In this episode, we explore the role that healthy eating plays in diabetes management. We cover a range of topics, including carb counting, glycemic index, artificial sweeteners, alcohol, various dietary patterns, like intermittent fasting and plant-based diets, and eating well on a budget.
Speaker: Jenna Walsh, RD, CDE
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[Music] welcome everyone my name is Anne besner
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I work with the people affected by diabetes knowledge and connection team at diabetes Canada and I will be your
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moderator for today's webinar I'd like to begin by acknowledging that I'm joining today's event from Ottawa
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which is the traditional unseated territory of the Algonquin anishinaabeg people
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as a health focused organization diabetes Canada recognizes that there is systemic racism within and throughout
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our institutions and that we have the responsibility and power to create culturally safe and
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appropriate environments of care from wherever you are tuning in I invite
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you to take a moment to reflect on the land on which we live recognize the harms and mistakes of the
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past and consider how we can all contribute in a meaningful way to reconciliation and collaboration
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we are here to kick off a new live webinar series at diabetes Canada called diabetes open hours thank you so much
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for being part of this event diabetes open hours is all about you the
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person who is affected by diabetes if you have been diagnosed or are caring for someone with diabetes you're not
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alone millions of Canadians are living this reality but diabetes is complex and different
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people experience it differently whether diabetes is new to you or you've been living with it for a long time
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you've inevitably got questions questions about risk factors complications management options
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questions like why me diabetes open hours is a live virtual
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agenda free hour that allows participants to interact with a feature guest in a community of individuals with
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lived and professional diabetes experience this is your time to ask Customs tell
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your story and share with others in a safe non-judgmental space diabetes open hours will take place
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toward the end of the month every second month each one will have a different guest that will be welcoming and a different
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broad theme diabetes open hours is being recorded and will be archived on the diabetes
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Canada website as well as on our YouTube channel for on-demand viewing
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today's theme is nutrition and we are so pleased to have with us Jenna Walsh registered dietitian and certified
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diabetes educator Jenna Walsh completed her degree in human nutrition at the University of
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Guelph followed by a dietetic internship through the Ottawa Hospital she has been working as a clinical
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dietitian in Renfrew County since 2010 dividing her time between long-term care
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inpatient and outpatient support Private Practice as well as Community nutrition
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which includes developing and coordinating an initiative called kids in the kitchen and more recently a
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virtual Eating Disorders Support Program she added certified diabetes educator to
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her resume in 2017 and continues to support those living with diabetes in
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her community by normalizing food and movement as part of their diabetes management
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she loves spending time outdoors with her spouse and three daughters and in the kitchen whipping up new recipes
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welcome Jenna thank you so much for being here thank you so much Anne I'm very much
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looking forward to chatting with everyone today so thank you okay here's how things are going to go
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over the next hour participants who are joining us for today's event can use the chat feature
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to submit their diabetes related questions to Jenna we know that nutrition is a really interesting
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subject it's a huge topic and one that can be a source of confusion for many because it's very Dynamic and evolving
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sometimes it's hard to separate nutrition fact from fiction and challenging to identify reliable sources
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of info about nutrition but not to worry Jenna is here to help us Wade through it all
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as a certified diabetes educator she has a wealth of knowledge when it comes to All Things diabetes and as a registered
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dietitian of course her area specialty is nutrition so we're in really good hands today with Jenna
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using that chart feature please starting now and throughout the next hour type in your diabetes nutrition questions for
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Jenna so you can simply click on the chat icon that's near the bottom of your screen to open the chat
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you can post your question by typing it into the text box with the recipient being everyone and that way everybody
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will be able to see your question we also encourage people to share their diabetes stories in the chat
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we welcome supportive positive comments and emojis from the audience so feel free to be actively part of the
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conversation through the chat as a moderator I'll relay the questions comments and stories to the group and
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we'll do our best to get through as many as we can in the time that we have together a few quick ground rules regarding the
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chat we just ask that any comments or reactions that you share be affirming
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and positive and that you use this time and the chat feature as an opportunity to further
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your learning engagement and curiosity and support the same for others
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following this webinar we'll be sending out an evaluation to hear what you thought about open hours and how we can
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better tailor it to suit your needs so with all of that Jenna are you ready
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to begin good to go great let's get started
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so while we are waiting for some questions to come in maybe we can just start by sort of setting the stage
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Jenna can you talk to us really briefly about what the connection is between nutrition and diabetes and what rules
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does healthy eating play in diabetes management um so I think I would start I mean I I
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think I'm a little bit biased in terms of the the role I I feel that nutrition
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plays um at the same time I really try to approach diabetes management with with
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patients and clients as part of management um we all come from very different uh
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socioeconomic backgrounds we all grew up with a different relationship with food some of our parents may have loved being
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in the kitchen they may have included Us in the kitchen other people may have grown up not having a clue how to cook
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we all have different food budgets um cultural preferences and so
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nutrition is a very um individualized part of management
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I think it needs to be and it should be but it can absolutely make a drastic
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role and in impact on our diabetes management so even into the guidelines we see at least a one to two percent A1C
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reduction potential with with nutrition I would say absolutely I've seen much higher than that with patients depending
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where A1C is starting and what level of change they end up making so nutrition is a pretty big one
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absolutely yeah that's very true Jenna
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um now we have people joining us who are impacted by diabetes in lots of different ways
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um may have nearly been diagnosed or have been living with diabetes for quite some time
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um maybe we can just kind of go back to basics um and this is useful for for anybody
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um who's living with diabetes can you take a second to just talk to us a little bit about carbohydrates so
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um what are carbohydrates and uh what impact do they have generally on blood
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sugar yeah absolutely and and I'm glad you bring that up because more often than not when I'm speaking to people I'd say
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at least half will pause me and say you know what which foods are carbohydrates um so there's a few different categories
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that we start to talk about when we talk about carbohydrates but essentially it's think of them as a like a chain I like
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people to think of food kind of like Lego blocks that make sense for people and then once we eat carbohydrates they
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essentially are broken down to simple sugars in our in our body so even if something is sugar-free they can still
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have carbohydrates meaning they will still impact your blood sugar once we ingest them so the big one that most
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people know about are starch-based foods so any grain based um think your wheat your oats your
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barley um all of those grains are carbohydrates
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and any of the foods that they end up making we also then have our starchy veggies that's where potatoes fall into
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as well and then our fruit they all naturally that's where we get their delicious sweetness from is from sugars
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right it's natural and dairy as well so oftentimes people forget that Dairy
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especially milk has lactose and lactose is simply a sugar or a carbohydrate so I
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like people to think not so much as like does it have sugar but thinking in terms of carbohydrates and that makes label
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reading a lot easier as well now with respect to diabetes though in blood sugar management just because
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carbohydrates affect our blood sugar it doesn't mean we can't eat them
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the most important piece I ask people to pay attention to is how much can each
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person's own body handle or tolerate at a meal or an eating period and blood
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sugar stay within target range so that's again where our nutrition becomes very individualized because a
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what carbohydrates do you like eating right which one still give you enjoyment
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with your meals and allow you to continue to eat that way how much of it do you need to feel satisfied from that
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meal and then on top of that you know does it keep your blood sugars within a within a safe range
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that's really helpful Jenna just a reminder to everybody that if you have questions please go to that chat feature
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and put them right in we're happy to answer any questions you have related to diabetes nutrition
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if you're more comfortable coming off mute you can certainly pose your question as well out loud
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um I see here from a comment in the chat that Kathy is having a bit of difficulty understanding with with an echo so we'll
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work on that Kathy apologies for that um but you can come off mute anybody if
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you'd like to ask a question or feel free to put that in the chat and while we're waiting for some more of those questions to come in Jenna
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um wondering if you could talk a little bit more about um some some different foods and their effects on blood sugar so what about
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vegetables you mentioned that potatoes are a starchy vegetable but what about other veggies what what impact do those
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have on um blood sugar yeah um so we we try to divide Foods up into
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sort of those starchy and then non-starchy right so non-starchy typically being
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um things like your dark leafy greens things like zucchini and cucumbers and celery whereas some other ones where
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that might have more sugar in them may have a bigger impact unless people are on multiple daily
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injections of insulin I try not to get them too focused on the exact number of carbohydrates in
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Foods versus focusing on eating more vegetables in general checking blood
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sugars two hours after and just seeing how that meal has affected them because the one really neat thing that
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some Studies have shown us is within each person right so the individual
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person not larger populations we will see repetitive similar responses to food
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so one person might say their blood sugars go through the roof after having you know some bran flakes and a banana
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and it might be you know whatever maybe they've had 45 grams worth of carbohydrates at that meal the person
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next to them might not it might be pretty modest we can expect for that person where that blood sugar has spiked
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with that specific food we can expect that to repeat so it's it's simple
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enough simple it's still a lot of tedious work and learning but we can start to learn our own patterns and
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which foods our body does well with versus what foods our body struggles a little bit more with and so absolutely
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some of those squashes the sweet potatoes potatoes the ones that really when we think about it have a little bit
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more of that sweeter taste tend to have more complex carbohydrates and and some sugars in them and they may
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they may affect your blood sugars more there's a more complex part to that in terms of what we know to be the glycemic
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index in terms of how much a particular food will spike a blood sugar so that part's important as well
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all really important points and and we can see some questions now coming in through the chat which is terrific keep
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those coming everybody um so Kathy asked a really excellent question here
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um thanks Kathy how do carbs impact type 1 diabetes versus type 2 diabetes versus
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pre-diabetes so maybe you can kind of unpack that a little bit for us great question
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um so I want you to think about type 1 diabetes uh so let's back up a little bit with diabetes when we eat those
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carbohydrates our body breaks them down into those very simple carbohydrates and then asks
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the pancreas for insulin so the pancreas is that organ that we have and in those
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beta cells that we have in the pancreas it secretes insulin insulin is just a hormone its job is to hook onto that
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Sugar bring it to our muscle and brain cells and convince them to open up and
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let that sugar in now sometimes with diabetes the insulin comes takes it cells don't
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open up that's foreign resistance with other people we may it may be more
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genetic in terms of type 1 diabetes sometimes it's a viral infection or something that damages those beta cells
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and they no longer are making insulin people with type 1 diabetes are not
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making any insulin okay so we pay a little bit more attention to you know specifically how
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many grams of carbohydrates we're getting in a meal because we have to then give ourselves the exact amount of
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insulin to keep blood sugars in range with type 2 diabetes we have a little
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bit more flexibility sometimes because we still have some insulin being made so the body is still taking care of some of
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that naturally right so we we have a little bit of wiggle room to say it also depends too if we're on any
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other medications so with type 2 diabetes we would also potentially be on some oral medications or pills that
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address different parts of blood sugar management so they may work at the cell level to reduce that insulin resistance
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we talked about convince those cells to open up and let the sugar in some medications work at the liver so while
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we're not eating the liver also slowly release the sugar back into our bloodstream so that the levels are
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consistent some medications work at the kidneys so the kidneys also filter out sugar
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um and and also keeps them in our blood so some medications try to convince the kidneys to pee more sugar out so those
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carbohydrates are important in all three stages so pre-diabetes type 2 and type 1
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were a little bit more specific with the amounts
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uh with type 1 because we're giving insulin for every gram of carbohydrate
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essentially type 2 if we're on insulin so sometimes we're still in insulin we are again
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being a little bit more specific we're paying attention to you know if I have 45 grams of carbohydrates how much extra
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insulin do I need right so we're still paying attention we may not be as specific with those
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starchy versus non-starchy veggies because you start to learn yourself how your body does
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with pre-diabetes think of pre-diabetes kind of as that yellow warning flag that
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things are starting to go awry we need to be more specific and more pay a
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little bit more attention to how our body's doing with meals now guidelines still don't really
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suggest that we have to be testing our blood sugars in the pre-diabetes stage I am a very vocal advocate for testing our
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blood sugars at this stage because of what we just talked about you can eat
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your normal meals and check your blood sugars two hours after to see how your body is coping with what you're eating
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um and I find even with people if we can get a you know continuous or floss glucose monitor on in the pre-diabetes
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stage for that two weeks we see such better outcomes because they
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can make small tweaks without being overly restrictive and they can maintain those changes for
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a long time and so little things Kathy like for
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example I often hear people when they're diagnosed with pre-diabetes being terrified if things even like carrots
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where as I would rather you eat carrots because they're nutritious and they're so valuable with lots of nutrition and
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let's just check and see how your body does and what are you eating with the carrots in terms of protein and other
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nutrients to see how that impacts it I hope that answered your question
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that's a really good point Jenna um certainly when we're eating we're not just consuming carbohydrates right so
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what else would make up our plate in terms of foods or nutrients and what
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kind of an impact would those things have on blood sugar and then how can we kind of incorporate
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all things to eat in a in a really well balanced way would you say
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yeah um I mean ideally we I try to focus um more on a plate method right where
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we're really trying to get Back to Basics around eating enough food first I
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I really don't find that anyone does well when we try to impose restriction and taking things away as opposed to
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First focusing on you know are you eating enough vegetables at every meal because they're high in fiber and
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they're typically low on carbohydrates are you eating enough protein a to maintain muscle mass
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um fantastic in terms of Just Energy and also satiety keeping us full longer and
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then those carbohydrates which also give us all the you know vitamins and minerals and fiber having all of those
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together again if I go back to that Lego analogy for people it's like having a really intricate Lego block that your
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body has to work really hard to pull all of those pieces apart it takes longer for the body to access those
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carbohydrates and so we don't see this massive Spike of blood sugars but you know hopefully more Rolling Hills
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and so for a lot of patients where we start is okay what are you currently doing when are you eating what are you
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eating how much are you eating and is there room to add so far you know typically having say you
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know toast and jam and a coffee for breakfast great but we're just having carbohydrates and
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carbohydrates can we add some veggies can we add some protein it might be adding some peanut butter and um sliced tomatoes on the side or
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something right a veggie omelet and one piece of toast try a whole bunch of different varieties a to see how their
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individual body tolerates I think that's really helpful
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um we've got another question coming in here from Jennifer uh Jennifer works at diabetes Canada and has lived with type
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1 diabetes for a long time and also happens to be a dietitian so I'm very knowledgeable when it comes to food and
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nutrition but she says in spite of all of this eating out for her can be an ongoing challenge so what's your advice on
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eating out for people who are living with diabetes um perhaps for for people with type 1 but also for people with type 2.
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um and how how would you go about sort of estimating um carb amounts of things like sauces
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which which may be a little bit trickier to figure out um and then working to kind of maintain
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those blood sugar targets yeah absolutely and I mean um eating out in in general is can be a
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challenge um for anyone living with diabetes in terms of knowing how much and also how it then
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impacts their blood sugars right so uh especially for type 1 whether they're MDI or whether they're pumping there's a
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few things I'm a big fan of first of all is be part of a group so any sort of
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diabetes online support groups Facebook has a ton of them but there's more outside of Facebook I really truly find
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that people living the experience have more inside scoop and knowledge of the
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best places to eat where they're serving consistent amounts right so most of the
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food chains that that we frequent have their nutrition information available
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but the sauces and all the little pieces really come down to are they following the amounts that that standard recipe
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suggests that they're putting on when it comes to sauces right versus are they just doing a big old squirt
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um easy enough we can ask for those things on the side that's always the safest
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it's sometimes annoying for sure but safest in terms of if we're if we're dosing specific amounts or bolusing
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the second piece too is what you may do especially if you're eating out often is
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you may have some of your own staple foods for a meal and just be getting a portion that's takeout so I've had some
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patients have success with that especially if they're on the road a lot say you're a busy um you know parent with sports and
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you're on the road a lot or um with work if you're traveling with work having some of those Staples where
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you're boosting fiber you're boosting protein um that can be easy as well to know the
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specific amounts that you're getting or vice versa you're bringing your carbohydrate amounts and what you're
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ordering might be like you know a salad with chicken to get extra
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it's a super question from Jennifer thanks so much and just as a reminder to everybody keep
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those questions coming recall that open hours is all about you so ask anything that's on your mind about diabetes and
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nutrition feel free to use the chat feature or you can come off mute and ask your question in person
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uh Jenna we've heard a lot about low carb diets so maybe we could talk a
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little bit about about that um what is your perspective on low carb
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diets um are they a fud are they helpful for people with diabetes
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um give us the lowdown yes so this is still a really big topic
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and still a very controversial one and controversial even I find in in terms of my own head
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um because it's only effective if it's effective
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and realistic for the patient long term and so when we look at eating patterns
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for people whether it's ketogenic meaning less than five percent of the diet is carbohydrates versus low carb
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which is typically under 20 percent of total calories coming from carbohydrates
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um it's effective we can eat well nutritionally balanced if it fits their
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budget they enjoy the foods they're eating they're eating enough nutrition and they're still managing their
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diabetes Well right so we can still be eating that 20 percent have very low carb very low carb
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and a higher carb meal without any medications and blood sugar still you know increase after that one meal so
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there's still some education there's still some learning there's still self-monitoring of blood glucose even in
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those contexts um is it necessary I would say no
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we can still manage our diabetes very well with a you know standard Mediterranean style of eating or a more
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flexible carbohydrates which I find for most people again I
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work a lot with eating disorders so I'm very sensitive to restriction and what
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long-term impacts that can have um if we can make sure that carbohydrates don't feel like a bad food
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for patients I'm all for that so yes it can be
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effective for patients if they're interested in addressing or trying a lower
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carbohydrate diet I definitely suggest that they chat with an RD or with someone who has experience just to make
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sure they're getting enough food they're never feeling restricted and they're still managing well
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in your experience what are some of the risks of somebody following a low carbohydrate diet particularly if if
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somebody maybe isn't um doing it alongside a registered dietitian or or hasn't
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um consulted with a healthcare provider about that so if someone's living with diabetes are are their risks
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yeah um absolutely um I think I think the biggest thing
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that we really want to look at right is um the reason that they're choosing
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right so it might naturally already be the way that they prefer to eat one of
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the key things that we really want to look at is you know what medications are they on some of them are not safe to
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continue taking and so we really want to look at you know where is insulin at and the sglt2s some of the sulfonurias
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certain medications we really should look at stopping so that's one thing
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that we definitely want to start with if there's any history of Eating Disorders or disordered eating
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that big red flag for me and it's something I I really dig deeply in with with people
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um risk factors too is really a cost right if they have a fairly low uh budget for
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food High veggies and high protein is really expensive
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so my my concern is actually more in terms of how are they managing to eat
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enough nutrition following a low carb diet uh that's a
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that's a big one that I think is overlooked way too often um I mean outside of that those are the
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biggest factors so the medications you know the disordered eating and then is it reasonable for that for that
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patient it's helpful to think about the benefits and the risks and making decisions about
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eating patterns um so and speaking of eating patterns you mentioned the Mediterranean diet
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so just wondering if you can describe what that eating pattern is like for people who aren't familiar with the
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Mediterranean diet yeah so I think it's great to think of it more as a as a lifestyle that's
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really the way that we know there's more benefit we're we're focusing on lots of plant Foods
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um lots of plant-based fats and proteins nuts and seeds you know olive oils avocados
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um less red meat so it's not gone but it's definitely less frequent like a few
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times a month as opposed to a few times a week more fatty fish like trout and and tuna sardines
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Etc um the lifestyle Factor too comes in in terms of focusing on taking time to eat
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right we're not scarfing food down in five minutes and going on a better day is making time to
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cook trying to cook more meals at home trying to sit socially together to eat
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we actually see much better outcomes and much more satisfaction from food when
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we're able to do that digestively too we tend to actually have better Digestive Health when we actually
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sit you know kind of that 30 45 minutes that we would all ideally have for three meals a day
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is important as well so it's not so much a diet in today's sense of the word but a way of eating
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now you mentioned with the Mediterranean way of eating that that it heavily features vegetables
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um I think uh one thing that a lot of people are wondering about uh when they're diagnosed with diabetes or
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they've been living with it for a while is is there any benefit to adopting a vegetarian diet so cutting out animal
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products all together and and you know whether it's a vegetarian diet or a vegan diet or any sort of variation can
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you talk to us a little bit about that is it necessary to be vegetarian when you have diabetes
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yeah so definitely not necessary um the interesting thing with the evidence that we have with uh vegetarian
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Lifestyles is that we also see a fairly significant reduction in heart disease for those who do follow more of a
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plant-based diet so less elevated cholesterol less elevated blood pressure
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which we know risk factors for both right when we have diabetes and heart disease is is high so we see
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improvements there um we also because I I got a lot of questions when people are asking to eat
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more plant-based and we're encouraging them to eat more pulses which is you know they're high fiber
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um beans and legumes and higher in carbohydrates and there's that moment of
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confusion of what I thought I had to watch my carbohydrates we don't see as much of an impact with a
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lot of those pulses when they're Incorporated with other plant proteins as well in high fiber grains because
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there is more protein in fiber so we see some benefits there as well
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from a higher intake of fiber when we're following more plant-based proteins
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because things like um you know almonds and walnuts and black beans and lentils they do they
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have protein but they also have a ton of fiber that helps to reduce cholesterol and
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also Keeps Us full longer and is lower on that glycemic index we talked about
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so we definitely see good at in outcomes sorry with respect to diabetes
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I would argue it's potentially cheaper meat is still through the roof right now since covid so budget wise we can really
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stretch that dollar with more plant-based I find for people it's more of a lifestyle switch we're very much
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still a meat potatoes veggie way of eating and so it can be more of a switch that way
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I find that's helpful for people to pick say one meal a day to start in terms of
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trying to transition to more plant proteins so they may have a salad or a soup and
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instead of putting meat on it putting again even canned black beans or canned lentils in that pot of soup or you know
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a quarter of a cup even to start on their salad or if they're having a wrap you know mashing some chickpeas and and
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using that as the protein instead of leftover chicken or ham or something along those lines necessary no but
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there's definitely benefits that's great I was actually going to ask you if you could provide some
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suggestions for how people can incorporate more plant-based proteins in their diet so
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um good to get those ideas for people who maybe are not accustomed to eating a lot of plant-based proteins but want to
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want to start um so we're about halfway through open hours now everybody the time is just
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flying by thanks again so much for joining us uh we're here with Jenna Walsh registered dietitian and certified
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diabetes educator she's here to answer all of your nutrition related questions so use that chat feature to ask anything
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about diabetes and nutrition you can certainly also share your story about how you're affected by diabetes talk a
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little bit about how diabetes is impacting your life um and and we'll just keep going
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um Jenna you were talking before a little bit about um
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different types of carbohydrates and wondered if you could just provide a little information about simple versus
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complex carbs so people may have heard those terms before and there may be a little bit of confusion about what those
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are so tell us about simple and complex cards
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yeah so think of your simple carbohydrates basically as your sugars
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there are one unit doesn't take your body much ever to break down it's going to be things like
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your honey your maple syrup um you know juice really is is
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everything's been broken down and removed as well they're they're very easy for the body to use right away now
32:56
most people when I say that say okay so they're about they're not bad but if we're having them
33:01
we want to have them with again going back to that protein and the fiber to help again reduce that Spike where
33:08
they're beneficial is when people are having a low so when blood sugars fall under that
33:14
four or three point eight we actually want to be reaching for those simple sugars
33:19
tablespoon of honey you know a half a cup of juice a half a cup of regular pop because that's what's actually going to
33:26
take little time for your body to bring those sugars back up to a safe level now on the flip side of that your complex
33:32
carbohydrates I want you to think of a whole bunch of sugars tied together like a chain
33:39
um they're complex they've got some hydrogen and oxygen as well and you know potentially different fiber molecules
33:45
some protein all of those good things again that really complex Lego block right
33:51
takes more effort for the body to break it down uh and to absorb it into the
33:56
bloodstream so from a meal in day to day into we want
34:02
to focus on more complex carbohydrate and yeah try to build most of our meals around
34:09
those on the flip side of that if we're having a low these are not the ones we want to
34:14
grab we don't want um you know a half a cup of lentils with whatever mixed in
34:20
veggies mixed in it's going to take too long for the body to bring those sugars up so complex exactly as they sound they're
34:27
complicated for the body to break down simple super easy very quick for the blood sugar to spike
34:36
okay that makes sense um now related to that concept and also something you mentioned before I'm just
34:43
wondering if you can expand a little bit on this whole concept of carb Counting what is it
34:49
who needs to do it how do you do it why is it important yeah
34:55
I um with type 2 diabetes I I avoid getting too in depth with carb counting
35:03
because I try not to have food become numbers for people with insulin use we do get into carb
35:11
counting not necessarily right away we start with kind of that plate method again but we're very much looking at a food
35:18
label or measuring food we have different lists for foods that let us know how many grams of carbohydrate per
35:26
weight of food so then we would be essentially weighing that food using that calculation to
35:32
figure out in what we're about to eat how many grams of carbohydrates
35:38
that with insulin we figure out a ratio of how many units of insulin we need at
35:44
a meal per grams of carbohydrate so that's pretty complex and detailed
35:51
for for today there may be some people out there any of our type ones especially or any of our type twos on
35:57
MDI who maybe have already you know been dabbling in that or experts in it that
36:03
is the simplest way to look at it if we are for example looking at a food product
36:09
and it says you know there's 48 grams of carbohydrates we also use an exchange
36:15
system to simplify that where roughly 15 grams of carbohydrate would be one
36:21
carbohydrate so for example we have some great resources that sort of already list the
36:27
carbohydrates in foods and what portion would equal one and the simplest way is
36:33
typically one piece of bread one cup of milk and one medium sized fruit are all roughly equal to 15 grams or one serving
36:41
so there's a difference depending where a patient is at with their their diabetes or what type and what
36:48
medications or insulins they're using that determines whether we get into that in depth
36:54
discussion around carbohydrates because it it even goes beyond that rate it also depends on the amount of fiber subtract
37:00
fiber from the total carbohydrate um the complexity of that meal again we
37:05
talked about you know how much protein is in there and fat so
37:12
but you can see why nutrition is such an interesting topic to people because it's it's complex and
37:20
um one question kind of leads into the next um so so happy to have you here to help
37:26
us um figure this all out um let's talk about carbs a little longer
37:33
and then maybe we'll shift away and again just encouraging people to bring up anything that they're wondering about
37:38
related to diabetes nutrition in the chat or you can come off mute to ask your question to Jenna
37:44
we welcome story sharing as well and reactions in the in the chat feature
37:51
um you mentioned uh recently um in one of your responses the glycemic
37:57
index um so walk us through that for people who don't know what the glycemic index
38:03
is tell us about how you use it and kind of what it's all
38:09
about yeah so um the easiest way to do it is there's
38:15
been different studies and evaluations on different foods on how quickly they
38:20
raise our blood sugar so from there then um
38:26
Foods were categorized using basically a light system so like green yellow red
38:32
into being low glycemic index meaning they had minimal impact or less impact
38:37
things like you know really um higher fiber higher protein really is
38:43
the easiest way to simplify it greens and cereals versus as they get more into
38:49
the red they're typically more refined with less protein and fiber right so
38:54
like really dense 12 grain bread being low versus like a low fiber low protein
39:02
white bread now since then though I mean if you look in
39:07
the bread aisle right there's 200 varieties of bread we also now have white bread that has added fiber and
39:12
protein and so it's different so we can't just simplify it that way um but we use it as a really good
39:17
starting point in education piece for patients um I don't know if I can share my screen
39:22
in but I did have it open in case anybody asked me amazing thank you you shared it perfect
39:29
I I figured that would come up it comes up a lot so it is one of those things I always say to people you know what use
39:35
it as a guide as a starting point and then little things right like I I brought up before
39:40
in terms of bananas for some people because that's a big one but even something like barley is low on
39:46
the glycemic index for some people they might have barley and it might still impact their blood
39:52
sugars fairly significantly we can also take a high glycemic index food
40:00
like instant white rice and add protein
40:06
canned tuna chicken lentils and veggies Frozen fresh canned
40:13
whatever you know fits your budget or makes you happy and make that high glycemic index
40:19
food a low glycemic index meal so again I never like people to feel stuck
40:27
with Foods or deterred based on their budget or their ability to cook certain foods we
40:34
can still eat really well on any of those budgets and also with any of the foods that we're used to
40:39
eating so again use it as a guide but keep in mind when we talk glycemic index and blood sugar spiking
40:47
we still have that ability to to reduce the glycemic load of a meal by adding protein and fiber and fat
40:56
I see a question in the chat here from Maria thanks Maria um so Maria is wondering about
41:01
incorporating glycemic variability into patient education and Maria's wondering
41:07
how you personally use this concept in your practice it's a it's a super
41:13
question Maria thank you yeah absolutely and um I think for some people so I think what
41:20
you're meaning is you know some people will stay fairly low carbohydrate and then you know occasionally have higher
41:26
carbohydrate meals um and or choosing right from some of those lower glycemic index foods and and
41:32
higher and trying to pair them and so both are always fine
41:38
right like having variety and variability in Foods is normal it's
41:43
natural that's an intuitive way of eating for a lot of people the most
41:48
important piece I always say or encourage people is just check your blood sugars
41:54
right so if most of the time you're eating fairly low glycemic index or low carbohydrate or whatever and blood
42:01
sugars are typically within Target and you do have something that's higher glycemic index or you do go out for
42:07
higher carbohydrate meal or you have one at home it's fine just check and see where your blood
42:13
sugars are at later because if we stay suddenly out of nowhere have um you know a lasagna or a spaghetti or
42:19
pizza and that's all we eat we have some room that even if blood sugars are high later again we can reduce that glycemic
42:26
load by adding some veggies with the next time around having more protein
42:31
right so maybe having less pasta have more sauce have a salad on the side so you can always have that variability
42:38
and that variety we always encourage that I'm hoping most people who are doing education are encouraging that as
42:45
well because it's not realistic for us to assume living with diabetes these are
42:50
the only Foods we're allowed to eat for the rest of our our time here we need to have variety
42:58
yeah that's that's a really terrific question from Maria um and just want to direct everybody's
43:04
attention to the chat where I put in the link to diabetes Canada's resource about the glycemic index food guide so
43:11
you can access that it's a PDF on the diabetes Canada website
43:17
um so wondering a little bit about sweeteners Jenna if you can talk to us a
43:22
bit about sugars and sweeteners so artificial sweeteners and then sort of natural sources of sugar
43:29
um and and starting with the whole idea of like are all sugar is created equal so brown sugar white sugar honey
43:37
molasses maple syrup are those all the same or are some better than others hmm
43:46
yeah it's such a big topic um sugar is sugar so when we're talking in a diabetes World
43:53
um all of the the sugars right whether it's agave syrup which again is like
43:58
this trendy sugar um lactose honey glucose all of it maple
44:05
syrup molasses it's all gonna give us you know those four grams of carbohydrates
44:11
um so in a diabetes world they're all the same some people will argue you know natural maple syrup has more
44:17
micronutrients the amount of sugar that we would have to eat to get any valuable
44:23
nutrition from them blood sugars would be through the roof so it's not a source of micronutrients
44:29
when we when we look at it and so the biggest thing is always if you're having sugar
44:35
or maple syrup or honey eat the one that you enjoy that's the most important piece when we
44:41
start to get into sweeteners right so everyone also has their own personal belief in view on sweeteners
44:48
that they're either okay or they're not good for us
44:54
from an Evidence point of view which is where we practice from is we look at you know what is the the
45:01
safety level that's been tested it doesn't necessarily mean Beyond there it's not safe it means that's the level
45:07
at which they've tested and there's been no adverse effects right so with each
45:13
sweetener that's out there um so there's sugar alcohols for example sugar alcohols are also naturally found
45:21
in in foods right so like sorbitol Mannitol all of these are are natural
45:27
sugars and same with Xylitol in Foods um there's no issue with them they they
45:34
don't boost our blood sugar like regular sugar does
45:39
the difference being with sugar alcohols is if you're having too much typically Beyond 10 grams a day you might have
45:45
digestive side effects because they pull fluid into the gut okay so any of those ones typically that end in ol
45:51
are those sugar alcohols outside of that there's there's a bunch
45:57
of of sugar-free substitutes available out there the one I typically like to
46:02
highlight to people where they potentially could be eating beyond that suggested safe limit is the cyclamate
46:09
which is like the sugar twin or the Sweet and Low the ADI which is that acceptable daily amount is really around
46:17
um just under that 600 milligrams and one of those pockets would be close to 270 milligrams so for people if they're
46:23
constantly eating Sweet and Low um that's the only one that you know to kind of just be cautious with outside of
46:30
that things like sucralose which is you know your Splenda again great you'd have to eat a lot of Splenda I think it's
46:37
close to two cups in a day to even come close to that um ADI uh Stevia again same thing you
46:45
can buy the actual Stevia plants and plant them if you really like it um
46:50
the levels are there it would take a lot for people to get close to that ADI and
46:55
again that tested level doesn't necessarily mean there's adverse effects Beyond it
47:01
um it's just more that that's the level they've been tested at again the bigger thing to look at that I
47:08
say to people you know if they're baking and all of a sudden they're feeling like okay well I'm gonna have to buy a Splenda or Stevia and start baking if
47:15
you're making cookies that have oats and flour and spending more money to add Stevia or
47:22
splenda that you don't like there's still carbohydrates in those cookies from the flower and the oats so
47:29
removing the sugar doesn't remove the carbohydrates it absolutely can decrease it but there's a balance between
47:36
the satisfaction from food and how much you need to be satisfied and enjoy versus
47:42
um just feeling restricted by a lot of Foods right so that's a balance if
47:50
you're having coffee and you're just as happy with stevia or splenda or whatever in your coffee amazing that makes a big
47:55
difference because some people will end up with a tablespoon or more um but in terms of baking and cooking again just be mindful in terms of
48:02
there's still going to be carbohydrates likely in a lot of those Foods
48:07
there's also a great resource and sorry and I can remove some of that as well yes I just popped into the chat a link
48:14
to the diabetes Canada resource on sugars and sweeteners again it's a PDF that people can access that has good
48:21
general information about sugars that affect blood glucose and
48:26
um sugars and sweeteners that don't so much so that's there for people to take a look at
48:32
um so we've got about 10 minutes left in our time here
48:38
um I can't believe how quickly this hour is going now is your chance everybody to put those questions into the chat come
48:44
off mute if you'd like to share your story or to talk to us a little bit about how diabetes impacts your life and
48:51
what you're wondering about nutrition uh maybe we can shift away a little bit
48:56
from um carbs and talk a bit about some other
49:01
things that we find in our food so alcohol and caffeine so what is the deal
49:07
with these for somebody living with diabetes do they have to avoid them are there special things that they should
49:12
know about intake of alcohol and caffeine what what do you tell people
49:18
yeah so um caffeine in general right so caffeine is
49:23
is going to constrict blood vessels and just the way that it affects the body is going to increase blood sugars and so we
49:30
know that even if it's black uh it doesn't mean don't drink it again biggest thing of awareness right if you get up in the morning and you have a
49:36
coffee and test your blood sugars two hours after and you know it's eight or ten or whatever and you haven't eaten
49:41
anything it's just be mindful that it's probably the coffee which is okay if you're you know hitting
49:48
Tim's for a triple triple there's a lot of added sugar in your coffee so I find it's not so much just
49:53
the caffeine sometimes it's what we're adding to it to be mindful that it can be impacting your blood sugar
50:00
um with alcohol the same is true in a few ways it's a bit more complex
50:05
right so alcohol in itself if we're just having liquor with no added carbohydrates is
50:12
going to divert the liver from releasing sugar while it breaks down the alcohol so we sometimes actually see blood
50:18
sugars dip a little bit now it gets a bit more complicated depending how much we have and also what
50:24
medications we're on because if we're on medications that can cause our blood sugars to go low
50:30
we run the risk of going low right I also find that if people are
50:35
having things like beer or alcohol as well like any of the coolers that do
50:41
have carbohydrates or even wine we get kind of just more erratic blood
50:46
sugars where you might see a dip but then you might see them Spike one way or the other because it also then depends
50:52
on how we're eating and behaving while we're having those drinks so
50:58
typically I mean people with pre-diabetes and type 2 if they're not on insulin it's not as much of a concern
51:05
from a safety perspective the other thing that alcohol does is it increases our triglycerides or it can which is a
51:13
blood fat which again it's just more that we kind of see that increased double risk of heart disease with diabetes
51:20
um there were just recently updated guidelines around the alcohol suggested
51:25
alcohol limits they're quite strict I don't know if people have already seen them and sort of what their thoughts on
51:31
on them are but it's really suggesting less than two drinks a week um and that's more from a heart health
51:38
perspective chronic disease perspective and and also cancer so
51:44
um you don't have to cut it out again it comes back to management right I mean if you're going to have a few
51:49
glasses of wine help them enjoy them but check your blood sugars that's all
51:55
yeah I think those those alcohol guidelines that you were talking about Jenna that were recently released are from the um Canadian Center on substance
52:03
use and addiction so people can check those out online
52:08
um and and you know good to consider the impact of both alcohol and caffeine on
52:14
blood sugars um so that people with diabetes are really aware when they're consuming
52:19
different things what effect it might have no speaking of beverages
52:25
um we know we hear from a lot of places a lot of sources that water is really important for our health
52:32
um but some people just are not crazy about water it can be maybe boring or
52:37
Bland so even though we know we should probably drink a fair bit of water in the day
52:43
um maybe we're less inclined so so what tips or tricks do you have for people to increase their intake of water
52:51
yeah uh first starting point I always suggest is whatever else you're having
52:57
at ice cubes it's an easy starting point tons and tons of ice every time you're having something else add ice
53:04
um outside of that is there's a little bit of mind over matter
53:09
too sometimes right like sometimes I find it's habit if we're always grabbing for something sweet it's because we've also trained our brain that this is what
53:16
I enjoy water tastes gross I hear sometimes because we're actually expecting the sweetness there's there's
53:23
some gradual transition that we see when people actually just actually start increasing their water so we we can
53:29
actually just start there versus also adding frozen fruit you can buy Frozen sliced
53:36
lemons and limes which are Super convenient to add into even a full jug of water and leave it in the fridge some
53:41
people really just like cold water so actually getting a really nice decanter or something that fits in your fridge
53:48
um to leave it in there so it's nice and cold the other thing that I ask is depending on your water
53:55
um you might not like the taste of it so some water is really high in iron or or
54:01
other minerals it might be worth investing in like a Culligan system right just even the ones where you can
54:07
get the filled up jugs so those are options you can also get now like the
54:12
carbonated um like the PC waters for the bubblies they're sugar-free they're really just
54:19
flavored carbonated waters um those are nice sometimes they're also a really nice alternative if you're
54:25
looking for that drink in the afternoon or in the evening there's something that's just a little bit different right
54:32
um yeah I'm a big fan of adding the frozen fruit sometimes even veggies like adding
54:37
mint and cucumber is lovely um and you can sometimes even just save
54:42
the tips of your cucumber and throw them in as in a tupperware or baggie in the freezer
54:48
and then throw them in your jug of water so that's super easy to do as well
54:55
outside of that I sometimes too if people are drinking coffee all day is even just start with before you fill up
55:01
another cup fill your mug with water and just down it
55:07
an easy way to start yeah that's a really good tips
55:12
um just on a couple minutes left here and welcoming any last questions comments stories anything in the chat or
55:20
you can come off mute to share um Jenna
55:26
um you've talked a couple times about cost and we we know right now that we're dealing with Rising food costs
55:32
um and that healthy eating can be quite expensive and sometimes people feel like
55:39
prohibitively so so what are what are some tips that you have
55:46
um really I mean for anybody but but specifically for people who are living with diabetes about
55:51
um eating well on a budget yeah um first thing and I think most people
55:56
who are on a budget know this is don't buy into the name brand um the No Name you know the the store
56:04
brand are typically as new nutritious for a fraction of the cost I'm a huge
56:11
fan of frozen veggies and fruit they're as nutritious you know they're picked up
56:17
Prime flash frozen for the most part and they last longer they're not going to spoil on us and now the lovely thing is
56:23
you know you can buy frozen spinach and frozen kale and Frozen edamame beans and you know pretty much every veggie Frozen
56:31
butternut squash all of those things that give you a ton of variety they give
56:37
you a lot of options for your meals and they're they're less expensive
56:42
I definitely don't recommend you know buying things out of season like strawberries and berries this time of
56:48
year are astronomical um there is some value sometimes also in
56:54
the points programs so different grocery stores like independent for example will do the PC
57:01
points you can surprisingly actually build up quite a bit of money to then get free groceries right so
57:09
people if you think of kind of some of those like coupon clipping behaviors if
57:14
you're mindful of what foods points are available for and you're
57:19
buying more of those things in bulk those weeks especially if they're frozen or canned items you can build up a lot
57:25
of return income for that outside of that canned and bagged beans so again
57:31
going back to the vegetarian it's like a dollar 25 to buy a bag of dried beans
57:37
um there's tons of YouTube videos on how to cook them what to add them to you can add them to anything
57:42
they're fantastic for protein and fiber balanced nutritionally right when we
57:49
really get down to it in terms of those two nutrients alone and so then adding even just
57:55
um whether it's rice or whether it's some frozen veggies and you have a nutritionally balanced meal for really
58:00
under a dollar fifty or two bucks compared to if we're trying to buy fresh veggies and meat and whatever else so it
58:07
makes a big difference that's a great practical note to leave things on
58:14
um Jenna I just want to thank you so much for being with us today on Diabetes open hours it was a pleasure and I
58:20
learned a lot from you I I hope that our our viewers did as well
58:25
um and and just as a final message to everybody we want to thank you the participants for joining us today and for being part of this very first
58:32
diabetes open hours um there will be an evaluation coming to you so please let us know what you
58:38
thought about this format and uh we are looking for ways to um to really tailor
58:43
this to suit you the the participants so please share your feedback with us to learn more and to stay up to date on
58:50
Diabetes Canada work and resources you can also visit our website diabetes.ca or check out our social
58:56
media channels we're on Facebook Twitter Instagram LinkedIn you can also call our
59:01
information team at 1 800 Banting so b-a-n-t-i-n-g or email us at info
59:08
diabetes.ca with Customs join us in April for our next diabetes open hours
59:13
and please stay tuned to our social channels and to the diabetes Canada webinar page if you Google diabetes
59:19
Canada upcoming webinars you'll find that page and there will be information there posted shortly about our next open
59:25
hours what the date will be and the topic as well as the registration information we hope you found this
59:31
webinar helpful for you and we look forward to hearing your feedback and to seeing you back again soon thanks so much
59:38
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