Shireen: Grace Rivers is a registered dietician, nutritionist, and certified diabetes care and education specialist who has been practicing for 27 years. She's currently writing on health and nutrition to reach a broader audience to help make lives easier for those with nutrition related issues. Welcome, Grace.

Grace: Thank you, Shireen. I'm very happy to be here.

Shireen: Well, glad to have you. So I would love to maybe start out with and learn a little bit more about your background, what led you to become a registered dietician and specifically practice within diabetes care.

Grace: For me nutrition, even as a young girl, I had that interest in nutrition, it always fascinated me, maybe how I felt after eating a certain food, or just what was all the hype about food, and I just have always had that interest. So later, I progressed that way in my education. And then as I actually started practicing, as a dietitian, I realized that so many people that I saw, actually had diabetes. So then I became very interested in wanting to learn more. So once I did that, I realized that it would help me tremendously. I actually got a certification in, in diabetes, which was another 2000 hours in taking care of diabetes patients, and understanding what they deal with as they go through their day to day life. I see.

Shireen:  And so I want to touch a little bit about and talk a little bit about diabetes, but also touch on certain comorbidities that go with diabetes. So what are these various chronic illness comorbidities that go with diabetes?

Grace: The comorbidities, or the other medical conditions that we see frequently with diabetes is obesity, and obesity and itself can cause insulin resistance, which in turn, can cause a rise in the blood sugar. Obesity also causes inflammation and then when you deal with just diabetes itself, is you're looking at the complications that can come from that. And the most frequently seen are cardiovascular diseases in the way of heart attack and stroke to name a couple. But those are the things that are most frequently seen from there, because the blood travels all over your body, you're dealing with issues from head to toe, and most people hear about the, the eye issues where someone can't see as well or they become blind. And one that a lot of people don't think of is our teeth to our dental health. And yes, it can cause cavities, it can cause beyond that trouble in the mouth and the gums, and certainly heart related, it can cause kidney issues. We also don't realize of many times that diabetes has an impact on our own gut health, that someone who has had diabetes for a long time that is not as well managed, as it maybe could have been or should have been, you start to see those problems coming in, in the gut where the gut just isn't functioning as it should. It can be any urinary issues as well, you have foot problems, and certainly nerve issues where you hear people complaining about pain in their feet or tingling in your hands. This is all issues that can be impacted from just having diabetes. 

Shireen: Interesting, and then how are all of these comorbidities or these illnesses connected? What is the sort of the common thread across all of them?

Grace: Um, well, again, frequently we're going to see the the heart being affected, and that could be coming from the obesity, but not everyone that has diabetes is obese. And the opposite is well, but we do frequently see obesity, and the tie in can be and when you think about if someone is obese, and that's causing insulin resistance, which can lead to just a high blood sugar level. Then you have that issue you're dealing with plus, you're starting to see because of the obesity, high blood pressure, and you can also be seeing high cholesterol levels, high triglyceride levels that all start to come with just having diabetes. And that inflammation alone causes stress hormones in our bodies to be released, causing our bodies to just be under a constant state of stress and that over time, can affect our immune systems.

Shireen: Now, what is the relationship between diet and these illnesses or even diet and obesity?

Grace: Diet plays a huge impact on all of us. Whether we have any disease or not, it is playing it it has an impact on us. So when you start looking at the effects of diet on a disease such as diabetes, or obesity, we're wanting to get foods in someone's diet that helps their guts be more healthy helps their immune systems be stronger. So we're looking at eating more fruits and vegetables, more whole grains and beans and legumes in that diet to help make us stronger.

Shireen: And so what what are all the difference? You talked about beans and legumes, but what can people do in addition to that, to really reduce their risk of such an illness?

Grace: In addition to that, you know, one of the first things that I think about, as far as our health is concerned is one of the main things people can do is move more, some form of exercise. And then along with that, start introducing the fruits and vegetables into the diet, I can't get off that, but make sure that you're including those foods, and that you are including some healthy fats in that diet. And that can be in the way of, say, nuts, or avocados, people love avocados and it doesn't have to be guacamole, something very simple, just to cut an avocado on your plate, and having nuts or olives in there. And when you're cooking sources things as canola oil, or olive oil could be helpful. And decreasing the amount of meat that a person may be eating if you're a meat eater, that realizing that, that chicken breast does not need to weigh a half pound that you put on your plate. And it doesn't need to cover half of the plate, just covering only a quarter of the plate.

Shireen: Interesting. And so what, what do good combinations of healthy foods look like? 

Grace: Uh, well, let's see, what if we just pictured an empty plate and has nothing on it. And if you start out by putting it again, if you're a meat eater, putting that kind of meat on the plate, and however much you're putting, try to keep it to only a quarter of the plate. And patients have said, but what am I going to do to not be hungry and this is where you add those fiber field foods. And no staple in my kitchen is lentils. So I'm really looking at lagoons to help fill us up and you can do this in the way of beings whether they're canned, or dried beans that you have soaked yourself and cooked. And peas, sweet peas, Black Eyed Peas that you get in there, all of those things fit in and you including those on your plate, and getting some whole grains in there. Whether it's brown rice, if that takes too long for you to cook, then various minute rice, and store brands work just fine. And you can include that in and certainly, let's try some fruits and veggies in there as well to help keep someone satisfied. I'm not a believer in being hungry. When you leave that meal, you shouldn't be very satisfied.

Shireen: Any recipe ideas that you can share with us?

Grace: The recipe ideas that, that I get when I am looking for just something different, I still refer people to going back on lentils. Many clients have said to me, I don't know where lentil is. and lentils for those that don't know are just very small, like little beans. And the cool thing about them is the reason they're such a staple in my kitchen is there are many times I've said I would like to have beans tonight. But I have… I don't have any canned beans and I didn't think about this yesterday. So what can I do this evening and you know, you can pull out the lentils and they're cooked within 20 minutes, anything over that you're going to start to look at mush. So pulling out those lentils and putting those on that plate can be very helpful. And if you go to lentils.org there is a multitude of recipes on there. Other places that I go for recipes is magazines that are very simple, like eating well or cooking light. And one that some of my patients have really enjoyed is diabetic living, because they will have recipes in there. And some of these people also have diabetes. So it gives them something they can connect to and you know it can be something as simple as start with a taco and instead of having so much meat in it, let's pull back on some of the meat and let's throw in some avocado and some more beans and it can be any kind of bean that you want. Whether it's black beans or Pinto, whatever you want to do. Whatever you want your talk over tastes like and throw in some more tomatoes. Or whatever you would like to do. Like that.

Shireen: That's making me hungry. One of the biggest myths that we hear throughout our program, Grace, is that eating healthy costs a lot. Now, I call it a myth, but I'd love to get your take on it. And if you could tell us why or why not.

Grace: Be happy to eating healthy does not cost a lot. And first thing to consider is, what are you actually considering healthy, and I think that's where people start to get into the issue of this is driving up the cost. Healthy is the things that I just described. And if you think about it, whole grains, and beans, lagoons, are very inexpensive. So those that is a form of healthy eating. And then when you throw in fruits and vegetables, getting things that are more in season, are very helpful. Getting fruits and vegetables that are canned, or frozen can also be very helpful. It comes in handy, where so many times I've seen where very well intended patients go to the store, they come home with all these veggies. And because of their lifestyle, they just get too busy and they forget to prepare then and then in a few days, they have a science project going on in the refrigerator. So had they purchased those things from a frozen state, they would still be good and they could use those items instead. So things like that can, can help control the cost of budget so absolutely not I do not consider healthy eating to be costly.

Shireen: Does it? It doesn't matter if it is canned versus fresh versus frozen. Does it lose nutritional value anywhere along the way there?

Grace: Oh, great question and be happy to answer that. So when let's take all three of them was awakened, canned, frozen and fresh. The one major difference in the three is the texture. If you think about that, that is a major difference in them. The other thing you want to consider with canned, fresh or frozen is when that food item, that fruit or that veggie got picked from its food source, that was its nutrient source. So its nutrition has been cut off and so you take our nutrition being cut off, we have what we have at the moment, and over time, it starts to go away. So if you take fresh fruit, or fresh veggie leaving the farm where it just got picked, it might be a week before you actually purchase it from your store. And then it might sit in your fridge a couple of more days before you actually eat it and in that time, it is losing some of its nutrients. So you might be more apt to want that texture, the nutrients have gone down in it. It doesn't mean it's lost all of its nutrients by any means they are still there because they are very potent in nutrients. But if you say, had your own garden, and you grew that, and you pick that fruit or veggie and you were eating it the day or two days after you picked it, then it would have more nutrition than the one that may have traveled 200 to 2000 miles to get to you. So that is a difference. The other thing to be considered with canned and frozen. Again, the really nice thing about them is they last, they have a very long shelf life. You can keep them store for when you need them and let's go back to when they've been picked. Again, they've lost their nutrition, they've not their nutrition, they've lost their nutrient source and they are immediately sent to processing companies that can take them and heat them to help destroy any microbial bacterial growth in there. So once that is done, they can start to chill. In the case of frozen they start to chill these fruits and veggies in a very quick method. So and that helps to preserve the nutrients. So depending on when you bite that fresh one, you might be better off with the frozen one and when you're looking at canned while they are heated longer in the canning process itself helps to preserve them. That is the nice thing about them is it is preserving the nutrients in there. Big things to look at whether it's canned or frozen is look to see what are the ingredients in that package. If it's spinach, does it say spinach and that is it or does it say spinach comma salt sauce and then there's 15 more ingredients listed. and salt. So just up for the ones that just have that ingredient if it's Strawberries, does it, say strawberries, comma, sugar, or does it say strawberries only, that's what you're after. So that you're getting the most nutrients there. And, and really, and then when you look at, they can veggies, especially well with canned fruit, be sure that it's either water packed, or in its own juice, because when you start getting into the syrupy issues, that really starts to add just too much sugar. So I'm not going there. When you're looking at canned vegetables, or whether it's canned beans, even looking at no added salt or low sodium versions, if you don't have that available, you can rinse them because that does help remove some of the sodium from the food that's in the can, that can be very helpful. So that's something that you can do. And overall, whether you want to eat canned, fresh or frozen, the bottom line is we don't eat enough. So just really try to get them in eat them

Shireen: One way or the other, and I like the fact, and one of the other things I like here is the longer shelf life on them. Because given COVID and everything that's going on around us of course, we don't want to keep going back to the grocery store and picking up fresh produce then you know sits in our in our, in our fridge. But it may be worthwhile to pick up some of these frozen and perhaps even canned options after reading the labels. But it may be worthwhile to pick those options up if you're not wanting to go to the grocery store that often. 

Grace: Exactly, yes, pick those up. And then you don't have to worry about going back to the store so frequently. 

Shireen: Yeah, yeah. Lovely. And that way you can get your nutritious foods and you know, manage your, manage your diabetes and do all of that at the same time. 

Grace: Yes, exactly. 

Shireen: Love it. Love it. Well, that's lovely. So we're ending toward the end of the episode here, Grace. One I would actually like to thank you for for joining us. But I also like for people to connect with you after this. How can people learn more about your work and connect with you?

Grace: I am on, at my website on eats, e a t s, eats with grace dot com and I am also on Twitter. Same handle at eats with grace and I'm also on LinkedIn, Grace Rivers. So I am one on that three ways that, that I can be reached.

Shireen: Lovely, okay, and what we'll do is we'll link it all up in the show notes so folks can click on it and connect with you that way.

Grace: Oh, thank you.

Shireen: No, thank you. So with that, thank you so much for your time, Grace, it was an absolute pleasure having you on. Thank you for sharing your  advice with us and sharing with us what we should be eating through this time and really to manage our diabetes. Appreciate that.

Grace: You are very welcome. Thank you again for having me.

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