Hello, Bergen County!

I’m thrilled to be featured in both (201) Magazine and Bergen Magazine this month, commenting on some amazing savory recipes and local products. I’m a Bergen County native born and raised, and I love serving my home community with my nutrition practice located right in Ramsey, New Jersey (though I counsel all of New Jersey with virtual video sessions).

I love that these are hearty recipes that also feature fruits and vegetables to show clever ways of improving the nutrition of your favorite comfort foods. I also spoke a bit about the health benefits of hummus while discussing the NJ-made White Camel Hummus company, and if you live in NJ or NY and love hummus, I honestly recommend you grab some White Camel Hummus ASAP because it is phenomenal!

 

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201 Magazine Feature 2019

Great Grains: Farro

Farro is one of my *favorite* ancient grains, and it lives up to the hype of Super Food for sure!

One serving is 1/4c dry (about 1/2-2/3 cup cooked) and packs 6 grams of protein plus 5 grams of fiber to keep you satisfied and energized!

Whole grains intake is linked to lower rates of heart disease, type 2 diabetes, stroke, and certain types of cancer. The USDA recommends that at least half of your grains be whole grains, so it’s important to incorporate things like farro, quinoa, brown rice, or whole wheat into your day.

If you’re looking for a new whole grain to swap into your diet, try throwing farro into soup, making it into a healthier risotto, adding it to salads, or cooking as a side dish on its own.

Happy New Year: Crafting a Realistic Resolution

“New Year, New You!”
“This year, I’m going to be healthy!”
“My New Year’s diet starts today!”

New Year’s is the perfect time to hit the reset button — a fresh year represents a new start where you can commit to self improvement.  I love the idea of establishing a New Year’s resolution to help kick start your healthy changes, but it’s hard to overlook the tendency of resolutions to fizzle out by the end of February.

To stretch the lifespan of your resolution and create a long-lasting behavior, try making it a very specific goal.   The solution lies in a classic goal-setting acronym S.M.A.R.T. Specific, Measurable, Attainable, Relevant, Time-Bound.  By tailoring your resolution

  • Specific: Define what actions you need to do to achieve your goal
    • If your overall goal is to be healthier, ask yourself HOW you will do that. Perhaps you want to eat more vegetables, less fast-food, or fewer refined sugars.
  • Measurable: How will you measure your success?
    • Avoid just stating you’ll do something “more” or “less” (work out more, eat more fruit, drink less coffee) and instead add a defined target goal, like eating at least 1 serving of fruit a day or going to the gym 3 times a week.
    • These concrete numbers will help you keep better track of your progress by giving you a reference point.
  • Attainable: Set goals you can realistically achieve
    • This is a huge part of setting successful goals- choose something that is challenging but doable, to make sure you can see it through.
    • If you haven’t touched a vegetable in years, it would be ambitious to say you’ll eat 3 servings of veggies every day. If you try to add one serving per day, though, you may stick with it much longer.
    • Similarly, you’re more likely to stick to “cutting back” than you are to “cutting out” foods or behaviors that aren’t particularly healthful. This will lead to sustainable behavior change so you can turn your resolution into your new norm.
  • Relevant: Is this goal going to help you achieve your big picture goal?
    • Here’s the key question: Will the specific goal you’re setting help you achieve the overall desired outcome?
    • If the answer is yes, then you’ve set a goal that aligns with your overall vision of health (relevant!).
    • If the answer is no, then your focus may have shifted throughout the process, so center your attention back on what it is you really hope to achieve.
  • Time-Bound: Factor in frequency or deadlines for your goals
    • There is no right or wrong timeline for a goal– it is entirely up to your current habits and your desired outcomes.
    • You might resolve to start eating at least one vegetable per day, one vegetable serving per meal, one new vegetable each week… They’re all worthwhile goals with a timing-specific limit (per day, per meal, each week).
    • Defining this aspect of frequency will help you be consistent, keep track of your actions, and know whether or not you’re hitting your target.

If you make your goals S.M.A.R.T, you will be able to gauge your success, stay dedicated, and hopefully see your resolution through for the year to come!

Wishing you a very happy, healthy 2019!

Frozen Foods: Off Limits or Fantastic Time-savers?

When we’re in a pinch for time, frozen foods seem to be the perfect answer: a full meal in a matter of minutes! But what do those time saving meals mean for your health?

I find that the freezer aisle is a very love-it-or-hate it area of the supermarket; either you can’t shake the image of a 1950’s family eating mushy TV dinners straight from the microwave and therefore won’t touch the stuff, or you adore the convenience of a pre-made, high-flavor complete meal that requires no prep (though you’ve probably never checked the label).

I fall somewhere in the middle. The health-food wave is slowly spreading throughout most supermarkets, and the freezer aisle is no exception! The trick to shopping here is to know what you’re looking for and how to compare products.

Here’s my Top 5 Freezer-Friendly Shopping Tips:

  1. Sodium Alert
    Salt has been used as a natural preservative since ancient times, which is why so many frozen (and canned) foods are packed with sodium! The American Heart Association recommends most people consume no more than 2000 mg sodium daily (the same as 1 level teaspoon), while those with a history of heart disease should aim for 1500 mg sodium.  For any large meal like a frozen dinner, choose meals with 600 mg of salt or less. Many popular brands have over 1500 mg in one serving, so definitely start eying the sodium before picking a meal!
  2. Well-Balanced Meals
    As tempting as it may be to purchase just frozen truffle macaroni and cheese, try to choose well balanced meals that have some fresh vegetables and whole grains. Many companies are creating more well-balanced meals using organic produce, ancient grains, and lean protein to help your meal be nutritious as well as delicious.
  3. Look Beyond the Label
    Perhaps more than any other aisle, the freezer is full of items marketed towards dieters. Just take a look at how many have words like ‘lean,’ ‘light,’ and ‘healthy’ in the brand name! While those foods very well might be great choices, a title alone doesn’t guarantee that. Always look at the nutrition facts before trusting the marketing, examining the calorie content (I’ve seen meals range from 200 to over 800 calories in a serving), saturated fat content (the goal is as low as possible here), and sodium amount to make sure your meal is actually a healthy choice.
  4. Bulk Up With Veggies
    Some meals look delicious on the cover but are far too small when you actually pop them out of the box (if you ever see a meal for under 300 calories, that’s a red flag that the portion will be petite). Instead of doubling up, bulk up your meal with frozen fresh vegetables! Frozen produce is often flash frozen right after harvest so the nutrients are preserved, and any vegetable on its own (without any sauce or butter added) is still very low calorie, high in fiber, low in sodium, and high in nutrients. You can add a lot of bulk to tiny but delicious meals this way.
  5. Be Adventurous!
    Take advantage of the wild array of recipes available at your fingertips! Food companies have recognized that consumers like to try foreign cuisines and complex meals that we wouldn’t cook for ourselves, so take a walk on the wild side and try some new flavors. I’ve seen Indian, Japanese, Chinese, and Mexican dishes as well as meals featuring ancient grains, unique herbs and seasonings like lemongrass, and flavorful curries.

 

Next time you think about ordering take out or driving through the fast food window, consider the freezer aisle for some potentially healthier alternatives. Do you have any brands or lines that are your go-to or that you’re looking forward to trying? Comment below!

 

Bonus: for some insight into frozen breakfasts, take a look at my Low-carb Breakfast post featuring a breakdown of some popular items!

Why Your Diet Doesn’t Work: The Imprecise Science of Caloric Balance

“Want to lose one pound of fat? Just cut 500 calories from your diet each day and you’ll shed one pound per week!” We’ve all heard that sensationalized claim before, and if it sounds a bit too good to be true, that’s because it is. This math is based on the premise that it takes exactly 3500 calories to burn one pound of fact, but that information itself is inherently flawed.

Weight maintenance is essentially a function of our basal metabolic rate, or BMR: the amount of calories your body burns daily just to survive. Just like it takes more energy to power larger machinery, it takes more calories to feed all of the cells in larger or heavier people– so they naturally have higher BMRs. If you were to lie in bed for 24 hours without any activity or intake, after fasting for at least 10 hours, your BMR is the number of calories your body would burn.

We can estimate our BMR with equations like the Harris-Benedict and Mifflin St Jeor equations, which take your height, weight, age, and gender into account. If you’ve ever tried to calculate your calorie needs online or via app, they probably use these equations.

The only way to actually measure your BMR, though, is through ‘calorimetry‘ (which literally means ‘calorie measurement’); direct calorimetry requires you to stand in a specialized chamber that measures how much heat your body is producing (impractical for most people), and indirect calorimetry can use respiratory tests to measure how much oxygen you inhale and carbon dioxide you exhale over a set period of time (somewhat more practical and actually available at some fitness and medical centers).

Of course we don’t just lie in bed all day. When we factor in our daily activities, we can find our Total Energy Expenditure (TEE), which means how many calories you burn on a typical day doing your usual activities. This is about 20% higher than your BMR if you are mostly sedentary to up to 90% higher if you are a professional athlete. Most people who are moderately active (1-3 days of intentional physical activity or exercise) burn about 38% more calories than their BMR.

This is where the error happens: It is very difficult to know how many calories you truly burn in a day. According to predictive equations, as a 5’4″, 27-year-old, mildly active, average weight female, my estimated BMR ranges from 1360 calories (Mifflin Jeor) to 1430 calories (Harris-Benedict), and my TEE should be about 1630 – 1720 calories daily.   I actually had indirect calorimetry done at a local gym last year, however, and my results showed that a better estimate for my BMR is 1123 calories and my TEE is close to 1350 calories.

That’s about 20% fewer calories fewer than traditional estimates- meaning that my body needs way fewer calories than the textbooks tell me.

Moving onto the second major issue: the 3500-calorie rule just doesn’t seem to be true.

This number came from a 1950s study by Max Wishnofky called “Calorie Equivalents of Gained or Lost Weight,” which posits that one pound of fat would require about 3500  calories to burn based on the scientific principles of fat. (If you’re interested in the gritty details: 1 pound (454 grams) of fat cells contains about 87% actual fat, and since it takes about 9 calories to burn one gram of fat, than a whole whole pound (454 grams) should burn up using about 3700 calories).  If you took a literal pound of fat and threw it into an incinerator to measure how much energy was required to literally burn it, that might be accurate. However, it doesn’t take our physiology into effect, and for better or for worse, our bodies are extremely adaptive at trying to preserve our energy stores.

Wishnofsky also examined a 1930s study by Strange, McCluggage, and Evans (“Further studies in the dietary correction of obesity”) which essentially starved for weight loss and found that they lost 0.6 pounds per day with a 2100 calorie deficit. How would one have such a severe deficit, you ask? They were put on a 360 calorie diet.

  • The diet: 360 calories made up of lean steak, fish, egg whites, whole milk, orange juice, yeast, minimal vegetables, and salt contributing ~58 grams of protein, 14 grams of carbohydrates, and 8 grams of fat each day. By today’s medical standards this would be a study of intentionally invoking severe malnutrition.
  • The participants: only 13 patients participated, and they were all in a hospital setting. Their weight ranged from 180 pounds to 427 pounds at the start of the study.
  • The outcomes: everyone obviously lost weight – the average was 35 pounds over 59 days. This was VERY inconsistent, though: actual weight loss ranged from 5 pounds over 8 days to 104 pounds over 176 days. 

This very small data pool based on a severe starvation diet showed that people lost about 0.6 pounds with a 2100 calorie deficit each day – making the weight loss ratio 1 pound to every 3500 calories. The 3500 calorie rule is based on these 13 people, severe starved for anywhere from a week to 25 weeks. 

I think this just exposes a truth we all know deep down inside: it’s just not that simple. Reviews of studies indicate that we lose weight more slowly than the rule would predict because our body burns fewer and fewer calories as we lose pounds. If you’ve ever watched a season of The Biggest Loser, you’ve seen this reality in action. Contestants used to lose over 20 pounds per week in the beginning when they were larger and had more excess weight to lose, but by the final weeks, they were following severe diets and working out 10 hours per day only to lose 2 – 3 pounds per week. Over time, their bodies required fewer calorie per day to run, so that calorie deficit rule shifted for them.

The good news is that researchers are now starting to battle this well-known rule to promote more realistic weight loss attempts. Dr. Diana Thomas and colleagues are leading this crusade with a math-driven approach, modeling actual weight loss journeys to create calorie / weight loss curves showing significantly less weight loss than the 3500 calorie rule predicts. Though many weight loss apps still use standard formulas to calculate how many calories you need per day for weight loss, a much more sustainable method would be to try to improve the overall quality of your diet, monitor what you currently eat and try to implement a slight deficit, increase your physical activity, and adjust things your plan as you go.

There is one slight upside to the 3500 rule, which is that it is memorable enough to communicate that caloric deficit is needed to burns weight. The downside is that it dramatically overestimates the rate of weight loss and can inspire dangerous levels of calorie cutting. I would never recommend eating less than 1200 calories; crash diets slow down your metabolism as your body adapts quickly to its new low-energy state, and nearly everyone rebounds back to a poor higher-calorie diet later on. Emphasizing overall nutrition quality, seeking a registered dietitian for ongoing nutrition counseling and support, and focusing on nutrition as a health goal rather than a means to an end can help you actually achieve your goals and maintain them long-term.

 

The overall takeaway:

  1. It is difficult to calculate your accurate BMR.
  2. It is even harder to then calculate your TEE
  3. Even if you can figure out how many calories you need daily, it is difficult to know how steep of a calorie deficit you would need to burn 1 pound of fat as the 3500 calorie rule is unreliable and based on absolutely extremist, insufficient research.
  4. Focus on improving diet quality, achieving a mild but sustainable caloric deficit, and seek assistance from a nutrition professional if you feel lost!

 

 

Resources:

Wishnofsky M.  Caloric equivalents of gained or lost weight. American Journal of Clinical Nutrition. 1958 Sep-Oct; 6(5):542-6.

Strang JM, McCluggage HB, Evans FA. Further studies in the dietary correction of obesity. American Journal of the Medical Sciences. 1930;179(5):687–693.

Thomas DM, Gonzalez MC, Pereira AZ, Redman LM, Heymsfield SB. Time to Correctly Predict the Amount of Weight Loss with Dieting.  Journal of the Academy of Nutrition and Dietetics. 2014;114(6):857-861.

Is Your Food Dangerous? Top Food Safety Tips You Might Not Be Doing

We often take food safety for granted and assume that everything we buy is likely fine to eat until a predetermined expiration date, but the truth is that some foods have far higher risk of spreading foodborne illness.

Anyone with a weakened immune system, including children, the elderly, or anyone taking immunosuppressants or undergoing chemotherapy is at a particularly high risk of catching a foodborne illness, but even generally healthy individuals at at risk with certain foods or poorly prepared dishes.

My top 5 tips for ensuring your food is safe:

  1. Read about Recalls: Rely on trustworthy sources like FoodSafety.gov for recall information! This is a phenomenal way to stay updated about any foods that may have been tainted before they reach your kitchen. While many major recalls make headlines, smaller recalls can slip by under the radar, so FoodSafety.gov’s information can help you protect yourself.
  2. Choose Pasteurization: Always choose pasteurized goods including milk, cheeses, and fruit juices as the pasteurization method kills dangerous bacteria
  3. Avoid undercooked meat: Even though rare hamburgers and raw tuna taste like delicacies, many bacteria thrive at temperatures under 165 degrees Fahrenheit, so foods need to be well cooked to ensure safety.
  4. Take caution at buffets and salad bars: the huge selection can be tempting, but food that sits out without proper heating or cooling puts you at major risk of foodborne illness. If your hot food seems cooler than 140 degrees Fahrenheit or your cold salad bar items seem warmer than 40 degrees, bacteria can be growing all day long. Look for trustworthy locations where you see employees checking temperatures and bringing fresh trays out often. Also keep an eye out for servingware that falls into any serving dishes, carrying bacteria from whomever touched it last.
  5. Use your Judgment for Sell-By Dates: That beloved Sell By date on your package is only a guideline used by retailers to know when products are generally safe or should be tossed:

“Sell-By” dates are a guide for retailers. Although many products bear “Sell-By” dates, product dating is not a Federal requirement. While these dates are helpful to the retailer, they are reliable only if the food has been kept at a safe temperature during storage and handling.

— USDA Food Safety and Inspection Services

If a product was stored at an unsafe temperature at any time, that date is no longer a good estimate of how long the product will keep, so always evaluate your food carefully; if there is a change in odor or consistency, it may be a sign of spoilage. Also note that most refrigerated products should be used within 7-10 days of opening, so don’t keep your opened sour cream or salad dressing for 2 months just because the Sell By date hasn’t yet arrived!

Check out this article by Healthy Way featuring some foods that are particularly risky with input from a food safety professional as well as my recommendations for alternative options!

 

 

 

Always read the ingredients!

Are your foods what you THINk they are?

Healthy Way recently published a great piece about foods that aren’t quite what we think. From pancake syrup to wasabi to bacon bits, the food industry often brands products based on how we perceive them rather than the actual ingredients.

The best way to keep yourself informed is to read ingredient lists as much as possible. This will show you if you’re eating maple syrup or maple flavored corn syrup (yes, that’s what many generic ‘table syrups’ really are).

Our owner Kelsey is quoted discussing some of the secrets of instant oatmeal so take a look at the article on Healthy Way!

A new study links the Mediterranean Diet to lower risk of Macular Degeneration

A new article in the journal Ophthalmology examined the diets and health outcomes of almost 5,000 participants who recorded their eating habits and wellness outcomes over several years. After analyzing the group’s food frequency questionnaires (which help paint a picture of what foods people tend to eat frequently or avoid), the researchers found that those following a Mediterranean-style diet had a 41% lower chance of developing macular degeneration.

The most interesting finding that that no single element of the Mediterranean diet correlated strongly to risk of macular degeneration, which implies that the protection came from the diet as a whole rather than any one portion. The Mediterranean diet is rich in fruits and vegetables, high in fiber with whole grains and legume consumption, and full of healthy unsaturated fats from plant oils, nuts, and fatty fish, while meat can be consumed in small amounts. These elements combine to help fuel your body and protect you from cellular damage. Adhering to this diet has been linked to cardiovascular health and lower risk of cancer, as well. To learn more about the components of a Mediterranean diet, check out these sources:

Bonus reading: Visit this summary from The Olive Oil Times to see The Peoples Plate featured as a nutrition professional commentator on the study’s findings!

What exactly is an RDN, and why should I trust one?

Everybody eats. All day long, no matter what you do from sun up to sun down, at some point your body needs food and you will eat. You’ll repeat that every day for the rest of your life, and so you will naturally form opinions about your food and perhaps which ones are ‘good’ or ‘bad.’ Your mother and your grandmother will tell you what to do to stay healthy; the fittest guy at the gym will swear he knows how to shred fat; catchy headlines and Google searches and talk show hosts will all offer ‘the key to weight loss!’ The enemy is fat! No, gluten! No, sugar!

I’ll give you a hint: if there was one key to overall health or weight loss, one simple meal plan to solve it all, whomever discovered it would be a trillionaire and you wouldn’t be reading this article. However, nutrition is much more complex than that. 

If you feel like there is an overwhelming amount of conflicting information out there, you’re right! That’s because there isn’t really one clearcut ‘healthy diet’ for everyone. Certain people DO need to cut out gluten, or watch how much potassium they eat, or strictly cut their sodium, or follow a medically-prescribed ketogenic diet to prevent seizures. However, deep Google dives will yield a lot of discordant information if you don’t know exactly what kind of nutrition information is a) pertinent to you, b) scientifically sound, and c) safe.

That’s why we need Registered Dietitian Nutritionists (RDN). Most people don’t know that an RDN is different than a ‘nutritionist’ or a ‘health coach.’ I myself didn’t know the difference until I pursued this path professionally, but those three little letters — RDN — hold a lot of meaning about the quality of nutrition education and counseling my colleagues and I provide. To become an RDN, you must:

  1. Complete an undergraduate degree including about 90 semester hours (more than a standard major) of in-depth science and nutrition-focused curriculum
  2. Complete over 1200 hours of supervised professional practice internship working under dietitians in clinical settings (hospitals, nursing homes, rehabilitation centers, dialysis centers), community locations (like WIC, Head Start, or Meals and Wheels programming for food security), and food service roles (implementing food safety standards and learning the managerial functions of food service directors)
  3. Pass a credentialing exam that covers principles of nutrition and food science, human anatomy and physiology, educational theory and application, counseling techniques, research techniques and interpretation, medical nutrition therapy for individuals in all stages of life and with varying diseases, employee and financial management skills, and menu creation and implementation just to name a few topics.
  4. Soon all RDNs will be required to hold Master’s degrees, though many dietitians (including myself) already hold a Master’s in areas like clinical nutrition, nutrition and food science, business, health care administration, or public health.

Other nutrition professions like ‘health coach’ or ‘nutritionist’ do not require the same degree of formal training (some have quick online courses that cover overall healthy eating without any explanation as to the scientific foundation of these principles or the medical implications). You may find some non-dietitian individuals who do have formal health education and experience, but you can’t be certain of the wealth of training your practitioner has completed unless he or she is a dietitian.

The New Jersey Academy of Nutrition and Dietetics has launched a campaign to support Registered Dietitian Nutritionists as the nutrition expert– and I highly suggest you check out the launch video here!

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: