Nothing about Nutrition

I realised that sometimes it is not essential to talk about nutrition during the first visit with the patient or client. Because nowadays, majority people practise an unhealthy hectic lifestyle that lead to their nutrition deficiency or diseases. The first measure should be to find out why are they unable to eat meal on time, eat high trans fat easy fast prepared food, eat their meals speedy and etc. And then suggest ways to overcome these obstacles. Especially for weight management clients. 

I have to admit that I am still a junior dietitian and there are a lots more for me to discover. Even till the day I become a senior dietitian, there are still much about nutrition and dietetics to explore because nutrition dietetics progress everyday to a better era. It is a long-life learning.

A senior pharmacist was chatting with me on the other day. He told me that my role is not only to educate about nutrition but also to consider little things about eating habits. For example: To eat fruits before or after meal? Is drinking water before a meal makes a better diet or worse? What kind of nutritious food when taken in large amount will result in indigestion?

I will try to answer these questions at here. But, to be frank, again there is no 100% in nutrition. Hence, every diet must be individualised. There is no one recommendation that works for everyone. 

1) To eat fruits before or after a meal?

   Many claim that we should eat fruits alone or on an empty stomach, due to better absorption of nutrients as all the enzymes work for the ingested fruit only. Some also mentioned that if fruit is taken with a meal, it will slow down the digestion process, leading to fermentation of sugar in fruits (fermentation by the bacteria). Hmm yes, fructose sugar might cause gastrointestinal problem for people who have sensitive bowels, but it also depends on how much fruit and what type of fruit. And generally, fructose sugar is easier to digest with the intake of other food or with intake of glucose. About better absorption of nutrients, our body is basically designed to absorb a mixture of nutrients/food, unless if the person has malabsorption problem. 

I guess, whether to eat fruits with a meal, before or after a meal is depending on your needs. For example, Vitamin C in fruits helps in absorption of Iron, therefore if you want to have better absorption of iron, please do not eat your oranges on empty stomach. Whereas, if you want to avoid over-eating during a main meal course, perhaps you can try eating 1 serving of whole fruit before your meal. Fibre in fruit can help to fill up your stomach with lesser calories.

2) Is drinking water before a meal makes a better diet or worse?

   I remember my coach dietitians were giving tips to weight management client on how to increase their satiety before they consume a main meal. Drinking 1 glass of water before meal can avoid the patient from over-eating during the main course. But somehow we have forgotten to mention when to drink water before a meal. 

Okay, one essential thing that I must mention is drinking water during a meal/with a meal is not essentially good. Because while our stomach is secreting gastric acid to digest the food in the stomach, if we were to drink too much water, we can potentially dilute the gastric acid and hence making the digestion not so efficient. Alright, my idea is too much of water is not good, but little water may be helpful, and also when you drink it. Drinking 1 glass of water 30 minutes before your meal, can prepare your stomach for digestion, other than giving satiety signal. And of course, sipping soups during your meal is definitely alright. But, keep in mind is sipping, not too much. 

I remember the gastroenterologist always consults his patients with this: If an emergency of acid reflux happens and you do not have any medications at home, you can try drinking lots of water so as to dilute the acid in the stomach. But of course, if too severe, please visit the Emergency Department.  

3) What kind of nutritious food when taken in large amount will result in indigestion?

   Beans, honey, garlic and onion are basically nutritious food. From my experience, after I advised the patient to stop eating these food and start them back in smaller quantity, their gastrointestional problem improved by almost 80% most of the time. 

Picture from www.wholesomeone.com

Please do consult your dietitian or pharmacist for any related topics.

Sorry, I give up.

I am sorry, sometimes I give up explaining to you about T1DM.

Today, I was consulting a 60 year-old Indian uncle about Food Intolerance and Diabetes. His diabetes is Type 2.

A few misconceptions that he is having:

1. Guava can help in lowering sugar level. But he forgot about eating guava with all other different types of fruits can increase his sugar tremendously, despite Guava is known to have a low Glycemic Index (GI).

2. Bitter gourd cannot help in reducing blood sugar level (which I agree with him, but I disagree with his explanation). His explanation is bitter gourd has a natural insulin property. So, when we eat bitter gourd, it will actually stimulate our pancreas to secrete less insulin. Less insulin = Higher sugar level.

3. I told him that I am also a diabetic patient, but is Type 1, in which my pancreas no longer produces insulin due to autoimmune. Then he started showing me an astonished face and saying that my parent must have diabetes but they didn't know yet. I told him, neither my parent nor my grandparent has diabetes. He insisted that my great grandparent must have diabetes, and during their time, medical diagnosis wasn't so advanced yet, so doctors missed out the diagnosis. 

Okay, I give up. If I continue to correct him, I wouldn't be able to finish my consultation and he would start pointing all my Nenek Moyang (ancestors) have diabetes. 

I do not want to sound too harsh in my consultation that would make him feel that I am offensive. Therefore, I corrected his "Guava" and "Bitter gourd" misconception slowly and I praised him that not many people know about Glycemic Index. One extra compliment for him is when I gave an example about 2 bowls of Brown Rice and 1 bowl of White Rice, he actually understands well about Glycemic Load. 

Okay la uncle, I forgive you because you certainly should know more about T2DM, instead of T1DM :)

Picture from BBC Science

Cost of Diabetes

Cost of diabetes, especially for T1DM, as follows:

1. Test strips

I can't afford to test my sugar for 8 times in a day ever since I was diagnosed. My mom who works as a home-based tailor strives hard to pay for my test strips. She knows testing sugar is essential for me. I always wanted to save money by using less test strips (I know it's bad, but I feel bad for using so much of my mom's blood sweat money).

2. Lancets

Honestly, I don't change my lancet often. Probably once in a blue moon (Okay, I know the recommendation is a new lancet for every pricks. But, I am the only one who is using the lancet only mah). I always change it when I feel it is no longer sharp.

3. Pen needles

     If I buy them individually, they will cost around 50 or 60 cents per needle. So, my mom always buys them in bulk like 10 boxes (Each box has 100 needles, so 10 boxes can last me for about 500 days if I were to use 2 needles/day).

4. Alcohol swabs

I am no longer using alcohol swabs nowadays. Okay, you may ask me no sanitation before you inject or before you prick your finger? Hmm. It is seriously not convenient for an MDI patient to swab alcohol every meal (Well T1DM is all about the inconvenience, or I am just lazy). But no worries, I always make sure my hands and injection sites are clean before I poke.

5. Insulin

I am getting all my short acting and long acting insulin supplies from Government Clinic, in which they charge only RM1 for each visit. Real cheap, but I have to wait for the whole morning to see a doctor and to wait wait wait and wait due to the long queue. And they are never ever going to get rapid acting insulin for me because according to the pharmacy, rapid acting insulin is much more expensive and very few patients are using them, so they will not order (Though I cannot accept this explanation, but due to economic constraints, I cannot afford to go to a private hospital, I have to accept the reality).

6. Blood test (HbA1c)

I check my HbA1c every 3 months which you can find my results on the right side of my blog. Now that I am working in a hospital, the lab person is charging me the staff price only! Very cheap!

7. Hypoglycemic agents

These agents are actually candies. Regretfully, I cannot find any pharmacy or supermarket selling Glucose Tablets or Glucose Gel in Malaysia. So, I am depending on the various types of sugar like Mentos, Skittles, Hard candies or Juice boxes. I used to take chocolate, but they melt too quickly and easily get over consumption LOL.

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I do not own any insurance before I was diagnosed. Anyhow, I heard some insurance company will not cover our diabetes supplies for long periods also *sighed

I have thought of changing from insulin pen to insulin pump. Have been seeing other T1D bloggers using pumps since decades ago. And they are receiving so much benefit from pumps and CGM! I am so tempted to buy one by installment payment. But, those infusion sets will cost a bomb for me every month, and it's currently hard to get rapid acting insulin from government hospitals. 

Anyway, to buy or not to buy a pump, I still have to wait when my pen needles are finishing. I still have like 600 or 700 needles more in stock. Hmm, let me finish those needles first.

Don't worry, insulin pump doesn't look a thing like that :p
(Picture from diabeteshealth.com)