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Common Sense Guide to Eating

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1 Common Sense Guide to Eating
This slide show is based on the full text article “Diet and Type 2 Diabetes” by Dr. James J. Kenney. It will show pre-diabetes and diabetes clients the most effective strategies for losing weight so they may reduce the need for blood sugar lowering medications with type 2 diabetes. It also explains the importance of eating a heart healthy diet and gives specific tips for doing so. This is not just a show to count carbs and manage blood sugar – it is how to eat the optimal diet for a better life. For People With Type-2 Diabetes

2 What You Will Learn Today
2 most important eating strategies Carbohydrates, protein and fat tips How to read a food label Supplement FAQs Meal planning to better your health Here are the topics for today – we are going to teach you how to manage your diet to better your health.

3 What Are The 2 Most Important Eating Strategies?
1. Lose Weight: Reduces insulin resistance Lowers blood pressure Improves blood sugar control Improves blood lipids Reduces risk of heart disease & stroke Reduces need for blood-sugar lowering medication Weight loss reduces insulin resistance, lowers blood pressure and helps prevent the development of Type 2 diabetes mellitus. It also improves blood sugar control which reduces the complications from diabetes and can reduce the need for blood-sugar lowering medication. It improves blood lipid profiles which reduce the risk of heart disease and stroke. Blood sugar and blood glucose are the same thing – we will use the term blood sugar through this show.

4 What Are The 2 Most Important Eating Strategies?
2. Eat A Heart-Healthy Diet: 2/3 of all people with type 2 diabetes die of heart disease The risk of dying of a heart attack is at least 2-3 times greater in people with diabetes It is important to eat a heart healthy diet, especially if you have diabetes. Over time, elevated blood sugar levels damage both small and large blood vessels.

5 The Importance of Weight Control
This graph shows that the risk of developing diabetes increases dramatically as body mass index goes up. The risk of developing diabetes increases as body mass index goes up

6 The Importance of Weight Control
This second graph shows that insulin resistance, on average, goes up as the percent of ideal body weight goes up. If you are overweight and you lose weight, your body is less resistant to insulin – this can mean a reduced need for blood sugar lowering medications. Insulin resistance goes up as percent of ideal body weight goes up

7 Weight Loss and a Heart Healthy Diet Go Hand in Hand
Eat more fiber Lower your cholesterol Feel fuller on fewer calories Eat less fat, especially trans fat and saturated fat Makes weight loss without hunger easier Improves blood lipids Reduces the risk of heart attack & stroke Eat fewer refined foods & more whole foods Better blood lipid profile Better weight control Eating a higher fiber, lower fat diet will improve blood lipids and the likelihood of sustained weight loss. This is because a high-fiber, lowfat diet is more satiating than a diet that is high in fat and refined carbohydrates – you feel fuller on fewer calories.

8 Carbohydrates The body’s main energy source
Some carbohydrate-rich foods are much better choices than others Most carbohydrates get broken down into glucose, which is the body’s main energy source. Some carbohydrate-rich foods are better than others. Some foods will break down to glucose much more quickly than others. But more importantly, the RIGHT carbs will help you feel fuller on fewer calories while the WRONG ones will lead to overconsumption of calories. Ask if anyone has an idea what is the right carbs? The answer: low calorie density/high fiber! Like the bananas – versus banana cream pie!!

9 Where Are Carbohydrates Found?
Starchy Vegetables Corn Potatoes Sweet potatoes Grains Cereals Breads Fruits Milk Sugars This list shows where carbohydrates are found. Speaker note: it may be fun to just show the title to the slide and then ask your audience if they know the foods/food groups that contain carbohydrates. After they are done guessing, you can click on the mouse or hit the enter button to list all of them. Most vegetables are very low in calories and carbohydrate, although starchy vegetables such as potatoes, corn and sweet potatoes are higher.

10 Choose Preferred Carbohydrates
Whole grains Whole wheat pasta Oatmeal Barley Whole grain cereal Brown rice Vegetables Raw Steamed Salad Stir fry Whole fruit Fresh Frozen Unsweetened Choose whole grain products such as whole wheat pasta, brown rice, barley, oatmeal, whole grain cereals, etc. Better still, choose whole grain products with a high moisture content to optimize your weight loss efforts. For example, whole wheat pasta, hot whole grain cereals, corn on the cob and brown rice are all very filling. They contain fewer calories than products made with refined white flour and little water content such as white bread, bagels, crackers, etc. The FDA now allows a claim for products made with 51% or more whole grains – look for it on packages of grain products: "Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat, and cholesterol, may help reduce the risk of heart disease and certain cancers." These are minimally processed, whole plant foods

11 Limit Refined Carbohydrates
Candy Brownies Cookies Bagels Croissants Biscuits Danish Pretzels White bread Fat free chips These products are refined – meaning they do not contain fiber and are not in a whole natural form. They tend to be higher in calorie density and spike blood sugar faster and higher than the preferred carbohydrates we just showed in the previous slide.

12 Make a Better Choice Instead of: Choose: white rice brown rice
white pasta whole grain pasta sugared cereal oatmeal French fries baked potato, yam candy whole fruit fruit juice whole fruit Choosing whole foods versus refined foods makes weight loss efforts more effective.

13 Advantage of Whole Plant Foods
Carbohydrate: Calories: Bagel Breakfast: 1 bagel (4 ounces) 60 g 311 Light cream cheese (2 Tbsp) 2 g 70 Milk, skim (1 cup) 12 g 85 Total 74 g 466 Total weight: 12.5 ounces Oatmeal Breakfast: Cooked oatmeal (2 cups) 48 g 281 Skim milk (1 cup) 12 g 85 Orange (1) 15 g 61 Total 75 g 427 Total weight: 28 ounces Notes: • You get twice the amount of food by weight by eating the Oatmeal Breakfast even though the grams of carbohydrate are almost the same. • The Oatmeal Breakfast contains 9 more grams of fiber and 10% fewer calories!! • It is also contains 3 less grams of saturated fat and 751 milligrams less sodium than the Bagel Breakfast. Glossary: Refined foods - foods that have been processed from whole ingredients often lose fiber and important nutrients. For example, white flour is a refined food made from whole wheat kernels. Sugar is a refined food made from sugar cane. Besides losing fiber, vitamins and minerals, these foods are most often much higher in calories per serving than their original form. For example, one cup cracked whole wheat contains 321 calories and 9 grams of fiber while one cup all-purpose flour contains 455 calories and only three grams of fiber. Whole plant foods - minimally processed foods from plants that are in their whole, near-natural state are generally lower in calories, higher in fiber and higher in nutrients than their refined counterparts and have a lower glycemic response. A four-ounce potato contains 82 calories while the same amount of potato chips contain 608 calories. Examples of whole foods are fruits, vegetables, beans or legumes and whole grains. Whole foods are more satiating - that is you feel more full on fewer calories. Even though these two menus have the same number of carbohydrates, the Oatmeal Breakfast and the Stirfry Dinner both have a lower calorie density and higher satiety value. This is important because most people with Type 2 Diabetes need to lose excess body fat to improve their blood sugar control and blood lipid profile. You Get To Eat MORE!

14 Advantage of Whole Plant Foods
Carbohydrate: Calories: Macaroni & Cheese Dinner: Macaroni & Cheese (1 cup) 40 g 390 Salad (2 cups) 13 g 81 Apple sauce (1/2 cup) 22 g 86 Total 75 g 577 Total weight: 22 ounces Stirfry & Brown Rice Dinner: Broccoli Stirfry & Brown Rice (2 cups) 48 g 259 Diced Fresh Fruit (1 cup) 13 g 55 Total 74 g 396 Total weight: 27 ounces Notes: • You get 22% more food by weight by choosing the Broccoli Stirfry with Brown Rice versus the Macaroni & Cheese even though the grams of carbohydrate are almost the same. By volume, you get 42% more food with the Broccoli Stirfry – 5 cups versus 3.5 cups!! • The Stirfry dinner has 181 fewer calories and 8 more grams of fiber. • It is contains 14 less grams of fat, 7.5 fewer grams of saturated fat and 480 fewer milligrams of sodium. These 2 slides illustrate the importance of choosing whole plant foods over refined foods for optimal weight control efforts. They help you eat fewer calories without being hungry. Because of their high fiber, low fat and low sodium contents, they are heart healthy too. You Get To Eat MORE!

15 Should I Avoid Sugar? You should try to limit refined sugars:
Weight gain and obesity Provides “empty” calories Displaces nutrient-rich carbohydrates Dyslipidemia and cardiovascular disease Natural sugars in fruits, vegetables and nonfat dairy products okay A long time ago, health professionals used to tell people with diabetes that they were not allowed to have any sugar or fruit. If you are trying to lose weight, you should really try to limit refined sugar in your diet. Sugar is sugar is sugar – even though honey (pictured above) is natural – it is still sugar and contains calories

16 Calorie Free Sugar Substitute Tips
Do not raise blood glucose levels Sweet taste without calories People with PKU should not use aspartame Sugar alcohols found in “diabetic foods” contain empty calories and may cause diarrhea Calorie-free sugar substitutes enable you to enjoy the sweet taste of sugar without the calories and without raising blood sugar levels. These are known as aspartame (Nutrasweet), saccharin, Asulfame-K and sucralose (Splenda). You can find sugar substitutes in many products, including diet soda, fat-free yogurt, pancake syrup, puddings, and gelatins. Sugar substitutes are okay for everyone to use with a few exceptions. People with phenyketonuria (PKU) should not use aspartame. Sugar alcohols such as sorbitol, mannitol, and xylitol are seen in many diabetic products. They contain empty calories and are absorbed into the bloodstream, but at a slower rate than regular sugar. Consuming sugar alcohols in large amounts (more than 20 to 50 grams, or 2/3 to 1-2/3 ounces per day) can cause gastrointestinal distress and diarrhea.

17 Protein Tips Most Americans eat too much protein
Portion control – deck of cards = one serving People who have kidney problems or nephropathy may have to limit their intake of protein Most Americans eat too much protein, which can be problematic. Red meat, poultry, whole milk products, and eggs are good sources of protein but they also provide saturated fat and dietary cholesterol, both of which increase risk of heart disease. People who have kidney problems or nephropathy may have to limit their intake of protein. Protein blunts but prolongs the rise in blood sugar after a meal. One problem with foods that are high in animal protein is that they often contain a lot of fat and this leads to weight gain.

18 Heart Healthy Sources of Protein
Very lean meat, fish, shellfish, and skinless poultry breast Beans, peas, and lentils Nonfat dairy products Nuts and seeds Egg whites Some soy products Speaker: You may want to stop this slide with just the title showing and ask your audience if they can name at least two types of protein that are heart healthy. Then show them the examples listed here. These sources of protein are heart healthy – meaning they are low in saturated fat and trans fat. Ask your audience if they eat fish on a regular basis? Encourage discussion on how they prepare it or their favorite restaurant for eating seafood. Ask them if they use nuts and seeds. Or if they have ever tried soy products. It may be fun to provide samples of these foods at the end of the class. See the recipe handouts for ideas using these ingredients.

19 Fat Facts Limit high fat foods for weight loss
Limit or omit saturated, trans fats, e.g. cheese, cream, fatty meat, fried foods Choose liquid oils and use sparingly Most Americans eat too much fat. We only need about 1-2% of our calories to come from fat, but Americans consume about 30-40% of calories from fat. If weight loss is not a priority, monounsaturated fats such as olive oil, canola oil, avocados, nuts, and seeds are preferred. They are the most healthful fats since they are not associated with heart disease or stroke.

20 Food Label Basics Look beyond the claim on the front of the box:
Cholesterol or trans fat free – doesn’t mean saturated fat free or low in sodium Heart healthy – generally okay Fat free, sugar free – doesn’t mean calorie free Baked doesn’t mean low in fat or calories Good source of calcium – doesn’t mean sugar or fat free Some examples:  Entenmann's Light Fat-Free Cakes and SnackWells - fat-free but full of sugar, many crackers are cholesterol free but high in hydrogenated fat (Wheat Thins), Extra Light Olive Oil - light refers to color and not nutrition, see label reading terminology handout for claims that have been defined by FDA.  The key is to look at the entire label - the big picture - not just what's on the very front of the package.

21 Food Label Basics Calories related to serving size?
Number of servings? Fat, saturated fat, trans fat and cholesterol content? Sodium? Fiber? Start here 5% or less is low; 20% or more is high Limit These Nutrients Note that the serving size is whatever the food manufacturer decides is the serving size - not what you want the serving size to be! All of the nutrition information is based on one serving, not the entire package. If the calories are listed as 100 per serving and there are 4 servings per package, you will have consumed 400 calories when you are finished with the product. Educating yourself about health claims will always be helpful. Reading food labels will be challenging at first, but if you keep working at it, you’ll see that it becomes easier with time. With regards to sugars on the label – the problem is that it doesn’t differentiate between refined and naturally occurring sugars. If an item has a lot of fruit and the portion is large then the sugars on the label will be high but this is not as bad as if a product is high in refined sugar. Get Enough of These Nutrients

22 Food Label Tip This food is considered high in sodium – look at the number of calories relative to the mg of sodium – ideally, they should be about the same Foods that are high in sodium are generally found in the center of the grocery store. Canned goods, frozen meals, deli items, bread, cereal, crackers, canned soups, condiments and chips/snacks are to name a few of the heavy hitters. Only 10-20% of the American sodium intake comes from the salt shaker. It is important to read the label. The label shown is for canned soup. Diabetics with hypertension, osteoporosis, kidney stones and or kidney disease may have to be very careful with salt intake. For an in depth discussion with figures and references on salt and high blood pressure, see and click on “Salt - has it gotten a fair shake or is it a serial killer?” by Dr. James J. Kenney, PhD, RD, FACN. This paper and accompanying CPE post test is approved for 3 CPE hours by the American Dietetic Association.

23 Food Label Success Label reading may seem hard at first, but it gets easier with time Start with one section of the grocery store and become familiar with those products Fill up with produce! These are tips to help you shop for healthy foods more quickly. Name the colors of MyPyramid: Grains, Veggies, Fruits, Milk, Meat/Beans – this is what you should eat – whole foods – not processed foods in boxes and cans!!

24 Dining Out Eat a light snack before you go Avoid bread basket
Choose low-fat items Keep portions small Order appetizers, soups, salads …Or Share …Or Take half home Skip dessert and alcohol It is still possible to dine out successfully and manage your diabetes. Try to call the restaurant in advance to receive a copy of the menu. Most restaurants will be happy to send you one. Several restaurants also have Web sites where you can print out menus. Scan the menu for healthful choices. Good choices include lean animal protein, baked potatoes, steamed vegetables, nonfat dairy products, and fresh fruit. If your choices are limited, try to eat something before you go. Once you get to the restaurant, you can just have a salad and soup (if your blood pressure is not high). Ask for the bread basket to be removed and order a salad to be brought while you are reading the menu. When dining out healthfully, it’s best to ask plenty of questions about the food. You may be able to speak to the chef regarding food preparation methods. Ask questions if you are not familiar with an ingredient. Avoid assuming that an entrée is healthful based on the description alone. When ordering, specify that no butter or salt be used in preparing your meal.

25 Mineral Supplements Supplements are not a substitute for a healthy diet Chromium - more research is needed on the long-term safety and efficacy Vanadium - not clinically justifiable Magnesium – may be good for people who do not consume enough whole grains Note to speaker: The next few slides represent common questions asked by diabetes patients regarding supplements. If you are dealing with a basic audience you may want to omit them. There is growing interest in the potential benefits of various food supplements for treating patients with insulin resistance (IR), impaired glucose tolerance ( IGT), and Type-2 DM. Since refined and highly processed foods are depleted in many vitamins and minerals and are low in fiber and other phytochemicals, some patients may benefit from supplementation. Vanadium does mimic the impact of insulin by increasing the rate at which tissue takes up glucose. Unfortunately levels of vanadium supplementation needed to produce this action are close to the toxic level. Claims of chromium picolinate causing the loss of body fat and increase in lean tissue are not supported by scientific research. More research is needed on the long term safety and efficacy of chromium supplements. Hypo magnesia is a common finding in diabetic patients in poor control and is associated with late stage complications. Whole grains, cereal fibers, and magnesium can be protective. All Americans should consume more whole grains and other magnesium-rich foods and limit their intake of refined grains. Patients who do not improve their diets may benefit from a daily supplement of mg magnesium.

26 Vitamin Supplements Vitamins E and C – some patients may benefit from supplementation of these antioxidants B12 - Many diabetic patients 50 years or older may benefit B Vitamins - Elevated homocysteine levels can be reduced with supplements of folic acid, vitamins B-6 and B12 Niacin – improves blood lipids but may have adverse effects on blood sugar regulation, more research is needed People with Type-2 DM may have a greater need for dietary antioxidants than people with normal BS levels. High doses of Vitamin E and Vitamin C are not warranted at this time. However, supplements of Vitamin E in the mg/d range may have some beneficial effects. Doses of Vitamin C up to 250 mg/d may be beneficial. Supplements are not a substitute for a healthful diet, exercise, or weight loss. Natural foods are much higher in a wide variety of phytochemicals that have potent antioxidant effects. Vitamin B12 is a common deficiency in people 60+ years due to a reduced ability to absorb this vitamin. It seems that many, if not most diabetic patients 50 years or older may benefit of a supplement of 100 to 1000 mcg/d. This has no known risk and much potential benefit. A decline in mental function may occur due to elevated homocysteine (Hcy) levels. These levels can be reduced with supplements of folic acid (800 mcg/d), Vitamin B-6 (5 mg/d), and Vitamin B12 (250 mcg/d).

27 Other Supplements L-Argnine:
Has been shown to promote insulin secretion High doses may cause diarrhea and are not justifiable by current research More research is needed Omega 3 fatty acids: Favorable effects on triglyceride levels May help lower blood pressure More research is needed to determine long-term effects Several grams of L-Arginine (ARG) supplements has been shown to promote nutrient-stimulated insulin secretion. ARG supplements of several grams daily are probably safe but more research is needed to determine long-term beneficial effects in patients with IR, IGT, and Type-2 DM. Very high doses (20-30 g/d) may cause diarrhea and are not justified by current research. Supplements of niacin and omega-3 fatty acids have some beneficial effects but more research is needed to determine long-term effects.

28 Herbs Growing interest for blood sugar regulation
Ginseng has shown some promise It is likely that some herbs may have medicinal effects, but most will have little impact and some may prove harmful There is growing interest in the use of herbal products in the regulation of blood sugar among both researchers and the general public. Herbal products are being utilized in hope of improving a wide variety of medical conditions. It is likely that some may have medicinal effects, but most will have little impact and some may prove harmful. However, one herbal product that has shown some promise for reducing both fasting and postprandial BS levels is American ginseng. It has been shown to have a modest hypoglycemic effect in animals. The long-term safety and efficacy of this product as a hypoglycemic agent for treating Type-2 DM requires more research. Always make sure you tell your physician, nurse or dietitian about any herbs you are taking. They can interact with other medicines that you are taking. Herbs are drugs even though they are not regulated as drugs in the US.

29 Spices Use spices in place of salt
Some evidence suggests that some spices, such as cinnamon, cloves, bay leaves and turmeric, may have a small but favorable effect on carbohydrate metabolism Spices add a lot of flavor to food. They are an essential part of a lowfat high fiber diet. Consider obtaining a good book on using herbs and spices so you can improve the flavor of your food. There is a wealth of information on the internet on the use of herbs and spices in cooking. You can also find good cookbooks on this subject. Visit and click on food links – click on food links again and then spices and you will find a list of spice sites on the internet.

30 What If I Overeat? There may be times when you overeat
Rather than feeling guilty, take a long walk Exercising after a big meal will help blunt the rise in glucose May require extra insulin or oral agents to prevent excessively high blood sugar Since many social gatherings revolve around food, there may be times when you overeat. Making healthful choices can be particularly challenging during the holiday season, when you are on vacation, or if you are at a party or someone else’s home. Rather than feeling guilty, take a long walk. If you do overeat, try to do a little more exercise to lower your blood glucose levels. Exercising after a big meal will blunt the rise in glucose. Your body may require extra insulin or oral agents to prevent excessively high blood sugar. If you know that you’ll be eating out for dinner, be extra careful about what you eat for breakfast, lunch, and snacks throughout the day.

31 Meal Planning Breakfast starters:
Cooked oatmeal Whole grain cereal Fruit Skim milk Herb tea or decaf coffee Whole grains are preferable to products made with white flour Breakfast should begin with whole grains, nonfat dairy or fortified soy and some fruit. Find a few fast favorites and rotate between them. It is important to keep the right things on hand so you can whip up a fast heart healthy meal with little effort.

32 Meal Planning Lunchtime good choices:
Salad with low-fat dressing Stir fry with vegetables, brown rice Bean soup Low-fat chili Baked sweet potato, yam or potato Fish Leftovers from healthy dinner Whole grain pasta Avoid deli-type items that are high in fat and sodium Heart healthy lunches can be easily packed and taken to work. Prior planning and shopping make this job easier and this saves you money from eating out frequently. If you must eat out, find a few close restaurants that facilitate healthy eating. If you are a local you can develop a friendly relationship with the staff to customize the menu for your diet.

33 Meal Planning Dinner ideas: Vegetables Salad Soup Baked potato
Stir fry Whole grain pasta Bean dishes e.g. chili, salad, soup, pasta, etc. Fish Lean poultry or meat Dinner is a whole lot easier to manage when you take the time to find heart healthy meals that work for you and your family. Planning ahead and shopping to have the right ingredients on hand are 2 vital keys to success. It helps to make things in larger batches and freeze them for future meals – either lunch or dinner. This maximizes time spent in the kitchen.

34 Meal Planning Snacks for your heart: Fruit Vegetables Baked potatoes
Baked sweet potatoes Soup Nonfat light yogurt Peanut butter on whole grain cracker* Nuts* Smoothie (heart healthy) *not ideal for weight loss, look for unsalted Here are some suggestions for heart healthy snacking. For more information on snacking, see the free article on our website at “To snack or not to snack, that is the question.” Frequent small meals are more effective for weight control/loss than larger meals that are eaten less frequently. Making the right choices, eating only when hungry and not missing breakfast are other tips that are given in that article. It is important to plan ahead and take heart healthy snacks with you. This keeps you from being tempted by the office cookie/candy stash, vending machines, fast food and other choices that are high in calories. Not all smoothies are created equal – use skim milk and whole fruit – a little wheat germ is also nice too. Avoid smoothies made with whole milk, sugar syrup, ice cream and frozen yogurt, such as the ones found in smoothie places and malls. Be aware that the sizes of these, along with their choice of ingredients, can make them quite high in sugar and calories – up to 400 or 500 per 24 oz. cup.

35 What Should I Eat? Whole grains – whole wheat pasta, oatmeal, barley, whole grain cereal, brown rice Whole grains consist of all three layers of the grain – bran, germ, endosperm. Examples include: -brown rice (versus white rice) -100% whole wheat bread (versus white bread) -oatmeal -barley -whole wheat pasta -quinoa -whole cornmeal -bulghur wheat The FDA now allows a claim for products made with 51% or more whole grains – look for it on packages of grain products: "Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat, and cholesterol, may help reduce the risk of heart disease and certain cancers."

36 What Should I Eat? Vegetables Raw Steamed Salad Stir fry
Vegetables are low in calories and high in fiber. They optimize your weight loss efforts and provide fiber, vitamins and minerals that are important for heart health.

37 What Should I Eat? Whole fruit Fresh Frozen Unsweetened
Whole in this slide refers to unprocessed fruit – as pictured. It does not mean canned in syrup, dried, frozen with syrup, fruit puree, juice or pie filling.

38 What Should I Eat? Lean poultry, fish, lean meat, some soy foods, beans and legumes Some soyfoods are better choices than others – read the label to find the protein and sodium content. Tofu is a better choice than some of the other soyfoods like hotdogs – it is higher in protein and lower in salt and less calorie dense.

39 What Should I Eat? Nonfat dairy: Milk Ricotta Yogurt
All are high in calcium but only skim milk is a reliable source of vitamin D. There are some new yogurts on the market that contain vitamin D.

40 What Should I Eat? Nuts, seeds, avocados and small amounts of unsaturated oils Minimize if weight loss is a goal, especially with oils If you are thin you can add a little more fat in your diet – it is best to use nuts, seeds, avocados and unsaturated oils since they do not raise cholesterol like saturated fat and hydrogenated fat. If you are trying to lose weight you should minimize added fats in your diet because they are high in calories.

41 What You Will Learn Today
2 most important eating strategies Carbohydrates, protein and fat tips How to read a food label Supplement FAQs Meal planning to better your health Quiz the audience on these and accept questions.

42 “Bite off more than you can chew, then chew it
“Bite off more than you can chew, then chew it. Plan more than you can do, then do it.” Anonymous The American diet and lifestyle is perfect for developing type 2 diabetes if you have the wrong genes. It is easy to eat rich foods and become sedentary in our society. To break this trend you have to change what you eat and your activity level. You are in the driver seat. Take the time to plan and set goals – don’t be afraid to give yourself high standards. Make small steady changes and be consistent.

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