Why Is My A1c High?

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Your daily random blood glucose readings are good. You watch your carbohydrate intake, exercise, take your medication as prescribed, avoid smoking, and try to live a healthy lifestyle.  But still, your Hemoglobin A1c (“HbA1c” or just “A1c”) is over 7.0 which leaves you frustrated, wondering what you are doing wrong. One thing to consider is that you check your blood glucose only a limited number of times daily. Your daily readings may look good the 3-4 times you check, but what is your blood glucose doing throughout the day when you are not checking it?

Taking daily readings is good, but taking an A1c test through your healthcare provider every 3-6 months gives insight into your long-term glucose levels. The higher the glucose in your bloodstream, the greater the glucose attachment to the hemoglobin portion of your red blood cells. The lifetime of your red blood cells is 2-3 months; therefore your A1c reading reflects the glucose level of your blood over the past 2-3 months. A target A1c for most adults is under 7.0.

Insulin from your pancreas is essential for properly regulated glucose throughout the day, which determines your A1c. Several factors can interfere with the work insulin is trying to do, including:

Excess body weight

The accumulation of body fat, especially visceral fat (the kind that surrounds your internal organs causing an apple shape), interferes with the work of insulin. Just a 5-10% decrease in body weight will improve glucose levels.

Stress

When you are experiencing stress it is your body signaling that something needs to change. Unfortunately, many people choose to push through stress on a daily basis and never consider addressing the source of stress in their life. Stress contributes to insulin resistance. It can also raise your epinephrine and cortisol levels, causing an increase in A1c. You also may be one of those people who engage in stress-eating for temporary calming which will elevate your weight, blood glucose, and A1c.

Sleep deprivation

Poor sleep patterns impair glucose metabolism. If you are getting less than 7-8 hours of sleep on a regular basis, it would be wise to address your “sleep hygiene” (such as developing a calming routine at bedtime) to help lower your blood glucose.

Portion control

Even though you are choosing healthy foods, portion control is still necessary to manage your A1C. Healthy foods still contain carbohydrates, and although you need to limit carbohydrates, you do need appropriate amounts of them for fuel.

Exercise Levels

Cardiovascular and strength or resistance training are important to maintain your weight and manage your glucose and insulin levels. Strength training helps your body respond to insulin better, so it should be a part of your weekly fitness plan. Cardiovascular exercise directly improves blood glucose in the moment.

Mindfulness

“Mindfulness” is when your mind is fully attending to what’s happening and what you are doing in the present moment. Often, we are not fully present for our current moments of life experience. We take flight and soon we are worrying about our future or revisiting our past with obsessive thoughts.  Increasing mindfulness lowers blood glucose and eventually A1c.

So remember – you do have control over many of the factors that affect your A1c. CB

Meal Prepping Made Easy

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I don’t know about you, but sometimes 24 hours a day is just not enough. With school and work, some days I struggle to find the time to eat nourishing meals because I don’t have the time to make a meal and any prepared options are usually not the best choices. I started meal prepping can help free up some time during the week by cooking meals ahead of time!

Set a Day for Meal Prepping

First, set a designated day to cook your meals. I like to cook on Sundays and Wednesdays making meals for three to four days so I don’t get tired of the same meals every day. Also, most of the time food only says good for about three to five days or so. This is also a great way to get the family into the kitchen. Getting kids to help out can spark their interest in healthy food and cooking. Plus, they are more likely to eat the food that they helped cook.

Plan Your Meals

Once you have set a day to make your meals, plan what you are going to make and write a list of food you need to get at the grocery store. Planning your meals in advance can help make grocery shopping much easier as you already know what to get. This way you only need to go to the grocery store once a week. When planning your meals, think about ingredients that could be cooked in multiple ways. For example, you can make spinach into a salad, put it in some soup, or sautee it with other veggies!

Don’t limit your meal prepping to just lunch and dinner. You can save time in the morning by portioning out your smoothie ingredients in mason jars or pre-making pancakes and cut fruit for an easy breakfast for the kids.

Having pre-made snacks make it easy for you to grab and go. Cut up and portion fruits and veggies! Portion out cheese, lunchmeat, and crackers for homemade Lunchables! Pre-package trail mix or cereals! The combinations are endless.

Be Efficient

Utilize your kitchen to the max!

  • Make sheet pan meals by roasting multiple items on the same sheet pan. That’s one less dish to wash at the end of the night!
  • Multi-task. Whether that be boiling some pasta while sauteeing some greens or baking chicken and roasting potatoes, make use of your time cooking.

Portion Out Your Meals

After making all your meals, portion out your meals. This makes it quick and easy to grab your lunch when you are on your way out the door! If you don’t have enough room in your refrigerator, pack your lunch and dinner the night before so you have it ready to go in the morning.

Mason jars are a great way to put salads in. Place your dressing in first and then put hardier vegetables like chickpeas or tomatoes or protein. That way your salad is not soggy when you eat it. It’s also great to use if you want instant noodle soups. Just cook your favorite noodles and shock them in ice water before adding it to the mason jar with other ingredients you want. Add miso, tum yum paste, a bouillon cube, or any other soup flavoring. When you are ready to eat, just add hot water and let it sit for a couple of minutes. And voila you have soup!

Freeze It

If you want to meal prep way far in advance, you can freeze the extra meals you made. You can marinate meat, cook vegetables,  or make soup and freeze it! Making and freezing family meals can be a huge time saver when you are running short on time to make dinner. You can make lasagna, oven bakes, or casseroles in a disposable pan and freeze them until you need them.

Fast food can be healthy. Meal prepping may require taking some time out of your week, but you can have ready to eat meals that you know are nutritious! You can make it as easy as you want it by simply putting everything in the oven or have fun making different meals. Not only does it save time during the weekdays, but it can save you money and unnecessary stress. Try meal prepping this week and comment below how you did it!

AN

Which Came First? Lack of Sleep or Nutritient Shortfalls?

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How are you taking care of yourself? Taking care of yourself directly impacts your ability to care for others. Think – are you getting the sleep you need, managing stress in a positive way, meeting your nutritional needs, getting in physical exercise? 

 

Which came first? Are nutrient shortfalls secondary to lack of sleep or lack of sleep secondary to nutrient shortfalls?

The answer – either one can cause an impact on the other. There are some common nutritional deficiencies that may prevent us from getting adequate sleep and/or caused by lack of sleep. Ideally, we should get 7 to 9 hours of sleep at night.  However, less than 1% of the population falls into the “exception” category of needing less or more than this. If you are not meeting this guideline, you are likely putting yourself at risk for nutrient deficiencies and causing your sleep to be worse. 

 

Adults with less than 7 hours of sleep at night have been found to have nutrient shortfalls in vitamin D, vitamin E, magnesium, vitamin C, vitamin A, calcium, vitamin K, potassium and omega 3s. 

  • Did you know 96% of Americans don’t eat enough vitamin D?
    • Vitamin D plays an important role in lung health, insulin secretion, bone health, brain health, heart health, inflammation, muscle health, and our immune system. 
  • Did you know 55% of Americans don’t eat enough magnesium?
    • Magnesium plays an important role in our bones/teeth, regulation of heartbeat, muscles, nervous system, metabolism, and cellular energy. 
  • Did you know 95% of Americans don’t eat enough omega 3s?
    • Omega 3s play an important role in eye health, maintaining healthy triglycerides, healthy blood pressure, brain health, heart health, and inflammation. 

Having a balanced diet with a variety of produce and protein sources can help prevent nutritional deficiencies. Nutrient-dense food sources include:

  • Vitamin D: Egg yolk, mushroom, fatty fish, cod liver oil, fortified foods/beverages (cereal/orange juice/milk)
  • Vitamin E: Almonds, avocado, fatty fish, sunflower seeds, hazelnuts, spinach, butternut squash, olive oil, kiwi
  • Vitamin C: Kale, broccoli, green chili pepper, bell pepper, coriander, kiwi, strawberry, lemon, grapefruit, pineapple, orange, papaya, tomato
  • Vitamin A: Liver, cod liver oil, spinach, butternut squash, mustard greens, tomato, fatty fish, carrot, sweet potato, cantaloupe, red bell pepper, parsley
  • Vitamin K: Kale, broccoli, brussels sprouts, cabbage, cucumber, asparagus, kiwi, avocado, cheese, eggs, chicken, butter
  • Magnesium: Pumpkin seeds, almonds, spinach, quinoa, beans, dark chocolate, peanuts, edamame, cashews, cacao powder, oatmeal, avocado, broccoli, banana
  • Calcium: Milk, cheese, yogurt, fish, spinach, kale, collard greens, beans, lentils, walnuts, edamame, fortified drinks (almond milk/orange juice), chia seeds, sesame seeds, almonds, broccoli, tofu
  • Potassium: Pistachios, beet greens, salmon, white beans, potatoes, milk, mushrooms, avocado, tomato, flaxseed, pumpkin seed, peanuts, almonds, banana, acorn squash, broccoli, brussels sprouts, celery, watermelon
  • Omega 3s: Fatty fish (anchovies, sardines, herring, trout, salmon, mackerel, albacore tuna), basil, chia seeds, flax seeds, spinach, walnuts, edamame, brussels sprouts, avocado

Whether lack of sleep causes nutrient abnormalities or nutrient abnormalities causes a lack of sleep, it is important to make both a priority to help the body function properly. They both play a key role in overall health. Speak with your Dietitian about ways you can improve stress, sleep, and nutrition. LN

Healthy Lifestyle Opportunities during Social Distancing

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Over the past few weeks, it’s become easy to focus on things we’ve lost- 24/7 grocery store access, Barre classes, dining at our favorite restaurants, and even taking our children to the park. As the days turn into weeks, we grieve the loss of control in our daily routines.

This forced slowed down lifestyle gives us the ability to pause and be intentional about our health and fitness goals. We’re staying home, living a much slower pace, we have suddenly found ourselves with opportunities to be present and intentional.

Healthy Lifestyle Opportunities during Social Distancing

Time and necessity to plan meals and grocery shopping lists

  • Increasing interaction with the public is definitely a risky business. A quick trip into the convenience store when all you really need is gas could put you at a higher risk of contracting the coronavirus but also lead to a few moments of misguided pleasure down the candy aisle. With recommended interactions outside of the home being brief, it’s a necessity to plan in advance to prevent multiple trips to the store and to decrease impulse choices such as convenience items. This is the perfect time to save on your food dollar plus trim your waistline by decreasing portions. Instead of the larger portion or a second serving, save it for the next meal.
  • Our best defense is a strong offense. Live the strongest healthiest version of yourself you can.  Be absolutely intentional with getting in at least six servings of fruits and vegetables daily. Purchase a rainbow of colors to assure you are incorporating a variety of nutrients. Don’t neglect to keep frozen fruits and vegetables on hand for when you run out of fresh.

Teachable cooking moments for your family

  • Food prep and cooking at home can bring healthy options to your table in a fun and creative way. Try new recipes or experiment with new ways to cook to make cooking a fun family affair. More opportunities for family meals mean more opportunities for everyone to learn this essential life skill eliminating some of the feelings of, “I don’t want to cook, I don’t like to cook, I don’t know how to cook.” While we hope to never experience another pandemic, your children will benefit decades down the road for learning this important life skill.

Learning physical hunger over emotional hunger

  • Embrace this time to figure out physical vs emotional hunger.  Is your hunger coming from your gut or possibly your head? Is your hunger tied to the current freeway of anxiety, worry, fear, panic? This is the perfect time to look into the emotions you are feeling with curiosity, not shame or blame.  Identify your negative feelings and respond to them with compassionate words such as “isn’t this interesting.” Take the time to explore your feelings and learn more about yourself and your relationship with food. Remember, food will not fix fear, anxiety, worry or panic. COVID-19 will still be here after you polish off the chips, nuts, ice cream or cookies, then how will you feel? If you choose to indulge in reckless eating you will be layering more “icky” feelings on top of your “icky” corona feelings.

Feel your feelings and get moving

  • Everything about the coronavirus feels pretty awful. Thank heavens we can still be outdoors to exercise for our mental health. The weather has been challenging with days that have felt too hot, too cold or too wet to get outside. Realize you may need to adjust to the weather, you can dress cooler, wear a coat and even carry an umbrella—- MOVING is a necessity to maintain mental health. A dance party in the house would also work, I couldn’t live without my hula hoop during these trying times.

Seize the day! The stage is set! This is the perfect opportunity to create that healthy and fit version of you. Go forth and be intentional.

CB

Make Sleep a Priority

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Amerian culture does not value sleep.

Sleep is an important part of a healthful lifestyle. While you are sleeping, your immune system works to repair damage and clean up cellular messes in the organs. The nervous system mends while memories are being formed during dream time.

Research has shown that inadequate sleep puts you at risk for diabetes (and it’s complications), obesity, cardiovascular disease, and early death. Some studies have found that even one night of poor sleep (less than 6 hours of sleep) increases insulin resistance.

Poor sleep can increase levels of your appetite-stimulating hormone (ghrelin), stimulate the production of your stress hormone (cortisol) and decrease glucose tolerance. It is optimal to get 7 to 9 hours of sleep per night. 

Tips to Improve Sleep:

  • Quiet time: Spend a half-hour with meditation, prayer, relaxing music or other quiet time prior to bedtime. 
  • Routine: Try to go to bed and wake up at the same time each day (even the weekends).
  • Self-talk: Tell yourself, “I’ve done all I can for today. I will do the rest another day. Now it’s time to sleep.”
  • Sunshine: Sunshine promotes sleep by causing the body to produce melatonin (which helps the body with sleep).
  • Activity: Get in some physical movement during the day, so your body will be tired when it’s time to sleep.
  • Environment: Set up an environment conducive for sleep – have a comfortable bed, dark room comfortable temperature and quiet. 

Things to Avoid at Night: 

  • Vigorous exercise: Vigorous exercise revs you up. It can be good for the daytime, so you are bedtime. Stretching or yoga work better at night.
  • Intake: Avoid a large meal before bedtime, which can cause heartburn. Avoid drinking a large amount of liquid before bedtime, which can wake you up during the night to urinate.
  • Alcohol/Caffeine/Nicotine: Caffeine and nicotine are both stimulants. Alcohol keeps your body in a light stage of sleep and prevents deep sleep required for healing.
  • Technology: Technology will stimulate your brain and can make it difficult to fall asleep.

LN

Meditation and Nutrition

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Meditation could have a positive impact on stress, anxiety, mindless eating, reckless food choices, weight loss, diabetes, and cardiovascular disease.

The ancient practice of meditation involves residing in a deep state of concentration uninterrupted by thoughts. Research shows meditation has the ability to clear, calm, and focus the mind with benefits such as moderating stress response, lowering glucose levels, decreasing blood pressure, and other issues associated with cardiovascular disease. It has also been shown to increase mindfulness for weight management and eating disorders. 

The role of a dietitian includes exploring a patient’s lifestyle as it relates to their relationship with food. What you eat can strongly be influenced by emotions (anger, disgust, fear, happiness, sadness, and surprise). It’s no surprise that food and emotion are interconnected. 

Starting off, meditation sounds challenging and downright impossible. 

Psychology Today recommends starting small with 3-5 minutes (or less). Beginners may find it strange to sit in silence with their innermost thoughts and feelings, and do nothing. Meditation does require some practice. Your mind will wander, try to maintain focus by slowing down and focusing in 60 seconds intervals. Try to focus on your breaths out or a single image. Meditation can take many forms such as mindfulness, visualization, walking meditation, or focused awareness. 

Reading, attending classes, listening to podcasts and apps can provide lots of information and guidance on mediation. Our patients have found apps like Headspace, Calm, Insight Timer to be helpful. Some informative podcasts about meditation include The Overwhelmed Brain, Meditation Minis, The Daily Mediation Podcast, and Meditation Oasis.

The value of meditation is not dependent on how much you do or how committed you are. The value of meditation is measured by how you are able to positivity impact your quality of life.

CB

5 Safe Ways to Detox this Summer

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Detoxing was once only known as a medical procedure to rid the body of dangerous, often life-threatening, levels of alcohol, drugs, or poisons.

Over the years, this term has been touted as a way to rid the body from toxins that cause symptoms from headaches to joint pain to depression.

The truth is, a detox lacks essential nutrients, such as proteins and fatty acids to keep our body healthy. In a healthy body, the skin, kidneys, lymphatic system, gastrointestinal system, and most importantly, the liver make up an astoundingly complex and sophisticated detoxification system.

Our lungs detoxify by removing gases, skin provides a barrier to protect us from outside substances, the colon detoxifies by eliminating waste from our bodies, kidneys filter toxins out of the blood into the urine and the liver detoxifies by filtering blood as well as secreting bile for digestion.

Here are 5 Safe Ways to Detox this Summer

1) Cut Back on Alcohol

In 2018, researchers found that 40 percent of American adults consume excessive amounts of alcohol. Ethanol has been identified as a known carcinogenic and can increase the risk of cancers in the mouth, liver, and breast.

Depending on who you are, drinking alcohol, moderately and responsibly, can lower cardiovascular risk. 

2) Eat More Fruits and Vegetables

Fruits and vegetables provide dietary fiber to help maintain bowel regularity. Fiber is even found in nuts, seeds, and whole grains. A variety of these foods support the body’s natural detoxification.

3) Unplug

It’s so easy to get wrapped up in the instant gratification literally at our fingertips. We have the ability to order items and have them delivered within hours. We mindlessly scrolling through feeds without realizing how much time has passed. You CAN detox simply by putting down the phone and connecting with the people around you. Unplug for an hour or even an entire day, if you can. 

4) Move Your Body 

You don’t need to pick up a rigorous plan. Ride your bike, walk in the park, go for a swim. In reality, the best physical activity is one you enjoy, but also the one you can easily fit into your daily schedule.

5) Get your ZZZ

Sleep deprivation has been linked to weight gain in adults and children. Children as young as 4 years old can have adverse effects from lack of sleep. A 2013 study published in Science, showed that during sleep the glymphatic system lets fluid flow rapidly through the brain. The glymphatic system helps control the flow of cerebrospinal fluid (CSF), a clear liquid surrounding the brain and spinal cord. The glymphatic acts as a “flushing system” to remove toxins, which appears to be the most active during hours of sleep.

 

If you have questions about how you can better support your body’s detoxification, contact our dietitians at Banister Nutrition. We can provide personalized nutrition counseling to meet your lifestyle, preferences and health-related needs.

 

Xie et al “Sleep initiated fluid flux drives metabolite clearance from the adult brain.” Science, October 18, 2013. DOI: 10.1126/science.1241224

Slice of Life- Folate and Pregnancy

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citrus-slices-on-tray

We often associate citrus fruits with vitamin C. Vitamin C is a water-soluble vitamin that aids in the growth and repair of body tissue. Vitamin C helps heal wounds and repair and maintain healthy bones, teeth, skin, and cartilage.

Let’s talk about folate!

Folate is also known as folic acid and is vital during pregnancy. Folate helps to reduce the risk of spine and brain deformities (known as neural tube defects).

Citrus fruits also provide a rich source of folate. Pregnant women need 600 mcg of folate each day, and breastfeeding women need 500 mcg per day. An average orange contains about 30 mcg of folate and an 8-ounce serving of 100% orange juice provides 15% of the recommended Daily Value for folate, due to fortification.

Some other foods rich in folate include beans, avocados, and spinach and fortified foods such as grains.

If you are considering getting pregnant, our dietitians at Banister can talk to you about a folate-rich diet during preconception for the optimal spine and brain development.

KD

Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: The National Academies Press. 1998:150- 188.

Tips To Sustain Healthy Habits

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A structural change to your eating habits can be a positive impact on your health. Here are a few tips on changing the way you eat at work and home, where the struggle is daily.

WORK:

  • Make sure you get up from your desk frequently.
  • Take your breaks.
  • Avoid eating at your desk or in your office at all costs. Eating in front of a screen takes away from the pleasure of eating, which means you end up eating more to feel satisfied.
  • Pack a healthy lunch and snacks if necessary.

HOME:

  • Serve salad and vegetables first with meals.
  • Pre-plate meals and serve from the stove or counter as opposed to leaving food on the table.
  • Sit at the table, turn the TV off and be present during the meal.
  • If drinking sweetened beverages (pop, juice or sports drinks), choose a container that holds fewer than 24 ounces.
  • Ensure bulk foods (think chips) are in individual serving bags.
  • Put pre-cut fruits and vegetables within easy reach on the middle refrigerator shelf.
  • Place a bowl of fruit on the dining room table.

sg