Program Manual Part 1: Useful Information and Resources for Participants Food for Life Program Eating and Cooking to Beat Diabetes in Indian Country Physicians Committee for Responsible Medicine Edited by Caroline Trapp, MSN, CNP, BC-ADM, CDE Director of Diabetes Education and Care ctrapp@pcrm.org www.ThePowerPlate.org 202-321-1820 Revised 7 27 2011 Table of Contents Resources Welcome Power Plate Foods Meal Ideas Power Plate Complete Nutrition Weekly Meal Planners (blank) Homework for Class 2 The Three Sisters (a poem) Quick Fiber Check All About Beans Important Information about Medication for Blood Sugar and Blood Pressure Monitoring Blood Sugar Grocery Store Treasure Hunt Cooking Grains Grow Your Own Sprouts How to Make-Over a Recipe Make Your Own Non-Dairy Milk Test Your Knowledge Page 2 5 6-8 9 10-13 14 15 16-17 18-22 23-24 25-26 27 28 29 30 35-38 39 2 Welcome! The information in this booklet helps to answer the question, “What foods can I eat to get healthy, and to stay healthy?” Four food groups make up the Power Plate, a pattern of eating built around whole grains, vegetables, legumes and fruits, that has been shown in many scientific studies to help people who have diabetes to turn it around, or avoid it in the first place. Heart disease, kidney disease, arthritis, bowel problems and certain cancers – these same foods fight these diseases, too. We thank our partners, the Indian Pueblo Cultural Center in Albuquerque, NM, the Navajo Nation Special Diabetes Project in Window Rock, AZ, and the Center for Lifelong Education at the Institute for American Indian Arts in Santa Fe, NM, for hosting multi-week classes based on the Food for Life Power Plate foods to prevent and treat diabetes, as well as our cooking instructors, chefs Lois Ellen Frank of Santa Fe, NM and Walter Whitewater of Pinon, NM, for being leaders in introducing a new way of eating, one which is actually centuries old. For most people, it takes a little time for a new way of eating to feel entirely comfortable. But soon, things fall into place, and that’s when the magic starts. Your energy levels get higher and higher, and aches and pains start to melt away. Your waistline trims down, and people start to ask you what your secret is. If you have other health issues, like high cholesterol or high blood pressure, they are likely getting better day by day. This pattern of eating has been proven to be healthy for everyone: children, pregnant women, elders, athletes, and everyone in-between. But don’t take any of this on faith. Give the recipes and meal ideas contained in these pages a try. Affordable, safe, effective, delicious and filling – try it yourself, and share with others who need help boosting their own health and vitality. And please join us at Physicians Committee for Responsible Medicine (pcrm.org or ThePowerPlate.org) for more resources. Neal Barnard, MD Physicians Committee for Responsible Medicine Washington, DC 3 " We are in a time when our younger generation wants to learn our traditional ways and reclaim the history of who they are, including, and especially, the foods that sustained our Ancestors. Returning to an ancestral plant-based diet is a way to reclaim our health. The foods that many Native communities ate in the past included corn, beans, and squash, known as "The Three Sisters." Wild harvested roots, vegetables, fruits, grains, nuts, beans, and herbs were also enjoyed. These provided a healthy diet, low in fat and high in nutrients. To heal diabetes and other health-related ailments, Native Americans are now rejecting highly processed foods and large amounts of animal-based foods. When traditional foods are revitalized, all of the cultural traditions associated with them are also revitalized - the songs that go with the planting, the sustainable agricultural techniques that each tribe uses, traditional knowledge on how to harvest wild foods, the foods that have medicinal qualities, the language, the stories, the baskets...everything. Native Ancestral foods are a tradition worth preserving.” Chef Lois Ellen Frank Food Historian, Award-Winning Author, Caterer, Ph.D. candidate Red Mesa Cuisine, Santa Fe, New Mexico “Pills and shots are like Band-Aids. They don’t really get at the underlying problems that cause diabetes and other chronic diseases. The resources, recipes and meal ideas described here have the power to heal, and to prevent many diseases in the first place. I hope you will give them a try. Work with your health care provider to safely adjust or eliminate medications. And enjoy the power that comes from reclaiming your health.” Caroline Trapp, MSN, APRN, BC-ADM, CDE PCRM Director of Diabetes Education and Care 4 Power Plate Foods to Reverse Diabetes (Recipes and information at www.ThePowerPlate.org) Avoid: All animal products Fats: all lard, shortening, butter, and limit oils Carbohydrates that raise blood sugar: Sugar, honey, cold cereals made with sugar or white flour White and most wheat breads Sweets and breads made with white flour Enjoy: Unlimited vegetables, especially all varieties of dark leafy greens Unlimited fresh, frozen, dried or unsweetened canned fruits Unlimited beans, peas and lentils Unlimited grains: Old-Fashioned oatmeal, muesli cereal, bran cereals, brown or white rice, wild rice, barley, quinoa, millet, amaranth, etc. Pasta noodles (egg-free), corn tortillas Potatoes: Sweet potatoes, yams, new potatoes, redskins Non-dairy milks on cereals and in recipes (Soy, Almond, Rice) Use agave nectar instead of sugar or honey Choose rye or 100% whole wheat breads Small amounts nuts and seeds Use a swipe of oil or small amount of oil spray to grease pans, and sauté onions and peppers in water or vegetable broth Water, tea, coffee (if desired) 5 EASY POWER PLATE MEAL IDEAS BREAKFAST— Hot cereals: oatmeal with cinnamon, raisins, banana, a small handful of nuts or seeds, and/or applesauce All Bran or muesli cereal with non-fat soy or rice milk and/or berries, peach or banana Apples, strawberries, bananas, oranges or other fruit Pumpernickel or rye toast, topped with jam (no butter or margarine) or beans and salsa Oven-roasted sweet potato “home fries” solo or smothered with “sautéed” mushrooms, peppers and onions Burrito filled with vegetarian “refried” beans, lettuce, and tomato (no egg or cheese) Tofu scrambler (sauté firm tofu and spices with cooked onions and peppers) Fat-free meat substitutes (e.g., Gimme Lean fat-free “sausage” or “bacon”) LUNCH— Soups Vegetable-based soups: carrot-ginger, mixed vegetable, mushroombarley, etc. Legume-based soups: black bean, vegetarian chili, spinach lentil, minestrone, split pea, etc. Instant or prepared soups as long as they are low-fat and free of animal products. Salads Garden salad with lemon juice, fat-free dressing, or soy or teriyaki sauce Legume-based salads: Three-bean, chickpea, lentil, or black bean and corn salads Grain-based salads: Noodle, couscous, bulgur or rice salads Commercial bagged salad are fine, but look for the fat-free or no-added fat versions. Top with cooked beans and fat- and dairy-free dressings. Sandwiches/Wraps Black bean dip, peppers, tomatoes and lettuce wrapped in a whole wheat tortilla CLT: cucumber, lettuce and tomato sandwich with mustard on pumpernickel or rye bread. Vary with grilled tempeh or tofu. Hummus sandwich tucked into whole wheat pita with grated carrots, sprouts and cucumbers Black bean and sweet potato burrito with corn and tomatoes Sandwich made with fat-free meat alternatives such as barbeque seitan, Lightlife Smart Deli turkey style or Yves veggie pepperoni slices and your favorite sandwich veggies 6 DINNER — Give legumes and grains the starring role in all your meals. Start with beana add a rice or other grain or potato dish, and add a couple of vegetables. Legumes: Use generous amounts of legumes, such as: Pintos, vegetarian refried and baked beans, black beans, garbanzos, kidney beans, lentils, split peas Starches: Grains: pasta, brown rice, barley, quinoa, couscous, millet, or others Potatoes: Favor sweet potatoes and yams, instead of baking potatoes. Breads: Pumpernickel, rye or whole-grain breads are preferred. Avoid breads that contain oil, eggs or milk. Vegetables: Try any vegetables you like. Lemon juice on greens or broccoli enhances the taste. Enjoy vegetables that are: *Steamed *Roasted with herbs *Fresh Main Dishes: Pasta marinara: Some commercial sauces are fine (any brand that has less than 2 grams fat per serving and free of animal products). Beans and rice: Try black beans with salsa, vegetarian baked beans, or fatfree refried beans. Soft tacos: Prepare this dish with flour tortilla, beans, lettuce, tomato, and salsa. Fajitas: Lightly sauté sliced bell peppers, onion, and eggplant in a non-stick pan, with fajita seasonings. Chili: Vegetarian boxed or canned versions are fine. Veggie lasagna: Made with low-fat tofu to replace the ricotta, layered with grilled veggies. Vegetable stir-fry: Season with soy sauce or other low-fat stir-fry sauce. Be sure to use a non-stick pan. Serve over pasta, beans, or rice. Fat-free vegetarian burgers: Look for lentil burgers or other commercial brands, such as Boca Burgers. DESSERTS and SNACKS: Fresh or cooked fruit Fruit smoothie (made with frozen fruit, pitted dates or agave nector or frozen fruit juice concentrate as a sweetener, water and/or non-dairy milk and/or juice. Sneak in some frozen spinach for a nutritious kick!) Carrot, celery, or other vegetables with low-fat hummus or bean dip Vegetarian Cup o’ Soup brands (split pea, lentil, etc.) Baked tortilla chips with salsa or bean dip Air-popped popcorn topped with nutritional yeast for cheesy flavor Toast with jam (no butter or margarine) 7 GENERAL TIPS TRYING NEW FOODS AND NEW TASTES: Explore new recipes, new books, new products. Be strict with yourself. It is easier than teasing yourself with small amounts of the foods you are trying to leave behind. Focus on the short term – give it 100% for a few weeks. If you have trouble finding recipes you like, please discuss this with group leaders or participants. There are always solutions. CONVENIENCE FOODS: Canned beans Use frozen vegetables or canned vegetables instead of fresh. Fat-free meat-substitutes are quick and can ease the transition. Buy prepared salads that are fat-free or have no-added fats. Try low-fat (less than 5g fat per meal), vegan, frozen meals (Amy’s, Mon Cuisine, Cedarlane Natural Foods and Dr. McDougall). ON THE GO: Travel Tips: Request non-dairy vegetarian meals for flights All hotels will have oatmeal, pasta with tomato sauce, potatoes, and vegetable plates, even if not on the menu. Bring along instant soup cups or instant oatmeal, nuts, fruit. Dining Out: Look for ethnic restaurants, especially Japanese, Chinese, Mexican, and Italian, as they normally have many vegetarian dishes. Japanese: Edamame (soy beans in pod); vegetable sushi; miso soup Chinese: rice with steamed tofu and vegetables (no oil) Mexican: bean burrito, without the cheese, sour cream, and guacamole; spanish rice. Ask the waiter to bring out warm corn tortillas to dip in the salsa and tell them to take away the fried chips. Italian: pasta e fagioli (soup); pasta marinara; ask that your meal is made with little or no oil. Thai: vegetarian selections with rice; avoid coconut milk Indian: rice dishes or breads (beware of curries—very oily) Middle-Eastern: tabouleh; hummus with whole wheat pita; lentil soup American: vegetable plate; salad bar; baked beans; spaghetti; fruit plate; veggie burger; vegetable soup; for salads, ask for no dressing, or try lemon or lime juice, ask that fatty toppings, such as cheese, bacon, eggs, olives, and avocados, be left off. 8 9 Weekly Menu Planner Monday Tuesday Wednesday Thursday BREAKFAST Friday Saturday Sunday LUNCH DINNER Provided by Physicians Committee for Responsible Medicine. For more ideas, visit www.ThePowerPlate.org and www.21DayKickStart.org 10 Weekly Menu Planner Monday Tuesday Wednesday Thursday BREAKFAST Friday Saturday Sunday LUNCH DINNER Provided by Physicians Committee for Responsible Medicine. For more ideas, visit www.ThePowerPlate.org and www.21DayKickStart.org 11 Weekly Menu Planner Monday Tuesday Wednesday Thursday BREAKFAST Friday Saturday Sunday LUNCH DINNER Provided by Physicians Committee for Responsible Medicine. For more ideas, visit www.ThePowerPlate.org and www.21DayKickStart.org 12 Before We Meet Again Find a food label from a food that is high in fiber (3 grams or more) and one that is low in fiber (1 gram or less). Write down the product names and the amount of fiber, or bring the labels to class to help everyone learn. Try out a new recipe that contains plant foods that are high in fiber (such as one that combines the Three Sisters). Before Our Second Meeting….. 1. Try out a new class recipe, and/or have a few meals that do not have any animal products. 2. Make a record of everything you eat in one day. Not a “good” day or “bad” day, just a typical day. Bring to class next week. Food (only one food or ingredient per line): _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ 13 Class 2 The Three Sisters Three plants grow in the same soil, In the same sunlight, Sharing the same air. Corn pushes skyward, carrying her sister, The entwined bean plant, with her as she grows. In turn, beans nourish the soil and strengthen the corn. The third sister, squash, Uses her broad leaves and spiny vines to protect them all. When we live together as well as these three sisters, In harmony and enduring peace with our neighbors, With the animals, and with the Earth The world will be a better place. In the short time we have on Earth, We dedicate ourselves to this ideal. Author unknown 14 Quick Fiber Check The Quick Fiber Check is a handy little tool. Using its simple scoring concept, which takes only a minute or two to learn, you’ll automatically be able to estimate the fiber content of virtually everything in the grocery store. To check your own meals, write down everything you ate or drank for one full day on this form. Now, next to each food, jot in its fiber score, using the following guide: Beans: For each serving of beans or lentils (one serving = one half cup) or any food that includes about this amount of beans or lentils as an ingredient, mark 7. One cup of soy milk or one-half cup of tofu rates 3. Vegetables: For each serving of vegetables (one serving = one cup), mark 4. An exception is lettuce, for which one cup scores 2. A potato with skin scores 4; without the skin, it scores 2. Fruit: For each medium piece of fruit (e.g., apple, orange, banana, one cup of apple sauce, a banana smoothie), mark 3. For one cup of juice, mark 1. Grains: For each piece of white bread, bagel, or equivalent, score 1. Whole grain breads score 2. One cup of cooked pasta scores 2. One cup of rice scores 1 for white and 3 for brown. One cup of cooked oatmeal scores 4. Score 3 for typical ready-to-eat cereals, 1 for highly processed and colored cereals, and 8 for bran, or check package information. Meat, poultry, or fish: Score 0. Animal products do not contain fiber. Eggs or dairy products: Score 0. Sodas, water: Score 0. 15 Interpreting Your Quick Fiber Check Score Less than 20 grams: You need more fiber in your diet. As it is, your appetite will be hard to control, and you may have occasional constipation. Boosting fiber will help tame your appetite and can cut your risk of many health problems. 20-39 grams: You are doing better than most people in Western countries, but as you bring more fiber into your diet, you will find that it makes foods more satisfying and cuts your calorie intake a bit. 40 grams or more: Congratulations. You have plenty of healthy fiber in your diet. It tames your appetite and helps keep you healthy. Fiber also reduces your risk of cancer, heart disease, diabetes, and digestive problems. 16 Quick Fiber Check Food (only one food or ingredient per line): Fiber _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ _______________________________ ________ Total ________ 17 All About Beans Adapted from Catherine DiCocco, Cancer Project Cooking Instructor Jump out of your bean rut and try some of the many varieties of dried beans available today. Why go through the trouble of cooking beans from scratch? Let me count the ways…. You have a larger variety of dried beans to chose from; you can vary their taste by adding different herbs and spices during the cooking process, and they are a lot cheaper than buying all those cans! They can be made up in large batches, drained, and frozen in smaller portions to use later in soups, salads, and dips. Bean Math Using dried beans is also the most economical choice. One 15oz. can of organic pinto beans yields approximately 1.5 cups of beans for $1.99 a can. That’s $1.32 per cup. One pound of dried organic pinto beans (approximately 2 cups) yields 6 cups cooked beans for $1.49. That’s $0.25 per cup. Beans are high in protein, low in fat, and an excellent replacement for meat. Bean Cooking Basics Rinse Sometimes you will find small rocks among dried beans. Take time to spread them out by the handful on a light-colored plate or pan so you can pick out anything that is not a bean. Rinse the beans in fresh water. Soak – Two Methods Overnight – Cover the beans with water, at least several inches above the top of the beans. Soak up to 12 hours at room temperature, or up to 24 hours in the refrigerator. Quick Soak – Place sorted and rinsed beans in a pot with three times the volume of water. Boil for 10 minutes. Remove from heat and let soak for 1 hour. Drain the beans, cover with 1 inch of fresh water, and return to the stove to continue cooking. Beans are done when they are tender, slightly soft when you pinch them. Seasonings and salt should be added after the beans have begun to swell I their skins. Small beans such as lentils and split peas do not need to be soaked. 18 Cooking Dried Beans Replacing Home-Cooked Beans with Canned Beans Using canned beans can save time and energy when you are busy. To replace 1 and ½ cups of home-cooked beans in any recipe, use 1 can (15 ounces) of canned beans. To get rid of the salt in the canned beans, drain the beans, rinse them well and drain them again before using. 19 Managing Digestive Problems A new diet can mean a change in bathroom habits – for the better! Eating highfiber foods helps keep our body “regular.” In our studies, many people reported bowel movements increased from a few times a week to one-three times a day. This is normal, and healthy! While not a good topic of conversation for the dinner table, or anywhere else people gather, it is worth saying a few things here about why it is important to have frequent bowel movements. This is the way our body gets rid of toxins, cholesterol, medications, waste hormones, and everything else that can make us sick. Why do some people have bowel movements only a few times a week, and have to strain to do so? Lack of fiber, or plant-roughage, is the most common cause. A shift to a plant-based, Power-Plate diet will cause more frequent bowel movements, up to two or three times a day. This change at first might be startling, but is good for you, keeping you healthier and feeling better. Any digestive problems that might occur with a new way of eating are not harmful. Here are some simple things to do for digestive problems. Constipation Constipation often occurs from not eating enough fiber. To relieve constipation, it is generally helpful to eat plant foods and drink more water. Fiber is found in whole grains, beans, peas and legumes, and fruits and vegetables. A plant– based diet will have plenty of fiber. Adults should eat 25 to 35 grams (or more) of fiber per day. It is important to remember to drink more water or other liquids. Aim for 8 to 10 cups per day. Walking more, or increasing any kind of exercise, may also help to cure constipation. Gas Some people find they get slightly “gassy” when they first switch to a Power Plate diet. Passing gas is a normal, healthy function, though may not be so good for your social life. Here are some tips to ease problems with gas from eating beans: After soaking dried beans, drain them, and then cook them in fresh water. It may also help to add a pinch of baking soda to the soaking water. 20 Make sure the beans are thoroughly cooked – they should be tender. Drain and gently rinse canned beans. This also decreases the amount of salt in some brands. People who eat beans regularly have little or no trouble digesting them, so start with smaller servings by putting beans in soups, salads and stews. Work up to larger and more frequent servings. Smaller beans are easier to digest for some people, so try black beans, black–eyed peas, and lentils, and work your way up to pinto, kidney and fava beans. Add a strip of kombu, a sea vegetable, to beans during cooking. Diarrhea Changing to a plant-based diet may cause loose stool at first in a small number of people. When experiencing problems with diarrhea, it can be very helpful to eat rice and well–cooked green, yellow, and orange vegetables, and, as we always recommend, avoid dairy products. A small handful of nuts or a tablespoon of nut butter may also help. Drink plenty of water to avoid becoming dehydrated. 21 Medications for Diabetes and Blood Pressure, and Diet Change Perhaps you would like to take less medication, or avoid it in the first place. A healthy diet of grains, legumes, vegetables and fruits can help. Below is information about diabetes medications that can cause low blood sugar and/or make it hard to lose weight. Discuss this with your health care provider. Low Blood Sugar It is exciting news that a plant-based diet may lower your blood sugar. Lowering it to a normal range is a good thing, but you don’t want it to go too low. This can happen by combining a powerful way of eating with strong medications. Low blood sugar, or hypoglycemia, can give you a headache, or make you feel dizzy or shaky or anxious. If you monitor your blood sugar, you might find you have these symptoms if your blood sugar drops below 70. Not all of the pills used for diabetes will cause low blood sugar, but if you are taking one of the medications that can – and you change your diet – be prepared to: 1) treat low blood sugar if it occurs and 2) notify your health care provider if you begin having frequent low blood sugar readings, such as two or more times in one week. Also be sure to let your provider know if your blood sugar gets so low that someone else has to help you get treatment. Ask what range is too low for you, and about having your medication reduced or eliminated. Below is a list of pills that can cause low blood sugar. These pills can make you feel hungry if you go too long without eating, which can lead to overeating and weight gain. Table 1: Common Diabetes Pills That May Cause Low Blood Sugar Amaryl (glimiperide) Avandaryl (Avandia and Amaryl combination) Diabinese (chlorpropamide) Diabeta or Micronase or Glynase (glyburide) Glucotrol or Glucotrol XL (glipizide) Glucovance or Metaglip (glyburide/metformin combination) Prandin (repaglinide) Starlix (nateglinide) Januvia (sitagliptin) Weight Gain Another group of medications to be aware of are those that can cause weight gain. Table 2: Common Diabetes Pills that Cause Weight Gain and/or Make It Hard to Lose Weight All those listed in Table 1 Actos (pioglitizone) Avandia (rosiglitazone) 22 Avandamet (rosiglitazone and metformin) Actoplus Met (pioglitizone and metformin) Avandaryl (Avandia and Amaryl) A Few Words about Insulin Any type of insulin combined with a powerful change in diet may cause your blood sugar levels go too low. In this situation, mild low sugar is good! It is a sign that your body is responding to a new way of eating, and that it may be time to cut back on your insulin. See the section on Low Blood Sugar above, and follow up with your health care provider. Even if you have never or rarely had low blood sugar or a reaction to insulin, if you make a major change in your diet, it is a good idea to always be prepared for an unexpected insulin reaction with some hard candies or glucose tablets. Some people see a drop in blood sugar as soon as they change their diet, and need to reduce the amount of insulin needed right away; others may need more time before this occurs. Insulin will cause weight gain if you eat more calories than your body needs. The Power Plate way of eating may reduce the amount of insulin needed and allow you to lose weight, or avoid weight gain. A Few Words about Glucophage (Metformin) for Diabetes Glucophage (metformin) is the most common diabetes pill. Because it tends to make people feel full, some lose a few pounds. It should not be used in people with any kidney or liver problem (which can be checked with periodic blood tests), or congestive heart failure. It is not recommended for those who drink excess alcohol. By itself, it usually does not cause low blood sugar. The most common side effects are gas, bloating, stomach cramps and diarrhea. Taking this medication on a full stomach may help. The side effects usually go away over time, but if they persist, this may not be a good medication for you. People taking metformin should have their B12 level checked periodically. Consider Blood Pressure Medication A plant-based diet has been shown to correct high blood pressure. Dizziness, especially when changing positions, such as from sitting to standing, is a sign that blood pressure may be getting too low. Work with your health care provider to monitor your blood pressure and your blood pressure medication(s). Summary The worst type of diabetes is diabetes that is uncontrolled for a long time. Use all of the resources to beat this disease: healthy diet, exercise if you are able, and, if needed, medication as prescribed. A change in your lifestyle may reduce your need for medication(s). Do not stop any medication without talking to your health care provider. C.Trapp 5/2010 23 Know Your Numbers *How to Obtain a Meter *Blood Sugar Monitoring *What’s Too Low? Unlike many chronic diseases, if you have diabetes you have the good fortune to be able to know, minute by minute, how you are doing. A blood glucose monitor is fairly easy to learn to use. The readings can let you see the effect of a particular meal, exercise, or medication. Here is what you need to get started. Obtaining a Meter Q. Who Should Test Their Blood Sugar At Home? A. You should test your blood sugar if you have been diagnosed with diabetes AND 1. Take any of the medications that can cause low blood sugar (See the handout, “Know Your Medications”) AND/OR 2. Have been told you have “uncontrolled diabetes” (generally defined as an A1c test of 6.5 – 7% or higher), AND 3. You or someone in your home is capable of learning to use the blood glucose meter. Q. Do I need a prescription? A. You can purchase a blood glucose meter at most pharmacies without a prescription. However, most insurance plans will pay for a meter and the testing supplies if you have a prescription. Sometimes you can take a meter prescription into any pharmacy. However, many insurance plans work with specific pharmacies or durable medical equipment companies. Your best bet to save time and money is to call the toll-free phone number on the back of your insurance care and ask how and where to obtain diabetes testing supplies. When choosing a meter, look for one that has a memory and requires a very small drop of blood (3 ug or smaller). Some meters allow you to download the readings to your computer. This is an especially good feature if you are an insulin user who is doing many tests each day. Blood Sugar Monitoring Q. Do you have any tips for how to learn to use the meter? A. Most blood glucose meters have a toll-free phone number on the back. Call for free over-the-phone training. Q. What should my blood glucose (also called “blood sugar”) levels be? 24 A. It depends on when you test. The American Diabetes Association suggests the following as a weekly average: Pre-Meals: 1-2 Hours After Meals: At Bedtime: 70-130 Below 180 100-140 Q. When and how often should I test? A. Check with your health care provider for guidance. Usually, insulin-users test three times a day and non-insulin users test once a day (and this is how your insurance plan determines how many test strips/month they will cover, unless there are other conditions requiring more frequent tests). In general, if you do not take insulin for your diabetes and are not having trouble with erratic blood sugars, test once a day. Vary the test time: do some tests before meals and some tests two hours after. That way, by the end of a week or two, you have a number of readings at different times and can really have a good idea of how often you are within the targets described above. You can also see the trends: are you usually high at night but lower in the morning? Or maybe your readings are fine before meals but much too high afterwards. Identifying the trends is the first step towards figuring out how to achieve good control. Insulin users are encouraged to test more often; three or more times a day. The best time(s) to test depend on what type of insulin(s) you use. Check with your health care provider. Some health care providers suggest that you test before each meal and at bedtime for three days in a row prior to your appointment, and bring the record with you. If you take diabetes pills or insulin, be sure to test anytime you don’t feel well or suspect a “low” blood sugar. Making a change in what you eat or how active you are may cause you to start having low blood sugars. Low Blood Sugar Q. How do I recognize and treat low blood sugar? A. The most common symptoms of low blood sugar are: Headache, or feeling grouchy, anxious, sweaty, shaky, dizzy and/or lightheaded. Low blood sugar tends to come on suddenly; one minute you feel fine, the next you just don’t feel right. It is most likely to occur if you have gone too long without eating, or if you are more active than usual. 25 A blood sugar reading of 69 or lower is usually considered too low, but check with your care provider regarding your target range. Many people do not have symptoms until their blood sugar is much lower, maybe 55-65. But don’t wait for it to get that low before getting some treatment. Low blood sugar can slow your reflexes, which can be a concern especially when driving. If you are at risk of low sugar, it is a good idea to always have a treatment with you. Good treatments: ½ cup of any kind of juice ½ cup of regular (not diet) soft drink 5-6 pieces of hard candy 3-4 glucose tablets (sold at drugstores) 1 or 2 teaspoons of sugar Repeat this treatment after 15 minutes if your blood sugar is still below 79, or whatever your target for normal is. If it is close to a mealtime, go ahead and eat. If it is the middle of the night, be sure to eat something a little more substantial to prevent your blood sugar from dropping back down. A small bowl of oatmeal or a slice of toast with a bean spread would work well. Remember: treat low blood sugar with a treatment, not a “treat!” A candy bar contains sugar, but also fat, and will not bring your blood sugar up very quickly. Q. When should I notify my health care provider about my blood sugar levels? A. Call for two mild low blood sugars in one week, or if you have a low blood sugar that requires help from another person. Ask your health care provider if these are the right guidelines for you. High blood sugar is also a concern. If you are above 140 for several days in a row, or above the target set with your health care provider, be sure you notify him or her. Ctrapp 2007, 10/2010 26 Class 4 GROCERY STORE TREASURE HUNT PRODUCE: 1) Find one or two fruits and vegetables in every color of the rainbow: Orange: Red: Dark Green: Yellow: Purple: Blue: White: 2) Find a fruit or vegetable that you have never before tried: 3) Does this store carry fresh herbs? Bulk herbs and spices? SALAD DRESSING: 1) Find a Fat-free Vinaigrette salad dressing: CANNED FOODS: 1) Find Fat Free Refried Beans: 2) Find Vegetarian Baked Beans: 3) Locate canned fruit with no added sweetener: DRIED GRAINS: 1) What kinds of dried grains do you see? 2) Name one that you have never tried before: PASTA: 1) Name a brand of dried pasta that is made without egg: JARS: 1) Locate a marinara/pasta sauce that has less than 2 grams of fat per serving and is made without cheese or meat: 2) Find a jar of applesauce with no added sugar: BREAD: 1) Locate and name the brand of a loaf of rye or pumpernickel bread: 2) If not rye or pumpernickel, find a brand of 100% whole wheat or a bread with 3 or more grams of fiber per slice: 3) Can you find a corn or flour tortilla with less than 1-2 grams of fat per serving? Miscellaneous: Can you find Tofu? Hummus? Non-dairy Milk(s)? Vitamin B12? 27 28 Growing Your Own Sprouts Growing your own sprouts is much easier than you think and the end result gives you healthy ingredients for almost any dish. Begin with seeds. For this article I used alfalfa, radish, lentil, mung bean, adzuki bean, and broccoli. What I found out is that stores such as Wild Oats and Whole Foods have sprout making products and complete kits that you can use to grow almost any sprout and that you can buy the larger beans and lentils in the bulk section of the store. You will need pint or quart size canning jars and cheesecloth. These jars work great because you can remove the inner lid piece and use the outer screw top over the cheesecloth. Place enough seeds to cover the bottom of the jar. Cut a piece of cheesecloth the size of the jar opening and place on top of the jar. Screw the out lid over the cheesecloth and you are ready to go. Fill the jar with water and soak the seeds overnight in water, then pour out the liquid the following morning. Place the jar(s) in a warm dark place (I put my jars on top of my refrigerator) and then rinse them with once a day. In 5 to 7 days, depending on the seeds you are growing, you will have fantastic and delicious sprouts. 29 How to Make Over a Recipe: Four Steps Incorporating healthier meals into your daily menu is easy. You can start by adapting the recipes you already use. Using healthy versions of favorite dishes will make your new diet much easier to follow. The step-by-step process below will show you how to make over a favorite recipe. Step 1: Substitute plant ingredients for major animal-product ingredients in a recipe. This is often the only adjustment necessary. Some examples include: Vegetarian pasta sauce instead of meat sauce. Use vegetarian burger crumbles or texturized vegetable protein (TVP) to make a vegetarian "meat" sauce. Another option is to use plenty of chunky vegetables to make a vegetable marinara sauce. Bean and rice burritos instead of beef burritos Moo shoo vegetables instead of moo shoo pork Barbecued tofu instead of barbecued ribs Bean chili instead of meat chili Veggie burger instead of meat burger Chickpea salad instead of chicken salad Scrambled tofu instead of scrambled eggs Step 2: Replace minor animal-product ingredients with plant ingredients or leave them out. Use vegetable stock instead of chicken or beef stock. Leave the bacon bits, anchovies, and fish sauce out of recipes that call for them and add some additional herbs or spices instead. Replacing eggs and dairy products is easy: Try leaving the eggs out of the recipe. This works best with breads and pancakes. Use a commercial egg-replacer powder (available at health-food stores). Other easy egg replacers include mashed tofu, ground flaxseed blended with hot water, cornstarch, or a banana. Replace cow's milk with soymilk, rice milk, or almond milk. Leave the cheese out of salads, sandwiches, and casseroles, and make pizza without cheese, using plenty of sauce and vegetable toppings instead. Step 3: Reduce or eliminate added fat or oil. Sautéing in water or vegetable stock is an easy way to replace the oil. In baked goods, use prune purée, applesauce, mashed low-fat tofu, or bananas to replace some or all of the fat. 30 Step 4: Reduce or eliminate added salt. This is especially important when using ingredients like canned foods that already have sodium in them. A dash of lemon juice or vinegar will bring out the flavors without extra salt. Step 4: Let herbs and spices boost the flavor. After reducing the fat and salt content, herbs and spices can increase the flavor. Be sure to taste the dish as you add small amounts and add more to suit your taste. Replacing Eggs Good reasons to avoid using eggs your diet include: About 70 percent of the calories in eggs are from fat, and a big portion of that fat is saturated, the kind associated with heart disease, breast cancer, and diabetes. They are also loaded with cholesterol—about 213 milligrams for an average sized egg. Because eggshells are fragile and porous and conditions on egg farms are crowded, eggs are the perfect host to salmonella—the bacteria that is the leading cause of food poisoning in the United States. Smart cooks have found good substitutes for eggs. Eggs are used for binding, leavening, and adding moisture to baked goods, but they can easily be replaced: If a recipe calls for just one or two eggs, you can often skip them. Add two tablespoons of water for each egg eliminated to balance out the moisture content of the product. Egg replacers are available in many natural food stores. Avoid reduced–cholesterol egg products, such as EggBeaters, which contain egg whites. Instead, choose egg replacers that egg–free and are usually in a powdered form. Replace eggs in baking with a mixture of the powdered egg replacer and water according to package directions. Make your own “egg replacer.” Use 1 heaping tablespoon of soy flour or cornstarch plus 2 tablespoons of water to replace each egg in a baked product. Or add 1 tablespoon ground flax seed to 3 tablespoons hot water to replace each egg. In casseroles or savory baked products, use 1 ounce of mashed tofu in place of an egg. In muffins and cookies, half a mashed banana or 2 tablespoons of applesauce can be used instead of an egg; this may also enhance the flavor of your recipe. For vegetarian loaves and burgers, use any of the following to bind ingredients together: tomato paste, mashed potato, moistened bread crumbs, or rolled oats. 31 Delicious Dairy-Free Dining Eliminating dairy products from the menu is easy, healthy, and tasty. It takes just a week or two to break the dairy habit, and, even in this short time, many people who go dairy-free can experience major health benefits, such as a drop in blood cholesterol levels, weight loss, and relief from allergies, asthma, indigestion, or chronic stomach problems. Most dairy products can be easily replaced by the many delicious dairyfree alternatives available. Next time you're at the grocery store, take a few minutes to see the surprising range of new nondairy products. Look for low-fat choices that are free of trans fats or hydrogenated fats. Dairy Products Healthy Alternatives Cow's milk Cream Soymilk Almond milk Rice milk "Silk" soy creamer for coffee or tea Silken tofu, blended, for creamy soups, dips or fillings Soy margarine Try our low-fat techniques and skip the added fat all together! (See below) Butter Cheese Nutritional yeast adds a cheesy taste to sauces, pizza, and casseroles. Add baked seasoned tofu slices to sandwiches, or bite-sized chunks to salads. Yogurt Ice cream Soy yogurt Soy or rice-based frozen desserts or smoothies Frozen peach slices or grapes 32 Going Low-Fat: Low-Fat Cooking Methods Grill or oven-roast for a delicious, low-fat alternative to deepfried foods. When oil is absolutely necessary to prevent sticking, apply a light coating of nonstick vegetable oil spray. Instead of sautéing vegetables in oil, heat a small amount of water, vegetable stock, wine, or other liquid in a large pan or skillet. Add the ingredients to be sautéed and cook over medium-high heat, stirring occasionally until tender (about five minutes for onions and most other vegetables). Add more liquid if needed. For cream soups, thicken soups with a potato instead. For soups that will be puréed, simply cook and purée the potato with the other soup ingredients. For other soups, cook a peeled and diced potato in enough water to cover it. When the potato is forktender, purée it in its cooking water in a blender and add it to the soup. You can also make bean or pea soups creamy by puréeing half the soup and mixing the purée back into the remainder. For sauces and gravies usually prepared with fat, flour, and liquid, eliminate the fat by toasting the flour in a dry pan until lightly browned. Whisk in the liquid to remove lumps, then cook over medium-low heat, stirring constantly until thickened. Replace oil in salad-dressing recipes with rice vinegar or any mild-flavored vinegar, vegetable cooking liquid, juice, or water. Use puréed soft tofu for a creamy base. If desired, use cornstarch to thicken the dressing. For baked goods, mashed banana, applesauce, cooked pumpkin, or prune purée can often replace all or part of the butter, vegetable oil, or shortening, with no change in taste or texture. Experiment with your recipes, adding a bit less fat each time and evaluating the results. When you cut the fat, you may need to add extra liquid to achieve the desired consistency. Replacing eggs with cholesterol-free, egg-free substitutes also cuts the fat significantly. Cooking without dairy products will also help to keep fat low. 33 Can You Improve This Recipe? Baked Spaghetti From A River of Recipes: Native American Recipes Using Commodity Foods, FDPIR Website, USDA Makes 4-6 servings ½ package (1 pound) spaghetti, cooked according to directions 4 (15.5 ounce) cans tomatoes, chopped, with juice ½ can luncheon meat, diced 1 teaspoon vegetable oil 1 onion, diced 1 bunch cilantro, chopped 1 teaspoon oregano 1 teaspoon sweet basil pepper, to taste 1 teaspoon garlic powder 1 cup shredded cheese or Parmesan cheese Variations: To lower the sodium content: substitute lean ground beef or lean ground bison for luncheon meat. Or omit meat or both luncheon meat and parmesan cheese. To lower the fat content: omit cheese or omit cheese and meat. 1. Preheat oven to 350ºF. 2. Rinse cooked spaghetti in cold water; set aside to drain. 3. Chop tomatoes as small as possible; set aside with juice. 4. Brown luncheon meat in large pan with oil. Add onion, lower flame and stir constantly until onions are brown. Add tomatoes with juice, cilantro, oregano, basil, pepper, and garlic powder. 5. Bring to boil, reduce heat and simmer 15-20 minutes, stirring occasionally. 6. In oiled 4 quart pan, layer half of the cooked spaghetti, ½ tomato mixture, then the rest of the spaghetti, then the rest of the tomato mixture. Top with cheese. 7. Bake at 350ºF for 30 minutes. Nutrition Information for each serving: Calories 660 Kcal Cholesterol 60 mg Sugar 11 g Calcium 150 mg Calories from fat 260 Kcal Sodium 1260 mg Protein 25 g Iron 8 mg Total fat 29 g Total Carbohydrate 92 g Vitamin A 300 RE Saturated fat 12 g Dietary Fiber 5 g Vitamin C 22 mg 34 Bonus: Plant Milks as an Alternative to Dairy Products I. Overview of Plant Milks Plant milks can be made from… o nuts e.g. almonds, walnuts, macadamia nuts, cashews, brazil nuts, pecans, pine nuts, etc. o seeds e.g. pumpkin, hemp, sunflower, sesame o grains e.g. oats, rice o other legumes e.g. soy beans o fruit e.g. coconut Plant milks can be store-bought and/or homemade: Store-bought: find in refrigerated section next to dairy products and in aseptic shelfstable cartons; coconut milk comes pasteurized in a can and is the extract of the grated flesh of mature coconuts (use sparingly due to its high saturated fat content) popular store brands include Silk, 8th Continent, Eden, Pacific Foods, Health Valley, Vitasoy, Westbrae, Westsoy, Rice/Soy/Almond/Hemp/Oat Dream, Living Harvest, Blue Diamond Almond Breeze, 365, etc. brands and formulas (light, plain, flavored, etc.) taste quite different – if you’re new to these products, try several to see which one(s) suit you many have vitamins and minerals added: calcium, vitamin D, vitamin B12, riboflavin Approx. $1.50 to $3 for 32 oz. Homemade: easy to make tastes better?! as economical as commercial brands – cost depends on the plant used e.g. last night I purchased 1 cup of walnuts for $2.66 ingredients available in bulk bins which reduces packaging expense/waste milk can be stored in re-purposed glass jars Plant milks have the following nutritional benefits: o no saturated fat from an animal o cholesterol-free o usually less in calorie content o as mentioned above, many commercial varieties have vitamins and minerals added such as calcium, vitamin D, vitamin B-12, riboflavin – see handout from Vegetarian Resource Group (www.vrg.org) for a comparison of brands o oat milk, in particular, is high in fiber since the whole grain is used 35 o o o hemp milk is high in Omega 3 essential fatty acids walnut milk is high in Omega 6 essential fatty acids fresh coconut milk (coconut water blended with coconut meat) is high in ascorbic acid, B vitamins, proteins, and electrolytes; it has powerful antibacterial and antiviral properties and is particularly good for boosting immunity; the medium chain fatty acids in coconut are more likely to be used for energy and less likely to be stored as fat, compared to other fats (source: Raw Food, Real World); coconut water is fat-free. Plant milks can be used in the following ways: o enjoy a stand-alone glass; consider topping w/ cinnamon and/or nutmeg to make it like a “nog” o topping for cereal o creamer in coffee o creamy base for smoothies o creamy base for soups o creamy base for sauces Important note: While these products are popular with many adults and children, none should be used to replace breast milk or infant formulas. They are not suitable for use by infants as a main food since they do not resemble breast milk or infant formula in composition. II. Making Plant Milks at Home Basic Tools: o blender, preferably high-speed like a Vita-Mix o some plant milks require the use of a strainer e.g. nut milk bag (approx. $8; see sources below), layers of cheesecloth, t-shirt, wire mesh sieve Sources for nut milk bags: www.TheRawFoodWorld.com www.RawGuru.com www.Amazon.com www.RawGourmet.com www.RawGlow.com (organic cotton nut milk bags) Basic Formula: o soak nuts for 1 to 2 hours up to overnight – harder nuts and nuts with skins e.g. almonds require longer soak times; discard soak water o seeds don’t need to be soaked o adjust ratio of fresh water to soaked nuts/seeds to your desired level of creaminess o use the sweetener of your choice: e.g. agave, dates, maple syrup o add salt to taste, preferably Himalyan or sea salt o add additional flavors as you like: vanilla, chocolate/cacao/carob, strawberry, banana, chai, etc. 36 o keep milk refrigerated and shake before serving Almond or Walnut Milk Source: Alive in 5 by Angela Elliott 5 cups filtered water 1 cup soaked raw almonds 3 tablespoons raw agave nectar 1+1/2 tablespoons vanilla flavor ¼ teaspoon salt, preferably Himalyan Combine the water and almonds in a blender, and process until smooth (approx. 2 minutes). Strain, and set aside pulp for another recipe. Rinse out blender jar and pour milk back into it. Add the remaining ingredients, and process until smooth and creamy. Makes 6 servings. Hemp Milk Source: The Thrive Diet by Brendan Brazier 3+1/2 cups water 1 cup hemp seeds 2 tablespoons agave nectar In blender, combine all ingredients. Keep refrigerated up to 2 weeks. Makes about 4 cups. Beautifying Pumpkin Mylk Source: Ani’s Raw Food Kitchen by Ani Phyo ½ cup pumpkin seeds ½ cup pitted dates ½ vanilla bean or ½ tablespoon vanilla extract pinch sea salt 5 cups water Put the pumpkin seeds, dates ,vanilla bean, salt, and water in blender and blend until smooth. Will keep for four days in the fridge. Other Non-Dairy Options to Try: Rice Milk, Oat Milk, Soy Milk Source: www.DeliciousWisdom.com 37 Rice Milk ¼ cup uncooked brown rice 4 cups water Optional: ½ teaspoon vanilla extract and/or sweetener, to taste In a large pot, combine rice and water. Bring to a boil, cover, and turn to low heat. Simmer for one hour. Let cool for a few minutes, and pour into a food processor. Blend for about one minute or until smooth, adding optional vanilla and sweetener if desired, then strain. Yield: 3 to 4 servings. Oat Milk 3 cups very hot water 1 cup rolled oats 2 teaspoons Sweet White or Barley Miso Combine all ingredients in a container with a lid, being sure that miso is dissolved. Cover tightly and refrigerate overnight. In the morning, blend until smooth in a blender or food processor. Soy Milk 1+ ½ cups dry, organic soy beans water Soak beans for 10-24 hours in about 4 cups of clean water. Drain and rinse. In a food processor, blend another 4 cups of water with soaked beans until creamy and combined. Pour mixture into a large pot and add an additional 4 cups of water. Bring a boil. Mixture will bubble up and try to boil over the edge of the pot. Stop it by keeping a glass of water next to the stove and sprinkling a few drops over the top while giving a good stir, as well as turning down the heat. Turn the heat back up and it will rise up again almost immediately. Add another dash of water and stir again to get it back down. Continue doing this until mixture no longer bubbles up, which will take about ten or fifteen minutes. Once mixture stops bubbling, let it simmer for an additional ten minutes. Strain through two pieces of cheesecloth. This is most easily accomplished by putting a metal strainer over another pot and lining it with the cheesecloth, then squeezing the pulp with rubber gloves on to get every last bit of milk. Save the leftover soybean bits to make burgers or add to spaghetti sauce. Cover and cool immediately. The quicker the soymilk is cooled, the longer it will stay fresh. If, after cooling, you get a skin on the top-- strain it off right away or you'll be picking gross-looking (though perfectly harmless) pieces of stuff out of your milk for days. Yield: 9 cups 38 Name_______________________________________________ Class 6 Review 1. Name the 4 food groups on the Power Plate 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 2. List one or two ideas for breakfast: 3. List three ideas for lunch 4. List three ideas for dinner 5. List three ideas for snacks 6. What one vitamin pill is needed for most adults over age 50, and everyone who follows the Power Plate diet, to prevent fatigue, nerve problems, and anemia? 7. Calcium is important for bones. Ads on TV make people think milk and cheese are the best foods for calcium. Name 3 healthy calcium-rich foods: 8. True or false? The Power Plate diet is good for children. _________ 9. True or false? The Power Plate diet is good for pregnant women. _____ 10. True or false? The Power Plate diet is good for athletes. ______ 11. Circle the correct answer: Animals foods are risky for people with diabetes or at risk of getting diabetes because: a. Animal foods tend to be high in fat, which can be bad for the heart b. Animal protein is hard on the kidneys, increasing the risk of kidney damage. c. Both a and b 39