Your Health Is Important To You
If you think you have diabetes, there are some things you should know. A visit to your physician or nurse and a registered dietitian can help. Your dietitian should have a glucose meter to check your blood glucose (blood sugar). They may use it as part of an assessment if you have had weight gain and a family history of diabetes. The Canadian Diabetes Association has worked with medical experts to determine the best possible glucose values for you as seen in the below chart.
The current guidelines for diagnosis of diabetes are: FPG ≥7.0 mmol/L Fasting = no caloric intake for at least 8 hours or
A1C ≥6.5% (in adults) Using a standardized, validated assay in the absence of factors that affect the accuracy of the A1C and not for suspected type 1 diabetes (see text) or 2hPG in a 75 g OGTT ≥11.1 mmol/L or Random PG ≥11.1 mmol/L
‘Random = any time of the day, without regard to the interval since the last meal.’
“2018 Clinical Practice Guidelines, Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome Diabetes Canada Clinical Practice Guidelines Expert Committee, Zubin Punthakee MD, MSc, FRCPC, Ronald Goldenberg MD, FRCPC, FACE, Pamela Katz MD, FRCPC. Can J Diabetes 42 (2018) S10–S15”
|Test taken||Value (mmol/l)||Action|
|Fasting Blood Glucose (before breakfast)||< 5.8||None – continue healthy life with regular diet and exercise|
|Fasting Blood Glucose (before breakfast||> 5.8||Ask your MD for a Hemoglobin A1c (HgA1c) test and ask your RD about regular diet and exercise|
|Random Blood Glucose (anytime)||< 7.8||None – continue healthy life style with regular diet and exercise|
|Random Blood Glucose (anytime)||> 7.8||Ask your MD for a glucose tolerance test and ask your RD about regular diet and exercise|
A Registered dietitian will need to know the following to make the best possible treatment plan/diet plan for you:
- Family history of medical conditions (on assessment template)
- Activity level (can benefit from a pedometer if you are not sure how much walking you do each day, in assessment package)
- Your waist circumference (in assessment package)
- A recent blood pressure reading
- A recent HgbA1c (the measure your doctor takes to determine your blood glucose over the past 3 months)
- A three-day food intake record with several blood glucose readings (template given with assessment)
- Current medications, if any
- Cholesterol levels (LDL, HDL, Triglycerides, the ratio of Total Cholesterol/HDL)
- How your kidney function is (urine micro albumin, serum creatinine and e GFR)
A treatment plan will include targets for all of the above: physical activity, nutrition plan with portion or carbohydrate counting, waist circumference target, blood pressure target, HgbA1c target, cholesterol and kidney function targets.
Nutritionassessment.com is happy to work with your MD in establishing goals for your diabetes care when your condition is mild to moderate or you are wishing to prevent future complications from high blood glucose.
High Blood Pressure
Salt, Alcohol, Fruit & Vegetables, and Weight Management
High Blood Pressure is often in your family medical history. Before an assessment if possible, take time to contact primary relatives and ask them about their blood pressure, blood sugar and cholesterol. Determine if they had risk factors such as a large waist measure, high stress, inactivity, smoked, high alcohol intake or had other lifestyle issues.
If you think your blood pressure is only high occasionally, ask your doctor for a 24 Hour Heart Rate Monitor machine to help determine if you have a problem. The Heart and Stroke Foundation has worked with medical teams to set the maximum blood pressure ranges for health in the table below. They also look at your BP in the office and other locations to see differences. Treatment consists of health behaviour (diet/exercise/weight loss) ± pharmacological management.
Read more from the 2020 Guidelines from Hypertension Canada.
|Blood Pressure Targets 2020||Systolic BP||Diastolic BP|
|Normal- Textbook BP||< 120||< 80|
|Well person with slightly high blood pressure (treatment diet change) AOBP threshold ≥ 135/85 mmHg||< 130||< 85|
|Diabetes Targets||< 130||< 80|
|High Risk||< 120||n/a|
Did you know you can reduce your blood pressure 11.4/5.5 mm Hg with a nutrition assessment and advice on the Dash diet and your sodium (salt) intake? Did you know that for every 10 pounds of extra weight you lose, your blood pressure will go down 7.2/5.9 mm Hg? Did you know limiting your alcohol consumption will reduce your blood pressure? Did you know that with the help of a dietitian you may not need as many blood pressure pills? Nutritionassessment.com is happy to work with your MD in establishing goals for your blood pressure when your condition is mild to moderate or you are wishing to avoid adding another blood pressure medication to gain control.
If you have high cholesterol it is likely that it is in your family medical history. Before an assessment, if possible, take time to contact primary relatives and ask them about their blood pressure, blood sugar and cholesterol. Determine if they had risk factors such as a large waist measure, were stressed, were inactive, were smokers or other lifestyle issues such as excessive alcohol consumption. LDL-cholesterol levels are directly linked to the development of atherosclerosis and its reduction is directly linked to
the reduction in cardiovascular disease events. Health behaviour modification remains a cornerstone of risk reduction*.
You can ask your MD to check your cholesterol and they will order a lipid profile for you through a lab. The Heart and Stroke Foundation has worked with medical teams to set the maximum cholesterol ranges for health in the table below. Your physician or nurse practitioner will help you determine your risk for cardiovascular disease with your family medical history, blood levels of cholesterol, your history of diabetes if any, blood pressure, body weight and lifestyle factors. The dietitians at nutritionassessment.com can help with the lifestyle factors that will help lower your cholesterol and blood pressure.
Your physician or Nurse will calculate risk (unless statin-indicated condition) using the Framingham Risk Score (FRS)✝ or Cardiovasular Life Expectancy Model (CLEM)✝ Repeat screening every 5 years for FRS <5% or every year for FRS ≥5%
Diet and exercise will be suggested first and medications may be used with the following. If the FRS is 10-19% risk and LDL-C ≥3.5 mmol/L or Non-HDL-C ≥4.3 mmol/L or Apo B ≥1.2 g/L or Men ≥50 and women ≥60 with one additional risk factor: low HDL-C, impaired fasting glucose, high waist circumference, smoker, hypertension*.
*Canadian Cardiovascular Society Guidelines, Anderson, Todd J. et al. 2016 CCS Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol , 2016;32;11:1263 – 1282
|Cholesterol Test||High Risk mmol/l||Intermediate Risk mmol/l||Low Risk mmol/l|
The dietitians at nutritionassessment.com know what foods will improve the specific cholesterol targets. They use a step-wise approach to treatment over a 3 month period and then have your lipid profile re-taken to see the results of the diet changes. It’s important to review this with a dietitian regularly to have access to new strategies and foods to reduce your LDL or improve your HDL.
People who have acquired a gastrointestinal condition can benefit from a nutrition assessment. Often some entire food groups are removed due to an allergy or intolerance. There are issues of malabsorption of specific nutrients and replacements are needed. Below are a few more common conditions.
Celiac Disease (Gluten Sensitivity)
Celiac disease is an autoimmune disease usually found in families. It occurs when we cannot digest gluten found in the wheat and other grain products. It is felt this condition is widespread in our population. Some people decide they have this condition without a thorough assessment and testing. To be diagnosed your MD would order a blood test. In order for the test to be definitive, a diet containing wheat must be taken continuously. It is incorrect to stop eating wheat products and then have the test. The authority on celiac is Shelley Case the author of the ‘Gluten Free Diet'. The Dietitians at nutritionassessment.com can help with food lists, recipes and menu planning, especially for multiple food intolerances.
 Case, Shelley, Gluten-Free Diet, Revised Edition, http://www.glutenfreediet.ca/index.php
Irritable Bowel Syndrome (IBS)
IBS is a chronic, often debilitating, functional (meaning disordered function or movement along the bowel) gastrointestinal disorder with symptoms including abdominal pain, bloating, and altered bowel behaviour such as constipation (IBS-C) or diarrhea (IBS-D), or alternating between the two stool consistency extremes. It is the most common gastrointestinal diagnosis worldwide and the most common disorder presented by patients consulting a specialist for gastrointestinal conditions. It is estimated 5 million Canadians have this condition and it is more difficult to manage in times of stress. For example, students have more problems during mid-terms and final exams than the rest of the term. The treatment of the condition is complex and different for nearly every person. The Registered Dietitians at Nutrition Assessment Clinic can help with a step-wise approach to food intolerance. Our first step is to to improve your gut microbiome using prebiotics you can tolerate. At each step the Registered Dietitian will guide the elimination of specific foods and sequence the the re-introductions of foods you want to try. It is important to go one step at a time and record your food intake and symptoms to achieve a happier bowel. Too many attempts that are not well monitored will result in elimination of too many foods in the diet and may not meet with success in stopping symptoms of IBS. Ask the dietitian if the low FODMAP diet or probiotics are appropriate for you.