Skip the Sip: Why you should keep the fruit but ditch the juice

Juice seems to be everywhere in the American diet, from apple juice at kids’ snack time to orange juice on every breakfast table.  While I love the taste of juice as much as the next guy, when it comes to health, I know that choosing an actual fruit is the way to go. (and yes, this includes 100% fruit juice).

Here’s the deal: nature packages fruit in the perfect way by combining sugar with tons of fiber.  Yes, you’re consuming some simple sugars, but by slowly consuming it along with slow-digesting fibers, you also slow down glucose absorption and minimize blood sugar spikes. When we instead take a fruit, squeeze out the sweet juice, and discard all of that wonderful fiber, we wind up absorbing way more sugar in a fraction of the time.  This leads to blood sugars that climb too quickly and go far above the desired limit. If you have pre-diabetes, diabetes, or insulin resistance, this is exactly the type of sugar overload you want to avoid.

A large orange, for example, has ~15 grams of sugar mixed in with 4.5 grams of fiber, and it will probably take a while to eat. Your standard 12 ounce single-serving bottle of orange juice, on the other hand, has about 35 grams of sugar and no fiber– and most of us could drink that in a few minutes!  Think about what a difference that makes for your blood sugar spikes.

Here are my tips for avoiding the fruit juice sugar spike:

  • If you just can’t kick the craving for juice, try diluting it to cut the sugar. Mix with water for a milder flavor, or try mixing with seltzer for a bubbly alternative.
  • Don’t be fooled by the healthy sound of “100% fruit juice”– although they may be pure natural juice, they are still incredibly high in sugar.
  • There are lower-sugar juice available on the market if you’re comfortable consuming non-nutrative sweeteners (aka artificial sweeteners without calories). Always check the label, though, to see just how much lower the total carbohydrates (which includes sugar) will be.
  • If you’re used to drinking juice with certain meals/snacks, try substituting it with fruit if cutting it out cold turkey sounds too ambitious.  If you like juice with breakfast, swap it for a small fruit cup, add berries to your pancakes or cereal, or slice up an orange for that same OJ flavor. If you usually choose juice for something sweet on the go, try a more portable fruit like grapes, clementines, or apples.
  • Juice can actually be a better alternative than other sweeteners if you’re using it as an ingredient in place of table sugar or corn syrup, as you will still get some vitamins and minerals from juice but not from straight sugar. Try substituting a 100% fruit juice concentrate like apple or grape for granulated sugar in your baked goods, keeping in mind that the sugar content may be similar but the nutritive value is a bit better.  You’ll likely need ~6oz juice for every 1 cup of sugar, and a bit less liquid as even juice concentrate contributes liquid.

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Low-Carb Alternative Ideas

One of the top questions I get as a dietitian is how to replace your favorite high-carb foods with lower-carb options.  Take a look at this article from Insider featuring recommendations from several nutrition professionals – including me!  I mentioned my favorite low-carb swap: zucchini noodles, which I recently shared so you guys can experiment on your own!

 

 

 

Dietitian-Approved Lower-Carb Breakfasts (Yes, they exist, and No, it’s not just eggs!)

Breakfast is the golden meal for many Americans, but one of the biggest complaints I hear is that our iconic breakfast foods are packed with carbohydrates. It’s a valid point: pancakes, waffles, cinnamon buns, croissants, coffee extra light and extra sweet, sugary cereals, grab-and-go granola bars… Your morning meal can easily turn into a landslide of sugar.

But let’s take a step back – don’t get frustrated and skip breakfast!  The word breakfast comes from breaking fast — it is a chance for your body to get some actual external energy to help fuel your day. Without it, your body will rely on your energy stores from the night before and, if those run too low, you may be sluggish and sleepy.

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Kodiak pancakes (they’re made with extra protein and whole grains) plus fresh berries and a drizzle of syrup (about 1 tsp) – my go-to weekend breakfast

Research stands behind breakfast as an important part of your routine (check out the links throughout this article for the original studies). Consistent breakfast intake has been linked to maintaining weight loss and higher levels of a hormone called Peptide YY which helps decrease appetite and intake.

Skipping breakfast, however, may lead to higher blood sugar spikes at your next meal, insulin resistance, and larger intake later in the day- which major implications for anyone with diabetes!

The actual foods that you eat for breakfast also play a big role in how hungry you are later as well as how high your blood sugar will go:

Higher protein / lower carbohydrate breakfasts have also linked to lower blood sugar after breakfast). Choosing lower Glycemic Index (GI) foods — foods that impact your blood sugar less drastically — can help you predict your blood sugar response even more than the just carbohydrates counting alone (study here), which supports the choice of whole grains and high-fiber foods rather than refined sugars.  A clinical trial also supported Low Glycemic Index / High Fiber breakfast combinations as they led to lower blood sugar spikes and less required insulin than High Glycemic Index / Low Fiber breakfasts (think high in refined grains and sugar). For more info on glycemic index, check out my break down.

Okay- so what can I eat?!

I generally recommend around 30 grams of carbohydrates with breakfast, which should provide you with some wonderful energy without spiking your blood sugar too much.

Try any of these combinations to get a moderate amount of carbohydrates, adequate protein, and healthy fats:

  • 1 slice whole grain toast + 1 tablespoon almond / peanut / sunflower seed butter + 1/2 cup fresh berries
  • 1 cup cooked plain oatmeal + 1 tsp maple syrup + 1 tsp cinnamon + 2 Tablespoons of walnuts or almonds
  • 1 whole wheat pancake + 1 tsp light butter + 1 tsp maple syrup + 2 links turkey bacon or sausage (~1 oz)
  • 1 piece whole wheat toast + scrambled egg mix (Mix 1 egg + 3 egg whites together, or 1/4 cup liquid whites alone) scrambled with 1/2 cup chopped veggies.
  • 1 whole wheat mini bagel + 2 tablespoons whipped cream cheese + 1 piece of fruit
  • 1 6-oz flavored Greek yogurt + 1 tsp of flax seeds + 1 Tablespoon sliced almonds
  • 3/4 cup bran flakes + 1 cup skim milk + 2 tablespoons of diced prunes or raisins
  • 3/4 cup cooked grits + 1/2 oz low fat cheese mixed in + 1 egg
  • 6 ounces plain yogurt + 1 tsp honey + 1/2 cup berries + 4 oz almond milk – blend for smoothie
  • 1 slice whole wheat toast + 1/2 sliced avocado (trendy but also healthy!)
  • 1/2 cup part skim ricotta + 1 tsp honey drizzled + 1/4 cup berries + 1 Tablespoon sliced almonds
  • 1 small apple + 1.5 Tablespoon almond butter 

If you have diabetes, you may want to substitute sugar-free syrup to minimize blood sugar spikes. For others, though, small portions of these items can still fit into a well rounded diet.

Bonus Round: Frozen Breakfasts

Are you used to grabbing something from your freezer before you hit the road each morning? Sometimes convenience is king, so I’d rather see you stock your freezer with healthy breakfast options than grab something high fat and high calorie from a fast food joint on the go. These are some of my top healthy options from the freezer aisle:

My main caution with frozen items is that they tend to have a ton of added sodium, so you may want to avoid these options if you are prone to hypertension. It’s also wise to eat lower sodium foods during the rest of the day if you rely on these quick and convenient breakfasts.  When looking at other options, I recommend avoiding anything with a croissant, biscuit, or texas toast (they tend to be both high fat and high carb). Anything made with whole grains, egg whites, and veggies is usually a decent option. If you’re choosing something with a breakfast meat, turkey bacon and sausage are leaner but higher in salt; bacon and regular sausage are higher in saturated fat.

Whichever breakfast option works best for you, remember to try to combine high quality carbohydrates from fruits, grains, and veggies along with lean protein and you’ll be setting yourself up for success! Choose one option here and make it your mission to try it out this week.

If you’re looking for more personalized nutrition advice, contact me for an appointment!

Is the Glycemic Index the secret to better blood sugar control?

“Glycemic Index” and “Glycemic Load” have become buzzwords for the carbohydrate-conscious public, but the burning question remains: What exactly is Glycemic Index?  Is it worth learning in an effort to control your blood sugar? How is it even different than counting carbs?

Counting carbohydrates will tell you just how many grams of carbs you are getting with each meal, but not all carbs break down in our body the same; some are made of longer-chain molecules or are higher in fiber and take longer for your body to break down. Simpler sugars tend to be digested and absorbed much more quickly, which leads to a more rapid blood sugar spike. Carbohydrate counting along does not provide that kind of information, but Glycemic Index does.

Glycemic Index (GI) measures how a 50 gram serving of a specific food will impact your blood sugar overall. It takes into account both how high your blood sugar will spike as well as how how long it takes for it to return to normal, and it summarizes this overall glycemic effect as a number on a scale from 0 to 100. Pure glucose has a GI score of 100, as a reference point, so lower scores mean a lower blood sugar response:

Low GI: 55 or less
Medium GI: 56-69
High GI: 70 or higher

The mortal flaw of GI, however, is that is is so incredibly variable that it is difficult to actually trust any specific number. Just take a look at the extensive table (over 55 pages long) found in the journal Diabetes Cares, which lists GI data for items based on a huge range of sources. Brown rice is listed multiple times with the GI ranging from 50 to 87— which obviously complicates the idea that we can quantify exactly how your blood sugar will react to 50 grams of brown rice.  Tufts University recently studied glycemic response within individuals by measuring people’s unique blood sugar response to doses of glucose and white bread, and they found that a person’s blood sugar response varied by 20-25% at different times. This study is important in showing that Glycemic Index isn’t as precise as we’d like, though it provides a good ballpark for you.

Reference this abbreviated table from Harvard University which is based on an American Diabetes Association article that looked at GI as an average of multiple valid studies – this average is likely the most accurate you’ll find.

One major issue is that eating a large volume of a low-GI item can be worse than eating a little bit of a high-GI food. This is because GI measures the impact of 50 grams of an item, so you can only compare the GI of (for example) table sugar (GI 60) and watermelon (GI 72) if you assume you are eating 50 grams of each. Hopefully, you don’t actually eat the same amount of straight sugar and watermelon, so the GI comparison is deceitful. This is where Glycemic Load (GL) comes into play. The GL applies GI concepts to actual realistic portion sizes to help you gauge how your intake will really impact your blood sugar, so you can see that the glycemic load of ~2 teaspoons of sugar (approximately 6) is higher than that of a 4 ounce portion of watermelon (GL of approximately 4).

Again, all Glycemic Load data is based on Glycemic Index, so you need to keep some flexibility in mind when using this information for food choice.

Glycemic Index also varies based on a number of different food qualities; the GI will be higher in foods that are riper, cooked longer, or processed into a finer / easier to digest product (like quick oats as opposed to rolled oats). Even once you have a good estimate of an accurate GI score, the combination of foods in a meal will change how your body responds because fat, protein, and fiber all slow digestion and therefore blood sugar spikes.

So what’s the verdict?

There is mixed research about Glycemic Index (GI) and Glycemic Load (GL) in terms of how helpful it can be for actual blood sugar control. Some studies have found no link to improved blood sugar at all, but a Cochrane Review of glycemic index examined the literature and found that lower-GI diets are linked to better blood sugar control when you consider all of the data together.

My takeaway is that understanding the glycemic impact of food can be a helpful reference tool but is too variable to rely on entirely. It may help you understand how different types of foods might impact your blood sugar, and it’s great for comparing similar items and to see which types of foods lead to a better glycemic response. The result will likely be that you’ll see the benefit of foods that are higher in fiber, less processed, lower in simple sugars, and higher in protein – which is the same generally healthy carbohydrate-consistent diet I would recommend in the first place.

Here is a summary of some major Glycemic Index numbers to consider.
Remember, this is Glycemic Index, so it does not take portion size into account, and these numbers have a big error range so assume they can be about 10 points higher or lower.  This information tells you how these items MIGHT impact your blood sugar ON AVERAGE if you consumed IDENTICAL PORTIONS of each.  Use this more for reference between similar items with a fixed portion. Should you necessarily avoid high GI foods like watermelon and potatoes all together? No! Just monitor your portion sizes and eat them with higher protein / fiber / fat foods to help slow digestion.

  • High GI: 70 or higher
    • Corn flakes (~81)
    • Puffed rice cereal (~82)
    • Instant potatoes (~80)
    • Instant oats (~79)
    • Potato, boiled (~78)
    • Watermelon (~76)
    • White bread (~75)
    • Cheerios (~74)
    • White Rice (~73)
    • Bagel (~72)
  • Medium GI: 56-69
    • Brown Rice (~68)
    • Popcorn (~65)
    • Table sugar (~65)
    • Sweet potato (~63)
    • Honey (~61)
    • Pineapple (~59)
    • Muesli (~57)
    • Plantain (~55)
  • Low GI: 55 or less
    • Sourdough bread (~54)
    • Rice noodles (~53)
    • Stone ground or pumpernickel bread (<55 per the American Diabetes Association)
    • Rolled oats (~55)
    • Corn (~52)
    • Banana (~51)
    • Spaghetti (~49)
    • Corn tortilla (~46)
    • Canned peaches (~43)
    • Oranges (~43)
    • Grapes (~43)
    • Fruited Yogurt (~51)
    • Milk (~39)
    • Apple (~36)
    • Lentils (~32)
    • Chickpeas (~29)
    • Under 20: Eggplant, broccoli, raw carrots, cauliflower, mushrooms, lettuce, red peppers, onions,  tomatoes

There are several Glycemic Index apps to help you keep this information in your pocket if you’re interested in learning more, though keep in mind that the numbers will always be estimates and you may find very different guidelines based on what the app references.

I also recommend the following resources and articles:

 

If you’d like to pursue more personalized counseling, contact us for information about in-person or virtual sessions!

Share your thoughts on Glycemic Index below – I’d love to hear your experience with this, whether you found it helpful, confusing, interesting, too restrictive, or otherwise!

The Numbers Game: Understanding Your Blood Sugar Levels

So your blood sugar runs high- but what is considered ‘high’? Are they slightly elevated, or are they far above your target range? Are they improving with time or do they keep climbing? The first step to blood sugar control for people with diabetes is understanding your numbers, which can help you identify personal patterns and track your progress over time. There are three main blood sugar measures to take into account: Fasting blood sugar, Post-prandial blood sugar, and Hemoglobin A1c.

Fasting blood sugar refers to the glucose level measured after several hours without food, like when you test first thing in the morning.

At this point, your body has already utilized whatever carbohydrates you consumed the night before and is now running off of stored carbohydrates which means it is trying to be very efficient; you should have enough glucose in your blood to help your cells run but not much more than that. Any elevated levels are a sign that something is off and your body is not able to move glucose into your cells optimally. Whether this is due to a lack of insulin (generally type I diabetes or progressed type II) or because your cells are not as sensitive to the insulin as they should be (generally type II), a high fasting glucose at a physical exam is often a first warning sign of diabetes for patients. A normal range is 70-100 mg/dL, with levels under 70 considered abnormally low and requiring intervention to bring them back up. Levels between 100 and 125 mg/dL fall within the prediabetic range, meaning you are at risk for diabetes and have some impairment of your glucose utilization, and levels over 125 mg/dL qualify as one sign of possible diabetes.

Post-prandial blood sugar simply translates to levels ‘after eating.’ This test is usually taken two hours after your last meal, and the numbers will generally be higher because you have just introduced a large volume of glucose into your system. Some degree of a blood sugar spike is normal after eating; your body digests whatever carbohydrate you consumed, breaks it down into small glucose molecules that enter your bloodstream, and insulin helps to move that glucose into the cells where it’s needed. Two hours after eating, a normal blood sugar level would return to under 140 mg/dL. For people with diabetes, that number is often over 180 mg/dL, which shows that your body is having a difficult time transporting the glucose from your blood stream into your cells. Your doctor may formally test this with an Oral Glucose Tolerance Test where you consume a controlled amount of glucose followed by blood testing two hours later, and levels over 200 mg/dL are considered within the diabetic range.

Hemoglobin A1c (often shortened to ‘A1c’) is a bit different than the other two tests because it reflects your average blood sugar over the last 90 days rather than at a set period of time. Your result is given as a percentage that shows how much residual glucose is stuck to your red blood cells, and a higher percentage means higher overall circulating levels of glucose. A normal A1c is under 5.7%, with the prediabetes range falling from 5.7% to 6.4%. An A1c of 6.5% or higher is a major sign of possible diabetes as it shows that your blood sugar tends to run much higher than the desired range.

Once a person is diagnosed with diabetes, there are similar goals that indicate good control: Fasting blood glucose should be under 130 mg/dL; 2-hour postprandial levels should be under 180 mg/dL, and Hemoglobin A1c should be under 7%.

For your reference, here’s how all of these numbers compare to each other:

Fasting Glucose (mg/dL)

Postprandial Glucose (mg/dL)

Hemoglobin A1c

Normal levels

70 to under 100

Under 140

Under 5.7%

Prediabetes

100 to 125

140 to under 180

5.8% to 6.4%

Diabetes

126 or higher

180 or higher

6.5% or higher

Goal for people
with diabetes
(after diagnosis)

70-130*

Under 180

Under 7%

*Some doctors may prefer fasting blood sugars of 80 or over to minimize risk of hypoglycemia, which is often the case for elderly patients. All of these numbers can also be impacted by other medical factors including medications, chronic diseases, and inflammation, so the results alone may not constitute a diagnosis – always speak with your physician if you are concerned.

These ranges are also slightly different for pregnant women as they have a larger volume of blood and therefore will have automatically lower concentrations of glucose. Imagine diluting 4 ounces of iced tea with 4 ounces of water – it may taste be less sweet as it is less concentrated, but the entire glass will still have the same amount of sugar as the 4 ounces of iced tea alone, so the low concentration is somewhat deceitful. Instead, physicians generally test for gestational diabetes (the onset of new diabetes symptoms during pregnancy) with an Oral Glucose Tolerance Test where they test their blood sugar response to a concentrated high-glucose drink.

Nutrition is a major influencer of blood sugar control. The carbohydrates you consume correlate directly to your increase in blood sugar, though the magnitude of change is different for each individual. I’m familiar with the tendency of many patients to start medication and believe it negates any need for dietary intervention, but combining a carbohydrate-consistent diet with medications will optimize your results. There is solid research that diet modification can help to decrease your A1c while also helping you better understand how your food choices impact your blood sugars, and many endocrinologists routinely refer patients to dietitians for medical nutrition therapy.

For more information on understanding your numbers, check out these trustworthy websites:

Rise and Shine!

A new study found in Frontiers in Endocrinology links early morning behavior with lower BMI and lower risk of Type II DM.

Participants with pre-diabetes were given a score on something called the Composite Scale of Morningness, which was a number representing how early the like to wake up, go to sleep, and go about their day (physical and mental activity). ‘Morningness,’ or the tendency to do everything earlier than most, was linked to lower BMI, as was longer sleep duration. The findings were strongest for those 60 and older.

Would you shift your schedule for health benefits?

To read the original article, visit the text online here.