India’s #1 & only magazine on diabetes with maximum reach diabeticlivingonline.in
SEP-OCT 2017
LD WORRT HEA Y DA L IA P S EC
` 150
DIABETIC FRIENDLY AND
HEART HEALTHY DIET
LESS SALT, MORE FLAVOUR p. 76
EAT SMART
SLEEP BETTER TONIGHT
+
VEGGIE-FULL HEALTHY FATS Recipes, p. 56
Southern Barbecue Pork Bowls, p. 77
32017090705
INDIA EDITION VOL 7 ISSUE 5
10
p. 46
WAYS TO OUTSMART DIABETES p. 38
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CONTENTS
SEP-OCT 2017
FEATURES
THRIVE 12 MOVING ON MEDS?
Most people with type 2 diabetes need medication to manage blood glucose. We’ll tell you how medications can put you on the path to good health.
16 DEALING WITH
DIABETES BURNOUT Tired of monitoring your blood glucose level? Don’t want diabetic policing from your closed ones? Here is how you can treat your burnout!
20 HOW PCOS LEADS TO DIABETES? PCOS – Polycystic Ovaries Syndrome is a sexual hormonal disorder in women. But did you know that it can lead to diabetes? Keep a check before it’s too late.
WELLBEING 24 DIABETIC NEPHROPATHY
20 32
42
Finding out that you have early diabetic nephropathy can alert you that your kidneys are in danger. It is important to take steps to protect your kidneys before the problem advances.
32 BREASTFEED TO KEEP
DIABETES AT BAY Gestational diabetes is a common phenomenon, but that shouldn’t stop you from breastfeeding your newborn child.
38 10 WAYS TO OUTSMART
DIABETES Tight glucose control will help protect you in each of these areas from the damage of complications.
ON THE COVER
photos Blaine Moats styling Jennifer Peterson
DiabeticLivingOnline.in
1
FITNESS
52
42 FITNESS MYTHS
DEBUNKED How workout-smart are you when it comes to nutrition? Sridhar Varadaraj sheds some light on misconceptions surrounding fitness and nutrition.
44 YOU ARE FREE TO
BE FIT Take a cue from one amazing and curvy trainer, who ditched fitness ideals to unleash her inner athlete.
46 5 EASY MOVES TO
SLEEP BETTER TONIGHT Aerobic and resistance training can improve mood, sleep quality, and diabetes management.
52 BLAME GAME
The easiest way to fix your diet is to understand the food you love. Here is your guide to do it!
54 DIABETIC FRIENDLY
AND HEART HEALTHY DIET When it comes to diabetes, we need to look beyond elevated blood glucose levels. Here is your guide to a diet that will keep everything in check.
diabeticlivingonline.in
SEP-OCT 2017
WORLD HEART DAY L SPECIA
` 150
DIABETIC FRIENDLY AND
HEART HEALTHY DIET
LESS SALT, MORE FLAVOUR
p. 76
EAT SMART
SLEEP BETTER TONIGHT
+
VEGGIE-FULL HEALTHY FATS Recipes, p. 56
Southern Barbecue Pork Bowls, p. 77
10
32017090705
INDIA EDITION VOL 7 ISSUE 5
2 Diabetic Living
p. 46
WAYS TO OUTSMART DIABETES p. 38
62 GO VEGAN!
Yes, it’s true. A vegetarian diet helps control weight. But it all comes down to the amount of food you’re eating. Know how to control and see the excess weight shed!
FOOD 70 IN SEASON - PEARS
NUTRITION
India’s #1 & only magazine on diabetes with maximum reach
54
These diabetes-friendly fruits are affordable and abundant right now. Each variety has its own subtle flavour and texture — and packs exceptional nutrition. Choose a favourite for these recipes.
66
Editor’s Letter
3
Advisory Board
4
Recipe guide
84
90
76 POWER UP
Power bowls are as easy as 1-2-3: Toss together a nutritious starch, a lean protein, and fibre-packed produce for a tasty meal that doesn’t skimp on flavour. We’ll show you how!
GUIDE TO ABBREVIATIONS AADE: American Association of Diabetes Educators. ADA: American Diabetes Association. CDC: U.S. Centers for Disease Control and Prevention. FDA: U.S. Food and Drug Administration. NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases. NIH: National Institutes of Health. PWD: person with diabetes. USDA: U.S. Department of Agriculture.
sep-oct 2017
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INDIA
FROM THE DESK
Publisher & CEO
NITIN AGARWAL
Associate Publisher Chief Operating Officer
ARPIT AGARWAL ALOK KATIYAR
EDITORIAL Associate Editor Correspondent Content Writer
KANCHI BATRA SUDHAKAR JHA ISHAAN LALIT
[email protected]
It’s a little surprising to realise that I’ve spent the majority of my working life sitting in an office chair, without moving. And not always in an ergonomically accurate position. In my previous edit note, I shared my own fight with being beset and making self-care a priority. And even though I still find this an area of challenge, I have been making slow but sound steps forward. Of late, I began a daily meditation routine, something I never would have anticipated in a billion years. But much to my surprise, it is just doing wonders for me. Even more important, I feel much serener and my days are less stressed out. I keep my social media presence really positive on the whole. And I thought I would write this, as a little message to myself as much as to you, as a reminder that even when times are rough, you need to seize the things that are exceptionally, intensely yours. The moments of bliss - the parks you adore, the foods you relish, the people that enthral you, the music that heals you. Don’t let go of those important things. It is with this pristine sense of serene that I wish to serve you this edition of Diabetic Living. People are usually bombarded by doctors and scientists giving them contradictory advice - eat this, don’t do that - so it’s hard to know what to believe and what to overlook. My aim is to clear the confusion and give you reliable information from writers and experts that you can trust. In this edition, Sridhar Varadaraj, Founder & Managing Partner of Zago debunks some of the common fitness myths, while Dr Madhavi Latha gives us her take on breastfeeding – benefitting both mother and the new born baby. Leading Endocrinologist Dr Sanjay Kalra tells us about consequences of chewing betel quid, while Chandani Chawla shares her own experience - dealing with diabetic burnout. I’m thrilled to be the Associate Editor for Diabetic Living and to be able to bring you these great stories. Heath needs to be celebrated every day in order to celebrate life. May this edition inform, empower and motivate you to live your best health.
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Diabetic Living India (DLI) magazine is printed and published by Nitin Agarwal on behalf of TCG Media Limited. Printed at: TCG Media Limited, DLI magazine is published bi-monthly. DLI magazine is a trademark of Meredith Corporation and TCG Media Limited. The entire content of DLI magazine are copyrighted to Meredith Corporation and TCG Media Limited. All rights reserved. The writing, artwork and/or photography contained herein shall not be used or reproduced without the express written permission by TCG Media Limited. TCG Media Limited or any employee(s) does not assume responsibility for loss or damage of unsolicited products, manuscripts, photographs, artwork, transparencies or other materials. TCG Media Limited does not assume any liability for services or products advertised herein. Disclaimer: DLI is not responsible nor liable for any advice, course of treatment, diagnosis or any other information, services or products that you obtain through this magazine. WWW.DIABETICLIVINGONLINE.IN
INDIA
Editorial advisory board The following health care professionals—all experts in diabetes management— review articles that appear in Diabetic Living ® magazine: Connie Crawley is a nutrition and health specialist for the University of Georgia Cooperative Extension Service in Athens, specialising in diabetes and weight loss. Connie is a member of the American Dietetic Association Diabetes Care and Education practice group.
Marion J. Franz has authored more than 200 publications on diabetes, nutrition, and exercise, including core-curriculum materials for diabetes educators. Marion is a member of the American Dietetic Association Diabetes Care and Education practice group.
Joanne Gallivan is executive director of the National Diabetes Education Program at the National Institutes of Health. Joanne is a member of the American Dietetic Association Diabetes Care and Education practice group.
Marty Irons practises at a community pharmacy and has served in industry and the military. Jeannette Jordan works for the Medical University of South Carolina in Charleston and consults with the Centers for Disease Control and Prevention.
Irene B. Lewis-McCormick is a fitness presenter and educator. Certified by the nation’s leading fitness organisations, she is a faculty member of the American Council on Exercise.
Chris Smith, The Diabetic Chef ® is the president of Health Range, Inc., and a professionally trained chef. He is a food consultant and cookbook author and conducts healthy-cooking classes.
Hope S. Warshaw is a writer specialising in diabetes care. She has authored several American Diabetes Association books. Hope is a member of the American Dietetic Association Diabetes Care and Education practice group.
Fred Williams practises endocrinology and specialises in diabetes. He is an active member of the American Association of Clinical Endocrinologists and serves on the board of directors.
John Zrebiec is director of Behavioural Health Services at the Joslin Diabetes Center in Boston and a lecturer in the department of psychiatry at Harvard Medical School.
4 Diabetic Living
sep-oct 2017
INDIA
Editorial advisory board, India The following health care professionals—all experts in diabetes management—review articles that appear in Diabetic Living® magazine’s India edition: Decorated with the Padma Shri and BC Roy award, Dr. Anoop Misra is Chairman, Fortis-CDOC Center of Excellence for Diabetes, Obesity, Metabolic Diseases, and Endocrinology, in New Delhi. He is also Chairman of the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and Director of the Diabetes and Metabolic Diseases, Diabetes Foundation of India. Dr. Misra has led several pioneering research studies on diabetes and has published more than 300 research papers. Dr Ambrish Mithal MD, DM: (Padma Bhushan Awardee 2015) Member Governing Council, Indian Council of Medical Research (ICMR), Doctor of the year DMA 2005, cited in the Limca Book of Records since 2005 - is presently the Chairman and Head of Endocrinology and Diabetes Division at Medanta, the Medicity where he has established one of India’s premier diabetes and endocrinology centres. Dr. V. Mohan is Chairman and Chief Diabetologist of Dr. Mohan’s Diabetes Specialities Centre and President & Director of Madras Diabetes Research Foundation, Chennai. He has published over 600 papers in prestigious peer reviewed journals and contributed over 100 chapters to text-books on diabetes. He has received the prestigious Dr. B.C. Roy National Award, and Fellowships from all the four Royal College of Physicians of London, Edinburgh, Glasgow and Ireland. Dr. Shashank R Joshi is a well-known endocrinologist in Mumbai. He is president of the All India Association of Advancement for Research in Obesity and vice president of the Association of Physicians of India. Padma Shri and BC Roy awardee Dr. KK Aggarwal is an eminent name in cardiology. President of the Heart Care Foundation of India and editor-in-chief of the Indian Journal of Clinical Practice, Dr. Aggarwal has a keen interest in mind-body healing. He is a regular columnist and expert for both print and television networks. Rekha Sharma is director of Clinical Nutrition and Dietetics at the Diabetes Foundation of India. This former chief dietician of the All India Institute of Medical Sciences in New Delhi has devoted several years of her life to the study of diabetes management. Madhuri Ruia is a nutritionist and fitness expert in Mumbai. A certified pilates expert from the Pilates Institute of UK, she runs Integym, a state-of-the-art centre that promises ‘intelligent fitness’ to its clients. Dr. DS Chadha is head of cardiology at the Command Hospital in Bengaluru. He has won dozens of awards, written several research papers in leading medical journals and chaired several national and international conferences on health issues. Working Committee Dr. Swati Bhardwaj is vice head at the Center for Nutrition and Metabolic Research and a nutritionist with the Diabetes Foundation (India) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Shubhda Bhanot is a certified diabetes educator and a nutritionist with 14 years of experience in the field. A life time member of ADE (Association of Diabetes Educators), she is presently working as chief diabetes educator at Medanta, The Medicity, Gurgaon.
DiabeticLivingOnline.in
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READERS’ WRITE
2
1
To say you have filled a much needed void is true; though, you have done much more than simply that. I want to thank you for giving all of us who want to live this lifestyle the gift of your magazine. Thanks for including the article on struggle in personal and work life. It was very inspiring. This is one of the most enlightening articles I have ever read on depression. Prerna Sharma - Bengaluru
Treasured by many! Most magazines these days are looked through quickly since it is mostly advertisements and steered away from anything resembling primitive. Diabetic Living is one of a kind that is treasured by many. Thank you for all your time in making this a great magazine. Shakti Arora - Rohtak
3
Mouth-watering food recipes! Thanks for including the Cuban Cuisine in the July-August edition of Diabetic Living. I can’t even describe the feeling I had looking through these wonderful pages. It is full of mouth watering food. I have tried all the recipes and now I am proficient in making fuss-free meals in no time. Inder Kaur - Nagpur
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` 150
ain a t this Maint thy gu
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DIABETIC FRIENDLY AND
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ME TOINE FATS Recipes, p.U 56IS WELCO N C IDE A OF CUBA E ING TH INDIA
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Chu nky Bacon 82 pg. camole,
Southern Barbecue Pork Bowls, p.Tur 77 key
10
p. 46
WAYS TO OUTSMART DIABETES p. 38
A S K
Y O U R
E X P E R T
Dr. Altamash Shaikh
Consultant Endocrinologist, Diabetologist and Metabolic Physician at Saifee Hospital
QA +
Always start with a snack before you go for weight lifting.
Q2 8 Diabetic Living
sep-oct 2017
Q1 I am a diabetic and suffering from corns and calluses. As I need to take care of my foot, can I use corn caps? What is the best way to deal with corn caps? Please help. These are thickening of skin formed due to pressure or friction over foot. Risk factors are poor fitting shoes/socks, socks with seams over toes, bare feet walking, athletes, manual labour, bony prominences, abnormal mechanics/ movements of foot, scar, damaged sweat glands, open heal shoes like flip flops, sandals, etc. The best way is to see a doctor, to get your risk factors checked. Avoidance of risk factors is most important part in treatment. You may be asked to use moisturiser, rub pumice stone/sand paper, soaking feet in water to soften (if there is no infection). Shoe modification, periodic shaving, antibiotics, salicylic acid as per individual case may be needed. Avoid using medicated pads or shave or cut corns and calluses away at home, without medical supervision.
I’m a gym enthusiast. I love exercising and have a very well maintained physique. Recently I was diagnosed with type 2 diabetes. Can lifting weights and intense workout affect me? Exercise has many benefits in type 2 diabetes, most important one is that it keeps your blood glucose under control, and may reduce dose of medication, if done regularly. However, please let your doctor know about your plans to exercise so that he gives you realistic goals to set and it is easy for you to do. After you have achieved good aerobic exercise regimen and stamina, strength training may be started. Always start with a snack before you go for weight lifting exercises, this will be decided by your doctor depending on your present control and medications. Also avoid any low blood glucose (hypoglycemia).
Q + A
Q3
Q4
I’m a 34 year old working professional with type 1 diabetes. Do I need to take my medications even on days that I feel fine? One needs to understand that for type 1 diabetes, problem is in the pancreas and it is no longer producing insulin in the body. So, in non diabetic where there is an insulin secretion in the body, in type 1 diabetes it is not. Hence, it is important to take insulin, even when one is feeling well. Basically, a complete type 1 diabetes management consists of following: blood glucose control and insulin management, exercise, nutrition and patient support. Ask your doctor what suits you best, which insulin regimen, or you can also try for newer options like insulin pumps.
My family has a medical history of diabetes. I’ve a oneyear-old baby boy. Will he also inherit it and what precautions can I take for my son? Please advice. Diabetes is of various types. Type 2 diabetes is very common in India. For your son the chance is, 1 in 7 if one parent is diagnosed before the age of 50, 1 in 13 if one parent is diagnosed after the age of 50, and 1 in 2, or 50 per cent, if you and your spouse both have diabetes. For anyone at risk of diabetes, (by and large we all are) keep your child’s food, weight and exercise regimen optimal from now onwards, including yourself. However, if your family/ immediate relative (parent, brother, sister, son or daughter) has history of type 1 diabetes, your son’s risk of developing T1D is 10 to 20 times the risk of the general population.
Q5
I’m a 61 year old retired officer. I’m a diabetic patient since 4 years. Kindly suggest me steps as to how do I keep my sugar level under control. That’s a very interesting question! The most important thing is acceptance that one has diabetes and has to start living with it. For control, please modify your diet regimen either from your doctor or your nutritionist (dietician). Avoid large meals, fried, sweets and soft drinks. You may be allowed to eat and need to learn portion exchanges for different foods. Walking for 30 – 60 minutes daily may be beneficial, as per your present condition. Maintaining your food and exercise regimen for long is a vital step in control of diabetes. Next is to adhere to your treatment plan given by your doctor, to achieve goals and avoid complications of diabetes. DiabeticLivingOnline.in
9
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MOVING ON TO
MEDS
writing Jill Weisenberger, M.S., RDN, CDE
12
M
OST PEOPLE WITH TYPE 2 DIABETES NEED MEDICATION TO MANAGE BLOOD GLUCOSE. YET SOME RESIST OUT OF FEAR OR GUILT. WE’LL TELL YOU HOW MEDICATIONS CAN PUT YOU ON THE PATH TO GOOD HEALTH.
MEDS BY THE NUMBERS
2.5x
increased likelihood of a hospital stay if you don’t take your meds. —American College of Preventive Medicine
You’re not alone in taking medication to properly manage your diabetes. Here’s a statistical snapshot of U.S. PWDs.
57% are on an oral med
15% Years ago, doctors often waited several months after diagnosing type 2 diabetes to prescribe medications, giving patients a chance to manage blood sugar levels with lifestyle changes alone. Now it’s more common for the prescription pad to come out the day of diagnosis. That’s because research shows even short periods of high blood glucose contribute to complications related to the eyes, nerves, and kidneys many years down the road. Plus, taking control of blood sugars early on helps protect you from heart disease. So health care providers want you to use every tool available right away instead of waiting to see benefits from lifestyle updates alone. Weight loss and other life changes contribute to diabetes management, but the results vary. Meds bring results within days or weeks. If your blood sugar levels are elevated despite healthy eating and exercise, ask your doctor if it’s time for medications.
Why medication? In type 2 diabetes, two main issues push blood sugars up. The first is insulin resistance, a condition in which the body responds inefficiently to insulin. The second problem—which tends to worsen the longer you have diabetes—is insulin deficiency, when the beta cells of the pancreas stop making enough insulin to keep blood sugars in a healthy range. It’s important to know: Filling a prescription isn’t a sign of failure. The failure is on the part of your beta cells. You could do everything right with eating, exercise, and weight management and still not make enough insulin. The progressive nature of type 2 diabetes makes it more stubborn as time goes on. Which medication when? When diagnosed with type 2 diabetes, you’re typically put on the drug metformin—a pill that makes the body
are on insulin and oral meds
77% take insulin as prescribed
85% take other meds as prescribed
sources CDC; AADE
13
5
TIPS TO SLOW AN INCREASE OF MEDS
1 Learn more.
Ask for a referral to a CDE and RDN. They’ll help put you in the driver’s seat of your management and ease fears. You’ll learn how meds, food, and exercise improve health.
2
Be active.
Exercise is free medicine. Like some meds, physical activity makes you more sensitive to insulin. Even a 10-minute walk helps.
3 Monitor.
By checking your blood sugar right before a meal and two hours later, you can learn the effects of the carbohydrate in that particular meal.
4
Lose a few.
Overweight? Drop a few pounds. It can lessen insulin resistance.
5 Breathe.
Spend a few minutes daily practicing stress management. Stress takes your focus away from good self-care practices.
more sensitive to insulin and often helps people lose a few pounds. It’s inexpensive, lowers the risk of heart attack in overweight individuals, is unlikely to cause low blood sugar, and can be taken for many years. If a single medication and your body’s insulin production are no longer enough to manage blood sugar levels, your doctor will prescribe a second. Nearly any class of medication could fill the bill as a second drug—they all work in different ways. Depending on your situation, you might take two separate medications or a single pill containing two drugs (called combination pills). These might be less expensive but offer less dosage flexibility. You could also be put on a non-insulin injectable medication such as liraglutide (Victoza) or exenatide (Byetta). These are injected because they are proteins and, like insulin, would be destroyed by the digestive system if taken in pill form. If your doctor recommends an injectable medication, this doesn’t mean your diabetes is more or less severe than if your doc recommends a pill. It’s simply a different tool in the medication arsenal.
If you’re taking two diabetes meds but your blood sugar levels are still not well controlled, your doctor can prescribe a third medication. There are many different types of drugs that could be added to your daily regimen. However, providers frequently recommend a once-daily, longacting insulin as the third medication because it’s highly effective and directly moves glucose out of the blood and into the target cells. Plus, once-daily injections are more convenient than mealtime insulin injections. Newer drugs tend to be more costly, and they may or may not lower your blood sugar levels any better than older medications. Talk to your doctor about whether a newer medication is ideal and if there are more-affordable options. Insulin for type 2 Insulin has been around a long time, is efficient at lowering blood sugar, and is safe when taken properly. About 30–40 per cent of people with type 2 diabetes take insulin. In fact, because there are so many more people with type 2 diabetes compared to those with type 1, most insulin users have type
EXPERT TIP The time to start thinking about blood sugar management is early on. That’s when you get your biggest bang for your buck. Starting a medication early is like an insurance policy. You can always go off if you don’t need it anymore. —Evan Sisson, Pharm.D., M.H.A., CDE, AADE spokesperson
photos Getty Images
2 diabetes. And that number will rise as people with type 2 diabetes live longer and lose their ability to produce insulin. Just as there are many new non-insulin medications on the market, there are also new and innovative types of insulin and insulin-delivery systems. Long-acting insulins, like Lantus and Basaglar, are usually taken once daily. Rapid-acting insulins, such as NovoLog and Humalog, are taken with meals and snacks. Afrezza is a type of insulin that’s inhaled. Good old-fashioned vials and syringes are the least expensive way to take insulin. Insulin pens, which look like a writing instrument, are easy and convenient. Insulin pumps, once used primarily for people with type 1 diabetes, now offer flexibility to people with type 2 diabetes who take insulin multiple times a day. A pump looks like a pager but provides insulin all day long and an extra burst of insulin whenever you need it for a carb-containing meal or snack. Providers frequently add insulin to other meds if blood sugar levels remain elevated. You shouldn’t fear insulin or feel like a failure if your doctor recommends it. It’s not a form of punishment. Very simply, your beta cells just aren’t making enough of this hormone. Once on meds, always on meds? Once you start taking diabetes medications, dialing back might be possible. You may need insulin or an additional medication just to get you over a temporary hump like surgery or insulin resistance caused by medications needed for other reasons. Lifestyle changes may not eliminate the need for medication, but eating right and moving more could allow you to take a smaller dose or fewer meds. Losing 10 or so pounds may cut your dose, and a 20-pound or greater weight loss may mean dropping a medication altogether. All of this depends on your beta cells’ ability to produce insulin.
INSULIN & TYPE 2
About 30–40 per cent of people with type 2 diabetes take insulin. In fact, most insulin users have type 2 diabetes.
DEALING WITH DIABETIC BURNOUT! Tired of monitoring your blood glucose level? Don’t want diabetic policing from your closed ones? Here is how you can treat your burnout! Chandani Chawla
T
he confidence of knowing the sugar readings at all times generates a sense of power within us diabetics. The power to be in control, this confidence stems from the quote “knowledge is power”. As a type 1 diabetic, having a solid data report of your sugar readings is the most vital information. This information has the power to manage your life. But power in general is not easily attained. It requires diligence, discipline and dedication, and when these phrases matter to your health, we go past them. Of course, this is a very common advice and all diabetics are highly aware about the importance of “checking sugar levels”, but I would like to
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honestly ask you, do you think you check your sugar enough? Do you always have a data log of your readings to show your endocrinologist? If you are, then kudos to you, if not, you are not alone. The American Diabetes Association did a survey that found 21 per cent of adults with type 1 diabetes never checked their blood glucose. Of those, with insulin-treated type 2 diabetes, 47 per cent never monitored. And among those with type 2 diabetes who were not using insulin, 76 per cent never checked. Aside from blaming people for being ignorant about their health, let’s dig a little deeper about why people don’t check their sugar levels as often as they should. The reason that made me avoid checking my sugar was because I was always told to “test” my sugar before eating, “test” my sugar before sleeping, “test” my sugar first thing in the morning, etc. The word “test” physiologically led me to consider the resulting number as a grade. Depending on the number that appears on the metre, I have either passed or failed. My metre seemed to be like a critic who was constantly telling me that I was a failure. Not surprisingly, I wanted to end this relationship. One starts to come up with excuses like, “I don’t need to check my levels, my body tells me when I am high or low”, and then having to justify to your family that you have it under control to avoid uncomfortable conversations. This kind of behaviour often leads to what we call a diabetic burnout. “You're getting burned out when you notice that your diabetes self-management starts to wear thin, making you weary and frustrated,” says Dr Bill Polonsky, an associate clinical professor in psychiatry at the University of California, San Diego, and the author of Diabetes Burnout: What to Do When
You Can’t Take It Anymore. "The things you're doing to take care of yourself start feeling old, and you start telling yourself that it's not worth the trouble. The idea that it's not worthwhile starts to grow," adds Dr Bill. Once that idea is firmly in place, you will start letting go of your necessary routine — sometimes one responsibility at a time, and sometimes everything at once. I want you to understand that it is okay to let go once in a while and not be too hard on yourself. But avoiding a diabetic burnout for too long can cause some serious health complications. The first step to a burnout is when you stop monitoring your sugar, because when you don’t know what your readings are, you pay less attention to the other routine diabetic tasks, basically going into denial about your condition and losing the power to be in control of your life. Everyone has personal reasons to go through a diabetic burnout and it is considered very normal according to Dr Polonsky. The important aspect to consider is that you are not alone and burnouts can be conquered. Take your time to figure it out, make peace with it and move on by taking bold steps for improvement and give yourself the power to live life to the fullest.
The word “test” psychologically led me to consider the resulting number as a grade.
The important aspect to consider is that you are not alone and burnouts can be conquered.
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THREE BASIC ELEMENTS THAT HELPED ME OVERCOME DIABETIC BURNOUTS:
1.
Blood glucose numbers are information and not a grade After years of ignorance and missed routine checks to prevent myself from feeling like a failure I finally met my endocrinologist, Dr. Monashis Sahu who made me look at my readings not as a grade but as a number. One should take instant action with the notion to stay motivated and not perfect. If your sugar is 300, don’t think about how you messed up, think about the action required to improve it (If you don’t know what to do, please contact your diabetic educator immediately). This positive change in mind-set made me check my sugar readings more regularly, giving me an idea on where I stand and wanting to improve myself. This can be tough to keep in mind, especially if you’ve also had years of comments from friends, family members, and
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perhaps even doctors that one particular reading is ‘terrific’ and another is ‘terrible’. Remember, that’s the past! Think of action solutions like a leader and not self-blame yourself like a victim. You will gradually see your results improving, making you feel incredible!
2.
Knowledge is power Having a good understanding of your sugar levels is the key because it gives you the power to do more in life. Personally, checking and recording my sugar on set times have always been a struggle, which prevented my doctor from understanding how to manage my type 1 diabetes. That’s when I decided to wear the Abbot Freestyle Libre sensor, a device as big as a 10-rupee coin on my arm. Having a sensor that records my sugar readings, at all times with no extra effort, has provided a solution in helping me manage my life better. I notice myself feeling more energetic, getting more tasks done and pursuing my hobbies due to the personal effort made with the knowledge received by this device. I wear my sensor with pride on my arm, as there is no shame in wearing anything that improves your wellbeing because when you feel well and confident, you end up looking and doing your best. So if the pricking, monitoring and recording process prevents you from attaining knowledge, look at other options that might help you better. We are blessed to be in an era where healthcare is at its finest. It’s time to take advantage of that and expand your horizons.
3.
Communicate with your loved ones
In all likelihood, your friends and family members care about you and want you to be as healthy as possible. But if you feel like your loved ones are constantly ‘policing’ your behaviour, you might become reluctant to check your blood glucose and bring further attention to your condition in front of them. The diabetic policing are well intentioned; they’re just trying to be helpful. They may know that their actions are irritating you, but they worry that your self-care will deteriorate if they don’t keep a close watch on you. The best way to rid yourself of this diabetic policing is by proving them wrong! By publicly taking charge of your diabetes, you will convince your friends and family that you can take care of yourself. If you don’t need your loved ones to remind you of your diet or exercise regimen, then prove it. Discuss with
them about your diabetes care plan and your ongoing efforts to follow it. Express the parts that are easy and the parts that are difficult. If friends and family members continue to make comments about your diabetes that upset you, sit down and talk to them about how their behaviour makes you feel. Convey that you appreciate their concern, but their policing actually makes you less likely to check your blood glucose when they’re around. Offer suggestions as to what sort of support you would prefer. Communicating honestly about your health with your loved ones is the best kind of support. Regular monitoring is important, yet for many (including me), it remains tough. The good news is that these barriers can be successfully overcome. Take the time to identify reasons for a burnout, address them and initiate solutions, starting with checking your sugar regularly. Now it’s up to you, do you want to be a diaburnout or a diabadass?
The best way to get rid of diabetic policing is by proving people wrong.
Take the time to identify reasons for a burnout, address them and initiate solutions.
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how PCOS
leads to diabetes? PCOS – Polycystic Ovaries Syndrome is a sexual hormonal disorder in women. But did you know that it can lead to diabetes? Keep a check before it’s too late. Dr. Ashwini Rakhame
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A
ccording to a study by PCOS society, one in 10 Indian women suffer from Polycystic Ovaries Syndrome (PCOS), and more than 10 million women globally are affected by this disease. PCOS is a disorder of the endocrinal system that causes an imbalance of female sex hormones. It is considered to be the most common cause of female
infertility. Most urban women are somewhat familiar with this condition. However, not many are aware that PCOS is closely related to a much more serious lifestyle disease – diabetes. In fact, PCOS is often referred to as a form of prediabetes, because the conditions have a lot in common. For instance, just like with type 2 diabetes, Polycystic
Ovary Syndrome often starts with insulin resistance. Some studies show that 50 to 90 per cent of women with PCOS are insulin resistant. According to the American Diabetes Association, insulin resistance leads the body to produce high levels of insulin, very similar to the early stage of type 2 diabetes. Moreover, a study by
While PCOS is connected with diabetes, not all women suffering from the disorder will become diabetic. Australian researchers found that women who had PCOS were three to five times more likely to develop type 2 diabetes than women who didn’t have PCOS. Conversely, another study by the Medical College of Virginia found that up to 27 per cent of premenopausal women with type 2 diabetes also have PCOS, signifying that both conditions are inter-related.
Who’s at risk? While it is apparent that PCOS is connected to diabetes, not all women suffering from the disorder will become diabetic. Research is being conducted to determine the lifestyle factors that affect the risks of PCOS. One major factor is weight. Extra body weight might be part of the connection between PCOS and type 2 diabetes, and since many women with PCOS are overweight or obese, even a 5 per cent loss can show improvement in PCOS symptoms. Another key factor is insulin, since women with type 1 diabetes are at an increased risk of developing PCOS. It is possible that large swings in insulin levels that accompany insulin injections may place extra stress on the ovaries. Raised insulin
levels have a direct effect on the ovaries, enhancing testosterone levels. In PCOS the body may have a problem using insulin, resulting in insulin resistance. When the body doesn’t use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.
Taming the beast with technology Regular exercise is crucial for keeping the body healthy, especially when it comes to fighting obesity and type 2 diabetes, and it has shown to help with symptoms associated with PCOS. A balanced diet that provides whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables is the key to reduce the risk of diabetes and to manage weight. However, with fast paced lives and the increased stress levels we experience today, professional intervention becomes equally important to keep a close watch on your health. Thanks to digital apps such as Lifeincontrol, one can not only ensure better compliance, but
also give doctors a chance to ensure timely intervention, thereby ensuring better outcomes and in many cases better management of the disease itself.
Here’s how they help A mobile intervention platform for diabetic patients provides patients with day-to-day support and real-time guidance to adhere to their treatment plan and manage their glycaemic levels. Armed with the right digital app one can: 1. Initiate better diagnosis and self-care. 2. Enable remote monitoring for doctors for better health management. 3. Receive day-to-day support and real-time guidance. 4. Reduce the progression of diabetes and its complications. With a condition such as PCOS that has no known cure, awareness can do a great deal to help women, especially those with diabetes, recognise symptoms and obtain an accurate diagnosis. The growing use of smartphone technology and mobile applications has led to better access to blood glucose readings, general health information, and much more. Smart diabetes-related apps have succeeded in empowering patients to become actively involved with their physicians, treatment regimens and lifestyle changes. Writer is the Chief Marketing Officer, LifeInControl, a diabetes management platform.
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SMART TRENDS
BEFORE Plan ahead. Talk to your health care provider to learn about the process. Choose wisely. With each puncture, infection risk rises—proper sterilisation techniques are top priority. Your tattoo artist should clearly display a state health department permit, proving the shop passed safety, education, and cleanliness requirements. If not, ask to see it. Be up-front. Tell your licensed artist you have diabetes—and discuss.
Getting
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Avoid tattoos on areas prone to circulatory problems, including i Ankles i Shins i Backside i Feet
DURING Check cleanliness. See that equipment is cleaned, needles and ink pots are changed between customers, and artists swap out gloves after contact with nonsterile items. Pack snacks. Plan for blood glucose (BG) checks and snack breaks.
Aim for good BG control (A1C 7.5 or less) to promote healing.
Ease pain. Pain can increase BG levels, so take an antiinflammatory med or have your artist numb the area.
AFTERCARE Keep it clean. Remove bandages when instructed. Wash—don’t soak—the area three times a day. Antibiotic ointments can speed recovery.
Don’t touch. Scratching may lead to infection. Unscented lotion can help. Watch closely. Inadequate circulation can make healing for PWDs last up to two weeks longer than average. Watch for redness or puffiness. Call the doc if anything seems off. Keep a record. Write down your tattoo artist and the ink’s lot number for quick reference if a problem occurs. Report problems. If you have adverse effects, tell the artist and your state’s Consumer Complaint Coordinator on the FDA website.
writing Karyn Wofford; photo Getty Images
Many people with diabetes choose lifesaving medical ID tattoos. Here’s how to get inked safely to avoid infection, allergic reaction, and disease.
INK-FREE ZONES
WELLBEING
Wellbeing is not a ‘medical fix’ but a way of living – a lifestyle sensitive and responsive to all the dimensions of body, mind, and spirit. – Greg Anderson
Diabetic
Kidney Disease
(Diabetic Nephropathy)
Finding out that you have early diabetic nephropathy can alert you that your kidneys are in danger. It is important to take steps to protect your kidneys before the problem advances. Dr. Venu MaDhaV reDDy G. MD (Internal MeDIcIne), DM (nephroloGy), cMc Vellore Dr. c.V. harInarayan DIrector - DIabetes &enDocrInoloGy InstItute of enDocrInoloGy, DIabetes, thyroID anD osteoporosIs, sakra WorlD hospItal
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P
eople with diabetes have a lot to juggle when it comes to their healthcare. Having diabetes puts you at risk of other health problems, including heart attacks, strokes, vision loss, nerve damage, and kidney disease. While all of that may sound overwhelming, there is some good news; many of the steps you need to take to prevent one of those complications may actually help to prevent them all. The kidneys play an important
role in the body: they filter the blood, removing waste products and excess salt and water. If the kidneys become diseased, they falter in their task, leaving the blood polluted. In some cases, diabetic nephropathy can eventually cause the kidneys to stop working altogether. If that happens to you, you will need to have a kidney transplant or dialysis, a procedure that filters the blood artificially several times a week.
Diabetic nephropathy symptoms Diabetic nephropathy usually causes no symptoms, and people who have the condition often produce normal amounts of urine. To detect diabetic nephropathy, healthcare providers rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function. When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine is a sign that the kidneys are in trouble. Often people who have diabetic nephropathy also have high blood pressure.
Diabetic nephropathy risk factors Having a family history of kidney disease can increase your risk of diabetic nephropathy. Although you cannot do anything to change your family history, there are several factors that increase your risk of developing diabetic nephropathy that you can change. These include: • Having chronically elevated blood sugar levels • Being overweight or obese • Smoking • Having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Diabetic nephropathy diagnosis Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis. The urine test is looking for a protein called albumin. If there is a very large amount of
albumin (protein) in your urine, it means you have diabetic nephropathy. You may be told that you have “microalbuminuria” or “moderately increased albuminuria”. That simply means that you have trace amounts of protein in your urine, but it still means that you are at risk for getting diabetic nephropathy, assuming you do not have kidney disease caused by another condition. The same urine test that is used to diagnose diabetic nephropathy will also be used to monitor your condition over time.
Diabetic nephropathy complications The key complication of diabetic nephropathy is more advanced kidney disease, called chronic kidney disease. Chronic kidney disease can, in turn, progress even further, eventually leading to total kidney failure and the need for dialysis or kidney transplantation.
Diabetic nephropathy treatment People with diabetes often focus
If there is a very large amount of albumin (protein) in your urine, it means you have diabetic nephropathy.
on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems. For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to: • Make healthy lifestyle choices • Keep your blood sugar as close to normal as possible • Keep your blood pressure below 140/90, if possible. Lifestyle changes
Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have diabetic nephropathy: • Limit the amount of salt you eat • If you smoke, quit smoking • Lose weight if you are overweight
Manage blood sugar levels
Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL; however, these targets may need to be individualized. A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree. Manage high blood pressure
Many people with diabetes have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. A healthcare provider can
diagnose high blood pressure by measuring blood pressure on a regular basis. The treatment of high blood pressure varies. If you have mild hypertension, your healthcare provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several high blood pressure medications. Your provider can discuss the pros and cons of each medication and the goals of treatment. A blood pressure reading below 140/90 is the recommended goal for most people with diabetic nephropathy, but a blood pressure reading below 130/80 is suggested for many people who have more than 300 mg of albumin (protein) in their urine per day.
A blood pressure reading below 140/90 is the recommended goal for most people with diabetic nephropathy.
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Blood pressure medications
Most people with diabetic nephropathy need at least one medication to lower their blood pressure. Several medications can be used for this purpose, but a medication known as an angiotensin-converting enzyme inhibitor (abbreviated ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) are used most commonly. ACE inhibitors and ARBs are particularly useful for people with diabetic nephropathy because they decrease the amount of protein in the urine and can prevent or slow the progression of diabetes-related kidney disease. In fact, the kidney benefits of ACE inhibitors and ARBs are so robust that healthcare providers sometimes prescribe them for people with diabetic nephropathy who have normal blood pressure. Still, despite their kidneyprotecting abilities, ACE inhibitors and ARBs do have their downsides. For instance, ACE inhibitors cause a persistent dry cough in 5 to 20 percent of the people who take them. Some people get used to the cough; others find it so disruptive that they cannot continue taking an ACE inhibitor. For them, ARBs are often a good alternative, because ARBs are less likely to cause a cough. In rare cases, you can have more serious side effects with ACE inhibitors and ARBs. These include a decrease in kidney function or a condition called hyperkalemia, in which too much potassium accumulates in the blood. To monitor for these and other side effects, healthcare providers sometimes run blood tests soon after starting these
with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under tight control. However, women who are pregnant or attempting to get pregnant should not take angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), as these drugs can cause birth defects. Instead, other medications (such as calcium channel blockers) are used during pregnancy to keep the blood pressure in check.
Diabetic kidney disease and other diabetes complications
drugs. In some people, the medications will need to be stopped. Monitor for signs of change
After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine protein levels have improved. If the urine protein levels have not improved or your kidney function has worsened, your healthcare provider may need to adjust your medications or recommend other strategies to protect your kidneys.
Pregnancy and diabetic nephropathy If you have diabetes and are interested in getting pregnant, it is important to talk with your healthcare provider well in advance, especially if you have diabetic nephropathy. Diabetes and its attendant problems can increase the risk of complications in pregnancy, especially in women with decreased kidney function. However, many women with mild diabetic nephropathy have normal pregnancies and healthy babies. To ensure the best outcome
To ensure the best outcome with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under tight control.
If the steps you need to take to protect your kidneys sound overwhelming, keep this in mind; controlling your blood sugar and blood pressure can help to reduce the risk or severity of several other debilitating diabetes complications, including: • Vision loss (due to diabetic retinopathy) • Nerve damage (called diabetic neuropathy) • Stroke and heart attack (both of which can be fatal)
Diabetic nephropathy prevention The same measures that are used in the treatment of diabetic kidney disease are also useful in preventing it. That’s true for the lifestyle choices mentioned above, as well as for the tight control of blood sugar levels and blood pressure.
In this interview, Dr. R.M. Anjana, Managing Director, Dr. Mohan’s Diabetes Specialities Centre, discusses issues surrounding the prevalence of diabetes in India and probable solution for this challenge by emphasising on the importance of ICMR-INDIAB study and its major findings. InterVIeW by kanchI batra
“Asian Indians
progress faster through the prediabetes stage to
frank diabetes”
Q
Diabetes has got us in a quandary. China, India and USA are among the top three countries with a large number of diabetic population. What makes the Indian population more vulnerable to diabetes? Although genetic factors may play a part, the rapidity with which the diabetes prevalence has risen among these populations reflects the far-ranging and rapid socioeconomic changes to which they have been exposed over the past few decades. Traditionally, obesity and its correlate, insulin resistance, have been considered the major mediators of type 2 diabetes risk. Recent evidence shows that early loss of beta-cell function plays an important role in the pathogenesis of T2D, especially in non-obese individuals such as South Asians. Indians also have peculiar characteristics known as the ‘Asian Indian phenotype’, which increase their susceptibility for diabetes. Despite having lower prevalence of obesity as defined by body mass index (BMI), Asian Indians tend to have greater waist circumference and waist to hip ratio thus having a greater degree of central obesity. In addition, Asian Indians have more total abdominal and visceral fat for any given BMI and for any given body fat they have increased insulin resistance.
Q
The sugar disease is posing an enormous health problem to our country today. There are millions of pre-diabetes patients in India. What are the public health measures required to cut this problem at its roots?
The high prevalence of prediabetes (one in every ten individuals) as shown in the ICMR-INDIAB study would mean that there is huge pool of individuals who will eventually develop diabetes in the near future. As evidence suggests, that compared to other ethnic groups, Asian Indians progress faster through the prediabetes stage to frank diabetes. Thus
Recent evidence shows that early loss of beta-cell function plays an important role in the pathogenesis of T2D.
the major task to curb the conversion of individuals with prediabetes to diabetes includes: Step 1: Creating awareness about diabetes Step 2: Screening programme to identify high-risk group Step 3: Prevention of diabetes in high-risk individuals (prediabetes) by initiating appropriate life style modifications. Identifying high-risk individuals at the community level and then initiating lifestyle intervention measures becomes a mammoth task which needs the involvement of all sectors, right from the primary health care centres. This greatest health challenge calls for coherent and well planned approach to confront the disease threat. As a developing nation the country also faces inadequacy of funds and workforce, this reinforces the involvement of community to ease the job. This emphasise the need for a multi-factorial and multi-sectoral approach to empower the community.
Q
What are the major findings of your recent study (The Lancet Report: Prevalence of diabetes and pre-diabetes in 15 states of India) and how it is different from the previous studies?
The cumulative data from 15 states/UT reported represent a total adult population of 363·7 million people (51% of India’s adult population). Among the 15 states/UT studied, there was large variation in state-specific diabetes and prediabetes prevalence ranging from 4.3% in Bihar to 13.6% in Chandigarh and 6.0% in Mizoram to 14.7% in Tripura respectively. The prevalence of prediabetes in India also varies widely in different states from 6.0% in Mizoram to 14.6% % in Chandigarh. We estimated the overall prevalence of diabetes in India to be 7·3% and the prevalence of prediabetes to be 10·3% (WHO criteria) or 24·7% (ADA criteria), depending on which definition was used. However, these estimates are based on data from 15 states/UT out of a total of 31 to be DiabeticLivingOnline.in
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studied, and cannot be considered as final, especially since the states yet to be sampled include the National Capital Territory of Delhi, Kerala (the state with the highest reported prevalence of diabetes in India so far), Uttar Pradesh (the most populous state) and Goa (the state with the highest per capita income). Our results also show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states.
Q
How beneficial this study would be?
Diabetes and other non communicable disease risk factors
like dyslipidemia, hypertension, obesity and metabolic syndrome are imposing a large and growing burden on public health. These conditions are preventable, but are often silent in their manifestation. Therefore the ICMR-INDIAB study will help to throw light on the large burden of undiagnosed risk factors and provide an opportunity for prevention of disease in this group of people. In addition for those with an established diagnosis of diabetes the level of control is assessed and opportunity for better control of diabetes. All participants in the study are also provided with general advice on prevention of NCDs. This will help to improve the awareness about NCDs in the population at large. Thus new initiatives like these are needed to institute
The overall prevalence of diabetes was higher in urban areas (11.2%) than in rural areas (5.2%). 30 Diabetic Living
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prevention programmes to curb the huge strain of NCDs on the national healthcare systems. The ICMR-INDIAB study helps not only in earlier detection of diabetes through screening, but also in planning prevention programmes for the country.
Q
Diabetes, once a disease of the affluent, is now rampant among the urban poor too. Is diabetes actually attacking people from low socio-economic stratum? Do we blame genes and changing lifestyles?
In the ICMR-INDIAB study conducted in the 15 states/UT, the overall prevalence of diabetes was higher in urban areas (11.2%) than in rural areas (5.2%). Compared to earlier studies, in the ICMR-INDIAB study, the prevalence of diabetes was higher in individuals of low socio-economic status in the urban areas of Chandigarh, Punjab, Tamil Nadu, Andhra Pradesh and Maharashtra, which are also ranked among the more economically advanced states of India. This finding suggests that the urban areas of more affluent states have transitioned further along the diabetes epidemic, such that less affluent individuals have a higher prevalence of diabetes than their more affluent counterparts. The results suggest that as the overall prosperity of states and India as a whole increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of the society, a transition that has already been noted in high-income countries. This trend is worrying because it suggests that the diabetes epidemic is spreading to those individuals who least can afford to pay for its management. In India, economic development has drastically modified lifestyles over the course of a single generation. The two aspects of this transition are the changes in physical activity levels and food habits. In addition to these, novel risk factors ranging from exposure to environmental pollutants, smoking, depression, short sleep duration, and built environment
The ICMR-INDIAB study will throw light on the large burden of undiagnosed risk factors and provide an opportunity for prevention of disease. have also shown to be associated with increased diabetes risk.
Q
Do you think patient faithfulness to medication and lifestyle modifications can play an imperative role in diabetes management? What would you describe as good lifestyle for diabetes prevention and control? Yes, the combination of proper medication, healthy diet, adequate physical activity, and behavioral modification is the most effective approach to healthier lives in individuals with diabetes. Diabetes occurs due to the synergistic effects of behavioral risk factors such as physical inactivity, unhealthy diets, tobacco consumption and the harmful use of alcohol. A good lifestyle for diabetes prevention/ control should include good quality of the diet in addition to adequate physical activity. Healthy diets are built by combining many nutrient dense food choices in optimal proportions and these includes whole grains, legumes, fruits, vegetables, low fat dairy and nuts. Unhealthy choices such as high use of refined grains, added sugar, added salt, saturated fats and trans fats should be dished off from the diet. Reaching out both at a health clinic through diet
counseling and at the community with public health nutrition awareness programme could empower people with better informed choices for healthy diet. In addition to healthy diet, to improve overall physical activity, at least 150 minutes of moderate-intensity aerobic or at least 75 minutes of vigorous-intensity aerobic activity throughout the week is recommended to reduce the risk of diabetes. Therefore, adhering to healthy diet along with increased physical activity will reduce the burden of diabetes.
Q
How in your capacity, you are improving awareness about diabetes and promoting healthy diets and active lifestyle?
Evidence shows that awareness levels regarding diabetes are still low. Ours is a tertiary care centre for diabetes control and prevention. Thus awareness and health education is a mandate for us. All our patients are educated about diabetes prevention and control. We are regularly conducting community based mass screening and awareness programmes to tackle the epidemic of diabetes. Education about diabetes, the various risk factors, complications, importance of a healthy diet, increasing physical activity levels, regular checkups
and the need for screening is also provided to individuals with diabetes, their family members and those with high risk of developing diabetes (prediabetes) in both urban and rural areas. Low cost informational material including pamphlets, posters, a prevention booklet and CDs (In English and regional language) have been developed and distributed to impart knowledge to lay public. Awareness programmes for children and adolescents to “Catch them Young” are conducted in schools and colleges through lectures regarding primary prevention of diabetes.
Q
What are the current treatment options available?
The first line of management of all diabetic patients is diet control and exercise. Medications are used to reduce the blood sugar levels if diet and exercise fail to achieve adequate control. These can either be oral tablets (oral hypoglycemic agents or OHAs) or insulin injections. Today we have a large number of medicines to choose from and hence there is no excuse for anyone’s sugar to remain uncontrolled. Better blood glucose monitoring including use of continuous glucose monitoring and ambulatory glucose monitoring have revolutionised the management of diabetes. DiabeticLivingOnline.in
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Breastfeed
to keep diabetes
at bay
Gestational diabetes is a common phenomenon, but that shouldn’t stop you from breastfeeding your new-born child. Dr. MaDhaVI latha
32
B
reast milk for a new born human baby is as important as a cow’s milk is important for its calf. If a cow or for that matter any mammal has no option but to feed its own milk to its newborn, then why should there be exceptions for humans? Mother’s milk is tailor-made for the baby and its benefits can never be replaced by any formula or cow’s milk. With today’s cutting-edge technology, the formula companies have managed to add iron, nucleotides, minerals, fatty acids like DHA, etc. to modify cow’s milk proteins to get these powders closer to breast milk. But it’s essential to know that
breast milk is a live fluid i.e. it has live white blood cells, antibodies and many other elements which can never be present in formulas. The idea of feeding a baby breast milk is not just for nourishment and weight gain, but to enhance the baby’s immune system. A lot of independent research reports have mentioned that children who are not breastfed enough are vulnerable to risks of high respiratory infections, high blood pressure, asthma, atopy (a disorder marked by the tendency to develop allergic reactions) and diabetes, too. A new mother who has
gestational diabetes during pregnancy increases the risk that her child will become obese during childhood. However, WHO recommends that breastfeeding a baby for at least six months neutralises that risk. Breastfed children of mothers with diabetes are no more likely to be overweight at ages six to thirteen than kids whose moms didn’t have diabetes. Breastfeeding for less than six months, though, showed no benefit in reducing obesity. Babies aren’t the only ones benefitting out of breastfeeding — it improves the health of mothers as well! Studies show that among women who had gestational diabetes, breastfeeding was associated with a lower rate of type 2 diabetes for up to 2 years after childbirth. The results suggested that breastfeeding after gestational diabetes may have lasting effects that reduce a woman’s chance of developing T2D. Breastfeeding increases insulin sensitivity and improves glucose metabolism in the mother. Breastfeeding for longer than 5 months lowers the risk of type 2 diabetes by more than one
half. About 5-9 per cent of pregnant women nationwide develop high blood sugar levels even though they don’t have diabetes before pregnancy. This condition, called gestational diabetes, drastically raises a woman’s risk for type 2 diabetes later in life. In type 2 diabetes, cells don’t respond properly to insulin, a hormone that signals cells to take in the sugar glucose from the blood. If left untreated, blood sugar levels can soar and cause a host of health problems, including heart disease, stroke, kidney disease, blindness and even amputation in some cases.
5-9 per cent of pregnant women develop high blood sugar levels even though they don’t have diabetes before pregnancy.
TIPS FOR MOTHERS WITH DIABETES Breastfeeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. To help prevent low blood glucose levels, try these tips: i Plan to have a snack before or during nursing. i Drink enough fluids (plan to sip a glass of water or a caffeine-free drink while nursing). i Keep something to treat low blood glucose nearby when you nurse, so you don’t have to stop your child’s feeding. Developing a meal plan with your health care provider or dietician will help mothers to achieve gradual weight loss and simultaneously be successful at breastfeeding. For mothers who have type 1 or type 2 diabetes and use either insulin or oral blood glucose-lowering medications, it’s important to understand the safety measures while breastfeeding. Most medications used to treat diabetes can be safely used during nursing, but it’s advisable to check with a doctor on its usage.
The author is a certified lactation consultant, physical therapist and a Lamaze-certified childbirth educator
Heart
Check
Diabetes and heart attack are inter related and there are chances of a CVD attack on you. Here’s your guide to prevent it! Dr. (prof.) heMraj chanDalIa
36 Diabetic Living
sep-oct 2017
H
eart disease is twice as common in people with diabetes as compared to age and sex- matched non-diabetic population. About 65-75 per cent of people with diabetes will eventually, and often prematurely, succumb to cardiovascular disease (CVD); coronary artery disease (CAD) being the main component of CVD. Other organ systems of the body where the impact of CVD is felt is in the brain, where it manifests as a stroke, and peripheral vascular disease (disease of the arteries going into legs) where it can result in gangrene. Coronary Artery Disease is uncommon in pre-menopausal women as compared to age-matched men, but in the presence of diabetes, CAD occurs in equal number of men and women. A diabetic without prior heart attack carries the risk of developing a heart attack which is equal to the risk faced by a non- diabetic who has previously suffered from a heart attack. In other words a diabetic carries higher risk of a heart attack. Heart disease in India is particularly devastating, because type 2 diabetes, as well as heart disease, affect Indians at a younger age, thus reducing their capacity to work and earn a livelihood.
Why does CVD and coronary artery disease affect young diabetics? Diabetes accelerates atherosclerosis; a process where arterial lining is damaged and thickened and prone to occlusion. This process is accelerated because of an increasing tendency of the blood to clot and occlude vessels. Uncontrolled diabetes also sets up an inflammatory process, which injures the lining of blood vessels. Another important cause of increased CAD in diabetes is the presence of comorbidities like high blood pressure, high cholesterol and obesity. Consumption of tobacco can also be a potent co-conspirator in this process. Therefore, besides controlling blood sugar in diabetes, it is considered extremely important to also control comorbidities. Such holistic approach yields satisfying outcomes. Most diabetics have high LDLCholesterol (commonly known as bad cholesterol) and low HDL- cholesterol (commonly known as good cholesterol). Additionally, they also have high triglycerides, another type of blood fat. High blood pressure is seen in about 60-80 per cent of
people with diabetes and is 2-3 times as common as seen in non-diabetics. Obesity is a highly prevalent comorbidity. In our series, 52 per cent of type 2 diabetics were overweight or obese. Obesity can also be a component of an interesting syndrome – a constellation of several morbidities like increased abdominal girth (> 90 cm in man, >80 cm in women), high blood pressure and high cholesterol. This is called metabolic syndrome which is an unholy alliance of several comorbidities.
Can we prevent CVD in diabetes? Yes, to a great extent! A healthy lifestyle is an important requirement. Obese people must
To prevent CVD, obese people must lose at least 7-10 per cent of their body weight.
lose at least 7-10 per cent of their body weight. Diabetes must be well controlled, right at the onset of the disease. A few important studies have demonstrated that first 10 years of good glycaemic control results in significantly higher cardiovascular benefits as compared to later 10 years of control. The HbA1c, an important parameter reflecting the state of diabetes control for the previous 2-3 months should be at 6-6.5 per cent in the early phases of type 2 diabetes and 6.5-7.5 per cent in the later years. Besides glycaemic control, the blood lipids should also be controlled. This is usually done by using a statin. These are a lot of maligned drugs on the internet, but when tolerated, they are important in preventing vascular disease. The blood pressure must be controlled meticulously and should stay below 130/80 mm of Hg. Elderly people may be permitted to keep their blood pressure up to 150/85 mm of Hg. It is important to apply all types of tobacco cessation strategies, like use of nicotinecontaining chewing gums or patches and certain medications. If heart disease cannot be prevented, we should try to detect it early. Therefore, a heart check-up is required in diabetics at regular intervals and early intervention is recommended if heart disease is detected.
“It is hard to fail, but it is worse never to have tried to succeed.”—Theodore Roosevelt, 26th President
MANAGE
GOOD TO KNOW
10
WAYS TO OUTSMART DIABETES
writing Lynda Lampert, RN; photos Blaine Moats
Tight glucose control will help protect you in each of these areas from the damage of complications.
1
KIDNEYS
Because uncontrolled blood sugars break down the smallest blood vessels in the body, the kidneys are particularly at risk—their tiny vessels do a lot of heavy lifting to eliminate toxic waste from your body. Keeping blood glucose under control prevents kidney disease. 38
2 Get checked: Visit your doctor for a yearly blood test to check kidney function.
HEART
Diabetes can damage blood vessels and lead to heart attack or stroke. To protect your ticker: Get your daily servings of fruits and veggies, whole grains, and healthy fats from nuts, olive oil, and fish. Lose weight if you need to and raise your heart rate with exercise for at least 150 minutes per week, doing activities such as walking or swimming. If necessary, your doc might put you on blood pressure and lipid-improving meds.
GOOD TO KNOW
3
6
MIND & SPIRIT
You deal with a lot of stress, and that can bring on depression. If you’re feeling hopeless, sad, or angry for more than two weeks, talk to your doctor. Depression medication or talk therapy can help. In the meantime, try meditation or yoga to relax. Even going for a short walk may make you feel better.
4
GUMS Chronic high blood glucose can cause gum disease and dental issues, so see a dentist every six months and report any bleeding, tender, or red gums, as well as bad breath. Brush for at least two minutes twice a day and floss.
EYES
5
CHOLESTEROL If your glucose numbers are high, your cholesterol numbers tend to be off, too. Need to correct yours? Focus on fibre, exercise regularly, limit fried and processed foods, and eat healthy fats such as almonds, fish, and avocado in moderation. If needed, your doctor may put youon cholesterol-lowering meds, such as statins.
Years of high blood glucose levels can cause the small blood vessels in your retina (“seeing” part of the eye) to bleed, which can detach it and cause blindness—so it’s important to maintain tight control. Note vision changes, such as floating specks, and get a yearly dilated eye exam.
7
NERVES
Too much glucose in the blood over time damages and kills nerve cells, causing neuropathy—most commonly peripheral (pain, weakness, numbness). Follow your treatment plan to control blood sugar levels. It helps.
8
LIMBS It’s hard for some PWDs’ feet to heal due to poor circulation, so a small wound or untreated sore can lead to a deep injury that doesn’t get better, which may lead to amputation. Check your feet with a mirror regularly and report any issues to your provider immediately.
39
9
SKIN
Chronic high blood glucose causes your body to lose fluids at a faster rate, leading to dry skin. Skin can also become dry when nerves are damaged and don’t get the message to sweat. Keep skin clean, dry, and moisturised (avoid moisturising between your toes) and use sunscreen. Keep showers warm, not hot—this may cause further dryness and cracking, especially on your feet. Report any problems to your doctor.
10
THOSE BP NUMBERS Too much sodium in the bloodstream can lead to high blood pressure. Although there’s a genetic component to high blood pressure, you can help your body by avoiding table salt (fresh herbs are a tasty alternative) and limiting processed foods, convenience foods, and fast foods—they usually contain staggering amounts of sodium. Aim for 2,300 milligrams or less per day.
Your hands are exposed to a lot. Give them extra attention with a moisturising hand cream.
Keep blood sugars in check with expert tips: DiabeticLiving Online.com/ Control
#
KNOW YOUR NUMBERS
photos Marty Baldwin (food), Pete Krumhardt (hands)
Keeping blood glucose under control is key to preventing diabetes complications. Work with your health care team to set goals that are right for you. General ADA guidelines: i Fasting: 80–130 mg/dl i Before eating: 80–130 mg/dl i 1–2 hours after eating: < 180 mg/dl
sources Sandra Arevalo, M.P.H., RDN, CDN, CDE, AADE spokesperson; Alicia H. McAuliffe-Fogarty, Ph.D., CPsychol, vice president of the Lifestyle Management Team at the ADA
40
FITNESS
To enjoy the glow of good health, you must exercise. – Gene Tunney
FITNESS MYTHS
DEBUNKED
How workout-smart are you when it comes to nutrition? Sridhar Varadaraj- Founder & Managing Partner – Zago (RiccoDelizio) sheds some light on misconceptions surrounding fitness and nutrition.
I
n recent years, Bangalore has seen a massive rise in the number of people trying out new and exciting workout forms. Crossfit, Functional Training, Zumba, Aerial Yoga, Pilates, MMA and kickboxing have taken the city by storm, and how! You walk down the road at any point of the day and you’ll find someone dressed in workout wear, ready to work it. But as more and more people are taking to fitness, it’s becoming increasingly important to debunk certain counter-productive myths. Can you imagine not seeing the rewards of your workouts only because you’ve been taking the wrong advice or not nourishing your body well? To get the most out of your hard work, you need to gather the right information before you hit the ground running. And we’re here to help you do just that.
42
MYTH 1
PROTEINS ARE JUST FOR PROS Proteins are for everyone! Proteins not only help to repair internal or external damage, they also support the immune system and contribute to an overall feeling of wellbeing. In fact, the average human body needs a daily fix on 1.4 grams of protein for every kilogram of its weight. If you’re exercising, or even just have an active action-packed lifestyle, the best nutrients to consume after a workout or excess activity, is a mix of carbohydrates and protein. The ratio of carbohydrates to protein should be 3:1 or 4:1 (carbohydrates: protein). This combination of carbohydrates to protein helps the body resynthesise muscle glycogen more efficiently than carbohydrates alone.
MYTH 5
IT’S NECESSARY TO CARBO-LOAD THE NIGHT BEFORE A RACE
MYTH 2
ENDURANCE ATHLETES DON’T REQUIRE PROTEIN DRINKS Nutrition is undoubtedly the most important part of an athlete’s life along with training. But a lot of endurance athletes tend to focus on carbohydrate intake and pay little to no attention to protein. We have similar protein requirements as bodybuilders, but the way in which our bodies use the protein differs. We require protein to repair existing muscle tissue that is undergoing constant wear and tear from day–to–day training.
MYTH 3
PROTEINS GIVE WOMEN MANLY MUSCLES The way your muscles develop are a function of your female hormones. Proteins can never make a woman look manly, but will strengthen your body in countless ways.
MYTH 4
NONVEGETARIANS GET ENOUGH PROTEIN
Proteins can never make a woman look manly, but will strengthen your body in countless ways.
9/10 Indians are protein deficient. Women need to consume at least 1 gram per kilogram of your bodyweight in protein for your body to function at its full strength.
Carbo-loading the night before a race is a big myth. If you’re going to carbo-load, you really should be doing it throughout your training. “When I go to marathon expos, I’m amazed how many people haven’t carbo-loaded properly. Runners train so hard and then arrive with a huge handicap. Proper carbo-loading - or filling your muscles to the brim with glycogen - won’t make you faster, but it will allow you to run your best.” adds Sridhar. Now that we’ve debunked the myths, let’s talk about the nutrition we need to keep our workouts working for us. We all need post-workout proteins, but protein powders come with the tedious process of mixing and measuring. Zago has a range of healthy, ready-to-drink health drinks that are perfect for urbanites who are fitness conscious. Get out and get fit! “As a mountaineer, ultramarathoner and triathlete myself, I have learnt it the hard way on how important nutrition is to get the most of your training and to perform your best in the race. Even if you are not an athlete, and your goal is general fitness, just exercising without proper nutrition is counterproductive. As a fitness conscious person, I was hard-pressed to find healthy products in the market that were delicious enough to consume on a daily basis. That was how Zago was born. Zago is healthy on-the-go nutrition for the modern urbanite whether it’s after work out or when your stomach can’t wait for the next meal.” - Sridhar Varadaraj.
43
GOOD MOVES
YOU’RE FREE TO BE FIT Take a cue from one amazing and curvy trainer, who ditched fitness ideals to unleash her inner athlete. Kaili Meyer
A
s early as she can remember, Louise Green fantasised about being a runner. But her lifestyle didn’t fill the bill. “I smoked, drank, and ate crappy food,” says the Canadian fitness trainer. “I’d go to the track, muster up one or two laps, and quit.” Desperate to lose weight, she cycled through failed diets, most of them ending in a discouraging binge. Green felt lost, alone, and trapped in a defeating cycle. But she didn’t quit. Instead, she signed up for a learn-torun 5K clinic. When another curvy woman decked in workout gear introduced herself as the group leader, Green’s jaw dropped. She’d
44
never seen someone who looked like her in the fitness field, much less a trainer. Heading home that night, Green couldn’t stop smiling. “I realised that I didn’t always have to struggle,” she says. “I could live my athletic dreams in my current body.” Green ran that 5k. Then she ran a few more. Today, she no longer dreams of being an athlete— she is one. And she helps others become the same. “I train for triathlons. I swim, run, and cycle,” Green says. “Exercise wipes my head clean. I have to have it.” Got athlete dreams of your own? Read on for Green’s top tips.
FIND THE JOY!
1
Start slow.
2
Inhabit your body.
Too much too early leads to injury and burnout. Take an honest look at where you are now, then work your way up gradually. Walking is an excellent start, Green says. It’s free, and most anyone can do it.
The pressure to be perfect is exhausting. Forget it. “There is no ideal body. Everyone is different—so let’s celebrate that,” Green says. Focus on your own positive thoughts. Believe in yourself for exactly who you are.
3
Do what you love.
4
Make time.
5
Find your team.
Not sure what that is? Think back to childhood. If you loved to swim, revisit the pool. If dancing was your thing, try a Zumba class. Were you always on your bike? Hop back on.
“Scrolling the Internet or watching TV? Replace some of that stuff with exercise,” Green says. Put it on your calendar like you would a meeting.
Surround yourself with strong friends who push and motivate you. Hold a mini interview with potential trainers, asking things like: “What does fitness look like to you? Can you give examples of exercises I’d do?” If you like what you hear, that’s a good sign.
6
Get S.M.A.R.T.
7
Buy good gear.
“Approaching fitness without goals is like flopping in the wind,” Green says. Make goals specific, measurable, attainable, realistic, and timely. An example: I will walk a 5K next month with only two rest breaks.
If you’re uncomfortable in your clothing, your workout will reflect that. Green’s musthaves: a supportive sports bra, compression leggings or pants with drawstrings, and properly fitted athletic shoes.
8
Fuel.
9
Make it social.
“Look at exercise as a joyful way of moving your body rather than something hard-core and punishing.” —Louise Green, trainer, author
Eat right. Before a workout, Green likes Greek yogurt and fruit, natural peanut butter on whole grain bread, or an apple with a handful of almonds.
Exercising alone can be intimidating or plain boring—you’re more likely to succeed with a buddy. “My friends became people living a healthier lifestyle,” Green says. Next time you grab coffee with a pal, take it to-go and hit the trails. Or do Zumba and dinner with friends.
10
Give yourself a chance!
Starting is the hardest part, so just go for it. “No greatness comes from easy things,” Green says. “Walk through the fear and you’ll be better for it.”
Read more about Louise Green’s journey in her book, Big Fit Girl (Greystone Books, 2017). It’s full of inspirational advice and actionable tips. `1,099; amazon.in
45
THIS ISSUE’S WORKOUT
5
EASY MOVES TO HELP YOU
SLEEP BETTER TONIGHT
YOU’LL NEED i Quiet, relaxing space i Comfortable clothes i Yoga mat i Chair i Rolled towel
Diabetes is stressful. It can disrupt your physical and mental health and make you feel exhausted all day. Unfortunately, that stress can follow you into the night. PWDs are more likely to report sleep problems brought on by low blood sugar, waking to urinate, anxiety about nighttime glucose management, and more. Just one sleepless night can affect diabetes management. Studies show that interrupted sleep can cause a surge of stress hormones that can raise blood glucose and worsen
writing Robert Powell, Ph.D., CEP, CSCS, CDE; photos Carson Downing; beauty Ivy Boyd; photo review Stephanie Kite
insulin resistance. Plus, chronic sleeplessness is linked to altered eating habits, weight gain, and muscle tension. Now the good news: Aerobic and resistance training can improve mood, sleep quality, and diabetes management. Yoga and relaxation moves can, too. This workout promotes a stress-free sleep by helping you relax before bedtime— or whenever you feel overwhelmed or tight. Each exercise can be performed at any time to ease tension, but doing them in sequence will provide the best results.
1
MOUNTAIN POSE
Stand as pictured. Stand tall with chest open and shoulders back. Head is in line with pelvis, chin parallel with the floor, and palms open. Rock back and forth slightly to find your center. Close your eyes and focus on breathing. Inhale and exhale slowly. Try to extend your breath duration and depth throughout the pose. Perform 10–30 breaths.
3
CHILD’S POSE
HOW TO START AND FINISH THIS WORKOUT WARM UP: Relax your muscles with a bath or just ease into the routine. For more calorie burn, you can march in place or use a stationary bike, treadmill, or elliptical trainer for 5–10 minutes. COOL DOWN: Sit or lie in a comfortable pose after the last move. Avoid light aerobic activity, as it may counteract the relaxation effects of the workout.
Sit on your heels (rest a pillow between calves and thighs if needed). Sit up straight, lengthening your back and opening your chest. As you exhale, bow forward, bringing stomach and chest to thighs, until your forehead touches the floor (you can use a pillow here, too). Extend your arms in front of your head, fingertips straight, palms down, elbows near your ears. With each exhale, relax and reach farther. Hold up to 2 minutes.
2
FORWARD FOLD
Gentle yoga may cut feelings of stress in half and improve your sleep quality by nearly
40%
Stand with feet together and arms at sides. Focus forward. Exhale and bend forward at the hips (knees slightly bent). Lower hands toward the floor, head hanging heavy. Stretch the back of your body as you press hips up toward the ceiling. As you breathe, expand stomach to thighs during inhale and raise hips during exhale. Hold for 10 breaths.
47
THIS ISSUE’S WORKOUT
A
B NOW ... CHILL
This move is designed to help you relax and sleep. Do it at night before bedtime or while lying in bed.
5
4
CORPSE POSE
COW-CAT POSES Get on your knees, allowing shins and tops of feet to rest on the floor. Lean forward, placing hands directly under shoulders and hips above knees.
HEALTH RX
A: For cow pose, drop your stomach toward the floor (back swaying down) as you inhale. Look up while lifting chin and opening chest, dropping shoulder blades down to create distance between shoulders and head.
B: Transition to cat pose, pulling stomach in as you exhale, arching your back like a cat. At the same time, drop head slowly toward the floor, bringing chin toward chest. Repeat cow-tocat 5–20 times.
TYPE: Progressive relaxation and flexibility exercises FREQUENCY: 2–3 times per week. PWDs may gain more benefits from daily participation.
Lying on your back, straighten your legs and place arms at sides, palms up. Close your eyes and let your body feel very heavy. Focus on progressive muscle relaxation from your toes up through each limb until you reach your head, clearing your mind of all pains and problems as you go. Breathe deeply and naturally. If you get sidetracked or feel physical tension returning, start over until your entire body is relaxed.
INTENSITY: Light, controlled effort TIME: For dynamic moves, perform 5–20 repetitions. For static moves, hold each movement at least 15 seconds and progress to 2 minutes. When focusing on your breathing, perform 10–30 breaths.
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NUTRITION
Diet is the essential key to all successful healing. – Michael Tierra
The Blame Game Sugar vs Carbs vs Fats The easiest way to fix your diet is to understand the food you love. Here is your guide to do it! Sridhar Vardaraj, Founder and Managing Partner, Zago
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T
he three amigos of dieting, over the last few decades we’ve seen a gamut of reasons to go sugar-free, carb-free and fat-free with a new fad diet to support each cause and deliver a slimmer waistline. Carbohydrates and fats, though often cited as unhealthy dietary components, are macronutrients that play a vital role in maintaining your overall health. Added sugar, on the other hand, doesn’t provide much of a benefit to the body. You have probably heard that carbohydrates can lead to weight gain (and this might lead you to think that sugar is worse) but you may have also heard that fat can lead to weight gain (and this may lead you thinking fat is worse). With these two thoughts in your head you can find yourself bouncing from a low-fat diet to a low-carb diet and then come back to a low-fat diet. Carbohydrates are the body’s main source of energy. Carbs, however, aren’t all created equal. The Harvard School of Public Health recommends getting your carbs from fruits, vegetables, legumes and whole grains. All of these carbs are complex,
which means they’re filled with vitamins, minerals, fiber and other nutrients. Simple carbohydrates, like refined grains and processed foods, rarely contain the nutrients found in complex carbohydrates, therefore don’t serve a true purpose for your overall health. Dietary fats are essential to your health. They’re used by the body for growth as well as to prevent of certain diseases, such as high cholesterol, type 2 diabetes and coronary artery disease. Certain fats are healthier than others, however, and all should be consumed with limits in mind. Sugar is actually a type of carbohydrate. The best forms of sugar are those found naturally occurring in foods, such as fruits, vegetables and dairy. But added sugars found in many processed foods aren’t good for the body, when taken in great quantity. Fat-free diets which may seem healthy are actually carb-heavy foods where good fats are replaced by sugars. Sugar is turned into fat in your body because your body doesn’t like to waste energy. When you drink a soda, or eat something sugary, your body
Dietary fats are used by the body for growth and to prevent diseases.
Excessive consumption of sugar is the main culprit for slow weight loss and rapid weight gain.
cannot possibly use all that sugar energy. Your body’s solution to extra sugar energy running around the body is to store it. This is why low-carb diets work, if you keep your blood sugar low then you also keep your body from converting blood sugar into body fat. The case against sugar is a strong one; there isn’t a single study that advocates high sugar diets as favorable additions to any diet. The role sugar plays in a well-balanced diet is a small one and yet excessive consumption of sugar is the main culprit for slow weight loss and rapid weight gain. In the blame game fitness and health enthusiasts can agree, sugar consumed excessively is not the best for those looking to improve their current and long term health. Fats are a misunderstood macronutrient, good fats are essential to maintain overall health as long the differentiation is made between the good and bad. Carbs aren’t the worst of the lot as they can still be sourced from healthy sources and can provide the body with fuel.
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Guide to a DIABETIC friendly
&
HEART HEALTHY DIET! When it comes to diabetes, we need to look beyond elevated blood glucose levels. Here is your guide to a diet that will keep everything in check. LUKE COUTINHO
D
iabetes is a metabolic disorder that calls for us to address our body as a whole. Many are not aware of the close connection between diabetes and heart health, but the reality is that a heart disease is one of the most common complications of diabetes. So common that for a diabetic, the risk of a heart stroke is almost double. Diabetes predisposes an individual to have heart disease or stroke, such as high blood pressure or elevated cholesterol levels. What really happens is that the elevated blood glucose levels, over time, put a kind of pressure and inflammation to the blood vessel and nerves connected to heart. Hence the only sustainable way to protect your heart is to manage blood glucose levels (A1C), blood pressure (B) and cholesterol (C) levels, aka ABC. So how should a diabetic friendly and heart healthy diet look like that will eventually manage the ABC! It’s of primary importance to first reduce the consumption of processed foods that are rich in sugar, salt, trans-fat, highfructose corn syrup, MSG, artificial sweeteners. They not only send the blood glucose levels on a roller coaster ride, but can also increase the risk of developing obesity, most seen around the mid-riff. Increasing weight and cholesterol are directly proportional to one another. It reduces the blood flow to the organs, raising blood pressure within them and putting additional strain on the kidneys. You decrease your body fat and you lower all heart ailments along with pressure and other medical conditions,
including diabetes. Some of the best heart healthy fats as a cooking medium are extra-virgin cold-pressed oils like coconut oil, mustard oil, cow ghee, rice bran oil, groundnut oil and sesame oil. Olive oil is good too, but should be used raw by drizzling over salads and other food preparations because of having a lower smoking point. Talking about other fat sources good for heart and diabetes are nuts and seeds. They are high in omega 3 fatty acids, calm down any inflammation in body and lower the LDL (bad cholesterol). Nuts and seeds are also a good source of potassium and magnesium that relax artery walls and lowers blood pressure. Eating fatty fishes from mercury free sources like salmon, mackerel, tuna, 1-2 times in a week also support heart (provided it’s grilled or steamed, not fried). Fibre is your friend when it comes to protecting heart and pancreatic health. It cuts cholesterol and slows absorption of sugar into the bloodstream, controlling blood sugar and improving levels of blood-sugar hormones. Fresh and raw fruits, vegetables, whole grains, nuts, seeds make the best fibre sources. Diabetics can take a step ahead by filling 50 per cent of their plates with non-starchy vegetables like cabbage, broccoli, okra, green-leafy vegetables and bottle gourds. Fruits like apples, guavas, plums, oranges are rich in soluble dietary fibre called pectin that naturally lowers cholesterol, fight diabetes and support weight loss. It works by binding to fatty substances in the digestive tract,
Vegetable juice recipe that will help stabilise blood glucose and pressure, reduce cholesterol and keep kidneys in shape 1 big Carrot, 1 cucumber, a pod of garlic, 1 tsp of extra virgin cold pressed coconut oil. Juice together and consume fresh in the morning!
including cholesterol and toxins, and promote their elimination. Salt does make the food taste better, but it can also raise blood pressure if taken in unhealthy quantities. Every gram of sodium needs 32gms of water to remain stable. So imagine the amount of water it holds in the body. This increase blood volume in the body and thereby increases pressure. Also when it comes to the kind of salt, pink Himalayan salt is what one must prefer over table salt. Spices and herbs like cinnamon, turmeric, garlic cloves, thyme, basil, oregano, bay and peppermint are all good to be included in the diet to manage diabetes as well as boost heart’s health. Thymol in thyme, curcumin in turmeric, allicin in garlic and cinnamaldehyde in cinnamon are good for blood sugar and also protect the heart. Specific vitamin and mineral deficiencies should be checked like B vitamins (for proper breakdown carbohydrates and fats), Chromium (stabilises blood sugar level and decreases body fat), CoQ10 (potent anti-oxidant).
Writer is M.D. Alternative Medicines and Founder – Purenutrition.me
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THE MIGHTY
MEDITERRANEAN writing Caitlyn Diimig, RD | recipes Amy Riolo, RD | photos Blaine Moats | styling Jennifer Peterson
Most nutrition experts will tell you to steer clear of diets, and advice on what to eat seems to change with the wind. But there’s one eating pattern that dodges the stigmas and looks better with every new stack of research. Find out why the Mediterranean diet continues to reign supreme.
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A
bout half of all American adults have one or more chronic diseases—many of which are related to poor diet. What we eat and drink every day really matters. That’s why every few years the USDA and U.S. Department of Health and Human Services charge a team of powerhouse nutrition experts to review all the latest research to make smart recommendations on how to improve the American way of eating. The most recent team recommended three dietary patterns. The Mediterranean diet was one of them—again. It’s no surprise, considering that people who live in countries along the Mediterranean Sea have longer life expectancies—consistently in the top 10 of
the world, while Americans rank 31st. Researchers and dietitians took notice. Then the scientific evidence piled up: A Mediterranean dietary pattern is beneficial for weight loss, heart health, and reducing the risk for type 2 diabetes. That’s a pretty solid endorsement. Compared to the typical American diet, the Mediterranean diet includes a lot more whole grains, fruits, vegetables, beans, nuts, fish, and seafood. It promotes eating less dairy and red meat and cuts back processed foods to decrease sodium and added-sugar intake. More good news: You likely won’t need a diet overhaul to eat this way. You’re probably already doing some of it. Here’s how to sail further into those Mediterranean waters.
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Greek Roasted Fish and Vegetables
It’s best to eat two servings of fish each week, but most Americans fall woefully short of that goal. You’ll get plenty of heart-healthy omega-3s from this sheet-pan dinner with salmon and vegetables. Roasted potatoes make it a balanced meal. Want a Greek flavour? Season it all with oregano, garlic, and lemon. Feeling Italian? Use fresh parsley, garlic, and low-sodium Italian seasoning. Either way, you’ll get bold flavour without relying on salt. See recipe, p. 87
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MediterraneanStyle Egg and Tomato Skillet with Pita In the Mediterranean diet, vegetables come first, and this one-pan meal, also called shakshuka, is a great example. Originating on the North African side of the Mediterranean, the dish cradles cooked eggs in a fiery, antioxidant-packed red sauce made with tomatoes and red sweet pepper. The sauce is truly the star. Top it with Greek yogurt, a lean protein, and fresh parsley. Then soak it all up by dipping with whole grain pita bread. This meal is great any time of day. Eat it as a savoury breakfast or a satisfying, quick weeknight meal. See recipe, p. 88
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Chicken and Vegetable Souvlaki with Barley Pilaf and Tzatziki Souvlaki is the Greek cooking method of grilling on a skewer. You’ll use less fat to cook, and any excess fat from the meat will drip off into the grill. Pair skewers with high-fibre barley, a North African staple that became popular in other Mediterranean countries. Then dip your dinner into tzatziki—a cucumber-yogurt sauce with a refreshing cool flavour and a tasty way to sneak more veggies into your diet. See recipe, p. 85
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Fisherman’s Stew with Roasted Garlic Crostini Abundant access to heart-healthy fish and seafood is just one benefit of living on the Mediterranean coast, and most of its countries embrace a traditional seafood stew. France has bouillabaisse. Spain has zarzuela. For Italy, it’s zuppa di pesce. Try swapping our own version for the typical American beef stew in your fall recipe lineup. We’ve used cod, shrimp, and fresh mussels to make it easier to shop for ingredients in the local supermarket. Tomatoes, garlic, and a little whole wheat Italian bread round out this nutritious meal. See recipe, p. 87
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want to lose
weight? go
vegan! Yes, it’s true. A vegetarian diet helps control weight. But it all comes down to the amount of food you’re eating. Know how to control and see the excess weight shed! luke coutInho, M.D. Alternative Medicine and founder - Pure Nutrition
T
here has always been a discussion around the best diet for diabetics. While there are several diets floating all over, one must understand that the basics of gaining glycaemic control remains the same. A balanced meal consisting of good carbohydrates, quality proteins, good fats, fibre, vitamins and minerals in appropriate portions should be preferred the most. Such a meal choice comprising foods from all groups encourages weight loss. And when an individual sheds excess weight it automatically improves A1C. Interestingly enough, a vegetarian diet seems to fit all the requirements! A typical vegetarian diet largely depends on fruits, vegetables, nuts, seeds, beans and whole grains. Being naturally high in fibre, protein, vitamins, minerals, antioxidants and low in saturated fat, it makes the best choice for anyone who is looking to manage weight as opposed to an animal-based diet. It’s a true that nonvegetarian food is protein rich, but they also come with a high amounts of saturated fats (particularly red meat) that tend to accumulate mostly around organs (visceral fat) and muscles (muscular fat) more in a person living with a faulty lifestyle. In addition to this, most diabetics add meat to their diet thinking
they need more protein, but tend to forget that if one consumes more protein than needed it gets converted into fat leading to weight gain. Several clinical trials, where participants were fed with vegetarian diet v/s nonvegetarian diet, have shown lesser deposits of visceral and muscular fat in individuals who are on a vegetarian diet. This is an important takeaway message because increasing visceral fat is directly linked with increasing insulin insensitivity and decreased glucose metabolism as a result. Also, by taking extra fat out of muscle cells we let insulin back in to convert sugar into energy. This wakes up a sluggish metabolism and improves glucose control. The researchers also noted that reduction in muscle fat enables better mobility and muscle strength and that in turn enables more movement and exercise. A quality plant-based
diet has also shown to lower blood pressure and LDL cholesterol levels which again works in favour of diabetics. It’s seen that in an attempt to find alternatives to meat, one starts to heavily rely on vegetables, lentils, whole grains
A typical vegetarian diet largely depends on fruits, vegetables, nuts, seeds, beans and whole grains.
and beans. The combination around these foods automatically renders a meal to be low on glycaemic index because of being high in dietary fibre. This brings about a feeling of satiety and may help avoid over-eating. Having said that, going vegetarian doesn’t necessarily equal weight loss and healthier sugar control. There are many exceptions of obese diabetic vegetarians on one side and healthy non-diabetic nonvegetarians on the other side. A rare meat eater who is particular about choosing a high quality meat (free of antibiotics and hormones), cooks it the right way, supplements with a decent serving of vegetables, and has all other lifestyle factors in check then there is no way he cannot control weight! On the other hand, a pure vegetarian who might be over eating even though plant-based, has a faulty carbohydrates metabolism due to Vitamin B12 deficiency, has high stress levels, then he might find losing weight a difficult task. So while switching to a plant based diet might be a better option, it all boils down to the overall quality of food one is eating and how much of it is getting absorbed actually.
Is diabetes connected to consumption of
MILK?
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We’ve always heard that milk is the best source of vitamins, proteins, minerals and nutrients, but it is connected to diabetes. We break the myth for you! VARDA MEHROTRA, DIRECTOR, FIAPO
“S
ugar is not the cause of diabetes, so no amount of cutting down of sugar and carbohydrates can reverse or cure diabetes. In fact, it’s the other way around. High blood sugar is the result of diabetes. Diabetes is caused due to insulin resistance or lack of insulin. So it stands to reason what if we understand what the cause of insulin resistance is, or why the body stops producing insulin, and remove this cause, we will be successful in reversing diabetes.” says Dr. Nandita, an expert in plant based diabetes reversal and Nari Shakti Puraskar awardee, supporting FIAPO’s #DontGetMilked Campaign. Whilst most people consider excess sugar consumption as the cause of diabetes, science explains otherwise. Diabetes is actually caused due to insulin resistance in human body. Let’s consider the scenario for an athlete who carb-loads before their event to store fuel supply for muscles. The
carbohydrates break down the starch into glucose in the digestive track, which then circulates as blood glucose and is absorbed by muscles to burn for energy. Insulin acts as a gateway for glucose to enter a cell, rendering it the key that unlocks a door into our muscle cells for glucose absorption. When fat builds up inside our muscle cells, as Intramyocellular lipid, it disables the insulin to absorb the blood glucose, thus causing excess sugar in blood, leading to diabetes. Fat deposits, not sugar, are the cause of diabetes. This does not mean diabetics or in fact anyone should consider sugar or refined carbohydrates as a safe food. This means that fruits and whole carbs can be taken by diabetics without worrying. Consumers of dairy products are mostly unaware of the correlation between dairy and diabetes; which is why the fact that consumption of animal
products is the leading cause of diabetes often comes as a surprised to them! Studies have shown that type 2 diabetes can be reversed on a whole plantbased diet without the support of any medicines. Many individuals have successfully cured themselves by simply following a vegan diet! From an evolutionary point of view, milk is a strange food for humans. Until 10,000 years ago humans didn’t domesticate animals and didn’t drink milk. Humans stop producing Lactase (the enzyme needed to break down lactose-the sugar in milk), between the age of 2-5 years. Lactose is the sweet taste in milk that contributes approximately to 40 per cent of cow’s milk’s calories. Milk also has significant amounts of fat, protein, and carbohydrate in one package. On an average, 1 litre of
cow’s milk contains 30–35gms of protein, mostly in the form of casein, apart from smaller amounts of dozens of other proteins, minerals, vitamins A, B complex, D, K, and E. Not only this, contrary to popular belief, consumption of milk is completely unnecessary for your bone health and is associated not only with diabetes but also a host of other autoimmune diseases such as breast and prostate cancers, hypertension, hypothyroid, polycystic ovaries amongst many others. Dairy proteins promote growth hormones which increase tumour growth as well. If you’re wondering about what are the alternatives of milk to fulfil your protein and other nutrient requirements, there are a plenty. 200 grams of soy milk contains
6.6 grams of proteins whereas 244 grams of milk contains only 3.4 grams of protein. Green peas, broccoli, spinach, beet greens, lettuce, turnip, chive, cauliflower, carrot, tomato, peanuts, cashews, almonds, walnuts, legumes and pulses are few nutrient-rich plant-based alternatives to animal meat and milk and can be easily used as a substitute in anything nonvegan! Dr. Michael Greger said, ‘Popeye was right about spinach: dark green, leafy vegetables are the healthiest food on the planet. As whole foods go, they offer the most nutrition per calorie. ‘Spend some time on the Internet, and you’ll be surprised by the scientific researches that are continuing to prove the ill-effects of dairy, especially on diabetics, and the whole lot of plant based substitutes that are bound to not only equivalently substitute dairy, but also make you healthier than ever before!
Until 10,000 years ago humans didn’t use to drink milk.
Popeye was right about spinach: dark green, leafy vegetables are the healthiest food on the planet.
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NOURISH
“When walking, walk. When eating, eat.” —Rashaski, Zen proverb
JUST TRY IT!
LENTILS
Fast-cooking, fibre-rich lentils lend their nutrition superpowers to this classic Indian dish.
Lentils, also known as pulses, are a smart and filling choice for people with diabetes. Just ½ cup cooked lentils contains 36 percent of your daily iron, 10 grams of protein, and 7 grams of blood glucosestabilising fibre. Unlike other dried legumes, lentils don’t need to soak. Simply cook them in a pot of boiling water 30–45 minutes (or less, depending on the kind). We recommend prepping a big batch at once and adding them throughout the week to stews, salads, grain bowls, and homemade veggie burgers for simple, veg-powered meals. Don’t be leery of lentils for fear of GI distress, either. Lentils are less sulfurous than beans, which means less gas and bloating.
Lentil Vegetable Dal with Chicken
In a large saucepan boil 2 cups water. Stir in 1 cup lentils, rinsed and drained; reduce heat and simmer 10 minutes. If needed, stir in 1/2 cup water. In an 8-inch skillet heat 1 Tbsp. olive oil over medium-high. Add 1/2 cup chopped onion, 1 Tbsp. curry powder, 3/4 tsp. salt, and 1 clove garlic, minced; cook 3 minutes, stirring occasionally. Add 3/4 cup chopped red sweet pepper; cook 3 minutes more. Stir together onion mixture, 4 cups packed baby spinach, and lentils. Divide 170g. cooked chicken among servings. SERVES 4 (1 cup each) CAL 286, FAT 5 g (1 g sat. fat), CHOL 30 mg, SODIUM 493 mg, CARB 36 g (8 g fibre, 3 g sugars), PRO 24 g
writing Katie Shields, M.S., RDN; recipe Heather Lawless; photos Blaine Moats; styling Jennifer Peterson
Pulse power
FOOD
There is no love sincerer than the love of food. – George Bernard Shaw
FOODS FOR A
HEALTHY
HEART
There is no all-cure food which can give everything that your heart needs, but here are five foods that will lower the risk of a heart disease! Kiran Dalal
Eating for a healthy heart means filling your plate with heart-healthy stuff like fruits and vegetables, paying attention to fibre, eating healthy fats and limiting trans-fat as well as salt. And although no single food is a cure-all, certain foods have shown to improve the health of your heart. Let us understand how these foods may help lower our risk of heart disease!
2. Whole grains and beans
1. Yogurt Research shows yogurt may protect against gum disease. Left unchecked, gum disease may elevate a person’s risk for heart disease. Researchers from Japan analysed dietary intakes from nearly 1,000 adults and found those who consumed the highest levels of dairy—specifically yogurt and yogurt-type drinks— had the healthiest gums. Experts believe that probiotics may help to counter growth of the “unfriendly” bacteria in the mouth. Probiotics are live active cultures used to ferment foods; such as yogurt, studies suggest that they may improve digestion and boost immunity too.
Research suggests that people who eat nuts two to four days or more per week have a lower chances of a heart disease.
People who eat plenty of whole grains tend to be leaner and have a lower risk of heart disease than those who do not. This is probably because whole grains contain antioxidants, phytoestrogens and phytosterols that are protective against coronary disease. The fibre in whole grains also has its benefits. Various studies link a high-fibre diet with a lower risk of heart disease. In a Harvard study of female health professionals, people who ate a high-fibre diet had a 40 per cent lower risk of heart disease than those who ate a low-fibre diet. Eating beans regularly is good for our heart. A study published in the Journal of Nutrition suggests having just 1/2 cup of cooked beans daily might lower cholesterol level. Aim to include foods that are rich in soluble fibre as studies
show that it helps to lower “bad” Cholesterol (LDL). Soluble fibre binds bile acid, a key component in fat digestion that our bodies make from cholesterol. We can’t digest fibre, so when bile acids are bound to it, they get ushered out of the body as waste. This causes the body to convert more cholesterol into bile acids, which ultimately has the effect of lowering circulating cholesterol levels. Foods high in soluble fibre include oatmeal, barley, beans, okra and eggplant, and citrus fruit, such as oranges.
3. Nuts Nuts are chock-full of vitamins, minerals, monounsaturated fats and low levels of saturated fats. Research suggests that people who eat nuts—walnuts, almonds, hazelnuts, pistachios,
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pine nuts and peanuts (which actually are legumes)—two to four days or more per week have a lower chances of a heart disease than people who eat them less often.
5. Green Tea
4. Fruits Fruits have always been a man’s best friend. Haven’t we all heard that an apple a day keeps the doctor away! Here are the fruits that should be in your diet. A) APPLES Apples are associated with a lower risk of death from both coronary heart disease and cardiovascular disease. They are rich in pectin, a form of soluble fibre known to help lower cholesterol, and they provide a decent amount of vitamin C, another antioxidant for a stronger heart. B) BERRIES Eating just under a cup of mixed berries daily for eight weeks is associated with increased levels of good cholesterol (HDL) and lowered blood pressure, two positives when it comes to a healthy heart, according to a study of 72 middle-age people published recently in the American Journal of Clinical Nutrition. Polyphenols may increase levels of nitric oxide, a molecule that produces a number of heart-healthy effects. One is helping to relax blood vessels, which subsequently results in lowered blood pressure. C) POMEGRANATES Studies have shown that the fruit may help reduce the build-up of plaque in arteries and also lower
blood pressure. Experts believe that pomegranate’s benefits come from its powerful punch of polyphenols—including anthocyanin (found in blue, purple and deep-red foods) and tannins (found in wine and tea). D) BANANAS The potassium in bananas helps maintain normal heart function and the balance of sodium and water in the body. Potassium helps the kidneys excrete excess sodium, thereby contributing to healthy blood pressure. This mineral is especially important for people taking diuretics for heart disease, which not combat sodium and water retention, but also strip potassium from the body in the process. E) TOMATOES An excellent source of vitamin C, vitamin A, potassium and fibre, tomatoes are high in lycopene, which works with other vitamins and minerals to aid in disease prevention. Research suggests that the combination of nutrients in tomatoes may help prevent cardiovascular disease. Cooking tomatoes may actually increase the health benefits of this lush fruit because although cooked tomatoes have less vitamin C, their lycopene is more available and antioxidant activity is undiminished by cooking.
Although cooked tomatoes have less vitamin C, their lycopene is more available and antioxidant activity is undiminished by cooking.
Some of the strongest evidences of tea’s health benefits come from studies of heart disease. Scientists have found that those who drink 2 (12 ounces) or more cups tea a day are about half as likely to have a heart attack as non-tea drinkers. Scientists also reported that Japanese men who drank a cup of green tea daily significantly lowered their risk of developing a gum disease —more the tea, lower the risk. The researchers believe antioxidants called catechins in green tea are the key. Catechins hamper the body’s inflammatory response to the bacteria that causes gum disease. People with gum disease are twice as likely to suffer from heart problems.
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W H AT ’ S I N S E A S O N
PEARS
These diabetes-friendly fruits are affordable and abundant right now. Each variety has its own subtle flavour and texture— and packs exceptional nutrition. Choose a favourite for these recipes.
recipes Andrea Kirkland, M.S., RD | photos Jason Donnelly | styling Jennifer Peterson
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FORELLE
RED ANJOU & ANJOU
KO R E A N & ASIAN SECKEL
WHAT’S YOUR TYPE
i Anjou or D’Anjou: juicy with citrus notes i Red Anjou: fresh and slightly tart i Bartlett: fragrant with lots of juice i Red Bartlett: sweet and juicy i Bosc: crisp and woodsy with a hint of honey i Comice: subtle butter notes i Concorde: earthy with distinct vanilla flavour i Forelle: crisp, tangy, and refreshing
BARTLETT
BOSC
i Korean or Asian: crunchy, juicy, and sweet i Seckel: petite and crunchy i Starkrimson: aromatic, moist, and delicate
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Open-Face Pear and Ham Ciabatta, p. 89
Pear Crostini with Blue Cheese Spread, p. 84
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EAT THE PEEL Pear peels are rich in antioxidants, which fight off damaging free radicals in the body. And removing the peel results in a 25 per cent decrease of vitamin C, according to a 2011 study published in the Journal of Agricultural and Food Chemistry.
Chocolate, Pear, and Pistachio Tart, p. 86
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PERFECT PEARS How to tell if a pear is ripe and ready:
1
COLOUR TEST
Don’t use peel colour as an indicator. Most have little colour change. Only Bartletts brighten as they ripen.
CHECK THE NECK
Press your thumb to the neck. If it yields to gentle pressure, it’s ready. To ripen, leave it on the counter at room temp.
3
CHILL OUT
Once the pear is ripe, you can refrigerate it to slow the ripening process and make it last longer.
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CinnamonGinger Spiced Pear Muffins, p. 84
Sources USA Pears; Melissa’s Produce
2
PEAR DOWN People who eat a pear a day are 35 per cent less likely to be obese compared with non-pear eaters, according to National Health and Nutrition Examination Survey (NHANES) 2001–2010 data. Perhaps that’s due to the fruit’s hunger-satisfying fibre—one pear contains 20 per cent of your daily value.
Roasted Pear with Crumble Topping, p. 86
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as easy s a e ls ar er a w o eth er b Pow Toss tog h, a lean d : e rc 1-2-3 ious sta re-pack l that b a it nutr in, and fi asty me r. We’ll t u e prot ce for a on flavo u prod ’t skimp ! n does you how show
CARIBBEAN BOWLS pg. 88 recipes Andrea Kirkland, M.S., RD | photos Blaine Moats | styling Jennifer Peterson | illustrations Cory Say
SOUTHERN BARBECUE PORK BOWLS pg. 89 PROTEIN: Pork
STARCH: Corn
PRODUCE: Cabbage
SAUCE: Barbecue
PORK, APPLE & GRAPE BOWLS pg. 89 PROTEIN: Pork Tenderloin
STARCH: Red Quinoa
PRODUCE: Arugula, Apple & Grapes
DRESSING: Honey-Mustard
LAMB & CHICKPEA BOWLS pg. 84 PROTEIN: Lamb Sirloin
STARCH: Chickpeas
PRODUCE: Cucumber & Tomatoes
DRESSING: Red Wine Vinaigrette
SALMON AND SQUASH BOWLS pg. 87 PROTEIN: Salmon
STARCH: Farro
PRODUCE: Zucchini, Summer Squash & Mushrooms
DRESSING: Lemon-Caper Vinaigrette
SHRIMP, BULGUR & TOMATO BOWLS pg. 88 PROTEIN: Shrimp
STARCH: Bulgur
PRODUCE: Grape Tomatoes
DRESSING: Lemon Vinaigrette
CHICKEN BURRITO BOWLS pg. 85 PROTEIN: Chicken
STARCH: Quinoa & Black Beans
PRODUCE: Tomatoes & Lettuce
DRESSING: Avocado-Lime Crema
BREAD WINNER Panzanella Salad In a 10-inch skillet heat 1 Tbsp. olive oil over medium. Add 56 g. stale whole wheat bread, torn. Cook and stir 5 minutes or until toasted. Add 1 clove garlic, minced; cook and stir 1 minute. In a bowl combine bread mixture, 4 cups torn romaine lettuce, and ¼ cup each pomegranate seeds and crumbled goat cheese. Toss with 2 Tbsp. light Italian salad dressing. SERVES 8 (1 cup each) CAL 59, FAT 3 g (1 g sat. fat), CHOL 3 mg, SODIUM 91 mg, CARB 5 g (1 g fibre, 2 g sugars), PRO 2 g
The egg rehydrates the bread in this frittata so you have tender pieces—just like with French toast.
Broccoli Frittata In a bowl whisk together 2 eggs, 2 egg whites, 1 Tbsp. low-fat milk, and dash black pepper. In a 6-inch oven-going skillet heat 1 tsp. olive oil over medium. Add ½ cup broccoli florets and ¼ cup chopped onion; cook 4 minutes, stirring occasionally. Stir in 1 ⅓ cups stale whole wheat bread cubes. Add egg mixture. Cook 2 minutes or until eggs are partially set. Sprinkle with 3 Tbsp. shredded sharp cheddar cheese. Bake at 185°C 6 minutes or until eggs are set. Sprinkle with snipped fresh parsley. SERVES 2 (1/2 frittata each) CAL 255, FAT 12 g (4 g sat. fat), CHOL 197 mg, SODIUM 329 mg, CARB 22 g (3 g fibre, 3 g sugars), PRO 16 g
Cranberry Bread Pudding Coat a 2-qt. square baking dish with nonstick cooking spray. In a large bowl whisk together 3 eggs, 1 ½ cups low-fat milk, 3 Tbsp. vanilla instant pudding and pie filling mix, and 1 tsp. each ground cinnamon and vanilla. Stir in 5 cups stale whole wheat bread cubes and ⅓ cup dried cranberries. Transfer to prepared baking dish; press lightly with a spoon. Bake at 190°C 35 minutes or until center is set. Sprinkle with 1 tsp. powdered sugar. SERVES 9 (1/9 bread pudding each) CAL 146, FAT 3 g (1 g sat. fat), CHOL 64 mg, SODIUM 233 mg, CARB 23 g (2 g fibre, 11 g sugars), PRO 7 g
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recipes Lauren Grant; photos Blaine Moats; styling Jennifer Peterson
Stale bread? Think beyond the crumbs. Use that past-its-prime loaf in one of our recipes. Cutting food waste never tasted so good.
RECIPE GUIDE High-standards testing This seal assures you that every recipe in this issue has been tested by the Better Homes and Gardens® Diabetic Living® Test Kitchen. This means each recipe is practical, reliable, and meets our high standards of taste appeal. ®
Inside our recipes We list precise serving sizes to help you manage portions. Test Kitchen tips and sugar subs are listed after recipe directions. If kitchen basics such as ice, salt, black pepper, oil, and nonstick cooking spray are not listed in the ingredients list, then they are italicized in the directions.
Nutrition information Nutrition facts per serving are noted with each recipe; ingredients listed as optional are not included. When ingredient choices appear, we use the first one to calculate the nutrition analysis.
Key to abbreviations CAL = calories CARB = carbohydrate CHOL = cholesterol PRO = protein
APPETIZERS & SIDES
Pear Crostini with Blue Cheese Spread SERVES 8 HANDS ON 20 min. TOTAL 30 min.
170 g. white or whole wheat baguettestyle French bread, cut into 24 slices Nonstick cooking spray 56 g. reduced-fat cream cheese (neufchatel), softened 1/4 cup crumbled blue cheese (25 g.) 3 Tbsp. light sour cream 2 cloves garlic, minced 1 medium pear, cut into 24 slices or 48 very thin slices 1 Tbsp. purchased balsamic glaze 1 tsp. fresh thyme 1. Preheat oven to 200°C. Arrange bread slices on a large baking sheet and coat with cooking spray. Bake 10 minutes or until golden. Remove; cool on wire racks. 2. Meanwhile, in a medium bowl stir together both cheeses, sour cream, and garlic. 3. Spread cheese mixture on bread and top with pear slices. Drizzle with glaze and top with thyme. PER SERVING (3 crostini each) CAL 103, FAT 3 g (2 g sat. fat), CHOL 9 mg, SODIUM 181 mg, CARB 15 g (1 g fibre, 3 g sugars), PRO 3 g
HANDS ON 30 min. TOTAL 35 min.
450 g. boneless lamb leg sirloin or beef sirloin, trimmed and cut into 1-inch pieces 1 tsp. ground coriander 1/2 tsp. ground cumin 1/4 tsp. crushed red pepper 1/4 cup snipped fresh mint 2 tsp. lemon zest 2 cloves garlic, minced 2 425-g. cans no-salt-added garbanzo beans (chickpeas), rinsed and drained 1 cup chopped tomatoes 1 cup chopped English cucumber 1/4 cup snipped fresh parsley 1 Tbsp. red wine vinegar 1/4 cup plain fat-free Greek yogurt (optional) 1. Preheat oven to 190°C. Toss meat, 1 Tbsp. olive oil, the coriander, cumin, 1/4 tsp. each salt and black pepper, and the crushed red pepper in a 2-qt. baking dish. Roast 20 minutes. 2. For gremolata, in a small bowl combine mint, lemon zest, and garlic. 3. In a large bowl combine chickpeas, tomatoes, cucumber, parsley, vinegar, 1 Tbsp. olive oil, and 1/4 tsp. each salt and black pepper. Divide meat, chickpea mixture, gremolata, and, if desired, yogurt among bowls. PER SERVING (85 g. meat + 11/4 cups chickpea
mixture + 1 Tbsp. gremolata each) CAL 366, FAT 15 g (3 g sat. fat), CHOL 74 mg, SODIUM 369 mg, CARB 27 g (7 g fibre, 3 g sugars), PRO 32 g
BREAKFAST
LAMB
Test Kitchen tip: handling hot chile peppers Chile peppers can irritate skin and eyes. Wear gloves when working with them. If your bare hands do touch the peppers, wash your hands with soap and warm water.
Cinnamon-Ginger Spiced Pear Muffins SERVES 18
Lamb and Chickpea Bowls
HANDS ON 20 min. TOTAL 1 hr.
SERVES 4
1 cup all-purpose flour
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1/2 11/2 1 1/2 1/2 1/4 1/4 1 1 2/3 1/3 2 2 2 1
cup whole wheat flour tsp. baking powder tsp. ground cinnamon tsp. baking soda tsp. ground ginger tsp. salt tsp. ground nutmeg egg, lightly beaten cup buttermilk cup packed brown sugar* cup canola oil tsp. vanilla medium pears tsp. lemon juice tsp. powdered sugar
1. Preheat oven to 200°C. Coat eighteen 2 1/2-inch muffin cups with nonstick cooking spray. In a bowl combine the first eight ingredients (through nutmeg). Make a well in center of mixture. 2. In a small bowl combine the next five ingredients (through vanilla). Add to well; stir just until moistened. 3. Peel pears; cut one into 18 thin slices and brush with lemon juice. Chop remaining pear; fold into batter. Spoon batter into prepared cups. Top with pear slices. 4. Bake on separate oven racks 18 minutes, switching positions of pans halfway. Remove from cups; cool. Dust with powdered sugar. PER SERVING (1 muffin each) CAL 127, FAT 5 g (1 g sat. fat), CHOL 11 mg, SODIUM 129 mg, CARB 20 g (1 g fibre, 11 g sugars), PRO 2 g
*Sugar Sub Choose Splenda Brown Sugar Blend. Follow package directions to use 2/3 cup equivalent. PER SERVING WITH SUB Same as above, except CAL 114, CARB 15 g (6 g sugars)
CHICKEN
Chicken and Vegetable Souvlaki with Barley Pilaf and Tzatziki
SERVES 4 HANDS ON 1 hr. TOTAL 1 hr. 30 min.
1/2 1/4 1/4 6 450 2 1/2 2 1/2 1 1/4 2 2 1
cup lemon juice cup snipped fresh parsley cup olive oil cloves garlic, minced g. skinless, boneless chicken breast halves, cut into 1-inch pieces cups cherry tomatoes cup regular pearled barley Tbsp. snipped fresh basil cup coarsely shredded English cucumber 150-g. carton plain low-fat Greek yogurt cup snipped fresh dill medium zucchini, halved lengthwise and sliced 1/4 inch thick medium sweet peppers, cut into 1-inch pieces small red onion, cut into 8 wedges Lemon wedges
1. In a large shallow dish combine lemon juice, parsley, oil, garlic, 1/2 tsp. salt, and 1/4 tsp. black pepper. Add chicken, turning to coat. Cover; marinate in refrigerator up to 2 hours. 2. For pilaf, cut 1 cup of the tomatoes in half. In a small saucepan combine halved tomatoes, 1 cup water, the barley, basil, and 1/4 tsp. salt. Bring to boiling; reduce heat. Simmer, covered, 45 minutes or until barley is tender and water is absorbed. 3. For sauce, press cucumber through a sieve to remove as much liquid as possible. In a small bowl combine cucumber, yogurt, dill, and 1/4 tsp. salt. 4. Drain chicken, discarding marinade. On eight 14-inch skewers thread chicken, remaining 1 cup whole tomatoes, the zucchini, sweet peppers, and onion, leaving 1/4 inch between pieces. 5. Grill chicken skewers, covered, over medium 10 to 12 minutes or until chicken is no longer pink and vegetables are tender, turning once. 6. If desired, serve pilaf with additional basil. Serve skewers with pilaf, sauce, and lemon wedges. PER SERVING (2 chicken skewers + 1/2 cup pilaf + 3 Tbsp. sauce each) CAL 371, FAT 11 g (2 g sat. fat), CHOL 86 mg, SODIUM 500 mg, CARB 35 g (8 g fibre, 10 g sugars), PRO 35 g
Chicken Burrito Bowls SERVES 4 HANDS ON 35 min. TOTAL 35 min.
1/2 cup quinoa, rinsed and drained 1 tsp. ground cumin 2 220-g. skinless, boneless chicken breast halves, halved horizontally 1 Tbsp. olive oil 1/4 of an avocado, peeled 1/4 cup finely snipped fresh cilantro 2 Tbsp. plain fat-free Greek yogurt 1 to 2 tsp. lime juice 3 to 4 Tbsp. fat-free milk (optional) 2 cups shredded lettuce 1 cup chopped tomatoes 3/4 cup canned reduced-sodium black beans, rinsed and drained 1/4 cup shredded reduced-fat cheddar cheese (25 g.) 2 Tbsp. roasted and salted pumpkin seeds (pepitas) 1. Cook quinoa with cumin and 1/4 tsp. each salt and black pepper according to package directions. 2. Sprinkle both sides of chicken with 1/4 tsp. each salt and black pepper. In a 10-inch nonstick skillet heat oil over medium. Add chicken; cook 6 to 8 minutes or until no longer pink, turning once. Remove and let stand 5 minutes; slice into strips. 3. In a small bowl combine avocado, cilantro, yogurt, and lime juice until nearly smooth. If desired, thin with milk to reach drizzling consistency. 4. Divide lettuce among bowls. Top with quinoa, tomatoes, beans, chicken, avocado mixture, cheese, and pumpkin seeds. PER SERVING (3 oz. chicken + 1/3 cup quinoa + 3 Tbsp. beans + 1/2 cup lettuce each) CAL 377, FAT 14 g (3 g sat. fat), CHOL 88 mg, SODIUM 512 mg, CARB 26 g (6 g fibre, 2 g sugars), PRO 36 g
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DESSERTS
PER SERVING (1 piece each) CAL 173, FAT 9 g (5 g sat. fat), CHOL 7 mg, SODIUM 86 mg, CARB 23 g (2 g fibre, 8 g sugars), PRO 2 g
sat. fat), CHOL 3 mg, SODIUM 11 mg, CARB 13 g (1 g fibre, 12 g sugars), PRO 1 g
Peanut Butter-Chocolate: Dip slices into 85 g. melted peanut butter pieces and 1/8 tsp. coconut oil. Sprinkle with 3 Tbsp. mini semisweet chocolate pieces.
Chocolate, Pear, and Pistachio Tart SERVES 10 HANDS ON 30 min. TOTAL 3 hr.
1 1 2 11/2 4 11/2 85 1 1 1 2
cup all-purpose flour Tbsp. sugar Tbsp. cold butter, cut up Tbsp. light sour cream to 5 Tbsp. ice water cups frozen light whipped topping, thawed g. bittersweet chocolate, finely chopped medium pear, sliced tsp. lemon juice tsp. honey Tbsp. salted roasted pistachio nuts, chopped
1. Preheat oven to 232°C. In a bowl stir together flour, sugar, and 1/4 tsp. salt. Using a pastry blender, cut in butter until mixture resembles fine crumbs. Add sour cream and 1 Tbsp. canola oil; toss with a fork. Gradually moisten with the ice water, tossing gently. Gather pastry into a ball, kneading gently just until it holds together (pastry may be crumbly). Form into a rectangle. Cover in plastic wrap; chill 1 hour. 2. Roll pastry between waxed paper into a 16×7-inch rectangle, lightly flouring as needed. Press into a 14×4 1/2-inch tart pan with removable bottom; trim edges. Prick pastry; line with a double thickness of foil. Bake 8 minutes; remove foil. Bake 6 to 8 minutes more or until golden. Cool. 3. In a bowl combine whipped topping and chocolate. Microwave 30 seconds to melt. Spread in tart shell; let stand 15 minutes. 4. Toss pear slices with lemon juice. Arrange slices on tart; top with honey and nuts. Chill 1 hour or until set. To serve, slice into 10 pieces.
Little Dippers SERVES 6 HANDS ON 30 min. TOTAL 20 min.
For each variation, use 1 medium apple, cut into 12 slices. Arrange coated slices on a waxed paper-lined tray and let stand until firm before serving.
Maple-Pecan: Dip slices into 85 g. melted butterscotch pieces and 1/8 tsp. coconut oil. Sprinkle with 3 Tbsp. finely chopped toasted pecans. PER SERVING (2 slices each) CAL 120, FAT 6 g (4 g sat. fat), CHOL 0 mg, SODIUM 10 mg, CARB 15 g (1 g fibre, 13 g sugars), PRO 0 g
Dark Chocolate-Ginger: Dip
Strawberry Shortbread: Dip slices into 85 g. melted white chocolate. Sprinkle with 3 Tbsp. crushed shortbread cookies. Let firm. Drizzle with 3 Tbsp. warmed reduced-sugar strawberry fruit spread. PER SERVING (2 slices each) CAL 121, FAT 6 g (3 g sat. fat), CHOL 3 mg, SODIUM 24 mg, CARB 18 g (1 g fibre, 15 g sugars), PRO 1 g
Chocolate S’more: Dip slices into 85 g. melted bittersweet chocolate. Sprinkle with 3 Tbsp. crushed graham crackers and 12 tiny marshmallows, cut up. PER SERVING (2 slices each) CAL 104, FAT 6 g (3 g sat. fat), CHOL 0 mg, SODIUM 17 mg, CARB 15 g (2 g fibre, 10 g sugars), PRO 1 g
slices into 85 g. melted bittersweet chocolate. Sprinkle with 3 Tbsp. crushed gingersnaps. PER SERVING (2 slices each) CAL 101, FAT 6 g (3 g sat. fat), CHOL 0 mg, SODIUM 18 mg, CARB 15 g (2 g fibre, 9 g sugars), PRO 1 g
White Chocolate-Granola: Dip slices into 85 g. melted white chocolate. Sprinkle with 1/4 cup granola. PER SERVING (2 slices each) CAL 108, FAT 5 g (3 g sat. fat), CHOL 3 mg, SODIUM 21 mg, CARB 16 g (1 g fibre, 13 g sugars), PRO 1 g
Caramel-Pretzel: Dip slices into 85 g. melted white chocolate. Sprinkle with 3 Tbsp. crushed pretzels. Let firm. Drizzle with 1 1/2 tsp. caramel ice cream topping. PER SERVING (2 slices each) CAL 104, FAT 5 g (3 g sat. fat), CHOL 3 mg, SODIUM 38 mg, CARB 15 g (1 g fibre, 13 g sugars), PRO 1 g
Margarita: Dip slices into 85 g. melted white chocolate. Sprinkle with 2 Tbsp. lime zest. PER SERVING (2 slices each) CAL 93, FAT 5 g (3 g
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PER SERVING (2 slices each) CAL 132, FAT 6 g (5 g sat. fat), CHOL 0 mg, SODIUM 29 mg, CARB 17 g (3 g fibre, 13 g sugars), PRO 3 g
Roasted Pear with Crumble Topping SERVES 4 HANDS ON 15 min. TOTAL 45 min.
2 medium red pears, halved lengthwise 2 tsp. butter, melted 1/4 tsp. vanilla 1/4 cup regular rolled oats 2 Tbsp. coarsely chopped pecans 1 Tbsp. packed brown sugar* 1/8 tsp. salt 1/8 tsp. ground cinnamon 1/2 cup light vanilla ice cream 1. Preheat oven to 200°C. Line a 15×10inch baking pan with parchment paper. Brush cut sides of pears with 1 tsp. of the butter. Place, cut sides down, on one side of prepared pan. Roast 15 minutes.
2. In a bowl stir together the remaining 1 tsp. butter and the vanilla. Stir in the next five ingredients (through cinnamon). Add oat mixture to baking pan. 3. Roast 8 to 10 minutes more or until pears are tender and oats are golden, stirring oats once. Cool slightly. Serve with ice cream. PER SERVING (1 pear half + 2 Tbsp. oat mixture + 2 Tbsp. ice cream each) CAL 150, FAT 6 g (2 g sat. fat), CHOL 10 mg, SODIUM 103 mg, CARB 24 g (3 g fibre, 15 g sugars), PRO 2 g
*Sugar Sub Choose Splenda Brown Sugar Blend. Follow package directions to use 1 Tbsp. equivalent. Roast pears 18 minutes. Then add oat mixture to pan and roast 5 minutes. PER SERVING WITH SUB Same as above, except CAL 149, CARB 23 g (14 g sugars)
FISH & SEAFOOD
intact if desired. Rinse fish and shrimp; pat dry. Cut fish into 2-inch pieces. Scrub mussels in cold water. 3. In a 6-qt. Dutch oven heat 2 Tbsp. olive oil over medium. Add parsley and minced garlic; cook and stir 30 seconds. Add tomato paste; cook and stir 1 minute. Add wine. Cook and stir over high 5 minutes. Add tomatoes, crushed red pepper, and 1/4 tsp. black pepper. Cook 5 minutes, stirring occasionally. Stir in 1 cup water. Simmer, covered, 10 minutes. 4. Add the fish, shrimp, and mussels. Cook, covered, 5 to 7 minutes or until fish flakes easily, shrimp are opaque, and mussel shells open. Discard any mussels that do not open. 5. For crostini, brush both sides of bread with 1 Tbsp. olive oil; place on a baking sheet. Bake 3 minutes or until toasted. Squeeze roasted garlic from bottom of bulb; spread garlic onto bread. 6. If desired, top stew with additional parsley. Serve with garlic crostini. PER SERVING (2 cups each) CAL 417, FAT 12 g (2 g sat. fat), CHOL 160 mg, SODIUM 410 mg, CARB 23 g (3 g fibre, 3 g sugars), PRO 47 g
1 Tbsp. olive oil, the garlic, and 1/8 tsp. each sea salt and black pepper. Transfer to a 15×10-inch baking pan; cover with foil. Roast 30 minutes. 2. Toss sweet peppers, tomatoes, parsley, olives, and oregano with 1 Tbsp. olive oil and 1/8 tsp. each sea salt and black pepper. 3. Rinse salmon; pat dry. Sprinkle with 1/4 tsp. each sea salt and black pepper. Spoon sweet pepper mixture over potatoes and top with salmon. Roast, uncovered, 10 minutes more or just until salmon flakes. 4. Zest lemon. Squeeze juice from lemon over salmon and vegetables. Sprinkle with zest. PER SERVING (113 g. salmon + 1 1/2 cups vegetables each) CAL 422, FAT 19 g (2 g sat. fat), CHOL 78 mg, SODIUM 593 mg, CARB 31 g (6 g fibre, 7 g sugars), PRO 33 g
Salmon and Squash Bowls SERVES 4 HANDS ON 45 min. TOTAL 45 min.
Fisherman’s Stew with Roasted Garlic Crostini SERVES 6 HANDS ON 30 min. TOTAL 1 hr. 15 min.
1 garlic bulb 907 g. fresh or thawed frozen skinless cod fillets 340 g. fresh or thawed frozen large shrimp in shells 340 g. fresh mussels in shells, debearded 1 Tbsp. snipped fresh parsley 5 cloves garlic, minced 1 Tbsp. no-salt-added tomato paste 1 cup dry white wine 2 cups chopped tomatoes 1/2 to 1 tsp. crushed red pepper 6 28-g. slices whole wheat Italian or sourdough bread 1. Preheat oven to 200°C. Cut off top 1/2 inch of garlic bulb. Place bulb, cut end up, on a double thickness of foil. Drizzle with 1 tsp. olive oil; wrap with the foil. Roast garlic 50 minutes; cool. 2. Peel and devein shrimp, leaving tails
Greek Roasted Fish and Vegetables SERVES 4 HANDS ON 35 min. TOTAL 55 min.
450 g. fingerling potatoes, halved lengthwise 5 garlic cloves, coarsely chopped 4 140- to 170-g. fresh or thawed frozen skinless salmon fillets 2 medium red, yellow, and/or orange sweet peppers, cut into rings 2 cups cherry tomatoes 11/2 cups chopped fresh parsley 1/4 cup pitted Kalamata olives, halved 1/4 cup finely snipped fresh oregano or 1 Tbsp. dried oregano, crushed 1 lemon 1. Preheat oven to 218°C. Place potatoes in a large bowl; toss with
3/4 2 450 3 450
1 2 2 1 1
cup farro lemons g. fresh skinless salmon fillet cloves garlic, minced g. zucchini and/or yellow summer squash, cut into 1/4-inch slices 226-g. pkg. fresh button mushrooms, halved Tbsp. finely chopped shallot Tbsp. snipped fresh parsley Tbsp. drained capers tsp. Dijon-style mustard
1. Preheat oven to 232°C. Line a 15×10inch baking pan with foil. Cook farro with 1/4 tsp. salt according to package directions. 2. Meanwhile, remove 1 tsp. zest and squeeze 1/4 cup juice from lemons. Rinse salmon; pat dry. Place salmon in prepared pan. Rub salmon with 2 tsp. olive oil, one of the garlic cloves, and 1/8 tsp. each salt and black pepper. Sprinkle with 1/2 tsp. of the lemon zest and 1 Tbsp. of the juice. Bake 13 to 15 minutes or just until salmon flakes. 3. Coat a 10-inch skillet with nonstick cooking spray; heat over medium-high.
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Add squash, remaining two cloves garlic, and 1/8 tsp. each salt and black pepper. Cook 7 minutes or until squash is crisp-tender, stirring occasionally. Remove from skillet. Add 2 tsp. olive oil to skillet; add mushrooms. Cook 7 minutes or just until mushrooms are tender. Return squash; heat through. 4. For vinaigrette, whisk together shallot, parsley, capers, mustard, remaining 1/2 tsp. lemon zest and 3 Tbsp. juice, 2 tsp. olive oil, and 1/4 tsp. each salt and black pepper. 5. Divide farro, squash mixture, and salmon among bowls. Top with vinaigrette and, if desired, additional parsley. PER SERVING (85 g. salmon + 1/2 cup farro + about 3/4 cup squash mixture + 1 Tbsp. vinaigrette each) CAL 392, FAT 15 g (2 g sat. fat), CHOL 62 mg, SODIUM 577 mg, CARB 35 g (6 g fibre, 5 g sugars), PRO 31 g
are opaque. 4. Divide bulgur among bowls. Top with shrimp, tomatoes, pine nuts, cheese, and remaining basil.
MEATLESS MAIN DISHES Caribbean Bowls SERVES 4 HANDS ON 40 min. TOTAL 55 min.
Mediterranean-Style Egg and Tomato Skillet with Pita HANDS ON 30 min. TOTAL 40 min.
SERVES 4 HANDS ON 25 min. TOTAL 30 min.
680 g. fresh or frozen large shrimp in shells 1 cup bulgur 2 cups boiling water 2 Tbsp. lemon juice 1 cup fresh basil leaves, coarsely snipped 2 cups grape tomatoes, halved 3 Tbsp. pine nuts, toasted 2 Tbsp. shredded Parmesan cheese 1. Thaw shrimp, if frozen. In a large bowl combine bulgur and 1/4 tsp. salt; add the boiling water. Let stand, covered, 15 minutes. Meanwhile, peel and devein shrimp, leaving tails intact if desired. Rinse shrimp; pat dry. 2. In a small bowl whisk together 2 Tbsp. olive oil and the lemon juice; stir into bulgur. Stir in half of the basil. 3. In a 12-inch skillet heat 1 1/2 tsp. olive oil over medium-high. Add shrimp; sprinkle with 1/4 tsp. each salt and black pepper. Cook and stir 3 to 4 minutes or until shrimp
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PORK
PER SERVING (about 3/4 cup bulgur + 113 g. shrimp + 1/2 cup tomatoes each) CAL 396, FAT 15 g (2 g sat. fat), CHOL 240 mg, SODIUM 524 mg, CARB 32 g (6 g fibre, 3 g sugars), PRO 37 g
SERVES 4
Shrimp, Bulgur, and Tomato Bowls
PER SERVING (1 cup each) CAL 303, FAT 13 g (3 g sat. fat), CHOL 189 mg, SODIUM 410 mg, CARB 33 g (6 g fibre, 11 g sugars), PRO 15 g
2 2 1/2 2 1 1/2 3 1 4 1/2
Tbsp. olive oil cups chopped red sweet peppers cup chopped onion Tbsp. no-salt-added tomato paste tsp. smoked paprika tsp. crushed red pepper cups chopped tomatoes tsp. ground cumin eggs cup plain low-fat Greek yogurt Snipped fresh parsley 2 whole wheat pita bread rounds, halved crosswise and warmed
1. In a 10-inch skillet heat oil over medium. Add the next five ingredients (through crushed red pepper). Cook 5 to 7 minutes or until onion is tender, stirring occasionally. Stir in tomatoes, cumin, and 1/4 tsp. salt. Bring to boiling; reduce heat. Simmer 10 minutes or until tomatoes begin to break down. 2. Make four indentations in tomato mixture. Break an egg into a small bowl and slip into an indentation. Repeat with remaining eggs. Simmer, covered, 5 minutes or until whites are completely set and yolks begin to thicken but are not hard. 3. Top with yogurt and sprinkle with parsley. Serve with pita bread.
1/2 1/2 1 1 1 1 1 1/2 1/2
cup uncooked brown rice tsp. Jamaican Jerk Seasoning orange Tbsp. white wine vinegar Tbsp. lime juice Tbsp. honey cup chopped fresh pineapple cup sliced red onion of a fresh jalapeño chile pepper, seeded (if desired) and finely chopped 450 g. natural pork tenderloin, trimmed and cut into 1-inch pieces 3/4 cup canned reduced-sodium black beans, rinsed and drained 1 avocado, halved, pitted, peeled, and sliced Fresh cilantro 1. Cook rice with 1/4 tsp. salt and 1/4 tsp. of the Jamaican Jerk Seasoning according to package directions. 2. Meanwhile, for vinaigrette, remove 1/4 tsp. zest and squeeze 1 Tbsp. juice from orange. In a small bowl whisk together orange zest and juice, 1/8 tsp. salt, 1 Tbsp. olive oil, the vinegar, lime juice, honey, and 1/4 tsp. black pepper. 3. In a medium bowl combine pineapple, onion, and jalapeño. 4. In another medium bowl toss together meat, 2 tsp. olive oil, 1/4 tsp. each salt and black pepper, and the remaining 1/4 tsp. Jamaican Jerk Seasoning. 5. Heat a 10-inch nonstick skillet over medium-high. Add meat, half at a time, and cook 5 minutes or until slightly pink in center. Add 1 1/2 Tbsp. water; cook 1 minute more or until liquid is evaporated, stirring to scrape up browned bits and coat meat. 6. Stir beans into cooked rice. Divide
meat, rice mixture, and pineapple mixture among bowls. Drizzle with vinaigrette and top with avocado and cilantro.
Jamaican Jerk Seasoning In a small storage container stir together 2 tsp. onion powder; 1 tsp. each sugar, crushed dried thyme, and crushed red pepper; and 1/2 tsp. each ground cinnamon and ground cloves. PER SERVING (85 g. meat + 1/2 cup rice mixture + 1/3 cup pineapple mixture + 1 Tbsp. vinaigrette each) CAL 401, FAT 14 g (2 g sat. fat), CHOL 74 mg, SODIUM 519 mg, CARB 40 g (6 g fibre, 9 g sugars), PRO 29 g
Open-Face Pear and Ham Ciabatta SERVES 4 TOTAL 20 min.
2 85-g. ciabatta rolls, split Nonstick cooking spray 1/4 cup light mayonnaise 1 Tbsp. snipped fresh basil 1 tsp. lemon juice 1 cup baby arugula 1 to 2 tsp. white wine vinegar or cider vinegar 113 g. thinly sliced lower-sodium cooked ham, such as Hillshire Farm 2 cups thinly sliced pears 1/4 cup thinly sliced red onion 28 g. shaved Parmesan cheese
Pork, Apple, and Grape Bowls SERVES 4
Southern Barbecue Pork Bowls SERVES 4
HANDS ON 35 min.
HANDS ON 1 hr.
TOTAL 40 min.
TOTAL 2 hr.
1/2 1 2 2 1 2 1 1 1 1/4 450 1 1
cup red quinoa, rinsed and drained cup arugula Tbsp. olive oil Tbsp. balsamic vinegar Tbsp. snipped fresh basil tsp. lemon juice tsp. honey tsp. Dijon-style mustard clove garlic, minced tsp. black pepper g. natural pork tenderloin, trimmed large apple, cut into 12 slices medium onion, sliced and separated into rings 1 cup seedless red grapes, halved 1/4 cup crumbled goat cheese (chèvre) (28 g.)
1. Preheat broiler. Place rolls, cut sides up, on a baking sheet; coat with cooking spray. Broil 4 to 5 inches from the heat 1 to 2 minutes or until toasted. 2. In a small bowl combine mayonnaise, basil, and lemon juice; spread on rolls. In another bowl drizzle arugula with vinegar; toss to coat. Top rolls with ham, pears, arugula, onion, and cheese.
1. Cook quinoa with 1/4 tsp. salt according to package directions. Stir in arugula. 2. Meanwhile, for vinaigrette, in a screw-top jar combine the next eight ingredients (through pepper) and 1/4 tsp. salt. Remove 2 Tbsp. of the vinaigrette and brush on meat, apple slices, and onion rings. Place apple and onion in a grill basket. 3. Grill meat, apple, and onion, covered, over medium 12 to 16 minutes or until meat registers 145°F and apple and onion are tender, turning every 3 minutes. Remove from grill. Cover meat with foil and let stand 3 minutes before slicing diagonally. 4. Divide meat, quinoa mixture, and remaining ingredients among bowls. Drizzle with remaining vinaigrette.
PER SERVING (1 open-face sandwich each) CAL 272, FAT 9 g (3 g sat. fat), CHOL 27 mg, SODIUM 623 mg, CARB 38 g (4 g fibre, 12 g sugars), PRO 12 g
PER SERVING (3 oz. meat + 1/2 cup quinoa each) CAL 395, FAT 13 g (4 g sat. fat), CHOL 81 mg, SODIUM 417 mg, CARB 39 g (6 g fiber, 18 g sugars), PRO 30 g
1 4- to 41/2-lb. boneless pork shoulder roast, trimmed and cut into 1-inch pieces 3 Tbsp. salt-free Southwest chipotle seasoning, such as Mrs. Dash 1 cup unsalted beef broth 2 ears of corn, husks and silks removed 1/3 cup plain fat-free Greek yogurt 3 Tbsp. light mayonnaise 1 Tbsp. cider vinegar 2 tsp. Dijon-style mustard 1 tsp. honey 1/2 tsp. celery seeds 1/4 tsp. salt 1/4 tsp. black pepper 4 cups packaged shredded cabbage with carrot 8 dill pickle slices, chopped (optional) 1/4 cup barbecue sauce 2 Tbsp. chopped green onion 1. In a large bowl toss meat with chipotle seasoning. Coat a 6-qt. Dutch oven with nonstick cooking spray; heat over medium. Cook meat, half at a time, until browned. Add broth. Bring to boiling; reduce heat. Simmer, covered, 1 1/2 hours or until meat is tender. Reserve half of the meat for another use. 2. Meanwhile, preheat oven to 218°C. Brush corn with 1 Tbsp. olive oil; place in a shallow baking pan. Roast 15 minutes, turning once. Cool; cut kernels from cobs. 3. For coleslaw, in a bowl combine the next eight ingredients (through pepper). Stir in cabbage mix. 4. Divide meat, corn, coleslaw, and, if desired, pickles among bowls. Drizzle with barbecue sauce and top with green onion. PER SERVING (4 oz. meat + 1/4 cup corn + about 2/3 cup coleslaw each) CAL 372, FAT 16 g (4 g sat. fat), CHOL 97 mg, SODIUM 569 mg, CARB 22 g (3 g fibre, 13 g sugars), PRO 34 g
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SWEET ENDING
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A typical caramel apple can contain almost 60 grams of carbohydrate. But there’s no need to feel left out this apple season. You can still enjoy a sweet treat, just with a few tweaks. It’s all about portion control with these goodies. Start with a medium apple (about 3 inches in diametre), then core and slice into 12 equal pieces. Pick your flavour, such as caramelpretzel or maple-pecan, then get dipping! This will easily become a new family tradition everyone will love—and you won't overdo it on carbs and calories.
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Balance sweet dippers with tart Granny Smith or pick a super-crisp Pink Lady.
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recipes Colleen Weeden; photo Marty Baldwin; styling Kelsey Bulat
APPLE CANDY
Tarot forecast for Sept-Oct 2017
ARIES
Card of the Period: Hermit You need to balance your health efforts with your professional and personal responsibilities. Be sure that you are taking time out for rest, relaxation and healing. If you put it in the last of your list, then your health will definitely suffer. Your goal should be progress, not perfection. Something new and fresh is growing within your emotional being. Money, in very adequate amounts, will allow you to begin a whole new path of happiness, most likely within the present relational circumstance. Tarot Tip: You will be leaving your sorrows of the past behind you.
CANCER
Card of the Period: Seven of Wands You are on the right track; keep doing what you are doing. But don’t load yourself with too much of work; you need some rest and easy tips to improve the quality of your health. You may get busy amidst the hustle bustle in life; its best to prioritise your work and health should be your priority. It’s your own creativity and intuitive imagination that has set you on a path, which is more serene, as well as more satisfying than before. Tarot Tip: Information comes your way, which confirms that your wishes come true. This brings about a sudden and extreme change in lifestyle.
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TAURUS
Card of the Period: Eight of Pentacles Be careful when exercising, indications are of a minor injury or sprains. If you’re in the process of healing from an injury, don’t overdo it. You may be suddenly introduced to a new way of looking at things. You may turn to spirituality as well. After a short period of dissention where your career is concerned, you will find a win coming you way. Although there will certainly be a financial advancement with this, it will also be a moral or ethical win. Tarot Tip: New opportunities will blossom and you’ll be working with joy which is your cherished field.
LEO
Card of the Period: Strength You may suffer on account of your health. Health problems or some illness may crop up and make a big hole in the pocket. Timely attention is must. Try to follow a strict regimen to avoid any more illness and better see a doctor before anything serious comes up. Lots of activity and travel are on the cards. Tarot Tip: An aspect of your career that has been of great joy for you in recent times has now found you a bit exhausted to be enjoying what is at this time a burden. You’ll overcome this ennui and get back in the professional saddle as it was.
GEMINI
Card of the Period: Empress Your health will be giving positive indications this month. This is a result of all the hard work you have been doing to improve it. Following a strict regimen is on the cards. Maintain your exercise schedule and if you do not have one, try to start one as soon as possible. One aspect of your current income stream will cease to hold any appeal for you. Once this is achieved, you’ll be much more emotionally content with your work for remuneration. Tarot Tip: You will have already planted the seeds necessary for new talents to bloom at professional standard.
VIRGO
Card of the Period: Hierophant You may not be taking adequate care of your body and ignoring its needs. Do not worry, all you need to do is take care of yourself and get medical attention if necessary. You will not have time to relax and may be held accountable for an unpleasant situation at your workplace. You are capable enough to clear up the mess. Your life is going to be tougher than usual this time, try and unburden yourself and let others help you. Tarot Tip: A combination of your own canny money management and the gifts of the universe keep you happy and prosperous.
Madhu Kotiya (Tarot mentor, energy Vastu expert, Numerologist, spiritual and pshychic healer) | Email:
[email protected] | Website: www.indiatarot.com
LIBRA
Card of the Period: Temperance A good health that is combined with a youthful energy will keep you on your toes. It is time to listen to your body with great care and great compassion. Be involved in playful activities so you can have fun at the same time. You may be worrying about your job. If you are looking for one, stay positive and leave your anxiety. But as the month unfolds, we once again warn you to take a break, have a holiday, rest. It’s been a year of major karmic events unfolding. Tarot Tip: Take time out to just hang out and put plans and ambitions on the calendar for next month.
CAPRICORN Card of the Period: Three of Pentacles
The balance of body, mind and spirit is the theme of the month. Spirituality plays an important role and you are fully aware of it. You can heal yourself nicely, just be in tune with nature and positive mind set. In case you have been feeling emotionally weak; don’t hesitate to consult a counsellor or a holistic healer. You’ll be celebrating a financial boon that was quite unexpected. Somehow there’s a connection to foreign climes or someone who is abroad that is karmically destined. Tarot Tip: Keep your health in check and your finances in flow. Be careful about what you spend this month.
SCORPIO
Card of the Period: Ten of Wands This is the time to keep you young by feeling young. You don’t have to undergo some full scale, uncomfortable, and difficult regime to feel better. Small, positive steps are most likely the kind of change that you can live with and make permanent. Don’t try to blame people or the circumstances for your situation. If you’re unattached but looking for love, this card indicates that you are likely to meet someone. This is definitely a destiny driven, karmic meeting. Tarot Tip: The purpose of this meeting may not be romantic, though for some this may be the case.
AQUARIUS
Card of the Period: Towers You will experience an inner strength to take control of your own health. It may be getting rid of bad habits that you know are not good for you and starting a new regime which will be good for the physical well being. Proving yourself dependable to your colleagues can give you a good confidence booster in realising your dreams. As one side of your being opens up to new spiritual truths and possibilities, another aspect will argue with it. Tarot Tip: You tend to undertake the most obvious and traditional set of spiritual beliefs, but there’s a part of you that rejects this pre-digested creed.
SAGITTARIUS Card of the Period: Four of Pentacles
Health remains good if you aware of the needs of your body, listen to your body with great care and compassion. Be spiritual, it might be helpful to give yourself the time and space to consider your mental thirst too. Maintain a healthy lifestyle. Eat and sleep right and you will see the difference. Tarot Tip: Use your resources well. It would be a shame to forget this store of knowledge, even though it’s not a full time option, but if you put a little energy into it, new possibilities that don’t interfere with other work will flourish to your advantage.
PISCES
Card of the Period: Lovers You need to let go of old wrongs and wounds in order to move forward. Others may also try to hold on to you and your health in ways that are not good for you or them. Meditation, particularly around issues of freedom and relaxation, is useful now. You are likely to travel in connection to your work. You are generally very satisfied with your emotional or relational life at this time, but something arises that suddenly sees you having to undertake more of a burden than you’d expected. Tarot Tip: You are confident and passionate in your work and are marching ahead with full energy.
93
INDIA
INDIA’S FIRST MAGAZINE ABOUT DIABETES
India’s #1 & only magazine on diabetes with maximum reach diabeticlivingonline.in
SEP-OCT 2017
D WORL T HEAR DAY IAL SPEC
` 150
DIABETIC FRIENDLY AND
HEART HEALTHY DIET
LESS SALT, MORE FLAVOUR p. 76
EAT SMART
SLEEP BETTER TONIGHT
+
VEGGIE-FULL HEALTHY FATS Recipes, p. 56
Southern Barbecue Pork Bowls, p. 77
32017090705
INDIA EDITION VOL 7 ISSUE 5
10
p. 46
WAYS TO OUTSMART DIABETES p. 38
reader survey
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