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What to do when there’s no nutrition info label at the deli?

What to do when there’s no nutrition info label at the deli?
On the Shelf

By Alyssa Schwartz

Information is power, especially when it comes to eating well. For people living with diabetes (and those who are not), nutrition information is an important tool that can help you make the best decision about what to eat for your health. This means choosing foods that are higher in fibre and other important nutrients, and lower in calories, saturated fat, or sodium.

According to one study from Drexel University School of Public Health, people who had nutrition information on restaurant menus consumed, on average, 151 fewer calories, 224 fewer milligrams of sodium, and 3.7 grams less saturated fat than those who did not have this information available. In other words, the information helped to change their behaviour in a good way.

If you are shopping for packaged foods at the grocery store, finding nutrition information is easy: Health Canada requires information to appear in a standardized format on most food labels. But if you are shopping at the prepared food or deli counter, the facts may not be as easy to find.

“According to Health Canada, foods prepared or processed at the store—including bakery items, salads, cooked items, and more—are not required to have the Nutrition Facts table,” says Stephanie Boutette, a registered dietitian and education coordinator with the Canadian Diabetes Association (CDA). “This can make it more difficult to make comparisons between products, which you could easily do if you had two packaged goods in front of you.”

However, given that prepared foods can be a good way to eat a healthy meal when you do not have time to cook at home, what should you do?

How to be a food detective

The lack of detailed information does not mean the prepared food counter is a no-go zone, but it is important to make choices based on factors that go beyond what looks good.

The first thing Boutette recommends: Ask for more information. “Sometimes there are ingredient lists or other nutrition information behind the counter,” she says. Ingredients such as added salt, sugars, and fats can be a sign that a food might be less healthy; vegetables, pulses, whole-grain whole-wheat flour and other nutrient-filled ingredients may be healthier options.

If the ingredient list is not available, ask how an item was prepared. “Whether a food is baked, steamed, broiled, or fried can tell you about the nutritional value of a food,” Boutette says, who suggests staying away from fried foods on most occasions. At the deli counter, words such as “smoked” or “cured” can also indicate which meats are processed. These are often higher in sodium and saturated fat, and have been linked to an increased risk of colon cancer, she says.

Eyeballing dishes can also be a good indicator. “If they’re breaded, loaded with gravy or creamy dressing, or drenched in oil, those may be items you want to have less often,” Boutette says.

Bottom line? When chosen carefully, prepared foods can be a good way to add fresh, healthy ingredients—beans, legumes, fresh vegetables, or lean proteins such as chicken or fish—to your meals. “[The lack of readily available information] doesn’t mean these products aren’t good choices,” Boutette says. “It’s often just a matter of looking more closely and digging for more information.”

Did You Know?

Whether at restaurants, takeout counters, vending machines, or corner stores, making healthy choices is possible and important. For tips to help you enjoy healthy meals wherever you are, visit “Eating from Home”.

Receive a great diabetes-friendly recipe every month when you subscribe to Diabetes Current, the CDA’s monthly e-newsletter. Sign up for your free subscription here.




Hold the meat and add some veggies!

Hold the meat and add some veggies!
Nutrition

By Rosie Schwartz, RD

For more than a decade, the Meatless Monday campaign has urged people not to eat meat on Mondays. The goal? To inform people that by cutting down on the amount of meat they eat, they could reduce their risk for chronic diseases (such as heart disease, obesity, and type 2 diabetes), and also help promote the idea of a healthier planet. Recently, the movement toward eating less meat and other animal products has really started to catch on. And, increasingly, people are enjoying vegetarian and vegan meals. Here are some reasons why you may want to eat more meatless meals, too.

Better for your health

A vegetarian diet is one way in which people with type 2 diabetes can maintain good blood glucose (sugar) levels, says Joanne Lewis, diabetes education manager at the Canadian Diabetes Association (CDA), who also points out that it is one of the healthy dietary patterns that the CDA recommends in the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.

So how does a plant-based diet help? It offers a range of nutrients with blood sugar benefits, including fibre and compounds that increase insulin sensitivity, making the insulin more effective.

“[These] diets have been fully explored by a series of studies and show that the benefits for those with diabetes include better control of blood sugar as well as blood lipids [cholesterol and triglycerides],” explains University of Toronto researcher Dr. David Jenkins. Problems with controlling blood sugar and blood lipids tend to worsen heart disease, “and heart disease is the chief cause of death for those who have diabetes.” Jenkins is co-creator of the Glycemic Index (or GI, a scale that ranks carbohydrate rich foods by how much they raise blood sugar levels compared to a standard food), and is a vegan, which means he eats no meat or animal products, such as eggs and cheese. (See “What’s a Vegetarian?” for an explanation of the different types of vegetarian eating preferences.)

Whether or not you have diabetes, a vegetarian diet is good for anyone trying to lower the cholesterol in their diet. The beneficial ingredients of a vegetarian diet—including proteins found in foods such as soy and pulses (such as beans), fibre, and unsaturated fats found in foods such as nuts and seeds—are linked to lower levels of both blood cholesterol and triglycerides (the main component of animal fats). In the human body, high levels of triglycerides raise the risk of heart disease and stroke.

Other benefits? Research shows that vegetarians tend to weigh less than meat-eaters. Lower blood pressure readings are another advantage of a healthy vegetarian or vegan diet. Your kidneys may also benefit: “Emerging research shows that for those with diabetes, plant proteins may be gentler on the kidneys than animal foods,” says Jenkins. People following a vegetarian diet have also been found to have a lower risk of developing some cancers such as colon cancer.

Better health for our wallets

As food costs rise, the price of meat has skyrocketed as well. Many plant foods offer plenty of protein and a range of nutrients, and although we have seen some steep price increases for fruits and vegetables recently (remember the $7 cauliflower?), they are not likely to be as expensive as meat overall.

Better for our planet

Internationally renowned scientists with a variety of nutritional philosophies, including Jenkins, met recently at “Finding Common Ground,” a nutrition conference in Boston sponsored by the non-profit health education group Oldways. They were there to talk about what we should be eating. Whether they were nutrition experts who promote vegetarian or vegan diets, or those who recommend eating meat, they all agreed that when making food choices, we should take the environment into consideration, both in terms of how foods are grown and what effect they have on climate change.

The cows, pigs, sheep, and other animals that are raised for our meat, for example, contribute to the release of greenhouse gases (such as methane, carbon dioxide, and nitrous oxide) because of the manure they produce, the fertilizers needed, and the digestive processes of these animals. These greenhouse gases are believed to lead to climate change and dramatic weather changes. Livestock production also uses large amounts of water. As well, large-scale production adds to water pollution, while the large amounts of manure allow potentially harmful substances into the water supply.

Plant proteins can have the opposite effect: Because a vegetarian diet generally requires less energy, land, and water resources than a meat-based diet, it sustains these resources better, maintaining them for use by future generations. Growing pulses actually increases the fertility of the soil, which then has a positive impact on the environment. In fact, the Food & Agricultural Organization (FAO) of the United Nations has declared 2016 to be the International Year of Pulses. (See “Top 10 Foods for Vegetarians or Vegans” for more on pulses.)

What’s a vegetarian?

Here’s a short guide explaining the different types of vegetarian eating styles:

  • Vegetarian: someone who does not eat meat, poultry, fish, or any products containing these ingredients, but may eat other animal products such as dairy and eggs
  • Lacto vegetarian: a vegetarian who also eats dairy products
  • Ovo-vegetarian: a vegetarian who also eats eggs
  • Lacto-ovo vegetarian: a vegetarian who also eats dairy products and eggs
  • Flexitarian: this is a new classification; it describes a person who eats mainly vegetarian but does eat some animal products occasionally
  • Vegan: someone who does not eat any animal

Top 10 foods for vegetarians or vegans

  1. Pulses: Pulses, from a Latin word that means thick soup, are the edible seeds of dried peas, beans, lentils, and more. Not only are pulses an inexpensive source of protein, they are also full of fibre and key vitamins and minerals such as folate and potassium.
  2. Soy foods: Fresh soybeans are used to make a variety of high-protein foods such as tofu and soy milk. These foods supply assorted benefits, including blood cholesterol-lowering action.
  3. Nuts: They provide protein, fibre, and healthy fats. Walnuts contain omega-3 fats, a type of fat that is most often found in coldwater fish such as salmon and sardines. All nuts are rich in a variety of nutrients—but enjoy them in moderation since, like seeds, they are also high in fat and calories.
  4. Seeds: Seeds such as hemp, flax, and chia are also rich sources of omega-3 fats, which may be in short supply in vegetarian and vegan diets. (Like nuts, these should be enjoyed in moderation only, because they are also high in fat and calories.)
  5. Whole grains: They are full of all kinds of key nutrients for vegetarians such as fibre, protein, iron, and magnesium. Try quinoa if you have not yet tasted it; it ranks above other grains in protein content. Or stretch your food horizons further and go for other whole grains, such as barley, millet, and kamut.
  6. Extra virgin olive oil and/or canola oil: These healthy fats improve the absorption of fat-soluble nutrients such as beta-carotene and lycopene, the colourful pigments found in fruits and vegetables.
  7. Leafy greens: These vegetables are loaded with nutrients, particularly iron and vitamin C. Iron is a nutrient necessary for healthy red blood cells, but it can be poorly absorbed from plant sources. Kale is an excellent source of vitamins A, C, and K; and also offers calcium, folate, and potassium. If it is not your favourite vegetable, other good options include Swiss chard, spinach, and broccoli.
  8. Citrus fruits: These are well-known for their vitamin C, a nutrient that boosts absorption of iron from plant food sources. Including a vitamin C-rich selection at meals is key for those who do not eat meat. Other vitamin C-rich fruits include papaya, strawberries, and pineapples.
  9. Allium vegetables: This family of vegetables includes onions and garlic. When cooked together with whole grains, these vegetables have been found to increase the amount of iron and magnesium the body absorbs from the grains. Magnesium is a mineral that plays a role in regulating blood sugar and blood pressure. Like iron, it can be poorly absorbed in a meatless diet.
  10. Mushrooms: All types offer health benefits but for vegetarians, they also supply tasty options. For example, they can be used to make rich-tasting broths that can replace prepared chicken or beef broth. Mushrooms also offer a meaty texture in dishes such as sauces, and can even be a replacement for burgers.

Here are four delicious recipes where you won’t even miss the meat.

Green Goddess Dip

Nourish: Whole Food Recipes Featuring Seeds, Nuts and Beans (Whitecap) by Nettie Cronish and Cara Rosenbloom is hot off the press. This book is filled with lots of delicious recipes, but is also packed with nutrition information and tips for healthy eating. Here is a dip that will entice anyone to eat more vegetables.

350 g (12 oz.) silken tofu
¼ cup (50 mL) extra virgin olive oil
2 tbsp (25 mL) fresh lemon juice
1 tbsp (15 mL) honey
¼ cup (50 mL) finely chopped fresh dill
2 tbsp (25 mL) minced sweet onion
3 tbsp (45 mL) minced dill pickles (about 1 small pickle)
1 tsp (5 mL) Dijon mustard
½ tsp (2 mL) sea salt
1/8 tsp (0.5 mL) freshly ground black pepper

In a food processor, combine all ingredients. Process for about 1 minute or until puréed.

Pair this dip with fresh vegetables—such as carrots, jicama, red peppers, celery, grape tomatoes, and cucumber—sliced to your preference.

Makes about 8 servings (1 cup/250 mL)

Nutritional breakdown per serving (each about 2 tbsp [25 mL]): 2 g carbohydrate, 1 g protein, 4 g total fat, 0 g saturated fat, 0 g fibre, 108 mg sodium, 47 calories

Tempeh Pâté

This recipe is also from Nourish: Whole Food Recipes Featuring Seeds, Nuts and Beans. Co-author Nettie Cronish has been a vegetarian for decades and offers this advice about tempeh: If you love chopped liver, the flavour profile of this pâté will please your palate. Tempeh has a firm, chewy texture, and adds a meaty layer to recipes. It is made by fermenting crushed, cooked soybeans that have been treated with a bacterial culture. The fermentation process enhances the flavour and makes the protein in the soybean easier to digest.

1 cup (250 mL) raw unsalted almonds
2 tbsp (25 mL) extra virgin olive oil
1 onion, diced
2 garlic cloves, minced
2 cups (500 mL) sliced button mushrooms
250 g (½ lb.) tempeh, fresh or thawed, cut into ½-inch/1 cm) cubes
1 tsp (5 mL) sodium-reduced tamari
½ tsp (2 mL) each dried thyme and dried sage
½ cup (125 mL) chopped fresh dill
¼ tsp (1 mL) sea salt

Preheat oven to 350°F (180°C). Spread almonds on a baking sheet lined with parchment paper and bake until golden, about 5 minutes. Remove from oven and allow to cool.

In a medium-sized saucepan, heat olive oil over medium heat. Add onion and garlic, and sauté 5 minutes or until soft. Add mushrooms, and sauté for 3 to 5 minutes.

Add tempeh to the vegetable mixture, and stir to combine. Add tamari, thyme, sage, dill, and salt. Cook for 12 to 15 minutes or until most of the liquid has evaporated.

In a food processor, grind almonds. Add cooked mushroom mixture and process until pâté is thick and smooth. Cover and chill for at least 30 minutes.

Serve with cut vegetables and whole-grain crackers.

Tip: Find tempeh in the fridge or freezer at the grocery store or health food store. Always check the expiry date on fresh tempeh and keep it refrigerated. Tempeh can be frozen for a maximum of 6 months.

Makes about 8 servings (1 cup/250 mL)

Nutritional breakdown per serving (each about 2 tbsp [25 mL]): 7 g carbohydrate, 8 g protein, 12 g total fat, 2 g saturated fat, 2 g fibre, 106 mg sodium, 162 calories

Chickpea and Cauliflower Curry

This recipe is from Pulse Canada, which is the national industry association that represents growers, processors, and traders of pulse crops in Canada. Their website, pulsecanada.com, contains information about pulses, as well as a variety of recipes.

3 tbsp (45 mL) canola oil
1 small onion, chopped
2 cloves garlic, minced
2 tbsp (25 mL) curry powder
1 tsp (5 mL) cinnamon
1 tsp (5 mL) paprika
½ tsp (2 mL) cayenne
1 bay leaf
½ tsp (2 mL) fresh or ground ginger
1 tsp (5 mL) sugar
Pinch salt
1 can (540 mL) chickpeas, rinsed and drained
1 small cauliflower, cut into small pieces
1 cup (250 mL) frozen green peas
¾ cup (175 mL) reduced-sodium vegetable broth
¾ cup (175 mL) coconut milk
10 sprigs cilantro, chopped

Heat oil in a large skillet. Sauté onion and garlic about 5 minutes or until golden. Stir in curry powder, cinnamon, paprika, cayenne, bay leaf, ginger, sugar, and salt. Stir until fragrant, about 2 minutes.

Add chickpeas, cauliflower, and peas. Stir in broth and coconut milk. Bring to a boil, then reduce heat to simmer for 20-25 minutes, or until cauliflower is cooked through.

Remove from heat and remove bay leaf. Garnish with cilantro and serve.

Makes about 8 servings

Nutritional breakdown per serving: 29 g carbohydrate, 10 g protein, 13 g total fat, 5 g saturated fat, 6 g fibre, 105 mg sodium, 256 calories

Zucchini and Yellow Split Pea Sauté

Here is another offering from Pulse Canada. Many pulses that are purchased in dried form (such as kidney beans or chickpeas) need to be soaked before they are used, but those such as split peas and lentils do not. If you do not have the time to soak, canned pulses are a great alternative (just be sure to rinse them before cooking, to get rid of excess sodium).

1 tbsp (15 mL) olive oil
2 green onions, chopped
2 medium zucchini, sliced
1 cup (250 mL) dried yellow split peas, cooked according to package
2 medium tomatoes, sliced
1 cup (250 mL) reduced-fat shredded cheddar cheese, divided
1 large red onion, sliced into rings
1 dash each of garlic powder, light soy sauce and pepper

Heat oil in a large skillet over medium-low heat. Sauté green onions and zucchini until slightly tender, about 5 minutes. Add cooked yellow split peas. Stir gently.

Layer tomato slices overtop and sprinkle with 2/3 cup shredded cheese. Layer onion rings over mixture and add remaining cheese. Sprinkle garlic powder, soy sauce and pepper overtop.

Reduce heat to low, place lid on pan and heat ingredients for about 5 minutes. Serve immediately.

Makes about 8 servings

Nutritional breakdown per serving: 17 g carbohydrate, 10 g protein, 5 g total fat, 2 g saturated fat, 3 g fibre, 184 mg sodium, 144 calories

The last word

“If you use prepared meat substitutes such as vegetarian hot dogs and burgers be sure to check their sodium content, as some are quite high in sodium.” – Joanne Lewis, diabetes education manager, Canadian Diabetes Association

“If you’re thinking about moving toward a vegetarian diet, start with having meatless meals one day a week, and increase the frequency as you find new recipes you like. Making the change gradually can help families adapt to going meatless.” – Joanne Lewis, diabetes education manager, Canadian Diabetes Association

Did You Know?

Fibre is a part of plants that we cannot digest—but it is a key part of our diet, especially for those with diabetes. It is associated with benefits such as better regulation of blood sugar, lower blood cholesterol and blood pressure, and easier weight control. Yet most of us eat too little fibre. The Canadian Diabetes Association offers more information about fibre and tips for boosting your intake here.




No benefit to metformin for overweight type 1 teens

No benefit to metformin for overweight type 1 teens
News

By Elizabeth McCammon

Youth with type 1 diabetes have more to worry about than pimples when they hit puberty: Hormonal changes can increase their body’s resistance to insulin, so that it works less effectively. If they are also overweight or obese, these teens may require high doses of insulin during this phase of their life; however, this can lead to problems controlling blood glucose (sugar) and may result in further weight gain.

In search of other possible solutions, researchers at the Jaeb Center for Health Research in Tampa, Florida, did a six-month study with insulin and metformin (an oral glucose-lowering pill commonly used in treating type 2 diabetes).They found that the combination did not improve the blood sugar control for overweight youth (12 to 19 years) with type 1 diabetes, and published their results in December 2015 in the Journal of the American Medical Association.

Our expert opinion: Physicians sometimes prescribe both metformin and insulin in treating overweight adolescents with type 1 diabetes. The ultimate aim of this combination is to reduce average blood sugar levels and decrease the total daily dose of insulin in individuals receiving large doses; the combination, along with other lifestyle changes, is also prescribed to help individuals lose weight. “This study is important because it questions this pragmatic approach,” says Dr. Céline Huot, a pediatric endocrinologist and an assistant professor of pediatrics at the University of Montreal. “A more refined understanding of the individuals’ metabolism and genetics might help physicians better select the patients who would benefit from this combined approach.”




Diabetes, heart disease and air pollution

Diabetes, heart disease and air pollution
News

By Elizabeth McCammon

Air pollution is a major risk factor for heart and blood vessel disease (known as cardiovascular disease, or CVD). In a large study to determine what factors make people more vulnerable to the effects of air pollution, researchers from Women’s Hospital and Harvard T.H. Chan School of Public Health in Boston made a surprising discovery: Type 2 diabetes was the strongest factor in determining an individual’s risk from the effects of long-term exposure to air pollution.

The researchers looked at rates of CVD in more than 100,000 people in the Nurses’ Health Study. They found that as air pollution increased, a woman’s risk of CVD increased by 44 per cent if she had type 2 diabetes. This increase in risk due to diabetes was greater than any other factor considered, including age, family history of heart disease, weight, smoking status, and where in the United States the women lived.

In the Journal of the American Heart Association report (November 2015), the researchers cautioned that because the participants were mainly middle-aged to elderly white women, further studies are needed to see if these patterns are also seen in other groups, such as men and other races.

Our expert opinion: “Air pollution is a recognized risk factor for heart disease,” says Dr. David Fitchett, an associate professor of medicine at the University of Toronto and a staff cardiologist at St. Michael’s Hospital. “Control of air pollution remains a major public health issue that could have a major impact on cardiovascular disease, especially in individuals with diabetes who already have a very high risk of heart attack and stroke.” There is a need for an improved understanding of environmental health issues, including air pollution, he says, as well as an understanding of the benefits of a heart-healthy lifestyle, especially not smoking.




Just how different are men & women?

Just how different are men & women?
News

By Elizabeth McCammon

Men’s and women’s bodies often respond differently to medication. A study by the University of Copenhagen in Denmark suggests both groups may also respond differently to instructions about managing their disease, which can have a big impact on their health.

In the Diabetes Care in General Practice trial, published in Diabetologia in November 2015, researchers looked at the way people newly diagnosed with type 2 diabetes responded to a “structured personal care program” in which doctors stressed the importance of diet and physical activity, worked with patients to set individualized goals, and received coaching and continuing medical education themselves on diabetes related issues. Looking at 13 years’ worth of data for 970 participants, the researchers found that women who were given personal care were 26 per cent less likely to die of any cause, and 30 per cent less likely to die of a diabetes-related cause, than women who were not given this personalized attention. In contrast, the study found no difference in the health of men who received personalized care compared to those who did not.

Why is this? The researchers think that women “accept” having a disease more easily, and are more willing than men to make changes to manage their disease. By contrast, for men, “masculinity may be challenged by diabetes,” meaning they are less likely to deal well with having diabetes.

Our expert opinion: “Gender difference in diabetes care has not previously been studied in any depth, and it is an area that could help us individualize education and support,” explains Dr. Maureen Clement, a clinical assistant professor at the University of British Columbia’s Faculty of Medicine. “Beyond the gender differences, this study reinforces what is presently known about the importance of structured care,” as well as the need to help people reach their target blood glucose levels early in diabetes, in order to reduce heart disease and death.




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