Flavourful holiday recipes to lighten up your meals!

Here are some tasty side dishes to consider rather than the usuals.

 

Balsamic Roasted Squash and Root Vegetables:

Great option instead of mashed potatoes or a sweet potato casserole.  The flavour of the balsamic vinegar with the vegetables is sweet and tangy–delicious! Leftovers are great added to a salad of spinach with feta cheese and a balsamic vinegar dressing.

Ingredients:

1 butternut squash, peeled and cut into 1 inch cubes (or 1-2 packages pre cut butternut squash)

4 Parsnips, peeled and cut into 1/2 inch chunks

4 medium carrots, peeled and cut into 1/2 inch chunks

1/3 cup balsamic vinegar

4 tbsp canola oil

salt and pepper

Directions:

Preheat oven to 425F

Mix all ingredients together into an oven proof glass dish.

Roast in oven until tender, about 30-45 minutes, stirring once or twice while cooking.

 

Kale and Brussels Sprouts Salad (from Epicurious.com).

Even if you don’t love Brussels Sprouts, you will love this salad.  It’s been a big hit with all of my family, and even some co-workers who were not big fans of Brussels sprouts.

Ingredients:

1/4 cup fresh lemon juice
2 tablespoons Dijon mustard
1 tablespoon minced shallot
1 small garlic clove, finely grated
1/4 teaspoon kosher salt plus more for seasoning
Freshly ground black pepper
2 large bunches of Tuscan kale (about 1 1/2 pounds total), center stem discarded, leaves thinly sliced
12 ounces brussels sprouts, trimmed, finely grated or shredded with a knife
1/2 cup extra-virgin olive oil, divided
1/3 cup almonds with skins, coarsely chopped
1 cup finely grated Pecorino

Directions:

Combine lemon juice, Dijon mustard, shallot, garlic, 1/4 teaspoon salt, and a pinch of pepper in a small bowl. Stir to blend; set aside to let flavors meld. Mix thinly sliced kale and shredded brussels sprouts in a large bowl.

Measure 1/2 cup oil into a cup. Spoon 1 tablespoon oil from cup into a small skillet; heat oil over medium-high heat. Add almonds to skillet and stir frequently until golden brown in spots, about 2 minutes. Transfer nuts to a paper towel–lined plate. Sprinkle almonds lightly with salt.

Slowly whisk remaining olive oil in cup into lemon-juice mixture. Season dressing to taste with salt and pepper. DO AHEAD: Dressing, kale mixture, and toasted almonds can be prepared 8 hours ahead. Cover dressing and kale mixture separately and chill. Cover almonds and let stand at room temperature.

Add dressing and cheese to kale mixture; toss to coat. Season lightly with salt and pepper. Garnish with almonds.

Barley and Pomegranate Salad

A great side dish that can be made ahead of time–a nice light option with great flavours and colour.  A great option to take to potlucks!

Ingredients:

1 cup pearl barley
6 celery sticks (leaves picked and reserved), cut into small dice
4 tbsp olive oil
3 tbsp sherry vinegar
2 small garlic cloves, crushed
2/3 tsp ground allspice
3 tbsp chopped dill
3 tbsp chopped parsley
300g pomegranate seeds (2 large pomegranates)
salt and black pepper

Directions:

1. Rinse barley with cold water, the place in a medium saucepan and cover with plenty of water. Simmer for 30-35 minutes until tender, but still al dente.
2. Drain, and transfer to mixing bowl. While hot add all ingredients except for dill, parsley and pomegranate seeds which are to be added when cold

 

Happy Holidays and Happy Eating!

Farewell Ramona!

Mona - Collage

After 42 years of  Nursing and a long dedicated career with Markham Family Physicians and Markham Family Health Team, our Lead Nurse Ramona has decided it is time to retire.

Her family is putting together a Book of Memories highlighting her career over the years and we thought that since she has cared for so many generations of our patients, some families might like to write her a little message that would be included in this book.

If you would like to let her know how much you value the care she has provided to both you and your family over the years, please go to our website www.markhamfht.com, go to Blog and choose Farewell Ramona. Please enter your name and email address (required fields) and then enter your comment and Post Comment. It is as simple as that. We promise to pass along your kind words to her family.

We ask that you help us keep this a secret until it is ready to present to her.

Mona has always been such a vital part of the day to day operations of this practice. It is hard to imagine not seeing her every day but one thing we all agree on…..she has most certainly earned some rest and relaxation.

Assess your Diabetes and Pre-Diabetes Risk

This post is for those who have not yet been diagnosed with diabetes–so you may be pre-diabetic, or have been told that your sugars are a little high.  Maybe your sugar levels are fine, but you want to check in with your health and see whether you are at risk of developing diabetes.  Maybe you are concerned about a friend or a family member and their risk for developing diabetes (especially if there is a family history).  Whatever the case, there is a handy website to visit that will help you to assess your risk of developing pre-diabetes and/or diabetes in your lifetime.

Go to this website and complete the CANRISK test (see the green box):

Don’t Be Risky

Completing the survey can help you to know if you are at risk for developing diabetes.  This knowledge can help you consider making lifestyle changes that can make you happier and healthier for longer–for example, eating more vegetables, reducing your portion sizes, quitting smoking or moving your body more.  Did you know that a 5% reduction in your weight can reduce the risk of progression from pre-diabetes to diabetes by 60% (1)–that’s huge!  Keep in mind, that for someone who weighs 200 lbs, a 5% weight loss means losing 10lbs.  This does not need to be done in the next month as even a gradual reduction over a year will pay off with big health benefits!  To help make this happen, you could skip the can of regular pop in the day, reduce the amount of cream and sugar used in your coffee, skip an evening snack if you’re not actually hungry!

The more we know about our health, our bodies and healthy behaviours, the more power we have to change our lives.  Take the test!  Send it to your loved ones!  If you have any questions about the test or the results, or if you want help with making lifestyle changes, talk to your healthcare provider or your diabetes team–support can make all the difference!

Andrea

 

References:

1. Ransom T, Goldenberg R, Mikalachki A et al.  Reducing the Risk of Developing Diabetes.  Can J Diabetes:2013; 37 (suppl 1): S16-S19.

Nov 5th – Diabetes Educator Day!

November 5th is Diabetes Educator Day!

 

Certified Diabetes Educator (CDE)®  is a health professional, committed to excellence in diabetes education and who has a sound knowledge base in diabetes care/management and education processes, as well as good communication skills and who has passed the Canadian Diabetes Educator’s Certification Board (CDECB) exam.

At the Markham Family Health Team you are lucky to have two CDE’s working at the practice, myself, Sheetal (Clinical Pharmacist) and Andrea (Registered Dietitian). We each have our own areas of expertise but overall have a good command of diabetes care and management.  We often like to see patients together so that we can provide the most comprehensive approach to diabetes care and with the help of our diabetes team which includes doctors, nurse practitioners, nurses, chiropodist, and social workers you can pretty much get all your diabetes needs met here at the practice. Keep in mind however that diabetes care can extend even beyond our walls. As a patient you may be referred to a Diabetes Education Centre (DEC), LMC clinic, endocrinologist and/or nephrologist. You may also get diabetes care through your community pharmacist. It can get confusing with all the different players that may be involved but keep in mind the most important is you!

Here are a few tips that I recommend to patients to get the most out of their diabetes care; (and a few documents to get you on your way!)

1. Be prepared for your visits.

http://guidelines.diabetes.ca/CDACPG_resources/Prepare_For_Your_Diabetes_Care_FINAL.pdf

2. Know your targets, goals and results. 

http://guidelines.diabetes.ca/CDACPG_resources/Targets_Goals_May_10_2013.pdf

3. Know your diabetes team.

http://guidelines.diabetes.ca/CDACPG_resources/Know_Your_Team_FINAL.pdf

4. Write things down!

http://guidelines.diabetes.ca/CDACPG_resources/My_Team_Notes_FINAL.pdf

Sheetal 

Sitting is the new smoking…

Maybe you’ve heard this phrase before but it really highlights the need for all of us to optimize our behaviours to become less sedentary. I thought I’d blog about this issue as it relates to diabetes but the issue of physical activity transcends diabetes and is something we all should prioritize.

According to Statistics Canada, less than 15% of Canadian adults meet the physical activity requirements outlined in Canadian guidelines updated in 2011 (http://www.csep.ca/cmfiles/guidelines/csep_guidelines_handbook.pdf).

Over the years health professionals have stressed again and again, the need to be physically active. The evidence supporting the benefits for physical activity is abundant. Studies show the health benefits of exercise can include:

  • Improved blood sugar control in patients with diabetes
  • Lower rates of obesity
  • Lower risk of heart disease, stroke and hypertension
  • Lower risk if developing type 2 diabetes
  • Lower risk of osteoporosis
  • Lower risk of premature death
  • Improved mental health
  • As we age – improved independence and mobility

It’s not news to anyone that exercise improves health outcomes but how do we get motivated to be more active? How do we change our behaviours to encourage physical activity? There are numerous barriers to being more active in our society. Cities are often designed with the automobile in mind so something simple like walking to pick up our groceries is often not an option. So many of our jobs, including mine, are spent sitting at a desk. Canadians spend a great deal of time watching TV or working at a screen of some sort. We need to do better as a society. As we often say to patients in the office, it’s not the gap between what we know and what we don’t know, it’s the gap between what we know and what we do that’s the problem. How do we start to change our behaviour?

There is a growing body of literature that is looking at the effects of being sedentary, and in particular sitting, on health outcomes. We’ve been stressing exercise for years to our patients but in addition to that we really have to combat our sedentary behaviour that is so ingrained in our modern culture. So how do we get moving? Here are just a few suggestions:

  • Walk/cycle to the store or the coffee shop instead of jumping in the car.
  • When you move, think about whether your new home location will encourage you to walk vs drive.
  • At work – think about walking meetings. Stand up to take a phone call instead of sitting. Walk at lunch. Start a walking club.
  • Park the car a good distance from your destination and walk the rest of the way.
  • Get off the subway or bus a stop ahead and walk that extra block.

There are a multitude of little things we can do in our everyday lives to be even a little more active. These are just a few suggestions.

Coming back to the idea of motivation – how do we motivate ourselves to get moving, to get off our behinds and do what we already know what’s good for us? There is a lot written recently about “nudge theory”. This theory talks about tiny little things we can do that “nudge” us to make even a small change in our behaviour to achieve a more active life. We know that behaviour change is always challenging especially if it is a big change. The idea with nudge theory is that it if we can make a really small change in our behaviour then we can start to make more small changes and eventually manifest enough change to result in a better health outcome. One of the things that have nudged me to be more active this year is getting a pedometer.

Pedometers have been around for a long time but the newer high tech fitness trackers that are now available bring the concept of tracking activity to a whole new level. If you’re a bit of a gadget lover this may be for you. I actually got this idea from a patient of mine who was trying to keep herself and her diabetic husband more active. It was really working for them and I was inspired. There are a number of activity trackers on the market at the moment. Some of the brands are Fitbit, Nike Fuelband, Jawbone and Garmin Vivofit just to name a few. The new, soon to be available, Apple watch will have a tracking function as well. Most of them clip to your belt/pocket/clothing or you can wear it as a wristband. If cost is an issue you can stick with an inexpensive low-tech pedometer which will track your steps accurately.

Personally I love my device. It tells me how many steps I’ve done each day. I set a personal goal as to how many steps I want to get. It links to my phone and nudges me along to keep active throughout the day. It’s a constant reminder all day that I need to be vigilant against inactivity. It doesn’t let me forget that I need to stay active and keep my health at the forefront of my priorities. These trackers often have a cool feature where you can compare (in real time) your activity with friends and family who also have a similar device. This allows you to tap in to your natural competitiveness and allows your friends to nudge you (or taunt you!) to keep moving. It’s a fascinating phenomenon that starts to happen when you wear these trackers and stay connected with friends and family who are also trying to stay active. It becomes a bit of a high tech support group over time.

I hope this post reminds you to not just stay active (ie exercise) but to combat our sedentary lifestyles every day.

So how do you stay motivated to keep active? What’s your secret? Please share in our comments section so we can learn from one another. We need all the tips and tricks that we can get to stay healthy.

Dr. Bill

To test or not to test?

“How often should I test my blood sugar?”  This is very common questions I get and my answer always is…”it depends!”

 

Self monitoring of blood sugar (or SMBG as medical people call it) is not a one size fits all approach.  Previously as diabetes educators, we were trained to tell patients to do routine testing but the benefits of that approach have come into question due marginal benefits and significant costs. There has also been studies to show routine testing may be associated with depression and reduced quality of life.

The thinking now is that the frequency of  SMBG should be based on your current diabetes management. This can be broken down into 3 categories;

1. For most patients on insulin +/- other diabetes medications – SMBG should be tailored to fine tune insulin therapy to acheive optimal blood glucose control. If on once daily long acting insulin (i.e. basal insulin) you should be doing no more than 14 tests for the week on average. If on 2+ insulin injections per day, more testing may be required but speak to your diabetes educator to determine an meaningful and realistic schedule.

2. For most patients on diabetes medications (other than insulin) – routine SMBG is not recommended. Periodic testing can be done in certain situations but only if it helps determine a specific course of action. Examples of situations include: changes to medications, having an illness,  diet and/or exercise changes and to confirm a low blood sugar.

3. For most patients who control their diabetes through diet and exercise – routine testing is not required unless you are trying to reinforce diet/lifestyle changes.

Bottom line is test meaningfully…if testing does not change a specific course of action then don’t bother!

 

 

 

Signing the Diabetes Charter of Canada

What is the Diabetes Charter of Canada?

Briefly, the Diabetes Charter of Canada is a document that the Canadian Diabetes Association has created to ensure that all people in Canada, living with diabetes, are treated with the dignity and respect they deserve.  The goal of the charter is also to advocate for equal access to the best possible diabetes care and support, and to improve the health and quality of life for those living with diabetes, their family members and caregivers.

Click on the link above to read and review the diabetes charter in full!

Click on the link below to add your name to the thousands of Canadians who have already signed in support of the Charter.

World Diabetes Day is November 14, 2014 and the Canadian Diabetes Association would like to have 25,000 signatures by them.  Pass this along to family and friends to encourage them to show their support as well!

Sign the Diabetes Charter

Sleep Hygiene

Sleep.  We all wish there were more hours in the day to get everything done, and still get enough of that deep, restful, restorative sleep!  With busy lives and many things on the go at all times, it can be hard to wind down at the end of the day, or even get to bed at a time that we feel is appropriate.

What are the down sides of not getting enough sleep?

Lack of sleep can make it hard for us to concentrate, be productive at work, can affect our driving and even our social life.  Studies have also shown that fatigue can lead to changes in our food take because of the effect that lack of sleep can have on our hormones that regulate hunger!  Often we crave more carbohydrate rich foods, or have an increased appetite when our bodies don’t get enough rest–often leading to overeating or poor food choices.  For those who are chronically sleep deprived, some studies have shown that it may increase the risk of heart disease, stroke, diabetes and kidney disease.

How much sleep do we need?

The National Heart, Lung and Blood Institute recommends that adults aim to get 7-8 hours of sleep per night.

So, then what can we do to help maximize our sleep quality and quantity??

Try to maintain a regular sleep and wake schedule–aim to hit the sack and wake up around the same times every day to get your body into a pattern.

Exercise regularly–it can help you feel more energized during the day, but also help you sleep at night. Try not to exercise 2-4 hours before going to bed.

Avoid or limit caffeine, alcohol and/or nicotine–these stimulants can keep you up and/or disturb your sleep.  Caffeine can last in your body up to 8 hours, so try to avoid having caffeinated coffees, teas, pop (colas or Mountain Dew) or energy drinks in the afternoon or evening hours.

Have a regular sleep routine–find ways to relax and shut your mind off before bed.  Maybe it’s reading, or taking a bath, or doing some meditation or relaxed yoga.  Whatever works for you, stick to it and your body will learn to prepare for sleep.

Consider where you are sleeping–a quiet, cooler, darker room can help you sleep.  Also try to remove any distractions like computers, TVs or other electronics.  Keep your bedroom as a relaxed retreat that you can go to unwind at the end of the day!

Try not to eat a heavy meal too close to bed time or drink large amounts of fluids within 2 hours of going to sleep.  

 

As I am writing this, I am actually feeling quite sleepy after being out late last night curling and having to be up early for an appointment!  So I certainly need to work on a few of the above!   I hope the tiredness hasn’t caused too many mistakes in this post 🙂

 

Resources:

University Health Network Sleep Hygiene Handout

What are Sleep Deprivation and Deficiency?

University of Maryland Medical Centre: Sleep Hygiene

Autumn Vegetables

For some reason today I seem to be inspired by beets, also known as beetroot–a colourful vegetable that is freshest in the fall months. Beets are a great source of fibre, a source of vitamin C, iron and magnesium and rich in anti-oxidants. There are so many ways to incorporate beets into your diet, and increasing any vegetables is a great thing!! I often get the question “aren’t beets high in carbs?”. A 1 cup serving of beets has 13g of carbohydrates, but also has almost 4 g of fibre, so in the end you are left with 9 grams of net carbohydrates that affect your blood sugars per 1 cup serving. Fantastic!! So, how can you incorporate this wonderful, earthy and sweet vegetable into your diet? Here are a few suggestions and recipes.

1. Beetroot on sandwiches or burgers.
I learned about this and tried this for the first time in Australia. DELICIOUS! Previously roasted beets or sliced pickled beets can be easily added to a sandwich with turkey, chicken, or tuna with lettuce, tomato, cucumber and just some low fat mayo or honey mustard or some hummus. Give it a shot and elevate your flavours!

2. Roasted beets in salads
Clean off your beets and cut in half or quarters if they are large beets, coat with a small amount of canola oil, sprinkle with salt and pepper and wrap in tinfoil. Roast in the oven at 425F for 45-60 minutes or until tender. When they have cooled off, peel the beets (the peel will come off more easily after they are cooked).
Cut beets into smaller pieces. Then mix beets with spinach, 1/4 cup toasted walnuts and 1-2 ounces of goat cheese. Mix it all with extra virgin olive oil and balsamic vinegar or your favourite balsamic vinegrette and enjoy as a side with your meal!

Tip: if you’re going to roast beets, do some extra and keep in the freezer, or keep them in the fridge and add to salads, sandwiches or just have drizzled with balsamic vinegar on their own as a side dish with dinner. They will keep in the fridge up to 5 days.

3. Roasted vegetables
Peel and cut the beets into 1/2 inch pieces, mix with carrots, parsnips, onions and mushrooms, toss with small amount of canola oil and sprinkle with italian herbs and roast in the oven at 400F uncovered until vegetables are tender. Toss half way through cooking. Drizzle balsamic vinegar on just before serving. Instead of dried italian herbs, you could use a mixture dried cumin, coriander and pepper for something different.

4. Raw beets
You can grate raw beets onto your salads, or into wraps or on sandwiches. Just peel and then grate. It adds fantastic colour!
I made this salad up one day and really enjoyed it–maybe you will too!

Ingredients

Salad:
1 small container mixed greens or baby spinach
1 medium beet, peeled and grated
4-5 medium Brussels sprouts, shaved
1/2 cup fresh blueberries
2 oz feta cheese
3 tablespoons sliced almonds
2 tbsp coarsley chopped fresh mint
2-3 tbsp fresh coriander leaves (optional)

Dressing (or you can use low fat creamy poppyseed dressing):
1/4 cup granulated sugar
3 tablespoons apple cider vinegar
1 tablespoon olive oil
1/3 cup plain Greek yogurt
1/8 cup low fat mayonnaise
1 1/2 teaspoons poppy seeds

Directions:
1 Mix all prepared salad ingredients together in salad bowl.
2 Mix first 5 ingredients of dressing together in separate bowl. Mix until well blended. Add in poppy seeds.
3 Dress salad just before serving.

Anyone else enjoy beets? Any tips or recipes to share?

photo

Get Moving

Living in a cold country like Canada makes getting moving challenging at times- especially with this week’s damp August weather. When I am at the cottage there are plenty of things that are tempting to do. Last week I went for an amazing bike road on the back roads- smelling the clover in the fields, dodging garter snakes on the curb, and intrigued some goats in the meadow.

No matter how old or young, there are many ways to get started. Try and  reflect on when you are more likely to enjoy activity in busy Southern Ontario with time being chewed up on simple things like  commuting, which is a way of life here.

Reflect on what you like to do- it makes it less of a chore that way. Dancing,  swimming, gardening, walking- it all counts. Social aspects of group activities  are underestimated. Local community recreation centers have relatively  cheap weekly programs to explore. My friends dragged me to zumba and as we  stiffly tried to emulate the instructor’s bobbing hips and sensual rhythms, the  laughter made my heart rate go up and was good for the soul.

Having an exercise buddy- makes you accountable and motivates you to show up. None of us like to let down our friends! Rain or shine, I meet my buddy Mel for a walk on the waterfront trail. Good way to decompress after a long day.

For those who don’t like exercise, fool yourself into going by telling yourself- “I’m only going to go for 5 minutes, and I can stop when I want to”. Truthfully, I am pretty stubborn, and on occasion my pillow tries to talk me out of a morning run. I use the 5 minute rule and I have never turned back to date! Most of us drag ourselves through our routine- getting moving helps turn around the fatigue that was the obstacle in the first place. Enough of my stories: I want to hear from you.

The Canadian Diabetes Association has identified some common barriers to physical activity. Why don’t you reflect on your top three barriers that stop you from being physically active. If you want to share, I bet other people feel the same way. In fact, they may have tips on what has worked for them in the past. Here are some common barriers…

I have no time. Every minute of physical activity has health benefits, especially for people with diabetes. Start with 5-10 minutes @ different times throughout the day. This may be all you need to get going.

I am too tired. Regular physical activity will give you more energy and help you to sleep better. It may be hard to get started, but once you start, you’ll feel better. In the end, it will be worth the effort.

I do not have the motivation. Start with 5 minutes of physical activity and allow yourself to stop if you are not enjoying it. That way you can at least start, and once you are into it, you may want to keep on going.

It costs too much to join a gym. You don’t need a gym membership or a personal trainer to be active. You can do simple things around the house or in your neighbourhoods that do not cost money- go for a short walk, or start a project in the yard.

I cannot be physically active on my own. Start by sharing your activity plans with friends or family. You may be surprised by the support you receive. Doing your activity with others can help to get you started and keep you going. Your local recreation centre, senior’s centre, or Diabetes Care Team may also be able to help you find activity partners.

Bottom line… getting more physically active is a challenge and often we don’t know where to start.

START right here, right now.

START slowly; have fun.

ASK your health care team to help with the first steps