May 27, 2019 Take control: simple steps to preventing type 2 diabetes

(Farah Esmail)
0:00 So now we’d like to welcome our speaker. Mandy Megan Conyers Smith and thank her for joining us today. But before turning it over to Many Megan, I’d like to give you a brief introduction. Mandy Megan Conyers Smith has been working as a dietitian for over 7 years. She received a Bachelor of Science and Human Nutrition at Mount Saint Vincent University in Halifax, Nova Scotia and is currently pursuing a Masters of Science degree in clinical nutrition at Rutgers, the state university of New Jersey. Mandy Megan is very passionate about nutrition and healthy living and is committed to helping people improve their health through tailored medical nutrition therapy and food and nutrition education. For more information on Mandy Megan, please read the speaker bio section to the left of your screen. So without further ado, I’d like to present to you Mandy Megan.

(Mandy Megan)
1:00 Thank you Farah for that introduction and thank you everyone for joining me today for the presentation I hope by the end of this presentation we will all be able to make a goal to help us reduce type 2 diabetes as it affects so many of us. So let’s get started. So first we would like to discuss exactly what is diabetes. Diabetes occurs when the body cannot make enough insulin or cannot properly use insulin that it makes. So when you eat foods that contain sugars or carbohydrates they are converted in the body into simple sugars and you’ll hear the term glucose which is the term that represents sugar in the blood when we eat food such as bread, pasta, rice, beans or certain fruits, vegetables as well as dairy products such as milk, sugar enters the blood stream as sugar rises in the blood stream it signals the pancreas to release insulin to help us get sugar into the cell.

2:13 So insulin is a hormone that is responsible for allowing glucose to get into the cell. So I have a little picture on my slide, you can see it that represents this mechanism. So you see the cell is the blue circle and the glucose represents the little red molecules. The yellow key or golden key is the insulin. With diabetes, the insulin is either not available to let the sugar into the cell or it is there but the cell is not responding to it.

2:55 So there is different types of diabetes and I will juts briefly go through each one. Type 1 diabetes occurs when the immune system attacks and permanently disables the insulin-making cells in the pancreas. This can happen at a very early age and this is why this type of diabetes used to be called juvenile diabetes. Because it was found in many kids but we do know now that adults can be diagnosed with type 1 diabetes.

3:24 Type 2 diabetes occurs when cells stop responding to insulin or there is a resistance to the response of insulin. So insulin can be present but the cells are not responding and this used to be called adult onset diabetes because we used to see this a lot in older adults instead of kids so we now we do know that children can also be diagnosed with type 2 diabetes. Gestational diabetes occurs during pregnancy and the body cannot produce enough insulin to handle the effects of the baby. We have a lot of hormones changing during that time and prediabetes happens when the blood sugar levels are higher than normal but not high enough to be called diabetes or to be diagnosed with diabetes. So there are a few risk factors that can increase your chances of developing type 2 diabetes

4:23 And as I go through them you’ll realize that some of these factors you cannot change and there is one that you can change. So age can definitely affect our risk of diabetes so the older we get the higher our risk, so the age of 40 or older. Whether or not you have diabetes within the family, so you have a family member, a sibling, a mother or father diagnosed with diabetes. If you are a member of a high risk group such as Aboriginal, Hispanic, South Asian, Asian or of African descent. If you have given birth to a baby or have had gestational diabetes you are also at risk of developing diabetes later on in life. If you’ve been diagnosed with prediabetes and also if you are overweight, especially if the weight is mostly carried around the tummy.

5:16 So in terms of reference for the circumference size around, some of the risk factors are 40’ and over or 102 cm in males. Or 35’ or more or 88 cm in females. Other health complications or problems on medications you’re taking can also increase your risk and your doctor will definitely be able to tell you how that affects your body. So we know that healthy lifestyle can delay or help to prevent delay type 2 diabetes. In the earlier slides we talked about the prevention. We talked about the fact that carrying around extra weight or being overweight is a risk factor.

6:08 And healthy lifestyles can help us to reduce those factors involved in weight gain that can increase your risk of diabetes. We know that about 80-90% of people living with diabetes do carry some extra pounds. So we’re going to talk about 3 healthy lifestyle habits that can lower our risk of diabetes today. And we’re going to break them down into weight management, healthy eating, which has a few factors involved and also active living. So let’s started off with weight management. So having excess fat in the body can affect the way cells respond to insulin.

7:04 So if you remember, we talked about that resistance to insulin earlier with type 2 diabetes. Your health care team can help you understand your weight status and how it may influence your health. For those who are concerned about weight or overweight, good news it that research shows weight reduction with lifestyle intervention such as healthy eating and active living has been shown to reduce the incidence of diabetes by almost 60%. And in combination when you look at the research, just a small amount of weight loss is actually quite effective. So just five to ten percent of your body weight is the first goal that you want to aim for.

7:47 So now let’s talk about healthy eating. So healthy eating includes a variety of things. So we’re going to touch on a few topics today, really briefly. But when we talk about healthy eating we are focusing on ensuring that our diet is adequate in essential nutrients, and by essential we’re talking about those nutrients that we must get from food that our body cannot make or make enough of. That we have a variety in our diet. So we’re eating many different foods from the food group because each food will provide us with different nutrients. For example, if we just look at just a simple example of the fruit and vegetables group. A banana is a fruit. An apple is a fruit. And we do know that a banana and an apple, they carry different nutrients for us.

8:38 We want to definitely make sure we are eating a variety of foods within a food group. In addition, we also want to make sure that we are getting the right portions so that we’re getting enough nutrients. And also that we’re not getting too much that can lead to excess calories that can be stored as unwanted fat. When we use the term balance meal, and I know you’ve probably heard that many times, what does that really mean? A balanced meal is having at least 3 out of the 4 groups present at your plate. The benefits of having a balanced meal and eating balanced is that it supports the adequate intake of daily essential nutrients and to support health and reduces the risk of chronic diseases because you are fueling your body with all those healthy nutrients that you need everyday.

9:32 Portion control. So consuming foods in the right portion at each meal, as I mentioned earlier, can prevent excess intake of food or calories that can lead to weight gain. The healthy plate is a great way for you to visualize what portions look like and if you’re not familiar with the healthy plate, it’s basically separating your plate in half. That half will include foods from your fruits and vegetable group. Then you divide the other half into half. One fourth of that plate will then be your grain products and the other will be your meat and alternatives. This is just a guideline or an example of what a healthy plate looks like.

10:13 In terms of portion, you can find portions on Canada’s Food Guide but an easy way is to also use your hand as a tool. So the fist can represent your choice for grains and starches and fruits for one serving. Vegetables are usually your hands, so as much as you can scoop up in your hands would be enough for a vegetable serving. Your meat and alternatives would be the palm of your hand. So palm size. And fat, such as margarine, would be the amount of the tip of your thumb. A serving size for milk, for example, would be a cup of milk.

10:52 Eating healthy also includes having regular eating patterns. So yes, you’re eating balanced. You’re making sure your food is portion controlled but you’re also paying attention to when and how often you eat. A general rule is for us to eat a balanced meal three times per day. And that should be spread out evenly throughout the day. Generally, we tend to eat every four to five hours which is considered enough for us to get three balanced meals in without us having to worry about being hungry or skipping nutrients that we could have gotten from a meal that we skipped.

11:40 So spreading your food out over the day helps you control your blood sugar and appetite. So you can reduce the chances of over eating and prevent cravings. It can take about a minimum of six to eight hours for food to fully digested. The stomach can be emptied at around four to five hours. So at that point when your stomach is feeling empty, you will feel hungry. And of course the longer you go without eating your hungry, the greater your chances are of picking foods that are more high in sugar. Or making choices that you would not normally make if you weren’t on a hungry stomach, if that makes sense.

12:27 Healthy eating also includes adding fibre to the diet. So dietary fibre is part of the plant foods that our bodies can’t fully digest or absorb. And fibre has many benefits for us. It helps us to feel full for longer, which is a great tool for weight management. It helps to slow the digestion of food and therefore slowing the movement of sugar in the blood. It helps to normalize or slow the release of blood glucose into your system. It also helps to keep our bowels regular, and therefore support a healthy digestion system. So choosing foods such as vegetables and fruits, lentils, whole grains such as cereals, bread and pasta, all helps to support good intake of fibre. Research also shows that eating more fibre may help to lower your blood cholesterol.

13:26 We also want to make sure we’re reducing the amount of added sugars to our diet. Added sugars are those sugars and syrups that we put into foods during preparation or it can be added to foods in processing. So these sugars aren’t naturally found, we’re adding the sugars for taste. So we want to limit sugars such as honey and molasses, brown and white sugar, candy, chocolates, sweet deserts, pastries and high-calorie baked goods because they are loaded with sugars. Not saying that we can never have them but just be mindful and try to limit as much as possible. The World Health Organization actually recommends for good health under prevention of chronic diseases that we limit our added sugars to 10% or less of our total calorie intake.

14:20 So the average person that’s taking in about, say, 2000 calories a day, that would equal about 48 grams of sugar a day. Which is about 12 teaspoons. So if you take a can of pop and you look at the amount of sugar inside one can, we’re very close to having almost 10 teaspoons already just for having that one can of pop. So it really adds up. When foods with added sugar are eaten or drunken in large amounts, these foods may replace healthier foods in your diet, so you have to be mindful of that as well. These added sugars also add calories without adding any other nutrients and of course, we are focused on weight management when we’re looking at prevention of type 2 diabetes. Eating too much sugar can contribute to extra calories, unwanted calories or empty calories and unwanted weight gain.

15:20 Another factor that we want to look at is fat. So we all need fat in our diet. Fat is considered an essential nutrient. However, we do know that fats and oils are really high in calories so portion is really important. We want to get them and we want to get them in the right amount. But most important, we want to pay attention to the type of fat that we’re eating. Saturated and trans fat may rise or increase your risk of heart disease, or heart attack or stroke, because they increase your bad cholesterol. So you may have heard the term LDL which stands for low density lipoproteins.

16:01 I like to say also [inaudible] allows to keep it low. Saturated fat is mostly found in animal products, so we’re talking about our meat and our dairy products. These are really important for us to get certain nutrients. We know our meat is our protein source. Dairy we get our calcium, Vitamin D. We want to go ahead and choose lean meats that we’re getting the benefit from that food group without the extra added saturated fat. We also want to make sure we are also choosing dairy products that are lower in saturated fats itself. For example, skim milk or 1% milk versus whole milk.

16:40 Trans fats is made within the industry by adding hydrogen to vegetable oil. The trans fat also increases your bad cholesterol, your LDL. And you can find out more about how much trans fat is in your food by reading the food label, which we will talk about soon. Unsaturated fat however, are considered our good fat or our healthy fat and they help to increase our good cholesterol which is really good for us. They can also help to lower your LDL cholesterol. You can find this is in plant sources, vegetable oils, seeds and fatty fish.

17:24 So here a picture of a food label and nutrition labels they do help us make informed decisions as consumers when we’re buying our food. A very simple way to read a food label is to first, look at the serving size to make sure that is what you’re eating. If you’re eating double, you have multiply it by two. Then you want to look at the daily percent value. Once you are able to look at the daily percent value or you’re checking exactly what nutrient you’re looking for, you use the number 5% and 15% as a guide. 5% or less means a little of the nutrient. 15% or more means a lot. When you think about what do you want a lot of and what do you want a little of.

18:10 For example, if you’re looking at saturated fat at this label, it says 5%, so this product serving is 2/3rds of a cup. It’s considered low in saturated fat. But if you were concerned about fibre and this product you can see fibre is 4g. It says 16%, so we know that for sure this product gives us a lot of fibre. So 5-15% is an easy way to read your food label. We also want to make sure we are focusing on remaining very active. Being active for at least 30 minutes a day, 5-7 days or roughly 150 minutes per week is adequate for us to receive benefits of physical activity.

19:02 Being active helps us control our weight. It helps to lower us our blood glucose by using glucose for energy. It’s also known to help strengthen our bones and muscles. And it improves our ability to do our daily activities. So the more you move, the more you’re able to move. So when it comes to physical activity you want to start with, if you’re not active, guidelines say that you want to start at only a few minutes a day and then you can build up to thirty minutes. So if you want to just start off at just ten minutes and then as you feeling more and more fit, you can then build up to thirty minutes. Include activities that make your heart beat faster, like brisk walking, swimming or bike riding. You should able to talk but you shouldn’t be out of breath, but your heart should be beating pretty quickly. On at least two days a week you want to include strengthening exercises that will strengthen your muscles and bones such as lifting weights or doing yard work or even yoga.

20:12 The next step is to seek support. If you are concerned about diet or you have questions about your diet or you want to have a tailored meal plan, a registered dietitian can help you make healthy food choices and tailored meal plans to help you and your family meet your nutrition related goals. Every person and every family has different goals and it’s really important that the information you are receiving is helping you reach your goal. In regards to physical actives if you’re not active, that you talk to your doctor first about your plans to be active. And get consent or the go-ahead from your doctor to start working out or start living a more active lifestyle. You can ask for resources at your doctor’s office or resources in the community that can help you get started with activity. Sometimes they know about programs that are going on that you may not know about.

21:20 Now I just want to talk about making SMART goals. We talked a little bit about a few steps that can help us live healthier lifestyles but it’s really important that we set goals so that we can achieve the goals that we want. So a SMART goal can help us improve our health. SMART goals are specific, they’re measurable, they’re attainable, they’re rewarding and they’re timely. So let’s use an example, a scenario from today, to make a SMART goal. So let’s just say that you’re listening to this presentation and you realize that you want to improve your diet or your healthy eating patterns. And you say to yourself, you know, I don’t get enough fruits and vegetables in my diet. In fact, I get no fruits and vegetables in my diet. Overall, you want to make healthier eating part of your lifestyle but just to say I want to eat healthier is not a specific or a SMART goal. So when you break it down, you’re realizing that vegetables and fruits is something that’s lacking, you’re getting more specific.

22:40 Then you’re thinking about how will I do it. Okay, if I incorporate fruits and vegetables into my diet at every mealtime that’s more specific cause now you’re saying when you’re going to do it – you’re going to do it at mealtimes, and what you’re going to do – fruits and vegetables. Okay, then you’re going to go to how much and how many. Then you think about what you can do. So if I add one serving of fruits and vegetables at mealtime, one at breakfast, one at lunch and one at supper, that’s measurable because now you can see you’re incorporating something that you can measure. Then you want to think about if it’s something you can do. Can you actually do that? If you’re able to say yes but you can actually incorporate, you’re able to go to the grocery store, you can afford the fruit and vegetables, then yes it’s attainable.

23:40 Then, you have to ask is it rewarding. Is it something I want to do. You want to eat healthier. You know by starting with a simple step will get you closer to meeting those guidelines or general rules for healthy eating. In yourself, this is going to be rewarding or the first step in making a healthy change. And then you think how long are you going to do it. Usually I’ll do it for one month. So every meal time, breakfast, lunch and supper, I will incorporate one serving of either a fruit or vegetable at each meal and I will do that for at least one month. I hope that makes sense. These are my references for today and now I’m going to open the floor to any questions that we may have.