Check out this haul from my first grocery shopping trip for Carb Counting!

Yes, we drink a LOT of milk at our house.

I think I’m going to like this particular meal plan that I am using because it offers more flexibility than other meal plans I have used in the past. It gives lists of sample breakfasts, lunches/dinners, and snacks and allows me to pick and choose the ones I like, as well as repeat meals to use leftovers, which definitely helps with some of the issues I have with meal plans in general (which I described here).

So I thought I’d start out by describing what carb counting is all about. As described here, eating too many carbohydrates at one time can raise blood sugar too high for someone with diabetes. First thing’s first: which foods have significant amounts of carbohydrates?

• breads and grains like rice, pasta, and oats
• beans and legumes
• starchy vegetables like potatoes, peas, and corn
• milk and yogurt
• fruit and fruit juice
• sweeteners like sugar, brown sugar, agave, syrup, honey and sugary beverages like soda and sports drinks

These are the foods we primarily “count” as we count carbohydrates. The specific goal for carbohydrate intake varies between individuals based on height, weight, gender, activity levels, and blood sugar control goals. If you have diabetes and don’t know how many carbohydrates you should eat, find a Registered Dietitian who can help you find out.

For me, my goal is going to be 45-60 grams of carbohydrate per meal and 15 grams of carbohydrate per snack, as well as meeting the recommended activity goal of 30 minutes of moderate exercise 5 days per week (This can really help blood sugars!)

To help make carb counting easier, something called a “carbohydrate portion” or a “diabetes portion” was introduced. This is basically the amount of any carbohydrate food that contains 15 grams of carbohydrate.

As you can see by my carbohydrate counting goals, they are in multiples of 15 grams. So basically, at meals I can select 3-4 “carbohydrate portions” and at snacks I can choose 1. I can then fill in the gaps with non-carbohydrate foods like meat, eggs, cheese, vegetables, nuts, or seeds.

Carb counting can be tricky, but with some practice, awareness, and strategy, most people with diabetes find that they can live a relatively “normal” food life. I’ll see if I can make it happen in these three weeks and, if so, hopefully I can pass some useful info on to you!

No matter how you say it, it’s serious. Diabetes is common and can wreak havoc on someone’s body, so I’m more than happy to spend some time focusing on this condition and how to manage blood sugars by counting carbohydrates.

For anyone who is looking for a review of what carbohydrates are or what they do in the body, check out this post. Carbs are the numero uno focus when it comes to managing diabetes and reducing risk of complications.

To understand how diabetes works, let’s go back to the house/insulin key/sugar explanation I wrote about here. Check it out because my upcoming explanation will likely not make sense if you’re not in on the metaphor. Let’s also bring my highly sophisticated representative drawing back for a second look:

 In people with diabetes, the sugar people are not able to get into the house, causing a buildup of sugar people in the streets. They get crowded and angry and start flipping cars, breaking windows, and rioting all over the place. It makes for a pretty hostile environment.

This buildup of sugar people in the streets typically happens for one of three reasons:

1. The person has an autoimmune condition that prevents the body from being able to make insulin keys at all. This is called Type 1 diabetes.
2. The person’s locks are all rusty and take a long time to open. While the lock and key are fumbling around, sugar people build up in the street. This happens for a variety of reasons including genetics, obesity, stress, and inflammation, among others. This is called Type 2 diabetes.
3. The person’s locks are temporarily rusty because of the effects of hormones associated with pregnancy. This is called Gestational diabetes and most of the time it goes away after the baby is delivered, though it does increase a woman’s risk of having type 2 diabetes later in life.

In order to keep there from being too many angry sugar people in the blood, nutrition recommendations include portioning total amounts of carbohydrates eaten at one time. In other words, we send sugar people into the street single file all polite-like rather than stampeding en masse. That is why, in support of my patients and anyone with diabetes, I will be counting and moderating intake of carbohydrates at each meal and snack starting on Monday. We’ll also be going over more specifics about what types of foods are carbohydrates.

There are several other things we can do to help keep the sugar people from building up and rioting – look for more info in upcoming posts!

So, which diet did you choose for Dietitian on a Diet to follow next?

Carb counting for diabetes! That means I’ll be keeping on eye on the types of foods that break down into…*gasp*…SUGAR!!! I’m looking forward to this one for a few reasons:

1. Diabetes is really common. Scary common. According to the American Diabetes Association, as of 2012 9.3% of the population had diabetes, and about 8.1 million of those were undiagnosed. With nearly 1 in 10 Americans having diabetes, chances are very high you know several people with diabetes.
2. There are a lot of misconceptions about eating for diabetes. For some reason, the message has come across that eating for diabetes is very restrictive and the portions are teensy. The truth is, it doesn’t have to be that hard. It takes intention and awareness, but it’s not a death sentence for your tastebuds. Promise.
3. Sugar is the root of all evil. Or so a lot of people say. Therefore, foods that break down into sugar must be evil. Or so a lot of people say. We’ll definitely address that while I’m on this diet.

I’ll be delving into this diet starting Monday – stay tuned if you’re interested in learning how to live with (or support someone who lives with) diabetes!

Limiting sodium can be a bit tricky at first. Most of the flavor we enjoy in food comes from one of three things: sugar, fat, or salt. Our palates just love the tasty stuff. And the more of it we eat, the more we need in order to experience the same pleasurable taste sensation. Sound kind of like addiction to you? Ehhhhh-xactly.

Besides flavor, sodium is also used as a preservative in many foods and often foods that don’t even taste salty, which can be confusing for some people just learning about limiting sodium.

Anyway, it is possible to decrease sodium intake without eating tasteless cardboard. I promise! There are several ways to increase flavor and leave the sodium out:

• Herbs and spices: These are the best! Natural, delicious, and many are anti-inflammatory. Find a bulk section (like Winco) or grow your own for the best value. Check out the chart below from the Academy of Nutrition and Dietetics for tips on matching herbs and spices to the food you’re making tonight:
  

  Food Item	Flavorings
  Beef	Basil, bay leaf, caraway, curry, dill, dry mustard, garlic, grape jelly, green pepper, mace, marjoram, mushrooms, nutmeg, onion, parsley, pepper, rosemary, sage
  Chicken	Basil, cloves, cranberries, mace, mushrooms, nutmeg, oregano, paprika, parsley, pineapple, saffron, sage, savory, tarragon, thyme, tomato, turmeric
  Egg	Chervil, curry, dill, dry mustard, green pepper, lemon juice, marjoram, mushrooms, paprika, pepper, tarragon, tomato, turmeric
  Fish	Basil, bay leaf, chervil, curry, dill, dry mustard, green pepper, lemon juice, marjoram, mushrooms, paprika, pepper, tarragon, tomato, turmeric
  Lamb	Cloves, curry, dill, garlic, mace, mint, mint jelly, onion, oregano, parsley, pineapple, rosemary, tarragon, thyme
  Pork	Applesauce, basil, caraway, chives, cloves, garlic, onions, rosemary, thyme
  Vegetables	Basil, dill, garlic, ginger, lemon juice, mace, marjoram, nutmeg, onion, tarragon, tomato, salt-free salad dressing, vinegar
  Desserts	Allspice, anise, cinnamon, cloves, ginger, mace, nutmeg, vanilla extract

• Pre-made spice mixes: If you aren’t big on growing or buying herbs yourself, you can get a little help from sodium-free spice mix products like Mrs. Dash. The Mrs. Dash line has several pre-made spice mixes like Caribbean Citrus, Italian Medley, or Steak Grilling seasonings, all made without salt. I personally have only tried the original and I like it, especially on fish. I have several patients who have tried other flavors with success!
• Lite salt/salt substitutes: These are usually made with potassium chloride as opposed to sodium chloride (table salt) to decrease intakes of sodium. I use it at home and in recipes and the taste is similar enough I don’t notice it. Be aware: people with kidney disease or who are on certain diuretic blood pressure medications should not use salt substitutes because their bodies can not clear potassium as well as others. Ask your doctor before switching to salt substitute if you have any of these concerns.

Lastly, be patient! Your tastes will adjust to the point where they will enjoy the flavors of food with less salt, but it does take time. Most of my patients say that after 4-6 weeks of limiting sodium, the high-sodium foods they used to eat taste way too salty for them! You can do it!

Recipe feature time! My awesome husband made these amazing pork chops and they were probably the most delicious pork chops I have ever had. Smothered in mushrooms and surprisingly flavorful sauce (I had to ask him three times if he added extra salt to the sauce), these pork chops leftovers barely lasted 2 days. I would eat these almost every week if I could!

Today was my last day on the heart healthy diet. I learned a lot nutritionally and psychologically in the last few weeks. I’ve summarized my take-aways into 4 main points:

1. Limiting sodium was (mostly) easier than I expected. At first, things are a little bland and it seems like there are a lot of things you “can’t have,” but over time I saw that I had several days well under 2,400 mg so I started adding a sprinkle of salt to bland food and found I did have a little room to add some sodium. You do also get used to needing less salt for flavor. I learned some tricks for adding flavor without salt, too. Be careful, though, because certain foods can blow almost your entire sodium budget in one fell swoop…*cough* seafood fettuccini *cough*.
2. Limiting saturated fat was quite a bit harder than I expected. Those saturated fat grams are sneaky little suckers! I went into the heart healthy diet assuming sodium would be my biggest challenge and I quickly learned that saturated fat was much more difficult to keep within my 12 gram per day limit. Saturated fat is primarily from animal sources like butter, lard, dairy fat, and meat fat. The way I generally teach people to limit saturated fat is to eat oil-based spreads (instead of butter), low-fat or nonfat dairy, and lean meats and fish. I figured since I mostly eat that way I wouldn’t have to worry much about saturated fat on this diet. I was wrong! More often than not, halfway through the day I would check my saturated fat consumption and find it well over halfway through the budget. I now know that if patients are committed to limiting their saturated fat within recommendations, they probably need more specific guidelines and tips to keep that in check.
3. Having dietary “restrictions” is a nasty mind game. It makes your inner petulant toddler come out: What do you mean I can’t have it? I want it! Suddenly I want lots of it! It’s a tricky thing to navigate when educating people about how to properly care for their bodies and live a life worth living.
4. Fish is expensive. Very expensive. And I rarely get 2-3 servings per week. Unless you’re eating tuna all the time, getting in 2-3 servings per week racks up the grocery budget awfully quick-like.

Overall, I pretty much broke even on every outcome I was measuring, which didn’t really surprise me because I wasn’t eating in a drastically different way from how I normally eat. I did much better this week on my own than I did last because I made a more concerted effort to keep my saturated fat down.

So that about wraps up my experience on the heart healthy diet. What diet will I be doing next?

So I gotta be honest – I’m about 2 and 1/2 weeks into the Heart Healthy diet, and it’s getting to that mental point where I kinda just want to eat something REALLY salty. Because I LOVE salt, and there is that mental game we play where anything we are limiting suddenly becomes highly desirable. This is where things get tough. Yesterday, the rubber met the road.

One weekend a month, the kids go to grandma’s and my husband and I have date weekend. This particular weekend is date weekend and yesterday, Charlie and I went a-wandering. We started out at one of our favorite breakfast places and I wanted something delicious and I also tried to get something that would be mostly heart healthy: huevos rancheros. They make these with a crunchy taco shell, black beans, poached eggs, cheese, and avocado. Mostly low in sodium and pretty darn low in saturated fat. I ate half the plate and took the rest home. So far, so good.

Mid-morning we walked around a park and got a tad chilly in the fall air, so we went to a local coffee shop and I wanted a pumpkin steamer. To be true to my heart healthy diet, I elected to have it made with soy milk (though fat free milk would have been fine) to avoid saturated fat. So far, still good.

Then it got tough. We drove up to Tacoma to check out some stores and about mid-day hunger set in. I had a craving for some super-not-heart-healthy tortilla chips with nacho cheese. Cheap, not-even-food, concession-stand machine, plasticky pasteurized processed cheese product straight from 7-11. Definitely not conducive to meeting my nutritional goals for the day, particularly since I knew we had plans to go to another restaurant for dinner and I needed to save sodium and saturated fat for that. But I was started to listen to the devil on the shoulder: “You’re sick of watching your sodium. Come ooooonn…you’ve been so good for 2 and 1/2 weeks! Just don’t worry about it.” He was right – I was sick of limiting my sodium! So there! I’m going to eat it and I don’t even care!
So I ate it. And it was just as satisfying as I anticipated it would be. Alright, worth it. Maybe for dinner I’ll try to pick something more carefully.

We went to a nice restaurant for dinner and I thought I might to try getting a lean meat with some steamed veggies and maybe a roll or something. Then I got my menu and there it was – my favorite food. Seafood fettuccine. Ooooohhhhh boy.

At least I got the salad instead of the chowder…right?

I got it. I had to. It was amazing. In the whole day I overdid my calories by 300, exceeded my sodium goal by over 900 mg (I had 138% of my daily goal!) and blew my saturated fat out of the water by more than quadruple with that cheesy nacho goodness and creamy white wine butter sauce.

If I had high blood pressure or high cholesterol, this one day probably wouldn’t have been too big of a deal as long as it didn’t happen super often. If I had congestive heart failure, my sodium binge could have hospitalized me. Here enlies the mental game of a “diet,” which also tends to be one of my least favorite things about the idea of dieting. Diets are likely to promote this pendulum swing from restriction to bingeing. For me, it’s much more desirable to focus on including lots of the things that are really good for me than focus on restricting things that aren’t as good and overall promoting healthful moderation, for this very reason. But it’s super tricky if not restricting something could land you in a hospital bed or worse.

Things are back to normal now that I got my crazy day out of my system, but anyway, I wanted to make sure I kept myself honest and took note of this mental game – even dietitians are not immune to the psychology of “dieting!”