Prakash Chandran: Good nutrition is an important part of any healthy lifestyle. And it's especially important. When you have diabetes. Today, we'll learn how nutrition can help you manage blood sugar throughout your life. Let's talk about it with Sarah Desjardin, registered dietician and a certified diabetes educator at Harrington Hospital. This is Healthy Takeout. The podcast from Harrington Hospital. My name is Prakash Chandran so first of all, Sarah, thank you so much for being here. Really appreciate your time. Now I wanted to get started by asking about good nutrition. It can mean so many different things, but what does it mean for someone that has diabetes?

Sarah Desjardin: All right. Well, thanks for having me. Good nutrition for someone with diabetes really incorporates just a healthy, balanced diet. So we want a diet that is lower in carbs, that contains protein. And that is lower in fat as well.

Prakash Chandran: That makes sense. And just to get a little bit more specific, what food should people be eating to maintain that healthy, balanced diet?

Sarah Desjardin: So what we usually recommend is that patients really strive for a protein source at each meal because proteins do help the control blood sugar rise after meals. So that is the most important. Again, we wanna try to limit carbs. And then of course make sure you get your veggies in there as well.

Prakash Chandran: Okay. So you mentioned limiting carbs a couple times, and I was just gonna ask about the foods that should be limited. me maybe position the question another way. Are there foods that people with diabetes typically turn to are no-nos that you see time and time again?

Sarah Desjardin: Okay. So I think it's very common knowledge that sugary beverages really aren't great for any of us with, or without diabetes. So of course I start with that. And the sugary beverages could be soda. It could be juice, it could be things like Gatorade, powerade. Lovely, coollattas. And like ice teas, things like that. All of those things should either be avoided or try to replace with diet beverages or zero calorie beverages. Other foods that I strongly recommend avoiding would be bagels. One bagel is equivalent to six pieces of bread. So it really does affect blood sugar.

And they contain a lot of calories. Things like cereal and oatmeal, cream of wheat. Again, they are just grain based and they turn to sugar as soon as we eat them and they really greatly affect blood sugars. Things like, again, your snack foods, right? Your processed snack foods. So whether it's chips or it's crackers, it's cookies, it's brownies again. Those should really be limited as well.

Prakash Chandran: Yeah, that makes a lot of sense. And it's so funny that you mentioned juice. I remember growing up, I don't think that was something that my parents necessarily knew, so they drank a lot of juice. They would give us a lot of juice because they thought it was healthy. So lots of orange juice, lots of apple juice, but you're just saying that there's just a lot of added sugar in there, right?

Sarah Desjardin: Yes. I mean, honestly, juice is equivalent to soda when it comes to the sugar content. And again, it just reeks havoc with blood sugars. There really isn't great nutritional benefit from juice. I always say to patients, I'd rather, you eat a piece of fruit than drink juice any day. And I say that to both pediatric patients and adult patients.

Prakash Chandran: Okay. How do you think about tailoring a nutrition plan to each individual patient, especially when it comes to trying to get them things that they can eat and actually enjoy while still maintaining that healthy, balanced diet?

Sarah Desjardin: I mean, every patient has greatly different tastes and preferences when it comes to food. So working with patients one on one, I kind of go over what they like and what they don't like. We have some patients that are more driven to like, Sweet foods. And they kind avoid like the salty snack foods. Where other patients, again, like the salty, crunchy foods. So again, just working with their preferences and trying to find replacements for those things is what we try to do.

So stuff if it wasn't like a dessert type food or if that was their preference was a dessert type food. Going for things that might be sugar free. So like sugar free putting sugar, free jello sugar free popsicles. If they prefer ice cream reaching for really low carb ice cream. But no sugar added. And the low sugar ice cream still have sugar in them. So they're still going to affect blood sugar. And when it comes to snack foods, too, really looking at foods that are pre-portioned.

And I know that we pay more for packaging, but it really helps to control blood sugars. It helps to control calories. It helps when carb counting. So like pre-portioned like ice cream treats, whether it's a no sugar added like Klondike bar or an ice cream sandwich or like a sugar free Popsicle. Again, I know that we pay more for these things but it's your health. And so I think the investment's worth it.

Another with salty snack food it's not that you can't have potato chips or pretzels or crackers or popcorn. It's the quantity that we consume. And again, the pre-portioned little bags of those treats. Are much better to help us with portions and again, calories and blood sugar control.

Prakash Chandran: So what about times of the day? Like, are there certain times of the day that diabetics should or should not be eating?

Sarah Desjardin: I would say no. It really comes down to foods at certain times of the day. So if I could switch that question, you know what I mean? If we could switch that question, so it's not a matter of timing when it comes to like you shouldn't eat after a certain time. And I know there's a lot of people out there that I think we've heard for years, you shouldn't eat after seven o'clock at night. Again, you can follow that rule if you choose to, but when it comes to diabetes, it's really the foods that we consume at nighttime.

When we eat foods that are higher in carbohydrates at night, they affect blood sugars through the night, but they also affect fasting blood sugars the next morning. So patients that check or test blood sugars in the morning again, when they consume very carb heavy meal and or carb heavy snack before bed, again, that's with them all night long and therefore fasting blood sugars are much more elevated in the morning.

Prakash Chandran: Yeah, and I suppose this is somewhat related, but what about weight loss? Like, can you talk about healthy ways that can safely lose weight?

Sarah Desjardin: Sure. So two things one way would be to limit carbs. I usually say, per meal, when I talk to patients, our goal, whether you're male or female is 30 to 45 grams of carbs per meal. And snacks should be between 15 and 25 grams of carbs per snack in a perfect world. As adults, we don't really need a ton of snacks. So we should only be limiting snacks to like one or two per day. With controlling and limiting carbs. Our calories are limited as well usually. And then I always talk about calorie counting with patients because we do consume calories and we burn calories. And so we need to make sure we have a happy medium with both of those things in mind.

So when I talk about calorie accounting, I usually reference apps. We all have cell phones these days. And so apps like My Fitness Pal or Lose It. Those are my two most favorite apps to recommend to patients they're free. They're pretty easy to use and they're pretty accurate. 80% of weight loss is just your diet. So if we can control calories and be consistent with a certain calorie intake every day we will see weight loss. And again, as we know, weight does affect blood sugars. So if weight comes down and we can control that, then blood sugars also follow suit and they become controlled.

Prakash Chandran: Can you talk at a very high level about the relationship between like calories and those macros like because I can imagine that there are people that may be taking less calories, but it might be like a very carby meal. It might be over that 35 to 45 gram recommendation that you just mentioned. do they interplay with one another?

Sarah Desjardin: So when we consume carbs, our body breaks them down into sugars. And so therefore somebody with diabete s their blood sugars become very elevated. When we first started this podcast, we talked about the importance of having protein at each meal. And so what I like to talk to patients about is like, when we talk about any meal again, I always say the first question is where's my protein. Then you can have a carb, but again, we want those carbs limited to the 30 to 45 grams because the protein slows down digestion.

So blood sugars don't rise as fast or as quick. And so we see much better blood sugar control from just making that change. Just that pairing of those two macronutrients, the protein and the carbs together. We see great blood sugar control from that. But again, the trick is the carbs have got to be limited to the 30 to 45 grams of carbs. So when I talk 30 to 45 grams, an example would be like 30 grams of carbs could be two pieces of bread and I'm not talking light wheat bread. I'm talking like a regular bread, whether it's white wheat rye, pumpernickel, or a multi grain.

30 grams of carbs could be one cup. Of mashed potatoes. It could be one medium baked potato and that's whether it's a sweet potato or a white potato, it's the same monster. So, again, it's still 30 grams of carbs. 45 grams of carbs is equivalent to one cup of cooked rice. And again, it doesn't matter whether it's brown rice, white rice. Spanish rice, Bosma rice, Jasmine rice, same monster, one cup of cooked pasta is 45 grams of carbs. And again, it's the same thing. Wheat pasta, white pasta gluten-free pasta, same thing.

So again, really thinking of like, if we look at a plate, we have a piece of meat, let's say it's four to six ounces of meat, whether it's chicken or it's lean steak or a piece of pork, we have that one cup of a starch. Or one medium baked potato, and then we have some other veggies that aren't starchy.

Prakash Chandran: Okay. Got it. And then when you say like, the 30 to 45 grams of carb per meal, how should people with diabetes be eating per day?

Sarah Desjardin: In a perfect world. Everybody should be consuming three meals a day. There are many patients that consume two whether it's work schedules or how they were raised. Like some patients report like nausea in the morning, or they just don't have an appetite. And if they do force themselves to eat, they feel even more nauseous. Some people get sick. So for those folks, obviously it's not something that I push them to do. But from a medication standpoint with diabetes and just from a blood sugar control, and again, from a diet perspective our bodies are machines and they need to be fed and to make our metabolism be the best it can be, we should be eating three meals a day. And again, it helps to control blood sugars as well.

Prakash Chandran: And are there any vitamins or supplements that you recommend taking just to enhance that nutrition?

Sarah Desjardin: So. If a patient has a healthy digestive system and they don't have any GI issues or digestive problems. And they're eating a balanced diet, they don't need to take any vitamins. And so for me, like a balanced diet would be, again, a protein at each meal. The carb content, 30 to 45 grams of carbs per meal. We're eating veggies with lunch and with dinner and then maybe one or two servings of fruit. So if we're consuming that on a regular basis, we don't really need a vitamin or supplements. For patients who do have absorption issues or digestive issues, a multivitamin is really the only thing that's recommended.

For some patients they might have had lab work done by maybe a doctor or primary care physician that shows they have vitamin D deficiency. So therefore they're prescribed or directed to purchase over the counter. Vitamin D sometimes it's a prescription from the pharmacy to supplement for their low vitamin D level. Other patients that do have digestive issues, they might also be recommended from another physician to take certain vitamins because they're not able to absorb them from food. But a typical person, again, if diets are balanced, they don't really need to take any supplements.

Prakash Chandran: Well, Sarah, this has been a really informative conversation. There's always one question I like to end with, and that is given your. as a registered dietician and a certified diabetes educator, what's one thing that you just know to be true, that you wish that people living with diabetes knew before they came to see you?

Sarah Desjardin: All right. So I think the biggest misconception that I hear I would say on a daily basis is that patients are misguided to believe that cereals and oatmeal are healthy for people with diabetes and they are not. Despite our marketing industry and despite What others may say, again, those foods are literally just a bowl of carbohydrates. And as soon as they ingest them, they reek havoc with blood sugar. So again, the focus, I think for a lot of doctors per diagnosing a patient with diabetes is like, don't drink the sugary beverages and don't eat the junk food.

Don't eat the ice cream or the candy, but really also it comes down to please avoid cereals and oatmeal and things like cream of wheat for the same reason, because they're really all the same. Like your body just turns them to sugar. And again, we can't control blood sugars. When patients eat those foods,

Prakash Chandran: Wow. Yeah, that is quite a revelation because. You think that things like cream of wheat and certain type of cereals are good for you and even the thing you were saying about bagels like that, it equals six pieces of bread. I mean, that's so this education is just so important.

Sarah Desjardin: Right. Yeah. I mean, and again, our patients really believe our marketing industry and I blame a lot of our health issues on our marketing industry. And so again, just kind of undoing or reeducating, you know, what they feel is the truth. Or what they feel they know to be the truth. And again, especially with this disease state teaching them how you, how these foods react with their bodies and their blood sugars is super important.

Prakash Chandran: Well, Sarah, thank you so much for your time today. I really appreciate it.

Sarah Desjardin: You're welcome. My pleasure.

Prakash Chandran: That was Sarah Desjardin, a registered dietician and a certified diabetes educator at Harrington Hospital. can head to Harringtonhospital.org to get connected with Sarah or another provider. If you found this podcast, that'd be helpful. Please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name's Prakash Chandran. Thank you so much for listening and be well.