Frequently Asked Questions

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Reviewed by South Asian Dietary Resource Working Group - 2007

Frequently Asked Questions

Introduction

The content of this resource is based on focus groups with members of the South Asian community (n=53) and South Asian dietitians (n=8). The represented South Asian regions include India, Pakistan, Sri Lanka and Bangladesh. This resource consists of dietary questions asked by community members during the focus groups sessions and/or common questions identified by dietitians. Answers to the questions were compiled and reviewed by a working group of dietitians. The purpose of this resource is to provide background information to health professionals, but can also be used as a teaching tool/handout for clients.

Acknowledgement

Reproduction is permitted, provided source is acknowledged. Based on original work by Sadia Mian RD MSc CDE, with Research Grant funding from the Canadian Diabetes Association (CDA). Revised as necessary by The South Asian Dietary Resource Working Group (CDA - 2007). All content approved by the Canadian Diabetes Association, 2008.

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Reviewed by South Asian Dietary Resource Working Group - 2007

Frequently Asked Questions

CARBOHYDRATES

1. What are carbohydrates and how do carbohydrates affect blood glucose levels?

Carbohydrate is a major nutrient that is the best source of energy for the body. Carbohydrate foods will raise your blood glucose, but it is still very important that you eat enough of these foods. It is important to spread carbohydrate foods over the day instead of having large amounts at one meal. Foods that contain carbohydrate include grains and starches (e.g., roti, rice, and potatoes), fruit, and milk & alternatives (e.g., yogurt and lassi).

2. Why do some fruits and vegetables have more sugar than others?

Fruits have natural sugars in them. These will raise your blood glucose, but they also give you important nutrients. You can eat fruits but you need to watch portions. For example, one medium apple, orange or pear has the same amount of sugar as one small banana or half a mango. It is best to choose fresh fruits more often. Wash thoroughly before eating, and always try to eat them with the peel or skin. The peel of the fruit contains fibre (chilka), which can help manage blood glucose and cholesterol. If you are having canned fruits, choose those with no sugar added packed in their own juice rather than in syrup. Have fruit for dessert or for snacks.

Most vegetables contain little carbohydrate, so they don’t have much effect on blood glucose. Vegetables are very healthy because they provide many vitamins and minerals, as well as fibre; therefore it is important to include more vegetables at meals. Try to choose bright colored vegetables more often. The main vegetables that include carbohydrate are: potatoes, corn, squash and peas.

3. How does fibre affect blood glucose levels?

Foods that have fibre (chilka) in them, such as whole wheat flour, do not cause your blood glucose level to increase very rapidly and spike. Because of the fiber in the food, the sugar is released into the body slowly and over a longer period of time, rather than all at once. It also makes you feel full and reduces your cholesterol levels. Thus having more fibre (chilka) can help you control your blood glucose, cholesterol and weight. Fibre is found in fruits, vegetables, dahls (legumes/lentils) as well as whole grain breads, cereals and flours.

4. Does the growing method affect the amount of carbohydrates in foods?

No, the growing method does not change the carbohydrates in foods. For example, tomatoes ripened on the vines versus those ripened in hot houses do not have any difference in the carbohydrate content.

5. Does soaking/washing rice and dahl drain away the starch?

Soaking or washing rice and dahls does not drain away starch. Soaking rice and dahls in water for a long time may lead to the loss of water soluble vitamins and is not recommended.

6. Are artificial sweeteners or sugar substitutes safe?

Yes, using artificial sweeteners such as sucralose (Splenda), aspartame (Equal, NutraSweet, Sugar Twin, Sweet’N Low), cyclamate (Sucaryl, Sugar Twin, Sweet’N Low), saccharin (Hermesetas), and acesulfame potassium K are safe, when used in moderation.

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Reviewed by South Asian Dietary Resource Working Group - 2007

7. Can I have juice? What type should I select? (100% juice/nectar/fruit punch)

Juice can raise your blood glucose and therefore it is better to drink water than juice or carbonated (aerated) beverages. If you have to have juice it is better to have 100% juice which is

unsweetened (no added sugar). Avoid nectars and punches. Limit your juice intake to no more than half a cup of juice daily. You can also try diluting juice with water.

DIABETES

1. Does genetics play a role in causing diabetes? What about gender? If I have diabetes, how can I decrease the chances of my children developing diabetes?

Yes, genetics play a role in causing diabetes. Having a parent, brother or sister with type 2 diabetes increases your risk of developing diabetes. At the present time, it appears that gender doesn’t play a role in causing diabetes. If you have diabetes, your children are also at increased risk of developing diabetes. You can decrease their chances of developing diabetes by helping them to adopt a healthy lifestyle. Healthy eating, physical activity and weight management can all reduce the risk of developing diabetes.

2. Do immigrants, who have a higher level of stress, have a higher risk of developing diabetes?

No, there is no evidence that stress is a risk factor for developing diabetes, and therefore

immigrants do not have higher risks of developing diabetes because of stress. Immigrants have higher risks of developing diabetes due to other factors like genetics, lack of physical activity, and adapting to new foods and meal patterns. However, stress may sometimes unmask a diagnosis of diabetes, by revealing high blood glucose levels. This is often seen after a heart attack or stroke, where raised blood glucose levels may be encountered for the first time. Stress can aggravate your blood glucose control if you already have diabetes.

3. Does lack of exercise cause diabetes?

Lack of exercise or physical activity is associated with type 2 diabetes. People who are inactive also face greater risks for cardiovascular disease and premature death. Being active is one of the most positive things you can do to prevent or delay the onset of diabetes and improve your overall health. Besides reducing your risk of type 2 diabetes, exercise also helps lower your blood

pressure, helps you lose or maintain weight, and improve your overall well being by improving the health of your heart and lungs.

4. Do fertilizers, preservatives and chemicals found in foods, such as in canned or frozen products, cause diabetes?

Fertilizers, preservatives and chemicals found in foods have not been shown to be associated with causing diabetes. Canada has strict guidelines for the use of fertilizers, pesticides, and other chemicals; foods are monitored by the Canadian Food Inspection Agency to see that they meet these guidelines.

MEAL PLANNING & PORTIONS

1. Why are small frequent meals better than large meals?

Small frequent meals can help with controlling portions by preventing excessive hunger. However, the need for small frequent meals in people living with diabetes needs to be assessed individually. Depending on the type of meals and snacks, eating every few hours can keep blood

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Reviewed by South Asian Dietary Resource Working Group - 2007

glucose levels elevated. We should have 3 meals a day to provide our body with energy through out the day, but also to help distribute intake of carbohydrate over the day. Our meals should be spread 4-6 hours apart to give our body enough time to use glucose from the blood. When our body gets food at regular intervals, we can control our blood glucose better.

2. Do I need to snack? What are some healthy snack foods? How should I snack, how much and how many times? Is a bedtime snack okay if I am still hungry at night?

Three balanced meals a day spaced 4-6 hours apart is the ideal plan. You could have snacks in between. Space snacks at least two hours away from meals. Whether you need a snack in between your meals will vary depending on if you take medications for diabetes, are on insulin, and/or if you are trying to lose weight. Consult your dietitian about snacks if you are on insulin or take medications for diabetes.

If your meals are more than 6 hours apart, you may need a small snack such as 1 low fat yogurt, or 1 cup low fat milk, or 7 whole wheat crackers with low fat cheese, or 1 slice of whole wheat bread with peanut butter, or a medium fruit. You can choose to snack on vegetables like celery, carrots, cauliflower and broccoli any time of the day. One serving of carbohydrate is 15 g carbohydrate. The recommendation is 0-2 servings of carbohydrates per snack. If you have an early dinner (before 7:00 pm), then have a bedtime snack 2-3 hours after dinner. A small bedtime snack may help control fasting blood glucose (sugar) in the morning. If you have a snack at bedtime, check your blood glucose in the morning to see if it was higher or lower than on a day you did not have a bedtime snack.

3. Can I fast if I have diabetes?

The ideal way to control your blood glucose levels are by having 3 balanced meals and snacks if needed. If you take medications for diabetes or are on insulin, fasting can cause hypoglycemia (low blood glucose) which is dangerous. Fasting should be avoided if you take insulin or diabetes medications. If you manage your diabetes through diet and activity only, see your diabetes care team to find out if fasting can be included.

4. How many serving from each food group on the Beyond the Basics Poster should I have?

See your dietitian for an individual meal plan based on your energy needs and weight goals. Some recommendations to get you started include:

a. 3-5 servings of carbohydrate per meal and 0-2 per snack are usually appropriate Examples of carbohydrate containing foods are:

Grains and starches

Fruits (2-3 servings per day)

Milk and alternatives (2-3 servings per day) Other choices (in moderation)

b. Vegetables (choose more often)

c. 6-8 ounces of lean protein a day (e.g., lentils, soy, tofu, low-fat paneer, chicken, fish) (3 ounces of protein is the size of the palm of your hand or the size of a deck of cards) d. 4-6 servings of fat a day (e.g., vegetable oils, non-hydrogenated margarine

5. Can I only have the portions/amounts listed on the Beyond the Basics guide (e.g., ¼ of a naan)? Can I have 2 foods from the same group at one meal?

The portions listed on the Beyond the Basics guide are considered one serving. For example, ¼ of a naan is one serving of carbohydrate, which means ½ a naan would be two servings of

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Reviewed by South Asian Dietary Resource Working Group - 2007

carbohydrate and the whole naan would be four servings of carbohydrate. Your dietitian will give you an individual meal plan with number of servings to have at each meal and snack. Generally, 3-5 servings of carbohydrate per meal and 0-2 per snack are appropriate amounts. Checking your blood glucoses 2 hours after a meal will help you learn how the different portions affect your blood glucose. It is good to include a variety of foods at each meal. Try to have at least 3 out of the 4 key food groups at each meal. The food groups include: grains and starches, fruits and vegetables, milk and alternatives, and meat and alternatives.

ALTERNATIVE FOODS AND OTHER DIET RELATED QUESTIONS

1. Do spices affect blood glucose levels?

Spices like curry powder, pepper, cardamom, cloves, cinnamon do not affect blood glucose levels. These spices are a healthier alternative to salt for use in cooking.

2. Is there a difference in brown versus white sugar, with respect to increasing blood glucose levels? What about jaggery (gur) and honey?

There is no difference in brown sugar versus white sugar with respect to increasing blood glucose levels. Jaggery and honey also raise blood glucose. These sugars raise blood glucose levels quickly, which is why they can be used to treat hypoglycemia (low blood glucose). One

tablespoon of honey contains 15 grams of carbohydrate, which is the same amount found in one tablespoon of white sugar.

3. Is there any affect of bitter melon, bitter gourd, fenugreek, cinnamon on blood glucose?

There are several studies done regarding the effects of these foods on blood glucose levels. Some studies show that these foods may help reduce blood glucose levels but their affect is very small. You can include these foods in your diet as a part of healthy eating. However, you still need to follow your meal plan, physical activity routine, and take diabetes medications as prescribed by your doctor.

4. How can you get omega-3 fats if you are allergic to fish or are a vegetarian?

You can get omega 3 fats from sources besides fish. Some other sources of omega 3 fats include ground flaxseeds, flaxseed oil, walnuts, canola oil, omega 3 eggs, and DHA enriched milk.

5. Is the nutritional value of canned and frozen foods similar to fresh foods or foods made from scratch?

Fresh, frozen and canned fruits and vegetables are all healthy food choices. Make sure extra fat is not being added to canned and frozen products in the form of sauces. Rinsing canned foods with water, if possible, can help flush away some of the extra salt.

6. Is using the microwave not healthy?

Using the microwave is safe. There are some nutrient losses in every method of cooking; these losses are less in the microwave compare to when food is cooked in boiling water. Be sure to use microwave safe utensils.

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