Healthy Eating with Diabetes
Autumn Kumlien, RD shares different healthy eating tips for diabetics.
Featured Speaker:
Autumn Kumlien, Registered Dietitian, Nutritionist
Autumn Kumlien, BS RDN CD, is a Registered Dietitian Nutritionist with Stoughton Hospital, with over 12 years of experience as a clinical dietitian, consultant dietitian, and instructor of nutrition at the college level. Autumn received a BS degree in Dietetics and a BS degree in Natural Sciences from the University of Wisconsin – Madison in 2002. She completed a Didactic Internship at the University of Wisconsin Hospital and Clinics in May of 2003. A mother of a 7 year old daughter and 2 year old son, she finds many opportunities to get her children to eat more fruits and vegetables! Transcription:
Melanie Cole (Host): If you’ve been told that you have diabetes, you know you have to eat healthy. Everybody tells you that, but what does that even mean? Do you know even where to start? My guest today is Autumn Kumlien. She’s a registered dietitian/nutritionist at Stoughton Hospital. Autumn pleasure to have you back with us. What a great guest you are. Please tell us what happens when we eat? Why do we need to understand insulin and blood sugar if someone has been told that they have diabetes?
Autumn Kumlien (Guest): Okay, well thanks Melanie, thanks for having me again. Yeah when people get a diagnosis of diabetes, a lot of times we’d like to hopefully do it in the early stages when it’s considered prediabetic or more in the prevention end of things, but sometimes we’re not that lucky, but the biggest thing to keep in mind is that you don’t have to eat special foods necessarily. The biggest goal is to really get back to healthy eating and when we focus on that, we’re looking at whole grains, fruits, vegetables. You can even eat starchy vegetables like peas, corn, and potatoes but it all really balances down into portions because it’s the carbohydrates in some of those foods, the carbohydrate foods like I mentioned you know bread, oatmeal, potatoes, brown or white rice, that type of thing that are contributing to carbohydrates. In addition to your fruit has carbohydrate and milk and those starchy veggies as I mentioned, but basically anything that’s not meat and fat has some forms of carbohydrates, but a misconception is people think because they’re diabetic or they have to watch their carbohydrate intake, they tend to really eliminate a lot of that and we want to avoid that because carbohydrates get broken down to glucose which fuels your brain, your cells and gives you the energy that you need. So if you’re not eating enough carbohydrates, your body is going to find another way to get that nutrition and it’s usually not in a good way, it’s breaking down other components of your body to do so. So we really want to encourage healthy eating, balanced eating, and really looking at portion control. So the biggest thing is focusing on complex carbohydrates. So choosing the whole grains. When you choose whole grain foods, you’re choosing the bread or the rice or the pasta that still has the three components intact. It still has the fiber, the hard outer layer of that grain, still has the germ which is the fat of the seed which your B vitamins are prevalent in, and then also has the white starchy part, or the endosperm. So making sure that you have all three components is going to make sure you’re getting whole grains, whole wheat, that type of thing and you’re getting that better grain product or the complex carbohydrates. So when you’re also looking at other foods, you’re drinking citric juice, eat the whole fruit. Starchy carbs like peas and corn and potatoes. It’s again about portions. It’s not that you can never have a potato or you can never have corn or rice, it’s just portions, and so we measured those portions based on how much carbohydrates they provide. For most people that get diagnosed with diabetes, we recommend anywhere from 45 to 60 grams of carbohydrates per meal. So some people will go and do that carb counting where they can exchange them, but a lot of people find it easier just to say 45 to 60 grams and really focusing on food labels, not just looking at total sugars because the sugars are already included in total carbohydrates so you really want to look at the big picture. So total carbohydrates and making sure that serving size is what you would consume and then look at those total grams of carbs that are provided and see where that falls in hour 45 to 60 grams per meal. So by doing that we can be better involved in terms of what we eat and being more consistent with our carbohydrate intake from meal to meal and so that is going to be helpful and useful for people that are taking oral medications like metformin or taking insulin where you have to know exactly how much carbohydrates to how much you dose with insulin. So the goal, especially in type 2 diabetes, is really try to keep people off of insulin if possible and try to modify the diet and take their medication as prescribed and try to get their blood levels where they need to be in terms of showing that they’re having diabetes management.
Host: Wow Autumn, there’s a reason you’re such a good guest from Stoughton Hospital. That was an excellent explanation because people are afraid of carbohydrates and they think they cannot eat any of them at all so I love that you cleared that up and what are the good ones that you can eat and you’re really pointing out that the bad ones, that the processed ones, that the white ones, and the fake ones, those are the ones that people with diabetes really need to stay away from. So we’ve talked about carbohydrates, what about things like legumes because again those kind of fit into that category where people are not sure if they can eat beans or lentils, but those things are so good for you.
Autumn: Absolutely and they’re great sources of protein too, so they’ve got that protein and fiber component and as you mentioned, yeah focusing on those good carbohydrates and less of those white flour ones, high starchy ones. I’m not saying you can never have one but again they’re going to come at a cost in terms of how much carbohydrate you’re going to spend but definitely incorporating legumes and beans, you know sky’s the limit, there are so many different types of beans that you can – but you’ll get that carb component but the protein and the fiber will stay with you longer and will slow the rate the blood sugars rise, so they’re going to be a really good choice for people to incorporate into their meals and to help blood sugars not rise as rapidly especially when there’s other carbohydrates in the meal.
Host: So then explain the term low glycemic index because you pretty much have, but explain it to the listeners, when they hear that, what does that mean and how do the different foods that we’ve been talking about so far fit into that category?
Autumn: Well typically when we’re talking about low glycemic, it has to do with how it effects your blood sugar. So typically there’s a glycemic index, so it’s a number from 0 to 100 that they’ve assigned to a food. Pure glucose is given the trade value of 100, so that represents the relative live in the blood glucose 2 hours after consuming the food. So the lower the glycemic number, the lower that it’s going to effect the blood sugars. So we try to – some places will designate foods to have certain values, so based on a low glycemic versus a high glycemic number, they would know okay we’ll consume more of the foods that in the low to medium and less than are in the high. So it just gives another view or another way to look at the foods and how they impact your blood sugars as you try to pick the foods that are going to make your blood sugars rise less rapidly and they’re going to keep them more consistent and overall just keeping your blood sugar levels more even.
Host: So then speak about a few other types of foods and alcohol, does that process differently for someone with diabetes? And what about fats? And also as you’re talking about these, speak about snacks because you mentioned fruit, eating the whole fruit, but snacks, you know people see the granola bars, they see all the sugar in these kinds of snacks, so fats, alcohol, and snacks Autumn.
Autumn: Sure, okay so for fats obviously we want to really encourage the omega-3 fatty acids so nuts are going to be a great choice and you know unsalted is going to be your best choice for that and choosing more nuts that are not just peanuts, peanuts being more of a legume so you want to make sure also you’re getting true nuts like almonds are really good in terms of heart heath for example, walnuts same thing, so a lot of variety there, but just making sure portions are taken into consideration. So it’s usually a quarter of a cup or just what fits into the palm of your hands, so incorporating those good heart healthy fats from nuts. Also using olive oil versus other oils. So olive oil is considered the gold standard, and the reason it’s considered the gold standard is because it will lower your LDL or your bad cholesterol levels but it also protects the HDL, which is your good cholesterol levels where as a lot of our other plant based oils, or like vegetable oils, corn oil, sunflower oil, safflower, they will lower the bad, the LDL, but they will also lower your good, your HDL, and that’s a risk for heart disease, so you want to make sure that that’s protected. So olive oil seems to do the best there, so we say olive oil, peanut oil, some people will consider grape seed oil, different ones like that but the olive is usually typically the gold standard. Now also when we talk about heart healthy fats, we’re talking about omega-3’s as they come from seafood or fish, so salmon and tuna and mackerel being the highest components of those omega-3 fatty acids for brain health but also heart health. So that would be the good recommendation for fat, just to watch your intake and make sure the fats that you choose are those heart healthy fats. When we’re talking about snacks for example, we want to encourage people to – snacks be an extension of the meal. So not thinking about processed packaged, things that come in little bags as having to be snacks. A snack can be half a peanut butter sandwich. It could be a handful of nuts and an apple. It could be an apple with peanut butter, so snacks could be many different things but they should be more thought of an extension of your meal and not something processed or that a kid would categorize as a snack, like we say fruit snacks, not really fruit or really a snack, so yeah you want to make sure you’re looking at that and making sure that those snacks are good choices. There’s so many things like granola bars and ready to go stuff. There are some really great products out there, so when you do look at it, look at the nutrition facts label, look at how many carbohydrates, look at the serving size, is it half the bar, is it whole bar, does it seem like you’re going to cost you a lot of carbohydrate for what it’s worth and can you maybe make a better version of it? You know there’s a lot of great resources online and you can find some really good lower carbohydrates so you’re not spending all your carbohydrates on one little snack, but you’re keeping it from 1 to 2, so we usually say 15 to 30 grams per snack. And as far as alcohol, what we have to keep in mind with that and diabetes is that alcohol can actually have a negative effect on blood sugars. So what it can do is it can cause blood sugars to dip too low, and in those cases, it can make it so the person’s blood sugar would dip in dangerous levels and bring them down lower than what they should be, so not a recommended way to get your blood sugars down obviously, but be very mindful and cautious of that, especially when people do combine mix drinks and they’re using like a diet soda and alcohol together. So again kind of a double whammy, makes your blood sugar go really low and there’s actually no carbs coming in from that diet soda to help with that and counteract that at all. So use in moderation. There are people that do have diabetes and they do enjoy it but they have to learn how to count it and make sure that they’re aware of how much and recommendations, dietary guidelines is 5 ounces of alcohol per day for females and up to 10 ounces per day for males, and that would be more like looking at wine for example or 12 ounce can of beer, that kind of thing. So be mindful of the recommended portions and also how it’s going to effect the blood sugar. It’s going to make it go lower, so having a snack to counteract it, but maybe not making that also your main thing that you dabble in for example.
Host: You’re so specific, and that is what’s so important about these educational podcasts Autumn is you’re specific with the amount of grams and the types of foods. So wrap it up. Give us your best advice and what you tell people about healthy eating when they are diagnosed with diabetes and how important it is to read the labels and understand what a sugar is, understand what a carbohydrate is so that they can get the best, you know really the best quality food and what their body needs.
Autumn: Absolutely, so I think the biggest thing is focus on whole foods as much as possible, really watch those portions. Try to find maybe variations of your favorite foods that you like and how you can make it better fit your plan, not going into it thinking, oh my gosh, I can’t eat anything. This is horrible. This is terrible. Keep in mind there is really no have to eat food. It’s really recommended for everybody to get back to healthy eating and a healthy diet like this can be good for anyone whether they have diabetes or not. So just making sure that you’re keeping that in mind and small changes. You know, if you get a diagnosis that you have diabetes, you’re not going to change it overnight, but every little step you do towards it – if you’re typically a soda drinker, work on that – really work on cutting back until there’s a point where you’re not drinking soda anymore because soda costs a lot of carbohydrates and it’s going to in fact affect your blood sugars. So start with one thing. Maybe you really like a big, kind of Denny’s like grand slam breakfast. You know find another way. Make some eggs on your own with using muffin pan and putting your half egg whites to one egg and a lot of veggies in it and then you can just pop them in the oven and you can put them in the freezer, you can reheat them and enjoy them and it will be much healthier than running to a fast food place or having an unhealthy greasy breakfast for example, but think about the small changes that will have the biggest impact. And just keeping in mind that portions is the biggest thing when it comes down to the diabetes and having a diet that is controlled is really be mindful of what you’re eating, and these are things that the whole household could benefit from is trying to be more aware of what you put into your mouth and be mindful of how much sugar something has and could we do without or is there a healthier, better option out there that we could change to. So just be open minded and starting small and making those little changes and just thinking that it’s not a dreaded diet, it is just how everybody should be eating. Everybody should be focusing on heart healthy, lower sodium, less sugar, more whole foods. So that’s the main goal I think I would leave everybody with.
Host: Absolutely to the point and spot on Autumn. Thank you so much, and it’s true. It is how everybody should be eating whether you have diabetes or not, so thank you so much for coming on with us today again and sharing your incredible expertise and giving us such great advice about healthy eating with diabetes and that wraps up this episode of Stoughton Hospital Health Talk. Head on over to our website at stoughtonhospital.com for more information and to get connected with one of your providers. If you found this podcast as informative as I did, please share with your friends and your family. I’m sure you know people with prediabetes or type 2 diabetes, share this show with them because it will help them to eat healthier and be healthier as a result, and don’t miss checking out all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): If you’ve been told that you have diabetes, you know you have to eat healthy. Everybody tells you that, but what does that even mean? Do you know even where to start? My guest today is Autumn Kumlien. She’s a registered dietitian/nutritionist at Stoughton Hospital. Autumn pleasure to have you back with us. What a great guest you are. Please tell us what happens when we eat? Why do we need to understand insulin and blood sugar if someone has been told that they have diabetes?
Autumn Kumlien (Guest): Okay, well thanks Melanie, thanks for having me again. Yeah when people get a diagnosis of diabetes, a lot of times we’d like to hopefully do it in the early stages when it’s considered prediabetic or more in the prevention end of things, but sometimes we’re not that lucky, but the biggest thing to keep in mind is that you don’t have to eat special foods necessarily. The biggest goal is to really get back to healthy eating and when we focus on that, we’re looking at whole grains, fruits, vegetables. You can even eat starchy vegetables like peas, corn, and potatoes but it all really balances down into portions because it’s the carbohydrates in some of those foods, the carbohydrate foods like I mentioned you know bread, oatmeal, potatoes, brown or white rice, that type of thing that are contributing to carbohydrates. In addition to your fruit has carbohydrate and milk and those starchy veggies as I mentioned, but basically anything that’s not meat and fat has some forms of carbohydrates, but a misconception is people think because they’re diabetic or they have to watch their carbohydrate intake, they tend to really eliminate a lot of that and we want to avoid that because carbohydrates get broken down to glucose which fuels your brain, your cells and gives you the energy that you need. So if you’re not eating enough carbohydrates, your body is going to find another way to get that nutrition and it’s usually not in a good way, it’s breaking down other components of your body to do so. So we really want to encourage healthy eating, balanced eating, and really looking at portion control. So the biggest thing is focusing on complex carbohydrates. So choosing the whole grains. When you choose whole grain foods, you’re choosing the bread or the rice or the pasta that still has the three components intact. It still has the fiber, the hard outer layer of that grain, still has the germ which is the fat of the seed which your B vitamins are prevalent in, and then also has the white starchy part, or the endosperm. So making sure that you have all three components is going to make sure you’re getting whole grains, whole wheat, that type of thing and you’re getting that better grain product or the complex carbohydrates. So when you’re also looking at other foods, you’re drinking citric juice, eat the whole fruit. Starchy carbs like peas and corn and potatoes. It’s again about portions. It’s not that you can never have a potato or you can never have corn or rice, it’s just portions, and so we measured those portions based on how much carbohydrates they provide. For most people that get diagnosed with diabetes, we recommend anywhere from 45 to 60 grams of carbohydrates per meal. So some people will go and do that carb counting where they can exchange them, but a lot of people find it easier just to say 45 to 60 grams and really focusing on food labels, not just looking at total sugars because the sugars are already included in total carbohydrates so you really want to look at the big picture. So total carbohydrates and making sure that serving size is what you would consume and then look at those total grams of carbs that are provided and see where that falls in hour 45 to 60 grams per meal. So by doing that we can be better involved in terms of what we eat and being more consistent with our carbohydrate intake from meal to meal and so that is going to be helpful and useful for people that are taking oral medications like metformin or taking insulin where you have to know exactly how much carbohydrates to how much you dose with insulin. So the goal, especially in type 2 diabetes, is really try to keep people off of insulin if possible and try to modify the diet and take their medication as prescribed and try to get their blood levels where they need to be in terms of showing that they’re having diabetes management.
Host: Wow Autumn, there’s a reason you’re such a good guest from Stoughton Hospital. That was an excellent explanation because people are afraid of carbohydrates and they think they cannot eat any of them at all so I love that you cleared that up and what are the good ones that you can eat and you’re really pointing out that the bad ones, that the processed ones, that the white ones, and the fake ones, those are the ones that people with diabetes really need to stay away from. So we’ve talked about carbohydrates, what about things like legumes because again those kind of fit into that category where people are not sure if they can eat beans or lentils, but those things are so good for you.
Autumn: Absolutely and they’re great sources of protein too, so they’ve got that protein and fiber component and as you mentioned, yeah focusing on those good carbohydrates and less of those white flour ones, high starchy ones. I’m not saying you can never have one but again they’re going to come at a cost in terms of how much carbohydrate you’re going to spend but definitely incorporating legumes and beans, you know sky’s the limit, there are so many different types of beans that you can – but you’ll get that carb component but the protein and the fiber will stay with you longer and will slow the rate the blood sugars rise, so they’re going to be a really good choice for people to incorporate into their meals and to help blood sugars not rise as rapidly especially when there’s other carbohydrates in the meal.
Host: So then explain the term low glycemic index because you pretty much have, but explain it to the listeners, when they hear that, what does that mean and how do the different foods that we’ve been talking about so far fit into that category?
Autumn: Well typically when we’re talking about low glycemic, it has to do with how it effects your blood sugar. So typically there’s a glycemic index, so it’s a number from 0 to 100 that they’ve assigned to a food. Pure glucose is given the trade value of 100, so that represents the relative live in the blood glucose 2 hours after consuming the food. So the lower the glycemic number, the lower that it’s going to effect the blood sugars. So we try to – some places will designate foods to have certain values, so based on a low glycemic versus a high glycemic number, they would know okay we’ll consume more of the foods that in the low to medium and less than are in the high. So it just gives another view or another way to look at the foods and how they impact your blood sugars as you try to pick the foods that are going to make your blood sugars rise less rapidly and they’re going to keep them more consistent and overall just keeping your blood sugar levels more even.
Host: So then speak about a few other types of foods and alcohol, does that process differently for someone with diabetes? And what about fats? And also as you’re talking about these, speak about snacks because you mentioned fruit, eating the whole fruit, but snacks, you know people see the granola bars, they see all the sugar in these kinds of snacks, so fats, alcohol, and snacks Autumn.
Autumn: Sure, okay so for fats obviously we want to really encourage the omega-3 fatty acids so nuts are going to be a great choice and you know unsalted is going to be your best choice for that and choosing more nuts that are not just peanuts, peanuts being more of a legume so you want to make sure also you’re getting true nuts like almonds are really good in terms of heart heath for example, walnuts same thing, so a lot of variety there, but just making sure portions are taken into consideration. So it’s usually a quarter of a cup or just what fits into the palm of your hands, so incorporating those good heart healthy fats from nuts. Also using olive oil versus other oils. So olive oil is considered the gold standard, and the reason it’s considered the gold standard is because it will lower your LDL or your bad cholesterol levels but it also protects the HDL, which is your good cholesterol levels where as a lot of our other plant based oils, or like vegetable oils, corn oil, sunflower oil, safflower, they will lower the bad, the LDL, but they will also lower your good, your HDL, and that’s a risk for heart disease, so you want to make sure that that’s protected. So olive oil seems to do the best there, so we say olive oil, peanut oil, some people will consider grape seed oil, different ones like that but the olive is usually typically the gold standard. Now also when we talk about heart healthy fats, we’re talking about omega-3’s as they come from seafood or fish, so salmon and tuna and mackerel being the highest components of those omega-3 fatty acids for brain health but also heart health. So that would be the good recommendation for fat, just to watch your intake and make sure the fats that you choose are those heart healthy fats. When we’re talking about snacks for example, we want to encourage people to – snacks be an extension of the meal. So not thinking about processed packaged, things that come in little bags as having to be snacks. A snack can be half a peanut butter sandwich. It could be a handful of nuts and an apple. It could be an apple with peanut butter, so snacks could be many different things but they should be more thought of an extension of your meal and not something processed or that a kid would categorize as a snack, like we say fruit snacks, not really fruit or really a snack, so yeah you want to make sure you’re looking at that and making sure that those snacks are good choices. There’s so many things like granola bars and ready to go stuff. There are some really great products out there, so when you do look at it, look at the nutrition facts label, look at how many carbohydrates, look at the serving size, is it half the bar, is it whole bar, does it seem like you’re going to cost you a lot of carbohydrate for what it’s worth and can you maybe make a better version of it? You know there’s a lot of great resources online and you can find some really good lower carbohydrates so you’re not spending all your carbohydrates on one little snack, but you’re keeping it from 1 to 2, so we usually say 15 to 30 grams per snack. And as far as alcohol, what we have to keep in mind with that and diabetes is that alcohol can actually have a negative effect on blood sugars. So what it can do is it can cause blood sugars to dip too low, and in those cases, it can make it so the person’s blood sugar would dip in dangerous levels and bring them down lower than what they should be, so not a recommended way to get your blood sugars down obviously, but be very mindful and cautious of that, especially when people do combine mix drinks and they’re using like a diet soda and alcohol together. So again kind of a double whammy, makes your blood sugar go really low and there’s actually no carbs coming in from that diet soda to help with that and counteract that at all. So use in moderation. There are people that do have diabetes and they do enjoy it but they have to learn how to count it and make sure that they’re aware of how much and recommendations, dietary guidelines is 5 ounces of alcohol per day for females and up to 10 ounces per day for males, and that would be more like looking at wine for example or 12 ounce can of beer, that kind of thing. So be mindful of the recommended portions and also how it’s going to effect the blood sugar. It’s going to make it go lower, so having a snack to counteract it, but maybe not making that also your main thing that you dabble in for example.
Host: You’re so specific, and that is what’s so important about these educational podcasts Autumn is you’re specific with the amount of grams and the types of foods. So wrap it up. Give us your best advice and what you tell people about healthy eating when they are diagnosed with diabetes and how important it is to read the labels and understand what a sugar is, understand what a carbohydrate is so that they can get the best, you know really the best quality food and what their body needs.
Autumn: Absolutely, so I think the biggest thing is focus on whole foods as much as possible, really watch those portions. Try to find maybe variations of your favorite foods that you like and how you can make it better fit your plan, not going into it thinking, oh my gosh, I can’t eat anything. This is horrible. This is terrible. Keep in mind there is really no have to eat food. It’s really recommended for everybody to get back to healthy eating and a healthy diet like this can be good for anyone whether they have diabetes or not. So just making sure that you’re keeping that in mind and small changes. You know, if you get a diagnosis that you have diabetes, you’re not going to change it overnight, but every little step you do towards it – if you’re typically a soda drinker, work on that – really work on cutting back until there’s a point where you’re not drinking soda anymore because soda costs a lot of carbohydrates and it’s going to in fact affect your blood sugars. So start with one thing. Maybe you really like a big, kind of Denny’s like grand slam breakfast. You know find another way. Make some eggs on your own with using muffin pan and putting your half egg whites to one egg and a lot of veggies in it and then you can just pop them in the oven and you can put them in the freezer, you can reheat them and enjoy them and it will be much healthier than running to a fast food place or having an unhealthy greasy breakfast for example, but think about the small changes that will have the biggest impact. And just keeping in mind that portions is the biggest thing when it comes down to the diabetes and having a diet that is controlled is really be mindful of what you’re eating, and these are things that the whole household could benefit from is trying to be more aware of what you put into your mouth and be mindful of how much sugar something has and could we do without or is there a healthier, better option out there that we could change to. So just be open minded and starting small and making those little changes and just thinking that it’s not a dreaded diet, it is just how everybody should be eating. Everybody should be focusing on heart healthy, lower sodium, less sugar, more whole foods. So that’s the main goal I think I would leave everybody with.
Host: Absolutely to the point and spot on Autumn. Thank you so much, and it’s true. It is how everybody should be eating whether you have diabetes or not, so thank you so much for coming on with us today again and sharing your incredible expertise and giving us such great advice about healthy eating with diabetes and that wraps up this episode of Stoughton Hospital Health Talk. Head on over to our website at stoughtonhospital.com for more information and to get connected with one of your providers. If you found this podcast as informative as I did, please share with your friends and your family. I’m sure you know people with prediabetes or type 2 diabetes, share this show with them because it will help them to eat healthier and be healthier as a result, and don’t miss checking out all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.