Rivanna’s two cents about healthy eating with Type 2 Diabetes

Learning to eat well with a new diagnosis of diabetes (of any kind – Type 1, Type 2, Gestational etc.) can be a challenge in itself. Add in picky eating behaviours or special diets and the work gets even harder! Recently I was contacted by The Diabetes Council to answer a few questions about eating well with Type 2 Diabetes. Click on the link below (and scroll to #40) to see my answers!

https://www.thediabetescouncil.com/dietitians-answer-questions-about-energy-levels-picky-eaters-plant-based-diet-more-for-those-with-type-2-and-prediabetes/

Rivanna is on Huffpost Living – The Dietitian Dish!

Eating out while trying to maintain a healthy diet can be a challenge, especially if you’re travelling and don’t have many options for meals apart from restaurants. But fear not! Like most things related to diet, it can be done – with a bit of research and quick thinking.

Recently the staff at Huffpost Living Canada asked me to contribute to their recurring “The Dietitian Dish” column, where RDs from all over the country are asked what they might choose to eat at various chain restaurants.

See my answers to what I’d choose at Montana’s Cookhouse and Kelsey’s at the links below:

Montana’s Cookhouse:

http://www.huffingtonpost.ca/2015/07/20/montanas-healthy-food_n_7832180.html?utm_hp_ref=the-dietitian-dish

Kelsey’s:

http://www.huffingtonpost.ca/2015/09/14/kelseys-menu_n_8135340.html?utm_hp_ref=the-dietitian-dish

Encouraging healthy eating behaviours at meals

Creating the right environment at mealtime can help promote healthy eating habits. Infants and children like routine and boundaries, and so setting these for mealtimes as you would other parts of their day can be very helpful, especially if you are finding mealtimes with your child challenging.
It’s important to remember the different responsibilities that parents and children have at meals. Parents are responsible for deciding what, when and where children eat, and children are responsible for deciding if, what and how much of what is offered they eat. Understanding and accepting this can be very helpful for parents, especially if you aren’t sure if your child is eating enough. Children are incredibly good at deciding how much they need to eat. To adults this amount can sometimes seem ridiculously small, but most children will vary their how much they eat meal to meal, balancing out their intake through the day. The amount that kids eat (or don’t eat!) is a huge source of stress for most parents , but unless your child isn’t growing well or you feel that there isn’t enough variety in their diet, try to relax (it’s hard!)!
You can help make your child’s mealtime experience better by following a few easy steps, outlined below.
• Set a routine to your day, so that your child knows to expect meals and snacks. Of course day-to-day life makes having a rigid routine impossible (and that’s probably a good thing), but keeping the timing roughly the same helps your child recognize hunger signals and know it’s time for a meal (or snack).
• Meals should be calm, pleasant, and enjoyable, ideally for everyone involved.
• Children are easily distracted, so turn the television, computer, or tablet off, and put your phone away. If you have music playing or the radio on, turn it off, or right down, and choose slower, more soothing songs. There should be no toys or books at the table to compete for your child’s attention. By doing this you make it clear to your child that mealtime is for eating, not playing or watching.
• Ideally, all meals should take place at a table. Your child should sit in a highchair, booster seat or regular chair, depending on his or her age, and be at the table with the rest of the family.
• If it’s possible, eat together! Many young children like to share and eat food off of their parent’s plates. They also see their parents eating a wide variety of foods, so may be interested in trying new foods if they see you eating them.
• Meals are not the forum for arguments. Instead, talk to your child about his or her day, or any other pleasant or fun topic they might enjoy. Engage your child in conversation, talking about things other than the food on his or her plate, or how much he or she is eating.
• In the same vein, try to avoid focusing on your child’s intake (this is very hard to do). Infants and children respond best to positive reinforcement, so praising them when they do eat, and not addressing it when they don’t may help encourage more reliable eating patterns.
• Keep meals short – maximum 20-25 minutes. Children have short attention spans, so don’t make them sit at the table for long periods of time. This may only cause more battles, or a fussy kid who hates mealtimes.
Following these strategies will give you the tools to creating healthy eating habits and foster enjoyable meals. Good luck!

Introducing solids: which foods are best to start with?

So you’ve determined that your baby is ready to start solids, but what do you give them first? In the past, people used to use cereal, fruit, vegetables and meat/fish as the preferred “order” in which to introduce solids, but new Health Canada recommendations actually suggest iron-fortified cereal and meats as first foods, because they are excellent sources of iron. For breast fed babies in particular, iron becomes an important nutrient at about 6 months of age, as the iron stores they built while in the womb have been depleted, meaning an external source of iron is required. Iron is key for brain development, and so it is a vital nutrient for infants and toddlers. Start with an iron-fortified single-grain cereal mixed with breast milk or formula, or pureed meat (lamb, beef, pork, or chicken etc).  Once your baby has been established on iron rich foods, they can start having food from different food groups, like fruit, vegetables, grains and dairy – in any order you prefer!  Usually it’s a good idea to introduce one food at a time, every 2-3 days, so that you can screen for allergies, but once your child has tolerated a food, there’s no reason why you can’t mix foods together. For example, many babies love avocado mixed with banana, or meats and vegetables combined. You can buy ready-made baby foods from the store, or make your own. Just make sure that if you’re making your own food at home, to avoid all salt and sugar. That being said, there’s no reason to avoid flavour! Many people believe that babies should be given bland foods, but once your child is established on a good range of foods, he or she might prefer flavoured foods. For example, why not consider trying spices like rosemary, basil, oregano, or garlic to both enhance the flavour of the food and expand your child’s palate? Many children who are exposed to a variety of healthy foods and flavours often continue to choose these foods as they get older.

Purees are the easiest foods to start with, but it’s a good idea to move fairly quickly towards lumpy foods that your child can easily handle. Most babies at 6 months can handle finger food that dissolves in the mouth, like cereal rings, rusks, arrowroot cookies or rice cakes. They may also do well with small, well-cooked pieces of vegetable or pasta, or chunks of soft fruits like banana or pear. Let your child feed his or herself these foods to promote independence and fine motor skill development. Some children struggle with mixed textures (i.e. lumps in a sauce), so consider separate textures in the beginning. Children prefer not to work for their food, so don’t be surprised if your child gags with lumpier foods – this is normal, and a part of development! It’s extremely important to progress to lumps and textured foods before your baby is 9 months old – afterwards there’s a higher risk of feeding issues, which can be very difficult to manage. By a year of age, your baby should be eating all textures of foods, and eating the same meals as the rest of the family (slightly modified for safety, of course!). If you’re struggling with introducing solids, speak to your family doctor or paediatrician, or consider consulting a dietitian.

Introducing solids: how to start

I often get asked about introducing solids, particularly by first time parents. They want to know how to gage whether or not their child is ready, and how to practically start introducing foods other than breast milk or formula. The World Health Organization (WHO) and Health Canada now recommend waiting until 6 months of age to start solids, but some infants may be ready before that, say at 5 months or so. A baby who is ready to start solids can hold his or her head up independently, and can turn away from the spoon if the food is not wanted. He or she will open their mouth widely when they see the food coming, and keep the food in their mouth and swallow it as opposed to just squishing it out. Babies at around this stage of development may also be fascinated with your food, or the food others are eating around them, and may try to grab plates, cups, or pieces of food right from your hand! You may notice that they’re putting everything they can find in their mouths, drooling more when they see food, and can’t be distracted from the plate. Some parents tell me that their children no longer “seem satisfied” with breast milk or formula alone.

Starting solids is an exciting time, and should be enjoyed! Remember that in the beginning your baby may only take 1 or 2 small spoons of food once a day – they’re just learning and experiencing new things. At this point in time the majority of your baby’s nutrition will come from breast milk or formula. As he or she starts take larger volumes, and eats more times in the day, you may notice that his or her breast milk or formula intake drops slightly. As long as your baby is still growing and gaining weight this is absolutely fine! Positive reinforcement is key when starting solids: you should be as excited as your baby is by this process! Let him or her get messy, hold a spoon, gurgle, and laugh with you. To help make this happen, choose a time in the day that works for both you and your baby to start feeding. A time when things are calm, there are few distractions and limited noise. Turn the TV or the ipad off, and place them out of your baby’s line of sight. Put your baby in a highchair and sit in front of them. Many parents tell me that lunchtime is a good time to start because everyone’s awake, and there’s less hustle and bustle around the house. Offer small amounts of food on a baby-sized spoon, and let your baby decide how much to take off of each spoonful, and how many spoons to take in total. Try to let your baby see how excited you are, not how stressed you might be (because as exciting as introducing solids might be, for many parents, it’s just as stressful!). Babies can read your stress levels and respond, sometimes in ways that make you even more stressed! The goal is to enjoy mealtimes together, and to start to set a positive tone around food and mealtimes that will hopefully last your baby the rest of his or her life!