Here’s Why the CDC Updated their Mask Recommendations (Again)

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

On Tuesday, July 26, 2021, the Centers for Disease Control (CDC) in the United States issued new masking recommendations amidst increased rates and much more dangerous variants of COVID-19 in the US. There are two big and related reasons why:

  1. Masks are the most effective way to slow the spread of COVID-19, no matter your vaccination status. This is particularly important in places with high transmission rates; you can check your county’s rate here.
  2. We are in a fourth surge of COVID-19 in the United States, with hospitalization rates surging to higher than when the pandemic began. This is due to the more contagious and more dangerous delta variant of COVID-19.

Who Needs to Be Wearing a Mask and When?

Everyone, particularly when you’re in indoor public spaces (because you’re breathing in other people’s air, and they’re breathing in yours).

If you’re vaccinated, this is primarily to do your part to protect others. Breakthrough cases, (where a vaccinated person gets the COVID-19 disease) are rare, but vaccinated people can still carry the coronavirus to others without having any symptoms. Luckily, vaccinations still make a massive difference – people who are vaccinated are less likely to carry coronavirus and are extremely unlikely to experience any severe symptoms from the disease.

If you’re not vaccinated, this is to protect yourself and others, as you can carry high levels of COVID-19 to others even if you don’t get sick yourself. However, even if you’re an otherwise healthy person, it’s important to keep in mind just how much more dangerous the new variants of COVID-19 are.

These variants will continue to develop rapidly until almost everyone is vaccinated—because they have so many hosts in which to thrive—and they are more contagious than the original COVID-19 variant. This is due to how viruses mutate (all viruses do this; it’s why we have new flu vaccines every year to address new variants of the flu). And because so many people are still unvaccinated, the virus has lots of places to thrive and change, making it more contagious and more dangerous.

Why Do Vaccinated People Need to Wear a Mask in Indoor Public Spaces?

The delta variant can live in small amounts in people who are vaccinated, so even with no symptoms of COVID-19 ourselves, vaccinated folks can still pass the virus to other people.

This is particularly dangerous for the elderly or ill who have already been vaccinated but cannot afford to take on the high viral load of the delta variant and for children who are not yet eligible to be vaccinated.

To combat high transmission rates, several cities have already instituted mask mandates again, like Washington, D.C., Savannah, GA, and St. Louis, MO.

What Can We Do to Protect Ourselves and Others From the New Variants?

Getting vaccinated against COVID-19 and continuing to wear masks in indoor public spaces are the most impactful things we can each do to protect ourselves and others. Doing so right now matters, as we do not want to give the novel coronavirus more time to continue mutating beyond what we know how to prevent and treat. We have the tools to stop the current COVID-19 variations but they mean nothing unless we all use them now.

What if I’m Too Healthy to Get COVID-19?

Particularly if you have diabetes, you pay so much attention to your health, and you already do so much to make sure your system is healthy and strong. But think about this – hospitals are getting overwhelmed by COVID patients again, which means they cannot provide care for anyone else who needs it. Check out this statement from the Chief Medical Officer of Our Lady of the Lake Hospital in Louisiana.

Even if you don’t get COVID-19, can you absolutely guarantee that you won’t have a diabetes issue that needs medical help? That you won’t get in an accident where you need the emergency room? What if you just get the normal flu and you need IV-fluids, but there aren’t enough medical professionals to help you because they’re all dealing with COVID patients?

COVID-19 is a disruptor to our entire medical system. Protecting yourselves and others against it by getting the vaccine is the best way to ensure that you and your loved ones will be able to get the care they need, when they need it.

When Will This End?

When the vast majority of people are vaccinated against COVID-19, giving the virus no more places to hide and mutate into stronger and more dangerous versions.

Do your part. Get vaccinated. If you’re hesitant about them or want to learn more about their safety, read this piece clarifying a few myths about the vaccines, or this piece explaining how mRNA vaccines work.

For more information on the COVID-19 vaccines for kids, read this.


More Control Than We Think – Pandemic Strategies for Healthy Eating

This content originally appeared on diaTribe. Republished with permission.

By Katie Bacon

As you look toward staying healthy in the new year, meaningful changes to your diet may help you manage glucose levels and maximize health in the face of COVID-19. Four experts – Whole Cities Foundation’s Dr. Akua Woolbright, low-carb guru Dr. Mariela Glandt, San Francisco General’s Dr. Rita Nguyen, and Harvard’s Dr. Lee Kaplan – shared insights for eating well, finding affordable food, and keeping your body’s immune system strong.

As we’ve learned more about COVID-19, it’s become clear that the virus presents a particular threat to people who have diabetes or other metabolic conditions, including obesity. With that in mind, I spoke with a range of experts who had specific, actionable tips on how to make nutrition and lifestyle changes during the pandemic, with an eye toward improving glucose management and metabolic health – even at a time when increased stress may make that more difficult. Though their perspectives and advice differed, each expert agreed that the disruption caused by COVID is a good time to make changes. Many of their suggestions offer ways to improve health – and not just during COVID. Others offer ways to make your money stretch further at a time when many people are economically on the edge (especially in the diabetes community), yet are also looking for healthier ways to eat. Though many of us feel helpless right now, we actually have more control than we may think, and the small decisions we make about food each meal can lead to positive changes.

All of the interviews have been condensed and edited for clarity. For more nutrition information for people with diabetes, click here.

  • Dr. Mariela Glandt is the founder and director of the Glandt Center for Diabetes Care in Tel Aviv, Israel, which specializes in treating diabetes through very low carbohydrate diets. She is also the author of How to Eat in the Time of Covid-19.
  • Dr. Lee Kaplan is an internist and gastroenterologist, a leading researcher, and the director of the Weight Center at Massachusetts General Hospital.
  • Dr. Rita Nguyen specializes in internal medicine and has served as the Director of Chronic Disease Prevention for the San Francisco Department of Public Health, where she founded and directed the city’s Food As Medicine Collaborative. Currently, she is leading the department’s efforts to write COVID-19 guidance for all city sectors.
  • Dr. Akua Woolbright is the National Nutrition Program Director at the Whole Cities Foundation, an independent nonprofit foundation started by Whole Foods Market with the goal of increasing access to fresh, healthy foods and quality nutrition education.

What advice are you giving people during COVID, particularly in terms of nutrition?

Akua Woolbright: I have a mantra that I recommend: whole foods, plant based. Eat from the Earth, things that your great, great, great, great, great, great, great grandmother would have found in her outdoor environment. Another way I like to say that is food made by nature, not by people.

When I say plant-based, I don’t mean that everyone should necessarily be vegan or vegetarian, but that by building our meals around green and colorful vegetables, colorful fruit, whole grains, legumes, a few nuts, and seeds, our food starts to become micronutrient dense. We’re naturally getting less of what we don’t need (excess calories, saturated fat, and cholesterol) and more of what our bodies use for fuel and energy – vitamins, minerals, antioxidants, and phytonutrients.

Instead of looking at one diet for weight loss and something else for high blood pressure and then doing something else for cancer prevention and then thinking about diabetes, I try to construct a diet that will be beneficial to all of our systems, organs, cells, and DNA. Here are some of my strategies:

  • That mantra “whole foods, plant based” can be used as a touchstone when you’re walking through the grocery store, when you’re going to restaurants, and preparing meals in your home. Try to avoid those packaged food products.
  • For someone who has diabetes, lean more on the green and colorful non-starchy vegetables. Go more towards the tart fruit like berries, and avoid starchy produce.
  • To start, think about changing breakfast. Breakfast in America tends to be pancakes, cereals, all of that stuff. And so instead, perhaps eat some beans for breakfast. That sounds crazy to people, but we know that beans with resistant starch can help regulate blood sugar for the rest of the day. Beans are simple, they’re affordable, and you can mix them up so many different ways – pinto beans with chili powder, curried black beans – I try to get people to be creative.
  • Start lunch and dinner with a large salad or a vegetable soup. This will give you a lot of micronutrients and fill you up with some bulk in fiber so you’re better able to manage your blood sugar and your cravings.
  • Drinking plenty of water is important. Some of your water can come from eating watery fruits and vegetables and drinking herbal teas. Herbal teas are great because they’re high in antioxidants and vital nutrients. And by getting proper hydration, you can remove toxins from your body and curb hunger.

I try to have some urgency around the changes we need to make to lead healthier lives – we can do so much more to support our own health.

Mariela GlandtMy message is that now, more than ever, is the time to pay attention to our metabolic health. And the best way I know of to do that is to reduce how much insulin your body needs, by changing the way you eat. I argue that when you lower insulin levels, it can be possible to correct metabolic issues, like heart diseasehigh blood pressure, high cholesterol, obesity, and type 2 diabetes. There is a much greater chance of getting severely ill if you have a complicated metabolic condition.

So how can you improve metabolic health? By avoiding the foods that demand insulin, which are carbohydrates and sugar. For the people I work with who have type 2 diabetes, I recommend a ketogenic diet (high in fat, low in carbohydrates). Type 2 diabetes is the body telling you, “Please, don’t bring in any more sugar; I don’t have anywhere to put it.”

As far as bang for your buck, you can see many more effects from changes to diet than from exercise or other aspects of lifestyle. It’s really worth paying attention to what you put in your mouth. Here are some tips to help you:

  • Go as “real” as possible – the least amount of store-bought and processed food. Stick to the outer aisles of the grocery store for the fresh food. Try to make things at home. Chicken, fish, eggs, and vegetables. That in itself brings you a lot closer to health.
  • Drop that bowl of cereal in the morning and have two eggs instead.
  • I’m against snacking. I think we should eat enough fat and protein to feel full without snacking. Aiming to eat no more than three meals a day can help to decrease insulin levels throughout the day.
  • Eat dinner as early as possible, because humans are not meant to be eating during the night time. That one change of eating earlier can be really helpful in terms of reducing insulin levels.

Rita Nguyen: The people I typically see are at our county hospital, so they tend to be economically and socially disadvantaged. Now, with the economic stress brought on by COVID-19, more people are facing similar economic situations to my patients. When you have plenty of money and access to food, it’s much, much easier to comply with dietary recommendations for diabetes. In the setting of restricted resources, I tell my patients that portion control becomes more important because you’re not able to always pick the healthier items, and oftentimes you may be only able to purchase or access shelf-stable foods.

For people facing financial constraints, here’s what I suggest:

  • You may end up eating more carbs to keep yourself full, but you should be particularly mindful to seek out complex carbs rather than simple carbs, and whole grains whenever you can (although some of the nicer whole grains are more expensive).
  • Try to cook from scratch as much as possible.
  • Protein is meant to keep people full longer and has less of an effect on your blood sugar.

People can do these things anytime, but these strategies become even more important when you’re facing real limitations in what you can purchase.

The final piece of advice I give is to quit smoking. The leading cause of death among people with diabetes is heart disease, and smoking contributes greatly to heart disease. Plus, cigarettes are expensive. If you smoke a pack a day, that costs over $2,000 a year. I totally understand that increases in smoking and drinking happen when there’s increased economic stress. But for some people, if you point out the economic and health costs, it can help them quit.

Lee Kaplan: Because we’re all eating at home to a much greater extent during COVID, we have the opportunity to learn how to cook and eat less processed foods than we did previously. This disruption provides a good time to make long-term lifestyle changes – whether it’s reducing stress or getting better sleep or eating healthier food. That’s the silver lining of all this. You can build new patterns with a keen eye toward where you eat, when you eat, how you eat, and what you eat, which all become part of a healthier dietary lifestyle.

To decrease the risk of developing diabetes, other metabolic diseases, cancer, and heart and vascular disease, you want to eat the diets that have been shown to improve specific risks [read about the American Diabetes Association’s dietary guidelines for diabetes here] – for instance, you want to follow diets that have iron, Omega-3s and Omega-6s, and are low in saturated fats, have no trans fats, and are low in concentrated carbohydrates. But none of those recommendations, in my view, has been demonstrated to cause substantial or durable weight loss. So, you should follow these diets for their health benefits, not because they will necessarily cause weight loss.

To the greatest degree possible during this time, you should also:

  • Decrease stress.
  • Have physical activity in your life.
  • Get healthy sleep.
  • Normalize your body’s internal rhythms through regular patterns of eating and sleeping, and accommodating third shift work or travel as needed.

Do you have specific recommendations around trying to boost the immune system during COVID?

Akua Woolbright: I like to make sure that we’re getting a variety of colorful produce at every meal. Every color corresponds to a different set of nutrients that feed different parts of the body. By eating a variety of colorful produce – purple foods, red, orange, yellow, green, brown, white – you are feeding different systems and organs, and really drilling down into your cells with nourishment and the ability to heal and rejuvenate the body.

When we’re looking for immunity, the three colors that stand out are orange, yellow, and green foods. This includes things like citrus, yellow or orange peppers, squashes, even some sweet potatoes, dark green leafy vegetables, broccoli, and cabbage. They’re all effective in strengthening immunity, and those green foods give an added boost by removing toxins from the body.

I also like to talk about high-quality protein and making sure that people with diabetes and those who are trying to build a healthy immune system are careful to get enough protein throughout the day. Aim for at least 10 grams of protein, up to 20, spread throughout the day at breakfast, lunch, and dinner. Why is protein so important for blood sugar and maybe even weight loss? It helps to stabilize cravings and blood sugar and makes you feel more even and balanced, allowing you to make active choices.

The quality of protein throughout the day is also important because our immune antibodies are made from protein. So we’re looking at lean meat: salmon is particularly great for immune boosting. When I’m looking for a plant-based protein powder, I’m looking for something clean, made with few ingredients, and with the protein coming from hemp, brown rice, or green peas.

With the pandemic economy, many people have even less ability than they did before to buy certain foods. How do you talk to people about healthy food choices at a time when so many are so economically stretched?

Rita Nguyen: Right now, it’s all about connecting people to resources through things like food pantries and food pharmacies, because you can only go so far with advice.

Healthcare can’t ignore the fact that you have to address food insecurity. You can’t assume that the person sitting in front of you has been employed the last nine months and has enough to eat. For people with diabetes facing food insecurity, if you maintain the dose of insulin or other medications, you either risk hypoglycemia because they’re not eating consistently, or maybe you’re under-treating them because their eating habits have changed. So for any diabetes healthcare professional, I think screening for food insecurity should be part of the standard of care at least during the pandemic.

Mariela Glandt: It’s a matter of prioritizing and looking for the sales. You can get meats that are on sale. Eggs also provide a huge amount of nutrition, they’re amazing, and they’re much cheaper than meat.

Akua Woolbright: I kind of treat this like church, where I give you all of the Ten Commandments, all the dos and don’ts. But then I tell people, “You’re going to start where you are and do what you can. If you can only go buy the fresh produce or dried beans, do that. If you can buy one new item, figure out which one you like and start there.”

Some of the recommendations I help people think through are logistical. If there’s one person in your neighborhood or your family who has a car, maybe you come together and drive further out to a grocery store that’s more affordable. Maybe you find hardy produce on sale, like cabbage, carrots, or squash, that will last for two to four weeks. Or look for fresh produce on sale. You purchase it and freeze it for later.

I talk to people about being creative in how you use frozen foods and canned and dried beans to stretch what you have so you can go to the grocery store less frequently. In the face of the coronavirus, we don’t want to be out in the grocery store every day anyway.

I eat very simply, and that’s how I encourage others to eat too. I make this wonderful curried chickpea dish with canned chickpeas. It’s a little bit of curry powder, turmeric, salt, garlic in the skillet with some oil. Add the chickpeas, stir them all up until they start turning yellow from the curry and the turmeric and then let them just simmer for a minute. Then I top that with whatever greens I have, and then maybe some chunks of tomato. I put that on top of some brown rice, and I am happy. And chickpeas are inexpensive.

Any other tips you are giving your patients now, specifically in terms of COVID?

Lee Kaplan: COVID is creating all kinds of stress, including a lot of economic stress for people. Be aware of that and pay attention. Stress is a huge negative factor in all the health conditions we’re talking about, whether it is obesity, diabetes, or liver disease. I think it’s very important to try to find new ways of relieving the stress, if possible. Whether through walks, time for solitude, or whatever activities help you relax.

Mariela Glandt: The virus is going to go around. It matters where it lands. It matters if it lands on fertile soil or not; I think that how metabolically healthy you are plays a really big role here. So in this regard, we have more control than we think. I’m not saying we have all the control, definitely not, but at a time when we can feel helpless, there’s a lot we can do to try to be healthy – and we can start by deciding what to eat.

Click here to read more about nutrition and diabetes.

About Katie

Katie Bacon is a writer and editor based in Boston. Her daughter, Bisi, was diagnosed with type 1 diabetes in August, 2012, when she was six. Katie’s writing about diabetes has appeared on and ASweetLife. Katie has also written for The New York Times, The Boston Globe, and other publications.


Staying Safe – And Staying Well – During a Pandemic Winter

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

Unfortunately, the COVID-19 pandemic is not going away just yet, and as the weather grows colder and the holidays approach, you may have questions about how to keep yourself and others safe this winter. Here’s how to know (and lower!) your risks, plus tips for staying as healthy as possible

As cases of COVID-19 are spiking across the globe, the weather is also growing colder in many parts of the world. As we are starting to see in the United States, winter is intensifying the effects of the pandemic:

  • Due to the cold weather, people are moving outdoor gatherings indoors, where the risk of COVID-19 transmission is much higher.
  • For the same reason, it’s harder for people to be physically active outside to keep themselves healthy.
  • With the holidays approaching, many people are making plans to travel or visit loved ones, bringing the virus with them.
  • It’s flu season, and it can be dangerous to get COVID-19 and the flu at the same time – read our article “Flu Shots Are Even More Important During A Pandemic.”

These factors can all be scary for people with diabetes, who are at an increased risk of severe COVID-19 illness. In this article we’ll answer the questions you might have, and we’ll discuss ways that you can keep yourself and others as safe as possible this winter. You can find more resources on COVID-19 here.

Click to jump down to a section:

How is the virus spreading?

Coronavirus is transmitted through contact with infected people, whether or not those people show symptoms. COVID-19 is primarily spread through the droplets that come out of an infected person’s mouth or nose when they talk, breath, cough, sneeze, laugh, or sing. The virus is carried through these small droplets. Anyone close by can be infected by the virus if the droplets enter their mouth, nose, or eyes. Droplets can also land on surfaces (like door handles or food at the grocery store) and infect someone who touches a contaminated surface and then touches their face. Finally, according to the World Health Organization, COVID-19 can sometimes spread invisibly when tiny droplets stay in the air for an extended period of time after they are released.

With many ways for COVID-19 to spread, avoiding public spaces and people who do not live with you can dramatically reduce your chances of infection. We know that not everyone can stay home – if you are an essential worker, thank you for the work you are doing and please be as careful as possible. If you’re not an essential worker, do your part to slow the spread and stay at home whenever possible. Read our article “Not Everyone Can Work From Home: Addressing Worker Safety During COVID-19” for more information.

Know your risks: how can I stay as safe as possible?

The best thing you can do this winter is evaluate your risk. What does this mean? Over the next few months, every time you are considering doing something outside of your home, you should consider your chances of getting COVID. Here are the questions to ask yourself:

  • Is COVID-19 spreading in my community? Check out this interactive, county-level, risk assessment tool from researchers at Georgia Tech.
  • Will I come into close contact with other people who are not in my household? If so:
    • How many people might I encounter? How long will I be around them?
    • Will people be wearing masks?
    • Will I be indoors or outdoors? Will I be able to keep six feet away from others?
  • How will I get there? Will I have to travel to other cities or states?
  • Do I, or others in my household, have diabetes or other health conditions that increase risk for severe illness?

The CDC states, “In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher your risk of getting and spreading COVID-19.” These questions can help you understand the risk of an activity, to determine how it may affect your health or the health of your loved ones. Below we’ll talk about the risks – and ways to lower those risks – for gatherings and travel.

Is it safe to gather with family and loved ones?

The holidays this year may be challenging and different than what you are used to. Given the chances of COVID-19 transmission, many families are asking whether they should visit each other and celebrate together, especially if they have to travel to do so. For families with diabetes, it’s even more important to consider the risks of exposing yourself and others to additional people.

Every time you come into close contact with a new person there is a risk of being infected with COVID-19, or infecting that person (if you have COVID-19 at the time, whether or not you are showing symptoms). The best way to stay safe is to minimize contact with other people; even a small gathering can be quite dangerous.This may mean that your family will celebrate the holidays virtually, rather than through an in-person gathering. The CDC recommends that people who have diabetes or who live with someone who has diabetes avoid in-person gatherings with people outside of their household.

If you do decide to see others, here are some of the best ways to be careful:

  • Do not host or attend a gathering if you or someone you live with has symptoms of COVID, may have been exposed to someone with COVID, or is waiting for test results, tested positive for COVID less than days ago, or has a fever.
  • Strongly encourage everyone who will attend to quarantine for 14 days before the event, avoiding contact with anyone outside their household. This will greatly reduce their chances of catching COVID and transmitting it to other guests.
  • Limit the number of guests as much as possible, and try to include only people from your local area.
  • Gather outdoors whenever you can; if people will be inside, open windows to increase air flow.
  • Have hand sanitizer and masks on hand to help keep people healthy.

What are the risks of travel and transportation?

As with every activity, when you travel, you run two risks: getting COVID, or infecting others with COVID. Here are the main questions you should ask if you are considering travel to a new place:

  • Is COVID-19 spreading at your destination?
  • Are you – or someone you live with – at an increased risk for severe COVID-19 illness?
  • Will you be around many people while you are in transit? If so, will people be wearing masks and taking safety precautions?

Each type of travel carries its own risks. What type of travel are you considering?

Risk factors

Image source: diaTribe

When traveling or using public transportation, you should always wear a face mask when you are in public spaces. As much as possible, stay at least six feet away from people not in your household and avoid touching any surfaces. Wash your hands (or use hand sanitizer) frequently, and upon arrival. Read more about travel recommendations from the CDC here, or read about transportation safety here.According to the CDC, the lowest-risk options are to travel short distances by car with the people you live with, or to stay home. The highest-risk option is air travel with airport layovers.

What other precautions should I still be taking?

It’s important to continue following the guidelines that recommend to protect yourself whenever you are outside of your home. Here are some basic steps you can take to prevent the spread of COVID-19:

  • Social distance by staying at least six feet away from other people.
  • Wear a cloth face covering when around other people in public. Your mask should fully cover your mouth and nose and fit snugly against your face. Read more about wearing and cleaning masks in our article, “The Latest on COVID: Staying Safe as The Pandemic Surges.”
  • Wash your hands often with soap and water for at least 20 seconds; use a hand sanitizer with at least 60% alcohol when you don’t have access to soap and water.
  • Avoid touching your eyes, nose, and mouth. Cover coughs and sneezes. Do not remove your mask to cough, sneeze, or talk to others.
  • Avoid close contact with people who are sick, even in your home.
  • Monitor your health and be aware if you begin developing any symptoms.

One of the most important parts of being careful is wearing a mask – please wear a face mask when you are out in public, and encourage others to do the same! Face masks are essential to reducing COVID infection rates this winter. Learn about face masks, why they work, and what type to buy in this article from Johns Hopkins Medicine.

What can I do to keep my body as healthy and strong as possible?

It’s not too late to get a flu vaccine! This year, flu shots are more important than ever to avoid getting the flu and COVID at the same time – especially for families with diabetes. Read “Flu Shots Are Even More Important During A Pandemic” to learn how to tell the difference between the flu and COVID, and read “Get Your Flu Shot Now” for more information on how having diabetes can affect recovery from the flu.

For people with diabetes, it is especially important to carefully manage your blood glucose levels. Keeping your blood glucose levels stable will keep your body healthy and ready to fight off an infection. Please continue to take your medication, and keep extra medication and diabetes supplies at home, as well as supplies for low blood sugar events.

It’s also a good idea to maintain habits for healthy eating and exercise. Check out our delicious, low-carb recipes from Catherine Newman, including comfort foods and winter soups. As the weather grows colder, it may be harder to exercise outside, however, the American Heart Association has tips for staying active during the winter.

Finally, remember to take care of your mental health. The combination of the pandemic, diabetes, and the winter can be really challenging for many people. You can find our guide to managing stress and anxiety during the pandemic, and a list of free mental health resources here.