She weighed herself for the first time in two weeks, to see that she’d dropped to 323.6 pounds. Jeff pointed out she was losing at a rate of about five pounds per week – which is definitely a healthy rate of weight loss. However, a few days later she went to visit her nutritionist Helen who also weighed her in and found that Ruby had actually gained about 20 pounds, as she weighed in at 355 pounds. She was shocked and just kept saying “no way.”

Her nutritionist, trainers and even roommate Jeff prodded to find out where she fell off. She admitted to not using the OurLife meals, not using her food journal, and not exercising each day. She expressed her anger at the scale, but recognized that the fault was her own.

The entire situation made Ruby “want to give up,” but she persevered, met with her trainers and they decided to use this slip as motivation to continue working.

She had a disappointing meeting with her psychiatrist, Dr. Brewerton, and it was likely her last. He felt that she was blowing him off, avoiding her and being disrespectful. Unable to resolve the issues, Ruby walked out saying she’d “gone as as far as I could go with him.”

Then she met with Dr. Bradley and expressed a desire to consider bariatric surgery. He referred her to a colleague, Dr. Angstadt. In that meeting Ruby learned that the surgery is “not an easy way out.” He explained that weight loss surgery is 25 percent operation and 75 percent working the program – meaning diet and exercise. The prospect of a psych consult prompted Ruby to tears and she may not follow through knowing what she now knows about the surgery.

This week she was also confronted with a huge temptation – a bake sale at her church. “I’d be lying if I said I don’t crave it,” remarked Ruby standing next to a sea of cupcakes and pies. She told Dr. Bradley her sugar cravings were hard to suppress lately. He said you have to be fair to yourself when you find yourself in situations like that, but also know how to quench cravings responsibly. Watch this video to learn more about the Glucerna diabetic-friendly snacks he recommended.

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Ruby Recap – Episode 2.8

Following the Food Exchange guidelines can help a diabetic manage a healthy diet.

The food exchange lists were developed in the 1950s by the American Dietetic Association, American Diabetes Association, and the U.S. Public Health Service in attempt to simplify the strict and complicated diabetic diet. The idea behind the exchange lists was to provide an educational tool to diabetics and to help provide structure in meal planning. The key to controlling diabetes is to control your blood sugar/blood glucose level. This system does a great job of outlining what you can do to help yourself to control your blood sugar.

A major downfall to this system is cracking down the complexity in order to implement it into your daily life. Therefore, it’s recommended for individuals to meet with a Registered Dietitian (a certified diabetes educator is ideal) in order to fully grasp this diet and help individualize it to your life and needs. The dietitian will recommend a certain number of daily exchanges from each food group based on your individual needs. You and the dietitian will work together to decide the best way to utilize the exchanges in order to control your blood sugar within your target range.

The Basics

• The word “exchange” in this context refers to the fact that a particular food in a certain list/category of food may be switched or interchanged with any other food item on the same list.
  

  An example of food exchanges for vegetables and very low-fat milk. (NHLBI.NIH.gov)

• Each list is a group of measured or weighed foods of approximately the same nutritional value.

• Foods are grouped into basic types — starches, fruits, milk, meat, vegetables, fats, etc.

• Within each group, you’ll see how much you can eat of various foods for the same amount of calories, carbohydrates and other nutrients.

• You can exchange/trade/substitute foods within a group because they’re similar in nutrient content and the manner in which they affect your blood sugar.

By controlling your blood sugar you help to prevent or delay the start of diabetes complications such as nerve, eye, kidney, and blood vessel damage.  Implementing this exchange system can not only help with your blood sugar, but also be beneficial toward helping you manage your weight.

(Source: NHLBI.NIH.gov)

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Understanding the Food Exchange List

In contrast, the consumption of low-glycemic index foods results in lower, but more sustained, increases in blood glucose and lower insulin demands on pancreatic beta-cells. However, this does not necessarily mean that a low-index food is healthier than a high-index food.

How the Glycemic Index was Developed

To determine the glycemic index of a food:

• Volunteers were/are given a test food that provides 50 grams of carbohydrate one day and a control food (white bread or pure glucose) that provides the same amount of carbohydrate on a different day.
• Blood samples are taken prior to eating and at regular intervals after eating over the next several hours.
• The changes in blood sugar/glycemic response is calculated and multiplied by 100 to give a percentage.
• For example, a baked potato has a glycemic index of 76 relative to glucose and 108 relative to white bread. Meaning the blood glucose response to the carbs in a baked potato is 76 percent of the blood glucose response to the same amount of carbs in pure glucose and 108 percent of the blood glucose response to the same amount of carbs in white bread.
• In contrast, cooked brown rice has a glycemic index of 55 relative to glucose and 79 relative to white bread.

(Confusing, I know, but I wanted you to see a little behind how these values are found and therefore how the food is ranked.)

Although this glycemic index does provide us with a benefit of potentially helping lowering an individual’s blood sugar levels, it is very complicated because many factors affect the glycemic value of a specific food (i.e. how it’s prepared, what’s eaten with it, and some foods are unable to establish a glycemic value). For these reasons, the American Diabetes Association has concluded there isn’t enough evidence to recommend the general use of a low glycemic index diet for people with diabetes and there is much controversy as using it as a tool for losing weight.

If you’re interested in learning more about this meal-planning tool, talk to a registered dietitian. She/he can help you make changes in your diet.) The best advice I can give when dealing with carbohydrates, is try to consume mostly whole-grain, whole-wheat options, choose healthy fruits and veggies, and try to eat carbs and protein together to help with blood sugar maintenance.

Learn more in “What Everyone Needs to Know About Carbs.”

Post from: Diets in Review Blog

Understanding the Glycemic Index