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Stevia Side Effects – How Safe is Stevia for Your Pregnancy?

stevia rebaudiana flowers

Artificial sugar sweeteners have been around for a long time. Until recently, sucralose (brand name: Splenda) dominated (and arguably still dominates) the sugar sweetener market. However, consumers are seeking more ‘natural’ sweeteners, such as stevia. Stevia rebaudiana (official name of the stevia plant) is native to South America and has been used for centuries to make medicine and flavor foods. Stevia is currently used in Japan, South Korea, Malaysia, Taiwan, Russia, Israel, Mexico, Paraguay, Uruguay, Venezuela, Columbia, Brazil, and Argentina.

Canada approved the use of stevia as a table top sweetener and as a food additive in November, 2012. This means stevia may be used as a sweetener at coffee and tea shops and stevia recipes replacing sugar are safe as well. Just keep in mind that two-thirds of a teaspoon of stevia is equal to two teaspoons of table sugar in terms of sweetness.

 

Stevia Side Effects

The likelihood of stevia rebaudiana side effects is very low. However, some people may experience bloating, nausea, dizziness, muscle pain and numbness.

 

For pregnant women, Health Canada states that:

Scientists in Health Canada’s Food Directorate identified no toxicological concerns with the use of steviol glycosides and consider it safe for consumption in foods by the general population, including pregnant women and children, as well as individuals with diabetes, at dose levels not greater than 4 mg per kilogram body weight per day, expressed as steviol equivalents.”

 

However, given that Canada only recently approved stevia, if you are concerned that there has not been sufficient time or research related to stevia consumption during pregnancy or lactation, then exercise caution and avoid use.

 

SweetLeaf ® Sweetener is a brand name product that contains only stevia. This means that Sweetleaf stevia side effects should be minimal, if any, because unlike Truvia ®, it does not contain any sugar alcohols. Excessive consumption of sugar alcohols has been known to create unpleasant side effects such as diarrhea, cramping, and bloating. Thus, if you’ve heard of xylitol side effects or sorbitol side effects including gas and abdominal discomfort, it’s because some people are sensitive to sugar alcohols.

 

It’s worthwhile to mention that there are also reports of Splenda side effects including the same uncomfortable symptoms above as well as headaches and dizziness. Fortunately, these effects only occur in some people, but this means there will always be conflicting opinions as to what it good for your health and what isn’t. My best advice would be to figure out what you’re comfortable trying, experiment, then observe whether you experience any discomfort. You know your body the best so let that be your guide.

What About Other Sweeteners or Sugar Substitutes

According to HealthLinkBC

Health Canada has approved: aspartameacesulfame potassiumneotame,sucralose and thaumatin to use as food ingredients or sweeteners. They are safe for use, in moderation, during pregnancy. Be sure that foods made with these sweeteners do not replace more nutritious foods or drinks. Some natural health products contain Stevia, which is considered safe to use in moderation during pregnancy. Stevia currently is not approved as a sweetener or as food ingredient. Saccharin and cyclamates are not recommended during pregnancy.

Sweetener (Sugar Substitute) Safe During Pregnancy?
Aspartame (NutraSweet, Equal) YES – in moderation
Saccharin (Hermesetas) NO
Cyclamate (Sweet’N Low) NO
Sucralose (Splenda) YES – in moderation
Acesulfame Potassium (Sunett) YES – in moderation

 

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Folate and Folic Acid Before, During, and After Pregnancy

peas

What is Folate or Folic Acid?

Folate and folic acid are (almost) the same thing. Folate is a B vitamin (B9) found naturally in foods. Folic acid is the synthetic (man-made) form of folate that you find in fortified foods and vitamin supplements. In Canada, folic acid is added to white flour, enriched pasta and enriched cornmeal. Other foods that may contain added folic acid include breads, buns, cookies, crackers, pasta, and ready-to-eat cereals. Folate and folic acid share the same function in the body, so you can get your daily requirement either naturally or via fortified foods and supplements without needing to worry that one is superior to the other.

Why Should Women Take Folate and Folic Acid Before, During and After Pregnancy?

Folate and folic acid is used by the body to make healthy blood cells to cell to help you and your baby grow. It is an extremely important B vitamin during the first four weeks of pregnancy to ensure that the baby’s spine, brain, and skull develop normally. Inadequate intake of folate and folic acid leads to an increased risk of the baby developing neural tube defects (NTDs), which in severe cases can lead to stillbirth or early infant death postpartum.

The Spina Bifida and Hydrocephalus Association of BC reports that 1 in every 750 children born each year in Canada are born with a NTD. The most common type of NTD is spina bifida, a condition where the baby is born with paralysis in one or more of their muscles (in the legs, bladder, and/or bowel). Babies born with spin bifida will require medical care their entire lives as the condition is irreversible.

The reason why Health Canada recommends that all women who can become pregnant  take daily multivitamin with 400 micrograms (may also be written as “mcg” or with the symbol μg or as 0.4 mg) of folic acid in it is because some women may not realize they are pregnant until after they’ve missed their period for one to two weeks. Since NTDs occur in the third and fourth week after conception, it’s highly possible that a pregnant woman (without knowing they were pregnant) did not take enough folate in their diet to meet the increased demands of their developing baby and as such, increased their risk of NTDs. Therefore, despite widespread folic acid fortification in common food products in Canada, it is still suggested that women of childbearing age (14 to 50 years old) take 400 mcg of folic acid per day on top of any folate they’re getting through food.

Some women are at a higher risk of having a baby with a NTD. This applies to women who:

  • have a family member with a NTD
  • have a medical history of diabetes, obesity or epilepsy
  • have already had a baby with a NTD or a pregnancy affected by a NTD

Women who fall under this category of increased risk should talk to their doctor or midwife to discuss whether a higher dosage of folic acid supplementation is necessary.

How Much Folate Does a Woman Need?

Recommended Dietary Allowance (RDA) for Folate (Daily)
All women
(Age 14 to 50)
400 mcg
Pregnant women 600 mcg
Breastfeeding women 500 mcg

 

Most prenatal multivitamins contain 1000 mcg, which is the upper limit for folic acid supplementation (more details below). Most daily multivitamins contain 400 micrograms (also written as mcg or μg), which is equal to 0.4 milligrams (mg) of folic acid. This is sufficient for women before pregnancy without additional folate taken from the diet. For pregnant and breastfeeding women, continue taking  a multivitamin with 400 mcg folic acid and increase the dosage if you’re not getting enough folate through your diet to meet the recommended amounts of 600 mcg and 500 mcg respectively.

Do not exceed the daily limit of folic acid of 1000 mcg unless you’ve been advised by a physician to do so. Over-supplementation of folic acid can lead to other health problems. The upper limit of 1000 mcg applies only to supplements and folate fortified foods. According to HealthLinkBC, the amount of folate in enriched foods is given as a percentage of the daily value (DV) and the standard used is 220 mcg. For example, if a serving of cereal has 15% of the daily value, it has 33 mcg of folic acid (0.15 x 220 mcg = 33 mcg). It’s estimated that 100-200 mcg of folic acid is taken daily from fortified foods.

Naturally occurring folate does not have a upper limit as it has not been shown to have adverse effects.

Those who have folate deficiency from malabsorptive conditions such as Celiac Disease or inadequate intake of folate (such as in chronic alcoholism) should speak with a physician about how much folic acid supplementation is appropriate. According to Merck Manual, folate deficiency is usually treated with supplemental 400-1000 mcg of folate daily.

When choosing a multivitamin, choose one that also has vitamin B12, which works with folate to make DNA.

Good Sources of Folate in Foods

Good sources of folate include:

  • beans
  • peas
  • lentils
  • edamame (green soybeans)
  • asparagus
  • avocado
  • spinach
  • broccoli
  • romaine lettuce
  • beets
  • Brussels sprouts
  • green peas
  • gai-lan (sometimes called Chinese kale)
  • bok choy
  • oranges
  • orange juice
  • wheat germ
  • sunflower seeds
  • yeast extract (such as marmite)
  • peanuts
  • liver (do not eat more than 75 grams of liver per week because it is very high in vitamin A. Too much vitamin A can harm your developing baby and cause birth defects and/or liver toxicity.)
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How Eating Breakfast Helps You Lose Weight and Keep It Off

breakfast

You’ve heard it likely a MILLION GAZILLION BAZILLION times.

Breakfast is the most important meal of the day. Is it true though?

How harmful is it REALLY to skip breakfast? So long as I don’t overeat at lunch and dinner and have some snacks in between..that should make up for things…right?

The disclaimer here is that I skip breakfast quite frequently…I know, don’t judge me. Yes, I’m a dietitian, and yes I should know better and yes, as a health professional I should really practice what I preach. (Insert whatever you need to say now to get the shock factor out of your system now.)

All done? Okay, so the reason why I’m telling you that I struggle with having breakfast everyday is because I’m human too! And as a human being who works and lives life, I (very) often prioritize sleeping in an extra 10 minutes in the morning over having a simple breakfast to start my day right.

So BELIEVE ME when I say, I KNOW WHAT IT FEELS LIKE to want to skip breakfast.

But the truth is, breakfast is truly the most important meal of the day. And here’s why:

The National Weight Control Registry tells us that the people who lose weight and successfully keep it off have a number of traits in common: one of them is eating breakfast within an hour of waking up.

Having breakfast within one hour (or two hours max) of waking up kickstarts our metabolism so we are not prolonging the fasting period that lasted during the night. As mentioned in a previous post, prolonged fasting slows down our metabolism, making our bodies hang on to every calorie we do eat out of fear that we’ll never eat again! There’s no telling how long it takes a slowed metabolism to return to normal, so best not to slow it down at all. After all, as we age, our metabolism naturally slows down, and people who are not physically active also have a slower metabolism. Which means, if you’re someone who is aging (all of us are!), who is not exercising very much or at all, AND you skip breakfast, then you’re putting yourself in a very difficult position for losing weight.

Finally, as you may already know, skipping breakfast also has other repercussions:
1) It’s harder to concentrate and think straight at school and work and may decrease productivity.
2) It’s harder to make good food choices later in the day when we finally decide to eat.
3) It’s tougher to say no to high fat, high sugar, high salt foods that we normally can resist or have a reasonable portion of.
4) It’s impossible to have good blood sugar control for those with diabetes and prediabetes.
5) It’s near impossible to control and maintain a healthy weight without developing lifelong good eating habits such as eating breakfast.

So what ARE some healthy breakfast ideas? Are these breakfast foods that help you lose weight? A healthy breakfast has 3 out of the 4 food groups. There are no specific foods I would recommended in particular to induce weight loss. Simply eating SOMETHING right after waking will be beneficial to kick starting your metabolism and to get you on the right track to make good decisions the rest of your day. Try the following breakfast ideas and see if you can carve out 10 minutes of your morning to take another step towards a healthier you.

Homemade Good Morning Oatmeal

Place the following into a microwaveable bowl:
1/3 cup dry, plain, quick cooking oats (1.5 minute oats)
1/2 cup frozen fruit (no sugar added)
Water (to your preference of thickness)

Microwave for 1.5-2 minutes. Add 1/4 cup chopped nuts and/or 1 tablespoon flaxseed or hemp. Chow down!

Wake Up Smoothie

Place the following into a blender (or Magic Bullet if you have one):
1/2 cup frozen fruit (no sugar added)
1 100g yogurt (plain or sweetened)
1/2 cup milk (skim, 1 or 2%)
1/4-1/3 cup of high fibre cereal

Pour into reusable mug and bring it along on your commute to work/school or drink immediately.

That’s a Wrap!

1 whole grain tortilla
2 tablespoons of peanut butter
1 whole banana

Lay tortilla flat on a plate. Spread peanut butter onto tortilla either in a thin layer or plop it on and leave it as a big blob. Peel banana and place onto tortilla. Beginning at one end, wrap the banana up with the tortilla like you’re cuddling it up in a blanket. Eat immediately or bring it on the go with you.

*Personally, bananas give me cramps, so I would opt for just the peanut butter on tortilla and have a tennis ball sized fruit on the side instead.

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Spice Up Your Health with Indian Food

traditional indian food

Traditional Indian food is filled with amazing spices and ingredients that are not only delicious, but may also carry health benefits as well! A little while ago, my colleagues and I did a project where we researched how common spices used in South Indian cooking may be beneficial to your health. Here’s a quick synopsis of common spices using in cooking Indian food.

 

Fenugreek is commonly used to flavor chutneys. It is thought by some to aid in digestion and hyperlipidemia as well as diabetes management. Some studies have shown that fenugreek may decrease blood glucose levels. It has also been shown in some studies to decrease triglycerides and increase HDL (healthy cholesterol). More studies are needed to be done to come to a conclusion about fenugreek and its health benefits.

 

The Bottom Line: There’s no harm in taking fenugreek, but there’s no hard science saying its beneficial. Flavor-wise though? Awesome.

 

Cinnamon is a spice that is often used in South Indian cuisine to flavor curries, not just Indian desserts! Traditionally cinnamon has been used to tackle gastrointestinal complaints. More recently, cinnamon’s claim to fame was in helping to manage type 2 diabetes by improving glucose and insulin metabolism. It has been shown that cinnamon may improve blood pressure, but this is more consistent in poorly controlled type 2 diabetics.

 

The Bottom Line: No harm in taking cinnamon, whether that’s in curry, baking, or beverages. As for how much to take daily, more research needs to be done to decide on an optimal dosage. Never take cinnamon in place of your usual diabetes and heart medications.

 

Garlic is used in the many traditional South Indian recipes to add flavor to dishes (i.e. rice dishes). Garlic is known for its heart healthy benefits. However, studies show that garlic may reduce total cholesterol only modestly and it cannot be recommended for management of hypertension (high blood pressure). Overall garlic is unlikely to prevent cardiovascular disease on its own. But adding garlic to your meals will help flavor your meals and result in lower salt intake, which WILL lower your blood pressure.

 

The Bottom Line: It is important to be aware that there are drug interactions (for example, with warfarin) when taking large doses of garlic. Ask your doctor if you’re a garlic lover or if you’re taking garlic supplements.

 

Not all Indian food menus or buffets will list the ingredients of each dish. So if you’re interested in what’s in the food and to get another perspective of spices that make up a huge part of Indian food history, ask a friendly server who is knowledgeable or at least willing to ask the chef for you.

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Vegetarian Food = Awesome Eats Without the Meats

protein rich vegetarian food

You don’t have to be a vegetarian to enjoy vegetarian food. Carnivores who enjoy vegetarian food at least once a week can reduce their risk for cardiovascular disease, diabetes, obesity, and cancer. Additional benefits include being earth friendly since copious amounts of fossil fuel and fresh water is used to process meat from farm to table. In fact, there’s an international movement called “Meatless Mondays” that encourage people to enjoy vegetarian food on Monday, because people will be more prone to make health conscious decisions for the rest of the week.

 

Easy Steps to Enjoying Vegetarian Food

  1. Create a vegetarian food list. Add pulses, a protein rich vegetarian food, that has twice as much protein as wheat, oats, barley, and rice. (see tips below)
  2. Search for vegetarian food recipes you’d like to try. For simple, delicious, and well tested recipes, visit www.pulsecanada.com/food-health/recipes or search your favorite website for recipes using beans, lentils, peas, tofu, soy, quinoa, nuts, and seeds.
  3. Reserve a spot on your fridge for a vegetarian grocery list to remind yourself of your commitment to go meatless at least once a week.

 

Tips on Cooking Pulses

  • “Pulse” is the term for edible seeds of legumes (plants with a pod), such as lentils, beans, dry peas, and chickpeas, but does not include fresh green beans or peas.
  • Similar to pasta, pulses can double or triple in size while cooking. Make sure you use a large enough pot when boiling legumes.
  • Pulses should be cooked slowly so their seed coats remain intact. Follow cooking time guidelines for the pulse you are cooking (see reference: www.pulsecanada.com)
  • Pulses are considered done when they are cooked until tender
  • Freely add fresh or dried spices, herbs, and seasonings while cooking
  • Avoid adding salt and acidic ingredients such as tomatoes, vinegar, balsamic, citrus until the pulses are fully cooked because acids slow the cooking process

 

More Tips on How to Add Pulses to Your Diet

  • Maintain a variety of legumes in your pantry – try different colors because we truly ‘eat with our eyes first!’
  • Store canned legumes on hand in case you’re in a hurry
  • Replace meat with legumes in soups, salads, rice and pasta dishes
  • Cook lentils into your favourite pasta sauce in addition to meat or as a substitute
  • Add hummus along with cheese and vegetables into a tortilla or place into pita
  • Season mashed legumes with spices to create low fat, high fibre spreads and dips

Basic Introduction to Diabetes Management

basic diabetes diet management

The following is for basic information purposes only. Please consult your physician for your customized diabetes management plan or ask for a referral to your local diabetes center. For additional information for yourself or a loved one with diabetes, visit www.diabetes.ca.

 

 

To maintain steady blood sugars, there are a few key strategies to implement:

 

  1. Have at least 3 out of the 4 food groups at every meal. For example:
  • Breakfast: oatmeal with apple, nuts, and a splash of milk
  • Lunch or Dinner: green salad with 3 ounces of salmon and wild rice.
  • Follow a plate method by keeping half your plate devoted to vegetables (non-starchy ones), a quarter for starchy vegetables or grains and a quarter for protein.

 

  1. Choose lower glycemic index (GI) foods. Glycemic index is a measure of how foods affect your blood sugar. The higher the GI, the more quickly your blood sugar rises. The lower the GI, the slower your blood sugar rises – this is good. Spikes in blood sugar are not good. Lower GI foods are typically higher in fiber, so choose whole grain rice, pastas, and breads whenever you can. This works especially well in diabetes type 2 management. It also works for diabetes type 1 management, but it’s a little less crucial because a high blood sugar reading would prompt the individual to take more insulin to bring blood sugar levels within an acceptable range.

 

  1. Eat at regular times, with main meals spaced 4 to 6 hours apart. Do not skip meals! This cannot be overstated. Skipping meals makes your body work overtime to produce its own glucose to keep blood sugar levels steady. By the time you finally eat, your blood sugar is already raised and will continue to rise because of the digestion of food you just ate. Having high blood sugars can cause uncomfortable symptoms, but what you can’t see is damage to your blood vessels, most important of all, the tiny blood vessels in your kidneys.

 

  1. Use a blood glucose monitor to check your blood sugar levels. It’s the only accurate way of determing how good your blood sugar control is. Some people keep a diabetes management journal where they log all their blood sugar readings before and 2 hours after their meals. It’s a great way to see trends, for yourself and for your physician, who may need to adjust your medication or insulin regime to match your eating pattern. The good news is, diabetes management software such as newer blood glucose monitors or insulin pumps keep your records for you, making it much more convenient to stay on track. Here are your target blood sugar ranges:
    1. Before Meals: 4.0-7.0
    2. 2 Hours After Meals: 5.0-10.0

*Your specific target ranges might be slightly different. (check with health care team) 

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How Much Sugar Per Day am I Allowed?

how many grams of sugar per day

 

Here’s the skinny on sugar.

 

There are many different types:

  • granulated sugar: white or brown
  • milled sugar: icing sugar
  • screened sugar: decorating sugar
  • sugar cubes: granulated sugar pressed into a block shape
  • liquid sugar: syrups
  • artificial sugar: not really sugar, but rather a sugar substitute such as aspartame, sucralose, saccharin, and stevia*

 

*there will be a separate post on sugar sweetners

 

I’m not sure when it started but I feel like there’s a growing fear of using sugar because of different books or internet buzz saying it’s the source of all evil, or perhaps something less extreme, but nonetheless negative.

 

The fact is, there are guidelines available that answer some of the burning questions I’ve been asked, which include:

 

How many grams of sugar per day am I allowed?”

 

Healthy Families BC suggests limiting added sugar* to 13 teaspoons (52g) per day.

 

The American Heart Association (AHA) recommends:

For women, no more than 100 calories per day from sugar (about 6 teaspoons)

For men, no more than 150 calories per day from sugar (about 9 teaspoons)

 

*Added sugar is sugar added to foods such as sweetened beverages, cereals, desserts, breads. This is different than naturally occurring sugars such as lactose sugar in milk products and fructose sugar in fruits.

 

Why isn’t there a ‘how much sugar per day calculator or app’ available?”

 

Short answer: You don’t need one.

Long answer: 1 teaspoon of sugar = 1 sugar cube = 4 grams = 16 calories

Explanation: 1 gram of sugar = 4 calories

 

How much sugar per day to lose weight?”

 

1 pound of weight = 3500 calories = 875g sugar = 219 teaspoons or sugar cubes

219 teaspoons dividied by 365 days in a year = 0.6 teaspoons

 

So…if we chose to stop using just over 1/2 teaspoon of sugar everyday for the entire year, we’d lose 1 pound. Now…this may seem insignificant. But the math gets better.

 

Say you’re a coffee drinker and you add 2 teaspoons of sugar in your coffee everday

 

2 teaspoons/day x 365 days = 730 teaspoons

730 teaspoons x 4grams / teaspoon = 2,920 grams

2,920 grams x 4 calories / gram = 11,680 calories

 

Don’t forget, 3,500 calories = 1 pound of body weight

Therefore 11, 680 calories divided by 3,500 = 3.33 pounds

 

So imagine that…

 

If you changed your daily habit over to use a zero-calorie sugar substitute or you flat out stopped taking sugar in your coffee, you could potentially lose over 3 pounds in the coming year (if all other factors in your life stayed the same).

 

How much sugar per day for diabetics?”

 

Whether you have type 1 or type 2 diabetes, blood sugar management is highly individualized. Using sugar substitutes as your “added sugar” would be highly recommended so that your oral medications or insulin can just cover your carbohydrate intake from natural foods such as fruits, vegetables, grains and dairy products.

 

Type 1 diabetics using insulin can technically administer insulin to match the amount of carbohydrate (from food and added sugar sources) taken. However, the insulin simply enables sugar to be used by the body for energy. When the sugar provides calories in excess of what it needs, the sugar gets stored as fat. Thus, too much sugar can lead to weight gain, which is not beneficial for diabetes management if a patient becomes overweight or obese.

 

How much sugar per day for kids?”

 

Preschoolers – no more than 4 teaspoons of added sugar per day (64 calories)

Children 4-8yr – no more than 3 teaspoons added sugar per day (48 calories)

Preteens & Teens – about 5-8 teaspoons of added sugar per day (80-128 calories)

 

Perspective:

1 cup of juice (250mL) = about 5 teaspoons (80 calories)

1 can of pop (355mL) = about 8 teaspoons (128 calories)