Eating Well with Health Challenges -- Andrea Dunn, RD, LD, CDE -- 9/23/2003

By Andrea Dunn
WebMD Live Events Transcript

It's hard enough to eat right with so many unhealthy choices out there. Adding special dietary restrictions to the mix can make proper nutrition a difficult goal. On Sept. 23, 2003, we talked about foods that can help or hurt those with diabetes, hypertension, heart disease, and more. Cleveland Clinic nutrition expert Andrea Dunn, RD, LD, CDE, was our guest.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD University: "Eating Well Is a Start Towards Healthy Living." Our guest today is Cleveland Clinic nutrition expert Andrea Dunn, RD, LD, CDE. Today we are talking about special health challenges to eating well.

Support for this WebMD University course provided by Medical Mutual.

Moderator: Welcome Andrea.

Dunn: Hello, class, how's everyone today?

Moderator: We have a classroom full of students here who are anxious to get their questions answered. Let's get started.

Member: My interest is meal planning, especially breakfast. I have hypertension.

Dunn: You're already doing a great thing by eating breakfast already. One of the big issues with fighting high blood pressure through diet is getting enough fruits, vegetables, and whole grains. So consider what you like to eat first thing in the morning. Some ideas:

  • A hot bowl of oatmeal
  • Cold cereal with fresh fruit (Try to look for cereal with more than 5 grams of fiber in it might be a good start. We know the higher the fiber the longer that food might make you feel fuller too and stay with you through the morning.)
  • An occasional egg, including a low-fat protein source, such as low-fat cheese
  • Peanut butter on whole-grain bagel or bread
  • If you don't like fruit, but enjoy juice, including a 6 ounce glass of juice in the morning would be a great addition to breakfast
  • Typical high-sodium breakfast foods such as bacon and sausage should be eaten less frequently

Member: Protein carries me longer than carbs, but fat is a big no-no.

Dunn: Many people do enjoy a protein serving at breakfast and like you, it does seem to stay with them so they don't get hungry midmorning. But don't forgo the carbohydrates at breakfast, because carbohydrate is the brain's main source of energy. So some carb in the morning can actually get that brain going.

Member question: I have diabetes 2, high cholesterol, hypertension (am on meds for all), am lactose intolerant, and take a pancreatic enzyme to digest fats, and also have severe depression. I feel overwhelmed and cornered when I try to plan a meal. Where do you start?

Dunn: When you have multiple medical problems the first start might be in what you can tolerate. So being lactose intolerant, trying some of the milk replacement products that are on the market, such as the soy milk or the rice milk might be a good start if you like milk on your cereal.

As far as the diabetes element and diet, looking at the total amount of carbohydrates that you eat each day and each meal will help you in managing your blood glucoses. A heart healthy diet is low in fat and overall salt, so it may not be as unmanageable as you may be thinking. A lot of it, though, may be working with what you can tolerate.

Member question: I leave too early in the morning for breakfast. What's a good alternative?

Dunn: That's a good question. When you're in a hurry in the morning, there are a couple of approaches you can take.

Number one is planning the night before. Getting your breakfast out -- if you do want to eat breakfast -- and packing your lunch the night before, is going to help you get out the door faster.

Another approach is to prepare or have foods ready that you can grab and go. I'm not a big fan of eating in the car, unless you're a passenger, because I think you should really concentrate on driving (unless where you're driving is better than my Cleveland traffic). The rest of us should be paying attention to the road. So maybe you're thinking in terms of taking something to eat once you get to work.

If you like cold cereal, some people would put cold cereal, without the milk, of course, in a small baggie. For a protein source you could throw in a half ounce of nuts. You could nosh on that at work and have a decent breakfast. Yogurt's a great grab and go. Some people throw cold cereal or low-fat granola on top of yogurt and have that for breakfast.

If you like a hot item and you have a microwave at work you could take a tortilla, roll in a stick of low-fat string cheese and melt that in the microwave once you get to work. Have a piece of fruit with that.

Member question: Aren't tortillas bad for you?

Dunn: I'm not sure what your reference is in thinking tortillas are bad. I myself don't really categorize foods as good or bad. Certainly a tortilla can be very low in calories. A small tortilla, whether it's corn or wheat based, might only have 80 calories in it. If you buy them very low in fat it's going to be what you put on top of them that's going to build the calories. Adding a slice of low-fat cheese and cut-up vegetables sounds healthy to me.

Member question: Is it better for a type 1 diabetic with heart disease to consume oatmeal or protein sources for breakfast?

Dunn: There's no reason why you couldn't have both of them if you wanted to. With type 1 diabetes the biggest goal is to match the carbohydrate in the meal with the correct amount of insulin, so depending upon the insulin regimen that you are following, you certainly could have oatmeal in the morning if you wanted it.

Research has not shown that having a protein source prolongs the rise in blood glucoses, though certainly having a protein source with a meal might make you feel fuller or give you some satiety. So the bottom line is, if it's something that you want, let's work it into your meal plan.

Member question: I'm on Novolog insulin three times a day with meals, and Lantus at night. I have a real "mental" problem with the idea of no snacks. The doctor says three meals, eat them and inject, or don't eat and don't inject. Any ideas for non-food snacks I can use to get over this hump of, 'It's HOURS 'til the next meal - I better eat more now,' feeling?

Dunn: You might want to talk to your doctor about including the snacks that you want and how much insulin you would need to inject for the snacks. Because you're the one that has to live with this style of eating, so it makes sense if you want snacks you should plan them in.

There are many low-carbohydrate type foods you could try as fillers. Certainly a serving of most of your vegetables, as in fresh vegetables, are going to be only four or five grams of carbohydrate. Dipping them into something like salsa is not going to add very many calories.

Sugar-free gelatin or a stick of sugar-free Popsicle might be other choices for an occasional low-calorie snack.

Member question: I have celiac disease (recently diagnosed), avoid the usual migraine trigger foods, can't have citrus or fatty foods for stomach problems, lactose intolerance, and am severely iron deficient (on supplements sporadically for that, they tear up my stomach). I'm severely underweight. Any suggestions for foods to help me gain weight?

Dunn: It sounds like you need to make an appointment with a registered dietician to go over all your food options.

Member question: Andrea, I had GD when I was pregnant with my son; he's 2 years old now. Lately my blood sugar has been high. I need to establish a more healthy eating habit. I just don't know how. I don't eat a lot; yesterday all I ate all day was a bag of popcorn. One meal is typical for me; I'm just not hungry. Is it better to start eating three meals a day even though I don't feel like eating? Do you have any suggestions?

Dunn: We do know that mothers that have had gestational diabetes do have a higher chance of developing type 2 diabetes. When you mention your blood glucoses have been running high, are you being monitored by a physician?

Member: My mom has diabetes. I've been testing with her meter.

Dunn: It may be time to check with your doctor, as you may need medical intervention to bring the blood glucoses down.

In answer to your eating questions regarding meals, most people find that spreading out their calories throughout the day does help them to be less hungry. Also, eating first thing in the morning does tend to jump start your metabolism. It sounds like your metabolism might be low.

One other area, besides diet, that you may want to look at would be exercise. With some people there's a big problem with insulin resistance. Your pancreas is producing insulin but your body may not be able to use it. Exercise helps reduce this insulin resistance and might help with normalizing blood glucoses in some individuals. Results of a recent diabetes prevention program showed that about 58% people with prediabetes who lost even just a small amount of weight and exercised even just by walking 150 minutes a week were able to prevent type 2 diabetes.

Member question: I have a mixture of illnesses going on. I am DM II, HbA1c of 5.8. I have congestive heart failure and GERD. My two main concerns are diet for the CHF (strict cardiac diet) and my DM II (diabetic diet). What can I do to make these two diets really work without side effects towards each other? I grill or bake all meats; I use Splenda for sugar substitute; I add no salt to anything; I use spices and herbs to flavor meals; I watch my carb intake. I need help more with portion control. Can you help?

Dunn: A carbohydrate-controlled meal plan goes hand in hand with a heart healthy style of eating. With an A1C of 5.8 you have your blood glucoses under control.

Portion control is important, even when choosing healthy foods that are low in fat and salt. If you don't already have a kitchen scale, you may want to get one. You can find them for less than $5. Some of the electronic ones might be $30 or more.

One way to limit salt, fat, and, of course, total calories, would be to weigh out your meats after they're cooked. Weigh them trimmed of fat, bone, and remove any skin. Limiting your total meat for the day to 5 ounces if you're a woman, or 6 to 7 ounces if you're a man is probably a good range to start. Most people overeat meats and protein, but calories are calories to the body.

A good sodium goal for congestive heart failure would be under 2000 milligrams of sodium per day unless your physician has given you another guideline.

Member question: What do nutritionists have to say about the low-carb diets that seem to be in vogue? I am having success but my fear is that the diet works against my cholesterol and blood pressure reduction medications. Can low-carb choices result in a well-rounded healthy diet that will not only allow weight reduction and reduce habits that contribute heart disease risks?

Dunn: The low-carb diets currently on the market are just that: Diets. For most people, the word diet is a four-letter word, and it means a start and a stop. If you're only following these fad diets for a short period of time the average healthy person will probably not be negatively impacted by it. The problem you run into long-term is avoiding certain foods that we know promote good health, such as fruits, low-fat dairy products, and whole grain products. There have only been limited studies done looking at the effect of low-carbohydrate diets, and they've only been done short-term.

What you need to do, if you have high cholesterol or other lipid problems, is to be in contact with your physician. If you want to try the low-carb diets for weight loss, give them a try and follow up with your physician after three months, monitor your lipid levels, and see if the diets made an impact or not on your cholesterol level.

There are many versions of low-carbohydrate diets, and each individual may respond differently, depending on how they interpret the meal choices.

Member question: I have to have a nuclear scan done on my thyroid. For one week I cannot have any food containing iodine or salt. Are there any vegetables or fruits I should avoid?

Dunn: I would advise you to contact your hospital to see what kind of meal plans they want you to follow prior to the test. They must have specific guidelines that they'll want you to follow.

Member question: Dinnertime is between 7 and 8:30 pm -- my last glucose test is at 11pm with my Lantus injection. I've had night readings of 113 followed by morning readings of 170, and conversely had nights of 170 with mornings down to 120. I know I don't eat in my sleep, so do you have any idea what might be happening?

Dunn: One thing to keep in mind is that the liver can release glucose independently from what you eat. What that means is that during the night your blood glucoses could be going up because of glucose released from the liver. You already may be on a medication to control this, or you may not be. Lantus is a long-acting insulin that works over 20 to 24 hours.

The other factor that may be going on is the amount of carbohydrate that you eat throughout the day. If you consistently take the same amount of insulin you need to be consistent with the amount of carbohydrates that you eat.

Member question: I am a type 2 diabetic and can't have any fruits because the sugar sets off a rise in my blood sugar. Is there a way of preventing the rise and enjoying the fruit?

Dunn: Sometimes taking the fruit with a mixed meal, for example, fruit for dessert with lunch or dinner, may prevent that rise in blood glucose that you may see when you eat fruit as a snack on an empty stomach. You may also want to try different fruits to see which ones don't spike your blood glucose as high.

Member question: Can you make recommendations for someone with sensitivity to gluten who would like to lose 15 pounds and get into better physical shape?

Dunn: When you're trying to lose weight, we need to look at calories in and calories out. To lose a half a pound a week, you probably need to fine-tune what you eat each day by about 250 calories. So whether or not you're on a gluten-free style of eating or a low-fat or a carbohydrate- controlled meal plan, you still need to address the calorie issue to lose weight.

Many people benefit from keeping a food journal, tracking what they eat and the calories. That might be a good start for you in terms of looking at where you might be able to trim a few calories here and there.

Sometimes just leaving a bite or two behind each meal helps create a calorie deficit. For others, it might be having vegetables as a second serving instead of the meat and side dish. But the bottom line for any weight loss is going to be total calorie.

Member question: I have added nuts to my diet (almonds, pecans, and walnuts) as I read that eating these helps to decrease the risk of heart disease; however thy also have a relatively high-fat content. Is eating nuts at cross-purposes to a health diet?

Dunn: You are very observant! You've not only read the latest research that shows nuts can be very heart healthy, but you've also keyed into the fact that a small amount of nuts goes a long way in adding calories. As little as 24 almonds can give you about 170 calories. Seven whole walnuts also have about the same calories. So measuring out, as in a small handful, maybe 2 tablespoons as a serving size, and including some nuts a couple times a week, might be a good start.

The trick is, calorie wise, to then use those nuts as a replacement for another food item so you're not adding additional calories to your day. For example, midafternoon, instead of having those fat-free pretzels have a small handful of nuts instead. Or if you enjoy a mealtime salad and usually throw cheese on top, throw a few nuts in its place. Exchanging those calories for other calories in your meal plan should prevent weight gain.

Moderator: We are almost out of time. Andrea, do you have any final comments for us?

Dunn: A healthy style of eating includes a variety of foods. So if you're not able to include the foods that you want to enjoy every day, then it might be time to meet with a registered dietician so you can readjust your meal plan and eat what you want. Have a good day!

Moderator: We are out of time. Our thanks to Andrea Dunn for being our instructor today, and thank you class for joining us! For more information, please be sure to sign up for the entire WebMD University course. It's free and easy. And check out all of the nutrition information on WebMD.



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