So far, we’ve covered carbohydrate counting as the primary method of managing blood sugars. It is by far the most important nutritional factor to pay attention to. There are, however, other lifestyle factors that affect blood sugar and are critical to know.

If you have diabetes, have a family history of diabetes, or just want to promote health and prevent chronic conditions, check out the list below to learn about the types of things that can affect blood sugar aside from your diet:

• Stress – This one is HUGE. Stress of many kinds raises levels of a hormone called cortisol that raises blood sugar (1). It’s important to keep in mind here that stress is more than mental and emotional stress (bills, relational issues, busy schedules…you get the picture). It also includes physiological stress (think chronic pain, poor sleep quality and/or quantity, infections, illness, etc) that may not come to mind when we think of the word stress. It is important to make a priority of identifying effective methods of managing stress by addressing the roots of these issues.
  • Mental/emotional stress – The “best” methods of stress management vary for each person but good options include yoga, walking, meditation, deep breathing, and enjoyable hobbies. If you struggle with depression, anxiety, or trauma that causes ongoing stress, find a qualified counselor you trust to help you work through these very real and overwhelming conditions.
  • Physiological stress – Pursue the root cause of your physiological stress. If you suffer from chronic pain, discuss pain management options with your doctor (there are many options beyond pain pills!) or talk with a Registered Dietitian who is knowledgeable about methods of eating to reduce inflammation. If you have poor sleep quality, practice good sleep hygiene habits and consider asking your doctor to have a sleep study done (especially if you snore!) to see if you might have a potentially serious condition called sleep apnea.
• Physical inactivity – Our bodies are designed to move and groove. Doing so activates receptors to let more sugar out of the blood and into the cell to make the extra energy we need for all that movement. My favorite part about the benefit of exercise for blood sugar is that just 30 minutes of moderate exercise (brisk walking, dancing, swimming, biking – whatever you like!) can improve blood sugars for 1-2 days afterward (2). Talk about return on your time investment!
• Inflammation – Inflammation is a type of stress, so I could have included it under physiological stressors, but it’s such a big deal I felt it deserved its own bullet point. Type 2 diabetes is an inflammatory disease, and inflammation is one of the causes of the insulin resistance that is a precursor to type 2 diabetes. Reducing inflammation through exercise, anti-inflammatory eating, and achieving a healthful weight can significantly improve blood sugars (3).
• Medications – Certain medications can raise blood sugar significantly in some people. This typically resolves after they stop taking the medications, but not always. For people with diabetes, these meds raise blood sugars even farther. Taking these medications is not always avoidable, but if you’re concerned about your blood sugars, check the side effects on any medications you take and discuss them with your doctor.

1. Aronson, D. (2009) “Cortisol – Its Role in Stress, Inflammation, and Indications for Diet Therapy. Today’s Dietitian, 11(11). Retrieved from http://www.todaysdietitian.com/newarchives/111609p38.shtml
2. Colberg, SR, et al. (2010) “Exercise and Type 2 Diabetes: American College of Sports Medicine and the American Diabetes Association: Joint Position Statement.” Medicine and Science in Sports and Exercise, 42(12). Retrieved from http://europepmc.org/abstract/med/21084931.
3. Shoelson S, Lee J, & Goldfine A. (2006) Inflammation and Insulin Resistance.” The Journal of Clinical Investigation, 116. Retrieved from http://www.jci.org/articles/view/29069?search%5Babstract_text%5D=&search%5Barticle_text%5D=&search%5Bauthors_text%5D=&search%5Bfpage%5D=1793&search%5Bissue%5D=&search%5Btitle_text%5D=&search%5Bvolume%5D=116.

Have you ever been following a “diet” and then been faced with that darn thing called life?

Stress, donuts in the break room, or (like for me) date night can throw the best-laid plans out the window and then many people sit, riddled with guilt and feeling like a failure, wondering whether or not to throw their healthy goals out the window simply because they ate something their over-restrictive plan “didn’t allow.” That’s why I am all about focusing on including lots of nutritious choices, being aware of harmful foods and ingredients, and especially having a plan that includes the foods that make your life worth living!

Check out this great article written by a fellow RD about building a healthy relationship with food! I’m in agreement that the mental game of dieting and restriction can be just as destructive as poor eating habits!

“Yes, I’m a registered dietitian and I care deeply about nutritious, wholesome foods and eating. But I also wholeheartedly believe that there’s a time and a place for a treat.”
– RD Paige Smathers, quoted from KSL.com

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!

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!

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?