Three Strategies for Heart Healthy Eating

This content originally appeared on diaTribe. Republished with permission.

By Constance Brown-Riggs

Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, is a national speaker and author of several nutrition books for people with diabetes.

​Nutritionist and educator Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, discusses the relationship between food and heart health, and how you can make eating choices to prevent heart disease.

If you have diabetes, you are at a much higher risk for heart disease. The good news is, there are steps you can take to lower your risk. What you eat is one of the most important steps to managing diabetes and reducing your chances of heart complications. What are the three main ways to do this? Choose heart-healthy fats, heart-healthy carbs, and reduce sodium in your diet.

Many people find that changing eating behavior is very hard. But it doesn’t have to be that way – not if you take the right approach. Some people use a food tracker to see how much of certain nutrients like carbohydrates, fat, salt, they are eating. And research shows that making small, gradual changes works best. Rather than drastically changing your eating habits in a day, start with setting just a few small, achievable goals that you can stick with. To help you get started, you will find tips and “small wins” throughout this article – these step-by-step changes can make your meals and recipes healthier for your heart.

Education is key to managing diabetes and heart health. Click here to learn about Diabetes Self-Management Education and Support (DSMES) services to help you live well and navigate your diabetes journey – and check out the Diabetes Food Hub for even more resources.

1: Choose Your Fat Wisely

Dietary fat often gets a bad rap. So, it might surprise you to know that fat plays a vital role in our health. We need fat to insulate our body, protect our vital organs, and transport and absorb vitamins A, D, E, and K.

Fat is also the most concentrated energy source for the body, providing nine calories per gram, more than double what is found in carbohydrates and protein. And when it comes to food, there is no denying fats’ ability to make food taste good.

Fats are made up of fatty acids that are linked together. There are three types of fatty acids: saturated, monounsaturated, and polyunsaturated. The predominant type of fat in a food determines which category the food falls into:

  • Saturated fat is usually solid at room temperature and is found mainly in foods that come from animals, such as meat, lard, bacon, poultry, dairy products, and eggs. Coconut oil, palm kernel oil, and palm oil are also saturated fats. This type of fat can cause your body to produce too much cholesterol (a natural substance that the body needs, but in limited quantities – read all about cholesterol here).
  • Monounsaturated fat is usually liquid at room temperature. Monounsaturated fat is mainly found in vegetable oils such as canola and olive oils, avocadoes, and peanuts. Monounsaturated fats are often called heart-healthy fats because they don’t cause higher cholesterol levels.
  • Polyunsaturated fats are usually liquid or soft at room temperature. Polyunsaturated fat is found mostly in vegetable oils such as safflower, sunflower, corn, and flaxseed. It’s also found in walnuts and fish like salmon, albacore tuna, herring, and mackerel. Polyunsaturated fats are also heart-healthy fats because they don’t increase cholesterol levels.
  • Trans fats are polyunsaturated fats that have been chemically changed to make them stay solid at room temperature. Hydrogenated vegetable oils such as vegetable shortening and margarine contain trans-fatty acids – as do the foods you make with these oils. Trans fats act like saturated fat in the body, raising your cholesterol levels. The American Diabetes Association recommends avoiding foods with trans fats as much as possible.

When it comes to the heart, monounsaturated and polyunsaturated fats are much better for you. Read “Dietary Fat: The Good, The Bad, and The In-Between” to learn more. Here are some tips for adding more heart-healthy fats to your diet:

Small Win:  Shift the fat you use from saturated to healthy oils, like olive and canola. Chef Wesley McWhorter, spokesperson for the Academy of Nutrition and Dietetics, says, “Don’t forget to add healthy fats in your recipes from things like avocado, beans, nuts, and seeds – which will also keep you full longer and prevent overeating.”

Small Win: Try a “protein flip.” Chef McWhorter suggests you keep the animal proteins and their fats that you love but shift the proportion of the ingredients. For example, instead of an all-beef burger, make a half vegetable burger by adding beans and veggies or mushrooms. “Blended burgers are great because the moisture from the mushrooms actually makes your burger taste better,” says McWhorter.

Tips for Choosing Heart-Healthy Fats

Healthy eating facts

Image source: diaTribe

Remember: Choose low-fat and reduced-calorie foods wisely because they can contain more added carbohydrate than the full-fat version.

2: Opt for Heart Healthy Carbohydrates

There are three main types of carbohydrates: sugar, starch, and fiber.

  • Sugar is called by many names – simple sugar, table sugar, cane sugar, brown sugar, turbinado, demerara, maple syrup, molasses, honey, and high-fructose corn syrup. Simple sugars are often referred to as fast-acting because they rapidly raise blood sugar levels. Sugars may be added to foods or occur naturally, like the fructose in fruit and lactose in milk.

Foods made with added sugars tend to have little or no nutritional value and are usually high in calories and fat. Simple sugars, especially high fructose corn syrup, raise triglyceride levels which is associated with heart disease. And when it comes to blood sugar levels, foods with added sugar like cookies, donuts, and cakes lead to blood sugar levels spiking which, when treated with insulin, can cause large, unpredictable blood sugar swings – also not good for the heart.

  • Starch is a complex carbohydrate. It’s made from lots of simple sugars that are linked together in long chains. Complex carbohydrate foods include whole-grain bread and cereal, starchy vegetables (green peas, corn, lima beans, potatoes), and dried beans (pinto beans, kidney beans, black-eyed peas, and split peas). Unlike fast-acting carbohydrates, starches are slowly broken down during digestion, resulting in a lower, steadier release of sugar into the bloodstream.
  • Fiber is also a complex carbohydrate. Fiber is the indigestible part of any plant food, including the leaves of vegetables, fruit skins, and seeds. Fiber helps to move food waste out of the body and may help lower cholesterol and keep your blood sugar in range. Dietary fiber is found in foods that come from plants, including fruits, vegetables, nuts, seeds, avocados, beans, peas, lentils, and whole grains.

Increase Fiber

Fiber is important for heart health and keeping your blood sugar in range. The American Diabetes Association recommends that people with diabetes eat at least 14 grams of fiber per 1,000 calories – or about 28 grams of fiber per day for women and 34 grams of fiber per day for men. However, increasing fiber too quickly can cause gas, bloating, and constipation. Before increasing your fiber intake, figure out approximately how much fiber you are currently eating.

Aim to increase your daily fiber intake slowly – on week one, increase your daily fiber intake by two or three grams, then the following week increase it by two to three more, until you’ve reached your goal. In addition, increase the amount of water you drink. This will help prevent constipation. If you begin to experience gas or bloating, slow down – instead of changing every  week, change your daily fiber by two to three grams every other week.

Small Win: McWhorter suggests swapping processed grains like pasta for whole grains like farro, millet, quinoa, or bulgur. Fiber is one of the best things for your heart, and whole grains are a great way to get more of it,” says McWhorter. “The good thing is there are so many delicious, whole grains out there.”

Tips for Choosing Heart-Healthy Carbs

Healthy eating facts

Image source: diaTribe

3: Slash the Sodium in Your Food

Your body needs sodium (or salt) for normal muscle and nerve functions and to keep your body fluids in balance. But, too much sodium in your diet can lead to high blood pressure, heart disease, and strokes, as well as bloating, puffiness, and weight gain. Most people eat about 3,400 mg of sodium a day – almost double what’s recommended by the American Heart Association. People with diabetes and prediabetes are encouraged to consume less than 2,300 mg of sodium per day – that’s about one teaspoon of table salt – to care for their hearts.

Despite what you may think, over 70% of dietary sodium comes from eating packaged and prepared foods – not from table salt added to food when cooking or eating. Reading the nutrition facts label on packaged and prepared foods is the best way to make informed decisions about how much sodium you eat.

Small Win: McWhorter suggests building flavor throughout the cooking process. “It’s important to focus on how to add flavor through herbs, spices, acid, and texture, which can help you reduce the sometimes, excessive saturated fat, sugar, and salt in your dishes. Don’t be afraid to experiment with new seasonings and get away from the typical ‘salt and pepper’ approach. Trust me – flavor matters,” McWhorter says.

Tips to Reduce Sodium

Healthy eating facts

Image source: diaTribe

Remember, homemade food typically contains less sodium than prepared food (whether it’s canned, frozen, packaged, or from a restaurant). This is also true for sauces like pasta sauce, barbeque sauce, teriyaki sauce, ketchup, and salsa. As much as possible, aim to buy fresh, unprocessed ingredients and turn them into your favorite dishes. For heart-healthy recipes, click here.

Overall, the key to a heart-healthy meal plan is variety: fruits and vegetables, lean protein sources, nuts, legumes, whole grains, and healthy fats like avocados or olive oil. When revamping meals, chef McWhorter recommends starting with the whole plate in mind. “Our meals are most often focused on the main protein versus the whole plate. What is left leaves little room for creativity and deliciousness for the fiber-rich and nutrient-dense vegetables, whole grains, nuts, and seeds that we really want (and need) on our plate,” McWhorter says. And remember to start with small wins on your path to heart healthy eating.

Learn more about nutrition here.

This article is part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

About Constance

Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, is a national speaker and author of Living Well with Diabetes 14 Day Devotional: A Faith Based Approach to Diabetes Self-ManagementDiabetes Guide to Enjoying Foods of the World, a convenient guide to help people with diabetes enjoy all the flavors of the world while still following a healthy meal plan, and The African American Guide to Living Well with Diabetes. Learn more about Constance and follow her on Instagram Twitter, and Facebook.

Source: diabetesdaily.com

Hitting a Nerve: Introduction to Neuropathy

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

What is neuropathy? And more specifically, what is diabetic neuropathy? What are the symptoms and how can you prevent and treat neuropathy?

When someone hears about the long-term complications of diabetes, problems with the feet, foot ulcers, and even amputations are often brought up and can be some of the scariest outcomes. What leads to these issues is something called neuropathy, or damage to the nerves.

But neuropathy, and those subsequent complications, aren’t by any means a given – and prevention is possible. What is neuropathy and what can you do to avoid it entirely, or minimize it so that you can keep your feet, and the rest of your body, as healthy as possible?

What is the difference between neuropathy and diabetic neuropathy?

Neuropathy is the term used to describe any damage to nerves in the body (for example, an injury from a car accident can damage the nerves). Diabetic neuropathy, or diabetes-related neuropathy, is the term used to specifically describe the nerve damage from high glucose levels (hyperglycemia) over the long term.

Diabetes can cause three main types of neuropathies: peripheral neuropathy (medically referred to as distal symmetric sensorimotor polyneuropathy), autonomic neuropathy, and focal neuropathy.

Peripheral neuropathy affects the nerves outside of the brain and spinal cord, and often leads to symptoms involving the hands and feet. “This is what most people associate with diabetes-related neuropathy,” said Chris Memering, a nurse and inpatient diabetes care and education specialist at CarolinaEast Health System in New Bern, North Carolina.

Peripheral neuropathy involving the feet is the most common form of diabetic neuropathy. Loss of function in particular nerve fibers can change sensation and reduce strength in the foot. Loss of sensation can lead to injury from shoes that don’t fit, stepping on sharp objects you can’t feel, or not knowing the sidewalk is too hot. Neuropathy can also lead to pain, burning or other unpleasant sensations which may respond to medication.

But diabetes isn’t the only condition that can cause peripheral neuropathy. Other conditions that can lead to peripheral neuropathy include heavy alcohol consumption, trauma, nerve entrapment (such as that which occurs in carpal tunnel syndrome), vitamin B deficiency, chemotherapy, and an autoimmune process that attacks the nerves.

Neuropathy can also affect the functioning of the autonomic nervous system (which controls things like blood pressure, heart rate, digestion, and bowel and bladder function). This is called autonomic neuropathy. Autonomic neuropathy can lead to a variety of complications.

“In diabetes care, many people are familiar with hypoglycemia unawareness, erectile dysfunction or female sexual dysfunction, gastroparesis [when the stomach can’t empty properly and digestion slows], neurogenic bladder [when the nerves that tell your brain to tighten or release the bladder muscles don’t operate properly], or orthostatic blood pressure changes [dropping blood pressure when you stand up],” Memering said, adding that all these could be a result of neuropathy.

Finally, focal neuropathy results from issues with one or more nerve roots and usually happens suddenly. Focal neuropathies often involve both motor functioning – such as weakness – and sensory deficits, which can cause discomfort and pain.

What causes neuropathy?

Chronic hyperglycemia can damage both small and large nerve fibers. Over time, elevated glucose levels, often made worse by high triglycerides (a type of fat that can be found in the blood) and associated with inflammation (the body’s natural way of fighting infection) can cause damage to the nerves. That damage disrupts the way nerves interpret sensory information and how the messages about sensation are transmitted to the brain.

Usually, nerve damage from high blood sugar levels happens in the long nerves first (which run from your spine down to your toes), which is why the symptoms of peripheral neuropathy occur first in the feet. “The length of time someone has lived with diabetes increases their risk of developing neuropathies, as does that person’s level of blood glucose, in terms of A1C, Time in Range, and glucose variability,” Memering explained.

In essence, higher glucose levels over time increases your risk for developing neuropathy. This was confirmed by the famous Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications study (EDIC). The studies showed that the prevalence of confirmed peripheral neuropathy was 64% lower among participants in the intensive management group (those who managed their blood glucose carefully with treatment and kept their levels as close to normal as possible).

What does neuropathy feel like?

Symptoms of neuropathy usually start in the toes and progress upward. The sensations experienced with peripheral neuropathy differ from person to person. Some describe the feelings they have as numbness or tingling, while others say it feels like burning. Some say they are sensitive to being touched and cannot bear the feeling of a sheet or blanket covering their feet, while others describe it as feeling like they are always wearing a sock or a glove.

“Ultimately, you could end up losing protective sensation – which can be very dangerous and puts you at risk of not realizing when a part of your body is hurting or being injured,” Memering said. “While you may be able to still feel pressure – you know you are stepping on the ground with your foot – you may not be able to feel pain if you step on something sharp or hot.” This means you might not withdraw your foot from the unsafe environment, harming it further, and without realizing the extent of the damage.

The biggest concern about peripheral neuropathy involving the feet is that the loss of normal pain sensation can lead to greater skin and tissue damage. “Injury can result in the formation of a foot ulcer, which, if infected, can progress to ongoing tissue damage that can lead to amputation,” said Dr. Robert Gabbay, the chief scientific and medical officer for the American Diabetes Association. That’s why it’s so important to prevent, recognize, and treat any symptoms of neuropathy.

How is neuropathy diagnosed?

To assess for neuropathy, your healthcare team should do a thorough examination of your feet looking for sores or ulcers, changes in skin color, diminished pulses and any abnormality or injury to your foot. They can test for diminished strength, a change in your ability to know the position of your toes, and a change in sensation or sensory perception.

A foot exam will always involve taking off your socks and shoes, and your healthcare professional will inspect your feet to check for color changes, pulses, open areas, redness, rashes, and the overall condition of your feet, said Dr. Cecilia C. Low Wang, a professor of endocrinology, diabetes, and metabolism at the University of Colorado Anschultz School of Medicine.

A monofilament test uses a soft fiber to test for sensation in various parts of the feet and body, and a tuning fork can also help healthcare professionals understand how much sensation a person has lost. The monofilament test, as well as a pinprick test, can check to make sure you have good sensation, while other tests will evaluate vibration and position sense (whether you are aware of where your foot is). “The main question I would suggest asking your diabetes provider is whether they notice anything concerning about your foot exam, and whether they think you need to do anything different, or see an additional specialist, such as a podiatrist,” said Dr. Low Wang.

In this age of telehealth visits, some podiatrists have been sending a monofilament (a small strand of nylon attached to a piece of plastic) to a person’s home and teaching them how to use it to determine if they have reduced sensation in different areas of the feet. Podiatrists might even examine a person’s foot onscreen during a video visit and ask questions about how the foot feels or looks. “If there’s something of concern, they will schedule an in-person visit,” added Memering.

If someone is experiencing symptoms of autonomic neuropathy, a healthcare professional may recommend a specific test depending on what the autonomic symptoms are. For example, if there are issues with blood pressure control, taking your blood pressure as you change positions from lying to sitting to standing or using a formal tilt-table test, may show loss of autonomic control of how your body regulates your blood pressure. If you have symptoms of delayed gastric-emptying (stomach-emptying), specialized radiology tests might be ordered that show the time it takes for food to exit the stomach. The Mayo Clinic has an informative list about many of these tests. If you have any symptoms of autonomic neuropathy, such as bladder or erectile dysfunction, feeling faint on standing up, or bloating and fullness, talk to your healthcare professional and explain what you are experiencing.

What are the best treatment options for neuropathy, especially in the hands and feet?

Although it is not always possible to prevent neuropathy completely, the best way to slow its progression (as shown in the DCCT) is to closely manage your blood sugar levels and try to stay in range as much of the time as possible. If neuropathy does develop, medications can decrease the burning and tingling sensations, said Dr. Gabbay.

“Diabetes is a leading cause of neuropathy, and the higher someone’s blood sugar levels are over time, the more likely they are to develop neuropathy,” Dr. Gabbay said. “The good news is by managing blood sugar levels, one can significantly reduce their risk of developing neuropathy.”

With painful neuropathy, “treatments are generally to try to manage symptoms,” Memering said. “Medications such as Neurontin [gabapentin, a drug used for pain and seizures], Lyrica [pregabalin, a drug used for pain and seizures], or Cymbalta [duloxetine, a drug used for chemical balance in the brain] may be used to help with pain associated with painful peripheral neuropathies. These medications can be very effective, but it may take a few weeks to adjust and find the right dose. However, people should know that the medications can also be somewhat sedating.” Other drugs that may be effective include drugs used for mood disorders such as venlafaxine, nortriptyline, or amitriptyline, said Dr. Low Wang, but they may have side effects at higher doses and with older age.

Dr. Gabbay added that neuropathy “is a very active area of research to identify new and effective treatments.”

There are also various treatments to help improve the symptoms of autonomic neuropathy:

  • For Postural Blood Pressure Changes:
    • If you have a significant decrease in your blood pressure on standing, your healthcare professional can teach you how to get up slowly to allow your body to regulate your blood pressure with positional change.
    • You can also wear an abdominal binder, which Memering described as “a big elastic girdle that puts more pressure on the big blood vessels in the body,” so that they have more support when changing positions.
    • Other treatments include adjusting salt intake, using compression stockings, doing physical activity to avoid deconditioning, and staying hydrated, said Dr. Low Wang.
  • For Neurogenic Bladder:
    • If you are experiencing a neurogenic bladder, urinating at regular intervals during the day and night can help the bladder empty even if you no longer feel the urge to urinate. You might also undergo a urinalysis or a bladder scan, said Dr. Low Wang. Medications can also help.
  • For Gastroparesis:
    • Eating low-fiber, low-fat foods in smaller and more frequent meals and getting a greater proportion of calories from liquids might help, said Dr. Low Wang.
    • Sometimes the drug metoclopramide (Reglan) may be prescribed and gastric electrical stimulation might be used in severe cases.
  • For Erectile Dysfunction:
    • You may be prescribed one of the medications – sildenafil, tadalafil, avanafil, or vandenafil – but you may also need to undergo a physical exam, or other tests.

If you are experiencing any of the symptoms of neuropathy, you should speak with your healthcare professional to determine what diagnostic tests need to be done and what treatment course might be best for you.

Can you reverse diabetic neuropathy?

Currently, neuropathy can’t be reversed, but its progression may be slowed. Keeping blood sugar levels in the recommended targets is the key to doing so, Memering said. “The use of diabetes technology may be very helpful – especially continuous glucose monitors – for keeping your blood sugar in range, along with eating a varied diet, including vegetables and fruits, and exercising regularly,” she said.

Tips for living with diabetes and neuropathy

The two best things someone with diabetic neuropathy can do are to:

  1. Manage their blood sugar levels to keep the neuropathy from getting worse.
  2. Check their feet regularly, both at home and during healthcare appointments.

Check your feet at home

Dr. Gabbay, Dr. Low Wang, and Memering each recommended that all people with diabetes, whether young or old, newly diagnosed or not, should regularly check their feet. Dr. Gabbay advised, “Use a mirror to see the bottoms of the feet and make sure there are no cuts or ulcerations” that would need immediate attention to ensure they don’t worsen. If need be, ask someone in your household to help you inspect your feet.
To help avoid foot injury, Dr. Low Wang recommended: “Always wear socks and well-fitting shoes, avoid going barefoot, and look at shoes before putting them on to be sure there is nothing in them.”

No matter where you are in your diabetes journey, daily foot checks “partly establish the habit before there are any problems, but are also a way to get to know your body so you can understand what is normal for you and what is not,” Memering said. “That way, when there is a change, you can all your healthcare office right away. Don’t wait until your next appointment ­ – call,” she said, adding that they should be able to tell you if you need to make an appointment right away.

Remember, as with many complications of diabetes, for neuropathy prevention is key! To learn more, view or download our infographic on preventing neuropathy.

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

Source: diabetesdaily.com

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