Weekend Ramble: Sugar-Free may not be a Panacea

As you may or may not be aware, I belong to quite a few diabetes oriented food groups. There seems to be a recurring theme of people championing sugar-free foods, because they've been taught to only count carbs. While counting carbs is a valid way to lose weight, it may not play as great a role in maintaining a diabetic system as one might want to believe.

When I first started the MDF blog back in 2014 after being diagnosed type 2, my motto was DUMP THE CARBS!, and I truly believed that motto was going to save my life. A decade later I've learned that it's not just simple carbs we have to watch. There are the factors of glycemic index and load as well as portion control, and it seems newer studies are showing that replacing simple carbs with artificial sweeteners may not really be all it's cracked up to be.

This week's Weekend Ramble features two articles from 2014 and 2022. Studies are ongoing and there is a ton of information at your Google inspired fingertips, but it's my hope that these two pieces will give my followers a bit of insight and something to think about when they're preaching:

"OMG SUGAR FREE XYZ IS SOOOO GOOD!!!"

Study: Artificial Sweeteners May Trigger Blood Sugar Risks
National Geographic

By Dan Vergano, September 17, 2014

Bacteria in your gut might determine whether saccharin triggers glucose intolerance.

Sugary sodas have come under fire for contributing to obesity and diabetes, but new research suggests artificial sweeteners may also raise blood sugar levels. Photograph by Sam Hodgson, Reuters

There's no such thing as a free lunch, or at least a free artificially sweetened one, a new study suggests. Saccharin and other artificial sweeteners may raise blood sugar levels – a condition the sugar substitutes aim to help prevent – by altering digestive bacteria, Israeli researchers reported on Wednesday. (Related: "What Lives in Your Gut?")

Sugar-free sodas and diet snacks abound with artificial sweeteners, invented more than a century ago as a cheaper sugar substitute. Amid an obesity epidemic, the U.S. Food and Drug Administration has to date approved six artificial sweeteners, which are widely used and roughly 500 times sweeter than sugar. These additives cut calories from foods and drinks, and are seen as precluding the elevated blood sugar, or glucose intolerance, that often precedes diabetes. (See "Sugar: Why We Can't Resist It.")

But a first-of-its-kind study suggests one reason why diet sodas and their ilk don't seem to have made much difference in the obesity crisis. The answer may lie within ourselves, or at least in the bacteria in our intestines that are exposed to artificial sweeteners, a joint team headed by Eran Segal and Eran Elinav of the Weizmann Institute of Science in Rehovot report in the journal Nature.

"This huge and poorly understood microbial world which resides within each one of us, starting from birth, has been shown to have a huge effect on our physiology," Elinav says. Although cautioning that the findings are preliminary, he says, "our results suggest the consumption of artificial sweeteners may affect the microbiome in ways that cause glucose intolerance in some people."

Over decades of study, research results on artificial sweeteners have been mixed, with some pointing to artificial sweeteners raising the risk of elevated blood sugar levels, obesity, diabetes, or other ailments, and other research suggesting lower risks. Many of the people in those studies already suffered from these conditions to some extent or ate an unhealthy diet, or both, when they enrolled, which greatly complicated the results.

A 2012 review of the safety of artificial sweeteners by the American Heart Association (AHA) and American Diabetes Association (ADA) suggested that "when used judiciously," artificial sweeteners might help people lose weight.

But the review also concluded that more research was needed on the panoply of health questions surrounding the additives. The only one that seems answered is that saccharin doesn't cause bladder cancer, a well-known fear raised by lab rat studies in the 1970s, which subsequent studies determined was unfounded, according to the National Cancer Institute.

Epidemic of Caution

In a briefing for reporters, Segal said that the study authors are "by no means" calling for people to make any changes to what they eat or drink, but are asking the scientific community to confirm the new results and reassess artificial sweeteners.

Experts reacted to the study results with a mixture of caution and interest, noting that the research was conducted largely on mice and included only seven human volunteers. And they downplayed a direct link between artificial sweeteners and the obesity epidemic. More than one-third of U.S. adults are now obese, according to the Centers for Disease Control and Prevention.

"Artificial sweeteners are associated with overweight in humans, but the obvious connection is that overweight people use them more," says New York University nutrition expert Marion Nestle, by email. "This is the first study I have seen suggesting that the connection is mediated through the microbiome. I'm not crazy about artificial sweeteners (I think they taste terrible), but this needs confirmation before taking it too seriously."

Epidemiologist Judith Wylie-Rosett of the Albert Einstein College of Medicine in New York agrees. "It would be a disaster if people with diabetes started drinking sugar-laced drinks because of this one study, so we need some caution," says Wylie-Rosett, who co-chaired the 2012 AHA/ADA review of the safety of artificial sweeteners. "It is an interesting hypothesis at this point."

Of Mice and Men's Guts

In the new study, the team began by adding one of three FDA-approved artificial sweeteners – saccharin, sucralose, or aspartame – to the drinking water of mice. The researchers compared these groups of mice with others that drank only water. Within 11 weeks, the mice drinking sweetened water had developed glucose intolerance, most notably when saccharin was added to their diet.

To see whether the mice's intestinal bacteria contributed to the problem, the team then used antibiotics to wipe out the mice's intestinal bugs and found they could return the mice's blood sugar levels to normal.

Finally, they fed fecal samples from glucose-intolerant mice to normal mice, transferring the unhealthy mice's gut bugs. The normal mice that got these fecal samples then developed glucose intolerance within six days.

Analysis of mouse gut bacteria after the experiments found a proliferation of the bugs involved in digesting carbohydrates in the glucose-intolerant mice. (Carbohydrates are found in breads, cereals, and other foods in the human diet.)

"I think this is surprising," Elinav says. He calls it "counterintuitive" that artificial sweeteners, which are not meant to be absorbed by the digestive tract, end up apparently altering its performance.

To see if the effect extends to humans, the team first looked at 381 people in a nutritional study headed by Segal. They found links between artificial sweetener use, symptoms of obesity and elevated blood sugar, and the kinds of altered gut bacteria seen in the mice.

In particular, the study noted a 20-fold increase in the numbers of Bacteroides fragilis bacteria, linked to inflammation in the gut.

Finally, as a proof of concept, the team enrolled five adult men and two adult women who didn't use artificial sweeteners in a one-week experiment. In the experiment, the volunteers ate the FDA's recommended allowance of saccharin, about 120 milligrams daily; they had their blood sugar levels checked every five minutes and underwent a daily glucose tolerance test.

Sweetener made from stevia plants, here in a research greenhouse at Michigan State University, has gained popularity as an alternative to artificial varieties. Photograph by Kevin J. Miyazaki, Redux

"Notably, even in this short-term seven-day exposure period, most individuals (4 out of 7) developed significantly poorer glycemic [blood sugar] responses," says the study. Normal mice fed fecal samples from the four human volunteers with glucose intolerance developed the same condition.

Along with a historical shift toward processed foods over the past century, the move toward artificial sweeteners "coincides with the dramatic increase in the obesity and diabetes epidemic," the study concludes. "Our findings suggest that [artificial sweeteners] may have directly contributed to enhancing the exact epidemic they themselves were intended to fight."

Microbiome Mystery

"This study reinforces the idea that what we eat directly influences our gut microbiota, which, in turn, is intimately linked to many facets of our health," says Stanford University microbiologist Justin Sonnenburg. He called for closer examination of the results, pointing to the uncertainty over the mechanism behind the changes in the gut bacteria seen in the study. (Related: "The Quantified Microbiome Self.")

For starters, when people eat artificially sweetened foods, only milligrams of the sweetener ends up in their gut, compared to most of the sugar eaten in normally sweetened foods, notes Stanford University's Christopher Gardner, another co-chair of the 2012 AHA/ADA artificial sweetener safety review. If the gut bacteria are eating artificial sweeteners, then very small amounts of the material seem to have a disproportionately large effect on the community of microbes, he says.

The missing piece in the study is a mechanism for the artificial sweeteners to directly spur a population boom in some gut bacteria and a population bust in others.

The researchers acknowledged that they don't understand how artificial sweeteners would stimulate the growth of potentially harmful intestinal bacteria. It's possible, but untested, that the sweeteners may change conditions in the gut in some way that spurs the growth of the microbes, even if the microbes are not eating the additives.

Elinav says the results also point to the very individual nature of how people respond to changes in diet, noting the three out of seven people whose blood sugar remained unaffected in the last part of the study.

"Eventually, we may be moving toward an era of personalized nutrition," he says, where individuals' diets are tuned to their digestive tract's tendencies. (Related: "Discovering My Microbiome.")

Personalized nutrition, like personalized medicine, is a hot topic among health experts, says Wylie-Rosett, but there are fairness issues to consider: "We want to see we don't move toward an era of diet haves and have-nots. Obesity, unfortunately, has a larger effect on the have-nots."

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Spate of new research points to the potential harms of artificial sweeteners

Recent studies suggest that consuming too many artificial sweeteners could elevate blood sugar levels and raise one's risk of heart disease or stroke.

Sept. 8, 2022
By Aria Bendix (Breaking health reporter for NBC News Digital)

New research adds to mounting evidence that artificial sweeteners may be harmful to your health.

A study published Wednesday in the BMJ (British Medical Journal), which involved more than 100,000 adults in France, found a potential link between consumption of artificial sweeteners and heart disease.

The results showed that participants who consumed large amounts of aspartame — found in the tabletop sweeteners Equal and NutraSweet as well as cereals, yogurt, candy and diet soda — had a higher risk of stroke than people who didn’t consume the sweetener.

Similarly, people who consumed high quantities of sucralose — found in Splenda as well as baked goods, ice cream, canned fruit, flavored yogurt and syrups — and acesulfame potassium, often used in "sugar-free" soda, had a higher risk of coronary heart disease.

"Artificial sweeteners may not be a safe alternative to sugar," said Mathilde Touvier, the study’s author and a research director at the French National Institute for Health and Medical Research.

Last month, a smaller study found that consuming non-nutritive sweetener — sugar substitutes that contain few calories or nutrients — could alter a person's gut microbes and potentially elevate blood sugar levels. High blood sugar can increase one's risk of diabetes, heart disease or stroke.

Prior to that, a June lab study found that artificial sweeteners prompted gut bacteria to invade cells in the intestine wall, which could ultimately raise one's risk of infection or organ failure.

Other previous research has linked artificial sweeteners to obesity, high blood pressure, diabetes and increased cancer risk as well.

"The more data that comes out showing these adverse health effects, the less we're going to want to encourage people to switch from added sugars to non-nutritive sweeteners," said Dr. Katie Page, an associate professor of medicine at the University of Southern California.

But the healthiest course of action, Page said, isn't to opt for regular sugar instead.

"We really need to encourage people to eat sugar in more moderation and try to decrease sugar consumption," she said. "And the way to do that isn’t to consume more non-nutritive sweeteners."

Some sweeteners thought of as natural aren't preferable either, Page said.

"I definitely would not switch to agave," she said. "I know people think that’s healthy, but it actually has a very high fructose content."

An emerging link between sweeteners and heart disease

As a category, artificial sweeteners are low- or no-calorie additives often found in soft drinks and other highly processed foods like yogurt, granola bars, cereal or microwaveable meals. They're also sold as tabletop sweeteners like Equal, Splenda, Sweet ‘N Low and Truvia.

The sweeteners were originally billed as a healthier replacement for sugar, which is known to promote obesity and diabetes and can increase one's risk of heart disease if consumed in excess.

Touvier said her study is the first to directly assess how overall dietary consumption of artificial sweeteners impacts one’s risk of heart disease. Previous studies mostly looked at how artificially sweetened beverages impact heart disease risk.

Her team defined a large amount of sweetener as around 77 milligrams per day, on average, which is a little less than two packets of tabletop sweetener.

More than half of the participants' artificial sweetener consumption came from soft drinks, while 30% came from tabletop sweeteners. Another 8% came from sweetened dairy products like yogurt or cottage cheese with fruit topping.

Sucralose is the most commonly consumed artificial sweetener worldwide, Page said, whereas "aspartame has kind of gotten out of favor, so people aren’t consuming it as much."

She said sodas are the biggest source of artificial sweeteners in our food supply, though "a lot of the non-nutritive sweeteners people are consuming are coming from foods that you might think of as healthy."

Two prime examples: flavored yogurts and sports drinks.

The best alternative to sugary food, Page said, is naturally sweet fruit. If water isn't a satisfying substitute for soft drinks or juice, she suggested carbonated water without artificial sweeteners.

Sweeteners could disrupt your metabolism and elevate blood sugar

A growing body of research suggests that artificial sweetener may disrupt the body's ability to properly metabolize glucose, which can be a risk factor for diabetes and cardiovascular health issues. 

For the study published last month, Israeli researchers asked 120 people to consume four artificial sweeteners — aspartame, saccharin, stevia and sucralose — for two weeks. Participants consumed six sachets of sweetener per day, which is within the Food and Drug Administration’s acceptable intake.

The researchers observed changes in the makeup and function of participants' gut microbes, which help break down food and ward off disease-causing bacteria. The changes were not seen in people who did not consume artificial sweeteners.

"All four sweeteners changed the microbiome, each in their unique way," said Eran Elinav, the study's author and a microbiome researcher at the Weizmann Institute of Science.

Two sweeteners in particular, sucralose and saccharin (found in Sweet ‘N Low), altered some people's ability to process glucose.

"It changed the way the bugs in their gut are functioning and that, in turn, led to increases in their glucose levels, which is of course not a good thing," Page said.

The researchers even transferred samples of gut microbes from the study participants with significant metabolism changes into mice. The mice, too, developed blood sugar alterations, Elinav said.

"That's pretty good evidence suggesting that [artificial sweeteners] have some type of effect on metabolism and on the gut microbiome," Page said.

Page said her team is now studying how artificial sweeteners affect children's risk of metabolic conditions like diabetes.

"There's been very, very few studies in children and there's data showing that the increases in non-nutritive sweetener consumption are even higher among children and adolescents," she said.

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Just so you all know that I actually practice what I preach (for the most part), I have decided to limit my artificial sweetener intake as much as possible. To that end, I am leaving Splenda out of my coffee... huge change for me... and not easy. BUT... as I have stated before... I wanna live, and after having researched the topic I can no longer justify what I was doing to my system. My next labs are in December... We shall see. :-)

Have a great week, everyone, and thank you for your support!

Blessed be… and happy cooking!

                                                            Chef Michael R

Weekend Ramble: 13 Low-Carb Snacks from WebMD

Full credit for article and pics goes to WebMD

One of the most asked questions in the culinary world of diabetes is "What can I eat for snacks?" Unfortunately what most people mean by that is how can they make their sugary stuff healthy... The key I found to a good diabetic diet is to slowly wean off almost all sugars, including artificial sweeteners. Natural foods are our friends, and this article outlines a pretty decent set of snacks that are easy to put together and will steer you in a better direction than the Gotta-Be-Sweet trail.

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13 Low-Carb Snacks

Medically Reviewed by Christine Mikstas, RD, LD on December 02, 2022

More Options Than You Think

Sometimes, the whole world of snacking seems to be based on the one thing you’re supposed to limit: refined carbs. Even the "healthier" packaged items, like granola bars, smoothies, and crackers, are full of them. If you look past the vending machine, though, you'll find plenty of other tasty options, like these smart snacks. The best part? They're as easy to toss together as they are delicious. 

Apples and Cheese

Sweet and salty flavors add up to a great snack. Pair a cup of apple slices with an ounce of mozzarella cheese for about  16 grams of carbs. The combination of protein, fat, and fiber makes it a filling and satisfying nosh.

Avocado on a Crisp

Avocados have a place in your diet outside the guacamole bowl. Mash 1/4 of a ripe avocado and spread it on 2 light rye crisps for a crunchy, creamy snack with about 29 grams of carbs, plus plenty of fiber and heart-healthy fat. It’s like a mini open-faced sandwich.

Yogurt and Cucumbers

Take your yogurt in a savory direction. Use a cup of low-fat, plain Greek yogurt as a creamy dip for 1 cup of refreshing cucumber spears. It adds up to12 grams of carbs and a mega dose (25 grams) of appetite-satisfying protein. It’s like a version of the famous Greek dish, tzatziki.

Turkey Roll-Ups

Deli turkey has uses beyond a sandwich filling. Lose the bread and roll up 1 ounce of sliced turkey in lettuce leaves with mustard. This light, crisp snack has 2.9 grams of carbs and will get you through the afternoon.

Cottage Cheese With Berries

Cheesecake doesn’t make for a healthy snack option, but you can mimic a little of the flavor in a healthier way. Pair a cup of low-fat cottage cheese with half a cup of fresh or frozen blueberries and a little of your favorite no-calorie sweetener. The result? A dessert-like snack with 17 grams of carbs.

Celery and Peanut Butter

Remember eating this snack with your homework after school? It's still a good idea! Fill two medium celery stalks with 2 tablespoons of natural-style peanut butter for a nibble  that will take you back to your childhood, with only 10 grams of carbs.

Better Beef Jerky

Jerky has been going upscale in recent years, and there are better options now than the over-processed mystery-meat versions you’ve had before. Look for jerkies made from grass-fed beef, which have big flavor and just 5 grams of carbs per serving (about 1.5 ounces). 

Hardboiled Egg With a Kick

Hard-boiled eggs are the original grab-'n'-go power snack. Cut one in half and spread on a little hot sauce (such as sriracha) to make it as full of flavor as it is of protein. That’s a zesty bite for less than 1 gram of carbs.

Nuts

Mixed nuts are an all-time snack classic for good reason. They're just as satisfying at your desk as they are at a party. One ounce of crunchy, salty, mixed nuts will keep your energy up for hours for only 6 grams of carbs per ounce.

Kale Chips

Even kale haters come around when they taste kale chips. Some store-bought varieties have less than 10 grams of carbs. You can cut that number even further by making them at home. Tear the leaves from a bunch of kale. Rinse and dry them. Toss with 1 tablespoon of oil and 1/4 teaspoon of salt. Roast them in your oven at 300 degrees for 20-25 minutes, until the kale is crispy.

Edamame

Also called steamed soybeans, edamame taste great, are full of fiber and protein, and have just 6.9 grams of carbs in a half cup of shelled edamame. They're easy to make in your microwave, so keep a bag in your freezer.

Hummus and Red Bell Pepper Wedges

Though they're often spotted together, hummus isn’t married to high-carb pita bread. Spread  1/4 cup of hummus onto wedges cut from one red bell pepper for a filling, tasty snack that has 16.4 grams of carbs.

Tuna-Stuffed Tomato

Get the health benefits from tuna without all the carbs that come with your typical tuna sandwich. Pack 3 ounces of canned tuna into a ripe tomato half for a hearty snack with only 3.5 grams of carbs.

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Have a great week, everyone, and thank you for your support!

Blessed be… and happy cooking!

                                                            Chef Michael R

Food as Medicine: A Conversation with Chef Amy Foote

Welcome to my Weekend Ramble!

For a number of years I was getting roughly 90% of my fish through a monthly subscription with Wild Alaskan Company. These folks not only provide amazing proteins, but the way they run their company makes their customers feel like family. Their newsletters are often filled with philosophical takes on the world around us. Monica's email from March 23, 2023 featured an interview by Kristin Gole - WAC Content Strategist with Chef Amy Foote - Director and Executive Chef of Alaska Native Tribal Health Consortium (ANTHC) Medical Campus in Anchorage, Alaska. 

Chef Amy's beliefs got me thinking and saying to myself... hey... I do something similar with my blog! My intentions have always been to help people eat better and healthier, but after reading through the interview I am seeing my efforts may very well be going a step further by actually doing some healing.

When we eat good food, we feel good. When we eat healthy food that is also good, we don't feel guilt often associated with "cheating". When we create and consume meals that leave us satisfied and happy as we leave the dinner table smiling we may very well feel a sense of pride and happiness. 

Remember a Weekend Ramble a while back where I touched on things we can and can't control regarding our disease and overall health? Our food is absolutely in our control and good food promotes happiness and healing. 

I feel good about this. Huge thanks to Monica, Kristin & Chef Amy for helping me to see that what I'm doing is important and may very well make a difference in the lives of my followers. Please read on to learn more from Chef Amy Foote.

Have a great week, everyone!

Blessed be... and happy cooking!

Food as Medicine: A Conversation with Chef Amy Foote

March 22nd, 2023

How a Hospital Food Program in Anchorage Strives to Heal the Alaska Native Community

Dear friends,

While I’m still out on leave (just for a little longer!), and in honor of Women’s History Month, I want to share an inspiring conversation one of my colleagues had with Amy Foote, Director and Executive Chef of Alaska Native Tribal Health Consortium (ANTHC) Medical Campus in Anchorage, Alaska. Just for some context, the ANTHC provides comprehensive medical and health services to Alaska Native and American Indian patients through programming that strives to meet their unique needs. 

Through her work, Chef Amy uses food as medicine to help patients heal, often tapping into the culinary heritage of her patients to ensure they’re having all of their needs met. Food, after all, is so much more than a dietary requirement. Food can be medicine to the body and soul. 

I’ll let my colleague Kristin Gole, WAC Content Strategist, tell you a little more about Chef Amy and the incredible work that she does. 

***

When I first (virtually) met with Chef Amy Foote, a photo of her holding something floral and interestingly-patterned appeared on the zoom screen. I told her they reminded me of the cherry blossoms that were starting to bloom outside of my window in New Jersey. She enthusiastically painted an animated description of the herring eggs she was holding in the picture, which had been harvested on a spruce branch, then explained how she used the eggs to feed the patients she serves at the Alaska Native Medical Center in the Tribal Health Consortium Campus. It was clear we were from different worlds, but her excitement drew me in immediately.  

Chef Amy and her team serve over 5000 meals a day, but unlike other hospital food programs, she takes into account the healing properties of food — a lesson Alaska continues to teach her over and over. Her work bridges tradition and innovation in search of the larger impact food and food systems have on our lives. 

You’re originally from Montana. What brought you to Alaska?  

I worked summers in Alaska since I was 15, in Prince William Sound. After spending time back in Montana, I kept asking myself, how do I get back to Alaska? Alaska is really polarizing for people. It either moves in and sets up camp in your heart, or it doesn’t. For me it always called me back.

I totally hear you on that one. What did that call sound like for you?  

For me, it’s almost a spiritual connection, magical. There’s this surreal awe that happens living here. We just had the most amazing northern lights. They were so close to my house, it felt like you could touch them. I can come around the corner driving home and see a moose giving birth.

I can pull up in my driveway and have a grizzly bear in my yard. There are magical extremes that play off of each other. We have restricted times and then vast blasts of beauty.

There are things in Alaska you can only experience in Alaska. The ability to be really, truly alone in the wilderness. You can feel that stillness. Having that connectivity for my kids was really important to me. I wanted my kids to be self-sufficient, to be able to learn that everything you need is around you. Alaska is one of the few places that you can still do that. You walk out and you have your food source and your medicine source right there. Both of my boys stack firewood, harvest moose, catch fish. My youngest is a plant nerd in the making.

Tell me a little bit about your understanding of food as healing.

Healing through food comes in many forms. The act of growing and foraging is healing. Interacting with the land, the act of sharing and giving, is an act of healing between each other. The act of eating gives comfort, nourishment and wellness. The act of honoring the ingredients and utilization is healing. Using food for healing is actually a secret and rewarding gift of working here. 

Specifically in your line of work, how do you go about using food to heal? 

People usually have this stigma for hospital foods, but we get to actually heal people. We had a patient that was here for months. They had lots of long term healing to do after a plane crash. People get tired of eating the same thing, so I went and sat with the patient. We talked about the foods that sounded good, the foods they would consume, even their own family recipes.  

One of the big things we bring in when we can is seal [an ingredient respected and long used by native Alaskans], so I made them seal soup. They were amazed! They asked, “Where did you get seal?? How do you know how to cook seal??” 

Just watching this patient take this first spoon of seal soup and the relaxation that occurred after that — there goes your stress, there goes your anxiety, after months of being in a hospital. If you can make someone take a deep breath, it’s a huge part of healing. The medicine has its place, but if you are anxious, food can add that comfort, which provides that calmness that can allow you to heal. 

There’s also a nutritional aspect. To be able to offer the foods that are tied genetically to our patients that their ancestors ate — like seal, like caribou, like moose — that’s another aspect of healing we get to provide. We serve a lot of salmon. Salmon is tied to all of the regions of Alaska, and we’re feeding people from all over the state. 

Well, we love salmon here at WAC too! Tell me about your relationship with salmon. 

Salmon is what Alaskans live and die by. It’s how we feed ourselves, how we feed our children, how we feed our sled dogs. We even use it as a textile, like salmon leather!

A lot of fishing happens in Alaska, and one of the things I frequently hear about is the frustration of discarded litter, of carcasses and eggs after a fishing trip. But all of those are nutrient dense and completely edible foods. So last year we started a program and began to collect donations of heads, spines, eggs (what’s called spoon meat). We turned it into fish head soup. There’s a lot of collagen in it. It’s really great healing, and that’s what you want in a hospital.  

It’s women’s history month, so I have to ask, what is it like being a female in a male-dominated industry? 

After over 30 years, it has been an evolution. In my earlier years, I was frequently the only woman in the kitchen. This required working twice as hard, proving myself each and every moment of each and every day. 

Eventually, there was a point where I felt like I’d proven myself enough. I got tired of proving myself to people and I wanted to take those lessons and help others learn and grow and blossom. I went into more of a teaching, mentoring role. 

I’m a builder. I’m known for pushing people out of their comfort zones and challenging them to do things they didn’t know they could do; like presenting, teaching, being in front of a crowd, carving at a station. I have folks I’ve hired that were unhoused and on the street. I hired them and mentored them into sous chef roles. I believe in constant learning, giving back, offering opportunities for growth and honoring my own teachers. I also strive to create a culture of family where we all support each other toward our common success. 

What lessons have you learned from female mentors or elders? 

Elders are the keepers of the past to help guide us to the future. I have learned many powerful lessons from female elders. Most resonant in me is to ethically harvest, take only what you need and can honor by using every bit of. Support your elders who can no longer harvest and learn from those who can. Observe quietly and learn all you can. Do everything with reciprocity, intention, respect and love.

What do you want people in the Lower 48 to know about seafood from Alaska? 

People need to look at their box of wild Alaskan fish as a box of gold. 

Knowing the survival it took for that fish to grow, the voyage to even get out to sea and survive — I want everyone to have awareness and passion for continuing to protect what allows us to have that beautiful fish, whether that’s looking at the water regulatory practices, the land, to making sure that fish can continue to come back every year. That’s really important to me. I also want people to know that fishing is the livelihood of a very awesome community of people.

And from a chef’s perspective: please don't overcook it! Wild Alaskan salmon is less fatty than a farm raised Atlantic salmon. I sometimes hear, “Oh it’s so dry,” but it’s not if you don’t overcook it! Honor that ingredient!

***

Thank you to Amy for talking with the WAC team! 

Before I sign off today, with Ramadan beginning this week, I am reminded of a wonderful New York Times article published last year about how the diverse Muslim community in Anchorage observes this period of fasting. I highly recommend this read — in fact, I just reread it myself. 

For those of you who observe Ramadan, I wish you a happy and generous Ramadan. And Happy Women’s Month to all! 

Live Wild,

Monica

Pictured above: Chef Amy Foote in her chef jacket, alongside a couple of the culinary creations that she’s developed to help nourish patients at the Alaska Native Tribal Health Consortium Medical Campus.

Have a great week, everyone, and thank you for your support!

Blessed be… and happy cooking!

                                                            Chef Michael R

Weekend Ramble: Vegetarian and Plant Based Eating

I'm not gonna lie... I'm not a huge fan of plant based eating as I firmly believe I was born a carnivore. I do, however, respect people's choices regarding healthy foods and I have even been known to embrace some vegetarian dishes as they cross my path. Since my audience is global, I thought I should do at least one Ramble on the subject.

To that end, here is a very good article originally published by Beth Israel Lahey Health's Joslin Diabetes Learning Center

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Vegetarian and Plant Based Eating

Joslin Education Team - March 29, 2022

A plant-based diet consists of mostly whole grains, fresh fruits and vegetables, legumes (pulses), unsalted nuts, and healthy oils such as olive oil or canola oil. Meat, fish, poultry, and other animal products are included but eaten less often and only in small portions. A vegetarian diet eliminates meat, fish, or poultry or any foods that contain animal protein. It includes whole grains, legumes (pulses), nuts, seeds, vegetables and fruits with or without the use of dairy products and eggs.

There are several different types of a vegetarian diet:

• Semi-vegetarian: Does not eat red meat(s), but occasionally eats fish or poultry and dairy products. Semi-vegetarians are often people who are making a transition to a vegetarian diet.
• Lacto-ovo vegetarian: Eats milk, dairy products and eggs but not meat, fish or poultry.
• Lacto-vegetarian: Eats milk and other dairy products but not meat, fish, poultry or eggs.
• Pescetarian: Eats a diet of fruits, vegetables, grains, legumes and includes fish. They may or may not eat eggs and dairy
• Vegan: Do not eat any animal products (meat, fish, poultry, eggs or dairy foods). A vegan eats only plant-based foods.
• Raw Vegan: Eats only plant foods; including vegetables, fruit, nuts and seeds, legumes (dried beans, peas, and lentils), and sprouted grains. The majority of the food is uncooked varying from 75% to 100%.

Can people with diabetes follow a vegetarian or plant-based diet?

Research shows the many benefits of omega-3 fatty acids. They may reduce the risk for cardiovascular disease, improve cognitive function and vision, and act as an anti-inflammatory agent in the body. The primary sources of omega-3 fatty acids in the diet are fish, organ meats, and DHA-enriched foods such as eggs. Based on these food sources, vegetarians may not get enough omega-3 fatty acids in their diet. Adding some plant-based omega-3 rich foods can help the vegetarian meets their needs.

What are the health benefits?

There are many reasons why people choose to follow a vegetarian or a plant-based diet, including financial reasons, ethical, environmental concerns and religious beliefs. Some people make the change for health reasons, as well. Vegetarian and plant-based eating may help reduce the risk of:

• Cancer
• Diabetes
• Heart disease
• High blood pressure
• Kidney disease
• Obesity

Yes. They can be higher in carbohydrates and lower in protein than meat-based diets, so glucose levels may be affected. As a result, your healthcare provider may need to change the amount or type of your diabetes medicine. Anyone interested in changing to vegetarian or plant-based eating, including people with diabetes, should work with a dietitian to make sure they are meeting their nutritional needs.

Is vegetarian/plant-based eating nutritionally adequate?

A well-planned vegetarian/plant-based diet can be healthful and nutritionally adequate. Keep in mind that the more restricted the diet, the greater the chance of a nutritional deficiency. Below are some considerations.

Protein:

Vegetarian/plant-based diet(s) can provide an adequate amount of protein as long as you eat a variety of foods and consume adequate protein sources. Protein is made up of amino acids, nine of which are called essential amino acids. Animal foods contain all of the essential amino acids, whereas plant foods are missing one or two. However, if you eat a variety of plant foods, you will get all nine essential amino acids.

Sources of Plant Protein:

Legumes (Pulses)

Legumes include dry beans, peas, and lentils. They are an excellent food to extend or replace meat. Legumes are low cost, high in nutritive value, and contribute iron, B vitamins, and fiber to your diet. They are not a complete protein, because they do not contain all of the essential amino acids the body needs. When combined with a variety of other plant-based foods throughout the week, legumes can become valuable protein sources in your diet. Legumes may be purchased dry or canned. Dry legumes tend to be less expensive

Dry Beans: Rich in protein, iron, calcium, phosphorus and potassium. There are many varieties of dry beans including black beans, garbanzo beans (also called chickpeas), kidney beans, lima beans, navy beans and pinto beans.

Dry Peas: Good sources of protein, iron, potassium and thiamin. They are green or yellow and can be purchased split or whole.

Lentils: They are rich in protein, iron, potassium, calcium and phosphorus. They are small disc-shaped legumes; they can be brown, yellow or red.

Soy Products: Soy products include tofu, soymilk, tempeh and other products. They are derived from soybeans, a rich source of plant-based protein. Protein in soybeans contains as much complete protein as meat and are a good source of B vitamins and essential fatty acids, including some omega-3s. Soy foods are typically low in unhealthy fats (saturated/trans) and are cholesterol-free. They also contain isoflavones which may help lower the risk of some chronic diseases.

Soybean: A legume, which is an excellent, inexpensive source of protein and iron. Soybeans can be eaten in their whole form and, but are also used to make a number of vegetarian substitutions for meat, dairy, and eggs.

Soy cheese: A cheese-like product made from soybeans. They come in a variety of flavors such as parmesan, mozzarella and cheddar. Not all soy cheeses are vegan; some contain the milk protein casein.

Soymilk: A milk-like product made from soybeans, with a similar amount of protein and less fat than cow’s milk. Not all soymilks are vegan as some contain the milk protein casein. Fortified soymilks have calcium and vitamin D added.

Tempeh: Made from fermented soybeans and other grains, tempeh is a replacement for meat.

Textured Soy Protein (TSP): Commonly used as a substitute for ground beef; TSP is derived from soy flour.

Tofu: Made from curdled soymilk and pressed into blocks. It can be used as a replacement for meat, eggs and cheese and can be eaten fresh or cooked in many different ways. Tofu is an excellent source of protein. Types and suggestions of how to use tofu:

• Extra-firm tofu: frying, roasting, grilling or marinating
• Firm tofu: stir-frying, boiling or use as a filling
• Soft tofu: pureeing
• Silken tofu: pureeing, simmering, egg substitution, used in vegan desserts and smoothies

Nuts and Seeds:

Nuts and seeds are some of the best plant sources of protein. They are rich in fiber, folic acid, potassium, antioxidants (vitamin E and selenium) and phytochemicals as well. Nuts are high in monounsaturated and polyunsaturated fatty acids, including omega 3 fatty acids. Because nuts and seeds are high in fat, portions should be limited.

• Tree nuts: Includes almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts.
• Seeds: Includes pumpkin, sesame, sunflower, chia and flaxseed.
• Nut Butters: Peanut butter is the most popular but other nuts and seeds make butter: sunflower, almond, cashew, hazelnut and soy.

Omega-3 Fatty Acids

Sources of Omega-3 foods:

• Flaxseed
• Chia seeds
• Hemp seeds
• Walnuts
• Canola oil
• Soy
• Some soymilks and breakfast bars

Iron:

Plant foods contain a different form of iron than animal foods, called non-heme iron. Non-heme iron is not as well absorbed as heme iron. Non-heme iron will be better absorbed if eaten along with foods that contain vitamin C, or by cooking foods in cast-iron pots and pans. The daily recommendation for iron intake is 1.8 times higher for vegetarians than those who eat meat. For most vegetarians, an iron supplement is recommended to help meet iron requirements.

Sources of iron:

• Bran flakes cereal Pumpkin seeds Instant oatmeal Dried beans/peas Fortified cereals Tofu
• Sea vegetables Textured vegetable protein

Sources of vitamin C:

• Cantaloupe 
• Strawberries
• Honeydew melon 
• Broccoli
• Citrus fruits 
• Green peppers
• Kiwi 
• Tomatoes
• Papaya 
• Brussels sprouts

Zinc:

As with iron, zinc is a mineral that is present in plant foods but better absorbed from animal sources. As a result, some vegetarians can have lower concentrations of zinc than non-vegetarian diets. Most vegetarians still have levels within the normal range. True zinc deficiencies are rare in Western civilizations. Including foods rich in zinc can help the vegetarian maintain adequate levels of zinc in their body. Like iron, zinc can be better absorbed when eaten in combination with vitamin C-rich foods. (See list above)

Sources of Zinc:

• Legumes
• Grains
• Cheese
• Nuts

Vitamin B-12:

Vitamin B-12 is found mainly in animal foods. Some plant foods contain vitamin B-12, but not in a usable form. A lacto-ovo or lacto-vegetarian diet will provide adequate amounts of vitamin B-12. Certain foods are fortified with vitamin B-12, such as some breakfast cereals, soymilk and meat substitutes. If you are a vegan, you must either make sure you eat these fortified foods, or take a B-12 supplement.

Sources of Vitamin B-12:

• Fortified cereals 
• Eggs
• Brewer’s yeast Milk and milk products
• Fortified meat substitutes 
• Fortified soy milk

Calcium:

A lacto-ovo vegetarian diet generally is adequate in calcium. A vegan diet tends to provide lower amounts of calcium, although, with careful planning, a vegan diet can supply enough calcium. Your dietitian may recommend a calcium supplement if you can’t meet your calcium needs through food sources.

Note: Calcium decreases the absorption of iron. If taking supplemental calcium or iron, take them at separate times of the day.

Sources of calcium:

• Milk and milk products 
• Legumes
• Fortified soy milk 
• Collard greens
• Tofu (made with calcium) 
• Turnip greens
• Fortified orange juice 
• Kale

Vitamin D:

Vegan diets may be low in vitamin D, since cow’s milk is the most common source of this vitamin. However, if you follow a vegan diet, you can get enough vitamin D from fortified cereals and fortified milk alternatives. Unprotected exposure to sunlight (hands and arms) for 15-20 minutes a day can also supply adequate vitamin D. Some people may need a vitamin D supplement. Your dietitian may recommend supplemental vitamin D if your diet is deficient and/or your vitamin D level is low.

Sources of vitamin D:

• Fortified cereals 
• Fortified soy milk
• Milk
• Sunlight

Getting started with vegetarian/plant-based meal planning

Choose a variety of foods, including whole grains, vegetables, fruits, legumes, nuts, seeds, and, if desired, dairy products and eggs.

Try gradually decreasing the amount of animal protein to allow time to adjust to a vegetarian/plant-based diet.

Substitute soy products (tofu, meat substitutes) and legumes for meat, poultry and fish.

If you use milk products and eggs, choose lower-fat versions of these foods, such as skim or 1% milk and yogurt, and egg whites or egg substitutes.

If you are following a vegan diet, be sure to include a regular source of vitamin B-12 in your diet along with a source of vitamin D if sun exposure is limited. Supplements are often required to meet nutrient needs.

Use fats sparingly; choose unsaturated fats, such as olive, canola and peanut oils, nuts and seeds, instead of saturated fats, such as butter, margarine and cream cheese.

Limit your intake of high-fat foods, such as cheeses, whole milk, nuts, seeds, avocados and oils, especially if you are trying to lose weight.

Be sure to count the carbohydrates in foods – many vegetarian diets can be very high in carbohydrates. Keep your carbohydrate intake consistent and read food labels carefully for their carbohydrate content.

It is important to monitor your glucose regularly if you are changing to a vegetarian diet/plant-based diet. Your diabetes medication or insulin dose may need to be adjusted, especially if you are eating more carbohydrates than before.

Vegetarian meal ideas

Below are some meal ideas to help get you started? Again, be sure to include a variety of foods in your eating plan.

• Breakfast: Whole-grain cereal and skim/1% fat or milk alternatives; whole-grain toast; bagels; English muffins; pancakes and waffles; fruit; eggs and egg substitutes; nonfat Greek yogurt; regular/low-fat cheeses; peanut and nut butter; tofu “cream cheese”; vegetarian/plant-based proteins “bacon” and “sausage”.
• Lunch/Supper: grilled cheese sandwich; hummus and vegetable sandwich; peanut butter and jelly sandwich; minestrone, bean, split pea and lentil soups; vegetable pizza; rice and beans; bean and vegetable burritos bowls; macaroni and cheese; vegetarian lasagna; stir-fry vegetables and tofu; “veggie/plant-based” burgers; vegetarian-style chili

Note: Many vegetarian and planted-based frozen products are not necessarily healthy choices. Some of the products can be high in calories and fat. Always read the nutrition facts to make sure the item is appropriate for your goals. 

Resources:

The Vegetarian Resource Group - https://www.vrg.org/
Eating Vegetarian - https://www.nutrition.gov/topics/basic-nutrition/eating-vegetarian
Vegetarian Times - https://www.vegetariantimes.com
Mark Bittman - https://www.markbittman.com/
PBS, Jazzy Vegetarian Cooking Show - http://www.pbs.org/food/shows/jazzy-vegetarian/
Forks over Knives - https://www.forksoverknives.com/
The Plant-Based Network - https://plantbasednetwork.com

Although this content is reviewed by Joslin Diabetes Center healthcare professionals, it is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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Have a great week, everyone, and thank you for your support!

Blessed be… and happy cooking!

                                                            Chef Michael R