Archive for the ‘Food and Diet’ category

Disordered?

February 23, 2011

I read Lee Ann’s post today about National Eating Disorders Awareness Week and it stuck with me. Not because I’ve experienced diabulimia, but because, even though I’ve not, I can still relate to her comments and experiences.

And, like  Lee Ann, I have often struggled to put into words my complex relationship with food, exercise, and insulin. How do you explain a behavior that is clearly detrimental to your health, but so wrapped up in emotions and memories that you do it anyway?

You see, when you grow up with a constant focus on food, your ideas about it become warped. You learn early to see the two very different sides of food. To treasure it as a sarced gift, and to despise it as an enemy. An ice cream cone can be the reward for a hard-earned 82, the punishment for a foolish 23, or the reason for a disappointing 265.

My mom (also a type 1 diabetic) did her best to allow me to enjoy activities that revolved around food. She learned early on how to use regular insulin to cover an extra treat. But I was still taking shots then, so the treats had to coincide with a regularly scheduled injection or meal.

When we had holiday parties at school, I was allowed to choose three pieces of candy to enjoy with my classmates. The rest was packed carefully in my valentine box or my Easter basket so that I could enjoy it later at home. We tested and corrected for the treats before dinner. At Halloween, I trick-or-treated with the best of them and brought home a large selection of goodies. My cousins and friends would devour most of their loot right there on the spot, but I would have three pieces and save the rest. I was allowed three pieces every night after dinner until the candy was so stale I had no choice but to throw it away.

School lunches were always a struggle and I spent many a lunch with my Cabbage Patch Kids lunchbox, gazing with envy at the trays of my friends and classmates. Oh how I wanted chocolate milk, instant mashed potatoes, and canned corn. The food messages I learned in those early school days are burned in my brain. To this day, I can’t bring myself to eat mashed potatoes with corn, breaded meat on a bun, or canned fruit in syrup.

So even at a young age I was learning about rationing food and choosing my treats carefully. I can remember lining up my skittles by color and forcing myself to eat them one at a time so that the experience would last. I ate them in order from least favorite to most favorite: all of the green ones, then the yellow ones, and so on until I reached the best flavor: grape. This habit stems from a suggestion from my grandma one morning over my oatmeal. After she poured the carefully measured ½ tablespoon of maple syrup onto the center of my oatmeal, she suggested that I eat around the edges, working into the center of the bowl to save the best part for last. I took that one and ran with it. I saved the best for last with everything from breakfast to dinner. When I have a choice, I still eat the foods on my plate one at time, starting with my least favorite and ending with my most favorite. And I still divvy up my skittles, jelly beans, and gummy candies by color if given the chance.

In middle school, I learned that if I wanted to eat something extra, I could exercise to burn it off. So I would ride the exercise bike for an hour, or run up and down the steps until I had “earned” a popsicle.

As a teenager, when I was chunkier and stockier than the other girls in my class, I struggled with body image. My doctors said I was healthy, but I was not tall and lanky like my friends. My mom mentioned to me once that the only way to lose weight is to take less insulin. I never omitted the insulin I needed to cover my food, though. I was too scared of the consequences. Instead, I starved myself: no breakfast, a juice box for lunch, and a light dinner. Of course, I couldn’t survive for long on this kind of a diet, and after months of “success”, I would give in to the cravings and binge on pizza or fast food with my girlfriends.

My exercise obsession continued through high school. I played soccer, swam with the swim team, and generally tried to stay active. During one summer, I worked at a day camp chasing kids all day, practiced with the swim team at noon, and worked out with the soccer team in the evenings. All summer. And I existed, most of the time, on that noontime juice box and a light dinner after soccer practice.

In college, my obsession turned to foods and their values. I embraced carb-counting, but I still also relied on the old exchange program. Always counting and weighing and measuring. A half cup of this. 8 ounces of that. How badly did I want that cookie? It was worth two slices of bread. Or two servings of potato chips. Or a serving of ice cream. Was I willing to give up my afternoon snack? To take an extra shot? To run around the block?

It never crossed my mind that these behaviors might be unnatural, or even dangerous. In fact, I was proud of my accomplishments and my ability to “control” my weight. And no doctor ever asked me about my eating habits or feelings about food. As long as my A1cs where good, I was given a clean bill of health and sent on my way.

Today I like to think that my relationship with food is much more balanced. I do not starve. I eat when I am hungry. But I still struggle with my internal dietician. How bad do I want that order of French fries? Could I settle for the side salad? Just this once? I will pour over a menu in a restaurant, considering all of my options. And if I’m trying out a new place, I might scour the restaurant’s webpage first so that I can compare calories and carbs and fat ahead of time. I am typically the last to order at the table and, at home, deciding what to make for dinner is often an epic dilemma.

And when I finally do decide to have the fries, I blame myself for making a bad decision. If my BG is high afterwards, I tell myself that I deserve it. It’s my fault. I made a bad choice. I should have done better.

I’m on better terms with my body now, too, but it is a daily struggle. I am always trying, but it’s hard. Because this damned disease has done weird things to my metabolism, my appetite, and my body shape. It is hard to keep your weight down when you are always hungry. Add to that the fact that I take exorbitant amounts of insulin to cover the food that I eat, and weight loss and a sense of balance are an uphill battle.

I’ve talked to doctors, dietitians, and therapists about these issues over the years, but none of them really get it. We never really dig into the issue, just skim over the top. There seems to be little interest in helping the diabetic with this ongoing issue. When will the medical community recognize the mental effects of this disease on our ability to maintain a healthy perspective on food and body? And, as patients, what would we ask them to do to help us?

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Ode to Dunkin Donuts

January 26, 2011

Coffee just right — it’s nutty, not bitter.

I could shout it from the rooftops, or announce it on Twitter.

 

And the flavor shots, there are so many, it’s hard to decide.

With no sweeteners or calories, I’ll take another on the side.

 

But the donuts, my weakness, especially Blueberry and Jelly.

Oh why must you inflate both my BGs and my belly?

 

Thank goodness for the Smart Menu, with egg whites and flatbreads.

Low calories, carbs, and fat, my reason to rise from bed.

 

And the prices? Not bad, in fact they’re downright good.

About half the price of the other chains in my ‘hood.

 

The hours, they’re impressive, too, at 24/7.

Day or night, and night or day, it’s like coffee heaven.

 

My friends, they drink Starbucks with sweet flavors like Pumpkin

But me? No way, I’ve converted. I run on Dunkin.

New School Lunch Guidelines

January 19, 2011

Did you see that the USDA is planning to announce new school lunch guidelines? I nearly choked on my tea when I read the headline over at  Fed Up with School Lunch on Friday morning.

I was skeptical when I opened the link. We all know how well the existing regulations are serving our children, but I was pleasantly surprised by the new guidelines:

Limit starchy vegetables such as potatoes, corn, and peas to one cup (two servings) per week.

Finally! Schools will now be required to offer nutrient and vitamin rich vegetables in place of the calorie dense but nutritionally weak French fries, instant mashed potatoes, canned peas and baked beans.

Reduce sodium levels by more than half over the course of the next ten years.

According to this USA Today article, the average high school lunch now has about 1,600 milligrams of sodium. The recommended daily allowance (RDA) of sodium for high school-aged children is between 1,500 and 2,300. One school lunch contains the maximum amount of sodium many high school students should consume in the whole day! The new regulations would limit sodium in high school lunches to a much more reasonable 740 milligrams, and even less for younger children whose recommended daily allowances for sodium are even lower. Nice work!

Establish calorie maximums.

You might recall that I reported in Pet Peeve: Unhealthy School Lunches that current regulations set a minimum number of calories, but do not set a maximum number of calories:

So while the school is required to serve at least 667 calories per week to its K-6 grade students, it can offer WAY more calories than that. And as the calorie count goes up, so does the allowable fat amount because the fat restriction is a percentage of the total calories provided.

According to the USA Today, the new calorie allowances would be,  “For lunch: 550 to 650 calories for kindergarten through fifth grade; 600 to 700 for grades 6 through 8; 750 to 850 for grades 9 through 12.”

This improvement is positive on several levels: First, it breaks the calorie requirements down by age group. This allows the requirement to more closely match the actual calorie requirements of the students because older children typically require more calories than do younger children. Second, the allowances are more in line with the USDA’s actual recommended daily allowances for children (depending on age and gender, the maximum number of calories allowed by the new regulation is roughly one third to one half of the recommended daily allowance of calories. Third, it places a cap on the number of calories the school can offer, limiting the ingestion of empty calories and, instead, encouraging schools to focus on nutrient and vitamin-rich foods.

For more information on the recommended daily allowance of calories for children see TABLE 3. Estimated Calorie Requirements (in Kilocalories) for Each Gender and Age Group at Three Levels of Physical Activity in Dietary Guidelines for Americans 2005, Chapter 2 Adequate Nutrients Within Calorie Needs at http://www.health.gov/dietaryguidelines/dga2005/document/html/chapter2.htm.

Limit milk offerings to only 1% or fat free milk.

Well, this is a start. Previously, schools were permitted to offer milk with any fat content. Now they are required to reduce the fat content, but they can still offer flavored milk (chocolate and strawberry) Hopefully the calorie requirements above will further force their hands, though. Chocolate milk, at 158 calories per half pint, would eat up about a quarter of the calories allowed in a lunch for students in kindergarten through fifth grade. I still wonder why we couldn’t offer water. It’s free and we all need it. My guess is that we have the dairy lobby to blame for this one.

Increase the variety of vegetable offerings.

During each week, schools must offer at least one serving of each of the following types of vegetables: orange vegetables (including carrots, sweet potatoes, and summer squash), green leafy vegetables, beans, and starchy vegetables (you might also notice that starchy vegetables are also limited to one serving by the “Limit starchy vegetables” requirement). The hope here is to increase students’ exposure to a variety of vegetables. Certainly a step in the right direction. Schools will also be required to offer one serving of fruit with breakfast and 1.5 servings of vegetables at lunch. The current requirement is a weekly one, which means schools could theoretically offer all of the required fruit and vegetable servings in on meal while the rest of the week’s meals are devoid of any fruits or vegetables.

Increase whole grain offerings to at least half of the total grain offerings.

The current regulations do not require whole grains at all, which helps explain the pasty white landscape of today’s school lunch. At least half of the pasta, buns, rolls, and rice would be replaced with whole wheat, whole grain, or brown versions immediately and all grains would be whole grain two years after implementation. Yay!

Minimize trans fat

The new regulation requires schools to use foods that contain zero grams of trans fat per serving, as indicated on the food’s nutrition label. As long as schools use the prescribed serving sizes, we should be good here. Because a food can actually have up to a half gram of trans fat per serving before the manufacturer is required to list the grams of trans fat on the label, if the school uses large quantities of these foods, they could unknowingly be serving more than acceptable levels of trans fat.

You can read the entire proposed regulation here.

The USDA is seeking input from the public on the new requirements. You can tell them what you think on regulations.gov at http://www.regulations.gov/#!documentDetail;D=FNS-2007-0038-0001. Your responses must be received by April 13th. If all goes well, the new requirements should be in place (and on our children’s lunch trays by the start of the 2011-2012 school year.

Despite a couple of shortcomings, the new regulations look promising. It’s too bad that the regulation does not put a cap on sugars, for example, but hopefully the calorie cap will help toward that end. I hate to get too excited, but this one could really work.

References

USDA calls for dramatic change in school lunches in The USA Today, http://www.usatoday.com/yourlife/food/diet-nutrition/2011-01-12-schoollunch13_ST_N.htm?csp=34news

Good news in school food on Fed Up With School Lunch, http://fedupwithschoollunch.blogspot.com/

USDA Unveils New School Lunch Standards on Food Safety News, http://www.foodsafetynews.com/2011/01/usda-unveils-new-school-lunch-standards/

Exclusive: USDA to Announce Healthier New School Lunch Guidelines on ABC News/Health, http://abcnews.go.com/Health/ConsumerNews/usda-announce-school-lunch-guidelines/story?id=12603193

How Will the New USDA Guidelines Improve School Lunch? in Health, http://health.change.org/blog/view/how_will_the_new_usda_guidelines_improve_school_lunch

USDA announces new nutrition standards for school lunch program on Nourishing Thoughts, http://www.nourishinteractive.com/blog/2011/01/17/usda-announces-new-nutrition-standards-for-school-lunch-program/

7 CFR Parts 201 and 220, Nutrition Standards in the National School Lunch Program and School Breakfast Programs; Proposed Rule in the Department of Agriculture’s Federal Register Part III, http://www.fns.usda.gov/cnd/governance/regulations/2011-01-13.pdf

Let Them Eat Cereal

September 18, 2010

I have a confession to make: I love breakfast cereal. It doesn’t matter what kind, I’ll eat them all. There’s something about that combination of cool, creamy milk and crispy yet slightly soggy cereal pieces that just makes  my day. I can eat cereal at any time of day. I find it particularly comforting for dinner or as a bedtime snack.

Unfortunately, breakfast cereal doesn’t like me.  If you’re diabetic, or just familiar with the glycemic index, you probably know where I’m coming from. The cereal tastes great until about 2 hours later when it’s pressing on my stomach walls  like a lead balloon, causing a nasty headache, a cottony coating on my tongue, and that hung-over high blood sugar feeling. Yuck.

I had sworn off the stuff for years after one final nasty experience in college. I over bolused for a giant bowl of late-morning cereal in the cafeteria, which resulted in a low about an hour later and then a nasty high that lasted most of the afternoon.  That was the last straw. I avoided the cereal aisle at the store, and stopped buying milk.

But a couple of years ago, my resolve weakened and I risked the cereal aisle again. I spent nearly an hour there reading labels, looking for a high-fiber, low sugar cereal. I settled on frosted shredded wheat. And through trial and error, I discovered a neat little secret: cereal works if I don’t add the milk. So I began a new love-affair with cereal — with dry cereal.

But this small step back towards my weakness proved fatal. Soon I was craving cereal with milk again. I tried it a couple of times, and even after carefully measuring both cereal and milk, I still faced the nasty post-cereal high. Certainly there was a better way. I explored the dairy section, looking for a low-carb milk or a milk substitute. Unfortunately, all of the lactose-free milks still had high carb counts. Then I stumbled upon the “alternative” milks in the health food section. Rice milk was out, because the carb count was still high, but soy milk (unsweetened,  of course,) might work.

I tried it. It was disgusting. And it didn’t agree with my stomach. I had just about given up my search when I noticed a new variety of “milk” in the health food section: Almond milk.

The clouds parted and the sun shone on that little box of magic. Just two grams of carb, 3 grams of fat, and 40 calories per every 8 ounce serving. And while it doesn’t taste exactly like milk, it’s pretty darn good, especially with a nutty cereal like Grape Nuts or, my favorite guilty pleasure, Cranberry Almond Crunch. I find that I need to add a little extra artificial sweetener to compensate for the lack of lactose, but my craving is satisfied and, as long as I choose a fiber-rich cereal, I can avoid the nasty post-cereal high.

As an added bonus, it’s packaged in these giant juice-box-like containers that are shelf stable for months. I keep one in the pantry and one in the refrigerator, so I’m ready whenever the cereal craving hits!

Making the Low Go: Over the Years

May 12, 2010

So I’m a day late with this post, but they always say better late than never, right? I spent most of the day in bed yesterday fighting some sort of stomach disturbance. I am on the mend, though, and ready to continue with Diabetes Blog Week

Here’s the topic du jour:

Making the low go. Tell us about your favorite way to treat a low. Juice? Glucose tabs? Secret candy stash? What’s your favorite thing to indulge in when you are low? What do you find brings your blood sugar up fast without spiking it too high?

This topic got me thinking about all of the different ways I’ve treated low over the years. And reminded me of one reason why I have such a weird relationship with food.

Back in my early days of being diabetic, some 25 years ago or so, my lows were much more severe than they are now. Thanks to the peaking effect of NPH insulin and the less-accurate BG testing methods we used, I would sometimes end up passed out, then convulsing. This usually happened in the middle of the night, although I did once have a “reaction” in the cafeteria at school. I was in the fourth grade. My friend told me later that I dropped my lunch tray and that some kid stole my milk. So not cool.

In the beginning, we treated these lows with glucose gel that came in a clear bottle that looked a lot like an Elmer’s glue bottle. It had a twist-open lid that was red and white. The “doses” of glucose were marked on the side of the bottle. Later we upgraded to “Insta-Glucose,” an awful-tasting pink gel that comes in one-serving squeezable tubes, kind of like toothpaste containers. Eventually, we added Glucagon to the mix. This shot was part powder, part liquid, had to be stored in the refrigerator, and could not be mixed in advance. The routine was that my mom would force the pink goo into my mouth, while I kicked and fought and spit, and then she would run to the kitchen to pull the Glucagon shot from the refrigerator and mix it while my dad stood by my bed to make sure I didn’t flop out.

Of course, I remember very little of this seeing as I was unconscious. But the evidence was there when I came to: pink goo all over me – in my hair, on my face, on my pajamas, and an aching sensation in whichever extremity my mom could get a hand on to give me the Glucagon shot.

After I was coherent, she would force Coca-Cola on me. She would beg and plead and finally threaten: “If you don’t drink this Coke, I’m going to have to call an ambulance.”

The Glucagon shot left me with an incredible case of nausea, so if I felt that aching sensation in one of my extremities, I knew that the night would not end without a trip to the toilet to empty the contents of my stomach: mostly Coke.

And then there is orange juice. Whenever I had a close call in public, and needed the help of a friendly waitress or shop clerk, or teacher, I usually ended up with orange juice. Because the general public seems to think that the only thing that helps a low blood sugar is orange juice. Of course I was grateful for the help, but I sure would have appreciated a glass of apple juice every now and again.

Needless to say, as a result of these traumatic memories, there are a lot of ways that I choose NOT to treat lows these days. Despite my doctors’ warnings and reprimands, I do not keep Glucagon in my house. I never treat with Coke unless it is an absolute dire emergency, and I do not treat with anything resembling Insta-Glucose, including those squeezable icing packs and those sports “shots” of dextrose gel. I also avoid orange juice like it’s the plague.

I have hung onto a couple of those early low-treaters, though. When I was a kid, I always carried a bike pouch or make-up bag full of granola bars and lifesavers. By the time I needed them, they were usually smashed and stale, but who really cares when you can hardly think straight? When I was on the soccer team in high school, my water bottle had a false bottom in it. It screwed off to reveal a granola bar, a roll of lifesavers and a couple of quarters. You might think that the quarters were for a pay phone (These were pre-cell phone days, after all,) but they were actually for the nearest vending machine.

These days I’ve abandoned the granola bars because of the slow-digesting fat, but I keep rolls of lifesavers everywhere: in my purse, in the glove box in both my car and my husband’s car, in my laptop bag for work, in my desk, and in all of my coat pockets.

When I’m at home, I use those small, toddler-sized boxes of juice (berry and grape are my favorite,) and Dots (five of them is 15 grams of carb.) When I was in the first trimester, I was low ALL of the time. I treated with Jelly Belly jelly beans because they were just about the only thing I could stomach. When I’m out and about and there’s time, I will order a smoothie, because let’s face it, if you have to go through a low, it’s always nice to end it with a little treat.

Washington D.C. Council Approves Stricter School Lunch and Exercise Standards

May 6, 2010

Things have been pretty hectic around here lately, what with the SIX doctor appointments I have this week, so I’ve been kind of slacking on the blogging front.  I read an interesting story about a possible improvement to school lunches, though, so here is a quick review.

The article, from the Washington Post, reports that the Washington D.C. Council approved stricter school lunch and exercise standards for the school district.

In particular, the standard requires public and charter schools in the district to add more fresh fruits and vegetables and whole grains to school meals. In addition, the standard encourages schools to buy their food from organic farms, and to triple the amount of time that students spend exercising. The schools are also required to serve a different fruit and vegetable every day, to only offer low-fat or nonfat milk and whole grains, to ban trans fats, and to limit sodium and saturated fats.

While the measure is definitely a huge step in the right direction, it does fall flat on a couple of levels. In particular, the original measure also limited calories in the meals, but this stipulation was removed at the request of the USDA, even though the Institute of Medicine issued guidelines last fall that recommended calorie limitations.  You might remember from my first post about school lunches that the USDA establishes a minimum requirement for calories, but no maximum. My guess is that the USDA does not want to limit calories because this could potentially limit the amount of food purchased as part of the school lunch program. Luckily, the article reports that health professionals and nutrition advocates are working to get federal calorie limits lowered.

In addition, the measure limits milk to low-fat and nonfat, but does not restrict flavored milks. And we all know that 2% milk, so-called “low-fat,” is actually not low in fat at all. In fact, a half-pint serving of 2% white milk contains 120 calories and a full 5 grams of fat – a whole fat serving. In comparison, the same amount of skim milk contains 80 calories and no fat, while still providing the same amount of Vitamins A, D, C, and Iron as its 2% brother.

The measure also does not re-define a vegetable. So it seems that corn, peas, beans, and potatoes will still qualify as vegetables and will meet the new requirements as long as they are fresh.

Perhaps the most troubling issue is that the council has not yet decided how to pay for the upgrades to the lunch program. Estimated at nearly $6 million per year, the sponsor of the legislation, Mary M. Cheh, proposed a one-cent per ounce tax on canned and bottled soda to cover the increased costs. This tax would generate $16 million annually, but was rejected by other council members.

Nevertheless, it goes without saying that fresh fruits and vegetables, lower-fat animal products, reduced-sodium meals, and the return of exercise to the curriculum are definite improvements over the status quo. Hopefully the D.C. school district will succeed with this measure, and more schools will follow suit.

Healthy School Meals Act: More of the Same

April 21, 2010

Mrs. Q over at Fed Up with School Lunch: The School Lunch Project has been getting a lot of press lately about her attempt to chronicle her year of school lunches. As the school lunch debate continues to heat up, so do the comments and commentaries on her blog. I’m amazed that she has managed to stay anonymous for so long. I hope she’s able to make it all year without being outed.

Recently, she posted about the Healthy School Meals Act of 2010. On the surface, this sounds like a great plan. Even the name of the plan sounds good – how could you go wrong with healthy school lunches? That’s what we all want, right?

But, I took a look at the plan, and now I am not so sure. The plan is less about a well-balanced, calorie-appropriate meal for our children and more about plant-based alternatives to meat and dairy. According to the program’s website, the act would

improve children’s eating patterns by encouraging the inclusion of healthful plant-based options in the National School Lunch and Breakfast Programs. This important legislation will introduce plant-based foods to schools, increase the availability and affordability of these foods, and provide incentives for schools to provide daily plant-based options.

Don’t get me wrong, there is merit in a vegetarian diet and lifestyle, and one can definitely eat a varied and balanced diet while avoiding meat and dairy. But this proposal does not seem to give much guidance in terms of which plant-based items to include on our children’s trays. What, exactly, is “healthful?” And what makes this group think that plant-based options are not already on school trays? Many of the items we detest … white bread, soy fillers in the meats, breadings and coatings on the “nuggets” and “patties”, white potatoes in all of their many forms, other starchy vegetables like corn, and peas, and canned, syrup-laden fruits appear regularly on school lunch trays today, and they are all plant-based.

Given that the current National School Lunch Program considers canned baked beans, frozen French fries, and instant mashed potatoes in the vegetable category, I shudder at the thought of what my child’s tray would look like if his school opted to replace the meat and dairy options with plant-based options. I’m picturing trays loaded with white bread, rice, pasta, frozen potatoes, and canned corn. Sure, the website suggests soy milk instead of cow’s milk, but what’s to stop a school from replacing the cow’s milk with calcium-fortified orange juice or, worse yet, calcium-fortified “orange drink?” And what’s wrong with skim white milk, anyway?

These plant-based alternatives are some of the cheapest foodstuffs out there. Seeing as our schools are struggling to find enough money to feed our children, it only makes sense that these are the types of foods they would migrate too. Goodbye chocolate milk and chicken nuggets, hello French fries and white bread.

The problem with school lunches today is not hard to recognize; it’s a lack of balance. What our children need is a healthy, balanced meal, complete with fiber-rich carbs, lean proteins, and vitamin-dense fruits and vegetables. Simply replacing one food group with another is not the answer here. The answer is switching from calorie-dense, nutrient-poor foods to lower-calorie, nutrient-rich ones. We need to replace the French fries and baked beans with REAL vegetables – green beans, tomatoes, broccoli, and spinach, for example. Get rid of the soy-filled and artery-clogging “hamburgers” in favor of lean protein alternatives like chicken breast, ham,  white turkey meat, and low-fat yogurts and cheeses. And beans are a great source of protein, but they are not a protein exchange (or a vegetable exchange for that matter.) We need to count the carbohydrates in those black bean burgers … and those cups of baked beans.

Resources

Healthy School Lunches, by the Physicians Committee for Responsible Medicine, http://www.healthyschoollunches.org/index.cfm