy veggies while Sheila Turkell and our guest speaker vainly tried to make the computer system display a PowerPoint presentation on the screen in front of us. At last Sheila introduced Mary Higgins, a Registered Dietitian with her Masters who specializes in diabetes at the Diabetes Management Center at Riverview Medical Center. Fortunately our speaker had handouts showing every page of the PowerPoint presentation.

Mary began with some remarks about dietary supplements. The best way to get the nutrients you need is in food, but there are some things we just can’t seem to get enough of so we might need a supplement. We do have to make sure our supplements are safe, that they don’t interact negatively, and we don’t overdo them. A website called consumerlabs.com can give you test results and other information about supplements.

Riverview has an “Eat Well Be Well” program: if you’re on a special diet you can make an appointment with a registered dietitian to work out a meal plan. If you have diabetes, Medicare and most insurance plans will cover diabetes education; if not, it depends on your plan coverage.

High blood sugar occurs either when the pancreas doesn’t produce enough insulin (in type 1 diabetes) or (in type 2 diabetes) when the insulin it produces isn’t used properly - often when you have “insulin resistance.” When you eat, all the carbohydrates, half the proteins, and up to ten percent of the fats are turned into glucose (the sugar that circulates in your blood). The glucose provides energy for the body cells and it requires insulin to get into the cells. If enough insulin is not there or not effective you have too much blood sugar and not enough energy; you feel fatigued.

A factor that has been focused on in the past ten years is that if you haven’t eaten for a while your liver converts stored glycogen to sugar and sends it out into the blood. If you have prediabetes or type 2 diabetes it can send out too much.

Dietary advice used to be specific to your disorder: low sodium for high blood pressure, low fat for high cholesterol, etc., and sometimes the advice was conflicting. Now the advice is more consistent. Control the total amount of carbohydrate because it’s important for triglycerides, and for blood sugar (hard to believe) it’s more important than the amount of sugar. Control the type of fat; a little bit of fat makes food taste good but use less saturated fat and trans fat. Control the amount of salt, not so much from the salt shaker as from prepared foods: canned, convenience, take-out, etc. - the recommendation is now 2400 mg of sodium or less for everyone. Fiber, you should have at least 25 grams a day.

Four points for controlling diabetes: diet, exercise, glucose monitoring, and medication.

Diet should be individualized; you have your own schedule and your own likes and dislikes. A registered dietitian can develop a meal plan for anyone. You don’t have to wait until you have diabetes and your blood sugar is out of control.

Diet guidelines: eat at consistent times, don’t skip meals, include an evening snack (it lowers morning blood sugar), limit carbohydrates, limit sweets, and choose high fiber foods.

To control blood sugar you have to have a consistent amount of carbohydrate at each meal. Carbohydrate targets are 60–90 grams per meal for men, 45–60 grams for women, and 15–30 grams at the evening snack for both. One “carbohydrate choice” is 15 grams. Target the lower limits to lose weight.

Exercise can help prevent diabetes. A diabetes prevention program found that half an hour a day most days of the week, and losing seven percent of body weight, led to a 58 percent reduction in the development of diabetes.

Blood glucose peaks about one hour after a meal, is still high two hours after, and takes three to four hours to come down to fasting level. For people with diabetes there are two different guidelines for blood sugar if you have diabetes, and different doctors can use different numbers. The American Diabetes Association says 70–130 fasting glucose, or less than 180 two hours after eating, is good. The American Association of Clinical Endocronologists wants to see less than 110 fasting and less than 140 two hours post-prandial (which is actually normal).

If you don’t have diabetes your blood glucose should be 60–100 fasting and less than 140 two hours post-prandial. If the fasting number is over 100 (formerly 110), up to 125, you have prediabetes.

For high blood pressure look to the DASH diet (dietary approaches to stop hypertensio). Limit your sodium (salt) intake but get enough potassium, calcium and fiber. Choose good fats. Monounsaturated fats (olive, canola and peanut oils, nuts like almonds and peanuts, fish) raise good cholesterol and lower bad cholesterol. Polyunsaturated fats (soy, safflower and most other vegetable oils, walnuts and flaxseed) tend to lower total cholesterol. Limit saturated fats (animal fats and tropical oils) and trans fats (partially hydrogenated vegetable oils); they raise total cholesterol. That’s more important than cholesterol in food.

What’s a good evening snack? Watch the calories. Nuts, in moderation. Fat-free frozen yogurt, half a cup, with nuts on top like a sundae. Popcorn with Parmesan cheese on it. Low-fat, low-salt tortilla chips with salsa. Traditionally, graham crackers with peanut butter.

High cholesterol? avoid saturated and trans fats, include 25 grams of fiber daily, omega-3 fatty acids (3 servings of fish per week), and exercise. High triglycerides? limit carbohydrates (especially sugar), total fats, control your blood glucose, and exercise.

Diabetes raises your risk for cardiovascular disease. You may have hypertension or elevated lipids. Small changes can improve your health.