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November marks the start of National Diabetes Awareness Month. We want to help spread awareness about managing diabetes with the ABCs of diabetes and tips on eating with diabetes. So What is Diabetes? When you have diabetes, you either make no insulin or not enough, which makes it difficult or impossible for your body to utilize carbohydrates. After you eat carbohydrate-containing foods (starchy vegetables, grains and baked items, fruit, and dairy foods), your body breaks the carbohydrates down into a sugar called glucose. Once the carbohydrates are broken down, the glucose produced gets absorbed into the blood. Glucose is used as fuel for your cells. In order for your cells to use the glucose, it needs to move from the blood into the cells. This is where insulin plays a role. Insulin is a hormone that acts like a key that unlocks the cell and allows glucose to enter.  There are Two Types of Diabetes: Type 1 diabetes: The body does not make insulin in this form of diabetes. People with type 1 diabetes need to take insulin every day. Type 1 is an autoimmune condition that typically appears earlier in life. Type 2 diabetes: The body does not make insulin or use insulin well. People with type 2 diabetes may need to take pills or insulin. Type 2 diabetes is the most common form of diabetes. ABCs of Diabetes The American Diabetes Association and the American College of Cardiology have teamed up to raise public awareness of the “ABCs of diabetes”. Managing your ABCs will help lower your chances of having a heart attack, stroke, kidney disease, or other diabetic complications. A is for the A1c test: This test shows your average blood glucose levels over the last 3 months. The A1c goal for most people is below 7%. B is for blood pressure: The blood pressure goal for most people is 120/80. A goal of 140/80 is appropriate for most people with diabetes. High blood pressure can put too much stress on your organs. It can cause heart attack, stroke, or kidney disease. C is for cholesterol: Cholesterol measures the amount of fat in your blood. The goal for most people is a value below 200 mg/dL for total cholesterol, less than 100 mg/dL for low-density lipoprotein cholesterol (LDL), and above 40 mg/dL (men) and 50 mg/dL (women) for high-density lipoprotein (HDL) cholesterol. LDL cholesterol can build up and clog your blood vessels. HDL cholesterol helps remove cholesterol from your blood vessels. Higher total cholesterol values put you at risk for a heart attack or a stroke. D is for daily exercise: Stay physically active every day. Aim for 30 minutes of physical activity per day or 150 minutes per week. Exercise can also help keep your blood sugar, cholesterol levels, and blood pressure in check. E is for eating well: Control your portion sizes, and stay on a regular meal schedule. Aim for the appropriate amount of carbohydrate calculated by your doctor or registered dietitian at each meal. F is for foot care: Check your feet for sores, blisters, or injuries every day. Diabetes can make you more prone to infections. Always wear well-padded shoes and try not to walk around barefoot. Eating with Diabetes Good diabetes self-care means following your meal plan and keeping track of what you eat and drink. Eat a variety of foods in the right amounts, check labels for calories, total carbohydrate, total fat, and sodium amounts, and eat regularly. Avoid foods that are too high in calories, cholesterol, saturated fat, trans fat, and sodium. Eating regularly throughout the day (every 3-4 hours), can also help to regulate blood sugar levels throughout the day. MyPlate is a great way to balance out your meals and control your carbohydrate intake. MyPlate focuses on filling half of your plate with non-starchy vegetables, ¼ of your plate with a carbohydrate source or starchy vegetable, and ¼ of your plate with a lean protein.  Healthy Food Choices Include:
Tips for Dining Out:
Bottom Line: At the end of the day, living an active life with a balanced diet can help manage your diabetes. Always make sure you check with your doctor or registered dietitian for methods to manage your condition. Other Resources American Diabetes Association: www.diabetes.org CDC: www.cdc.gov/diabetes/home Joslin Diabetes Center: www.joslin.org Academy of Nutrition and Dietetics: www.eatright.org MyPlate: www.choosemyplate.gov Written By: Katie Gallagher, MA, RDN, LD
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 These days there seems to be extra focus around the amount of added sugars in the standard American diet. This month, we’re focusing on added sugars in our diets and the many different effects that too much sugar can have on our health.
What are added sugars? All sugar is a form of carbohydrates that give you energy and raises blood sugar levels. There are two different types of sugar: natural sugar and added sugar. Natural sugars are those already present in foods such as fruit, dairy, and even some vegetables. Foods that contain natural sugars also provide important vitamins and minerals and other nutrients that help our bodies function. Added sugar is sugar or sugar products, such as syrups, that are added into foods when they have been processed or added in baking or cooking. The downfall of added sugar is that it contains little to no other beneficial nutrients like vitamins or minerals. So what are the health effects of too much added sugar? Too much added sugar can contribute to many different health effects. Added sugar can contribute to heart disease, raise triglyceride levels, increase blood sugars, and promote tooth decay. It can increase the risk for type 2 diabetes, weight gain, and other chronic diseases, which is why it’s important we limit our intake. Additionally, added sugars digest very quickly. This quick digestion may lead to a short burst of energy that might feel jittery, shaky, or unfocused. The quick energy burst then also leads to a fast energy drop, that might feel like fatigue, less focus, and even make you feel hungry. When we limit added sugars throughout the day, we might be able to notice the positive benefits to satiety and focus in the moment. So how much is too much? According to the Centers for Disease Control and Prevention, Americans should limit their consumption of added sugars to less than 10% of their total daily calories. According to the American Heart Association, women should limit added sugar to 25 grams per day and men should limit their added sugar intake to 36 grams per day. This is equal to 6 teaspoons in women and children, 9 teaspoons in men. To put that in perspective, one 16 oz. bottle of soda typically contains about 52 grams of sugar, or 13 teaspoons. That’s almost double what we should have in one day! How you can decrease added sugar? Added sugar is often hidden in many foods. The highest sources of added sugars can be found in juices, soda or soft drinks, baked goods, candy, sugary cereals, flavored yogurt, and ice cream. To begin reducing added sugar in your diet, you must know how much added sugar you are consuming. Reading the nutrition facts panel is the best way to find out how much sugar is in certain items. Check out this list of common names for added sugar here that you can find in the ingredient list on the nutrition facts label. One of the simplest way to decrease your added sugar intake is to avoid sodas and other sugar-sweetened beverages. Try drinking water flavored with fresh fruit or herbs. Sparkling water can be another excellent way to switch up your water intake. Other ways to reduce sugar in your diet, is to find alternative foods to satisfy your sweet tooth. If you find yourself reaching for sugary treats late at night, try to find healthier options to still get in something sweet. Other options might be:
Added sugar is hidden in a lot of the foods that we eat. Too much of this sugar can contribute to many different chronic diseases. As a part of a healthy lifestyle, work on your relationship with these sugary foods. You don’t need to completely eliminate them, but rather save them for special occasions and enjoy them as a part of a healthy, balanced diet. Resources: http://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugarshttps://www.choosemyplate.gov/what-are-added-sugars https://www.cdc.gov/nutrition/data-statistics/know-your-limit-for-added-sugars.html https://www.eatright.org/food/nutrition/dietary-guidelines-and-myplate/looking-to-reduce-your-familys-added-sugar-intake-heres-how By: Katie Gallagher, MA, RDN, LD  September is here which means that summer heat is coming to an end and the chill of the fall is soon to set in (depending on that Missouri humidity). Chilly fall days often call for cozy comfort foods. Give your comfort dishes a nutritional boost with whole grains. Did you know that the month of September is dedicated to celebrating whole grains? Arguably, whole grains might be one of the most underrated health foods on the market. In this month’s blog, we’ll talk whole grains 101, why whole grains are often the healthier choice, how to find whole grains, and ways to incorporate whole grains into your daily routine. Whole Grains 101 So what is a whole grain? By definition, a whole grain is made with or containing whole unprocessed grain. But what does that really mean? All grains are grown naturally in the whole-grain form. A grain has three major parts: the bran, the endosperm, and the germ. The bran is the outer shell of the grain that contains B-vitamins and most of the fiber. The endosperm contains carbohydrate and small amounts of vitamins and minerals. Finally, the germ contains the bulk of the B-vitamins, protein, and healthy fats in the grain.  Why Are Whole Grains The Healthier Choice? Refined grains were created in the early 1800s to create a more edible and longer lasting grain product. To refine a grain, the germ and the bran are removed, only leaving the endosperm. Now if we recall from above, the germ and the bran have the bulk of the fiber and nutrients of the grain. So through refining, the grain loses some nutrition and fiber. According to the Whole Grain Council, “Without the bran and germ, about 25% of a grain’s protein is lost, and are greatly reduced in at least seventeen key nutrients.” As dietitians, we often recommend choosing whole grain versions of grains and starches in order to get the most nutrition and fiber from our foods. Fiber can help promote fullness, increase digestive health, and regulate blood sugars, while B-vitamins can help give us energy, and promote brain health. Finding Whole Grains So how can you find whole grains? Many grains like amaranth, barley, bulgur, corn, farro, oats, quinoa, brown rice, or sorghum are often found in their whole grain form. The tricky part is finding whole grains within packaged foods or bread and pasta products. Don't be fooled by the product color or descriptions like wheat or multi-grain. Use these two simple ways to know if you are getting a whole grain:
 Including Whole Grains In Your Daily Routine The 2015 Dietary Guidelines for Americans recommend making half of your grain intake from whole grains. Simple ways to incorporate more whole grains in your diet are:
As promised, we have also included some healthy, whole grain, comfort recipes for you to try in these upcoming chilly months!
This month, aim to make at least half of your grains those hearty whole grains. What steps will you take to make whole grains a regular part of your diet? Let us know in the comments! Resources: https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/ https://wholegrainscouncil.org/ Written by Katie Gallagher, MA, RDN, LD  In April of this year, dockless bike sharing services rolled out (pun intended) in the St. Louis area. Since then, I’ve been spotting the colorful bikes all over town. I see clusters of the Lime bikes positioned in and around parks in my South city neighborhood. The yellow Ofo bikes popped up along my commute in a more random distribution with a customer’s ride ending at a city street corner or along a neighborhood sidewalk. The new bikes are part of a bike sharing network where bikes are available for short-term use. It’s a trend that has already hit cities like Chicago and D.C. In St. Louis, the system is dockless, meaning you locate the bikes using GPS via a smartphone app. Each bike is self-locking, so it doesn’t require a docking station, providing more flexibility with where you may end your ride. Our efforts with Let’s Move! STL are to encourage physical activity, and what better way to fit healthy movement into your day than during the daily commute to work or school. Since it is back to school time, I was curious - could bike sharing provide a way for students to try cycling? My curiosity led me to interview Bill, a Washington University (Wash U) student working as an intern within the Department of Health. Bill moved to St. Louis for school and lives north of the Delmar loop in U City. Though he is no stranger to biking leisurely and owns a bike, his use of the local bike sharing services could offer insight to those of you who may want to try it out. What led you to try bike sharing? I used bike sharing on a couple of occasions. The first was to explore Forest Park. I wanted a leisurely bike ride and the flexibility of leaving the bike in the park. If I used my own bike, I’d have to figure out how to get it back to my apartment before meeting up with friends. Bike sharing made it convenient to plan a one-way trip. The second time I used bike sharing I was meeting up with a friend early in the morning. I didn’t see a convenient bus route and the distance seemed too short for an Uber. My own bike was broken and I spotted the Lime bike. It was right there in the parking lot near my apartment. It sounds like the bike was right there and it made it very easy to use on that day. How did you locate the bikes at other times? The smartphone app makes it easy to locate a bike. Tell us about your experience. What did you like? It is convenient. The app makes it easy to find a bike and to locate an approved parking zone [you can’t leave them just anywhere]. There is a phone holder on handle bars to make it easier to use the app during your ride. There are 3 simple steps to get set up:
What could be improved? It isn’t a comfortable ride on rough roads and paths. The wheels are hard and there is no spring action where the frame meets the wheel so you feel the road with each bump. It may be best for a paved, dedicated bike trail. With my own bike, I can adjust the gears for hills. This isn’t the case with the Lime bike so it is challenging riding up a hill and there is no traction when riding down hill. The seat can be adjusted for height but the frame is not adjustable. The handle bars are wide set so the bike is more “one size fits all”. Since it isn’t tailored to your size, it isn’t designed for faster cycling. How do you think the bike sharing could impact active transportation within the city? My thoughts - without a dock, these bikes offer more flexibility in terms of where you can end your route, but it could mean a more haphazard placement. I’ve seen them knocked over on a sidewalk. I do see them on the Wash U and Saint Louis University campuses so students are using them. What would you tell others who may be considering using the service? It’s worth a try. Bike sharing companies are still finding their niche. I think St. Louis has a way to go in terms of “bike culture”. Ofo got started in China where there is more of a bike culture and the cost was more affordable. If you are a first time cycler, inform yourself of the rules of the road and tips for safely riding, like wearing a helmet. Also, bikes offered in bike sharing programs may be best for adults as bike fit is important when it comes to children riding safely. Bike sharing may be a great way to try a new form of active transportation or to give cycling a go as a new leisure activity. It sounds like Ofo is pulling out their bikes in the St. Louis area, but Lime bike is sticking around so you still have a chance to try it out. More great resources: Greenway Search: Locate Greenways with this handy tool! St Louis Bicycle Works: Earn a bike program gives kids a chance to earn a free bike while learning about bike safety and maintenance. St. Louis City resources to help you cycle safely: Bicycling Safety in St. Louis Trailnet: They are making walking and biking in St. Louis better for everyone with routes, group rides, and advocacy. Check out their page on Confident City Cyclin    Recent research has shown that recommendations for fruit and vegetable intake are not being met in the U.S. Only about 12% of adults are getting enough fruit intake, and about 9% are getting enough vegetable intake. Fruits and vegetables contain many vitamins and minerals that are not in other food groups. They also have fiber and antioxidants which help us stay healthy! It is recommended to get about 2 cups of fruit and 2 to 3 cups of vegetables each day. Start by slowly increasing your fruit and vegetable intake and build up to the recommendations once you have found an approach that works. Although the colder winter months bring some challenges with finding fruits and vegetables in season, it can still be done. There are still plenty of ways to reap all the health benefits of produce even when it is freezing cold outside. Try to purchase seasonal produce as much as possible (seasonal produce listed below). Seasonal Produce: Fruits
Don’t let the winter months discourage your fruit and vegetable intake. Instead, get creative and and enjoy some different selections and recipes. A little extra time and planning can improve your health in the long term.   The Health Department is striving to increase its reach to those most in need and enhance its inclusiveness for people with disabilities. To that end, Melissa Ramel, a nutrition coordinator with Nutrition Services, along with Saint Louis University (SLU) nutrition graduate students Yiwei Zhao and Allie Howard, provided a fun, interactive series of cooking classes for seniors at the Patch Neighborhood Senior Center. Although the seniors in this neighborhood live independently, about half of the ones at this center were living with disabilities. Being able to learn beneficial skills and behaviors that could be used at home could benefit them greatly. The goal of the cooking classes was to educate the participating seniors and promote healthy living through proper diet and physical activity. This was accomplished through a series of six classes. Each of the six classes included a specific nutrition topic and a tasty recipe that participants made and enjoyed at the center. The class topics ranged from MyPlate basics to adequate hydration to the importance of protein to nutrition label reading. Each recipe was chosen based on the number of ingredients, time it took to prepare, and likeliness of reproducibility. The classes were specifically tailored to allow maximum participation from all seniors regardless of ability. Each week, all thirteen participants were encouraged to help prepare the recipe and refresh their memory on food preparation safety and cooking skills. Participants not actively engaged in preparing the recipe were part of the nutrition education activities and discussions. At the end of each class, all participants received a bag of groceries to take home. The groceries included most of the ingredients used for making that week’s recipe. This allowed them to recreate the recipes at home and enhanced their food security, a concern for many seniors on fixed or limited incomes. Overall, the classes were beneficial for the participants. Through evaluation and observation, behavior changes were apparent. One notable example according to Ramel involved the use of the water cups provided during week three. Participants faithfully brought them to class and only filled them with water. Although the participants had varied backgrounds and ability levels, they all expressed their enjoyment with the class and continued interest in making healthier choices. In addition, working with the Patch Neighborhood Center created a new partnership, one that will allow for additional nutrition educations and cooking demonstrations in the future. Seniors are one of the most vulnerable populations today. Many are at an age where chronic diseases and disability can set in, and both support and resources may be limited. Teaching these seniors how to apply beneficial cooking skills and health behaviors, will help them to have a better quality of life in spite of whatever challenges they face. Nutrition Services is a contracted function between the City St. Louis Department of Health and Saint Louis University’s Department of Nutrition and Dietetics. Nutrition and dietetics professionals are available to provide health/nutrition education, perform cooking demos/classes, and educate community members on healthy lifestyle changes throughout the City. To schedule Nutrition Services for your agency, please contact us at 314/657-1571 or RamelM@stlouis-mo.gov. Written by: Melissa Ramel, MS, RD, LD   I remember as a little girl, Halloween was a chance to wear a funny costume and eat lots of candy. While much excitement and advertisement related to Halloween is focused on candy, it doesn’t mean you have to let your healthy eating guard down with your family. Try some of these simple tips to keep a rein on overindulging and keep the fun in Halloween. Balance Parents know that Halloween extends beyond October 31st; children bring home enough candy to last them weeks, maybe even months. Teaching them moderation is important so they are not filling up on candy and missing out on important nutrients. Instead of making candy and sweets off limits, teach your kids the importance of eating more healthy items and limiting the sweets and candy. Having open discussions about portions, balance, and how our bodies feel after eating certain foods will be more effective and rewarding than setting strict limits. Eating a balanced diet is also better for your teeth. Good dental hygiene in concert with limiting high amounts of sugar can prevent cavities. A great idea to make it easy for your kids to choose healthy foods would be to have options readily available. Some ideas include:
“Eat the pleasers, skip the teasers” Sometimes we eat foods because they are there, not because we are hungry for them or even enjoy eating them. However, we can teach children to be thoughtful about the foods they choose to eat, including candy. Teach your kids to separate the “pleasers” (the candies they really love) from the “teasers” (the ones they eat just because they’re there). Then give away or throw away the teasers. This idea will teach them mindful eating and to enjoy each bite. Dental Hygiene It’s no surprise that a high intake of sugar is a common cause of cavities. Dentist Dr. Ferraz-Dougherty says “it’s OK to eat that candy on halloween but it’s important to have a plan”. The American Dental Association (ADA) recommends halloween candy shortly after mealtimes. Saliva production increases during meals which cancels out acids produced by bacteria in your mouth and rinses away food particles. Another great ADA tip goes along with the idea of “eat the pleasers, skip the teasers” described in the paragraph above. Have your family choose only their favorites and donate the rest. Your teeth (and budget) will thank you if you limit your stash. Check to see if your dentist has a “candy take-back program”. Remember it is important to schedule regular appointments with a licensed dentist for you and your family. Check out the American Dental Association’s website “Mouth Healthy” for more tips on dental hygiene during halloween and all year long. http://www.mouthhealthy.org/en?source=ADAWebsiteTab Be active Walking from house to house can provide a reasonable amount of physical activity for trick-or-treaters and the parents who escort them. However, safety is important too. Be sure to find a safe area to trick or treat. A good rule of thumb would be to look for areas with a lot of other trick-or-treaters. Watch out for cars as you walk through the neighborhoods. Don’t forget to check the parks in your area for Halloween events. Many parks in St. Louis host activities on or before Halloween. With these simple tips, Halloween can be healthy and safe without ruining the fun. Check out these websites for safe places for trick or treating: https://www.tripsavvy.com/best-st-louis-kid-friendly-halloween-events-3950369 http://lafayettesquare.org/event/halloween-parade-party-5/ Written by: Vanessa Winegar RD, LD   Are you ready for an emergency? Would you be able to provide for yourself and your family if disaster struck? As the flooding happening in Texas right now has shown us, it is important to be prepared because emergencies do happen, often when you least expect them. September is National Preparedness Month. During that time, we are reminded to “Be Ready in 3” by 1) Creating a plan, 2) Preparing an emergency kit and 3) Listening for more information related to emergency response. In an emergency, two possible scenarios include sheltering in place (staying where you are) or evacuating to a safer location. Regardless of the scenario, having an emergency food supply is a must. Right now, you may be wondering a few things: What should I put in my kit to feed my family and what specific types of foods should I stock? How much emergency food should I have in my kit for each family member? How much water should I have? Here are the answers to those questions: What should I put in my kit to feed my family? The best foods for your emergency kit are non-perishable, canned or dried foods. These are typically packaged foods that have a longer shelf life. While this may not reflect your normal daily diet, keep in mind that an emergency is not a normal situation. Planning ahead can allow you to make rational choices about your emergency foods and reduce the possibility of not having something appropriate to eat. Many companies are marketing survival foods, foods processed and packaged specifically for use in emergencies. While these foods may be convenient as well as easy to stock and transport, they are not necessary and are often more expensive too. It is better to select from items commonly found in your local grocery store. What specific types of foods should I stock? Select items that are ready-to-eat and don’t require cooking. Some suggestions include canned tuna, raisins or other dried fruits, crackers, peanut butter, trail mix, nuts, granola bars, and cereal. (If you have any canned foods, remember to pack a can opener too.) If you have an infant, be sure to include formula and appropriate baby foods. Make sure all food items are stored in airtight, water-proof containers to preserve quality and keep them safe from pests. How much emergency food should I have in my kit for each family member? Pack enough to last for at least 3 days. A 3-day supply is generally sufficient to last until you can get to help or help can get to you. How long should I keep the food items in my kit? If you select non-perishable, packaged foods for your kit, check the dates on the packages. Use those dates to determine when to replace food items. Plan to replace your food items so that the items coming out of the kit are still safe for consumption. By rotating your emergency food items periodically, you will ensure that you have emergency food that is edible, and nothing goes to waste. How much water should I have? The general recommendation is one gallon of water per person per day, with enough to last at least three days. Water does not spoil, but may need to be replaced if not used in a timely manner. What about my pets? On a final note, pets are family members too. You need to provide for them as well in the event of an emergency. If your pet(s) will be with you as you shelter in place or evacuate, please have enough pet food and water to last at least 3 days. However, because your pets may not be able to access the same amenities your human family members can (i.e. come inside a shelter), the Humane Society of the United States and the American Society for the Prevention of Cruelty to Animals recommend having up to 7 days worth of food and water for each pet. Of course there are other items that should go in your emergency kit besides food and water. If you need more information on how to make a plan, what else to put in your kit or how to be more informed about emergencies, please visit: http://health.mo.gov/emergencies/readyin3/. Additionally, if you need more information about planning for emergencies when you have pets, check out: https://www.ready.gov/animals, the Humane Society or the American Society for the Prevention of Cruelty to Animals. Written by Lori Jones, MS, MPH, RD, LD When you have a tight budget, eating healthy and staying within your means can seem nearly impossible. However, healthy eating on a strict budget can be a realistic feat. See our tips below to maintain a set budget without skimping on nutrition.
Please comment with any experiences you have with saving money at the grocery store. Written by: Vanessa Winegar RD, LD   Summer is the perfect time to fire up your grill! Whether you are grilling meat, vegetables, pizza, or fruit, the smoky flavor you get by grilling is like nothing else. Here are tips for a safe, healthy and tasty barbeque.
Food Safety Tips: Follow these simple tips to significantly decrease your risk of food poisoning.
Start building your healthy barbecue around fruits and vegetables, which are low in calories, high in fiber and packed with nutrients. Look no further than your local grocery store or farmer's' market for fresh, seasonal fruits and vegetables. Here are a few ideas for a creating a healthy barbecue without sacrificing flavor.
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AuthorKatie Gallagher, Archives
September 2019
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