• Fresh Views

    Flipping the Paradigm: Applying a Solution-Focused Approach to Healthy Eating

    Problem talk creates problems, Solution talk creates solutions. – Steve de Shazer

    Tasty, healthy grilled mussels in garlic and lemon

    We are excited to launch into a 7-week series on applying a solution-focused approach to the AADE7 Self-Care Behaviors for managing diabetes. As you probably know, the AADE7 is a framework for organizing diabetes self-management education and support and for identifying key areas that may require behavioral changes to manage diabetes.  The 7 categories are:

    For those of you that follow our blog, you know that we are passionate about flipping the conversation from a “problem focused” (traditional medical) approach to a solution-focused conversation. We are advocates for the use of person-first, empowering language when speaking with and in reference to people with diabetes. #LanguageMatters in diabetes care and education; problem centered talk can make speaking about and managing diabetes more challenging.

    Each of the next seven weeks, we will focus on one of the above self-care behaviors and provide 3 practical illustrations of how to flip the conversation around it to solution-focused talk.

    AADE7 Self Care Behavior #1: Healthy Eating 

    “What can I eat?” is the #1 question asked by people with diabetes when they are diagnosed. Without a doubt it can be a confusing, challenging, and sensitive ongoing area of diabetes management. 

    Often the healthy eating discussion focuses on foods to avoid and “what went wrong” when blood glucose was out of range. The conversation continues with discussion on how to prevent that from happening again. This approach to eating can be painful and result in feelings of blame and shame. A solution-focused approach changes the dynamics of the conversation.  It helps flip the focus to what is working well and building upon existing strengths.

    Instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to flip the conversation:

    Try this: I noticed that you are drinking sweet tea or soda only three times a week now instead of every day. How have you been able to do that? 

    Instead of this: Are you still drinking sweet tea and soda? 

    Try this: I hear you saying that you’d like to lose 20 more pounds. I’m noticing you are down 5 pounds since we last met. I’m really proud of you. What do you think helped you lose those 5 pounds? 

    Instead of this: I hear you saying that you’d like to 20 more pounds. I see you’ve only lost 5 pounds. What have you been eating?

    Try this: We’ve been talking about trying to work in more non starchy vegetables at dinner to help fill you up without raising your blood glucose. How many days a week do you think it’s reasonable to start with? On a scale of 0-10, where 0 is not all and 10 is I can definitely do this, where would you rate yourself? 

    Instead of this: We’ve talked about trying to work in more non starchy vegetables to help fill you up. I want you to eat one at lunch and dinner every day. 

    Be a think partner

    During a solution focused conversation, the diabetes care and education specialist acts as the “think partner” in developing solutions by asking questions and helping the person with diabetes to use their own personal strengths to create solutions that work for them. 

    When you meet again, here are 3 follow-up questions to try:

    • What’s been better since our last session?
    • What skills did you draw upon to make changes?
    • What do you know about yourself that lets you know you can achieve what you want?

    We’ll challenge you each week to try incorporating some flips into your conversations and let us know what impact they have.

    Join us next week as we discuss a solution focused-approach to Being Active!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

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  • Fresh Views

    Reducing Carbohydrate: Tips and Swaps That Work

    View over the Mediterranean Sea where we enjoyed some delicious low carb meals on recent travels

    Is managing carbohydrate something you think about? Carbohydrate gets a lot of attention when it comes to managing diabetes because it is most directly responsible for the rise in blood glucose after eating. (It’s also the body’s preferred fuel. The other two sources are protein and fat). 

    Having diabetes does NOT mean totally avoiding carbohydrate foods, though many find blood glucose easier to manage and keep in range when eating less carbohydrate. In fact, in our July 10 blog post you’ll find the highlights from the new consensus report on nutrition therapy for adults with diabetes or prediabetes. The report confirms that reducing carbohydrate through a low or very low carbohydrate eating pattern has demonstrated glucose lowering power, and can reduce the need for glucose lowering medication! Low and very low carbohydrate eating are among the most studied eating patterns for type 2 diabetes.

    What exactly is a low carbohydrate or very low carbohydrate eating pattern?

    Well, there doesn’t seem to be a consistent definition. Generally, “low carbohydrate” means 26-45% of calories come from carbohydrate. And “very low carbohydrate” is less than 26% of calories coming from carbohydrate, or around 20-50 grams of non-fiber carbohydrate over the day. Don’t get caught up in the math. Just know that for many, this generally translates into eating less carbohydrate.
    Here is a low-carb meal we enjoyed on our recent trip to France. Crisp fresh salad greens, juicy yellow tomatoes (nope they’re not peaches), topped with fresh grated Parmesan cheese, olive oil and balsamic vinegar. Easy and delicious!

    Fresh Tomato Salad

    Low- and very low-carbohydrate eating means focusing on the following: 

    • Non-starchy vegetables that are low in carbohydrate (think broccoli, tomatoes, carrots, and salad greens). 
    • Foods higher in protein (like meat, chicken, turkey, fish, seafood, nuts, and seeds)
    • Healthy fats (like olive oil and avocado)

    Fruit and higher-carbohydrate vegetables can be worked in; however, added sugar-containing foods and grain products are often very limited or altogether avoided.

    How do you portion your plate?

    So if you think about how you might actually fill your plate to embrace lower-carbohydrate eating, aim for at least half of the plate filled with the vegetables that are not starchy. About one-fourth of your plate would be lean meat or other proteins. And the remaining one-fourth of the plate portioned with carbohydrate foods…dairy, fruit, or maybe a small portion of a starchy vegetable or beans. For very low carb eating, actually the majority of the plate may be filled with non-starchy vegetables and lean protein.

    Deb’s low carb portioned plate (that’s riced cauliflower) with a peach from her peach tree to balance it out

    Individualization is important

    The consensus report acknowledges that there’s no one size fits all carbohydrate goals for those with diabetes. Figuring out how much carbohydrate and which carbohydrate foods to eat are important every day decisions. 

    Monitoring what and how much carbohydrate is eaten (or drunk) and noting the blood glucose response are key to keep blood glucose in range after eating. While we are fans of using a continuous glucose monitor (CGM), a blood glucose meter can do the work as well. Check blood glucose 1 ½ -2 hours after eating. If blood glucose is above target, reducing carbohydrate at the next meal may help bring blood glucose into range. We encourage trying it and noting the impact. Taking a solution focused approach – if it works, do more of that. 

    If you are managing carbohydrate choices and blood glucose is still out of range after eating, a diabetes medication may need to be added, or a dose or timing tweak made with guidance from your healthcare team.

    Small swaps can reduce carbohydrate in a big way

    We’re all about being practical and keeping it real. If you’ve followed our blog for awhile, you may remember the swap Deb shared in our blog Making New Years Solutions which helped her swap a tall Starbucks Latte instead of a grande Mocha, a habit she still follows.

    So if you are trying to make some swaps to reduce carbohydrate, here are 7 small swaps to get you started. Make them all, and you’ve reduced your carbohydrate by over 100 grams!

    7 swaps to reduce carbohydrate

    1. Swap in unsweetened almond milk instead of dairy milk. Save 10-11 grams carbohydrate per cup.
    2. Swap in plain Greek yogurt for plain traditional yogurt. Save 6 grams carbohydrate per 6 oz container.
    3. Swap in cooked spaghetti squash or zucchini spirals for spaghetti noodles. Save 35 grams of carbohydrate per cup.
    4. Swap in quinoa for rice. Save 7 grams carbohydrate for each cooked ½ cup serving.
    5. Swap in tomato or vegetable juice for fruit juice at breakfast. Save 8 grams for every 4 ounces. 
    6. Swap in nuts for pretzels. Save 17 grams carbohydrate for each ounce.
    7. Swap in water or tea sweetened with a low calorie sweetener for a 16-ounce sweet tea. Save 20 grams carbohydrate.

    Making it a low carbohydrate day

    We’ve found that seeing how all of this could come together in the form of an actual meal is helpful. Here are some ideas to spark your thinking on what might work for you:

    Begin with breakfast. Veggie omelet or scramble with low fat cheese and  topped with diced avocado; fresh blackberries and raspberries with a dollop of Greek yogurt

    Leverage veggies at lunch. Green salad w/ tuna or salmon (foil pack for ease), sliced almonds, vinaigrette dressing

    Swap spiralized veggies for spaghetti at supper. Turkey meatballs and marinara over zucchini spirals or sauteed kale sprinkled with parmesan cheese; chopped romaine with light Caesar salad dressing;

    Seeks some satisfying snacks. string cheese; peanuts; cucumber slices with salsa for dipping

    What low carbohydrate foods are you already eating? How can you swap those in more often? What is do-able for you?

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    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

  • Fresh Views

    Highlights from American Diabetes Association Scientific Sessions (Part 2): Focus on New Nutrition Consensus Report

    Here is how Tami is getting more veggies this summer. A share from the CSA she joined!

    A couple of weeks ago we shared four highlights from ADA Scientific Sessions focused around behavioral health. This week our focus is on other exciting developments: Did you know that ADA has updated their nutrition guidance? The summary, Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report, was published in Diabetes Care, May 2019 and you can access it here.

    Since the last nutrition guidance was published five years ago, evidence has continued to evolve around the impact of food and nutrition on diabetes management and overall health. 

    Here’s what’s new…

    #1 – Enhanced focus and guidance around prediabetes and the impact of lifestyle change to prevent or delay type 2 diabetes.

    #2 – Evidence supporting that a variety of eating patterns and eating plans can help people with diabetes achieve metabolic goals and eat healthy. Individualization is important. There is not one “best” “one-size-fits all” approach. There are 8 different eating patterns acknowledged to be beneficial in managing type 2 diabetes:

    • Vegetarian or Vegan
    • Low fat
    • Very low-fat (such as Ornish or Pritikin)
    • Low carbohydrate
    • Very low carbohydrate
    • DASH (Dietary Approach to Stop Hypertension)
    • Mediterranean style
    • Paleo

    No one pattern has emerged as being superior to the others. The first six in particular are beneficial for weight loss. The low carbohydrate and very low carbohydrate patterns have demonstrated the most evidence for lowering blood glucose, so if blood glucose is above target or one desires to try to reduce diabetes medications, adopting a low or very low carbohydrate eating pattern is a helpful option.

    Four commonalities among all healthy eating plans include the following:

    • Emphasize non-starchy vegetables
    • Minimize added sugars and refined grains
    • Emphasize whole foods over highly processed foods
    • Replace sugar-sweetened beverages with water as often as possible. 

     #3 – Initial and ongoing support through individualized medical nutrition therapy (MNT) and diabetes self-management education and support (DSMES) make a difference. They are fundamental in diabetes management, not only at diagnosis, but during times of changing health status. Reported A1C reductions from MNT can be similar to or greater than what would be expected with treatment using currently available medication for type 2 diabetes. 

     #4 – The greater the weight loss, the greater the health benefits. In type 2 diabetes, 5% weight loss can help achieve health benefits, while 15% weight loss or more is the optimal goal when needed and can be feasibly and safely accomplished. For prediabetes the goal is 7-10% weight loss to prevent progression to type 2 diabetes. Keeping as much of the weight loss off over time is critical. Also noted is that more than 50% of people with type 1 diabetes have overweight or obesity. 

    One fun way we’re getting our fruit servings!

    6 solution-focused swaps to put the new nutrition guidance into practice and answer the question “What Do I Eat?” Nutrition has long been recognized as the cornerstone for successful diabetes management. One of the most commonly asked questions when receiving a diagnosis of diabetes is “What can I eat?” (In fact, Tami wrote a book addressing just that, entitled What Can I Eat Now?  (The 3rd edition will be released in early 2020). We are particularly excited to see acknowledgement that a variety of approaches can “work”. Personal preferences and maintaining the pleasure in eating as much as possible (while achieving health goals) are high priorities in our perspective. Here are 6 solution-focused swaps to help put the nutrition guidance into practice. 

    • Swap whole fruit in place of fruit juice.  Whole fruit has more fiber, is more satisfying, and will not raise blood glucose as quickly as the juice. A whole orange, for instance,has nearly three times more fiber than orange juice.      
    • Swap infused water (a zero calorie alternative) in place of a sugar-sweetened beverage. One favorite combination is sliced lemon, sliced cucumber, and fresh mint. Place in a large pitcher, fill with ice, add water to the top, and chill for 2-3 hours to allow flavors to infuse.The longer the water sits, the stronger the flavors become. Infused water bottles accomplish the same thing in a portable fashion. 
    • Swap unsweetened almond milk in place of dairy milk. Embrace a more plant-based option and save 10-11 grams carbohydrate per cup.
    • Swap cooked spaghetti squash or zucchini spirals in place of spaghetti noodles. Get extra non-starchy vegetables and save 35 grams of carbohydrate per cup.
    • Swap mashed avocado on a sandwich in place of mayonnaise. Get healthier fats, and embrace more plant-based and Mediterranean-style eating.  
    • Swap quinoa or brown rice instead of white rice. Get a whole grain, more fiber with a plant based and DASH friendly option.. 

    Eating healthy is a journey shaped by many factors. All food and beverage choices count. We encourage finding what works for you, and doing more of it! 

    You can read our part 1 review of the ADA Scientific sessions focused on behavioral health here.

    Subscribe to our blog and we’ll email you when a new post is published!

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    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

  • Fresh Views

    Happy 4th of July! 5 Solution-focused Strategies for Picnics and Celebrations

    Celebrating with family and friends on the 4th of July is a highlight of the summer for many. Sometimes it can be challenging to maintain healthy habits during group gatherings, especially if everyone is not on the same page. It’s helpful to have strategies in your back pocket to pull out. Today we want to share with you 5 solution focused strategies for navigating picnics and celebrations. We put these into practice during our recent trip to France, with the goal of enjoying a special vacation together, yet keeping it healthy. We’ll share how they worked for us. And we invite you to consider how the strategies may work for you. 

    Here we are: Four diabetes educator AADE past and current presidents (with our husbands), getting ready to enjoy a Mediterranean-style dinner at a house we rented on the southern coast of France in Eze (We all traveled together to Ireland 4 years ago so we knew we would have a great time!) Learn more about that trip in our blog post, Going off the beaten path..

    5 Solution-focused Strategies for Picnics and Celebrations

    #1- Eat fresh and local. We are fans of supporting local farmers and enjoying local produce at the peak of ripeness. When trying to decide what to take to a gathering, think local and fresh. Picnics can be laden with rich casseroles and sides, so taking a fresh, low carbohydrate side that you know will work for you helps to insure there is something you can eat at the event. One of our favorite go-to’s that is ALWAYS the first dish to disappear is this (you may know it as Caprese salad): juicy ripe sliced tomatoes on a platter, topped with a slice of fresh mozzarella cheese, chopped fresh basil (or a dollop of pesto sauce), then drizzled with olive oil and balsamic vinegar. Sometimes we’ll layer sliced avocado on the tomatoes as well. Serve with  salt and pepper grinders alongside so everyone can manage what goes on their salad.  

    A version of the Caprese salad we enjoyed in France made with yellow tomatoes

    Deb shopping at the local market in Arles, France 

    Fresh herbs at a local market in France

    #2 – Portion your picnic plate by the healthy plate for diabetes. When you are ready to sample the celebration spread, if there’s a choice on plate size, go with a smaller plate (maybe the ones that are out for salads or desserts). Then fill half the plate with non-starchy vegetables (such as veggie salads, green beans, or sliced tomatoes), one fourth of the plate with lean protein foods (such as a grilled turkey burger or grilled chicken), and one fourth with carbohydrate foods (this is where potato salad, corn on the cob, or a sweet treat may fit). When asked how high one can “pile the plate”…try to keep it no higher than a deck of cards is thick. This simple strategy has brought success for many when navigating picnics and celebrations. And, Tami recalls one client she worked with that embraced this as a “year-round” strategy, purchasing the “old fashioned” partitioned 9-inch paper plates to use at home. He went on to lose over 30 pounds managing his portions and blood glucose in this manner. And he was thrilled that he didn’t have to wash dishes!

    We put the healthy picnic plate into practice on one of our outings to taste local Provence wine. We had a lovely outdoor picnic (on the perfect sized plate), including fresh salad, vegetable quiche, and fresh strawberries, all  served in baskets! We felt very French!

    #3 – Stick with small tastings. Maybe there are a number of things on the picnic table that you want to enjoy. And maybe you are not sure exactly what is in some of the dishes or how much carbohydrate they contain. One tried and true strategy is to stick with small tastings. You can sample a number of different items if you choose, fitting them within the plate sections reviewed above. And there’s a lesser chance of sending your blood glucose out of range with small tastings versus a serving spoon portion. This is a great strategy for travel as well discussed in our blog on Traveling with Diabetes.

    We put this strategy into practice during our trip too as we embraced a Mediterranean eating style.. And while we had such fun sampling many delectable foods and treats, we came home without gaining any weight.

    #4 – Fit in fitness. With the eating and celebrating, fitting in fitness can help manage blood glucose and spend more time in range. Whether it’s participating in a local walk/run, swimming, playing cornhole, or joining the kids in a water balloon toss. How can you fit in fitness on the 4th?

    Fitness was a part of our daily routine while in France. Our days were filled with sightseeing and tons of walking, with most days averaging 15,000 steps or more. We came back in the afternoons and and swam in the pool.Then in the evenings we played games, laughed, and laughed some more as we de-stressed and regrouped. Below you can see part of our group walking down to our street to catch the train.

    Daily short walk to the train station

    5- Stay hydrated. No matter where you are at this time of year, it’s likely to be warm (or hot)! Keep a calorie-free beverage at your side to sip on. We are fans of the Yeti cups and water bottles (we’re not paid by Yeti to say this, just fans) which have kept our iced drinks cold for over 12-hours in the summer heat! Another favorite trick is to freeze bottled water and use it as ice packs in the cooler, then drink it as it thaws.

    In France, while the temperature was only 72, the sun was intense and felt more like 92. Hydration was important. We all brought our water bottles to sip on and stay hydrated in the heat.

     We had such a great trip that we are all hoping to gather together again in another 2 years and maybe this time explore the Greek Islands! 

    As you prepare for 4th of July celebrations, we encourage you to consider:

    • What strategies have worked well for you in the past to navigate picnics and gatherings? 
    • Which of the strategies that we’ve shared might help you? 

    We’d love to hear from you on strategies that worked for you! Happy Independence Day!

    Enjoying good food, good friends and Fresh Views near Marseilles, France!

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    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

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