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CONTENTS

FEATURES

THRIVE 12 ENIGMA OF DIABETES REVERSAL Do we have evidence that it is possible to reverse it?

14 10 WAYS TO BOOST

YOUR IMMMUNITY Winterise your health with these smart tips.

WELLBEING 18 PREP BEFORE A CHECKUP

Here’s how to maximise your time with your doctor.

20 GUT CHECK

Emerging research connects gut bacteria to diabetes.

24 THE NEED FOR VITAMIN D Enough vitamin D is important for overall health and may also be the key for managing diabetes. 26 ARE SUGAR FREE DRINKS SAFE FOR TEETH? Sugar is considered bad both for diabetes and dental health. But are its subsitutes safe?

28 VEDIC WAY TO MANAGE

DIABETES Herbs, along with few lifestyle changes can help reduce insulin dependence and bring down blood sugar levels.

30 10 TIPS ON DIABETES CARE

DURING WINTERS Winters in India come packaged with a kaleidoscope of complications. 10 things to remember…

ON THE COVER

photo Blaine Moats styling Jennifer Peterson

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LIVING 34 SO YOU’VE BEEN

DIAGNOSED Common complaints and anxieties around diabetes that need to be addressed.

38 DIETARY ASSISTANCE

POST BARIATRIC SURGERY It’s important to learn how to manage your diet after the procedure.

42 DIABETES AND

CANCER: SYMBIOSIS IN CAUSES AND THERAPY The two conditions overlap on several steps of diagnosis and treatment.

52 EAT THEM RAW

Certain things in their raw form that are suitable for consumption in winters and those that aren’t.

FOOD 58 A DISH TO SHARE

Slimmed down holiday sidedish classics so you and your family can have your casserole and eat it, too.

64 SMALL BITES

NUTRITION

BIG FLAVOURS With bold flavours in every bite, this spread of secretly healthy appetizers will delight partygoers.

46 EXCESS SUGAR

66 SHEET PAN SUPPERS

Here is why you should be wary of consuming sugar in large amounts.

48 NEW DIET

PERSPECTIVES A good understanding of your physical condition can help nutritionists and metabolic experts to carve a better dietary plan for you.

50 SWEET CRAVING

There are ways to fix the craving for sweets by understanding the causes.

India’s #1 & only magazine on diabetes with maximum reach JAN-FEB 2017

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Your favourite healthy meal essentials roasted and caramelized to perfection in these oven-cooked recipes.

FAST & HEALTHY

Weeknight Meals Dietary ASSISTANCE after Bariatric Surgery

2 Diabetic Living

78 BEAT IT WITH BEET Despite being high on sugar content beetroot has been given a clean chit by endocrinologists. Paint your winters red with these recipes.

GUIDE TO ABBREVIATIONS Educators. ADA: American Diabetes Association. CDC: U.S. Centers for Disease Control and Prevention. FDA: U.S. Food and Drug Administration. NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases. NIH: National Institutes of Health. PWD: person with diabetes. USDA: U.S. Department of Agriculture.

jan-feb 2017

INSIDE COVER Editor’s Letter

Advisory Board

Recipe guide

POWER FRUIT Lemons are so much more than a garnish for hot tea.

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72 LEMON: WINTER’S

LIVING AADE: American Association of Diabetes

10 Ways to Boost Your Immunity This Winter

24 GET CONNECTED Like us on Facebook and follow us on Twitter (@DLIndia). Purchase our digital edition at DiabeticLivingOnline.in/Subscribe

INDIA

The Game of Interpretations

INDIA EDITION

EDITORIAL

Publisher & CEO ASSOCIATE PUBLISHER COO

NITIN AGARWAL ARPIT AGARWAL ALOK KATIYAR

MEREDITH CORPORATION

Let us start with asking a question. Would you rather look back and reminisce over the past or look ahead and plan for the future? Before you form a solid choice, think of this question in context of a year ending. Many things come and go, incidences take shape, world events surprise or shock you, personal life goes through developments and upheavals. The obvious choice of a practical person in this case would be to, of course, without a doubt, plan for future as the past is past and will never come back. However, if we slightly change the language of the question without altering the meaning you might think differently. ‘Would you spend time introspecting your actions that occurred in the past or just move on with the future?’ This simple shift in perspective is what makes all the difference. Such questions are metaphors for our choices in life. We will only make the right choices if we have understood the question well. Unless you don’t twist and turn a situation like a kaleidoscope you will never be able to do justice to the possibilities it could be pointing at. As we enter the new year let us together try to be more open and perceptive towards possible perspectives in life, especially in health care. The current issue of Diabetic Living offers insightful stories with a sparkle of something new, as also in the overall look of the magazine. Thrive covers 10 ways to boost your immunity which often falls low in the winter season. It is not enough to go to your doctor for a check up, as the long queue in front of his door suggests less individual time with each patient. Understand how to maximise your time with your doctor in How to prep before a check up. December, January and February are usually the months when we can afford to bask in the sun and absorb some vitamin D, but with these new studies about its connection with diabetes as outlined in The need for vitamin D you might want to do it all year long. Besides regulars we have three separate stories on sugar from three different perspectives: sugar alternatives and dental care; management of sugar cravings; and the deconstruction of sugar to outline its harmful effects. And our favourite section on food is just perfect for the season. From lemons to beets everything that can add favour and wellness to your diet finds its way into the recipe section. Let us raise a toast of beetroot juice to new avenues and milestones in our journey of life. Happy New Year!

Chairman and CEO Vice Chairman Editor International Director

STEPHEN M. LACY MELL MEREDITH FRAZIER MARTHA MILLER JOHNSON MIKE LOVELL

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101, Arunachal Building, 19 Barakhamba Road, New Delhi-110001, India Tel: 91.11.41543666 Diabetic Living India magazine is printed and published by Nitin Agarwal on behalf of TCG Media Limited. Printed at: TCG Media Limited, Diabetic Living India magazine is published bi-monthly. Diabetic Living India magazine is a trademark of Meredith Corporation and TCG Media Limited. The entire content of Diabetic Living India magazine are copyrighted to Meredith Corporation and TCG Media Limited. All rights reserved. The writing, artwork and/or photography contained herein shall not be used or reproduced without the express written permission by TCG Media Limited. TCG Media Limited or any employee(s) does not assume responsibility for loss or damage of unsolicited products, manuscripts, photographs, artwork, transparencies or other materials. TCG Media Limited does not assume any liability for services or products advertised herein. www.diabeticlivingonline.in Disclaimer: Diabetic Living (India) is not responsible nor liable for any advice, course of treatment, diagnosis or any other information, services or products that you obtain through this magazine.

Editorial team

IT’S ALL GOOD INSIDE

Wellbeing

Living

Nutrition

INDIA

Editorial advisory board The following health care professionals—all experts in diabetes management— review articles that appear in Diabetic Living ® magazine: Connie Crawley is a nutrition and health specialist for the University of Georgia Cooperative Extension Service in Athens, specialising in diabetes and weight loss. Connie is a member of the American Dietetic Association Diabetes Care and Education practice group.

Marion J. Franz has authored more than 200 publications on diabetes, nutrition, and exercise, including core-curriculum materials for diabetes educators. Marion is a member of the American Dietetic Association Diabetes Care and Education practice group.

Joanne Gallivan is executive director of the National Diabetes Education Program at the National Institutes of Health. Joanne is a member of the American Dietetic Association Diabetes Care and Education practice group.

Marty Irons practises at a community pharmacy and has served in industry and the military. Jeannette Jordan works for the Medical University of South Carolina in Charleston and consults with the Centers for Disease Control and Prevention.

Irene B. Lewis-McCormick is a fitness presenter and educator. Certified by the nation’s leading fitness organisations, she is a faculty member of the American Council on Exercise.

Chris Smith, The Diabetic Chef ® is the president of Health Range, Inc., and a professionally trained chef. He is a food consultant and cookbook author and conducts healthy-cooking classes.

Hope S. Warshaw is a writer specialising in diabetes care. She has authored several American Diabetes Association books. Hope is a member of the American Dietetic Association Diabetes Care and Education practice group.

Fred Williams practises endocrinology and specialises in diabetes. He is an active member of the American Association of Clinical Endocrinologists and serves on the board of directors.

John Zrebiec is director of Behavioural Health Services at the Joslin Diabetes Center in Boston and a lecturer in the department of psychiatry at Harvard Medical School.

4 Diabetic Living

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INDIA

Editorial advisory board, India The following health care professionals—all experts in diabetes management—review articles that appear in Diabetic Living® magazine’s India edition: Decorated with the Padma Shri and BC Roy award, Dr. Anoop Misra is Chairman, Fortis-CDOC Center of Excellence for Diabetes, Obesity, Metabolic Diseases, and Endocrinology, in New Delhi. He is also Chairman of the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and Director of the Diabetes and Metabolic Diseases, Diabetes Foundation of India. Dr. Misra has led several pioneering research studies on diabetes and has published more than 300 research papers. Dr Ambrish Mithal MD, DM: (Padma Bhushan Awardee 2015) Member Governing Council, Indian Council of Medical Research (ICMR), Doctor of the year DMA 2005, cited in the Limca Book of Records since 2005 - is presently the Chairman and Head of Endocrinology and Diabetes Division at Medanta, the Medicity where he has established one of India’s premier diabetes and endocrinology centres. Dr. V. Mohan is Chairman and Chief Diabetologist of Dr. Mohan’s Diabetes Specialities Centre and President & Director of Madras Diabetes Research Foundation, Chennai. He has published over 600 papers in prestigious peer reviewed journals and contributed over 100 chapters to text-books on diabetes. He has received the prestigious Dr. B.C. Roy National Award, and Fellowships from all the four Royal College of Physicians of London, Edinburgh, Glasgow and Ireland. Dr. Shashank R Joshi is a well-known endocrinologist in Mumbai. He is president of the All India Association of Advancement for Research in Obesity and vice president of the Association of Physicians of India. Padma Shri and BC Roy awardee Dr. KK Aggarwal is an eminent name in cardiology. President of the Heart Care Foundation of India and editor-in-chief of the Indian Journal of Clinical Practice, Dr. Aggarwal has a keen interest in mind-body healing. He is a regular columnist and expert for both print and television networks. Rekha Sharma is director of Clinical Nutrition and Dietetics at the Diabetes Foundation of India. This former chief dietician of the All India Institute of Medical Sciences in New Delhi has devoted several years of her life to the study of diabetes management. Madhuri Ruia is a nutritionist and fitness expert in Mumbai. A certified pilates expert from the Pilates Institute of UK, she runs Integym, a state-of-the-art centre that promises ‘intelligent fitness’ to its clients. Dr. DS Chadha is head of cardiology at the Command Hospital in Bengaluru. He has won dozens of awards, written several research papers in leading medical journals and chaired several national and international conferences on health issues. Working Committee Dr. Swati Bhardwaj is vice head at the Center for Nutrition and Metabolic Research and a nutritionist with the Diabetes Foundation (India) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Shubhda Bhanot is a certified diabetes educator and a nutritionist with 14 years of experience in the field. A life time member of ADE (Association of Diabetes Educators), she is presently working as chief diabetes educator at Medanta, The Medicity, Gurgaon.

DiabeticLivingOnline.in

READERS’ WRITE

WINNER

I am a parent of a nine year old and my son has started gaining weight which, as his doctor says, may be an alarming situation for causes of complications like diabetes and heart issues. I found your article on overweight kids and malnutrition very informative and encouraging in the sense that things may restore control by simple corrective measures. Jagriti Sah - Gurgaon

Health and vacations Your story on Ananda as the perfect place to release tensions and rejuvenite for a healthier mind and body was amazing. I am from Uttarakhand and despite that it never occured to me that I could go to a place so easily accessible to me, whilst people from all over the world come there regularly. I know where my next holiday is going to be at. Shaifali Streeting Joshi - Ranikhet

Apple truth I am a regular reader of your magazine and especially love the food section. There was something about the article with apple recipes in your last issue that opened my eyes towards how big a difference a tiny change in portion size may make in its calorific value. Keep the good recipes coming! Anuja Peter- Mumbai

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Q1 Dr Anoop Misra

Chairman, Fortis-C-DOC (Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology); Chairman, National Diabetes,Obesity and Cholesterol Foundation (N-DOC)

QA +

Diagnosis of diabetes can constribute to anxiety of even depression, which can cause you to feel tired.

8 Diabetic Living

jan-feb 2017

I’ve had diabetes for seven months, and I’m always tired. Is there anything I can do to overcome being tired all the time?

Ans. Are you monitoring your blood glucose levels? Tiredness is common when glucose stays too high. The target level for fasting blood glucose (before eating) is 70-130 mg/dl and under 180 mg/dl one to two hours after meals. Monitoring your blood glucose can tell you a lot, including how meals and activity affect your blood glucose trends. Another thing to consider is how you’re coping with this new reality. A diagnosis of diabetes can contribute to anxiety or even depression. Depression can cause you to feel tired. Ask your provider to screen you for depression. Some things that help keep your blood glucose levels steady, such as getting enough sleep and daily physical activity, can help treat depression, too. Also ask your doctor about sleep apnea – a condition that prevents deep sleep. Depression and sleep apnea are common with type 2 diabetes; both are treatable.

Q + A

Q2 I’m 41 years old, overweight, and was just diagnosed with type 2 diabetes. My legs and feet hurt due to poor circulation. Will this lead to amputation? Is there anything I can do to improve the blood flow to my feet?

Q3 How many grams of carbohydrates should a woman with diabetes have each day?

Ans. Generally speaking, being a woman means you likely need to eat fewer carbohydrates each day than a man. However, the amount of carbohydrates you need should depend on many factors, including your size, age, activity, desire to lose weight, and food preferences. There is not a one-size-fits-all amount of carbs for all women. Everyone is different and has diverse nutritional needs. Carb intake depends on: • Height and weight. Are you currently underweight, normal weight, or overweight? • Activity level. Are you sedentary,

Ans. Rest assured, by getting and keeping your blood glucose under control and practicing preventive measures with regular foot care and annual (or more frequently if needed) leg and foot exams by your health-care provider, amputation can be avoided in many instances.

The pain in your legs and feet may be due in part to poor circulation but may also be due to diabetic neuropathy, nerve damage from higher than normal blood glucose levels over time. It is common for diabetic neuropathy to cause numbness, pain, tingling, and other symptoms in the legs and feet. Even though you were recently diagnosed with diabetes, it is likely that your blood glucose has been elevated for some time. As your blood glucose levels become closer to normal, the pain may gradually decrease. Keeping your blood glucose close to normal and caring for your feet can help improve circulation and delay further complications. You should take off your shoes and socks at every visit to remind your doctor to check your feet. Look at your feet daily, using a mirror or magnifying glass to examine the tops, bottoms, and sides. Seek medical attention if you spot a problem.

moderately active, or highly active? • Gender. Generally, men require more calories, and thus more carbohydrates, than women. Pregnant women and those who are breast-feeding require more as well. Most adults need 6-11 servings of carbs per day, depending on the factors listed above. The general starting point for a moderate-size woman is 45-60 grams of carbohydrates at each meal; for moderate-size men, 60-75 grams of carbs per meal. Most people with diabetes don’t need to eat snacks. If you enjoy eating a snack in the late afternoon or before bed, use some of your allotted carb grams, say 15-30 grams, for a snack.

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THE ENIGMA OF

DIABETES REVERSAL

Latest research and case studies have incidences of a possible backtracking of the condition of Type 2 diabetes. Learn what an expert has to say on this... writing Dr. S K Wangnoo

ew of the most frequent questions that I am asked in my daily routine, both by my students and outpatients are ... What is the basic nature of Type 2 diabetes? What causes it? Do we have evidence that it is possible to reverse it? The answer is simple enough and also not so simple! It is associated with obesity, and both insulin resistance and a Î˛-cell (cells in our pancreas that produce insulin) defect are involved. By the time one is diagnosed with diabetes, seven to 10 years have already passed in the pre-diabetic stage. Unfortunately, in our healthcare set up we do not lay emphasis on the concept of annual health check-ups. After the diagnosis blood glucose levels rise steadily, irrespective of the type of treatment. By approximately 10 years after diagnosis, almost 50 per cent of all people with Type 2 diabetes are on insulin therapy. This steady deterioration has been observed in many studies and clearly establishes the belief that Type 2 diabetes is an inexorably progressive disease.

12 Diabetic Living

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A possible turnaround

It has also become widely accepted that Type 2 diabetes is inevitably life-long, with irreversible and progressive beta cell damage. However, the restoration of normal glucose metabolism within days after bariatric surgery in the majority of people with Type 2 diabetes disproves this concept. There is now no doubt that this reversal of diabetes depends upon the sudden and profound decrease in food intake, and does not

relate to any direct surgical effect. Novel magnetic resonance methods have shown decrease in total body fat, leading to resolution of diabetes. It is now clear that Type 2 diabetes is a reversible condition of intraorgan fat excess to which some people are more susceptible than others due to several reasons. So what can we do towards this effect? First and the foremost, we need to understand that any two people are not alike at all. What works for one may not work for the other. ‘Reversing’ Type 2 diabetes is

something that is discussed all the time in magazines, on television and in social media with stories of people being ‘cured’ of diabetes. On closer inspection, all these stories have a common thread – the people who have reversed their diabetes have done so by losing large amounts of body weight, often the equivalent of 10-15 per cent of the total body weight. It is generally accepted as true that with weight loss, a person can potentially reduce the demands on their body so much that they now acquire

Consult a doctor. He candefinitely guide you better than google.

sufficient working insulin to control their glucose levels. When we eat and drink more calories (energy) than is needed by the body day after day and year after year, the excess calories are stored as fat in the liver, under the skin and around the abdomen. Research has shown diabetes being reversed with bariatric surgery and in people who follow very low calorie diets, with a majority being able to maintain the sugar levels in normal range, if they are able to be at an ideal body weight situation.

EXPERT’S TAKE People need to become accustomed to eating approximately two-third of the total amount that they used to eat, suggesting that the ‘reversal’ may be only remission and dependant on healthy eating. One should not embark on a very low calorie diet without medical supervision. With any weight loss programme, diabetes medication may require to be reviewed, especially if the medication puts the person at risk of low blood glucose levels. And then, even after achieving normal sugar levels, regular follow up is essential. Whether or not you will remain in remission or are cured, depends upon many parameters which are a subject of ongoing research. So, my advice is to eat well, live well and exercise regularly. Do not jump blindly on remedies and fads! Consult with your doctor – he definitely knows more than google!

Dr. S K Wangnoo, Sr. Consultant(Diabetic, Metabolism), Indraprastha Apollo Hospital DiabeticLivingOnline.in

“It is health that is real wealth and not pieces of gold and silver.” —Mahatma Gandhi

THRIVE

GOOD TO KNOW

WAYS TO BOOST YOUR IMMUNITY

writing Karen Asp; photos Blaine Moats (tea cup), Jacob Fox (tea bag)

Being sick with a cold or the flu can raise your blood sugar, and PWDs have higher risk of serious flu-related complications. Winterise your health with these smart tips.

2 Soothing GingerLemon Tea recipe, p. 112

GET QUALITY SLEEP

According to a study in the journal Sleep, people who logged between seven and eight hours of undisturbed Zs took fewer sick days. To get plenty of undisturbed sleep, avoid heavy foods, caffeine, and alcohol before bed. Sleep somewhere that’s dark, comfortable, cool, and quiet. 14 Diabetic Living

jan-feb 2017

Tea tip: Scald your hand on the teapot? A damp, cool tea bag takes the sting out of burns.

GREEN YOUR TEA

Among its many health benefits, green tea contains a compound that can increase your number of regulatory T cells. Research from the journal Immunology Letters suggests these might play a significant role in immune function. Even better, add a squeeze of lemon to that cup of tea to get your entire daily dose of antioxidant vitamin C. Check out our favourite recipe, Ginger-Lemon Tea, at DiabeticLiving Online.com/Tea.

GOOD TO KNOW

SAY OM

Yoga may do more than improve your flexibility. It could also increase your immune function, as indicated in a study from the Journal of Alternative and Complementary Medicine on people who did yoga 90 minutes once a week for 12 weeks. The takeaway: Add a few days of yoga to your weekly fitness routine.

POP THE VITAMIN D A lack of it may lower immunity, studies say. See our story on page 24.

BE A TREE HUGGER The Japanese call it forest bathing, and while it might sound a little out there, studies show that spending time among the trees activates natural killer cells, which are part of the immune system. Or just hug a human instead! Hugs lower the harmful effects of stress, which could protect you from infections, too, according to a study in Psychological Science.

KICK THE BUTTS Cigarette smoking lowers your immunity, making you more prone to sickness. But it’s not only regular cigarettes. Research from the University of North Carolina at Chapel Hill shows that e-cigarettes can also hurt immunity.

BOOK A MASSAGE

Talk about the perfect excuse to get pampered. In a study from the Journal of Alternative and Complementary Medicine, people who got a 45-minute Swedish massage had significant changes in levels of white blood cells that help defend the body against disease.

NOSH YOUR FIVE A DAY

Among folks who ate five servings of veggies a day, just 20 per cent reported illnesses compared to 33 per cent of people who ate only two servings a day, per a study from the American Journal of Clinical Nutrition.

DiabeticLivingOnline.in

LOG A SWEAT

Exercise has so many benefits, especially if you have diabetes. But what you might not know is that it can reduce the symptoms and severity of respiratory illnesses. In a study in the British Journal of Sports Medicine, people who did regular aerobic exercise were less likely to develop a cold; the least infected exercised at minimum five days a week. Even if the exercisers did get sick, their colds were less severe than sedentary folks.

GET UPLIFTED

Positive emotions aren’t just good for your spirits, they also have a direct effect on your immune system. The more that young adults experienced positive emotions—awe, wonder, and amazement—the more they lowered levels of cytokines, proteins that in high levels are associated with poorer health, according to a study in the journal Emotion.

Find your favourite workouts and exercise tips at: DiabeticLiving Online.com/Diet/ Fitness

Stay dry and dress warmly in several layers when you go outside in the cold.

photos Getty Images (pine tree and woman), Jacob Fox (pills)

Immunise! The CDC recommends that PWDs get both a yearly flu shot and a yearly pneumonia vaccine, unless told otherwise by a health care provider. 16 Diabetic Living

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WELLBEING “Wellness is the complete integration of body, mind, and spirit – the realisation that everything we do, think, feel, and believe has an effect on our state of well-being.”

OFFICE VISIT

HOW TO PREP BEFORE A CHECKUP

writing Hope Warshaw, RD, CDE; photo Getty Images

Those seven minutes with your doctor fly by. Hereâ&#x20AC;&#x2122;s how to maximise your time.

18 Diabetic Living

jan-feb 2017

3–6

DAY OF VISIT

MONTHS OUT

WEEK OUT

Schedule your visit strategically. Take the first appointment of the morning or the first one after lunch.

Make a list of the diabetesrelated tests and checks you need, such as an annual flu shot or kidney function test.

Ask how to share your blood glucose records. Some providers download the data from your meter when you arrive; others want to see your printout. Regardless, bring a hard copy that you have marked up with your thoughts so you can share observations about highs, lows, and trends.

Do lab work beforehand so you and your provider have results to ponder during the visit (check to make sure your health plan allows this).

Jot down questions as they arise. Having them in writing frees your brain for thinking rather than remembering.

Change is OK. If your care doesn’t meet expectations or you aren’t working as a team, find a different provider.

Organise tests and checks in chronological order. Keep them in an efficient and easily accessible system and bring to your appointment. This helps you and your provider better manage your diabetes over time. For example, track your meds, including when you start each one, the dose, dosage changes, and any side effects. Make a list of referrals you need. Annual eye exam? Mental health provider? You’ll need a referral for Diabetes Self-Management Education (DSME) and Medical Nutrition Therapy (MNT). Get to an endocrinologist if you and your provider are unable to get your diabetes under control. Time is of the essence—don’t wait until It says a lot to complications set in. Look over your questions from the past few months. Prioritise them.

providers when you’re actively engaged in your care.

Show up 10 minutes early, with records and questions in hand. Record results such as weight, blood pressure, and A1C. Get a copy of test results. Take off your shoes and socks for a foot exam. Bring monitoring supplies. Ask your provider or other knowledgeable person in the office to check your meter and technique. According to ADA, you should do this when you get your first meter or a new meter, and at regular intervals thereafter. Be honest. Note personal, financial, or family issues. For example, don’t agree to a new medication if you can’t afford it or take it at the required times or frequency. Don’t commit to behaviour changes you aren’t ready to make. Help your provider understand your concerns and challenges. Take notes on a smartphone, tablet, or paper to remember key points and action items.

sources George Grunberger, M.D.; Donna Tomky, ANP-BC-ADM, CDE; Susan Weiner M.S., RDN, CDE

DiabeticLivingOnline.in

GUT CHECK Why and how to build a healthy gut writing Debbie Koenig | illustrations Sam Ward

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Research suggests that when it comes to diabetes, two types of bacteria that live in your gut play key roles. Scientists are looking for ways to use this information to treat or even prevent diabetes. Even when you’re sitting alone in a room, you’re completely outnumbered. Inside your body is a microbiome of living organisms—trillions of them—that help you fight disease, process nutrients, and sometimes make you sick. These little critters live all over your body, but the largest microscopic world is in your gut. Researchers are working feverishly on new discoveries that may uncover the secrets of the gut microbiome, which offer promising new treatments for diabetes. What makes a healthy gut? We’re all born with a clean slate, gutwise, and start acquiring microbes at birth.

Everyone’s belly contains a unique combination of organisms, carrying a few hundred out of the roughly 1,000 known to exist. That variation makes it tough to define a healthy gut, says Robert Karp, Ph.D., program director for genomic and microbiome studies in the Division of Digestive Diseases and Nutrition at the NIH’s NIDDK. “There isn’t just one healthy version,” Karp says, “and there are many different ways to get there.” But research points to diversity as a crucial component of good health. “The general idea is that a diseased microbiome is relatively depleted,” Karp says. “It doesn’t have as great a variety of

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microbes as a healthy microbiome does.” One danger to your gut seems certain: antibiotics. They appear to change your gut’s composition, and some people never recover from that—scientists can’t yet predict who will be permanently affected. “Don’t use them unless you absolutely have to,” Karp says. The gut-brain connection Research suggests that variety matters because these belly bacteria perform so many functions, which they coordinate with the brain. “They process the things we have in our bodies, then send signals back to us,” says Betul Hatipoglu, M.D., an endocrinologist at the Cleveland Clinic. As the gut microbiome changes—due to diet, antibiotics use, even sleep disturbances—so do those signals. “When we start growing more of the bad bacteria for whatever reason, they work against us,” Hatipoglu says. “They produce chemicals that go to our liver and then to our blood, causing changes in our system. They make us more insulin-resistant, encourage inflammation, and even cause our blood sugar to go up.” Your gut and diabetes Along with the insulin connection, your gut is related to diabetes in other ways. When it comes to obesity and Type 2, research strongly suggests that two groups of bacteria play the largest roles: Bacter oidetes and Firmicutes. Though not all studies agree, multiple studies

comparing the gut flora of lean and obese people found a higher proportion of Bacteroidetes in lean participants. “The Bacteroidetes group are involved in protein and carbohydrate digestion,” Hatipoglu says. “Firmicutes are involved more in fat processing. People who had more of the Firmicutes seem to have an increased risk of obesity and Type 2 diabetes.” Today scientists are examining the roles those two bacteria groups play to determine whether it’s the amount of each that matters most or the ratio. They’re also looking for ways to use these new discoveries to treat or even prevent all types of diabetes. Some doctors are exploring customised dietary plans based on each person’s unique gut microbiome. Others are examining the potential for treatments using faecal transplants from nondiabetic donors. (Yes, we mean poop—that’s where your gut bacteria ends up eventually, so transplanting it is a relatively straightforward process.) Because the science is still so new here, our experts recommend caution before jumping on any fast-fix bandwagons. “We’re just on the cusp of understanding this,” says David A. Johnson, M.D., professor of medicine at Eastern Virginia Medical School and editor of the textbook The Gut Microbiome. “We’re just starting to get into the evidence that meaningful differences can come from simple things—maybe just from changing your diet.”

TINY MICROBES, BIG NAMES— AND BIG QUESTIONS Research suggests that when it comes to diabetes, two types of bacteria matter more than most: Bacteroidetes and Firmicutes. i We know: Multiple studies have shown that the proportion of these two groups is different in people with diabetes and obese people compared with healthy people.

ACTION STEPS So what can you do today to improve your gut microbiome? While scientists don’t know exactly which bacteria—or how much of each— our bodies need, our experts agree that certain behaviours can throw off the balance in our bellies. “It’s like buying a plant,” Hatipoglu says. “If you don’t give it sun and water, it’s going to die. You have to give the right environment to those good bacteria so they’ll keep growing and help you.” To give those bacteria what they need: i Eat more fibre. Bacteroidetes, which several studies have found to be the “good guys,” thrive on a plant-heavy diet. i Try kimchi. Scientists don’t know exactly why yet, but fermented foods act like a natural probiotic in our bellies, supporting the growth of healthy bacteria. Naturally fermented foods include kefir, yoghurt with live and active cultures, kimchi, kombucha, and homemade sauerkraut and pickles (store-bought are sterilised and lose the probiotic effect).

i Get more sleep. Studies in mice and humans have shown that a disruption in your circadian rhythm (such as from insomnia or jet lag) can affect the mix of bacteria in your gut. i Skip probiotic supplements. “When you take these, you’re changing whatever your basic bacteria is—you’re preselecting an organism that maybe didn’t have as strong a presence before,” Johnson says. “We don’t know yet which probiotic for which patient.” i Be sure about antibiotics. Avoid using them unless your doctor thinks you won’t recover without them. “Regardless of which antibiotic you take, it’s changing out some bacteria,” Johnson says. “These are major, profound changes that may not be good—and they’re certainly long-lasting.” If you need antibiotics, support your belly with a diet rich in fibre.

i We don’t know: Those studies haven’t reached consensus on how or why those bacteria matter. The bacteria groups each contain numerous strains, and scientists haven’t yet drilled down far enough to distinguish among them. At this point, they can’t tell which specific strains to focus on. “It’s like looking at a fuzzy picture,” Karp says. “We can’t exactly tell what’s going on.”

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WELLBEING

The Need For Vitamin D

Getting enough vitamin D is important for overall health—and early studies suggest it may also be the key for managing diabetes.

So why make the effort for this elusive vitamin? Because it’s crucial for so many aspects of your health, and new studies suggest it may help you manage your diabetes as well.

Why you need it Vitamin D helps your body absorb calcium and promotes bone health (people with diabetes are at risk for fractures). It’s also key for reducing inflammation and boosting immunity.

writing Marsha McCulloch, M.S., RD, LD; photo Getty Images

If a vitamin D supplement isn’t in your medicine cabinet, it should be. Data show that many Americans are deficient in the sunshine vitamin. That might be because vitamin D is a tricky little guy. It’s present in very few foods, and even then it appears in relatively small amounts. Lucky for us, nature built in a fail-safe: You can get vitamin D through sun exposure. But that has its challenges, too.

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Researchers note that fewer hours of sunshine in winter may be linked to why that time is cold and flu season. Emerging research suggests that people with Type 2 who have higher blood levels of vitamin D tend to have better blood sugar control. And people at risk for Type 2 with higher vitamin D levels are less likely to develop the disease. Even more: Studies show a link between low vitamin D levels and increased risk of nerve, kidney, and eye complications, as well as cardiovascular disease and hypertension. But clinical trials about the effects of adequate levels of vitamin D are mixed and in early stages. What we do know for sure: Vitamin D is important for many aspects of your health, so you should make an effort to get the recommended dosage each day.

What’s right for you So how can we get enough of the sunshine vitamin? It’s especially important for those who have difficulty

VITAMIN D: 1,500 IU

is the daily recommended amount for adults, according to the Endocrine Society.

maintaining adequate levels, including obese people, older adults, people with limited sun exposure, people with darker skin, and those with inflammatory bowel disease or who have had gastric bypass surgery. According to the USDA, fatty fish (salmon, tuna, and sardines) is a top source. You also get some vitamin D in egg yolks and beef liver. In the American diet, fortified foods provide a lot— including milk, orange juice, breakfast cereal, and even mushrooms exposed to UV-B light. Still, most of these foods have only tiny amounts of vitamin D. For example, you’d have to drink 13 cups of milk to get the 1,500–2,000 IU the Endocrine Society recommends for adults. A guideline for boosting your body’s D production is to expose the most skin possible to sunlight, getting half the amount of sun exposure it takes for your skin to turn pink, according to the Vitamin D Council. In the end, the best way to get enough vitamin D is to take a daily supplement. These pills are easy to take, affordable, and widely available. If you’re concerned you’re deficient, ask your doctor to check with a simple blood test at your next office visit. sources Michael F. Holick, Ph.D., M.D., professor of medicine at Boston University Medical Center; Anastassios Pittas, M.D., M.S., associate professor and codirector of the Diabetes Center at Tufts University Medical Center in Boston

SOAK UP VITAMIN D Try the D Minder Pro app to help you figure out how much vitamin D you can make from sun exposure in your location. It takes into account your skin tone, age, weight, and how much skin you expose. Free at dminder.ontometrics.com

VITAMIN D SUPPLEMENT KNOW-HOW i The Endocrine Society recommends 1,500 IU, while the NIH recommend 600 IU for adults. Ask your doctor what’s best for you. i Look for supplements labeled D3, the same form your body makes from sunlight. D2 is not as potent as D3. i 1,000 IU supplements are widely available in grocery stores and pharmacies; less potent versions mean more daily doses. i Supplements also come in gummies and chews, but note carbs so they don’t spike blood sugar. i Eat a fat source, such as peanut butter, avocado, or an egg, with your supplement to better absorb vitamin D.

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SUGAR FREE drinks SAFE for teeth? writing Shantanu Jaradi

Sugar has been marked as a villain, both for dental and diabetes care. But are the sugar-free substitutes available in the market safe?

ealthy eating is essential for your overall health. Choosing foods and beverages that provide the right amount of energy and nutrients goes a long way toward maintaining not only a healthy body, but also a healthy mouth. To prevent cavities and maintain good oral health, your diet – what you consume and how often you consume – is an important factor. Changes in your mouth start the minute you eat certain foods. Bacteria in the mouth convert sugars and carbohydrates from the foods you eat to acids, and it’s the acids that begin to attack the enamel on teeth, starting the process of decay. The more often you eat, drink and snack, the more frequently you are exposing your teeth to the cycle of decay. Eating a nutritious diet has many benefits. A well-balanced diet should include foods from the basic food groups and subgroups along with the right oils. Nutrients such as carbohydrates, fats, proteins, vitamins and minerals are a staple of healthy diets, but it’s also important to avoid eating too many or too few nutrients. Fighting sugar Your everyday table sugar, otherwise known as sucrose, has 16 calories per teaspoon and can be found in many foods and drink items. But as communities become more conscious of calorific intake and oral bacteria, many have turned to sugar free drinks as an

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alternative. Specialists often recommend that patients who are overweight or struggling from weight-related illnesses avoid drinking their calories. Still, store shelves and vending machines are introducing more sugar free drink choices to promote gentler diets. Although several beverages in the market are naturally sugar free, others use scientifically altered sweeteners that replace sugar to maintain their appealing flavour. Some examples of naturally sugar-free beverages include freshly brewed tea, coffee, and both regular and carbonated water. Naturally occurring, no-calorie sweeteners such as the stevia plant can be added to certain products as well, in addition to naturally sweet items that have calories, such as agave nectar and honey. The usual mindset of people Many people choose sugar-free beverages because they believe they are safer for their teeth. However, a label of ‘sugar-free’ should not automatically be taken to mean ‘safe for your teeth.’ The acidic flavourings and preservatives may in fact lead to dental erosion, even if they contain cavity-fighting and ‘tooth friendly’ xylitol. Unlike cavities, dental erosion is a process of incremental decalcification, which, over time, literally dissolves your teeth. Virtually any food or beverage that is acidic can contribute to tooth erosion, including carbonated beverages like soda, sports drinks, fruit juice, lemon juice and vinegar.

Benefits of Sugar Free Drinks Weight control and the prevention of Type-2 diabetes are the two main benefits of consuming sugar free drinks, or those that contain natural sweeteners. Sugar-laden drinks add unnecessary calories to the diets of those who consume them, leading to an increase in the risk for Type-2 diabetes for these individuals. Sugar free drinks eliminate these empty calories, giving you the freedom to indulge in a sweet taste without the added caloric intake. Negative Effects of Sugar Substitutes Although several surveys have raised concerns regarding the safety of consuming artificial sweeteners, no studies have confirmed that drinking products with artificial sweeteners added have a direct relationship with cancer diagnoses. Nonetheless, seek out sugar free drinks in replacement of sugary sodas, sports drinks, juices and energy drinks to ensure both the oral and bodily well-being of you and your family. Natural alternatives such as plain tea, pure coffee or a glass of water remain the best choices when youâ&#x20AC;&#x2122;re thirsty. Protection of the teeth Proper oral hygiene â&#x20AC;&#x201C; including twice-daily tooth brushing, flossing and the use of fluoridated toothpaste â&#x20AC;&#x201C; can help counteract effects of acid demineralisation. Those who experience sensitivity from consuming too many sugary or acidic beverages can often find relief through the use of toothpaste as guided by your dentist, containing potassium nitrate as an additional active ingredient that stop sensitivity at its source. Reducing or eliminating erosive beverages from your diet is important if you want to protect your teeth from unnecessary damage. Shantanu Jaradi, Aesthetic Dentist, Dentzz Dental clinic

VEDIC WAY TO MANAGE DIABETES writing Dr. Vinita Sharma

Herbs, clubbed with lifestyle changes can help reduce dependence on insulin and bring down blood sugar levels.

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eople want a quick solution to a problem like diabetes. In this disease there is an involvement of both body and mind, so it becomes essential to take care of all the measures which can bring eating habits under control. In Ayurveda diabetes is defined as Madhumeha, where when split the two Sanskrit words mean ‘sweetness’ (madhu) and ‘excessive urination’ (meha). It means a disease in which a patient passes sweet urine. According to Ayurveda diabetes begins with an imbalance of doshas. Tridoshas are three bio energies which govern the different functions in the body. • VATA DOSHA is responsible for all the micro and macro movements in the body. •P ITTA DOSHA is responsible for digestion and metabolism. •K APHA DOSHA is responsible for the growth and provide strength to the body. In diabetes Kapha and Vata doshas get imbalanced. According to Ayurveda there are 2 types of diabetes: 1. GENETIC (SAHAJ) – Insulin dependent diabetes mellitus or juvenile diabetes. 2. ACQUIRED (APATHYAJ) - Due to unhealthy lifestyle, it occur in old age and this condition is similar with Type 2 diabetes. Common dietary and lifestyle causes of diabetes are excessive consumption of Kapha aggravating foods like curd and its preparation, milk and its preparation, jaggery, sugarcane, carbohydrates rich food, repeated food intake, sedentary lifestyle, lack of physical activities and exercises, excess sleeping, genetic factor, stress, fear and long standing illness . Common symptoms of diabetes include polyphagia (excessive hunger), polydipsia (excessive thirst), polyurea (excessive urination) and blurring of vision. Apart from these signs Ayurveda describes some other signs as well like pallor of the body, dryness of the body, debility, insomnia, constipation and bad body odour. Boils and wounds are difficult to heal in a diabetic patient.

VEDIC NUTRITION THERAPY Vedic Nutrition therapy is extremely important for diabetic and pre-diabetic patients to control high sugar levels. It should be understood that the condition cannot be cured completely but it can be controlled with diet, lifestyle modifications and herbs. The therapy can be divided into three parts: • Dietary intervention • Physical activity • Hypoglycemic herbs Type 1 diabetes mellitus can be corelated with ‘Krsa Prameha’ and it is commonly found in underweight people. It requires restorative (Santarpan) treatment along with insulin treatment. It is usually found in Pitta and Vata prakriti patients. This treatment is prescribed if the patient is chronically ill with low immunity and is underweight. The therapy provides micronutrients to rebuild body tissues without increasing blood sugar and fat tissues. Herbs like Ashwagandha (Withania Somnifera) and aloe vera are beneficial for such patients. For Type 1 diabetes patients strenuous exercises should be avoided. They can do a regular walk for 25-30 minutes every day. A balance between nutrition and insulin has to be maintained to control sugar levels. Type 2 Diabetes Mellitus can be corelated with ‘Sthula Prameha’ and it occurs in obese people. It requires fat reducing (Apatarpana) treatments. It is usually found in Kapha Prakriti patient. This treatment is prescribed if the person is obese. In Type 2 diabetes (insulin resistance) diet and lifestyle modification plays a very crucial role. Some common herbs which help in lowering high sugar levels are Momordica charantia (karela) and Trigonella foenum (Fenugreek). • 1 tsp of Fenugreek seeds powder 1 tsp twice a day with water. • 3 gms of dry Jamun seed powder twice a day with water to maintain sugar levels. • Mix equal amount of Turmeric and Amla powder and have 1 tsp of this mixture twice a day with water. • Type 2 diabetes patients can do brisk walking for 20-25 minutes every day. Exercise helps to keep up the good metabolic rate. Apart from above herbs and dietary changes Ayurveda also recommends yoga, meditation and pranayama to treat stress. Once a person starts following Vedic nutrition therapy, it is very important to adjust the dosage of insulin or oral hypoglycaemic drugs to prevent hypoglycaemia. Dr. Vinita Sharma, Senior Ayurvedic Doctor, Dr. Shikha’s NutriHealth

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TIPS ON DIABETES CARE DURING WINTERS Ranging from a few weeks to a few months, winters in India come packaged with a kaleidoscope of complications. 10 things to rememberâ&#x20AC;Ś writing Dr Sanjay Kalra

With freezing temperatures come a lot of health challenges, managing which can be a daunting task, especially for those suffering from chronic disorders like diabetes. There are over 60 million people living with diabetes in India, and poor management can mean as many hidden health challenges. Caring for diabetes is difficult enough but frigid temperatures can make it even more challenging. Blood glocose and HbA1C levels tend to increase in colder temperatures and aid complications of diabetes.

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HERE ARE SOME TIPS TO MANAGE DIABETES AND STAY WELL THIS WINTER SEASON:

KEEP OFF WINTER WEIGHT GAIN

It is easy to gain weight during the winter months. A generally sedentary daily routine coupled with diminished exercise hours can easily assist in putting on five to 10 extra pounds. Abdominal obesity is one of the major risk factors for post diabetes complications. Make sure that you do not skip any exercise routine. Take a walk daily, while making sure that you’re well covered with layers of clothing. Avoid exercising in smog-like conditions.

KEEP YOUR HANDS AND FEET WARM Diabetes comes with associated circulatory and nervous complications, which can lead to chilled extremities. It is advised to use heating pads and warm water bottles (however, skip them and opt for warm socks and gloves if you have diabetes associated neuropathy).

TEST MORE FREQUENTLY

Continuously fluctuating temperatures can mean equally frequent fluctuations in blood glucose levels. Make sure you monitor your glucose and blood pressure levels on a regular basis with religious compliance.

MAINTAIN OPTIMAL HYDRATION It can be easy to ‘forget’ to drink optimal amounts of water daily during winter months. Dehydration is known to raise blood glucose levels. Coupled with dry air and usage of room heaters can lead to dry skin problems. Practice good moisturisation regime and use eye drops to prevent dry eye syndrome.

GET IMMUNISED People are especially prone to infections during the winter season, flu being the most common one. People with diabetes are almost six times more likely to catch an influenza infection, so it is advised that you stay updated on your flu vaccinations. Pneumonia vaccination is also generally recommended.

WATCH YOUR DIET

Eat foods that are hot and easy to digest whilst being high in calories. Go for heat producing options like warm milk, soup, cooked vegetables and oatmeal. Cinnamon, sesame and flaxseeds are known to have glucose regulatory properties, include them in your diet whenever possible. Avoid alcohol at all cost as it can dilate blood vessels, which makes the body lose heat more rapidly. DiabeticLivingOnline.in

KEEP A CHECK ON YOUR TEST STRIPS AND EQUIPMENT Cold weather can affect your insulin medications and damage your glucose test strips and monitors. Digital devices are also prone to de-calibration during colder temperatures. Keep them in a warm humidity-free place.

CARE FOR YOUR FEET

Winter can make feet feel numb and hence, we tend to pay less attention to them. Any case of unusual swelling, infections or cuts that do not heal should be immediately reported to the doctor.

STAY OUT OF COLD OUTDOORS

Cold weather can make the blood thicker and more prone to clotting. This can put you at further risk of diabetes associated health complications like stroke. Ensure that you maintain body warmth when outdoors.

WARD OFF THE STRESS

Stress can lead to elevation in blood sugar levels, which when coupled with frigid temperatures can cause serious health complications. Get enough sunshine and keep a healthy outlook.

Dr Sanjay Kalra, Consultant Endocrinologist, Bharti Hospital Karnal & Vice President, South Asian Federation of Endocrine Societies

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LIVING “There is no passion to be found playing small – in settling for a life that is less than the one you are capable of living.”

DIABETES

SO YOU’VE BEEN DIAGNOSED WITH

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Does your doctor not listen to all your problems or are you scared of the needle? Common complaints and anxieties that need to be addressed. writing Dr. K M Prasanna Kumar

When she turned 40, Anjali Wadhwan decided to do her first general preventive health check-up, especially because she was obese (her body mass index was over 30). The examining doctor found that her sugar levels were high. He referred her to me, but asked her to try and lose weight and to exercise. When in a month this didn’t happen, we put her on medication. Unfortunately, these did not have much of an impact either, and in a few months’ time she had to be put on insulin. Anjali was distraught for more reasons than one. “I suddenly felt old. My grandmother had been on insulin and had been diagnosed in her 50s. And here I was, at 40, with a condition I would live with for the rest of my life,” she says. Anjali was also petrified of injections, recalling her

childhood trauma for them. We reassured her that injections had undergone huge changes in the past 30 years, and that they no longer pained. We also reassured her that it didn’t have to be a permanent feature. If she reduced weight, changed her diet, and began to exercise, we could look at oral medication again. Anjali isn’t the only one who is worried at having to live the next 30 or 40 years with diabetes. She’s also not the only person petrified of injections. Here are a few of the biggest fears that I encounter as an endocrinologist/diabetologist, and the advice I give those who come to me, so they can live comfortably for the rest of their life. Use this article as a guide, not as a prescription—that is something your doctor needs to write out for you.

COMMON COMPLAINT

“MY DOCTOR DOESN’T LISTEN TO ME.” India has a paucity of doctors, so it’s possible that your doctor is conscious of the mile-long queue outside, to give all patients their due. Having said that, your doctor must be able to clear all your doubts and provide confidence and reassurance. People who are newly diagnosed with diabetes may be acting on several myths. Ask your doctor for a time that is convenient to him when you can clear all your doubts, note them down on a paper, and convey the message to him. A diabetologist must talk to you about your daily routine, exercise, diet, stress levels and of course medication, and guide you with each aspect.

COMMON

“INJECTIONS HURT, AND I FEAR THEM.”

The stomach is not the only site you should inject into. The back of the upper arm, the hips, the outer side of the thighs, are all possible sites. Try and use the same area at the same time of the day. For instance, if you inject in the stomach close to breakfast, then use the thigh at bedtime. Insulin is absorbed fastest from the stomach, followed by the arm, the leg, and slowest from the buttocks. So if you are going to eat a meal, you will need to have it covered with insulin in the abdomen. Again, you don’t need to keep injecting in the same spot—change it around. If you do keep injecting at the same spot, little fat globules will form under the skin that appear rubbery outside. These will disappear in time, but it’s better to prevent this in the first place.

COMPLAINT

Injections don’t hurt anymore. Most people remember the injections from their childhood which were indeed very painful. Today, there is an array of needles that can be used, which have shorter needle sizes than before, are thinner and sharper. Insulin pens, for instance, are very easy to operate when you need to inject yourself. Ideally, your doctor should guide your first dose, and also share some literature with you so you know you are injecting correctly. The idea is to inject into the fat, not the muscle.

COMPLAINT

“MY STOMACH WILL SOON LOOK UNSIGHTLY!”

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COMMON COMPLAINT

“I CAN NEVER EAT ANOTHER SWEET IN MY LIFE WITHOUT FEELING GUILTY.”

COMMON COMPLAINT

Factor in the odd sweet when you want to eat one. Ask your doctor how you can do this. When mango season comes up, again consult with him on how to eat a slice and balance it with medication. However, platefuls of sweets are not okay for anyone, no matter how healthy they may be, so if you’re feeling bad that you can’t binge, then reassure yourself that you’re on the road to getting out of a bad habit.

“I AM DOOMED — MY WHOLE LIFE WILL CHANGE.” Think of a diabetes diagnosis as a driving lesson. When you are learning to drive, and even in the first year or so of driving, you need to be conscious of the gear, the clutch, the accelerator. But over time, it becomes second nature, and you don’t even notice when you change gears. Your experience with diabetes will be the same. Initially, you will find it a nuisance to check your body insulin levels, to take the injections, to go for the check-ups. With time, all this will just become a part of your routine. If you don’t want it to be routine, change your lifestyle to reverse the disease to some extent.

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Dr. K M Prasanna Kumar, Senior Endocrinologist & Diabetologist Center for Diabetes & Endocrine Care (CDEC)

LOW GLYCAEMIC foods.... A product to DEZIRE

one are the days when diabetes was feared as a life threatening disease. With an increase in health awareness, people are now familiar with concepts like Glycaemic Index (GI) and why eating food with low GI is important for diabetics. In fact Dezire, a company that pioneered the concept of low GI foods as early as 10 years ago, has a full range of sugarless sweets, jams, lemon squashes, cookies and much more that are diabetic friendly, low on Glycaemic load and natural! When we visited their showroom in Bengaluru, it was very heartening to see not just older diabetics but also younger health conscious couples who understand the value of investing in health from a young age. Shivani, a young IT professional says, "Earlier I was buying Dezire

Natural Sweetener for my father who is a diabetic. But seeing that it is low GI and 100% natural, I have now started using it for my coffees and morning cereals. In fact, I really love their Lemon Ginger Squashes because it gives me instant energy before my workouts and keeps my energy sustained for much longer. A lot of my gym friends are now Dezire Delights offers a wide variety of Indian sweets like Badam Halwa, Kaju katli, Lados, Mysure Pak & Gulab Jamun, etc. Visit their Showrooms: • Chennai, • T.Nagar, Ph: 7358040224 &

• Anna Nagar, Ph: 8754411006, • Bengaluru at Gandhi Bazar, Ph: 9035515333 • Hyderabad at Ameerpet, Ph: 9030034329 or find them at Departmental stores in South India. To buy online visit www.deziregoodlife for pan India delivery.

fans of Dezire Squashes," she adds. Dezire offers a range of sweets made of natural sweetener, Levulose that is approved by leading diabetologists, and are as tasty as sweets made with sugar, only a healthier option. The GI of the sweetener levulose is just 19 as compared to 68 of sugar. Even the sweetness profile is almost 1.7 to 1.8 times more than sugar, resulting in the usage of just half the quantity as compared to sugar hence reducing even the calorific value of the products.

Surgery is considered to be one of the most extreme steps in cases of obesity, but its popularity has been growing. It’s important to learn how to manage your diet after the procedure.

DIETARY ASSISTANCE after

BARIATRIC SURGERY writing Dr. Rajat Goel

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ariatric surgery is a type of procedure performed on people who are dangerously obese, for the purpose of losing weight. It is a wonderful tool that helps patients with clinical obesity lose weight and gain their lives back. But after undergoing a life changing weight loss (bariatric surgery) you may need help to overcome difficulties in walking and performing other physical activities. Among others, exercises will help you restore your quality of life. After almost all bariatric surgery procedures patients have to change their food habits on a regular basis. Your doctor or a registered dietician will talk with you about the diet you'll need to follow after, explaining what types of foods and how much of it you can eat for each meal. No doubt exercises can play a critical role helping patients achieve long-term success in their efforts to fully recover and engage in a ‘normal’ routine of activities.

Purpose The bariatric surgery diet has several purposes: • To allow your stomach to heal without being stretched by the food you eat • To get you used to eating smaller amounts of food that your smaller stomach can comfortably and safely digest • To help you lose weight and avoid gaining weight again • To avoid side effects and complications from the surgery

Diet Details Diet recommendations after bariatric surgery vary, depending on where the surgery is performed and your individual situation. A bariatric surgery diet typically follows a staged approach to help you ease back into eating solid foods as you recover. How quickly you move from one step to the next depends on how fast your body heals and adjusts to the changes in eating patterns. You can usually start eating regular foods about three months after the surgery. After bariatric surgery, you must be careful to drink enough fluids to avoid dehydration, and pay extra attention to signs that you feel hungry or full.

Liquids For the first day or so after surgery, you'll only be allowed to drink clear liquids. Sip slowly and drink only two to three ounces (59 to 89 millilitres) at a time. Once you start handling clear liquids, you can start having other liquids too, such as skim or low-fat milk.

FOODS TO AVOID • Nuts and seeds • Popcorn • Dried fruits • C arbonated beverages • Granola • S tringy or fibrous vegetables, such as celery, broccoli, corn or cabbage • T ough meats or meats with gristle • Fried foods • Breads However, over time you may be able to try some of these foods again, with the guidance of your doctor.

Liquids you can have in stage 1: • Broth • Unsweetened juice • Decaffeinated tea or coffee • Milk (skim or 1 per cent) • Strained cream soup • Sugar-free gelatin or popsicles

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Pureed Foods

Solid Foods

Once you're able to tolerate liquids for a few days, you can begin to eat strained and pureed (mashed up) foods. During this phase, you can only eat foods that have the consistency of a smooth paste or a thick liquid, without any solid pieces of food in the mixture. To puree your foods, choose foods that will blend well, such as: • Lean ground meats • Beans • Eggs • Soft fruits and cooked vegetables • Cottage cheese

After about eight weeks on the bariatric surgery diet, you can gradually return to eating firmer foods. But foods must still be chopped or diced. Start slowly with regular foods to see which of them you can tolerate. You may find that you still have difficulty eating spicier foods or those with crunchy textures. Even at this stage, there are foods you should avoid because they may cause gastrointestinal symptoms, such as nausea, pain or vomiting.

Blend solid foods with liquids, such as: • Water • Skim milk • Juice with no added sugar • Broth It's important that you don't eat and drink at the same time. Wait for about 30 minutes after a meal before drink anything. Also keep in mind that your digestive system might still be sensitive to spicy foods or dairy products. If you'd like to eat these foods during this phase, add them into your diet graduallly and in small amounts.

Soft Foods After a few weeks of pureed foods, and with your doctor's consultation, you can add soft foods — in the form of small, tender, easily chewable pieces — to your diet. During this stage, your diet can include: • Ground or finely diced meats • Canned or soft fresh fruit (no seeds & skin) • Cooked vegetables (wihout skin)

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A NEW HEALT

HY DIET

Three to four m onths after wei ght-loss surger able to start ea y, you may be ting a normal he althy diet, depe your situation nding on and any foods that you may no tolerate. It's po t be able to ssible that food s that initially stomach after irr ita ted your surgery may be come more tole stomach contin rable as your ues to heal.

The golden 8

dieta

ry tips To ensure that you get enough vitamins and m keep your weigh inerals and t-loss goals on track, at each st bariatric surger age of the y diet, you shou ld:

1. 2. 3.

Eat and drink slowly. Eating or drinking too quickly may ca use dumping sy ndrome â&#x20AC;&#x201D; whe foods and liqui n ds enter your sm all intestine ra and in larger am pidly ounts than norm al, causing nausea, vomiting, dizziness, swea ting and eventu diarrhoea. To pr ally event dumping syndrome, choo foods and liqui se ds that are low in fat and suga and drink slow r, ea t ly, and wait 30 to 45 minutes be or after each m fore eal to drink liq uids. Take at le minutes to eat ast 30 your meals an d 30 to 60 min drink 1 cup (237 ut es to millilitres) of liq uid.

Keep meals sm all. During the diet progressio you should ea n, t several small meals a day an sip liquids slow d ly throughout the day (not w meals). You m ith ight first start with six small a day, then mov m eals e to four meals and finally, whe following a regu n lar diet, decrea se to three mea a day. Each mea ls l should includ e about half a cup to a cup of food. Make su re you eat only recommended the amounts and st op eating befo you feel full. re

Drink liquids between mea ls. Expect to dr at least six to ink eight cups (48 to 64 ounces, to 1.9 litres) of or 1.4 fluids a day to prevent dehydr tion. Drinking aliquids with yo ur meals can caus pain, nausea an e d vomiting as well as dumping syndrome. Also, drinking too much liqui at or around m d ealtime can le av e you feeling overly full and prevent you fr om eating enou nutrient-rich fo gh od. Dr. Rajat Goe l, Ba

riatric Surgeo n,

Chew food th oroughly. The new opening th leads from your at stomach into yo ur intestine is very small, an d larger pieces of food can bloc the opening. Bl k ockages preven t food from leav your stomach ing and can cause vomiting, naus and abdominal ea pain. Take smal l bites of food chew them to a and pureed consiste nc y before swallowing. If you can't chew the food thorough don't swallow ly, it.

Focus on high -protein food s. Immediately your surgery, ea after ting high-prote in foods can he you heal. Highlp protein, low-fa t choices remai good long-term n a diet option afte r your surgery, well. Try adding as lean cuts of be ef, chicken, po fish or beans to rk, your diet. Low -fa t cheese, cotta cheese and yogh ge urts are also go od protein sour ces. Avoid foods th at are high in fat and sugar. your surgery, it After may be difficu lt for your digestive system to tolerate foods that are high in or added suga fat rs. Avoid foods that are high in (such as fried fo fat ods, ice cream and candy bars Look for sugar-f ). ree options of soft drinks and dairy products .

6. 7.

Try new food s one at a tim e. After surger foods may caus y, certain e nausea, pain and vomiting or may block the opening of the stomach. The ab to tolerate food ility s varies from pe rson to person one new food at . Try a time and chew thoroughly befo swallowing. If re a food causes di scomfort, don' it. As time pass t ea t es, you may be able to eat this Foods and liqui food. ds that common ly cause discom include meat, fort bread, raw vege tables, fried fo and carbonated od s beverages.

Primus Super

Take recomm ended vitamin and mineral supplements. Because a port io n of your smal intestine is bypa l ssed after surg er y, your body won't be able to absorb enough nutrients from your food. You' ll likely need to ta ke a multivitamin supplemen t every day for th e rest of your life. Talk to your do ctor about wha t ty pe of multivitamin might be rig ht for you and w he th er you might need to take ad ditional supple ments, such as calcium.

Speciality Hosp

ital DiabeticLivingOnline.in

DIABETES CANCER

Symbiosis in causes and therapy

Without a direct link between diabetes and any type of cancer, the two conditions overlap on several steps of diagnosis and treatment. writing Dr. Anoop Misra, Dr. Amerta Ghosh

rs A S, a 55 years old known patient of diabetes since 14 years on oral anti diabetic medication came for regular consultation. Her blood sugars were perfectly under control, she vaguely mentioned about a lump in her right breast. We examined her and found a lump in her right breast with some skin changes. She was referred for a fine needle aspiration cytology and it was found that she had stage 3 breast cancer. She was referred to oncology department and had to undergo breast surgery, chemotherapy. She was started on insulin and continued on metformin. She came for her follow-up visits with us as advised and started gaining weight and feeling better; the last she came to us, just before writing this article. She is now a happy person and her sugars are well controlled.

42 Diabetic Living

jan-feb 2017

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DiabeticLivingOnline.in

The Link

Diabetes and cancer are the two most commonly occurring diseases, cancer being the more lethal of them. Traditionally cancer is not listed as a complication of diabetes. There is strong epidemiological evidence of increased risk of many types of cancer in individuals with diabetes. Also several cancers are seen to behave aggressively in people with diabetes. Diabetes, per se, as well as some of the anti-diabetic therapies, has shown association with cancer. The link between the two diseases is complex and multifactorial. Type 2 diabetes is characterised by a condition where the body has high insulin level circulating in the body (hyperinsulinemia) and itâ&#x20AC;&#x2122;s not being used, a condition that is called insulin resistance, causing high blood glucose. Hyperinsulinemia leads to cancer cell growth. Some evidence suggests that diabetes (hyperglycaemia), per se, provides a favourable ground for the cancer cells to thrive. There are some common modifiable risk factors like obesity, poor diet, physical inactivity, smoking, alcohol, etc. Obesity, independently, has proven association with cancer and also with Type 2 diabetes. Incidence of most cancers increases with increasing age and so does the prevalence of diabetes. There is an increased risk of certain cancers in patients with diabetes, like those of liver, pancreas, endometrium,

44 Diabetic Living

jan-feb 2017

colon, rectum, bladder, and breast. Interestingly, risk of prostate cancer is reduced in diabetes. Poorer survival rate is also related with diabetes Mr. R G is a known patient of diabetes since 5 years, on oral medication. He had anemia and after ruling out all causes of it he was subjected to colonoscopy where carcinoma rectum was detected. He underwent surgical resection followed by chemotherapy. His blood sugar levels were erratic during chemotherapy because of certain drugs. He was given a regimen to follow on chemotherapy days with insulin. He was given repeated insulin education counselling and was trained to adjust his blood glucose. He has three more cycles of chemotherapy left but his sugar level is managed very well.

EFFECT OF TREATMENT OF EACH OTHER

Treatments of diabetes and cancer meddle with each other in many ways. Studies suggest that certain diabetes drugs, like metformin, reduce the risk of cancer and cancer mortality. Metformin treatment is associated with higher pathologic complete response among early-stage breast cancer patients receiving neoadjuvant therapy. Chemotherapy, given in anti-cancer treatments contains glucocorticoids, which in turn raise the blood glucose. Normally these patients require changes in their drug regimen with addition of insulin, and dietary changes. These patients require insulin

education with proper insulin taking techniques, and ways to manage low and high blood sugar by a diabetes educator in a specialised diabetes centre. These patients are given certain insulin regimen to be practised on the days of chemotherapy to counteract the effect of glucocorticoids. Some anti-cancer medication can cause peripheral neuropathy and cardiac toxicity which is treated accordingly. Mrs. B S was diagnosed with periampullary carcinoma of pancreas five years ago. A part of pancreas was resected and she received chemotherapy. Recently she had reoccurrence of the cancer and whole of the pancreas had to be removed. She is undergoing chemotherapy and radiotherapy. As pancreas is the storehouse of insulin she was started on insulin injection. But her sugars were still very erratic as her appetite was still very low. She was injecting herself several times, and was initiated on insulin pump. An insulin pump is programmed to deliver insulin as physiologically as possible. When she came to us for her follow-up visit her blood glucose was perfectly under control, she had gained back her appetite and she had even put on some weight. She said she felt more relaxed as the pricks for insulin were reduced and her sugar level was fine. As discussed earlier diabetes and cancer have some common risk factors and these can be modified. The best approach is to maintain a healthy lifestyle, being physically active, weight reduction, smoking cessation, decreasing alcohol intake to acceptable limits, consuming a diet that includes healthy fats, whole grains, fruits and vegetable, and reducing processed foods and red meat. More studies are required to ascertain the link.

Dr. Anoop Misra, Director and Chairman, Fortis CDOC Hospital Dr. Amerta Ghosh, Consultant, Fortis CDOC Hospital

NUTRITION

“Don’t eat anything your great-great grandmother wouldn’t recognise as food. There are a great many foodlike items in the supermarket your ancestors wouldn’t recognise as food.. stay away from these.”

harmful effects

The

EXCESS SUGAR writing Dr. M Udaya Kumar Maiya

Sugar can have harmful effects on metabolism and contribute to all sorts of diseases. Here is why you should be wary of consuming it in large amounts.

efined sugar is a daily food staple and thanks to the growing prevalence of a chronic disease like diabetes in India, people are somewhat aware of the ill effects of high sugar intake. The general notion is that if you eat too much sugar as a routine for a long time, you may increase your chances of diabetes significantly. While this is somewhat true, the real truth about sugars is far more dire than this. Excessive consumption of foods with high glycaemic index (foods that quickly affect blood sugar levels) significantly raises the risk of obesity and chronic disorders like diabetes and heart disease. Every 150 extra calories consumed from sugar can raise the prevalence of diabetes by 1.1 per cent. Sugar has a global effect on the body and not only does it damage the vital organs like liver and pancreas but also has a harmful effect on almost every aspect of the bodyâ&#x20AC;&#x2122;s organ system.

46 Diabetic Living

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SUGAR DAMAGES THE IMMUNE SYSTEM Sugar can cause suppression of immune system which is our bodyâ&#x20AC;&#x2122;s defense against external pathogens. Most of the microbiota, i.e. the bacteria and yeast in our body, use sugar as food source, and research has shown that excessive consumption of sugar can impair the delicate balance of this useful microbiota.

SUGAR CAUSES TOOTH DECAY The bacteria in the mouth utilise excessively consumed sugar for production of acids and chemicals that cause damage to enamel of the teeth, which can cause caries, as well as affect gums.

SUGAR CAN IMPAIR COGNITION AND MEMORY High sugar diet interferes with the pleasure and reward system of the brain. When you consume sugary foods like processed beverages or ice cream, they release a dopamine surge in the body; dopamine is a feel good hormone. As soon as the sugar is withdrawn it can lead to

withdrawal symptoms like excessive craving and emotional mood swings. Sugar has also been shown to interfere with memory and cognition in the long run.

SUGAR CAN DAMAGE THE HEART Foods with high glycaemic index can lead to rapid spikes in blood pressure, which can lead to hypertension if the diet is not modulated. Hypertension is a major risk factor for heart diseases and stroke. Moreover, sugar prompts the liver to dump more harmful cholesterol and fat into the blood stream which also raise the chances of heart attack.

SUGAR CAN LEAD TO FATTY LIVER DISEASE Sucrose, a high glycaemic component of refined table sugar can trigger the liver to store more amounts of fat. Over time, this can lead to lipid build up in the liver which can cause fatty liver disease.

SUGAR INTERFERES WITH SATIETY AND APPETITE CONTROL Sugar can interfere with the hormone leptin, which signals the brain to stop eating when full. This can lead to mindless uncontrolled eating which can further worsen the risk of obesity and weight gain.

IT DAMAGES THE SKIN AND ACCELERATES AGEING Sugar can bind with blood proteins to form AGEs or advanced glycation end products. These products can damage collagen and elastin fibres which maintain the structural integrity of the skin. Dry and brittle proteins resulted from this attack can cause the skin to become saggy and wrinkly. Sugar and AGE inhibit the bodyâ&#x20AC;&#x2122;s antioxidant systems which can make the skin more prone to damage and cause early skin ageing.

SUGAR INCREASES STRESS After excessive sugar consumption, there is a sugar surge in the body which eventually comes down due to bodyâ&#x20AC;&#x2122;s regulatory mechanism. However, this dip in

sugar levels causes the brain to release hormones like adrenaline, epinephrine and cortisol which are potent stress producing chemicals.

SUGAR CAN THROW OFF NUTRIENT BALANCE Sugar can reduce the absorption of vitamin A, vitamin C, folate, vitamin B-12, calcium, phosphorous, magnesium and iron from food in the digestive tract. Dietary sugar control is just one of the aspects out of the many that determine the extent and course of diabetes in patients. It is advised that patients remain in constant contact with medical health professionals to stay updated on what is best for their health. Often these services are availed from the hospital or office physician visits; however these visits, especially after the initial period can be costly, and perceived as low utility. Home healthcare is a boon in such cases. Home healthcare services can include doctor visits, nurse visits (both short term and long term), physiotherapy services; advice and treatment by a nutritionist. Moreover, home care providers can advise the diabetic patients on various methods of managing their chronic disorder. This includes identifying and documenting present or potential risk factors in family members, preparing an individual plan of care tailored as per the needs of the patient. Several physiotherapy requirements can also be fulfilled including gait and posture adjustments, frozen shoulder, taking care of abnormalities arising out of diabetic neuropathy and visual impairment. Home healthcare can effectively and affordably bridge the gap between affordable healthcare and chronic diabetic patients who can then continue to enjoy a better overall quality of life. It ensures compliance in the management of diabetes and adherence to all the recommended treatments.

Consuming refined sugar depletes Vitamin B in the body and causes symptoms like fatigue, anxiety and insomnia

Dr. M Udaya Kumar Maiya, Medical Director, Portea Medical

DiabeticLivingOnline.in

new

DIET PERSPECTIVES writing Taranjeet Kaur

A good understanding of your physical condition can help nutritionists and metabolic experts to carve a better dietary plan for you.

e all understand the importance of controlling and managing diabetes because this disease has the potential to bring myriad complexities in the body. Diabetes can affect arteries, heart, eyes, kidneys, liver, skin, reproductive organs, etc. Awareness, maintaining blood parameters and a good healthy lifestyle is all you need to manage it. We need to be aware of our body and its symptoms. Sometimes, we notice the symptoms earlier in our body, but donâ&#x20AC;&#x2122;t respond actively until they start damaging it. In case we have a family history of diabetes or heart disease or if we have risk factors like obesity, smoking, etc. we should get our fasting blood glucose (FBG) checked at regular intervals. In fact, even normal individuals can get this tested at regular intervals so as to continue a healthy system. A rising FBG is a signal that we need to change our habits. Getting the HbA1C tests gives us a picture of how our blood sugar levels have been in the past three months. Whether we are insulin resistant, pre-diabetic or diabetic, we need to keep regular blood check-ups done. Moreover, we

need to make healthy changes in our lifestyle which will help manage our blood insulin levels. Chronically elevated insulin levels play a havoc in the system. They cause food cravings and evoke a feeling of hunger, making a person eat more. Elevated insulin levels encourage the fat build up, elevate the bad cholesterol (LDL) and create a pre-disposition to thrombosis. Not only this, the chronically raised insulin levels suppress the production of sex hormones, suppress the fat burning hormones and also deplete the quality and quantity of sleep. Metabolic balance, a German innovated nutrition programme works excellently on managing the insulin levels of our body. The founder of the programme, Dr. Wolf Funfack, an internal medicine doctor states that as insulin is one of the key hormones to manage our metabolism, we need to work on it. Diet and exercises are the best ways to regulate the blood insulin levels. He suggests having three meals a day and keeping a five hours gap in between the meals to help the body get adequate rest and time to produce the hormones and enzymes it requires. The metabolic balance programme developed by him gives an individualised food plan for each person, depending on their blood analysis, medical history, measurements and food preferences. The programme suggests balanced meals for each meal time, which include a high biological value protein with low glycaemic load vegetables, cereal and adequate amount of fat. At least two meals in a day also include a fruit portion. It is a well made, scientifically balanced diet. This kind of combination works really well to prevent blood sugar spikes and drops to occur in our system. The meals help in the slow release of sugar, which can be well absorbed by our system, creating less panic situations in our body. Diabetics should select complex carbohydrates with low glycaemic load, like cereals that convert to sugar slowly in the body preventing any sugar level spikes. Oats, rye, barley, and buckwheat are few other examples of them. Having a good amount of vegetables as salads or cooked also helps in providing fibre to the body. An adequate fat portion in the meal

further reduces its glycaemic load, helping in a slower release of sugar. Good fats like ghee, coconut oil, flaxseed oil, mustard oil and virgin olive oil should be included in our daily diet. Metabolic balance suggests an intake of good quality fats from the dairy, egg yolk, fish and lessening the use of processed food items and oils. The selection of proteins for each person is made on the basis of the personâ&#x20AC;&#x2122;s blood analysis in the programme. By this, we get to know which protein in what amount is required by our body to be in a healthy state. This selection of proteins provides the body with an ability to furnish the enzymes and hormones that are required to run the metabolism smoothly. We also need to drink adequate water as it helps remove toxins and keeps metabolism going at a good pace. Water intake also prevents us from overeating. Most of the times, we confuse our thirst for hunger and keep overloading ourselves with food. It is important to understand that once we come to know about our impaired glucose levels and the doctor indicates that we are becoming insulin resistant or are prediabetic, we need not panic. Instead, we should start looking for ways to make positive changes in our lifestyle. Good and healthy eating habits, regular exercise and meditation are important for us and need to be a part of our daily life. It is scientifically proven that prediabetes, if not cared for or left uncontrolled, can progress to a full blown diabetes within one or two years. On the other hand, it is also stated that prediabetics who lose 5-7 per cent of their weight and exercise regularly, reduce the risk of developing diabetes by 50 per cent. Regular exercise helps our body improve the utilisation of insulin, burning excess fat, improving muscle and bone strength, improving blood circulation, increasing our energy levels and surely reducing any type of stress. We also need to include some breathing exercises, like pranayam, as they have immense benefits in relaxing our mind and promoting good health. Taranjeet Kaur, Metabolic balance coach & Sr. nutritionist, AktivOrtho

Drink adequate water as it helps remove toxins and keeps metabolism at a good pace.

Your body asking constantly for sweets may be due to several reasons beyond the need for energy. There are ways to fix it by understanding the causes. writing Dr. Ankit Kumar Gupta

he smell of freshly-baked brownies or delicious caramelcoated vanilla puddings in the nearby bakery shop is sure to make you drool over the sweet delicacies. However, inching towards the refrigerator in search of chocolates regularly or indulging in a sweet treat everyday can be

a cause of worry. Craving sugar could indicate that your body is running low on energy and is in need to get its sugar fix to function better, irrespective of you being a diabetes patient or not. The most common reason due to which people with Type 2 diabetes crave for sweets is due to their unhealthy history of eating patterns. While it is not advisable to cut down on the entire sugar intake in a single day, those with diabetes should check their blood sugar frequently to differentiate between low glucose and a craving. While intense sugar cravings are linked to diabetes, there are several other reasons that may lead to cravings. Some of the most common factors that could lead to sugar cravings in a person are: Depression: Buckets of ice-cream invariably bear the first brunt of rapid mood swings or just a day gone badly. A lot of people suffering from depression rely upon sugary treats as an ideal way to bid adieu to the blues. While a butterscotch ice-cream or an overloaded chocolate brownie has the ability to help depression, the sugar in these food items can release serotonin, the pleasure hormone in the body, only for a short period of time. Post this sugarinduced rush, the body is left with a slump and a lot of unwanted calories that become difficult to handle.

50 Diabetic Living

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Improper eating habits: Those fond of eating sweets on a regular basis can end up developing unnecessary sugar cravings. So, it is necessary to limit the intake of sweet food items, which can otherwise lead to future complications. A low-carb diet: If you are on a low-carb diet, youâ&#x20AC;&#x2122;re bound to experience sugar cravings, at least during the initial days. Carbs in food items such as rice, bread and potatoes are broken down into sugar which keeps your body functioning smoothly. A sudden switch to a low-carb diet is bound to increase your sugar cravings. A sedentary lifestyle: With the kind of sedentary work culture and a general lethargic standard of life we have, exercise and other physical activities are a must. A sedentary lifestyle can cause your body to produce lower amounts of serotonin, thereby increasing sugar cravings. Struggling with stress: While you are constantly glued to your computer screen for hours and challenging yourself to meet deadlines, youâ&#x20AC;&#x2122;re likely to experience bouts of stress. Stress often causes poor sleep, which affects your hormone levels and cause you to crave high-calorie, sugary food. And, to beat the stress, you may resort to unhealthy eating habits and treat yourself with sweets and chocolates. While your body will feel satisfied for a short while, youâ&#x20AC;&#x2122;re bound to bounce back to the same level.

FIX YOUR SWEET CRAVINGS Overindulging in any eating habit is the main factor that leads to Type 2 diabetes. At times, diabetes patients are struck with a sweet craving and may feel like gorging on everything sweet in sight. Well, that can lead to further health complications. Therefore, it is essential to follow these simple steps, practice a regulated diet and lead an austere lifestyle to keep your sugar habit in check. Here are some steps that diabetes patients should follow to keep sugar cravings at bay.

Control your weight

The first and foremost thing to be done is getting your weight under control. Try to incorporate small dietary changes and cut those excess sugars from your daily cup of tea/coffee. Keep a watch on the quantity of oil/ghee/butter used in daily cooking at home and while eating out. Completely stop yourself from having sugar-loaded food items such as cakes, icecreams, mithai and manage your carb intake.

Consume food at regular intervals, but in small portions

You need not cut out on all the food items that you like, but simply limit the portions or consult your dietician for the exact amount of food to be consumed. Eating in

small portions every two hours will distribute the carbohydrate load and thus the need for insulin. Do not skip meals or take a long gap in between two meals. This can cause your blood sugar to drop, making you crave for sweets.

Drink plenty of water

Have healthy food

Stay happy

If you love to indulge in nonvegetarian food, you can indulge in fish, eggs, chicken and meat. Keep a check on the portions and avoid fast food, sweetened colas, pizzas, burgers, fruit juices and concentrates. Foods that you can include in your daily diet are spinach, broccoli, egg plant, cucumber, greens, cauliflower, cabbage, tomatoes, onions, capsicum, etc. and look for items that are non-starchy. Opt for whole grains and lots of vegetables.

Exercise, exercise and more exercise

It is highly essential to keep your weight under control and stay fit. One of the best ways is to exercise regularly and increase your energy levels naturally. Regular exercise and workouts have several benefits; it makes it easier to control your blood glucose (blood sugar) level. Take time to relax, practice breathing and meditation, which can all help to reduce cravings.

The risk of dehydration is greater amongst people with diabetes. The higher the blood glucose, the more the water intake should be. Water can help to get rid of the excess glucose in your blood.

The more you’re stressed, the more you will crave for sweet food items. Therefore, stay happy, keep yourself occupied in activities that take your mind off food and overall, laugh a lot. Frank Lipman, The Huffington Post, MD sums it up nicely when he writes, “The bottom line is that sugar works the addiction and reward pathways in the brain in much the same way as many illegal drugs… Sugar is basically a socially acceptable, legal, recreational drug, with deadly consequences — and like with any drug addiction, you have to have a flexible but structured plan to beat it!”

Dr. Ankit Kumar Gupta, Senior Medical Officer, Care24

DiabeticLivingOnline.in

Eat them

RAW

Certain things in their raw form that are suitable for consumption in winters and those that aren’t. writing Gaurav Dawar

52 Diabetic Living

jan-feb 2017

n winters when you hate getting up from the bed, it’s a good idea to opt for raw fruits and vegetables to munch on, that are altogether not harmful for diabetic patients. You can choose from a wide variety of foods and follow a proper diet plan that allows you to keep a check on the calorific value of what you eat during the day, per meal. And for that you need to be well aware of what should be consumed in this season. Diabetes is a condition wherein the body cannot make insulin or use it properly,

leading to high levels of sugar in the blood. A healthy diet, to keep blood sugar in check, can avert the complications of diabetes. There was a time when diabetics were advised to avoid sugary or starchy foods completely, but modern diabetic diets do not restrict a specific food completely. For example, chopped carrots have just 12 grams of carbs per cup, so it takes a full cup of carrots to count as a single vegetable serving when using a diabetes carbohydrate exchange system. It is possible to lead a healthy life by following certain prudent diabetes diet plans, in addition to exercise and prescribed medicines. Here are few tips for a diabetes diet that will prove helpful in controlling blood sugar levels. There are three deviations of raw food diets that include vegetarian, vegan and raw animal food diets: • Vegan raw food diets focus exclusively on fruits, vegetables, grains, nuts and seeds. There are no animal products consumed by people. • Vegetarian raw food diet consists primarily of plant foods, but also includes dairy, eggs and honey. • Raw meat diets focus on consuming animal products that can safely be eaten raw, such as muscle meat, raw dairy and also fruits, vegetables, nuts, and seeds, but not grains.

FHMSTORE.COM

WHAT SHOULD BE CONSUMED IN WINTERS Pomegranates Pomegranate seeds are rich sources of antioxidants and can help fight diabetes a great deal. You can have one fruit a day, which has 105 calories and 26 grams of carbohydrates. It should be consumed with seeds for better benefits.

• C onsume fruits that are fresh, local and in season.

Guava

Berries Berries, loaded with fibre and vitamins, help you control blood sugar and prevent unwanted weight gain in winters. In addition, they have Vitamin E and adequate amounts of liquid that saves you from dehydration. Blackberries are high in folate and low in calories. A cup of blackberries contains 75 calories, it has less than one gram of fat and 7.6 grams of fibre. Consume blackberries every day to give your immunity system a boost. There’s no nutritional difference between fresh and frozen blackberries.

Most diabetics also have the problem of constipation, and guava, which is rich in fibre, works well for them. Consuming it without skin reduces the sugar absorption in blood.

Carrots Carrots can be eaten raw and they are one of the main vegetables to be consumed during winters. They are rich in Vitamin A, C and K and taste the best in this season. Benefits of carrots include improvement of vision for those suffering from diabetes. They are low on carb content and have antioxidant properties. One cup of chopped carrots has 12 grams of carbohydrates (that breaks down sugar level).

Grapes Grapes are best effective when eaten on an empty stomach. They contain potassium and fibre, which makes them very nutritious. They are, therefore, the most recommended choice of fruit in winters and are always included in a diabetic diet plan chart since they prevent a sudden rise of blood sugar level. Half a cup of grapes can be consumed (50 calories) in a day.

54 Diabetic Living

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TIPS TO ENJOY IF YOU ARE DIABETIC

• A dd fruits in your diet that have a low glycaemic index. • T ry to avoid fruits intake with your main meals. It is better to have them in between meals or as snacks. • T here should be proper moderation with high glycaemic index. • H ave some nuts and olives to balance the glycaemic load. • A void the consumption of fruit juices as they tend to elevate the level of sugar in blood. • T he benefit of eating raw is definitely greater than cooked fruits and vegetables.

POWER FOOD FOR WINTERS

-Brussels sprouts -Kiwi fruit -Persimmons -Cabbage -Sweet potatoes -Snow crabs

FOODS TO AVOID There are some vegetables that are toxic when eaten raw, like potatoes, spinach, cassava, etc. Also, they tend to be hard on poor digestion. Hence, you should keep a balance between eating raw and cooked food otherwise you will be at risk of potentially serious illness. Keep moderation between intakes of foods which are high on carbohydrates.

Fruit Juices Juices are considered to be good for the body but in the case of diabetics they lose the fruitsâ&#x20AC;&#x2122; fibre content as compared to when consumed as whole. They are rich in nutrients but low on fibre which leads to rise in blood sugar levels.

Skip fruits which are larger in size The intake of fruits needs to be in the right proportion and in relation to how much they should be consumed. Sometimes, you cannot have a large apple but only half of it, depending on the requirement. According to experts, carbs influence the control of blood more than other fruits which are rich in nutrients. You can pick small raw fruits and cut your carbs too.

Dried Fruits They are also rich sources of carbohydrates and occupy less space in the stomach when consumed, due to which a person tends to overeat. It is always advisable to take 1-2 tbsp of them to remain healthy.

Added Sugar

Refined Flours Foods like white bread, pasta, white pizza dough and white buns should be avoided to keep a control on your diabetes, blood sugar and weight. These foods contain large amounts of carbohydrates which again leads to fluctuation in blood sugar level.

It is always advisable to avoid food items that contain lot of sugar, and this advice must be adhered to even more strictly by diabetics. Avoid items like chocolates, cakes, cookies, coffee and energy drinks, as they are not at all good for health.

Gaurav Dawar, Fitness and Nutrition Expert & CEO of Flabthugs DiabeticLivingOnline.in

INDIA

INDIA’S FIRST MAGAZINE ABOUT DIABETES

India’s #1 & only magazine on diabetes with maximum reach JAN-FEB 2017

diabeticlivingonline.in

LIVING

`100

Cold Comfort Boost Your Immunity

10 Ways to

This Winter

FAST & HEALTHY

Weeknight Meals Dietary ASSISTANCE after Bariatric Surgery

FOOD

“Some people will tell you there is a great deal of poetry and fine sentiment in a chest of tea.”

A DISH TO SHARE We slimmed down holiday side-dish classics so you and your family can have your casserole and eat it, too.

photos Adam Albright recipes Laura R. Walsh styling Jennifer Peterson

DiabeticLivingOnline.in

Balsamic Berry Vinaigrette Salad recipe, p. 84

Whisk together your own vinaigrette to save big on added sugars. This version gets its touch of sweetness from sugar-free strawberry preserves.

Roasted Cauliflower with Cheese Sauce SERVES 8 HANDS ON 20 min. TOTAL 45 min.

Nonstick cooking spray to 4 large heads cauliflower tsp. black pepper Tbsp. olive oil Tbsp. all-purpose flour cup low-fat milk (1%) cup shredded Gruyère cheese (2 oz.) 1/2 cup shredded Fontina cheese (2 oz.) 2 Tbsp. snipped fresh chives 3 1/4 1 1 1 1/2

1. Preheat oven to 220°C. Line two large baking sheets with foil; coat foil with cooking spray. Remove outer leaves from each head of cauliflower. Trim stem end, leaving core intact (the core keeps the slices together). Turn cauliflower head core side down. Cut cauliflower vertically into 1-inch slices. You should have about eight slices total. Reserve ends and loose pieces for another use.* 2. Place cauliflower slices on prepared baking sheets; coat with cooking spray and sprinkle with pepper. Roast 20 to 25 minutes or until tender and golden. 3. Meanwhile, for cheese sauce, in a medium saucepan heat oil over medium. Stir in flour; gradually stir in milk. Cook and stir until thick and bubbly. Cook and stir for 1 minute more. Gradually add both cheeses, stirring until melted. Spoon cheese sauce over cauliflower and sprinkle with chives.

*Tip Use the leftover cauliflower trimmings for mashed cauliflower, cauliflower pizza crust, cauliflower soup, or dippers on a veggie platter. PER SERVING ( 1 slice cauliflower + 2 Tbsp. sauce each) CAL 150, FAT 8 g (3 g sat. fat), CHOL 18 mg, SODIUM 189 mg, CARB 14 g (5 g fibre, 6 g sugars), PRO 9 g

Spiced MapleCranberry Sauce recipe, p. 84

Roasted Cauliflower with Cheese Sauce

Green Beans with Creamy Mushroom Sauce SERVES 8 HANDS ON 15 min. TOTAL 40 min.

Green Beans with Creamy Mushroom Sauce

3 Tbsp. olive oil 1 cup thinly sliced shallots 1 lb. fresh green beans, trimmed 1/2 tsp. kosher salt 1/4 tsp. black pepper 2 cups sliced fresh cremini mushrooms 1 Tbsp. fresh thyme leaves 2 to 3 cloves garlic, minced 1 Tbsp. all-purpose flour 1 cup low-fat milk (1%) 1/2 cup crumbled goat cheese (chèvre) (2 oz.)

1. In a 12-inch nonstick skillet heat 2 Tbsp. of the oil over medium-high. Add shallots; cook for 4 to 5 minutes or until deep golden, stirring occasionally. Drain shallots on paper towels, reserving drippings in skillet. 2. Add green beans, 2 Tbsp. water, 1/4 tsp. of the salt, and 1/8 tsp. of the pepper to reserved drippings. Cook, covered, over medium-high for 2 minutes. Cook, uncovered, for 6 minutes more or until beans are crisp-tender and starting to blister, stirring occasionally. Transfer to a platter; keep warm. 3. For mushroom sauce, add the remaining 1 Tbsp. oil to skillet. Add mushrooms; cook and stir over medium for 1 minute. Add thyme, garlic, and the remaining 1/4 tsp. salt and 1/8 tsp. pepper. Cook for 2 minutes more or until mushrooms are golden, stirring frequently. Stir in flour; gradually stir in milk. Cook and stir until thick and bubbly. Cook and stir for 2 minutes more. Pour mushroom sauce over beans and top with shallots and cheese. Roasted Herb and Garlic Smashed Potato Casserole recipe, p. 84

PER SERVING (3/4 cup each) CAL 119, FAT 7 g (2 g sat. fat), CHOL 5 mg, SODIUM 123 mg, CARB 11 g (3 g fibre, 5 g sugars), PRO 5 g

A LADLE OF GOODNESS Butternut squash soup boasts cancer-fighting antioxidants, but the health benefits fade when itâ&#x20AC;&#x2122;s made with cream. This version uses reducedsodium chicken broth and light coconut milk for smooth flavor in every spoonful.

Pumpkin Spice Butternut Squash Soup recipe, p. 84

DiabeticLivingOnline.in

PARTY STARTERS

SMALL BITES,

BIG FLAVOUR

With bold flavours in every bite, this spread of secretly healthy appetizers will delight partygoers.

AlmondThyme Party Toasts with Goat Cheese

Thai Peanut Chicken Wonton Cups

Baked Coconut Shrimp with Sweet Chili Sauce

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Almond-Thyme Party Toasts with Goat Cheese Spread 16 toasted party rye bread slices with 4 oz. soft goat cheese (chèvre). Sprinkle with 1/4 cup pomegranate seeds, 2 Tbsp. finely chopped almonds, and 2 Tbsp. fresh thyme leaves. To serve, drizzle with 2 Tbsp. honey.

photos Carson Downing; recipes Katie Shields, M.S., RD; styling Jennifer Peterson

SERVES 16 ( 1 toast each) CAL 66, FAT 3 g (1 g sat. fat), CHOL 3 mg, SODIUM 97 mg, CARB 8 g (1 g fibre, 3 g sugars), PRO 3 g

Thai Peanut Chicken Wonton Cups Coat twenty-four 1 3/4-inch muffin cups with nonstick cooking spray. Press a wonton wrapper into each cup; coat with cooking spray. Bake at 190°C for 7 minutes or until edges are brown. Cool in pan on a wire rack. Combine 2 cups coleslaw mix, 1 cup chopped cooked chicken breast, 1/3 cup peanut satay sauce, and 3 Tbsp. refrigerated unsweetened coconut milk. Fill wontons with coleslaw mixture. Top wontons with 1/3 cup fresh cilantro, 2 Tbsp. unsalted peanuts, and, if desired, crushed red pepper. SERVES 24 ( 1 wonton cup each) CAL 50, FAT 1 g (0 g sat. fat), CHOL 6 mg, SODIUM 77 mg, CARB 6 g (0 g fibre, 1 g sugars), PRO 3 g

EXPERT TIP Serve wonton cups right away. They will lose their crispness once refrigerated. —Carla Christian, RD, LD,

Diabetic Living® Test Kitchen Nutrition Specialist

Baked Coconut Shrimp with Sweet Chili Sauce Thai Kitchen won over our taste buds compared to other peanut sauces.

To keep sodium in check, choose A Taste of Thai Sweet Chili Sauce.

In a shallow dish stir together 3 Tbsp. flour and 1/4 tsp. sea salt. In a second shallow dish slightly beat 2 egg whites. In a third shallow dish combine 1/2 cup unsweetened shredded coconut and 1/4 cup panko bread crumbs. One at a time, dip 12 medium shrimps into flour mixture, then into egg whites, then into coconut mixture, turning and pressing to coat. Place on a baking sheet lined with foil coated with nonstick cooking spray. Coat shrimp with cooking spray. Bake at 230°C for 8 minutes or until shrimp are opaque and coating is golden. Serve with sweet chili sauce. SERVES 6 ( 2 shrimp + 2 tsp. sauce each) CAL 106, FAT 4 g (4 g sat. fat), CHOL 34 mg, SODIUM 244 mg, CARB 10 g (0 g fibre, 4 g sugars), PRO 6 g

DiabeticLivingOnline.in

SO E L P M SiSHEET PAN SUPPERS Your favourite healthy meal essentials are roasted and caramelized to perfection in these tasty oven-cooked recipes. Our four distinct flavour profiles promise youâ&#x20AC;&#x2122;ll never get bored using your trusty sheet pan. photos Carson Downing | recipes Jamie Gates | styling Jennifer Peterson

Spicy Jerk Shrimp recipe, p. 85

The pineapple makes a sweet sauce to balance the heat of the jerk seasoning.

SPiCY JAMAICAN JERK

DiabeticLivingOnline.in

WiTH LOVE FROM iTALY Roast lean chicken sausage, sweet peppers, and tomatoes for low-carb Italian fare.

Chicken Sausage and Peppers recipe, p. 85

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Maple syrup brings out the sweet notes of roasted Brussels sprouts in this classic dish.

SWEET TRADiTiON Maple-Roasted Chicken Thighs with Sweet Potato Wedges and Brussels Sprouts recipe, p. 85

DiabeticLivingOnline.in

C I F I C PA COAST ST YLE West Coast nachos get an Asian flavour lift with wasabi and Chinese five-spice powder.

Asian Pork Nachos with Wasabi Cream recipe, p. 86

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tips & tricks

TiPS & FOR SHEET TRiCKS PAN BAKING the 1 Pick right pan.

5 Space it out.

2 Line with foil.

6 Save time.

3 Cut it right.

7 Be safe.

Use a 15×10-inch baking pan made from heavy-gauge aluminum or steel. These materials create better browning on the ingredients.

For fast and easy cleanup, line the pan with foil first, then coat the foil with nonstick cooking spray.

Follow recipe directions for slicing thickness and dicing size. This ensures all ingredients will be cooked properly and won’t turn to mush.

Make it sizzle.

For recipes with larger pieces of meat such as chicken thighs, preheat the pan for 5 minutes before adding the ingredients. The hot pan will sear the meat, locking in flavor and juices.

Spread ingredients in a single layer for the best texture and browning. If too close together, they’ll steam and not roast. To fit an entire meal’s worth of food, you may need two pans.

Once the sheet pan dinner has made its way into the hot oven, start prepping any toppings and sauces so they’re ready when dinner is.

Because ovens can vary, you should always check the meat’s internal temp using an instant-read thermometer to ensure it’s fully cooked and free from foodborne pathogens.

8 Wrap it up.

Cover leftovers using the foil from Tip 2. To reheat, place foil on sheet pan and heat in the oven. (Food has better texture when reheated in the oven and not in a microwave.)

L E M O N

WINTERâ&#x20AC;&#x2122;S POWER FRUIT Lemons are so much more than a garnish for hot tea. Theyâ&#x20AC;&#x2122;re packed with nutrition (hello, vitamin C!) and flavour to lighten up sodium and sugar in any dish. photos Blaine Moats | recipes Andrea Kirkland, M.S., RD | styling Jennifer Peterson

Pink variegated lemons

Meyer lemons

Lisbon and Eureka lemons

WHATâ&#x20AC;&#x2122;S YOUR TYPE

Sour conventional lemons, such as Lisbon and Eureka, are available year-round but peak in winter. We love pink variegated for their tart pastel flesh and striped skin. Meyers have a floral aroma and are a touch sweeter.

DiabeticLivingOnline.in

LEMON TIPS

Get the most bang for your buck from this flavourful fruit.

i Taste

Use lemon to cut back on sodium when you cookâ&#x20AC;&#x201D;its sour flavour increases the perception of salt so you can use less.

i Health

Lemon packs a big vitamin C punch, which may lessen the duration of cold symptoms.

i Buying

A green colour doesnâ&#x20AC;&#x2122;t indicate ripeness; warm temperatures can give the peel a green tinge. Also, the heavier the fruit, the juicier it is.

i Storage

Lemons last longer when stored in the fridge. But bring them to room temp before using to get more juice.

Chicken Piccata recipe, p. 86

Vitamin C is heat sensitive, so youâ&#x20AC;&#x2122;ll lose some when the lemons bake. Adding zest to the glaze is a tasty way to gain a little back.

Scones with Candied Lemons recipe, p. 86

DiabeticLivingOnline.in

Research shows you can reduce salt by 75 per cent if you add lemon juice to your dish before serving. Just let the juice pass through fingers to catch seeds.

Lemon-Garlic Shrimp over Orzo with Zucchini recipe, p. 87

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GET ZESTY

Donâ&#x20AC;&#x2122;t forget the zest! Research shows that consuming citrus zest may reduce cancer risk.

Channel knife zester

Use a 2-in-1 tool to create two styles of zest. One blade creates sturdy, long strips while the other creates delicate, curled pieces.

Lemon Thumbprint Cookies recipe, p. 87

Plane zester

This tool (pictured) makes finely minced pieces. Avoid zesting the white pith of the lemon; it causes zest to be too bitter.

Versatile peel This medium-size zest adds flair and flavour to any dish. Itâ&#x20AC;&#x2122;s a great topper for seafood or desserts.

Cocktail attire Wide, long strips can be candied for desserts or used raw as a cocktail garnish.

Secret zest Stir tiny zest bits into vinaigrettes and glazes when you want flavour without texture.

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BEAT IT WITH

BEET Despite being high on sugar content beetroot has not only been given a clean chit by endocrinologists, it is in fact recommended to people with diabetes. Paint your winters red with these four scrumptious recipes. writing Gitanjali Gurbaxani

o why do we eat beets? They have a sweetness that the adult palate can appreciate. Beets are magical, they are true super foods and something we should all be eating more of. They are a great source of iron, potassium, magnesium, folic acid and vitamins A, C and B6, as well as richly packed with antioxidants. Beets contain an anti-oxidant known as alpha lipoic acid, which has been shown to lower glucose levels, increase insulin sensitivity and prevent oxidative stress induced changes in patients with diabetes. This also helps prevent the cells from damage caused by aging. All the iron in beetroot too is especially good for energy and fighting fatigue, as it allows your body to carry more oxygen to all the cells, letting them function more efficiently. Though high in sugar, beetroot does not result in high glucose concentration in the blood of diabetes patients. “When beetroot is consumed, glucose is released slowly in the blood stream. It is high in dietary nitrate, which is responsible for the potential health benefits of beetroot. Dietary inorganic nitrate is absorbed rapidly and completely in the proximal small intestine with 100 per cent

bioavailability,” says Ms Seema Gulati, Head, Nutrition Research GroupCentre for Nutrition & Metabolic Research (C-NET), New Delhi. The maximum health benefits of beetroot for diabetics are before or after a meal. “Approximately 25 per cent of the nitrate circulating in the plasma is then concentrated in the salivary glands and secreted into the mouth where around 20 per cent is converted into nitrite (NO2 -) by commensal bacteria on the tongue and subsequently swallowed. Upon reaching the stomach the NO2 - is either absorbed directly or reduced to nitric oxide (NO) as a result of the acidic environment of the stomach. Endogenously produced NO and NO2 - are vasoprotective agents with the ability to increase vasodilation, decrease blood pressure (BP) and improve cardiovascular function. Reduced endogenous NO production is associated with hypertension and there is evidence to support the hypothesis that the NO and NO2 - produced as a result of dietary NO3 - could induce health benefits. Since diabetics are at increased risk for CVD, including beetroot in the diet could be helpful for prevention of CVD event in diabetics,” adds Gulati. DiabeticLivingOnline.in

Beetroot Carrot & Apple Juice SERVES 2

1 medium beetroot, boiled & peeled 1 cup fresh dill Leaves, chopped 1 tsp. ginger, grated 250 ml. water 2 medium cucumbers, peeled & diced 3 medium carrots, peeled & diced 1 red apple, peeled & cubed Âž tsp. rock salt

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Place the beetroot, dill, ginger, cucumber, carrot and red apple in a blender along with some water and rock salt. Blend well. Pour out into two tall glasses. Serve immediately or cold, however desired.

MULTIGRAIN BEETROOT BREAD MAKES A 400 GMS LOAF

1 medium beetroot, boiled & peeled 50 gms barley flour 1 tsp fresh yeast 1 tbsp olive oil 50 gms buckwheat flour 100 gms refined wheat flour ¾ tsp salt 1 tsp ajwain seeds 50 gms cornmeal flour water as required Make a puree of the boiled and peeled beetroot. Sieve together the barley flour, buckwheat flour, cornmeal flour and refined wheat flour. In a large bowl, place the yeast and salt. Mix with your fingertips till it has melted. Add in a little water, the beetroot pulp and the flour alternately. Knead well till all of it has been used. Add in the olive oil and ajwain seeds. Knead for 5 minutes till well blended. Place the dough in a bowl covered with a damp cloth for 30 minutes. Later, knock it down and knead it again for 5 minutes. Now place it in a well-greased bread mould and set it aside to rise in a warm room for 2 hours. Bake it in a pre-heated oven at 220C / 450F for 10 minutes, then lower the temperature to 190C / 375F and cook further for 25 minutes. Let it cool for 20–30 minutes before slicing. Serve warm or at room temperature.

BEETROOT BABAGANOUSH SERVES 6

1 medium eggplant 1 tbsp lemon juice 2 tbsp tahini 2 tsp cumin seed powder ½ tsp honey 1 cup beetroot, boiled 1 tsp lemon rind 1 clove garlic 1 pinch of paprika powder 45 ml olive oil salt to taste Place the eggplant on a baking tray and place it in a pre-heated oven at 200C / 400F for 25 minutes, till it’s soft and pulpy. In the meantime, boil the beetroot in a pot of hot water for 10 – 12 minutes till tender. Lightly mash the eggplant in a large bowl. Add to it the peeled and mashed beetroot, along with the tahini, garlic, lemon juice, lemon rind, paprika, salt and

honey. Mix well. Add in the olive oil in a thin stream, whisking it all the time till well blended. Place this dip in a serving bowl

and refrigerate for 2 hours. Serve cold with an assorted platter of salad fingers and lavash.

SPICY BEETROOT YOGHURT DIP SERVES 6

2 medium beetroot, boiled & peeled 1 red chili 1 fistful of mint leaves 1 tsp Dijon mustard 2 tsp balsamic vinegar 2 tbsp yoghurt, natural 1 clove garlic, finely cut 1 bunch coriander leaves 1 tsp cumin seed powder Â˝ tsp cinnamon powder 3 tbsp extra virgin olive oil salt to taste Place the beetroot in a pan, cover it with water and bring it to boil, then simmer it for 30 minutes. Drain it and let it cool before you start peeling them. Place the coriander leaves, red chili, garlic, cumin seed powder, mint leaves, Dijon mustard, cinnamon powder, balsamic vinegar, salt, in a blender along with the beetroot. Blend well. Pour in the olive oil and blend further. Pour in the yoghurt and whisk it for just 10 seconds. Transfer it into a serving bowl, then refrigerate it for 2 â&#x20AC;&#x201C; 3 hours. Serve cold with a platter of finger size thin strips of cucumber, carrot, red bell pepper, yellow bell pepper, green bell pepper and radish.

Gitanjali Gurbaxani, Author and food consultant. gitanjaligurbaxani@gmail.com www.gitanjaligurbaxani.com Seema Gulati Head, Nutrition Research Group Center for Nutrition& Metabolic Research (C-NET), &National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi. seemagulati2007@gmail.com

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WINTER RECIPE GUIDE High-standards ®

testing

This seal assures you that every recipe in this issue has been tested by the Better Homes and Gardens® Diabetic Living® Test Kitchen. This means each recipe is practical, reliable, and meets our high standards of taste appeal.

Inside our recipes We list precise serving sizes to help you manage portions. Test Kitchen tips and sugar subs are listed after recipe directions. If kitchen basics such as ice, salt, black pepper, oil, and nonstick cooking spray are not listed in the ingredients list, then they are italicized in the directions.

Nutrition information Nutrition facts per serving are noted with each recipe; ingredients listed as optional are not included. When ingredient choices appear, we use the first one to calculate the nutrition analysis.

Key to abbreviations CAL = calories CARB = carbohydrate CHOL = cholesterol PRO = protein

Test Kitchen tip: handling hot chile peppers Chile peppers can irritate skin and eyes. Wear gloves when working with them. If your bare hands do touch the peppers, wash your hands with soap and warm water.

Lemon Meringue Sandwich Cookies 8g

carb

1/2 1 2 1/4 1/4 1/8 1

SERVES 12 HANDS ON 20 min. TOTAL 2 hr.

cup sugar* Tbsp. cornstarch egg whites, room temperature tsp. cream of tartar tsp. lemon extract tsp. salt recipe Yellow Cream Filling

1. Preheat oven to 150°C. Line two large cookie sheets with parchment paper. In a bowl stir together sugar and cornstarch. 2. In a medium bowl combine the next four ingredients (through salt). Beat with a mixer on medium to high until soft peaks form (tips curl). Gradually add sugar mixture, 1 Tbsp. at a time, beating on high until stiff peaks form (tips stand straight). 3. Spoon egg white mixture into a piping bag fitted with a large round tip. Pipe twenty-four 3-inch circles, 1/4 to 1/2 inch thick, onto prepared cookie sheets, leaving 1 inch between circles. 4. Place cookie sheets on separate oven racks; bake for 10 minutes. Turn off oven; let cookies dry in oven with door closed for 1 hour. Remove; let stand just until cookies are cool. (The cookies can quickly become tacky, especially if the weather is humid. Store unfilled cookies in an airtight container at room temperature for up to 3 days.)

5. Before serving, place Yellow Cream Filling in a piping bag fitted with a large round tip (or fill a large resealable plastic bag and snip off a corner). Pipe filling onto bottoms of half the cookies, using 2 tsp. for each cookie. Top with the remaining cookies, bottom sides down.

Yellow Cream Filling In a bowl beat 1/2 cup softened tub-style light cream cheese with a mixer on medium until smooth. Beat in 1/4 cup light sour cream, 2 Tbsp. powdered sugar,* and 1/2 tsp. lemon zest. Stir in enough yellow food colouring to reach desired colour. PER SERVING (1 sandwich cookie each) CAL 48, FAT 1 g (1 g sat. fat), CHOL 5 mg, SODIUM 61 mg, CARB 8 g (0 g fibre, 7 g sugars), PRO 1 g

*Sugar Sub We do not recommend using sugar subs for this recipe.

Soothing GingerLemon Tea 1g

SERVES 5

carb TOTAL 25 min.

1 2-inch piece fresh ginger, thinly sliced 8 lemon peel strips (21/2×1 inch each)* 6 green tea bags Splenda Granular sugar substitute (optional) Lemon slices (optional)

1. In a large saucepan stir together

DiabeticLivingOnline.in

WINTER RECIPE GUIDE

6 cups water, the ginger, and lemon strips. Bring to boil; reduce heat. Simmer, uncovered, for 10 minutes. Using a slotted spoon, remove ginger and lemon strips; discard. 2. Place tea bags in a teapot; immediately add simmering lemon water. Cover and let steep for 1 to 3 minutes. Remove tea bags, squeezing gently. Serve immediately in heatproof glass mugs. If desired, sweeten to taste with sugar sub and serve with lemon slices.

*Tip Remove lemon peel using a vegetable peeler. Avoid the white pith, which will taste bitter. PER SERVING (1 cup each) CAL 3, FAT 0 g, CHOL 0 mg, SODIUM 3 mg, CARB 1 g (0 g fibre, 0 g sugars), PRO 1 g

Balsamic Berry Vinaigrette Salad 8g

SERVES 8

carb TOTAL 20 min.

1/4 cup balsamic vinegar 2 Tbsp. plain fat-free Greek yoghurt 1 Tbsp. sugar-free strawberry preserves 11/2 tsp. olive oil 1 tsp. Dijon-style mustard 1 clove garlic, minced 1/4 tsp. kosher salt 1/8 tsp. black pepper

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3 cups fresh baby spinach 3 cups torn romaine lettuce 1 small cooking apple, such as Braeburn or Gala, thinly sliced 1/2 cup crumbled blue, feta, or goat cheese (chèvre) (2 oz.) 1/2 cup pomegranate seeds 1/4 cup chopped walnuts, toasted

1. For vinaigrette, in a small bowl whisk together the first eight ingredients (through pepper). 2. In an extra-large bowl combine the remaining ingredients. Drizzle with half of the vinaigrette; toss to coat. Pass the remaining vinaigrette. PER SERVING ( 1 cup each) CAL 90, FAT 5 g (2 g sat. fat), CHOL 5 mg, SODIUM 144 mg, CARB 8 g (2 g fibre, 5 g sugars), PRO 3 g

next six ingredients (through nutmeg). Bring just to boiling; reduce heat. Simmer for 15 minutes or until most of the cranberries pop and mixture is slightly thick, stirring occasionally. Remove from heat. Stir in maple syrup and orange zest. Cover and chill at least for 30 minutes (sauce will thicken as it chills). 2. Pour half of the sauce into a blender or food processor; cover and blend until smooth. Stir pureed sauce into the remaining sauce. PER SERVING ( 1/4 cup each) CAL 55, FAT 0 g, CHOL 0 mg, SODIUM 3 mg, CARB 14 g (1 g fibre, 11 g sugars), PRO 0 g

Roasted Herb and Garlic Smashed Potato Casserole

Spiced MapleCranberry Sauce 14 g carb

SERVES 12 HANDS ON 25 min. TOTAL 55 min.

1 medium orange 1 12-oz. pkg. fresh or frozen cranberries 1/2 cup water 1/2 cup unsweetened applesauce 1/2 tsp. ground cinnamon 1/4 tsp. ground ginger 1/4 tsp. ground nutmeg 1/2 cup pure maple syrup

1. Remove 2 tsp. zest and squeeze 1/4 cup juice from orange. In a medium saucepan combine orange juice and the

21 g carb

SERVES 8 HANDS ON 25 min. TOTAL 1 hr. 15 min.

2 lb. tiny new red potatoes, quartered 3 Tbsp. olive oil 1 tsp. salt-free herb and garlic seasoning, such as Mrs. Dash 1 garlic bulb 1 cup plain fat-free Greek yogurt 1/4 cup freshly grated Parmesan cheese (1 oz.) 1/4 cup snipped fresh parsley

1. Preheat oven to 160°C. Place potatoes in a 2-qt. rectangular baking dish. Drizzle with 1 Tbsp. of the oil and sprinkle with herb and garlic seasoning and 1/4 tsp. black pepper;

Spicy Jerk Shrimp 37 g carb

toss to coat. 2. Cut off the top 1/2 inch of garlic bulb to expose ends of individual cloves. Leaving bulb whole, remove any loose, papery outer layers. Place bulb, cut end up, on a double thickness of foil. Drizzle bulb with 1 Tbsp. of the oil. Bring foil up around bulb and fold edges together to loosely enclose. Roast potatoes and garlic for 50 to 60 minutes or until potatoes are tender, stirring potatoes once. 3. Carefully remove garlic bulb from foil; cool. Squeeze bulb from bottom of paper husk so cloves pop out. Add roasted garlic and any oil from foil packet, the remaining 1 Tbsp. oil, and 1/2 tsp. salt to potatoes. Coarsely mash. Top potatoes with yogurt, cheese, and parsley. PER SERVING ( 3/4 cup each) CAL 157, FAT 6 g (1 g sat. fat), CHOL 3 mg, SODIUM 148 mg, CARB 21 g (2 g fibre, 3 g sugars), PRO 6 g

Pumpkin Spice Butternut Squash Soup 16 g carb

SERVES 12 HANDS ON 40 min. TOTAL 1 hr.

1/3 cup chopped onion 2 cloves garlic, minced 8 cups peeled and cubed butternut squash 2/3 cup chopped apple 1/2 cup chopped carrot 3/4 tsp. kosher salt 1/2 tsp. pumpkin pie spice

1/4 tsp. black pepper 1 14.5-oz. can reduced-sodium chicken broth 1 14-oz. can unsweetened light coconut milk 1 Tbsp. packed brown sugar* 5 Tbsp. plain fat-free Greek yogurt 5 Tbsp. salted roasted pumpkin seeds (pepitas)

1. In a 4- to 6-qt. Dutch oven heat 1 Tbsp. olive oil over medium. Add onion and garlic; cook for 5 minutes or until tender, stirring occasionally. Stir in the next six ingredients (through pepper). Cook and stir for 4 minutes. Add broth. Bring to boiling; reduce heat. Simmer, covered, for 20 minutes or until vegetables are tender, stirring occasionally. Remove from heat. Stir in coconut milk and brown sugar. 2. Using an immersion blender (or working in batches in a food processor), blend mixture until smooth, adding water if needed to reach desired consistency. 3. Serve soup topped with yoghurt, pumpkin seeds, and, if desired, additional pumpkin pie spice.

*Sugar Sub Choose Splenda Brown Sugar Blend. Follow package directions to use 1 Tbsp. equivalent. PER SERVING WITH SUB Same as above, except CAL 129, 4 g sugars

HANDS ON 35 min. TOTAL 50 min.

11/2 lb. fresh or thawed frozen shrimp, peeled and deveined 4 1/4-inch-thick slices peeled and cored fresh pineapple, halved 2 cups bite-size strips red sweet pepper 2 cups sliced red onions 1 fresh jalapeño chile pepper, halved lengthwise, seeded, and sliced (tip, p. 112) 2 Tbsp. olive oil 1 Tbsp. Jamaican jerk seasoning 1/2 cup coarsely snipped fresh cilantro 11/3 cups hot cooked brown rice Lime wedges 1. Preheat oven to 220°C. Line two 15×10-inch baking pans with foil. 2. Rinse shrimp; pat dry. In an extralarge bowl combine shrimp and the next six ingredients (through jerk seasoning); toss to coat. Divide mixture between the prepared pans. Roast for 15 minutes or until shrimp are opaque. 3. Sprinkle with cilantro and serve with brown rice and lime wedges. PER SERVING (5 oz. shrimp + 1 cup pineapple mixture each) CAL 351, FAT 9 g (1 g sat. fat), CHOL 238 mg, SODIUM 411 mg, CARB 37 g (5 g fibre, 12 g sugars), PRO 33 g

Chicken Sausage and Peppers 20 g carb

PER SERVING (2/3 cup each) CAL 131, FAT 6 g (3 g sat. fat), CHOL 0 mg, SODIUM 133 mg, CARB 16 g (3 g fibre, 5 g sugars), PRO 4 g

SERVES 4

SERVES 4 HANDS ON 15 min. TOTAL 55 min.

Nonstick cooking spray 4 medium red, yellow, orange, and/or green sweet peppers, cut into 1-inch pieces 1 large sweet onion, cut into thin wedges 2 cups grape tomatoes 1 Tbsp. olive oil 1 Tbsp. balsamic vinegar DiabeticLivingOnline.in

WINTER RECIPE GUIDE

1 12-oz. pkg. Italian-flavor cooked chicken sausage, such as Al Fresco, bias-sliced into thirds 1 Tbsp. snipped fresh oregano Toasted baguette slices (optional)

1. Preheat oven to 220°C. Coat a 15×10-inch baking pan with cooking spray. In the prepared pan combine peppers, onion, and tomatoes. Drizzle with olive oil and vinegar; toss gently to coat. Roast for 30 minutes. 2. Push vegetables to one side, exposing one-fourth of the pan. Place sausage in pan. Roast for 10 to 15 minutes more or until vegetables are tender and sausage is heated through. Sprinkle with oregano. If desired, serve with toasted baguette slices. PER SERVING (11/3 cups each) CAL 249, FAT 11 g (3 g sat. fat), CHOL 65 mg, SODIUM 494 mg, CARB 20 g (5 g fibre, 11 g sugars), PRO 18 g

MAPLE-ROASTED CHICKEN THIGHS WITH SWEET POTATO WEDGES AND BRUSSELS SPROUTS 45 g carb

2 4 1 1

3 3

SERVES 4 HANDS ON 20 min. TOTAL 50 min.

Tbsp. pure maple syrup tsp. olive oil Tbsp. snipped fresh thyme lb. sweet potatoes, peeled and cut into 1-inch wedges lb. Brussels sprouts, trimmed and halved bone-in chicken thighs (11/4 lb.), skinned Tbsp. chopped pecans, toasted Tbsp. snipped dried cranberries

1. Preheat oven to 220°C. In a small bowl combine maple syrup, 1 tsp. of the oil, the thyme, 1/4 tsp. salt, and 1/4 tsp. black pepper. In a large bowl combine sweet potatoes and Brussels sprouts. Drizzle with the remaining 1 Tbsp. oil and sprinkle with 1/4 tsp. salt and 1/4 tsp. black pepper; toss to coat. 2. Line a 15×10-inch baking pan with foil. Heat pan in oven for 5 minutes.

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Remove pan from oven and coat with nonstick cooking spray. Arrange chicken, meaty sides down, in center of pan. Arrange vegetables around chicken. Roast for 15 minutes. 3. Turn chicken and vegetables; brush with maple syrup mixture. Roast for 15 minutes more or until chicken is done (80°C) and potatoes are tender. Serve topped with pecans and cranberries. PER SERVING ( 1 chicken thigh + 4 sweet potato wedges + about 3/4 cup Brussels sprouts each) CAL 436, FAT 14 g (3 g sat. fat), CHOL 133 mg, SODIUM 491 mg, CARB 45 g (9 g fibre, 18 g sugars), PRO 34 g

Asian Pork Nachos with Wasabi Cream 29 g carb

SERVES 4 HANDS ON 25 min. TOTAL 1 hr.

12 6-inch extra-thin corn tortillas,

1/2 2 2 2 1/2 1

such as Mission oz. shredded cooked pork loin or chicken breast Tbsp. reduced-sodium soy sauce tsp. Chinese five-spice powder Tbsp. light sour cream Tbsp. plain fat-free Greek yogurt tsp. water tsp. prepared wasabi paste cup shredded reduced-fat cheddar cheese (4 oz.) cups packaged shredded cabbage with carrot (coleslaw mix)

1/4 cup sliced green onions 1/4 cup snipped fresh cilantro

1. Preheat oven to 220°C. Cut each tortilla into six wedges. Arrange wedges, one-third at a time, in a 15×10-inch baking pan; lightly coat with nonstick cooking spray. Bake for 8 minutes or until golden and crisp. 2. In a medium bowl combine pork, soy sauce, and five-spice powder. For wasabi cream, in a bowl combine the next four ingredients (through wasabi paste). 3. Spread tortilla wedges in baking pan. Top with pork and cheese. Bake for 5 minutes or until cheese is melted. 4. To serve, top nachos with coleslaw mix, green onions, and cilantro. Drizzle with wasabi cream. PER SERVING (18 tortilla wedges + toppings each) CAL 325, FAT 13 g (6 g sat. fat), CHOL 58 mg, SODIUM 425 mg, CARB 29 g (4 g fibre, 4 g sugars), PRO 24 g

Chicken Piccata 10 g carb

SERVES 4 HANDS ON 25 min. TOTAL 35 min.

1/2 cup reduced-sodium chicken broth 2 tsp. cornstarch 2 8-oz. skinless, boneless chicken breast halves, halved horizontally 1/4 cup all-purpose flour 4 lemon slices (optional) 2 tsp. butter 3 large cloves garlic, minced

1/4 cup dry white wine 2 Tbsp. lemon juice 11/2 Tbsp. capers, drained 11/2 tsp. snipped fresh thyme 2 Tbsp. chopped fresh parsley (optional)

Scones with Candied Lemons

1. In a bowl stir together broth and cornstarch. Using the flat side of a meat mallet, flatten chicken between two pieces of plastic wrap until 1/2 inch thick; discard plastic. In a shallow dish stir together flour, 1/2 tsp. salt, and 1/2 tsp. black pepper. Dip chicken into flour mixture, turning to coat. 2. In a 12-inch nonstick skillet heat 4 tsp. olive oil over medium-high. Add chicken; cook for 8 minutes or until done (70°C), turning once. Remove from skillet; keep warm. If desired, add lemon slices to skillet. Cook for 30 to 60 seconds or until browned, turning once. Remove from skillet. 3. For sauce, in skillet melt butter over medium. Add garlic; cook and stir for 30 seconds. Carefully add wine. Cook for 1 to 2 minutes or until slightly thick, stirring to scrape up any browned bits. Stir in cornstarch mixture. Bring to boiling; reduce heat. Simmer for 1 minute or until thick. Stir in lemon juice, capers, and thyme. 4. Drizzle chicken with sauce and, if desired, top with lemon slices, parsley, and additional thyme.

PER SERVING ( 1 chicken piece + 21/2 Tbsp. sauce each) CAL 249, FAT 10 g (3 g sat. fat), CHOL 88 mg, SODIUM 354 mg, CARB 10 g (1 g fibre, 0 g sugars), PRO 27 g

(through salt). Using a pastry blender, cut in butter until mixture resembles coarse crumbs. Make a well in centre of

30 g carb

SERVES 12 HANDS ON 35 min. TOTAL 4 hr. 10 min.

3 lemons 1 cup granulated sugar* 11/2 cups all-purpose flour 1/2 cup whole wheat flour 3 Tbsp. granulated sugar* 11/2 tsp. baking powder 1/4 tsp. baking soda 1/4 tsp. salt 1/3 cup unsalted butter 2 eggs, lightly beaten 1/3 cup buttermilk 1/2 cup powdered sugar* 1 tsp. vanilla

flour mixture. 3. In a bowl combine eggs and buttermilk; add to flour mixture. Stir with a fork just until moistened (some of the dough may look dry). Knead in bowl until dough comes together. 4. Turn out onto a lightly floured surface. Lightly roll into an 8-inch circle. Brush top with additional buttermilk. Cut into 12 wedges. 5. Place wedges 1 inch apart on a large baking sheet; top with candied lemon. Bake for 12 to 14 minutes or until edges are golden. Cool on baking sheet on a wire rack for 10 minutes. 6. For glaze, in a small bowl combine

1. Cut part of one lemon into six very thin slices; discard seeds. Remove zest and squeeze 2 Tbsp. juice from the remaining lemons. In a large skillet heat lemon juice, the 1 cup granulated sugar, and 3/4 cup water over medium just until boiling, stirring until sugar is dissolved. Add lemon slices; reduce heat. Simmer gently for 15 minutes or until slightly translucent and rinds are softened, keeping slices in a single layer and turning occasionally. Remove from heat. Using tongs, transfer slices to a waxed paper-lined baking sheet; cool completely. Reserve syrup for another use. Cover and chill lemon slices for 2 hours. Cut slices in half. 2. Preheat oven to 200°C. In a medium bowl stir together 2 Tbsp. of the lemon zest and the next six ingredients

powdered sugar, vanilla, 1 Tbsp. additional buttermilk, and 1/2 tsp. of the lemon zest. Spoon over scones; let stand for 5 minutes. Serve warm. PER SERVING ( 1 scone each) CAL 187, FAT 6 g (4 g sat. fat), CHOL 45 mg, SODIUM 159 mg, CARB 30 g (1 g fibre, 13 g sugars), PROTEIN 4 g

*Sugar Sub We do not recommend using sugar subs for the 1 cup granulated sugar or the powdered sugar. For the 3 Tbsp. granulated sugar, choose Splenda Granular; follow package directions to use 3 Tbsp. equivalent. PER SERVING WITH SUB Same as above, except CAL 176, CARB 27 g (10 g sugars) DiabeticLivingOnline.in

WINTER RECIPE GUIDE Lemon-Garlic Shrimp over Orzo with Zucchini 30 g carb

SERVES 4 HANDS ON 20 min. TOTAL 40 min.

11/2 lb. fresh or thawed frozen large shrimp in shells 2 lemons, halved 3/4 cup dried orzo pasta 2 Tbsp. olive oil 1 Tbsp. unsalted butter 3 cloves garlic, minced 1/8 tsp. crushed red pepper 2 cups sliced zucchini 1/4 cup thinly sliced shallots 1 tsp. snipped fresh rosemary 2 Tbsp. snipped fresh dill weed 1. Peel and devein shrimp, leaving tails intact if desired. Rinse shrimp; pat dry. Using a vegetable peeler, remove zest from one of the lemons and cut into thin slivers; set aside. Squeeze 1/4 cup juice from three of the lemon halves. Set the remaining lemon half aside. 2. Cook orzo according to package directions, omitting any salt and fat; drain. 3. In a 10-inch nonstick skillet heat 1 Tbsp. of the oil and the butter over medium-high. Add shrimp, two of the garlic cloves, 1/4 tsp. salt, and the crushed red pepper. Cook and stir for 2 minutes or just until shrimp are opaque. Stir in 2 Tbsp. of the lemon juice. Remove mixture from skillet; cover to keep warm. 4. In skillet heat the remaining 1 Tbsp. oil over medium-high. Add zucchini, shallots, 1/4 tsp. each salt and black pepper, and the remaining garlic

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clove. Cook for 3 minutes or until zucchini is golden, stirring occasionally. Add 2 Tbsp. water, the rosemary, and the remaining 2 Tbsp. lemon juice, stirring to scrape up any browned bits. Stir in cooked orzo; heat through. 5. Stir shrimp mixture into orzo mixture and sprinkle with dill and reserved lemon slivers. Squeeze juice from the reserved lemon half over mixture. PER SERVING ( 3/4 cup shrimp mixture + 3/4 cup orzo mixture each) CAL 355, FAT 11 g (3 g sat. fat), CHOL 246 mg, SODIUM 476 mg, CARB 30 g (2 g fibre, 4 g sugars), PRO 35 g

Lemon Thumbprint Cookies 11 g carb

SERVES 48 HANDS ON 45 min. TOTAL 2 hr. 10 min.

3 to 4 lemons 3/4 cup butter, softened 1/2 cup granulated sugar* 1 egg yolk 2/3 cup granulated sugar* 2 egg whites 1 Tbsp. vanilla 21/4 cups all-purpose flour 1/4 cup cornstarch 1/2 tsp. baking powder 1/2 tsp. salt 2 Tbsp. powdered sugar* 1. Remove zest and squeeze 6 Tbsp. juice from lemons. For lemon curd, in a medium bowl beat 2 Tbsp. of the butter and the 1/2 cup granulated sugar with a mixer on medium just until combined. Gradually beat in 1/4 cup of the lemon juice and the egg yolk. Stir in 2 tsp. of the

lemon zest (mixture may appear curdled). 2. Transfer mixture to a small saucepan. Cook and stir over low until smooth. Increase heat to medium; cook and stir for 3 minutes or until slightly thick. Transfer to a bowl. Cover surface with plastic wrap and chill at least 1 hour (curd will thicken as it chills). 3. Preheat oven to 175°F. Line two large cookie sheets with parchment paper. 4. In a large bowl beat the remaining 10 Tbsp. butter and the 2/3 cup granulated sugar on medium until combined. Beat in egg whites, vanilla, 4 tsp. of the lemon zest, and the remaining 2 Tbsp. lemon juice (mixture may appear slightly curdled). In a bowl stir together the next four ingredients (through salt). Add to butter mixture and beat just until combined. If necessary, chill dough for 1 hour or until easy to handle. 5. Shape dough into 1-inch balls. Place 1 inch apart on prepared sheets. Using your thumb, make an indentation in centre of each ball. 6. Bake for 12 minutes or until bottoms are very lightly browned. If cookie centers puff during baking, re-press with the back of a small spoon. Cool on cookie sheets for 2 minutes. Remove; cool on wire racks. Fill centers with lemon curd. Sprinkle with powdered sugar and additional lemon zest. PER SERVING ( 1 cookie each) CAL 73, FAT 3 g (2 g sat. fat), CHOL 11 mg, SODIUM 55 mg, CARB 11 g (0 g fibre, 5 g sugars), PRO 1 g

*Sugar Sub We do not recommend using sugar subs for this recipe.

BOOKS SPARK JOY The secret to Marie Kondo's unique and simple KonMari tidying method is to focus on what you want to keep, not what you want to get rid of. Ask yourself if something 'sparks joy' and suddenly it becomes so much easier to understand if you really need it in your home and your life. When you surround yourself with things you love you will find that your whole life begins to change. Spark Joy is an in-depth, line illustrated, room-by-room guide to decluttering and organising your home, and this lovely hardback edition comes complete with a green elastic ribbon to wrap around the front of the book to keep it neatly closed in between reading. Spark Joy covers every room in the house from bedrooms and kitchens to bathrooms and living rooms as well as a wide range of items in different categories, including clothes, photographs, paperwork, books, cutlery, cosmetics, shoes, bags, wallets and valuables. Charming line drawings explain how to properly organise drawers, wardrobes, cupboards and cabinets. The illustrations also show Ms Kondo’s unique folding method, clearly showing how to fold anything from shirts, trousers and jackets to skirts, socks and bras. Marie Kondo’s first book, The Life-Changing Magic of Tidying, presents her unique tidying philosophy and introduces readers to the basics of her KonMari method. It has already transformed the homes and lives of millions of people around the world. Spark Joy is Marie Kondo’s in-depth tidying masterclass, focusing on the detail of how to declutter and organise your home.

Author: Marie Kondo Publication: Random House Pages: 304 Price: `699

YOU CAN HEAL YOUR LIFE

Author: Louise L. Hay Publication: Hay House India Pages: 272 Price: `399

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You Can Heal Your Life shows the readers how they can transform their lives by gradually changing their perspectives. The author says that the thoughts and beliefs of a person have more power than they realise. A person’s beliefs and attitude are mostly shaped during their childhood. The adult perspective is a product of the way their parents taught them to think, social norms, peer attitudes and other external factors. Each thought is an affirmation, whether it is positive or negative. Each affirmation carries its own energy and influences the person’s life. If a person thinks that life has made them a victim of circumstances, then, the author says that they are making sure they continue to be victims. Negative thoughts tend to attract the very things that a person wants to avoid. Health, prosperity, happiness, security, all these can be influenced by the way a person thinks. This book shows how to make those thoughts positive. It gives a set of positive affirmations that the reader can post in various places, to inspire themselves to remain positive always. It teaches the reader that they should first stop being hypocritical of themselves. She encourages a positive attitude towards one’s life and relationships. The author feels that if a person looks at the positive side of every aspect of life, they start attracting more positives to themselves. She emphasises that positive affirmations, accepting oneself as they are, looking for the positives in each situation, and being more cheerful can transform a person and the lives of those around them. The book says that the power to heal any adverse situation in a person’s life is in their own hands. They have more power over their lives than they realise, and the cure is simple. It is in gradually changing the way they think about themselves and the situations that affect them.

THE GREAT INDIAN DIET

MINDFUL EATING: A GUIDE TO REDISCOVERING A HEALTHY AND JOYFUL RELATIONSHIP WITH FOOD

Why run after the West when we already have the best? Join Shilpa Shetty and Luke Coutinho as they tell you just how nutritious your locally grown and sourced ingredients are and that there’s no need to look beyond borders to tailor the perfect diet. The book touches upon various food categories and not only tells you how to take care of your nutritional intake but also how to burn fat in the process. The combined experience of a professional nutritionist and an uber-fit celebrity who lives by the diet will open your eyes to why Indian food is the best in the world. In clear words and detailed analysis, this book brings about an amalgamation of experiences of an uber-fit Indian celebrity and a professional nutritionist and promises to bust every myth that surrounds basic Indian food.

Author: Shilpa Shetty Kundra, Luke Coutinho Publication: Random House India Pages: 288 Price: `299

Author: Jan Chozen Bays Publication: Shambhala Pages: 240 Price: `1,099

The art of mindfulness can transform our struggles with food—and renew our sense of pleasure, appreciation, and satisfaction with eating. Drawing on recent research and integrating her experiences as a physician and meditation teacher, Dr. Jan Bays offers a wonderfully clear presentation of what mindfulness is and how it can help with food issues. Mindful eating is an approach that involves bringing one's full attention to the process of eating—to all the tastes, smells, thoughts, and feelings that arise during a meal. Whether you are overweight, suffer from an eating disorder, or just want to get more out of life, this book offers a simple tool that can make a remarkable difference. In this book, you'll learn how to: • T une into your body's own wisdom about what, when, and how much to eat • Eat less while feeling fully satisfied • Identify your habits and patterns with food • Develop a more compassionate attitude toward your struggles with eating • Discover what you're really hungry for

DiabeticLivingOnline.in

BIG GIRL: HOW I GAVE UP DIETING AND GOT A LIFE A hilarious and inspiring memoir about one young woman's journey to find a better path to both physical and mental health. At twenty-nine, Kelsey Miller had done it all: crash diets, healthy diets, and nutritionist-prescribed "eating plans," which are diets that you pay more money for. She'd been fighting her un-thin body since early childhood, and after a lifetime of failure, finally hit bottom. No diet could transform her body or her life. There was no shortcut to skinny salvation. She'd dug herself into this hole, and now it was time to climb out. With the help of an Intuitive Eating coach and fitness professionals, she learned how to eat based on her body's instincts and exercise sustainably, without obsessing over calories burned and thighs gapped. But, with each thrilling step toward a healthy future, she had to contend with the painful truths of her past. It chronicles Kelsey's journey into self-loathing and disordered eating-and out of it. This is a memoir for anyone who's dealt with a distorted body image, food issues, or a dysfunctional family. It's for the late-bloomers and the not-yet-bloomed. It's for everyone who's tried and failed and felt like a big, fat loser. So, basically, everyone.

Author: Kelsey Miller Publication: Grand Central Publishing Pages: 288 Price: `819

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YOUR DOCTOR IS NOT GOD: HOW TO BE THE CEO OF YOUR OWN HEALTH A hilarious and inspiring memoir about one young woman's journey to find a better path to both physical and mental health. At twenty-nine, Kelsey Miller had done it all: crash diets, healthy diets, and nutritionistprescribed "eating plans," which are diets that you pay more money for. She'd been fighting her un-thin body since early childhood, Author: Aanchal Bhatia and after a lifetime of Publication: Bloomsbury failure, finally hit Pages: 207 bottom. No diet could Price: `299 transform her body or her life. There was no shortcut to skinny salvation. She'd dug herself into this hole, and now it was time to climb out of it. With the help of an Intuitive Eating coach and fitness professionals, she learned how to eat based on her body's instincts and exercise sustainably, without obsessing over calories burned and thighs gapped. But, with each thrilling step toward a healthy future, she had to contend with the painful truths of her past. BIG GIRL chronicles Kelsey's journey into self-loathing and disordered eating-and out of it. This is a memoir for anyone who's dealt with a distorted body image, food issues, or a dysfunctional family. It's for the latebloomers and the not-yet-bloomed. It's for everyone who's tried and failed and felt like a big, fat loser. So, basically, everyone.

Tarot forecast for January-February 2017

ARIES

Card of the Period: Knight of Wands It’s time to move ahead with caution. You would want to make sudden changes in your lifestyle but it’s advisable to take baby steps. People who have BP or cholesterol related issues, must keep a check on their temper and health. Avoid too much of spices and chilly food; avoiding the same can lead to stomach upset. It isn’t a bad idea to indulge in physical activities that can pump up your spirits. Senior citizens or those who have weak bones need to spend some time outdoors to improve their Vitamin D level. The most crucial thing is to act and up your game.

CANCER

Card of the Period: Knight of Cups This month is all about relaxation and taking a chill pill. If you have undergone any medical tests or medication, gear up to receive some good news as you have upped your game. Some of you would be happy emotionally and it’s a good sign that you are away from worries. If you have diabetes, is to avoid munching on sweets or fried foods. Hydrate your body during winters, it’s time to bid goodbye to your addictions like alcohol or smoke. Remember that your current actions towards your health would have long term implications, so be mindful. Keeping calm and meditation is the key.

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TAURUS

Card of the Period: Five of Wands Your health seems to be better with your dedication, however I can see minuscule complications or ailments that may still bother you. It would be good to stay away from negative vibes or situations. For all those who keep experiencing pain in joints, now is the time to be extra vigilant in order to avoid any major issue. It may be helpful to utilise some good yoga techniques that will keep your anxiety levels controlled. It’s a gentle reminder to be consistent with your health. This time is all about indulging in aroma therapy or physiotherapy to soothe your joints.

LEO

Card of the Period: Five of Wands Pick your battles wisely these two months, as over indulgence in petty issues can cause tension in the head. The guidance is asking you to keep a check on your joints-related ailment, especially knees and ankles. It’s time to involve yourself in some physical activity like running or aerobics to channelise your energy. People who keep falling sick because of stomach issues, this month is all about getting your eating habits in order. This would definitely keep you away from gastral or intestinal issues. Try an alternative medical treatment like homeopathy, etc.

GEMINI

Card of the Period: Wheel of Fortune Indicating the cyclic health changes, you may feel or experience transition in health. At times positive or not so positive, but rest be assured tables are turning. Now is the time to be extremely watchful of your health. Don’t ignore any ailments that you incur at this time. Your good eating habits and a healthy lifestyle will definitely bring a positive impact on your health. Whatever the case may be you have the positive vibes and luck that will keep you in good spirits. Be open to change, like physical activity or food patterns as the same can then cause imbalance if not followed.

VIRGO

Card of the Period: Four of Swords Have you been neglecting your health lately? If, yes then it’s high time that you went in hibernation mode. How about retiring for some time and focusing just on the health. People who have an issue with their back, would be strongly advised by their doctor to rest well. A health advice that would help you during this crucial time is to keep your energy levels intact. Let go of toxicity from your life and inculcate new good habits. It’s time to introspect on what went wrong and how you can better it. The keyword for you is to heal yourself currently.

Ruchika Beri (Tarot Card Reader, Oracle Card Reader, Coffee Cup Reader & Reiki Level 1 Channel) | Email: hello@tarotencounters.com | Website: www.tarotencounters.com

LIBRA

Card of the Period: Three of Pentacles Lately you have been getting impacted with petty ailments. And, these ailments like headache or watery eyes can have more adverse effects on your health. People who wear spectacles or have weak eyes, need to take good care of the same. Although your health is showing positive results, you can’t falter right now by getting careless. I can also see that some of you may feel the heat of pain in lower back or shoulder. It’s time to analyse what is going haywire and how you can improvise accordingly. Be prepared to shed some extra kilos and money by joining some health club.

CAPRICORN Card of the Period: Three of Cups

This is a celebratory time and it is easy to overindulge in the extremes too. Don’t push yourself so hard that it can have negative implications on health. Rather, indulge in some peppy activities like Zumba or dance that can lead to cardio exercise. A cautionary advice for those who have high sexual drive is to avoid unprotected sex as the same can give unexpected outcomes. Some of you may experience issues in ankles or legs. It will be a great idea to give hot water treatment after a rough day that will calm your nerves. Stay away from booze for some time to avoid health hiccups.

SCORPIO

Card of the Period: Two of Cups This is the time to rejoice as these two months are all about celebration and feeling happy. Your health and any other ailments that have been bothering you would start disappearing. For the same, the credit goes to either your medical practitioner or your spouse who is leaving no stone unturned. Heart patients or persons whose sugar levels keep fluctuating, must not indulge in cheat day diets as the same may not prove to be fruitful. You are the CEO of your own health, let your Zen mode be up. I see some health goals coming up between partners to up the health game.

AQUARIUS

Card of the Period: Queen of Wands Time to detoxify your body and spirit and you can do this by making some changes in your regime. Health transformation is in the pipeline, as many of you would want to set new health goals for 2017. Don’t get bogged down by petty health issues, rather work on making your immune system strong. It is advisable to keep your spirits high and energy up and going. Wear more happy colours as they will keep you away from negativities of life. It’s time to keep a check on your temper before it starts impacting your mental state. Relax and think happy thoughts.

SAGITTARIUS Card of the Period: The Empress

This is the card of happiness and joy and definitely good health. Pregnant women would be at a great space as they would be welcoming a new member in the family. People who have a tendency to put on weight need to balance their eating patterns with exercises. For thyroid patients it’s very crucial to keep a watch on your weight and joint issues (if at all). You deserve the much needed break if you have been working hard these days. Time to smell roses and pamper yourself, but don’t overindulge in junk food as I can see weight issues cropping up.

PISCES

Card of the Period: Four of Cups This is a very unhealthy space to be in where you are currently; move out of your low/depressive state. Some of you may experience extreme mood swings that can hamper your health and state of mind. Women who have issues like PCOD or irregular menstrual cycle issues need to pay utmost importance to it. Pregnant ladies, don’t be negligent towards your health as the same can lead to unfavourable outcomes. Don’t mull over negative emotions or things that aren’t happening. Branch out and seek external help before the issue gets out of control.

DiabeticLivingOnline.in

SWEET ENDING

A Spiced Spirit Orange Peartini STEP ONE: In a saucepan bring 2 cups peeled and chopped pears, 11/4 cups water, 1/4 cup sugar, and 1/4 cup orange juice to boil. Reduce heat; simmer, covered, for 20 minutes. Cool slightly. Transfer to a blender; puree until smooth. Strain mixture through a fine-mesh sieve; discard solids. Makes 21/3 cups pear puree.

PER GLASS: CAL 190, CARB 18 g (11 g sugars)

Try this recipe with your choice of pear: bartlett, Asian, anjou, or bosc.

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photos Blaine Moats; recipe Lauren Grant; styling Jennifer Peterson

STEP TWO: In a cocktail shaker combine 1/4 cup pear puree, 3 Tbsp. vodka, and 1 Tbsp. Cointreau. Add ice cubes; cover and shake for 10 to 15 seconds. Strain liquid into a martini glass. Add 3 Tbsp. club soda. If desired, serve with a cinnamon stick and orange peel twist.

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The magazine is well-organised Articles do not give me enough information Articles are colorful and attractive The text size is too small to read The text size is easy to see and to read Stories inform and educate me Stories inspire me to take self-care actions Stories encourage me to talk to my doctor or health care provider I can get the same information elsewhere The magazine keeps me up-to-date on the newest information about diabetes The articles are difficult to understand The stories are realistic for someone with diabetes The magazine shows/describes people I can relate to

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