I was lucky enough to be invited to attend the Johnson & Johnson Diabetes Institute in Milpitas, California at the beginning of April.  The Institute is a 2 day intensive diabetes education/training session to help Diabetes Educators, Nurse Practitioners, Physician Assistants, & other Health care providers find innovative answers to to some of the challenges facing diabetes care.  Topics ranged from Insulin Pump Therapy to Continuous Glucose Management to Reimbursement issues to Behavioral Change Techniques.  Overall, the session was very enlightening for me.  I was able to meet with Diabetes Educators from around the United States and share ideas on improving diabetes care. 

One session I really enjoyed involved the topic of diabetes medications.  With Type 2 Diabetes, the patient is usually diagnosed some time after diabetes has developed. Treatment is normally started with oral medications (pills) along with lifestyle & diet change.  Insulin is usually a last-ditch effort to improve blood sugar control.  However, Type 2 Diabetes is a progressive disease.  When Type 2 is diagnosed, many years may have passed since the patient truly developed the disease.  In that time, the pancreas may have already maxed out its insulin production.  What that means is that insulin may be needed sooner than would be expected.  What that also means is that insulin starts should not be seen as patient “failures”.  The nature of Type 2 Diabetes progression will eventually lead to that, regardless of overall control.  Therefore, it is important to at least start talking about insulin use soon after the diagnosis is made.  There is no question that initiating insulin brings up many fears in patients and providers alike.  But if you look at the types of insulin that are available today, we have significantly more choices and options than we did just 10 or 15 years ago.

Insulin is a medication that could be considered much more natural than its oral counterparts. Insulin is simply a hormone made by the pancreas to help the body utilize energy.  With insulin, you may run a higher risk of having hypoglycemic (low blood sugar) episodes but those can be minimized.  In fact, some oral agents are contraindicated in geriatric patients or those with kidney, liver or heart disease.  There is less risk to the liver and kidneys with insulin as it is not excreted through these organs like many of the oral agents.  A major benefit to using insulin is that it allows you to tailor your approach to blood sugar control.  It gives you the opportunity to fine tune adjustments and get exactly what you need, when you need it.  Of course, when using insulin you must still balance between exercise and proper food intake to get the maximum benefit! 

We need to make sure that we don’t view the use of insulin as a failure.  Insulin should be used more freely as a means to achieving better blood glucose control earlier on in the treatment of diabetes.  Once on insulin, we would encourage more frequent blood glucose testing.  This gives the patient instant feedback on how his or her therapy is progressing.  We have multiple tools available to us.  We must use them more efficiently.

If you are not meeeting your diabetes health related goals, talk to your physician about the possible use of insulin.  There are risks and benefits associated with any medication change, but if it enables you to control diabetes better, the benefits will far outweigh the risks. Take control of your diabetes!

It’s Your Health!  It’s Yor Life! Make That Change!

Johnикони

Wow!  We just completed a very successful National Nutrition Month!  March kept us busy as we celebrated Nutrition Month with the Elizabeth City community.   Take a look:

Monday March 2nd – John and I provided a Nutrition Presentation for the P.W. Moore Elementary faculty members.  We followed this with a “Wellness Wednesday” nutrition and fitness tip each Wednesday during the month that was read during the morning announcements. 

Monday March 16th:  Angie presented a Nutrition Presentation to twenty five girls between the ages of 8 and 12 at Girls, Inc. in Elizabeth City.   

Friday March 20th:  John joined host Sheila Lee for the ”Morning Joy” gospel radio show on ECSU radio WRVS 89.9.

Tuesday March 24th:  John and I participated in a radio interview in which we talked about the role of nutrition in chronic disease prevention with Letitia Evans on ECSU radio 89.9 WRVS.  (A special thank you to Host Greg Sampson for giving our son a tour of the station and allowing him to do his homework at your desk!  He is loving the “Parliament” CD!). 

Thursday March 26th:  John presented “Just Give me the Facts:  the Nutrition Facts”  for the Elizabeth City State University Drug Information Center.   

Saturday March 28th- Angie exhibited and participated in the “Ask the Expert” forum at “Diabetes Day:  A Three Rivers Healthy Carolinians Conference for People with Diabetes” at Edenton Baptist Church, Edenton, NC.

Tuesday March 31st:  Nutrition Pair (John and Angie with the help of our fellow RD/CDE, Kelly McCombs) exhibited at the Elizabeth City Chamber of Commerce Business Expo.

Here’s to a great month!  We’re looking forward to the 2010 celebration!

It’s Your Health!  It’s Your Life!  Make That Change!

 ~ Angie

Today, Tuesday, March 24th is American Diabetes Alert Day.  The American Diabetes Association has indicated this day as a “wake up call” to the seriousness of this disease. 

24 million adults and children in our country have diabetes.  About 25% of these do not even know that they have it.  However, early diagnosis is critical to treatment as uncontrolled blood sugars can lead to:

• Heart Disease
• Blindness
• Kidney Failure
• Stroke
• Lower limb amputations
• Death

Diabetes prevalence in the U.S. has more than tripled over the past 25 years.  Research has shown that obesity is the main reason for this increase.  Besides obesity, additional risk factors for diabetes include:

• Sedentary lifestyle
• Unhealthy eating habits
• Age over 45 years
• Family history of diabetes
• African American, Latino, American Indian, Asian American or Pacific Island ethnicity
• Women who have delivered babies weighing 9 pounds or more at birth.

Could you be at risk?  Take the free Diabetes Risk Test at www.diabetes.org/alert or call 1.800.342.2383.  If you have diabetes or are at high risk of developing diabetes, working with your physician and a Certified Diabetes Educator will help you to be better able to control your blood sugars.  Doing so will prevent the complications that can occur when blood sugars are uncontrolled. 

Nutrition Pair, LLC is a married couple of Registered Dietitians and Certified Diabetes Educators who, along with the care of your physician, can help those who have diabetes, prediabetes or who are at high risk for developing diabetes.  We know diabetes on both a professional and personal level as John has had Type 1 Diabetes for the past 18 years.  Contact us at http://www.nutritionpair.com/index.php?link=contact .

It’s Your Health.  It’s Your Life.  Make That Change!

~ Angie

Happy Registered Dietitian Day!  Today marks the 2nd annual Registered Dietitian Day sponsored by the American Dietetic Association (ADA).  Look for the ADA to ring the Opening Bell for the NASDAQ stock exchange tomorrow morning, March 12^th in recognition of National Nutrition Month and Registered Dietitian Day. 

What makes you unique?  We all have our own distinctive traits that make us different from the person sitting next to us. This is what makes us special.  And, this is why personalized service is so important.  It gives us the freedom to choose what we want when we want it.  Our MP3’s are loaded with OUR favorite songs.  Our DVR’s tape our favorite sports or shows so that we can watch them at a time that is most convenient for us.  Even children are getting into personalization.  They can go to “Build a Bear Workshop” and fashion a bear that reflects their own special interests. 

You are unique.  You deserve individualized attention. 

When it comes to improving health, it should be no different.  Look for a program that can be customized for your lifestyle:   your schedule, your health goals, your medical history, your meds, your culinary skills, your own cultural foods and your financial situation.    Personalization can make the difference between success and failure.  This is why diets don’t work.  They don’t tell you what to do when you go to eat at a friend’s house and they are not serving Week 2’s Thursday Supper Meal.  Diet books don’t talk back to you and are not always written by Nutrition Experts, or Registered Dietitians.  You need the knowledge and skills to make your flexible choices on your own terms. 

An eating plan should fit your lifestyle, not the other way around.  This is where a Registered Dietitian (RD) comes in.  We get personal.  Find yourself a personal nutrition coach, a Registered Dietitian. We can create a customized plan that fits your own unique lifestyle and values. Working on-on-one with your own RD to develop a plan together, taking in your own wants and needs can be exciting.  RD’s help people who want customized plans because of our in-depth training and knowledge of nutrition, medical issues, and food.  We are uniquely qualified to assess and counsel an individual with any kind of medical history or lifestyle.

Nutrition Pair will work with you on your terms, on your time schedule with your own goals in mind.  No diets allowed.  Contact us to set up an individualized on-line, phone or face-to-face appointment!

Great news in nutrition and chronic disease prevention!  This past Thursday, the Alliance for a Healthier Generation held a media event with the American Dietetic Association, medical associations, health insurers and major employers.  This was to kick off the Alliance Healthcare Initiative, an effort to combat childhood obesity in the U.S.  The plan is to offer comprehensive health benefits to children and their families to help prevent, assess and treat childhood obesity.  In doing so, children and their families will be allowed Medical Nutrition Therapy with Registered Dietitians as part of their health insurance coverage.  

As a result of this collaboration, several health insurance organizations have already added this expanded coverage, including Aetna, Blue Cross and Blue Shield of North Carolina and WellPoint.  Corporations who have joined forces to offer these benefits to their employees are Owens Corning, PepsiCo and the American Heart Association.  This initiative and coverage will include at least 4 visits with an RD and will be available to targeted groups in selected states.  North Carolina is among one of these states.   

The Alliance for a Healthier Generation is a joint effort between American Heart Association and the William J. Clinton Foundation.  The goal of the Alliance is to decrease the prevalence of childhood obesity in the U. S. by 2015 and to empower children to make healthy lifestyle choices.  The Alliance strives to create a positive atmosphere in environments that impact children’s health such as homes, schools, restaurants, doctor’s offices and communities. For more information, you can visit their site at www.HealthierGeneration.org .

I am so thrilled that health insurance companies are beginning to realize how important it is to cover prevention of medical conditions.   For so long, it has been only a reactionary approach.  For example, Medicare will cover the cost of Medical Nutrition Therapy (MNT) but only for those who have a diagnosis of diabetes or chronic kidney disease.   However, if Medicare were to reimburse for the cost of MNT in conditions such as obesity, hypertension or pre-diabetes, it is very likely that these beneficiaries would never develop a chronic disease such as diabetes or kidney disease.  MNT works.  We know this.  It works by reducing chronic disease, slowing disease progression, decreasing symptoms and reducing both hospitalizations and prescription drug use.   MNT also works by reducing health care costs.  In fact, a 2001 Massachusetts General Hospital study found $4.28 in health care savings for every $1 spent on MNT. 

If we can prevent problems before they occur, health care costs will be so much less.  That is why this new initiative is such great news.  Hopefully, other health insurance companies, including Medicare and Medicaid, will realize this and follow suit.  

It’s Your Health.  It’s Your Life.  Make That Change!

~ Angie

Be Heart Healthy at any Age!

 Are you wearing your red today?  Today is National Wear Red Day. Americans nationwide are sporting red dresses, red blouses or red ties today to raise awareness that heart disease is the #1 killer of women. National Wear Red Day starts The Heart Truth Campaign to celebrate February as American Heart Month.

 The Heart Truth and the introduction of the Red Dress as the national symbol for women and heart disease awareness were initiated in 2002 by the National Heart, Lung, and Blood Institute (NHLBI) and partner organizations. Read more about it here. The campaign is geared toward women between the ages of 40 to 60, which is the period in which a woman’s risk for heart disease begins to significantly increase. However, the message is also important for young women as heart disease can begin to develop as early as the teenage years. Older women have an interest too as it is never too late to take measures to prevent and control heart disease risk factors. For women who may already have heart disease, it is important to note that existing heart disease can be reversed through diet and lifestyle change.

Take a look at these stats:

• Women are twice as likely to die from heart disease than from all cancers combined
• 39% of women who have heart attacks do not survive their first attack
• More women who have heart attacks die within one year compared to men
• One in two women will have serious heart trouble in their lifetime
• Women with heart disease have different symptoms than men

The largest risk factor for heart disease, by far, is smoking. Other risk factors include African American or Hispanic heritage, obesity, physical inactivity, high blood pressure, diabetes and family history of heart disease. What measures can women take to prevent heart disease?

• If you are a smoker, stop!
• Begin a physical activity program
• Control blood pressure/blood sugar levels if you have HTN or diabetes
• Eat right. Adopt a Mediterranean-style or DASH Diet-style of eating
• Include omega 3 fats in your diet (salmon, mackerel, flax, walnuts are good sources)
• Practice relaxation techniques
• Seek appropriate management for medical conditions

Remember, a Registered Dietitian can be a true asset in helping to design an individualized eating plan for you to help you in meeting your weight loss, blood pressure or diabetes management goals.

Wear red today and help spread the critical message that heart disease is the #1 killer of women and that there are things that women can do, starting today, to reverse their risk of heart disease.

It’s Your Health. It’s Your Life. Make that change!
~ Angie

When we talk to clients about nutrition, there always seems to be some misinformation or misconceptions floating around.  We try to make things easier to understand.  There is no need to make nutrition more complex than it already is!  What I have tried to do today is break it down into easy to remember guidelines.  To get the most out of Nutrition For Your Health, remember the 5 Fs & 1 V:

F #1:  FATS~  Use your food label to monitor the type and amount of fats in your food.  The two main fats to be concerned about are Saturated & Trans Fats.  These fats have been shown to be the most damaging fats to the body.  They are responsible for raising cholesterol levels and increasing your risk for heart disease.  Daily intake levels vary but a general guideline would be for women to keep Saturated & Trans fats, combined, to no more than 12-14 grams a day.  Men should keep their intake to no more than 15-17 grams a day.  Remember, these numbers will vary according to your individual needs.  Foods high in Saturated fats include: Beef, Pork, dark meat of chicken & turkey, cheese, 2% or Whole Milk, butter,ice cream, chocolate bars, fried foods & many fast food choices.  High Trans Fats Foods include many commercially baked goods such as cookies, cakes, pies, & donuts, many fast food choices.  (Since food companies were required to list trans fats on the food label in 2006, it is interesting to note the number of foods that are now “Trans Fat free”!!)

F#2:  FISH~We have already discussed the fact that beef & pork are high in saturated fats.  Fish is extremely low.  Even the leanest cuts of beef & pork are still high in saturated fats.  The benefits of fish go beyond just the fat content.  In fact, fatty fish such as Salmon & mackerel are recommended for their unsaturated fat content.  It has been stated that eating ~6 oz of Salmon a week will provide you with a therapeutic range of Omega 3 fatty acids.  That can help you control cholesterol levels and protect your heart.  Eating more fish does not mean that you stop at your local fish fast food place or grab the fish stix out of the freezer section in the grocery store.  Those choices tend to be high in saturated/trans fats and lower in the beneficial fats your body needs.  They are also much higher in sodium!  You can find affordable salmon choices in your local grocers freezer section.  You can also use canned varieties as well.  Remember, you want to bake, grill, steam or boil your seafood.  Breading & frying tends to take us back to the high fat foods we’re trying to reduce.  Check out some recipes here! 

F#3 + a V:  FRUITS & VEGETABLES~  These two food groups continue to be the most overlooked foods on our list.  We know they are low in fat & calories but we continue to under eat them.  These foods provide our bodies with numerous vitamins & minerals.  They are referred to as “Natures Perfect Supplement”.  Increasing your intake of these foods can not only help you control weight, blood sugars and cholesterol levels, they can also help you lower blood pressure.  When patients are told by their doctors that they have high blood pressure, they are usually prescribed medications and told to avoid salt or sodium.  If you simply increase your intake of fruits and vegetables you can significantly lower your blood pressure….regardless of whether or not you lower your sodium intake.  If you do lower your sodium intake along with increasing fruits & vegetables, blood pressure levels drop even further.  The other benefit of increasing Fruits & Vegetables, it helps to increase your FIBER intake.

F#4:  FIBER~We are all aware that increasing fiber can help with regulating bowel movements.  But did you know that increases in Fiber can also help to lower cholesterol level?  Fiber will bind with cholesterol in the gut and help to remove it.  By eating more fruits & vegetables, whole grain breads and cereals, and adding dried beans & lentils to your daily intake you can easily reach the goal of 25-35 grams of fiber a day.  Read your food labels to determine the exact amount of fiber in your favorite foods.

F#5:  FUN!~Remember, you have to enjoy life.  Sharing a meal with others is about more than just eating the food.  We also benefit from the personal interactions.  Don’t focus on what you “can’t have” but rather on the good things you can have.  Find new ways to add more fun to your life.  It has often been said that, “Laughter is the best medicine!”  Focus on the positive choices you’ve made and keep moving forward!

So there you have it the 5F‘s and a V for better health:

1. Know your FATS

2. Eat more FISH

3. Increase your FRUITS & VEGETABLES

4. Check your FIBER

5. Have FUN!

It’s Your Health. It’s Your Life. Make That Change!

~Johnikoni

 Nutrition Pair participated in the North Carolina State Medical Assistants (NCSMA) Winter Seminar, “Bridging the Gap to Healthcare” held January 17^th at College of the Albemarle here in Elizabeth City.  There were 86 medical assistants from across the state in attendance. 

We exhibited at the conference and John provided the nutrition presentation “Discovering Your Path to Wellness”.  In it, he reviewed the current health of our nation as well as that of North Carolina.  For example, in North Carolina, 61% of adults are overweight or obese and 27% of adolescents are either overweight or at risk of becoming overweight (CDC, 2003).  Focusing on the health risks associated with poor lifestyle choices, John discussed ways for the attendees to improve their own health as well the health of their patients.  He stressed how important it is that we serve as healthy role models for our clients.  We also encouraged referring to a Registered Dietitian for Medical Nutrition Therapy for chronic disease management as well as prevention.  The NCSMA is a fun and lively group and we enjoyed being a part of their winter seminar.

It’s Your Health.  It’s Your Life.  Make That Change!

~ Angie

Nutrition Pair Exhibit at NCSMA

"Discovering Your Path to Wellness"

 

 

 

 

 

 

 

Are Sugar-Free Products Better?

When taking a trip to the grocery store, you will find many products that are labeled “sugar free”. But, take caution as these products are not always an ideal choice when you have diabetes. “Sugar free” products can actually be quite deceiving. A common error that we have observed as diabetes educators is that many people read labels for the amount of sugar instead of for the amount of total carbohydrate. Even if there are zero grams of sugar in a product, the food can still have an impact on your blood sugar level. The reason for this is that it is that total carbohydrate, not only sugar, affects blood sugar levels.

Carbohydrates (Carbs) can be classified as either simple carbs or complex carbs. Simple Carbohydrates generally include foods with added sugars like regular sodas and sweets. They are called “simple” because the body does not have to perform much in the way of digestion to break them down. Simple carbs offer very little nutritional value. Complex Carbohydrates include foods that occur naturally and without processing. Foods such as fruits, starchy vegetables, whole grain breads and rice would fall into the complex category. While complex carbs will raise blood sugar levels just like simple carbs, they differ in that they contain more vitamins, minerals and fiber than simple carbs. Because of that, complex carbs are a better choice than simple carbs.

You will find sugar (simple carb) listed on the Nutrition Facts label. However, the only complex carb that you will find listed is fiber. Thus, a product may not have sugar but it can still have other carbohydrates. It is important to look at the total carbohydrate content, not only the sugar content, when you are reading a food label.

As an example, take a look at these two labels. This is a comparison of a Sugar Free and a Regular Version of cookies:

Sugar Free Cookie Food Label

Murrays Regular Chocolate Creme Cookies

Note the difference between the two cookies: other than the nutrition label showing that the sugar-free cookie contains 0g sugar, there is very little difference. Knowing that you need to look for total carbohydrate instead of sugar makes all the difference. The total carb in the sugar free cookie is 19 grams while the total carb in the regular cookie is 21 grams. (Two grams of carb will not make a notable difference in your blood sugar level.) One carb serving/exchange is equivalent to 15 grams of carbohydrate. Although carbohydrate needs are very individualized, most people with diabetes will need to keep their mealtime carbs between 30 to 60 grams (2 to 4 servings/exchanges) and their snacks between 15 to 30 grams (1 to 2 servings/exchanges). Registered Dietitians who are Certified Diabetes Educators, such as John and I at nutritionpair.com, can assist you in determining your individual carbohydrate needs.

Back to the cookies—I should note the price per cookie. The sugar-free cookies cost 15 cents per cookie and the regular cookies cost 4 cents per cookie. The sugar-free cookies cost almost four times as much as the regular cookie! As you can see from the comparison above, there is very little difference in the impact the two different products would have on your blood sugar level. Your blood sugar reading would likely be the same after the sugar-free cookies as it would after the regular cookies. As you can see, you really don’t need to spend the extra money on “diabetic” or “sugar-free” products when you have diabetes. Just be a label reader and look at the total carbohydrate instead of the sugar. While you’re at it, check to make sure the product is low in saturated fat, high in fiber and high in vitamins and minerals. But, remember, the healthiest foods do not even have a nutrition label on them (hint: they are in the produce section!!!).

~ Angie

October has always meant the start of the Holidays for me.  Stores are already loaded with candy for Halloween, decorations for Thanksgiving and the new Christmas ornaments have been hanging in Hallmark Stores since July! As people begin to stress over avoiding the Holiday weight gains & finding the perfect gifts to be bought, we’re trying something new.  October is International Walk to School Month.  The walk to school program in the USA was started in 1997 as a way to increase awareness of the need for communities to be more walkable.  The program has expanded to raise awareness of not only healthier lifestyles options but also to promote safer bicycling & walking routes and cleaner air.  We have been trying to get our son’s school to help sponsor a local event but the process is slow.  Instead, Angie & I will promote the Walk to School ourselves by walking to school with Jonathan on designated days during the month of October.  Our first planned walk is October 8th, which is also Walk to School Day.  Hopefully, we will be able to generate interest and the program will grow into a larger event in the future.  I urge you to visit the Walk to School web site for more information and ideas on making it work in your community.  Walking to school would be a great way to get exercise as a family and give you more time to spend with your child.  We’ll let you know how things work out in Elizabeth City!

Take advantage of the October weather by getting outside and being more active!  Cooler temperatures, lower humidity & less grass cutting!! Enjoy October!

It’s your Health.  It’s Your Life.  Make that Change!

~ John