Pre Diabetes

Pre diabetes means your blood sugar level is high but not high enough to be called diabetes. The American Diabetes Association criteria to diagnose Prediabetes are as follows. First, impaired fasting glucose means faster fasting glucose between 100 and 125 milligramme per deciliter. Second, impaired glucose tolerance, meaning to our plasma glucose value to a 75 Miligram or glucose tolerance test between 140 and 199 milligramme per deciliter.

And third, HbA1C of 5.7 to 6.4%. If the diagnostic test is consistent with Prediabetes, it should be repeated yearly. People with pre diabetes usually do not have any symptoms. That is why it is important to have blood tests. However, if you have symptoms of dry mouth, excessive thirst, being hungry all the time, and excessive urination, may be reaching the stage of diabetes. risk factors for pre diabetes include the overweight family history of diabetes, over 45 years of age, high blood pressure, not being active enough being African American, American Indian, Asian American, Hispanic or Pacific Islander descent,

It’s important to understand that pre diabetes increases your risk of developing type 2 diabetes, but also heart disease and stroke. So let’s take a look at the statistics. The staggering statistic is that nine out of 10 of those who diagnosed with pre diabetes don’t even know they have it. The reason why is pre diabetes is completely asymptomatic, meaning people with pre diabetes don’t have any symptoms. Oftentimes, by the time people go in to see their doctor, and they do have physical symptoms, they’ve already progressed on to type two diabetes, it’s really important to keep those routine physicals with your doctor because the only way you can ultimately diagnose pre diabetes is by going through your regular bloodwork, where they check your blood sugar levels every year. If you have many or multiple risk factors, it’s even more important to get checked every year. So what are the risk factors, so the ones we can change our family history of diabetes. In our age, people over the age of 45 years old, both men and women are at higher risk of developing pre diabetes. Other factors and in fact, most of their risk factors are factors that you can change. So your weight being overweight, which is defined as having a body mass index over 25. Your race and ethnicity is something that you also can’t change but those who are minorities, often African Americans, Asian Americans, Hispanic Americans, and Native Americans are all at higher risk of developing pre diabetes, having a history of gestational diabetes. So having a baby that’s generally greater than eight pounds or nine pounds, is considered a higher risk for developing pre diabetes being physically inactive or sedentary. And we’ll define later on what that means and what the minimum amount is recommended for general health but also for weight management. Having high blood pressure or hypertension also increases your risk for developing pre diabetes. Having low HDL which is your good cholesterol, you want that to be high. Having a low HDL and also having a high level of triglycerides, which is another component of your total cholesterol also increases your risk of having something called polycystic ovarian syndrome. pcls also increases your risk of developing pre diabetes as well as type two diabetes, having something called reactive hypoglycemia and having a condition called a acanthosis. nigricans also increases your risk. It can’t This is nagger. Cannes is a condition in which we see darkening and velvety changes in the texture of our skin is often found in our skin folds, like behind the neck or increases, that can often be a sign that somebody already is what we call insulin resistant. And we’ll talk a little bit later what that means. But that also increases your risk. And surprisingly, which I think a lot of people aren’t aware of being deprived of sleep also increases your risk of developing pre diabetes. So insulin resistance, a lot of people hear this term. And essentially what it means is that people that have pre diabetes often are associated with something called insulin resistance. So Insulin is a hormone that is produced by our pancreas and its main job is to essentially allow the cells to open up and take in the glucose from our bloodstream and converted to energy. Or that same insulin allows, if we don’t use it up for physical activity, we store it as stored energy or excess weight. So insulin resistance is tightly associated with something called metabolic syndrome. It’s a condition or cluster of conditions that include central VCD, which is, you know, when we tend to gain weight in the abdominal region, and you can see an image here on the PowerPoint, having high blood pressure, hypertension, having high triglycerides, as we’ve discussed before, and having low HDL so having a combination of these two is called metabolic syndrome. And together This greatly increases our risk of developing pre diabetes and is very highly associated with this insulin resistance. So when we produce insulin, we have enough typically to bring in that
Extra glucose from our bloodstream into our cells to bring it down to a normal level. In some cases, especially with somebody who’s already progressed to pre diabetes, we see what we call insulin resistance, that means we have enough insulin, our pancreas is producing enough insulin to bring in that blood sugar into those cells. However, the cells don’t respond to the insulin, so they basically are resistant to the insulin. So even if we’re producing enough insulin, and we have all the sugar in our bloodstream, the sugar has nowhere to go, because the cells don’t respond to the insulin, it’s not allowing the sugar to come in. So that raises blood sugar. And what happens is our body tends to produce more insulin, and we see a higher level insulin, and this becomes this condition called insulin resistance. How do you know how you’re doing in terms of risk. So again, it’s really important to see your doctor to get all of this routine blood work to find out whether or not your blood sugar levels are normal. So your doctors are going to diagnose you with pre diabetes or diabetes based on a few different types of blood test. The most common one that’s used is the a one C or the haemoglobin a one C, it’s basically a average of your blood sugar levels and the previous three months or previous 90 days. And that number, if it’s less than 5.6%, that’s considered normal or healthy or optimal, that means you have no diabetes. And that number is usually correlated with an average blood sugar around maybe like 120 or less 130 or less. Somebody that falls in that a one c range of 5.7 to 6.4% is considered pre diabetic, that’s about, you know, a range of 140 to 199. And somebody that has an A one c above 6.4% is considered diabetic. So you can see that it’s somewhere in between, like we mentioned before in our first slide, that you’re somewhere between not being at an optimal level, but not high enough to be considered diabetic. So we want to make sure that we take pre diabetes seriously, because it’s the only period of time in which we can actually reverse it progressing into type two diabetes, we can actually also delay or prevent the development of pre diabetes with dietary and lifestyle changes. What other numbers to look at. So I mentioned before having pre diabetes does increase your risk of heart disease and stroke. So we want to look at your total cholesterol. So your total cholesterol is an indicator of what your risk of developing heart disease or stroke or heart attack is. So ideally, your total cholesterol should be less than 200. Your total cholesterol is made up of three different components, HDL, which you mentioned before, which is your good cholesterol, you want that to be high, anything over 40, if you’re a male is considered good, anything over 50. If your females also consider good, the higher the better, a good way to remember that he is happy, he is high. So they’re all associated with good numbers, higher numbers, LDL is the cholesterol that we consider bad or unhealthy, we want that to be lower. So l kind of you think of it as lousy cholesterol, you want that to be under 100, or as close to 100 as possible. And then your triglycerides, which makes up about 20% of your total cholesterol is considered a storage form of fat. And this is often raised by eating refined carbohydrates or sugars or added sugars and sweets, you want that total number to be less than 150. So how can we prevent the development of pre diabetes and hopefully type two diabetes, or how to reverse prediabetes if you’re already diagnosed with it? Well, studies show that losing as little as five to 7% of your body weight can help decrease blood sugar, but also blood pressure as well as cholesterol. So to kind of put that in numbers, if you weigh approximately 200 pounds, that’s about that’s only actually 10 pounds, losing 10 pounds can make a significant impact on your blood sugar levels, eating healthy and we’ll go into more depth of what that means exercising moderately for about half an hour, five days a week, or about 115 minutes a week. When we say moderate activity, we mean moderate intensity aerobic activity. And a good way to sort of gauge whether or not your activity is considered moderate intensity is to do something called the talk test. So the talk test is when you are able to carry on a conversation while you’re engaging in that activity. But you also notice an increase in your heart rate. High intensity is also something that you can consider doing if you prefer to do that high intensity would be activity that basically raises your heart rate to a significant degree to the point at which you can’t carry on a conversation. And that recommendation is about 75 minutes of high intensity aerobic activity per week if you prefer to do that over moderate intensity. So examples of modern tense aerobic activity would be something like brisk walking or it could be biking. It could even be something like swimming, but everybody’s conditioned a little bit differently. So if you’re just starting out you
Want to definitely check your own level, if you’re you know, even just walking 10 or 15 minutes you find you’re out of breath, then I would consider that high intensity aerobic activity. But over time your body does adjust, you become more conditioned. And so you can go for longer periods of time, and that eventually can become more of a moderate intensity aerobic activity. The other component of making sure that we can decrease our overall risk of developing prediabetes is to manage stress, stress as a huge factor in our blood sugar levels on our blood pressure on our cholesterol. And we’ll talk a little bit more about that as we progress through the presentation. So what is healthy eating? So first of all, we have to take a look at what the different nutrients how they affect our blood, you know, there are certain nutrients that raise our bad cholesterol, that LDL cholesterol, there are certain types of nutrients that raise your blood sugar, they’re not all bad, we just want to be aware of which ones you want to limit and which ones you want to eat more of. So a good kind of general guideline is a resource that is produced or offered by the USDA, their website is myplate.gov. And they should they have a lot of free resources, a lot of free handouts that kind of go along with this presentation. And they talk about all the different food groups, which we’ll talk about in the next slide. So first of all, carbohydrates are the primary type of what we call macronutrient, that raises blood sugar. So all carbohydrates basically get converted very quickly to sugar or blood glucose in our blood, and it’s our primary quick energy. So that’s why you think of when somebody is doing a long run or a half marathon, they do something called carbohydrate loading. Because it’s quick energy. As soon as you know, when you’re going to have a big boost of energy, you need to have some kind of, you know, carbohydrate to get you through that long run or that Robic activity. So examples of carbohydrates. These are I think a lot of us are probably already aware of all the different types of carbohydrates. And I should preface this by saying that carbohydrates are not a bad thing. It’s really dependent on the quality of the carbohydrate, how much you’re eating, and what types of carbohydrates you’re eating. So carbohydrates are a good thing, especially complex carbohydrates, which are a lot more nutrient dense. And you can see here in our presentation that we have a lot of good healthy examples things like whole grains, whole wheat bread, brown rice, fruits, any all fruits are considered carbohydrate. A question a lot of people ask me is, what about the sugar in fruits? isn’t that bad? Isn’t that gonna raise my blood sugar? Well, yes, because there’s carbohydrates in it. But you shouldn’t be concerned about the sugar because it’s naturally occurring. There’s nobody that added extra sugar in there, they it’s not like they added some brown sugar in there. It’s all naturally occurring. In addition, all fruits are very good sources of fibre, water, and lots of vitamins and minerals, essential vitamins and minerals. And fibre is a component of carbohydrates that basically don’t get digested by our bodies. So essentially, what it does is it actually slows the rise of sugar in our bloodstream when you eat something that has a lot of fibres. So if you eat an apple, that yes has carbohydrates, but also has fibre in it and you eat, let’s say, a piece of apple pie, your blood sugar is not going to go up nearly as high as eating that apple pie versus eating that Apple. Because the apple pie has much more sugar almost mostly all of its going to be added sugar, other sources of carbohydrates, milk, preferably, if you’re gonna choose to drink something like cow’s milk, you want to choose nonfat or 1% milk, the milk that’s found in dairy products and, and red meat. And basically anything that comes from a land animal is going to be high in what we call saturated fat, which is what raises their LDL cholesterol. So you want to choose non fat and low fat dairy if you’re going to drink it. Other non fat, lower carbohydrate choices would be plant based dairy. So if you are one that likes or has ever tried something like almond milk or soy milk, I would definitely choose one that says unsweetened. The label says unsweetened, which means that there’s no added sugar. So you should be careful with those non dairy alternatives because they do add sugar to it unless it says unsweetened other sources for example, that also have a good source calcium and protein that also have carbohydrates or yoghurt. They’re certainly lighter versions out there. But again, you want to choose the lower fat or nonfat versions. And then we look at other carbohydrates that sometimes are in the middle. You know some people think they’re healthy. Some people think they’re not healthy are things like juice and just sugar in general like honey, a lot of people tell me Well, what about honey? Isn’t that naturalism that healthier than eating? Like just, you know, regular sugar or is it a GAVI nectar better than, you know just the sugar you would find in you know, cookies and things like that. If you made it with a GAVI isn’t it healthier. So with honey and something like juice, even if it’s 100%

There’s no fibre. So when we drink or consume something like juice or soda or just pure honey, our blood sugars rise very rapidly. There’s nothing to slow it down other than the insulin that our pancreas is producing. So it’s really important to limit these you know, especially added sugars. The recommendation for added sugars, which are sugars that are added to food products are for women is no more than 25 grammes per day or about two tablespoons, and for men is no more than three tablespoons are about 38 and a half grammes of added sugar. If you use honey, if you can imagine if you put in something like oatmeal, if specially if it’s something like flavoured oatmeal, it already has added sugar. But if you put another two tablespoon or two honey in there, then that’s all the added sugar that’s budgeted into your your day if you’re a woman. So it’s really important to read nutrition facts, labels for things like added sugar. And now the new nutrition facts label that’s put out by the FDA actually has a line under total carbohydrates. This is added sugars. So now we’re more aware of how much added sugars in the actual product. So protein moving on to protein, so protein has no carbohydrates at all. So if you eat something like chicken or tuna or tofu, if it doesn’t have any added sugar in it, it’s not going to raise your blood sugar. However, what it does have is saturated fat depending on the type of protein. So saturated fat, which I mentioned earlier, is a solid fat, so it’s solid at room temperature. So if you can imagine something like butter, you know, when you go to a restaurant, you serve it on the table, it never loses its shape, it never becomes liquid, it stays solid. So that type of fat is primarily saturated fat, and it’s found in all land animals, so cows and pigs and anything derived from them. So things like milk and cheese and yoghurt and butter. So if you eat their counterparts, their non fat counterparts, then you don’t get any of that saturated fat, which is why we recommend the non fat or lower fat versions. But saturated fat is what primarily raises our LDL cholesterol that bad cholesterol that we had mentioned before, so you definitely want to limit your your saturated fat intake from these types of sources. better choices are poultry, chicken breast turkey brass, without the skin most of the saturated fat resides in the skin. If you want more of a plant based protein, something like tofu or tempeh Bay, just be careful if there’s a lot of added sugars in there. All those effects are heart health as well as our weight. When we eat a lot more food with more fat, it has a lot more calories. There are nine calories per gramme of fat versus for for protein and for for carbohydrates. So if you eat a high fat meat like red meat, it’s got more calories and more saturated fat. So things you want to be careful of. The good thing about protein is we do need it we but we don’t need as much as people think we only need about four ounces per serving, or four ounces of serving per meal. And to give you perspective, four ounces is about the size of the palm of your hand, minus your fingers and the thickness of your pinky. So about that three ounce three to four ounces per meal is sufficient to meet your protein needs. So protein, the good thing about it is when we combine it with something like our carbohydrates, like rice, or pasta or bread, it actually helps blunt the rise in blood sugar. So that’s an important part of what we should be eating. But we just need to make sure it’s a heart healthy choice that’s low in saturated fat. And then last macronutrient we want to take a look at is fat. So fat doesn’t really raise blood sugar at all. But again, as we mentioned before, it does affect your heart health, it raises LDL cholesterol, if it’s something that’s high in saturated fat, those red meats, the butters anything solid at room temperature, and that includes tropical oils. So coconut oil and palm oil are the two most common that we see in our, in our,

basics. So how do we know when to eat? How much do we kind of know what to eat as based on what we talked about, but it’s really important to space out your meals, you know, we often hear those friends that just eat one large meal during the day and then they’re satisfied. But is that necessarily the healthiest way to eat if you have pre diabetes, or if you have type two diabetes, or you’re concerned about your risk of developing these, it’s really important to include carbohydrates throughout the day. So eating your carbohydrates every three to four hours. It’s an essential part of what we should be eating again, I mentioned there’s nothing wrong with carbohydrates are a great source of energy. It’s really the quality of the type of carbohydrate does it have a lot of fibre does it have no added sugar, minimal amounts of added sugar is a good source of unsaturated fat, does it have you know essential vitamins and minerals. If it is, and you’re combining it with a good source of protein and a lot of fibre, then it should be a balanced meal. So we can take a look at a typical day here of a nice balanced healthy day. So in the morning, we start off with something like a non fat plain Greek yoghurt, which has no added sugar, we put some heart healthy almonds on there, we put a cup of berries and strawberries, which are good sources of fibre essential vitamins and minerals. They do have a little bit of carbohydrate as well as the yoghurt but with the protein the added heart healthy fats, it shouldn’t be your problem because those both don’t have an effect on blood sugar. In fact, they actually help bring blood sugar down, and then maybe a couple hours later you decide to have a snack. We have example here of Apple, which is a whole which is a carbohydrate, but it’s a whole fruit it has its fibre, it has all the nutrients, a little bit of cottage cheese. If you are somebody that likes cottage cheese, it’s a good source of protein, you want to make sure you pick again the nonfat lower fat version that doesn’t have all those added sugars. I know you can buy cottage cheese that has pineapple in it and some people have like to add other things to it to give it flavour but by itself if you combine it with their own naturally occurring sweetness like a piece of fruit, it should taste just as good as something that you could buy that already has a fruit in it. And then after your snack for lunch, you can have a nice balanced diet where you see that most of that plate is vegetables. In fact, most of our meals should be made up of vegetables, at least half your plate. When we talk about vegetables, we talk about more than non starchy vegetables. So those are the vegetables that don’t contain a lot of carbohydrates. The starchy vegetables are a lot fewer than they are compared to the non starchy. Good examples would be things like potatoes, corn, peas, winter squashes, like acorn squash, or delicata. Squash, those are all starchy vegetables, but they’re still good sources of nutrients, they have a lot of fibre, but you still want to treat them more like if they were a piece of bread or pasta or rice. It’s just pretty carbohydrate rich. So it does raise your blood sugar. In this example, for lunch, they don’t have any starchy vegetables, but they have a lot of you know leafy greens, which are a great source of vitamin C, lots of fibre. Again, it looks like they used a whole wheat bread, and there’s some lean protein, lean turkey in there. And then for another snack, you could do something like a whole grain piece of bread, just one slice. Nowadays, when you buy bread, it’s really big, you know, especially if you shop at places that sell food in bulk, you know, their their prices or bread are very, very large. And they’re probably equivalent to a more like two slices of bread. So this would be a good example. This looks like a relatively normal size of bread. on it, you can see they have some unsalted unflavored almond butter, or it could be peanut butter, as long as it’s unsweetened, I would always check the label. And the way you know if something has added sugar is again by looking at the nutrition facts label go down to the total carbohydrates line, and you’ll see total sugars and underneath that you’ll see added sugars. So if it has any kind of added sugar, it’ll say you know one or two or three grammes. A good sort of gauge to know if something’s pretty high and added sugar is to look at that line. And if it’s over five grammes per serving, I would consider that relatively high. The other way to see if something has added sugars in it is to look at the ingredient list. If it falls within the first three ingredients, it’s probably pretty high added sugar, and there’s a lot of hidden words for added sugar like brown sugar and brown rice syrup and honey and sugar itself and sucrose and dextrose. We could go on and on but you can definitely decipher that it’s probably sugar because most of the time it says either sugar or honey or brown rice syrup. And then your last meal. You can see as a nice healthy heart healthy fatty fish in a court and mostly half of its going to be those non starchy vegetables. So we have steamed green beans or it could be sauteed

And then last quarter of our meal is going to be our starchy vegetable, the potato. So again, that’s more of like a replacement for something like rice or bread. So we mentioned before, a good resource is going to the USDA website. This their websites choose myplate.gov. And it lays out when a nice balanced meal looks like so it shows you all the five different food groups I mentioned before most of your meals should be made up of those non starchy vegetables. And you can see here on the plate that the vegetables do make up the greatest portion of the plate, the other part of that plate is going to be fruits. So an easy way to remember that is mostly vegetables a little bit fruit, the other half is going to be equally divided between low lean protein about that three to four ounce we talked about before, and then a serving size of carbohydrate. So it could be something like a whole grain like brown rice, or it could be whole wheat bread, or it could be a potato or sweet potato or it could be corn. But that should be no more than a quarter of your meal. Or if you want a rough estimate you can always use your fist a nice thing about your hands is you don’t have to, you know you’re always carrying it you don’t have to think about well, is that a cop? Is that two cups your fist is approximately a cup and that’s about a serving size of carbohydrate.

All right, let’s take a deeper look at fruits and vegetables. What can we what kind of vegetables should we be eating or any kind we want to vary them you don’t want to eat the same fruit or vegetable every day. It’s important to eat every vegetable or as many different colours from the rainbow as possible because there’s no one superfood there’s no one food this can provide us with all the nutrients our body needs. A good way to remember this is to think about eating the rainbow. This is something I always like to tell my my paediatric patients it’s the easy way to remember to make half your plate a rainbow you know picking a different colour for every fruit or vegetable you eat. Each colour basically represents different nutrients, different antioxidants. So it really gives your your diet a lot all the essential nutrients it needs to stay healthy. eating more of the darker green and orange vegetables is better than eating you know, the potatoes are the core. And because it’s a lot more nutrient dense. It doesn’t mean that corn or potatoes are bad, but they don’t have as many nutrients, which is again why we don’t want it to be the majority of our plate, we want these dark green, red, orange, yellow fruits and vegetables to be the majority of what we eat. And then eating a variety of fruits like I mentioned before, just like the vegetables, not eating just the apple a day that we often hear about. Well with fruits, it’s really important to be careful of things like dried fruit, dry food often has a lot of added sugar. The few dried fruits that don’t have added sugar are typically apricots, raisins, and prunes. And anything other than that usually has a lot of added sugar. So you always want to take a look again at the gradient list to see where that adage where the sugar may fall on the on the list. If it’s in those first three ingredients is relatively high in added sugar. It doesn’t mean that you shouldn’t be eating dried fruit, but you want to be careful again, because they take out a lot of the water so it’s very dry, which means we can overeat them pretty quickly. A lot of times when we eat foods that are drier, they’re not as filling, they don’t create a lot of volume because they don’t have any water. It’s a matte it’s like imagining when you have you know three cups of just regular grapes, if you were to take all the water out of it, it would shrink down to maybe three or four tablespoons of raisins. So you can see how easy it would be to overeat three to four tablespoons of raisins versus three cups of regular grapes. But it’s still a good source of nutrients. It still has some fibre in it, but it’s just not as filling. So you want to kind of treat it more a little bit like you know an added sugar almost because it does add a little bit of sweetness but not too much. But it’s easy to overeat. The other thing you have to be careful of is juice. Even if it’s 100% juice. The USDA actually defines 100% juice and dried fruit without added sugar as a serving size of fruit. However, like we mentioned before, there’s no fibre. So if you have created by pre diabetes, or if you have type two diabetes, we typically recommend avoiding all juices because once you even drink just a little bit like four ounces, which is the maximum amount that we recommend for the general public. We can we often see a huge spike in blood sugars. So if you can help it just avoid drinking juice even if it’s 100% juice if you choose to do something like canned fruit, if you want to do that, that’s okay, but you want to pick ones that have that they’re in 100% juice or they’re in like syrup, or a better choice would be frozen fruit without any added sauces or creams. Oftentimes if you get something like frozen fruit and it has some added creams, it has a lot of added sugar and sometimes they add some saturated fat to that too usually because it’s made with cream. So just be careful of that. In general you want to choose more whole fruits and whole vegetables than anything. Same thing with frozen vegetables, no added sauces or creams. The tip

That’s a really good choice. And sometimes they’re a lot more nutritious those frozen fruits and vegetables and they’re fresh counterparts because they’re picked at the peak of their ripeness, and then they’re flash frozen to retain the nutrients.

My Plate protein, so a little bit more depth in protein. We talked a little bit about this in earlier slides. But protein again does not raise blood sugar, it’s really the fat that we have to be more concerned about. So again, you want to choose leaner cuts, poultry, Turkey and chicken, the breast is going to be leaner than things like wings and thighs. If you’re going to choose something like beef or pork, it doesn’t mean you can’t have any red meat but in generally want to limit how much you eat. The recommendation is about one serving per week. If you’re gonna choose red meat, you want to choose leaner cuts. leaner cuts are typically made from pork loin tenderloin top round Chuck Royce, Chuck rose.

And if you’re going to do something like round meat, choosing ground turkey or current ground chicken breast is a leaner choice. Or if you do regular ground beef doing 93% or 92% fat and eight or 7% lean is a good choice. Other sources, again are fatty fish. If you want to do something like eggs, egg whites, you can do whole eggs. But usually we recommend no more than a couple times a week to do whole eggs. lentils are good plant based protein beans, any kind of bean at all. And then if you’re going to cook your proteins, you know if you’re something like beans, and you can certainly just bake them most people do. But if it’s more like chicken or fish, there’s a lot of different variations. We recommend trying to cook your food your protein without any added fat. And that would be you know, it could be grilling, it could be boiling, it could be baking, it could be steaming, it could even be boiling, like if you want to boil chicken as part of a soup. And then if you’re gonna use a fattier cut of chicken or turkey, cutting away all of the visible fat and the skin, which is where most of that saturated fat resides. And then if there’s any kind of breading, you know, a lot of these breaded chicken breasts may sound pretty healthy. But be careful because bread of course is a carbohydrate. And if you eat something that’s very highly breaded, then you’re also consuming carbohydrates, which you may or may not account for. So be light on the brightening. If you’re going to use it. There’s more whole wheat versions too. So maybe has a little bit more fibres. And then that’s white counterpart.

So continuation of my plate grains. What do we mean by grains? I think most people understand that means things like rice and pasta and bread. And we’ve probably heard of things like whole wheat bread and brown rice. And a lot of times people don’t know what the difference is they when I asked them about what kind of bread they ate, they say it was like some kind of seed multigrain type of bread. You know, I’m not really sure is wild rice. Okay, so I get a lot of questions about the differences between breads, and Rice’s and things like pasta, and Keane was, so to give you a little bit more clarity. Basically, a whole grain is a grain, that’s when you harvest it has all three parts, it has the endosperm, which is where all the starch or the carbohydrate lives, we have the germ, which has the healthy oils, and we have the brand which is where all the fibre is, when we eat something that is whole grain, we eat the whole grain, so it has the germ, it has the carbohydrate, and it has the fibre. But when you eat something that’s refined grain, which means it’s gone through some processing, and they basically strip away the brand, so there’s no more fibre or very little, and they strip away the germs. So there’s not as many, there’s not many healthy oils, if there is any left. So all you’re left with is the starch. And that’s what we see when we eat things like white rice, white pasta, white bread. And when we see that term multi grain wheat doesn’t necessarily mean it’s a whole grain, it just means that there are multiple grains used to make that bread. So they might have a little bit of corn grain there, they might have a little bit of red wheat in there, they might have a little bit of another type of wheat in there. But it doesn’t necessarily mean it’s a whole grain. The best way to figure out if something is a whole grain is again to look at that nutrition facts label. The first ingredient should say made with whole wheat flour, or whole rye flour or whole corn flour, whatever that product is. And a good indicator too is that if it’s a whole green normally has something like three grammes of fibre per serving, if not a little bit more. So these are some good examples besides right brown rice, also whole wheat pasta, bolgar, oatmeal, barley, those are all really good sources of fibre and nutrients, heart healthy oils, and all whole grains. So it doesn’t mean you have to eat only whole grains but the recommendation is to make at least half your grains, whole grains. Another good option for those of you that aren’t really into rice or pasta or bread, or those starchy vegetables like the sweet potato and the corn you mentioned before. And then I’ve mentioned many times before about dairy again non fat or local.

fat dairy, any sweetened milk dairy alternatives also you want to avoid those if you’re going to do something like the almond milk or soy milk unsweetened is the best choice. My Plate oils. So we mentioned briefly before different types of fats and different types of oils. Again, you want to choose more unsaturated heart healthy oils, again, they’re liquid at room temperature. These are another example of other sources of heart healthy fats. Avocado, avocado oil is a lot, a lot more popular. Now it’s a good source olives to olive oil is always a good source. And you can see at the bottom down here, a picture of fried chicken and french fries. And the reason there’s a picture there of fast food is because up until last year, in our food system, we had what we call trans fat. And we often refer to that as the ugly fat because unlike saturated fat, which does raise LDL cholesterol, but doesn’t touch your good cholesterol, that HDL trans fats actually raise your bad cholesterol and lower your good cholesterol. So it does the exact same thing as saturated fat but double the problem and it became such an evident, you know, problems in terms of heart health that the federal government has banned all trans fats from our food system, including from restaurants, which is where most of the trans fats were coming from, as well as packaged goods. So trans fats now are labelled on nutrition facts, labels, and usually it’ll say zero grammes of trans fat if there’s less than point five grammes of trans fat per serving. But often, if you look in the ingredient list, another indicator that that product has trans fats is the word hydrogenated oils or partially hydrogenated oils. So even if it says zero grammes of trans fat, sometimes it could have point three grammes of trans fat per serving or point four grammes. It just depends on you know, what the product contains. But if it’s less than point five, they can always call it trans fat free, but luckily, in the last year, they did put that lot that into effect, so we shouldn’t have any trans fats in our food system now. And they should be banned from all restaurants. The reason why people the manufacturer started using trans fat is because it actually extends the shelf life of food products. So you could make a cookie using trans fats, and it would stay just as fresh, chewy, and taste just as normal as it would be if it came out of the oven for three years. And that’s what made it so appealing. And they could also make these products a lot cheaper and more affordable. But so we may still see some of these food products that are made from two or three years ago on their shelf. But over the next couple of years, they should be phased out completely. So you want to avoid all trans fat, there’s no safe amount. For saturated fats, again, you want to limit it, the recommendation is less than 10% of your total calorie intake coming from saturated fat. And you want to replace as much of that saturated fat with unsaturated fat, environmental control. What does that mean? Essentially what that means is setting up strategies and procedures to create an environment that supports healthy eating, and it has three components, adding to your environment, subtracting things from your environment, and using caution with other parts of your environment. So what can we add to your environment to encourage healthy eating and active lifestyle. One thing would be, you know, cutting up healthy snacks, it could be fruits or vegetables or carrying something like low fat yoghurt or light cheese. A lot of my patients have started carrying things like a cooler in their car, and they just throw in some yoghurt and some fruit, especially if they have a job where they spend a lot of time in their car. And it’s hard to stop over and eat something at a restaurant or, you know, they don’t want to spend too much time eating or figuring out what they’re going to have. nots are a good, good option. You know, nuts again, are a good source of heart healthy fats, but they’re mostly fat, so it’s easy to overeat. So having them pre portioned helps prevent overeating. They sell these individually packed hundred calorie nuts in the grocery stores. If you don’t want to buy those, you can always proportion them yourselves. A good serving size is about a quarter of cup. Just be careful that it’s not one that’s highly flavoured if it’s going to be salted, make sure you choose choose one that’s lightly salted. Or you can just go with the raw nuts, you know, it could be raw almonds, raw walnuts, those are pretty common and popular analysis they’re not too difficult to find. Keeping water at your desk you know, if you especially not that a lot of us are working from home, it’s easy to kind of just stay in the same place. And now we have a little bit more access to our kitchen which is not as far but having your water there in front of you and carrying it with you all the time is a good reminder to get you to drink water often and often throughout the day. And then subtracting a lot. You know now that we many of us don’t work in the office, maybe we don’t have that option.

candy bowl that somebody in the next desk or the next cubicle has. So it’s not as big of a trigger. And you know, we’re not having as many celebrations, so they’re not in the group kitchen. But it’s easy to have those things at home, especially if you live with other people that like those things that maybe don’t have the same health objectives as you do. So keeping those things outside the house is a good first step. It doesn’t mean you completely stop eating that forever for the rest of your life. But you might say, Okay, well, you know, I’m gonna have some chocolate made, but maybe I’ll buy a small bag, maybe I’ll buy a small bag like that I can share or I can, you know, divided into a smaller bag so that it’s not on the counter, and it’s not in view all the time. One thing I tell people good strategy is not to have anything on your kitchen counters, except for a bowl of fruit, or like a bowl of grape tomato, something that can sit out for a little bit. But other than that, don’t leave anything out. Because if you walk in that kitchen more than one time a day, you’re more than likely, even if you’re not hungry, even if you’re not thinking about cookies, if you’ve got cookies on the counter, more than more than not, you’re going to end up eating those cookies, especially again, if there’s someone else in your house, and they’re telling you how good those cookies are, oh, I just bought some Oreos, and they leave them on the counter, it’s very hard to avoid. So keeping them out of sight is a good method, also keeping them in a place where it’s a little bit different, more difficult to get to, like in the garage and a top cabinet. You know, whenever we act, add an extra barrier to getting to, you know, a food that we really like. Sometimes it’s enough to minimise that craving or that desire to eat that food. And then we want to use caution in places like fast food restaurants now that we don’t really have an opportunity to go out and eat. A lot of us are cooking at home. But we do get tired of cooking a lot. So we tend to want to eat out. And it’s very easy because we have all these apps, there’s things like grub hub and other delivery places Postmates you just click on a couple buttons and you’ve got fast food at your door in half an hour. So be careful of fast food restaurants, not just fast food restaurants, even seemingly healthy restaurants. You know, I won’t give specific examples but places that seem like they’re mostly salad and sandwiches. Again, you have to be careful because the portion sizes are a lot bigger than what you would normally prepare for yourself. They often use really large pieces of bread, or they’ll add the dressing already to your salad or they’ll put a you know, a 12 ounce piece of chicken on there. That’s maybe breaded so it might be a salad but then it has a lot of other components that have that up the sodium that up the saturated fat up the carbohydrates. So be careful when you’re looking at restaurants to eat at I would always advise they have it available looking at the menu ahead of time looking at the nutrition information if it’s available, and taking a look. Is it pretty high in fibre? Is it lower in sodium? A good cutoff if you’re looking at a meal in terms of sodium would be something like less than 500 milligrammes of sodium per meal. For somebody that has high blood pressure, you know, they recommend no more than 1500 milligrammes per day. And then also you could take a look at, you know, how much fibre is in there. fibre again is really important for controlling blood sugar, preventing high blood pressure or controlling high blood pressure.