Q & A with the Dietitian: Carbs and Sugar

First off, thank you all so much for your questions! They're wonderful are a great way for us to talk and share health information. If you have any insight or questions about the topics, don't be shy, share the knowledge and post a comment. I love hearing from you.

This weeks question is about the role carbohydrates and sugar have on blood sugar and why it matters for our health.

Carbs, sugar, carbs: 

what's the difference and why do I care??

Question:

Morgan wrote: "I've been really strictly monitoring my sugar every since I started my low carb diet on the 1st and I am wondering what effects my blood sugar more - carbs or sugar? I like these carb conscious protein bars. They have 18 g carbs, but 5 grams of sugar and I ate one last night because my sugar dropped to 77 and it didn't seem to help much. SO, should I be focusing more on the sugar or carb content on nutrition labels? Thanks."

Answer

This is a great question, especially for those who are diabetic or are interested in monitoring their  carbohydrate intake. The answer is quite complicated, so I'm just going to focus on basic information. In order to answer your question, it's important to understand the difference between various types of carbohydrates. Here's a very simplistic breakdown:

Three main types of carbohydrates:

1. Complex carbs: i.e. starchy vegetables, beans, grains
2. Sugar: i.e. milk, fruit, fruit juices, candy, sweets
3. Fiber: found in foods like fruit, whole grains and beans

As far as blood sugar is concerned, "complex carbs" increase blood sugar more slowly than "sugar". Complex carbs generally contain the most nutrients, vitamins and minerals and therefore should comprise the largest part of our total carbohydrate intake. Sugar (or refined sugar) is a quick-acting carb that will increase your blood sugar much faster than other types of carbs.

As far as nutrition labels go, in general it's better to eat foods that contain less "sugar". However, if you're having an episode of low blood sugar and you have a medical condition like diabetes, eating foods higher in "sugar" will increase your blood sugar more quickly.

So let's talk about your blood sugar and the protein bar you ate. First, a blood sugar of 77 mg/dL is good. Since your blood sugar technically wasn't "low", you don't have to worry about raising it. However, if you wanted to raise it slightly, you may need a larger dose of carbohydrate than the protein bar provided. Secondly, protein bars have a lot of.....protein, and that nutrient does not increase blood sugar.

The exact amount of carbohydrate you should eat to maintain a healthy blood sugar throughout the day depends on the diabetes medication you take (if you're diabetic) and how many carbs you're eating at meals and snacks. For people without diabetes, eating a healthy, well-balanced diet regularly throughout the day - and not over-eating - is adequate to maintain a healthy blood sugar range.

People with diabetes should talk to their doctors or a certified diabetes educator to layout how many carbohydrates should be eaten for meals and snacks and (if necessary) how much insulin or oral glucose medication is needed to keep blood sugar within a healthy range of 70-120 mg/dL. Lastly (and certainly not least), low-carb diets are not a good idea for people with diabetes - or anyone for that matter - because they can cause blood sugar irregularities, among many other health problems. That's a WHOLE other post!

Thanks for your question and don't by shy if you have any more :) 

Comfort Food, Re-Created: Creamy Mac and Cheese

Like many, mac and cheese is one of my favorite comfort foods. It's one of those decadent meals that takes you back to childhood....that blissful time when you neither thought nor cared about calories. No lie, mac and cheese is a high calorie dish, especially the way many restaurants prepare it (read: extra butter, extra cheese). I created this homemade version to be more health conscious yet still have that warm, creamy, comforting taste we all know and love.

But can macaroni and cheese be considered healthy? When eaten in moderation and prepared in a healthier way, the answer is yes. I can just hear it now....what about the CARBS?! Relax, don't worry. We need carbs. In fact, they're our bodies primary source of energy. However, when we overeat calories (which can come from carbs, protein or fat), that's when the weight problems begin.

So, mac and cheese can totally be on your menu once in a while. I limit my serving to about 1/2 to 3/4 cup and pair it with a side of steamed veggies to make the meal more complete.

Creamy Mac and Cheese

Ingredients

• 2 cups dried noodles (sub whole wheat noodles for extra nutrition)
• 1 tsp smart balance (or alternative heart-healthy butter spread)
• Pinch of flour
• 1/2 cup shredded cheddar cheese
• 1/2 cup cream cheese (low-fat would work well too)
• About 1/4 cup low-fat milk
• Salt to taste

Preparaion

Boil noodles in saucepan. Once tender, strain and set aside. In saucepan, melt butter and add a pinch of flour to create a roux which helps thicken the sauce. Mix until well combined, then add the milk, cheddar and cream cheese. Once the cheese sauce is heated and well combined, add cooked pasta. Stir until noodles are coated and enjoy!

Q & A with the Dietitian

I'm pretty sure 99% of the United States currently has football on the brain. But I confess, I'm apart of the 1% that doesn't. I'm sorry. I'm just not that into it. Food on the other hand, I'm totally into! This week for Q & A, we're talking "healthy juices". Are they really healthy? Is the "vegetable serving" some claim to have legit?

Last week, Cameron wrote:
"I have a question for you Tiffany. My three year old son is not a big fan of veggies. I have been buying the V8 fusion drinks because they have a full serving of fruit and vegetables. Is this a good alternative if your child is resistant to eating vegetables? Are those fruit drinks as good as they're advertised??"

Thanks for your question Cameron! This is a great topic because I know many parents struggle with getting their kids to eat veggies. And so many parents wonder whether fruit and vegetable juices (like the V8 fusion you mentioned) actually provide good nutrition comparable to whole fruits and veggies. As a mom myself, I've looked into these questions and here's what I've found.... 

The answer is a bit more complicated than yes or no. First, you have to consider the juice quality. Any juice that provides a legitimate serving of fruit and/or vegetables should be labeled "100% juice". If not, don't buy it. The juice in the image above is only 50% juice. So this, unfortunately is not the best option. However, there are a variety of 100% fruit juices available. The only 100% vegetable juice I know off hand is tomato.

Secondly, the amount of juice toddlers drink throughout the day should be limited to 4 oz. Why? Because it is a very concentrated source of sugar, calories and lacks fiber. This includes fruit juices and fruit/vegetable combo juices. According to the V8 fusion website, "*Each 8-ounce glass of V8 V-Fusion juice provides a 1/2 cup of vegetables and 1/2 cup of fruit." Therefore, 4 oz of juice would equal a 1/4 serving of vegetables and a 1/4 serving of fruit. Not really that much, considering we're aiming for 1 cup of fruit and 1 cup of veggies per day for our toddlers.
 
So, my recommendation is to 1.) limit juices to 4 oz per day of 100% varieties only, 2) continue to encourage your little one to eat whole fruits and veggies from other sources (like fresh, frozen, canned or dried). But HOW, you ask? I have a toddler at home and definitely had to put in some "work" to get him to eat fruits and veggies. Thankfully, he eats them pretty well and I credit some simple tactics I practiced everyday since he started solids at 6 months.

Tips on getting kids to eat fruits and veggies

1. Expose your child to a variety of fruits and vegetables by offering different kids regularly.
2. Offer your child a fruit and/or a veggie at meals and snacks, in addition to other healthy foods. If after you encourage them to eat their fruit and veggie, they refuse, allow them to but always continue to offer at each meal and snack.
3. Be patient and avoid forcing or bribing. This can set up an unhealthy relationship with food, and usually has the opposite result!
4. Lead by example and let them see you eating (and enjoying) fruits and veggies.
5. Here are some other great toddler eating tips from the American Dietetic Association

Thanks again for your question, Cameron! Hope this helps :)

Comfort Food, Re-Created

As the first trimester of pregnancy comes to a close, I am thankful for many things. Namely that nausea is subsiding and my appetite is making a comeback. Hooray for liking food again! In order to stay on track with weight gain, I've been re-creating my favorite comfort food cravings into healthier versions.

This week I made one of my childhood favorites: bagel bites! You know, those mini bagel pizzas? Maybe that was an early nineties thing, but I remember my Nana making them for us kids at family gatherings and OH MAN that platter of bagel bites was mine! All mine!

The healthier version I made is lower in fat and salt, but still packs that yummy bagel pizza flavor. Did I mention that - when you do give pizza to your kids - this is the perfect one because 1) it's easy 2) it's fast and 3) YOU decide how much cheese and salt to add? Go Mom! I served my delicious pizza creation with a salad for the adults and some peas for the wee one. There were no leftovers.

Tiffany's Bagel Pizza Recipe

Ingredients:

• Your favorite bagel (I used parmesan)
• Pizza sauce
• Reduced-Fat Mozzarella Cheese, Shredded
• Garlic Powder
• Dried Oregano
• Dried Basil
• Salt

Preparation:

Preheat oven to 450F. Slice bagel in half and smooth pizza sauce (as much as you like) over each half. Top with a small handful of shredded cheese. Next, sprinkle garlic powder, dried oregano, dried basil and salt to taste. Bake in oven for about 7 minutes or until cheese is melted.

Q & A with the Dietitian

Hello friends! Hope you had a great holiday weekend and were able to get some R & R. This week on Q & A we're talking about a topic I know most pregnant moms wonder about......healthy weight gain.

 
Question

Mollie wrote:

About how many calories should I be eating while pregnant and exercising? I know that the kind of food I eat is important as well, but some days it's just easier to keep track of calories (though some other simple guidelines would be great). I'm still exercising every day and ALWAYS feel hungry, but I don't want to gain more than the recommended amount.

Answer

Hi Mollie! Thanks for your question and congratulations! The amount of calories you need for pregnancy and exercise depends on your baseline calorie needs, which will change with each trimester. For a healthy woman of normal weight (BMI 18.5-24.9), aim to gain a total of 25 to 35 pounds throughout the entire pregnancy. This can be spaced as follows:

       First trimester: 2-4lbs
       Second and third trimester: About 4 pounds per month

It's important to gain weight especially during the second and third trimester as this is the time the baby needs the most calories for growth. Eating a healthy diet will ensure adequate nutrient intake and optimal growth for the baby. That said, if you're hungry all the time (and trust me...I hear you!), it may be helpful to modestly keep track of what you eat. I say modestly because pregnancy is obviously not the time to worry about gaining weight and stressing about how many calories you're eating. It's also important to listen to your body so if you have real hunger, eat! Regardless, for the average woman here is an estimate of how many calories to consume per trimester (without exercise):

Sample daily calorie needs during pregnancy:

       First trimester: ~1,800 calories
       Second trimester: ~2,100 calories
       Third trimester: ~2,400 calories

Now on to exercise....

The amount of calories you'll need in addition to the above mentioned estimates will depend on the type of exercise, the intensity and your body weight. Since it is recommended to either continue your normal pre-pregnancy exercise plan (or scale it back a little, especially as trimesters progress), you probably have a good idea of what you normally burn during your workout. Use that number and add to your calorie intake for the day.

So, for example if you run 3 miles one day during your first trimester, you may burn around 300-400 calories. Add that number to 1,800 calories and you'll need about 2,100 -2,200 calories for the day.

Click here for an example of a healthy pregnancy diet that I wrote for livestrong.com.

As a side, my answers for you today are straight from the textbook. Having experienced pregnancy myself, I can say that every woman is unique and does not always fit the textbook mold. Calorie needs may vary and weight gain may vary. The most important things are to listen to your body, gain enough weight by eating a healthy diet, continue exercising and don't stress. 

I hope this answers your question Mollie and feel free to ask more if you have any further questions. Also, for the rest of my readers, feel free to send me your own nutrition questions at tiffanythedietitian@gmail.com.

Easy Crockpot Dinner

I've been ALL about easy dinners lately. Since I'm still feeling a bit queezy from pregnancy, cooking has been less about spending extended time in the kitchen and more about getting a quick, easy meal on the table. This recipe is exactly that. I found it online and it turned out to be a real crowd-pleaser, especially with my husband and son.

Remarkably, my chicken-finicky toddler had three helpings and after my husband took one bite, he immediately said "this is amazing". When that happens, I know I have a winner!

Now at least with this recipe, "quick" and "easy" comes a bit of a sacrifice in terms of nutrition. It's definitely on the saltier side because of the canned soup and the italian dry salad dressing mix. You can lower the sodium a bit by using the reduced-salt soup, which is what I will do next time I make this....and there will definitely be a next time!

Easy Crockpot Chicken with Creamy Chive Sauce

Adapted from this recipe

Ingredients:

• About 2 lbs of boneless, skinless chicken breast
• 1 Tablespoon Smart Balance (or other heart healthy butter spread)
• 1 envelope of italian dry salad dressing mix
• 1 can condensed cream of chicken (or mushroom) soup
• 4 oz cream cheese
• 1/3 cup chopped chives
• 1/2 cup dry white wine

Preparation:

Place chicken in crockpot. Melt butter spread in sauce pan, then add soup, italian dressing mix, cream cheese, chives and white wine. Stir until heated and combined. Pour sauce over chicken, cover and cook on low heat for 4-5 hours.

Q & A with the Dietitian

It's question & answer time!

Do you have a nutrition question you want answered? Wondering whether a certain food is actually healthy? Need tips on making affordable healthy meals? Hitting a weight loss plateau and need advice? Or maybe you want to know more about getting your kids to eat nutritious foods? You ask it, I'll answer it. Send me your questions at tiffanythedietitian@gmail.com.

First question.....

QUESTION:

Hi Tiffany! Do you know what the final word is on a high dairy diet and weight loss? I know it's bounced around from dairy bad to dairy good. I was just curious because my weight loss has really slowed down even though I haven't changed my exercising and I've continued to slightly decrease my calories the smaller I get. (it's 1450 right now) so I'm looking a tweaking something, anything to help with my last 30 pounds. Thanks!!

--Andree

ANSWER: 

Hi Andree!

According to Registered Dietitians, as long as you don't have a dairy allergy, dairy products have always been considered healthy to include in your diet. Why? It offers calcium, vitamin D, protein, and carbohydrates to help keep you strong and energized. 

The dairy industry advertise that milk products can help you lose weight. This is only true as long as your total calorie intake is below your calorie needs. So, the weight loss comes from a calorie deficit rather than simply consuming dairy products. Aim to consume 3 servings of low fat dairy products per day as part of a healthy diet.

Now on to weight loss. Although it was not stated in her question, I'll give a little background : Andree is very active and exercises intensely at least 5 days per week, which in turn increases her calorie needs. After a few calculations based on height, weight and activity level, Andree should be eating at least 1600-1800 calories per day for weight loss. As odd as it may sound, it's important to eat enough calories when trying to lose weight to prevent your metabolism from slowing down. When we under-eat, a message is sent to our brains to slow our metabolisms to prevent starvation. To avoid this, it's important to eat adequately and only slightly less than your normal calorie intake.

The best way to determine your metabolic (i.e. calorie) needs is to consult a dietitian. A less precise, but still effective way is to figure out how many calories your body burns to maintain your current weight. Do this by recording what you eat for 2-3 days and adding your total calorie intake per day. Then, reduce that number by 250-500 calories per day and healthy, gradual weight loss will result.

Change your life and the body will follow

It's January and I guess that means it's time to get back in the gym.

I took a spin class this morning at a gym I'm considering joining and MAN - did it kick my butt! Every 15 minutes felt like 30. Over our holiday vacation in So Cal, I visited a local gym to take a little "me time" and workout. On the wall prominently displayed was this poster:

"Change your body, change your life"

To me, this sign sends the message that once you get that sexy body you've always wanted, your life will be better....maybe even sexy? Does the body really come first, then the great life? Or do you change your life, then see your body change? Hmmmm.....I'll go with option B.

This advertisement - like so many today - focuses on body image. Maybe it's just me, but I'm tired of the media directing so much emphasis on body image. Most of the time, the "ideal image" portrayed is far from healthy and it sends an unrealistic message to both women and men. The truth is that people come in all shapes and sizes: pear shape, apple shape, square shape, whatever. It's important to remember that regardless of whether your shape conforms to the model on the cover of a magazine, you can certainly still be healthy.

If I could re-write this poster, it would say: "Change your life and the body will follow". That may not sell gym memberships as well, but it certainly is more truthful about the real way to achieving lasting change.

Making healthier eating choices, exercising regularly, taking time to de-stress and getting plenty of rest are a few of the major components of a healthy lifestyle. Once these have been adopted, your body will change. Guaranteed.

So be kind to yourself my friends and remember that health comes in all shapes and sizes.

Back to Basics: Healthy Eating 101

Hooray for the new year!

Hooray for new opportunities and new beginnings!

Hooray for New Years resolutions! Okay, maybe not for me anyway. I've never been one to set "New Years resolutions", but I definitely appreciate the feeling of joy and liberation that comes with deciding NOW is the time to make a change. If you overdid it this holiday season and need a "new beginning" with your diet, don't worry, you're not alone. Too many cookies? Too little exercise? Haven't seen a salad in a while? No worries, let the change begin.

Enter, healthy food.

The best way to purify your body of excess poundage and all those rich, calorie-laden foods is to eat a healthy diet. Pretty simple, really. No detoxes or juice fasts. No vegan or fruitarian diets. No protein powder or supplements necessary. Because of all the misinformation available in nutrition, very few people clearly understand the basics of a healthy diet. Today, we're talking nutrition based on science, not fads.

A healthy diet of about 2,000 calories per day consists of the following (some examples included):

What to Eat

• Whole grains - 100% whole wheat bread, cereal, pasta, oats, quinoa and brown rice
• Lean protein - poultry, fish, eggs, red meat (with very little fat "marbled" throughout)
• Fruits - raw, frozen, dried or canned (with no or minimally added sugar)
• Vegetables - raw, frozen, canned (with no or minimally added salt)
• Low-fat dairy - fat-free or low-fat yogurt, cheese, cottage cheese and milk
• Healthy fats - olive oil, canola oil

According to the USDA, the daily serving recommendations for these food groups are: about 6 oz. of grains (half of them whole grain), 2 1/2 cups of vegetables, 2 cups of fruit, 5 to 6 oz. of meat or beans, 3 cups of low-fat dairy and about 7 tsp. of healthy fats. If you're like most Americans, you may not be eating enough fruits, vegetables, whole grains and low-fat dairy products.

So why include these in you diet? These foods and the quantity recommended provide the correct amount of calories, protein, carbohydrates, fat, vitamins and minerals that most people need in a day. Here is an example of how to include these foods in the correct amounts in your daily diet:

• Breakfast: 1 to 2 oz. of wheat flakes, 1 cup of reduced fat milk, 1 tangerine. 

• Snack #1: 1 slice of 100% whole wheat toast and a half a banana.

• Lunch: 1 to 2 oz. of quinoa, 1 cup mixed vegetables, 2 to 3 oz. chicken breast, 2-3 teaspoon of olive oil and vinegar dressing for drizzling on top of chicken and vegetables, and 1 cup of low-fat/low-sugar yogurt

•  Snack #2: 1/2 slice of pita bread, 1/2 cup baby carrots and 1 tablespoon of hummus dip. 

•  Dinner: 1 to 2 oz. brown rice, 2 to 3 oz. grilled salmon, 1 cup salad, 1 to 2 teaspoon dressing for salad, 1 cup of reduced fat milk, and 1/2 cup fresh melon for dessert.

Here's another way to create a healthy plate from the USDA. I've shown this before, but I really like how it's simple, useful and easy to use. Print it and keep on your fridge for an easy reminder of how to eat healthy.