Roughly 22% of adults report having gained weight during the COVID-19 pandemic. (1) 

COVID-19 has created a perfect storm for gaining unwanted weight. Insomnia, loneliness, depression, anxiety, decreased physical activity, and disruptions in our daily routines have increased chronic stress in our lives which can increase levels of the stress hormone cortisol. Cortisol is associated with increased food cravings and weight gain. (2)

Could consuming more umami increase enjoyment without increasing calorie intake?

Lately, I have been intrigued by the idea that the addition of umami could possibly help us achieve weight loss and increase our enjoyment of foods at the same time. Research shows foods with umami flavors tend to reduce people’s appetite without cutting their satisfaction with the meal. (5) 

Umami is that rich, deep, indescribable flavor of lusciousness

Umami is that rich, deep, indescribable flavor of lusciousness found in foods like Parmesan cheese, cured pork products, grilled or roasted meats, sausage, and soups and stews that have been slow-cooked for a long period of time. It occurs when glutamate breaks down into L-glutamate via fermentation, braising, or ripening. Glutamate alone, however, cannot produce the full flavor of umami. Instead, it arises from the combination of glutamate and ribonucleotides, molecules that serve as the building blocks for DNA and RNA. Interesting to me is that glutamate is also abundant in human breast milk; in fact, human milk contains as much glutamate as most savory broths.

When we taste something and our mouth waters, that is umami.

In 2000 scientists at the University of Miami identified the first umami receptor on the taste buds lining the surface of our tongues. Mushrooms, especially dried shiitake mushrooms, are rich in umami. Umami-rich ingredients can be found in cooking ingredients/condiments. Naturally brewed soy sauce, Marmite, anchovy relish, miso, tomato puree, fish sauce, and Worcestershire sauce are all great sources of umami. Recently, many seasoning products have been developed with umami as the goal – such as Takii Umami Powder-Magic Shiitake Mushroom Seasoning, Trader Joe’s Mushroom & Company Multipurpose UMAMI Seasoning Blend, and Taste No 5 Umami Paste.  

Umami discovered over 100 years ago by a chemist enjoying broth

Umami was named more than a century ago by Kikunae Ikeda a chemist at Tokyo University. As Dr. Ikeda savored a simple bowl of broth, he pondered the nature of deliciousness. How was it a lightly simmered mixture of water, dried fish flakes, and a little bit of dried seaweed that could be so mouthwatering?

Dashi, the broth that set Ikeda on his quest in 1907, maintains an essential place in Japanese cuisine to this day.  Over the course of a year, Dr. Ikeda boiled kombu, the dried seaweed, down into a tarry resin and stripped out salts and other organic compounds one by one. In the end, Dr. Ikeda harvested a single ounce of crystals strongly resembling the flavor of his bowl of dashi-a flavor that he called umami (roughly translated from the Japanese word for “delicious”).

The crystals producing the umami flavor turned out to be the amino acid glutamate. Hoping to provide cooks easy access to umami, he learned how to produce it in industrial quantities and patented the notorious flavor enhancer monosodium glutamate (MSG). 

MSG – amino acid glutamate – creates umami taste.

MSG was popular in the American food supply for decades. However, since 1968 the chemical has received bad publicity despite dozens of studies concluding that MSG is safe and the purported negative health claims found to have little supporting evidence. (6) Currently, MSG is popular in processed foods such as canned soups, frozen dinners, cold cuts, dressings, and Doritos. MSG can help reduce sodium in dishes without compromising flavor because of umami. MSG contains 1/3 the amount of sodium as table salt.

Since the pandemic, I have been cooking more and experimenting with creating physically nourishing and emotionally satisfying meals. Consciously including umami has been an exciting part of this experiment.

Smoky Roasted Mushrooms Recipe

Directions: Toss 2 pounds whole mixed mushrooms, 1 ½ tablespoons olive oil, and salt and pepper to taste in a bowl. Spread on a baking dish and roast at 425 degrees F, stirring a few times, until tender and browned for 30 to 35 minutes. Cook 3 thinly sliced garlic cloves and ½ tsp smoked paprika in butter until soft, toss with the mushrooms. Sprinkle with chopped parsley and salt. Enjoy.

This article is written by our resident nutrition expert, Dawn DeSoto, RD, CDCES

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Citations

-Zachary Z, Brianna F, Brianna L, et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Prat. 2020;14(3):210-216.

-Chao AM, Jastreboff AM, White MA, Grilo CM, Shinha R. Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring). 2017 Apr:2594):713-720

-CDC November 19, 2004/53(45);1066-1068. Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes-United States, 1988-1994 and 1999-2002

-Menke A, Casagrande S, Geiss L, Cowie CC.  Prevalence of the Trends in Diabetes Among Adults in United States, 1988-2012. JAMA. 2015 Sep 8; 314(10):1021-9

-Masic U, Yeomans MR. Umami flavor enhances appetite but also increases satiety. The American Journal of Clinical Nutrition, Volume 100, Issue 2, August 2014, Pages 532-538.

-Zanfirescu A, Ungurianu A, Tsatsakis AM, Nitulescu GM, Kouretas D, Veskoukis A, Tsoukalas D, Engin AB, Aschner M, Margina D. A Review of the Alleged Health Hazards of Monosodium Glutamate. Compehensive Reviews in Food Science and Food Safety. 2019 May 8/18(4):1111-1134

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Level 1 – Diabetes Fundamentals 2021 Updates

This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
• January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
• January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
• January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
• January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
• January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

The Winter Solstice, on December 21, marked the shortest day in the Northern Hemisphere. People in New York got just over 9 hours 15 minutes of sun, while those in Anchorage Alaska got fewer than 5.5 hours.

Personally, I am already yearning for more light.

Lack of light can contribute to depression. The idea that people are more susceptible to depression in the winter months wasn’t picked up until the 1980’s when South African psychiatrist Norman Rosenthal moved to the US and noticed a change in his mood during the New York winters. Dr. Rosenthal, Dr. Al Lewy, and Dr. Thomas Wehr investigated and identified Seasonal Affective Disorder (SAD). In 1987 it was included in DSM.(1) 

Depression rates higher during pandemic

This winter 2020 is an extra dark one.  A recent study showed that depression symptom prevalence was more than 3-fold higher during the COVID-19 pandemic than before. During the pandemic, many people are making a lower-income or have no income, have depleted their savings, and have more exposure to stressors, which were all associated with a greater risk of depression. (2)

Studies show that people with diabetes are more susceptible to depression. Depression is three times as prevalent in people with diabetes when assessed by self-report. The combination of diabetes and depression present a major clinical challenge as the outcomes of both conditions are worsened in the presence of the other. Quality of life is worse, diabetes self-management is impaired, the incidence of complications is increased, and life expectancy is reduced. (3)

Symptoms commonly associated with SAD and clinical depression include:

• Feelings of sadness, tearfulness, emptiness, or hopelessness
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts, or suicide
• A tendency to oversleep, early-morning wakefulness or insomnia
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Slowed thinking, speaking, or body movements
• Unexplained physical problems, such as back pain or headaches
• Loss of interest in things once pleasurable
• Fatigue
• Difficulty concentrating, remembering details, and making decisions
• Angry outbursts, irritability or frustration, even over small matters

It is an important time to check in with our clients, colleagues, friends, and family regarding symptoms of depression.

Refer to mental health providers as needed. As I am writing this blog my sister texted me that she is feeling very sad, unmotivated, and just wants to sleep. Diabetes Education Services has resources to help us screen our clients for depression in the Psychological Care Assessment Resource Page.

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Tumeric – Golden Spice for Healing

Can food, in particular a golden spice, help those of us without the more serious clinical depression cope this winter with milder winter blues?

Turmeric is a plant with a very long history of medicinal use, dating back 4000 years. In parts of Southeast Asia, turmeric is used not only as a principal spice but also as a component in religious ceremonies.

Turmeric, derived from the root of Curcuma longa, a flowering plant of the ginger family, is a gold-colored spice commonly used in the Indian subcontinent, not only for health care but also for the preservation of food and as a yellow dye for textiles. Curcumin, which gives the yellow color to turmeric, was first isolated almost two centuries ago, and its structure as diferuloylmethane was determined in 1910.

Since the time of Ayurveda (1900 BCE) numerous therapeutic activities have been assigned to turmeric for a wide variety of diseases and conditions. Extensive research within the last half-century has proven that most of these activities, once associated with turmeric, are due to curcumin. Curcumin has been shown to exhibit antioxidant, anti-inflammatory, antiviral, antibacterial, antifungal, and anticancer activities. (4)

“Curcumin can influence several mechanisms in the body; in particular, it is a powerful natural anti-inflammatory and antioxidant. This has relevance to depression because people with depression have greater inflammation and oxidative stress, which can affect all major organs of the body, including the brain”, reports Adrian Lopresti, PhD., a clinical psychologist and researcher at the School of Psychology and Exercise Science at Murdoch University. (5)

Due to curcumin’s anti-inflammatory effect, a 2013 review of studies suggests that curcumin can decrease the level of glucose in the blood, as well as other diabetes-related complications. (6) 500-1000 mg of curcumin per day has been found to promote the anti-inflammatory effect. (7) 1 teaspoon of fresh turmeric has about 200 mg of curcuminoids. Curcumin’s bioavailability can be enhanced by 2000% by combining it with black pepper (piperine is the major active component). (8)

Try turmeric tea or add turmeric to scrambled eggs, to rice as it is cooking, to stews. You can also try my favorite before bed treat, Golden Milk.

Golden Milk Recipe – Yield 2 servings 

 

• 2 cups milk (coconut, almond, soy milk can be substituted)
• 1 Tb honey or stevia syrup to taste
• 1 Tb coconut oil
• 1 tsp ground turmeric
• 1 tsp ground cinnamon
• Pinch of ground black pepper
• Pinch of grated fresh ginger or ¼ tsp ground ginger

Directions

Simply pour all ingredients into a small saucepan, whisk to combine ingredients.  Heat until hot to the touch but not boiling – about 4 minutes. Enjoy warm.

Written by Dawn DeSoto RD, CDCES, our resident Nutrition Content Writer

References

1. Melrose, S. (2015) Seasonal affective disorder: an overview of assessment and treatment approaches. Depression research and treatment. 2015
2. Ettman, CK, Abdalla, SM, Cohen, GH. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA NETW Open. 2020;3(9)
3. Holt RI, de Groot M, Golden SH. Diabetes and depression. Curr Diab Rep. 2014;14(6):491
4. Hewlings, S, Kalman DS. Curcumin: A Review of Its’ Effects on Human Health. Foods. 2017 Oct; 6(10): 92
5. Lopresti AL, Maes M, Maker GL, et al. Curcumin for the treatment of major depression: A randomized, double blind, placebo-controlled study. J Affect Dis. 2014;167:368-375
6. Zhang DW, Fu M, Gao SH, Liu JL. Curcumin and Diabetes: A Systemic Review Evid Based Complement Alternat Med. 2013,2013:636053
7. Gupta SV, Patchva S, Aggarwal BB. Therapeutic Roles of Curcumin: Lessons Learned from Clinical Trials: AAPS J. 2013 15(1):195-218
8. Prasad S, Tyagi AK, Bharat B. Recent Developments in Delivery, Bioavailability, Absorption and Metabolism of Curcumin: the Golden Pigment from Golden Spice. Cancer Res Treat. 2014 Jan:46(1)2-18

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Level 2 | Assessing Coping Skills Standards | 1.5 CEs

Topics include:

• Name assessment areas of healthy coping
• List psycho-social and emotional barriers
• Provide strategies for healthcare professionals to identify and overcome barriers
• Discuss strategies to develop an individualized diabetes education plan

This course is included in: Level 2 – Standards of Care Intensive. Purchase this course individually for $29 or the entire bundle and save 70%.

Enroll in our entire Level 2 – Standards of Care Intensive to join us for the below for Live Webinar Updates. All courses air at 11:30 a.m. (PST)

1. December 23, 2020 – Older Adults & Diabetes – 1.5 CEs
2. December 29, 2020 – Assessing Coping Skills Standards – 1.5 CEs
3. December 30, 2020 – Hyperglycemic Crisis Standards – 1.0 CEs
4. February 2, 2021 – 2021 Standards of Care Update  – 2.0 CEs

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

I have been eating chocolate daily for years. I crave chocolate. I love chocolate.

I am not alone. About 7.3 million tons of retail chocolate confectionery were consumed globally in 2015/2016! (1)

My family holiday tradition is the gifting of See’s chocolates, but as I attempt to decrease my sugar intake, I have made a commitment to eat less chocolate.

What is it about chocolate that we fall in love with?

Chocolate is made from tropical Theobroma cacao tree seeds. Its earliest use dates back to the Olmec civilization in Mesoamerica. The word cacao originated from the Mayan word, “Ka’Kau.” Ancient Aztecs considered Cacao the “Food of the Gods.” Cacao was a pillar of the Mayan, Aztec, and Nahua communities, economies, and religions as a sacred medicine.

In Mayan and Aztecan culture, cacao is a sacred crop and has historically been used for ceremonial practices, known as “Cacao Ceremony” or as offerings to the Gods.

Cacao & Cocoa

Cacao and cocoa are both milled and processed from the cocoa bean, but cacao is processed at a low temperature and considered raw. Cacao contains antioxidants, vitamins, minerals, and protein.

Cocoa is the term used to refer to the heated form of cacao. Cocoa undergoes a higher temperature during the processing and some of the nutrients are lost, although it still retains antioxidants.

Cacao is stronger flavored than cocoa. Dutch-process cocoa is cocoa that has been treated with an alkalizing agent to modify its color and give it a milder taste. Dutch cocoa forms the basis for much of modern chocolate.

In the 1980s phenylethylamine (PEA) was discovered in chocolate. PEA acts as a CNS stimulant and increases the brain’s production of norepinephrine and dopamine-producing the euphoric effect often associated with a “runner’s high.” Cacao also helps to boost anandamide, a fatty acid neurotransmitter, which is also known as the “bliss molecule.” And cacao contains theobromine which has an effect like that of caffeine in the nervous system.

No wonder why so many of us love chocolate!

Recently, there have been studies that found that cocoa flavonoids including epicatechin have an anti-diabetic effect by enhancing insulin secretion, improving insulin sensitivity in peripheral tissues, exerting a lipid-lowering effect, and preventing the inflammatory and oxidative damages of the disease. (2)(3)(4)

Chocolate is often heavily sweetened as in See’s candy, but there are many chocolate bars that contain more cacao or cocoa and less sugar. Lately, I have purchased cacao powder and have been making a hot drink with coconut milk, monk sugar, and spices.

New Tradition & Recipies

My daughter and I are going to start a new tradition this holiday season. We are not going to gift See’s candy, but instead, we are going to gift cacao.

1 TB Cacao powder has

• 3.2 gms of carb
• 0 gms of sugar
• 1.6 gms of protein
• 2 gms of fiber
• 0.6 gms of fat
• 0.8 mg of iron
• 14 mg of calcium
• 42.4 mg of magnesium
• 120 mg potassium
• 19.6 mg theobromine

Sugar Free Mexican Drinking Chocolate 

• 1 13. 5 oz can of full fat coconut milk
• 1 cup water
• ¼ cup cacao powder
• 4 Tb granulated monk fruit sweetener
• ½ tsp vanilla extract
• 1 tsp ground cinnamon
• 1 dash cayenne
• 1 dash Celtic sea salt

Combine is a small saucepan and whisk until the consistency is smooth and silky. Pour into mugs. Give thanks. Enjoy.

References:

1. Consumption of retail chocolate confectionery worldwide 2012/13-2018/2019. Statistic Research Department, Nov 2, 2015
2. Antioxidants (Basel). 2017 Dec;6(4):84, Published online 2017 Oct 31. Doi: 10:3390/antiox6040084
3. Marin M. A., Fernandez-Millan F., Ramos S., Bravo L., Goya I.,  Cocoa flavonoid epicatechin protects pancreatic bet cell viability and function against oxidative stress. Mol. Nutr. Food Res. 2013;58:447-456
4. Katz DL, Doughty K, Ali A. Cocoa and chocolate in human health and disease. Antioxid Redox Signal. 2011;15(10):2779-2811

As we all prepare for the holidays this year we may be having a difficult time feeling thankful.

As we continue to navigate this long-lasting pandemic there has been so much loss and heartache.  

Years ago I went to a conference on preventing burnout in healthcare providers with Dr. J. Bryan Sexton, associate professor in psychiatry and behavioral sciences at Duke’s School of Medicine and an expert in the idea of resilience.  He impressed me and I have talked about his conference to many colleagues over the years.

I loved sharing his wisdom with my clients, because of studies that link resilience to better diabetes self management. (1)

Lately, as I have been struggling with overwhelming feelings of sadness, I have remembered to practice some of his tools to cultivate resilience. Cultivating resiliency is something that takes daily focus. To cultivate means to nurture, grow, and encourage resilient behaviors.

Dr. Sexton suggests these three ways to increase resilience.

Three Good Things

Humans are hard-wired to remember the negative aspects of our day, but flipping around the natural inclination is simple.

Building resilience is possible by focusing on positive emotions – joy, serenity, hope gratitude, inspiration, pride, love, awe, and amusement.

Promoting positive thoughts and building resilience can be as easy as taking notes each night before bed. Think of three things that happened during the day that went well and your role in the positive outcome, then jot down those three things. Best results for this exercise come after 14 consecutive days. Empirical evidence shows that this elevates brain serotonin with positive effects on our mood that last for months. (2)

Show Gratitude

Grab a pen and paper and write a letter of appreciation to someone- anyone. Take five minutes to explain something they did, how it impacted you and the benefits you received. Whether you share the letter or not, Dr. Sexton said it can have lasting impacts, increasing happiness while lowering depressing thoughts because focusing on benefits forces us to linger on positive thoughts.

Rediscover Awe

Through an “awe intervention,” you can create a sense of slowed down time, which offers a calming sensation and a feeling of having more time available.

Awe also helps us to feel inspired. I call awe intervention, “joyful thanksgiving”. It is a practice that I am doing in which I acknowledge and give a little extra gratitude for the many amazing sights, sounds, tastes, relationships, information, and emotions that excite me and create awe right from the moment when I wake up. 

Today as I was practicing my joyful thanksgiving I paid special attention to my breakfast of oatmeal, blueberries, banana, walnuts and cinnamon. I love oatmeal in the fall and winter months.

I began to feel grateful for this medicinal food.  Oats, blueberries, banana, and nuts contain water soluble fiber which slow the absorption of sugar and fat from food, and therefore help prevent spikes in blood sugar and blood fat, possibly reducing the inflammatory response to food. (3)(4)

Fiber is a super food which provides important nutrition for our intestinal bacteria to live and prosper, that’s why fiber is called a pre-biotic. Vegetables, fruit, whole grains, nuts and legumes remain the single best sources of fiber in the diet.  High-fiber vegetables include many of the green leafy vegetables like kale, collard greens, chard, arugula, and even lettuces. Whole-grain sources of fiber include oats, quinoa, barley and rye. Legumes include beans like peas, soy, black, pinto and lentils.

Encouraging our clients to consider adding more fiber rich dishes to the holiday meals this season and perhaps telling them about Dr. Sexton’s tools for cultivating resilience may help them to feel happier and more hopeful and contribute to better blood sugar control.

Blueberry-Banana Overnight Oats

½ cup unsweetened coconut milk beverage

½ cup old-fashioned oats

½ TB chia seeds

½ banana

1 tsp maple syrup

½ cup blueberries

2 TB chopped walnuts

1/8 tsp cinnamon

Combine coconut milk, oats, chia, banana, maple syrup in a pint-sized jar and stir. Top with blueberries and coconut. Cover and refrigerate overnight. Heat up and sprinkle with walnuts and cinnamon in the morning.

285 calories, 6 gm protein,  57 gms carbohydrate, 7 gms fiber 6 gm fat

1. Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia . Arch Public Health. 2017; 75: 56.
2. Seligman, Steen, Park & Petersen (July-August 2005). Positive Psychology Progress: Empirical Validation of Intervention. American Psychologist
3. The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and

 Meta-Analysis. Nutrients. 2015 Dec; 7(12): 10369-10387p. 1392:8

• Chandalia, M., et al., Beneficial effects of high dietary fiber intake in patients with type 2     diabetes mellitus. N Engl J Med, 2000. 342(19):

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The holidays are upon us in the midst of a pandemic.

In past holiday seasons, I would check in with my clients to see how the holiday season was affecting their health.  We would talk about getting enough sleep and adapting exercise routines to adjust for cold weather and shorter days.

We would talk about stress management tools to help cope with the pressures to overeat and the pressures to eat foods that we have been attempting to avoid. 

This year is challenging because we are already taxed by the unbelievable stress of living in a pandemic.

I have found that I am already struggling with insomnia and less exercise. I have been overeating and craving sweets. In fact, I think that I have developed a sugar addiction during these last 7 months. I have been substituting ice cream, donuts, and chocolate for the hugs that I used to take for granted. I am missing gatherings,  parties, and shared dinners with friends. 

 

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I started to look at the total amount of free sugar that I was consuming.  On some days it added up to over 12 teaspoons per day! And I am a dietitian.

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Sugar is a powerful stimulant of serotonin that is lacking in my brain these days. I thought that I was developing a cavity and this woke me up.

I had to make a commitment to cut back on sugar. 

I thought about the World Health Organization’s sugar recommendation of lowering our free sugar intake to less than 5% of our total daily calories. This works out to about 6 teaspoons a day, depending on the person.

Free sugar applies to 

• Added sugars such as:
  • glucose
  • fructose
  • sucrose

• Naturally occurring sugars such as in:
  • fruit juice
  • honey
  • syrups

Whole fruit and milk sugar are not included in free sugar. 

I started to look at the total amount of free sugar that I was consuming.  On some days it added up to over 12 teaspoons per day! And I am a dietitian.

The average American consumes 17 teaspoons of sugar daily. This translates to 57 pounds of sugar consumed each year.

Hidden Sugars are Tricky to Find

Many people don’t realize that a lot of the sugar they take in are “hidden” in processed foods, according to the World Health Organization.

• 12 oz of soda may contain up to 10 teaspoons of sugar.
• Starbuck’s 12 oz Vanilla Latte contains about 7 teaspoons of sugar.
• 1 Tablespoon of ketchup contains 1 teaspoon of sugar.
• Fun size trick or treat plain M & M’s contain 3 teaspoons of sugar.
• 1 piece of apple pie contains up to 8 teaspoons of sugar.
• 6 oz of fruit-flavored yogurt has 6 teaspoons of sugar.

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Research does show that for some people eating sugar produces characteristics of craving and withdrawal, along with chemical changes in the brain’s reward center, the limbic region. These changes are linked to a heightened craving for more sugar. 

I am grateful to be able to consciously choose to lower my sugar intake to improve my health.

I am grateful that the whole fruit can be used as a sweet substitute for my sugar cravings.

I love the new fall crop of apples, pears, kiwi, and persimmons.

 

Delicious Naturally Sweet Recipes

Below are my recipes for baked apples and poached pears that are a delicious holiday dessert.

Simple Baked Apples

• 5 – 6 medium apples, peeled and cut into chunks
• 2 Tablespoons butter or coconut oil, melted
• 1 teaspoon cinnamon
• ½ cup chopped walnuts
• Preheat the oven to 350 degrees
• Place the apples in a medium baking dish

Mix the melted butter or coconut oil, walnuts, and cinnamon together and pour over the apples. Bake in the preheated oven until the apples are soft, about 20 – 30 minutes. Stir once during the baking.

Enjoy!

Poached Pears (Naturally Sugar-Free)

• 1 cup red wine
• 1 orange zest and juice
• 1 cinnamon stick
• 1-inch ginger root peeled
• 3 cloves whole
• 2 Conference pears, peeled, sliced in half, and core
• 1 Tablespoon sliced toasted almonds
• 2 Tablespoons thick plain Greek yogurt

Pour the wine into a small saucepan along with the orange zest and juice and all of the spices

Bring almost to a boil and add the pear halves. Turn down the heat and let the pears simmer gently for 20 – 30 minutes, or until they have slightly softened.  Carefully turn the pears over a few times throughout the cooking time to ensure they color evenly. When the pears are cooked remove them from the wine and place them on plates. Add a tablespoon of yogurt to each plate and sprinkle with toasted almonds.

Visit our Joy of 6 Page for sugar info and resources to share with your clients!

Written by Dawn DeSoto RD, CDCES, our resident Nutrition Content Writer

This time of year is my favorite. Seeing the beautiful colors of the fall harvest soothes and invigorates me.  Being outdoors with my community is especially healing during this unusual and stressful time of isolation due to the pandemic.

I especially adore shopping and gathering fresh produce and other goodies from our local Farmers’ Market!

The farmer’s market is also a special place for me because my daughter works there. Her booth is overflowing with all the pumpkins and winter squash they have harvested.  Last week, at the market, my daughter introduced me to her friend as they were talking about a pumpkin pie he had made from the pumpkin that he had purchased from her. 

“Unfortunately, I can’t eat the pumpkin pie anymore because I was just diagnosed with having Type-2 Diabetes,” he explained.

 I couldn’t help but tell him that I was a Dietitian and Diabetes Specialist.

We started talking about modifying the recipe using sugar substitutes or low carbohydrate crusts. We discussed portion control and going for a walk after eating a piece of the pie. He was intrigued. 

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My philosophy is that, with thoughtfulness and creativity, all of our favorite foods can be included in our meal plans with knowledge and love. 

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Pumpkin and other winter squash do contain carbohydrates but are nourishing food. Benefits include:

• They are high in fiber, beta-carotene, magnesium, potassium, lutein, and zeaxanthin. 
• 1 cup of pumpkin puree has 80 calories, 22 gms carbohydrate, 6 gms of fiber. 
• A piece (1/8  of a 9-inch pie) of traditional pumpkin pie made with sweetened condensed milk contains 379 kcal and 31 gms of carbohydrate or
• Compared to the included recipe (see below) of a piece of stevia-sweetened pumpkin pie (1/6 of a 9-inch pie) made with low fat evaporated milk and stevia containing 188 calories and 17 gms of carbohydrate. Both can be included in our meal plans if desired. 

It is important to take away the judgment around food choices, to encourage thoughtful choices, and find joy in our food.  At this difficult time, every effort to empower ourselves with choice and joy is highly recommended. 

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Stevia Pumpkin Puree Recipe (Serves 6):

Choose a pie pumpkin and wash it’s exterior. Cut in half lengthwise and remove the seeds and pulp. Roast in your oven for about 45 minutes at 350 degrees F.

Simply peel away the skin from the flesh and toss the pumpkin pulp into your food processor or blender.

Ingredients:

• 1 unbaked 9-inch pie crust
• ½ teaspoon stevia powder
• 1 teaspoon cinnamon
• ½ teaspoon ginger
• ½ teaspoon nutmeg
• ¼ teaspoon salt
• 2 eggs 
• 1 ¾ cups pumpkin puree
• 1 cup low-fat evaporated milk. 

In a large bowl, whisk eggs and pumpkin puree together. Add the rest of the ingredients and whisk together while slowly pouring in the evaporated milk.

Pour mixture into pie crust.Bake in the oven for 20 minutes at 390 degrees, reduce oven to 350 degrees and bake for another  45 – 60 minutes until inserted toothpick comes out clean. Store in the refrigerator overnight.

Written by Dawn DeSoto RD, CDCES, our resident Nutrition Content Writer

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Dawn Desoto, Nutrition Content Writer

Meet Dawn Desoto, our resident Nutrition content expert. Dawn has specialized in diabetes care for over twenty years.

As a diabetes specialist, Dawn provides individual and group coaching. Dawn launched a Diabetes Prevention Program in her community and provided plant-based cooking classes coupled with take-home recipes. The participants loved the helpful, delicious, easy-to-understand food demonstrations and recipes. But, a big motivation to keep coming to classes, was the fact that they felt celebrated and supported by the kind wisdom of Dawn’s approach.

In addition to her diabetes and nutrition expertise, Dawn loves to garden, cook, swim, bike and hike with her son and daughter. She also enjoys reading, traveling, and star gazing!

Please join me in welcoming my friend and colleague, Dawn Desoto, RD, CDCES 

Ireland’s Supreme Court announced that Subway’s sandwich “bread” cannot be legally labeled as bread.

After a Subway franchise in Ireland attempted to claim tax breaks for some of their items on the menu, a ruling was made that the bread Subway uses isn’t bread but more of a confectionary baked good.

“Subway’s bread is, of course, bread. We have been baking fresh bread in our restaurants for more than three decades and our guests return each day for sandwiches made on bread that smells as good as it tastes,” a Subway spokesperson said in a statement. The company says it’s reviewing the ruling.

Subway’s bread recipe has 10% of sugar to the weight of flour, which means their bread cannot be considered a staple food of bread and therefore ineligible for tax breaks.

This decision is in accordance with the Value-Added Tax Act of 1972 which states that “tax-exempt bread can’t have sugar, fat and bread improver exceed 2% of the weight of flour.”

This isn’t the first time Subway’s bread recipe has been questioned. In 2014 a petition went viral to remove azodicarbonamide, a chemical found in shoe rubber and items like yoga mats.

Overall, Subway, often revered as one of the healthier fast food options, may need to reevaluate its bread recipe and consider decreasing added sugar content.

To read more, click here. 

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Over 50% of people living with diabetes have fatty liver disease.

Over the next 20 years, non-alcoholic steatohepatitis (NASH) and type 2 diabetes will account for 65,000 transplants, 1.37 million cardiovascular-related deaths, and 812,000 liver-related deaths.
These statistics are from a 2020 article in Diabetes Care, Economic and Clinical Burden of Non-alcoholic Steatohepatitis in Patients With Type 2 Diabetes in the U.S.

Relationship between Type 2 and Fatty Liver Disease

Fatty liver disease is increasingly recognized as the hepatic manifestation of metabolic syndrome. Currently, there is no effective approved medical therapy to fix the fatty liver disease, management depends on lifestyle changes, such as weight loss and increased exercise.

Type 2 and Liver Disease Stats

About 34 million people in the U.S. have type 2 diabetes. Of those, over half are also living with liver disease.

In the U.S. in 2019:

• About 50% (18.2 million people) are living with Type 2 diabetes plus Non-alcoholic fatty liver disease (NAFLD).
• Of those, 37% (6.4 million) have a more severe form of liver disease known as non-alcoholic steatohepatitis (NASH).
• Advanced fibrosis among biopsied people with NAFLD and T2DM was 17.02%
• Twenty-year costs for NAFLD in these patients were $55.8 billion.

Should We Screen People with Diabetes for Liver Disease?

Given the high rate of liver disease in people with diabetes, I have been paying more attention to our client’s liver enzymes levels, including alanine aminotransferase (ALT) or aspartate aminotransferase (AST). Elevated levels of these liver enzymes indicate inflammation and a potential pathway to liver disease progression.

After discovering elevated enzymes, we send them for further diagnostic testing to evaluate the extent of liver disease. The question is, should we make liver health screening a part of our usual diabetes practice?

Is screening cost-effective and what are the next steps?

According to a recent article in Gastroenterology, screening for non-alcoholic fatty liver disease (NAFLD) followed by lifestyle modification among people with type 2 diabetes can be cost effective.

In a recent study, a team of researchers used a hypothetical cohort of people age 55 years with type 2 diabetes and developed a model that compared screening and treatment with no such protocol.

For the virtual intervention group, they measured ALT or AST and provided an ultrasound scan. If these tests came back positive for NAFLD, the participants underwent further screening with liver biopsies and transient elastography.

People found to have NASH with Stage 2 entered a year-long behavior program to help them with weight loss and lifestyle changes. They found the for participants with stage 2 fibrosis or higher, the screening and lifestyle intervention was just as cost-effective compared to the group with no screening.

“Our results indicate the potential value and cost-effectiveness of NAFLD screening” in people with type 2 diabetes, wrote the study authors. “Given the increasing burden of NAFLD/NASH and the expected rapid increase in approved medications, we recommend screening patients with type 2 diabetes for NAFLD.”

Click this link to read more about Screening People with Type 2 for Liver Disease.

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Upcoming Cancer & Diabetes Webinar | Level 4 – Advanced Level | 1.5 CEs
Join us live on September 9th at 11:30 AM (PST)

People with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid-induced hyperglycemia using a case study approach. 

Topics Include:

• Discuss the relationship between cancer, hyperglycemia and insulin resistance.
• State 3 benefits of normalizing glucose levels during chemotherapy.
• Using a case study approach, discuss strategies to improve glucose levels and quality of life.

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

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