I’m diabetic, how do I manage my sugar and carbohydrates intake?

 

It’s a common myth that people with diabetes can’t have carbohydrates and sugar. After all, diabetes is a metabolic condition with the hallmark feature of hyperglycemia (high blood glucose/sugar levels). So if carbohydrates, including sugar, increases blood glucose, then why can’t people with diabetes just restrict or eliminate carbohydrates intake?

 

Well, dietary carbohydrates are an important component of a healthy diet. Carbohydrates breaks down into glucose and is the main fuel utilised by the brain and central nervous system. Carbohydrates-containing foods also provide many nutrients, such as vitamins, minerals and dietary fiber. Hence, diabetic or not, it is an important macronutrient which we cannot remove from our diets.

 

Furthermore, blood glucose will increase for people with diabetes in both fed and fasted (un-fed) states. Although dietary carbohydrates increase postprandial (after meal) blood glucose levels, avoiding carbohydrates altogether will not make a diabetic’s blood glucose levels return to the normal range (Franz et al., 2002).

 

Due to these reasons, low carbohydrate diets are not recommended for managing diabetes. But, a primary goal in diabetes management would be to regulate blood glucose levels so as to attain near normal blood glucose levels. Long-term hyperglycemia can lead to macrovascular disease (disease of large blood vessels), which is linked to coronary artery disease (type of heart disease), the leading cause of death in people with diabetes.

 

Therefore, it is important for people with diabetes to choose the right sources of carbohydrates. Although most experts agree that the total carbohydrates intake in a meal is a reliable predictor of postprandial blood glucose, the impact of the type of carbohydrates may also be as important. Two tools which can be used are the glycaemic index (GI) and the glycaemic load (Ludwig, 2002).

 

The GI measures how blood glucose level changes following consumption of carbohydrates. Some foods cause a higher rise followed by a rapid fall in blood glucose, whereas others have a lower peak followed by a gradual decline in blood glucose. Additionally, the glycemic load of a food is the product of the GI value of the food and the total amount of carbohydrates consumed.

 

Here is a list of diabetes-friendly food, courtesy of the Health Promotion Board (HPB). Eating these in moderation as part of meals can help people with diabetes control their condition:

  • Wholegrains (brown rice, barley, buckwheat, rye, semolina, corn)
  • Pasta and noodles (wholegrain semolina or durum wheat)
  • Legumes (beans, lentils, peas, peanuts, soybeans)
  • Bread (100% wholemeal, wholegrain, rye)
  • Breakfast cereals (all-bran, oats, wholegrain wheat)
  • Beverages (unsweetened coffee and tea, vegetable-based juice, water)
  • Reduced-fat dairy (milk, yoghurt, cheese)
  • Whole fruits (papaya, kiwi, grapes, apple, pear, orange, berries, melon, dragon fruit, starfruit, guava, banana)
  • All leafy vegetables
  • Snacks (nuts, oatmeal cookies, wholemeal biscuits)

 

It is also good to keep in mind that though carbohydrates have the greatest influence on blood glucose, other macronutrients, ie., fat and protein, also affect postprandial blood glucose level.

 

For instance, dietary fat hinders glucose absorption and delays glycaemic response when a glucose-containing food is consumed. Additionally, though glucose is the main stimulus for insulin release, proteins increase insulin release when ingested with carbohydrates, and thereafter, increases the removal of glucose from the blood (Sheard et al., 2004).

 

Therefore, a good way would be to adhere to the HPB’s My Healthy Plate as a guide when planning meals. A quarter plate of whole grains (eg. brown rice, rolled oats, wholemeal bread) supply enough carbohydrates while providing ample vitamins, minerals and dietary fibre. Another quarter of protein can be made of oily fish such as tuna and mackerel or lean meat such as chicken breast. This ensures you get adequate protein and healthy fats in your diet. As for the remaining half plate of fruits and vegetables, choose mostly non-starchy, leafy vegetables and low GI fruits (GI less than 55) such as apples and grapes, just to name a few.

 

So yes, people with diabetes can still enjoy carbohydrates, but here’s the same ruling that applies to everyone, diabetes or not — always consume all food in moderation.

 

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Jacqueline Joose
About the Author: Jacqueline is an Accredited Practising Dietitian (APD) with the Dietitians Association of Australia, and an accredited member with the Singapore Nutrition and Dietetics Association. Jacqueline is passionate about translating nutritional science and communicating them through simple messages. She has worked across a wide range of clinical wards in major metropolitan hospitals in Brisbane as well as in the areas of food service management, community and public health nutrition. Her previous experience also include private practice where she individualised her nutrition interventions to clients with various health conditions, and has helped them to achieve their nutrition goals and attain optimal health. She is interested in what works for clients to sustain behaviour and realistic lifestyle changes, and seeks to continually keep herself up to date with the current scientific evidence to inform her care p

Cardiatrics Client Success Stories: Mr S.S

Patient Background 

  • Male, 53yrs, Indian descent.
  • Married with two children. Travels overseas weekly for work.
  • Strong family history of heart disease, has new onset angina, hypothyroidism on thyroxine replacement.

 

Patient has a strong family history of heart disease. Both his father and brother had heart attacks at their 40’s and 50’s. Recently, he has been newly diagnosed with coronary artery disease and is on medication for his high cholesterol. He was only slightly overweight for his tall build but has significantly larger waist circumference.

Patient was prescribed 4 months treatment with goals to lower his cholesterol levels, waist circumference and a slight reduction in body weight.


His success on the 4-month Program:

He has lost 5.6 kg
=> Weight: 81kg –> 75.4kg, Current BMI 22.8 (normal range).

He has lost 5.2cm from his waist
=> Waist Circumference: 95.2 cm => 90cm

Lipid profile has improved
Total Cholesterol 5.2 mmol/L → 4.3 mmol/L
LDL cholesterol 3.4 mmol/L → 2.4 mmol/L
HDL 1.1 mmol/L → 1.3 mmol/L
TG 1.4 mmol/L → 1.14 mmol/L
Ratio 4.1 mmol/L → 3.2 mmol/L

He is eating better
Past: High in refined grains, little vegetables, coconut-based cooking at home, frequent fried foods

Now: Has wholegrains, avoid sources of unhealthy fats, changed home cooking oil to olive oil and healthier cooking methods at home, reduced portions of meat and fried foods, reduced portion size, greater mindfulness of food choices

He is more physically active
Past: Sedentary lifestyle: 2000-3000 steps daily, drove to work

Now: Lightly Active lifestyle: 8000-9000 steps daily. Despite his busy work schedule and traveling weekly for work, he now takes public transport to work instead of driving, go for evening walks 3x a week

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Jacqueline Joose
About the Author: Jacqueline is an Accredited Practising Dietitian (APD) with the Dietitians Association of Australia, and an accredited member with the Singapore Nutrition and Dietetics Association. Jacqueline is passionate about translating nutritional science and communicating them through simple messages. She has worked across a wide range of clinical wards in major metropolitan hospitals in Brisbane as well as in the areas of food service management, community and public health nutrition. Her previous experience also include private practice where she individualised her nutrition interventions to clients with various health conditions, and has helped them to achieve their nutrition goals and attain optimal health. She is interested in what works for clients to sustain behaviour and realistic lifestyle changes, and seeks to continually keep herself up to date with the current scientific evidence to inform her care plans. Jacqueline obtained her Bachelor of Nutrition and Dietetics (Honours) from Queensland University of Technology, Australia.

 

NEWS FLASH!! We are Partnering with Watsons!

Watsons and Cardiatrics Enhance The Role of Pharmacists

To Offer Clinical Preventive Care

 

Customers Can Now Get Clinical Preventive Treatment through Cardiatrics

via All Watsons Pharmacies across Singapore

 

Through a 12-month partnership between Watsons and Cardiatrics, cardiovascular disease (CVD) prevention specialist, customers now have easier access to clinical preventive care via Cardiatrics’ unique personalised treatment products through all Watsons Pharmacists (about 40) across Singapore.

 

Cardiatrics products are geared towards the early detection of an individual’s risk of cardiovascular disease followed by a clinical personalised treatment to tackle the risk factors of CVD, namely high blood pressure (hypertension), high cholesterol, high blood glucose (pre-diabetes and diabetes) and high Body Mass Index (obesity).

 

Watsons and Cardiatrics established this partnership to offer a medically-driven preventive personalised treatment through the network of Watsons pharmacists. This strategic move is part of Watsons’ focus to bring an integrated range of offerings that provide both preventative care and disease management to its customers.

 

Watsons’ pharmacists will now not only offer traditional over-the-counter products, but also clinically based lifestyle intervention solutions in collaboration with doctors and other allied health professionals. The aim is to make clinically based medical lifestyle therapies easily accessible to all through Watsons’ wide retail network.

 

“Preventive and lifestyle medical offerings will play a bigger role in healthcare, especially in the Singapore setting where we enjoy one of the highest life expectancy in the world. This is also why Watsons is evolving its role in the area of community health with a holistic health care approach,“ said Irene Lau, Chief Operating Officer, Watsons Singapore.  

Irene Lau continued, “The newly launched Watsons Health Concept store at Heartbeat Bedok is designed to provide an integrated platform that brings together our pharmacists with healthcare experts from Cardiatrics to sports health to empower consumers to take greater ownership and be pro-active in seeking consultation for their overall well-being.”

 

Cardiatrics’s approach is based on the fields of Preventive Cardiology and Lifestyle Medicine, which were previously only available through a specialist doctor and team in a clinic or hospital setting

 

“Traditionally, people only see a doctor when they feel unwell, and tend to medicate or treat themselves when they feel their condition is early or mild. This is the case for many chronic diseases, where the symptoms are mild in the earlier stages. People might visit their local pharmacy instead for their health needs. Therefore, Watsons Pharmacists can play a key role in helping them find the most appropriate solutions to tackle their chronic conditions,” said Dr. Peter Ting, Founder and Chief Medical Officer, Cardiatrics.

Dr. Peter Ting added, “This includes the offer of Cardiatrics as a therapeutic option to help them manage or prevent chronic diseases to better and reduce their risk of CVD. Watsons can also help create greater awareness among the public that early risk detection is important in the case of chronic diseases and CVD as these conditions develop silently in the early stages and are usually severe by the time they manifest.”

 

Many studies and statistics showed that lifestyle modification is highly effective in treating CVD and its risk factors. A recent analysis of the past patients who have been on Cardiatrics showed promising preliminary results. Early results indicate that on average, patients may reduce their blood pressure by up to 11% (systolic pressure by up to 14mmHg, and diastolic pressure by about 8mmHg), an average of 16.4% reduction in “bad’ LDL cholesterol; 59% exercise more, 81% lose weight and 79% eat better.

 

This may be attributed to the fact that Cardiatrics is a doctor supervised treatment with personalised coaching support through its telemedicine mobile health platform. Such comprehensive and integrative approach has been found to be important to enhance motivation, accountability and longer-term adherence. It also ensures reliable health advice and information.

 

“Making lifestyle changes is challenging, many people who attempt on their own are not successful. They either were not able to change sufficiently to achieve the desired clinical improvement or they were unable to sustain their healthy habits. Although difficult, lifestyle interventions can be effectively sustained if delivered in the right way,” said Dr. Peter Ting.

4 mins easy desk stretch

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Ling Sze-An
About the Author:  Sze is a Health and Exercise specialist with a degree in Sport & Health Science. He is passionate in helping his clients achieve the best version of themselves, constantly exploring new ways to make healthy eating and exercise more enjoyable. Sze is also a fitness enthusiast who enjoys exercising through calisthenics in his spare time.

Cardiatrics Client Success Stories: Mr. R.F

Patient Background:

  • Male, 53 yrs, Caucasian descent
  • Married, 2 children, has a helper who prepares the meals
  • He is a CEO, so required to travel at least half of the year.
Patient has always been a fairly slim guy and able to maintain a healthy weight without much effort. However, in recent years he found his waistline increasing and seemingly tougher for him to lose weight. Recently he had a blood test and found that his cholesterol to be out of normal range. He knows of the risk with high cholesterol and decided to take charge and change his lifestyle. The patient was prescribed a 3 months treatment program with goals to lower cholesterol and reduce body weight and waist circumference.

His success on the Cardiatrics Program:
Lost 7kg in 3 months, more than targeted
90 kg —> 83kg (target was 85kg)
His blood pressure went down even though he did not have BP as a clinical goal
125/76 mmHg —> 119/68 mmHg
He lost 4cm from his waist (goal was <96cm)
100 cm —> 96 cm
Lipid profile has improved
TC: 6.54 mmol/L —> 5.22 mmol/L
HDL: 1.01 mmol/L —> 1.06 mmol/L
LDL: 4.91 mmol/L —> 3.67 mmol/L
Triglycerides 1.39 mmol/L —> 1.12 mmol/L
Lowered state of inflammation
hsCRP 1.7 % (medium risk)  —> 0.7 % (low risk)
His diet has improved 
From a C to a B
Increased fruits and vegetable intake, reduced saturated fat and sodium by cutting down on copious amount of butter, hard cheese and mayo-based salad dressings)
He has lowered his stress
From an average score to stress free
His tip for frequent travellers:
  • Plan in advance. Know where you are going and order healthier meals for the flight.
  • Focus on the fruit and vegetable section at hotel buffets.
  • Got to eat better if you know you cant clock much steps for the day
  • Get back on track immediately when you return.

 

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Trina Lam
About: Trina is Clinical Nutritionist with previous experience in tackling unhealthy lifestyle behaviors, and prescribing specialized meal plans for weight management, diabetes, hypertension and heart disease. She is passionate in helping her clients find healthier alternatives that are both realistic and enjoyable. Trina is a strong advocate in sustainably achieving healthy eating habits through a balanced diet. Trina received her Master’s in Clinical Nutrition from the University of Nottingham (UK).

Cardiatrics Client Success Stories: Samuel

Patient Background:

Male, 44 years old, Asian descent

Married with 2 children

Job: Procurement Director
Patient has a history of hypertension and high cholesterol and has tried to lose weight but with minimal success. A recent blood test also showed him to be diabetic, due to the increasing number of health problems, he decided to seek the help of a cardiologist for a heart check up.
Patient was prescribed a 3 month Cardiatrics treatment program with the goal to lose weight, lower blood sugar levels,
cholesterol and blood pressure.

 


His success on the 3 month treatment program
He lost 8kg in 3 months
Weight: 85 kg => 77 kg
His blood pressure has lowered
BP: 166/110 mmHg => 126/77 mmHg
He is no longer diabetic
FBG: 7.3 mmol/L => 5.7 mmol/L
HbA1c: 6.6 % => 6.1 %
He lost 8cm off his waist in 3 months
Waist circumference: 97 cm => 89 cm
His total triglyceride has also lowered
TG: 1.99 mmol/L => 1.5 mmol/L
He has improved his eating habits significantly 
Nutrition: From a C to A- grade
Increased fruit and vegetable intake, increased home-cooked meals and follows the my healthy plate portion size.
He’s leading an even more active lifestyle
Steps: Active lifestyle => Highly active lifestyle. Averages 14,000 steps daily
He also reduced stress significantly
Stress: Average stress => Stress-Free

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Ling Sze-An
About the Author:  Sze is a Health and Exercise specialist with a degree in Sport & Health Science. He is passionate in helping his clients achieve the best version of themselves, constantly exploring new ways to make healthy eating and exercise more enjoyable. Sze is also a fitness enthusiast who enjoys exercising through calisthenics in his spare time.

How to build your Yong Tau Foo bowl

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Trina Lam
About: Trina is Clinical Nutritionist with previous experience in tackling unhealthy lifestyle behaviors, and prescribing specialized meal plans for weight management, diabetes, hypertension and heart disease. She is passionate in helping her clients find healthier alternatives that are both realistic and enjoyable. Trina is a strong advocate in sustainably achieving healthy eating habits through a balanced diet. Trina received her Master’s in Clinical Nutrition from the University of Nottingham (UK).

Easy Peasy Banana Breakfast Pancake

Bananas are rich in potassium which helps reduce sodium absorption into the body. It is also a great source of fibre – one medium banana provides nearly half of the daily recommended fibre intake! Enjoy this high fibre and protein rich breakfast, made quick, easy and tasty as well.

INGREDIENTS LIST:

  • 1 medium ripe banana
  • 1 egg
  • ½ cup self-raising wholemeal flour
  • 2 tablespoons water
  • A small pinch of salt
  • Cinnamon (optional)
  • Olive oil (small amount to cook) / Spray  oil

Other stuff: You can also add additional fresh fruit to serve

WHAT TO SERVE WITH:

These additions are completely optional:  A small drizzle off honey on top; One teaspoon of peanut butter for that classic peanut butter and banana flavour. Of course these add additional calories, so use sparingly.  Finally, don’t forget your tea or coffee!

NOW IT’S TIME TO COOK:

  1. In a bowl, mash up the banana with a fork
  2. Add the egg and mix together well.
  3. Mix in self-raising wholemeal flour and salt
  4. Add in the water a little at a time, stop when it becomes easy to stir but not liquidy
  5. Heat up a frying pan and spray lightly with oil

(To test the pan is hot enough, pour in one small drop of batter, if it starts to sizzle, then you know your pan is ready)

  1. Pour the batter in the middle of the pan (it’s up to you if you make one large or a few smaller ones)
  2. When you see bubbles forming it’s time to flip over
  3. Cook for another 2 mins on the other side and you are done!

HOW TO SERVE:

Serve warm with additional fruit and toppings. Fresh is best!

NUTRITION INFORMATION:
Total Energy (calories): 400

  • Protein: 14g
  • Carbs:71 g
  • Fat 10g
  • Dietary fibre 9g
  • Sodium 309mg

 

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Trina Lam
About: Trina is Clinical Nutritionist with previous experience in tackling unhealthy lifestyle behaviors, and prescribing specialized meal plans for weight management, diabetes, hypertension and heart disease. She is passionate in helping her clients find healthier alternatives that are both realistic and enjoyable. Trina is a strong advocate in sustainably achieving healthy eating habits through a balanced diet. Trina received her Master’s in Clinical Nutrition from the University of Nottingham (UK).

Buffet Survival Tips

Nothing is more Singaporean than an all you can eat buffet.  Buffets offer you a plethora of delicious food choices that can make staying healthy and on track with your health goals a little challenging. Hopefully, these tips can help you out at your next buffet outing.

  1. Before heading to the buffet, do not attempt to starve yourself. Meals earlier in the day should be balanced and light.
  2. Try and divide your plate into sections before you start choosing foods from the buffet. Fill half your plate with vegetables first. Then, you can add dishes of lean meats and grains in the remaining plate space. Not only will you be getting sufficient dietary fibre, it can also make you feel more satiated.
  3. If you have identified some favourite dishes in each section of the buffet, try and eat no more than your regular portion. If you would like to try the entire spread, consider taking just a small spoonful of each item.
  4. Opt for dishes that are cooked using healthy methods such as grilling, steaming or baking. These dishes typically have less added fats and salt than fried dishes.
  5. Minimise consumption of sauces and condiments which have extra, hidden fat, calories or sugar. If there is a salad bar, choose “lighter” dressings such as vinaigrettes instead of oil- or cream-based ones.
  6. Pay attention to portion size. Instead of heaping your plate with food, take what you can manage and eat slowly. A slower eating pace helps you to stop eating just short of feeling full.
  7. Have plain water or tea as your beverage. Sweet drinks and alcohol will only serve as empty calories.
  8. Choose only appetisers and desserts that you really want to eat, and share them with your meal companions.

 

Buffet Favourites Healthier Options
Sweet drinks / Alcoholic beverages Water, Tea

Fruit juice (Limit to not more than 2 glasses)

Creamy pasta / Casseroles Avoid or small portion (half to one ladle), remember to load up on greens
Sushi station Choose the ones you really want to try, limit to one each. Avoid fried filling or those with those with too much sauce
Fried finger food Avoid when possible. Else, limit to small portion
Ice cream station Limit to one scoop if it is a must have and pair with cut fruits, no toppings unless nuts
Cakes Choose the ones you really want to try, get a small slice to share
Chocolate fondue If you must have this, choose fresh fruits instead of marshmallow as your fondue skewer item

 

References
HealthHub, 2015. Restaurant Guide to Healthier Eating [online]. Available at: https://www.healthhub.sg/live-healthy/167/restaurant_guide_healthier_eating [Accessed 30 Nov. 2017].
Schuna, C., 2017. How to Eat Healthy at a Buffet [online]. Livewell.jillianmichaels.com. Available at: https://livewell.jillianmichaels.com/eat-healthy-buffet-4780.html [Accessed 30 Nov. 2017].

 

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Trina Lam
About: Trina is Clinical Nutritionist with previous experience in tackling unhealthy lifestyle behaviors, and prescribing specialized meal plans for weight management, diabetes, hypertension and heart disease. She is passionate in helping her clients find healthier alternatives that are both realistic and enjoyable. Trina is a strong advocate in sustainably achieving healthy eating habits through a balanced diet. Trina received her Master’s in Clinical Nutrition from the University of Nottingham (UK).

The Healthiest Hawker Stall Ever?

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About Cardiatrics:  Preventing Cardiovascular Disease through comprehensive and personalised risk factor management. Taking a scientific approach to reduce high blood pressure, high cholesterol, blood glucose and optimizing weight control. For more information visit http://cardiatricshealth.com

 

Author: Jacqueline Joose
About the Author: Jacqueline is a qualified dietitian who is passionate about translating nutritional science and communicating them through simple messages. Jacqueline has worked across a wide range of clinical wards in major metropolitan hospitals in Brisbane as well as in the areas of food service management, community and public health nutrition. Her previous experience also include private practice where she individualised her nutrition interventions to clients with various health conditions according to their needs and preferences, helping them to achieve their nutrition goals and attain optimal health. She is interested in what works for clients to sustain behaviour and realistic lifestyle changes, and seeks to continually keep herself up to date with the current scientific evidence to inform her care plans. Jacqueline obtained her Bachelor of Nutrition and Dietetics (Honours) from Queensland University of Technology, Australia.