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!

On a note unrelated to any particular diet, I wanted to take a moment to spotlight one heck of a health and fitness inspiration.

I discovered this gal on a recent vacation when we had a TV in our hotel room (the kids were super psyched!) and watched a show called American Ninja Warrior. If you haven’t heard of it and you are in the right age range, you will best liken it to something along the lines of American Gladiators. If neither of those names means anything to you, American Ninja Warrior is a strength and agility competition in which contestants train to tackle a specific (very difficult) obstacle course. They are timed, and they must achieve certain times and complete certain obstacles in order to move on to the next round.

In the episode we watched, there was a very tricky obstacle christened “The Wedge” in which contestants hung from a horizontal bar with rubber tennis-ball-like objects on either end. This bar was wedged into what looked like two sheets of angled glass. The contestants had to use their momentum and body control to “jump” the bar across the tunnel between the two glass sheets, ensuring they keep the bar horizontal and don’t lose their grip. If my description makes absolutely no sense, fear not, for the video below will clear things up. “The Wedge” took no prisoners. Time after time, they would get to that darn wedge and their grip would slip or the bar would land slightly sideways and down they would plunge into the waiting pool below. It was beginning to look downright impossible.

Enter our heroine – Jessie Graff. Jessie is a stunt woman from Pennsylvania. She enters stage left with a delightful smile and a Wonder Woman costume. Her interviews gave a taste of her zest for life and her positive attitude. She is beautiful and fit on the outside, sure, but her mind and heart also exude beauty. Jessie, the only female in the show I watched, conquered the dreaded Wedge like it was a set of monkey bars on a playground.

So why am I all about Jessie Graff now? It’s not just because she’s a woman or because she “beat the boys” (though I’d be lying if I said there wasn’t a defiant third-grade girl inside me who found a little bit of glee in that). It’s because she surpassed everyone’s expectations – including her own. It’s amazing what we can accomplish when we combine discipline with a positive attitude. I so admired these qualities in her that I tracked her down on Facebook. Her page is littered with pictures of little girls in Wonder Woman suits and comments from people saying that she is inspiring others out of eating disorders by showing what the human body is capable of when properly fueled.

This lady is stupendous and has most definitely been added to my mental Wall of Inspiring People.

You and I also can (and should) make a practice of surpassing everyone’s expectations – including our own. Make a fitness goal to see what your body can do – even if it seems a little out of reach. Add some positive attitude and discipline and you can inspire the socks off of yourself and others too!

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!

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?

https://www.youtube.com/watch?v=Uw-SF5C2iHM

Living a healthy lifestyle of any kind – heart healthy or otherwise – can be daunting! It can sometimes feel like you should never eat those foods you love so much or that you’ll never enjoy food again. Not so! Check out this video I made to help you navigate a happy heart-healthy lifestyle.

heart healthy low sodium eating

Why is it that the Heart Healthy diet recommendations limit sodium? It’s highly unfortunate, as sodium is ever so tasty in many applications including (but not limited to) flavorful broths, crunchy kettle chips, and spicy sausage. Those are just a few of my personal high-sodium loves. Limiting sodium is tough for me because I can really go to town on the stuff. I’m not big on sweets – I can stay away from candies and pastries for the most part but put me near a good cracker with sharp cheese or salty chip and you have to fend me off with a stick. Limiting sodium can be a challenge. So what’s the benefit of doing it?

Research studies have shown that a lower sodium or sodium chloride (table salt) intake was associated with significantly lower blood pressure in adults with normal, slightly elevated, or high blood pressure. In most studies, “high sodium intakes” ranged from 2400-4800 mg per day while “low sodium intakes” ranged from 440 (holy low sodium!) to 2640 mg per day (Some study examples: Bray, 2004; Coruzzi, 2001; Geleijnese, 2003; He, 2004). You may wonder why sodium makes a difference in blood pressure. You are wondering, aren’t you? Of course you are.

Well surprise, surprise, it’s complicated! Bodies are complicated. The primary explanation is due to sodium’s role in directing how much fluid the body holds on to. Generally I explain it this way: Sodium and water are friends. Wherever sodium goes, water goes too – linked arm-in-arm with charged chemical attractions (oo la la!). So when we eat a lot of sodium (hello, pizza binge), our body holds on to a lot of water to hang out with it (hello, puffy bloat body). Some people notice the extra water because their feet, ankles, face, or belly swell with it. Some people can’t even tell it’s on board.

Either way, all this extra water has to move around the body to get filtered and whatnot. Guess whose job it is to move it? Your heart! Poor heart is pumping blood through the hoses of your veins and you’ve just increased the volume he has to move. His best response is to create more pressure to push all that extra fluid around to get rid of it. So, he pumps even harder and your blood pressure rises. That’s rough on him, as well as all of your hoses because in some places in your body (like your eyes and kidneys for example), your body has leeeeetle, tiny hoses that don’t respond well to pressure. Think fire hose pressure in your little green garden hose. Not a good match.

The goal of the Heart Healthy diet in limiting sodium is to keep blood pressure within healthy ranges for your heart and blood vessels. Now, as with everything in the realm of nutrition, there is debate about this. A few studies have recently been published that throw some doubt into the mix about the role of sodium in blood pressure regulation.

One such study by NutriNet-Santé found that sodium intake alone was not related to an increase in blood pressure, but rather found that the ratio of sodium intake to potassium intake was a much stronger predictor. Potassium is known as a helpful regulator of high blood pressure and foods high in potassium (like fruits and vegetables) are commonly promoted in diets recommended to lower blood pressure. Interestingly, I’ve been having a heck of a time meeting my potassium goals on this diet. More fruit! More vegetables!

There have been other studies that have suggested a notion of “salt responders” – people whose blood pressure is affected by their sodium intakes vs. others whose is not.

More research to come I hope! But overall, that’s a quick look at why we watch sodium as a contributor in the realm of promoting strong, healthy, not overworked hearts. Come back soon for ideas on how to cut sodium without sacrificing flavor (and joy)!