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Have prediabetes? Dietary changes can prevent Type 2 diabetes – The Globe and Mail



Q: I’ve recently been diagnosed with prediabetes. Are there foods I should eat to prevent getting diabetes?

An estimated 22 per cent of Canadians have prediabetes and some Canadians may not even know they have it.

Prediabetes is diagnosed when fasting blood sugar (glucose) is higher than normal (6.1 – 6.9 mmol/L), but not yet high enough to be considered Type 2 diabetes (7.0 mmol/L or higher).

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It occurs in people who have insulin resistance or whose pancreas can’t produce enough insulin to keep blood glucose in the normal range.

Insulin resistance is when cells in the muscles, fat and liver don’t respond properly to the blood-glucose-lowering action of insulin. Family history of Type 2 diabetes, abdominal obesity and physical inactivity can lead to insulin resistance.

If left unmanaged, prediabetes can cause damage to your blood vessels, nerves and kidneys and, eventually, it may progress to Type 2 diabetes.

The good news: Type 2 diabetes is largely preventable. By making diet and lifestyle changes now, you can prevent or delay prediabetes from progressing to diabetes.

Manage prediabetes, prevent diabetes

Lifestyle modification is the cornerstone of diabetes prevention – the landmark Diabetes Prevention Program, a large randomized controlled trial published in 2002, proved this point. People with pre-diabetes who were assigned to the “lifestyle” group (healthy diet, physical activity, weight loss) dramatically cut their risk of developing Type 2 diabetes.

The following strategies can help prevent prediabetes turning into Type 2 diabetes. (Some may even help reverse the effects.)

Lose excess weight. Being overweight is the strongest risk factor for prediabetes and Type 2 diabetes. Excess abdominal fat can cause fat cells to release inflammatory chemicals which are involved in insulin resistance.

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The Diabetes Prevention Program showed a modest 5 to 7 per cent weight loss significantly reduced the risk of developing Type 2 diabetes.

Choose whole grains. There’s convincing evidence that diets rich in whole grains protects against Type 2 diabetes.

The fibre in whole grains leads to lower and slower rises in glucose, meaning they have a low glycemic index. Whole grains also contain nutrients and phytochemicals that may help reduce diabetes risk.

Replace refined (white) grains with whole grains such as oats, quinoa, farro, freekeh, brown rice, millet, oats, de-hulled barely and whole grain pasta.

Choose breads made with whole or cracked grains such as stone-ground whole wheat, wholemeal rye and sprouted whole grains. Whole wheat bread is made with pulverized flour so, like white bread, its starch is quickly converted to glucose.

One-hundred-per-cent bran cereals aren’t technically whole grain since they contain only the bran portion of the grain. But since they’re a concentrated source of fibre that’s lacking in refined cereals, they’re good choices. Plus, they have a low glycemic index.

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Add magnesium-rich foods. Studies have found that people with prediabetes who have higher intakes of dietary magnesium have a lower risk of developing diabetes. Magnesium plays an important role in insulin action and insulin sensitivity.

Excellent sources include pumpkin seeds, sunflower seeds, almonds, hemp seeds, tempeh, tofu, black beans, chickpeas, lentils, cooked spinach, Swiss chard and 100-per-cent bran cereal.

Choose the right fats. Emphasize heart-healthy unsaturated fats in your diet, which are thought to have beneficial effects on insulin sensitivity.

Good sources of monounsaturated fats include olive oil, canola oil, peanut oil, avocado, almonds and cashews. Polyunsaturated fats include sunflower oil, walnuts, chia seeds and flax seeds.

Limit added sugars. Avoid sugar-sweetened drinks which have a high glycemic index and are tied to a greater risk of obesity and Type 2 diabetes. Limit cookies, pastries, cakes and other sweets.

Read labels on breakfast cereals, snack bars, flavoured yogurts and condiments. Some brands of “no added sugar” jams, for example, have 5 g of sugar (one teaspoon worth) per serving from fruit juice concentrate, an added sugar.

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Be active. Regular exercise can help maintain a healthy weight. Aerobic exercise, high-intensity interval training and resistance training have been shown to improve insulin sensitivity in prediabetes.

Participants in the Diabetes Prevention Program performed at least 150 minutes of moderate-intensity exercise a week (e.g., brisk walking).

Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

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Ontario hospitals may have to withhold care as COVID-19 fills ICUs



By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

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In COVID-19 vaccination pivot, Canada targets frontline workers



By Anna Mehler Paperny

TORONTO (Reuters) – Canada is shifting its vaccination campaign to target frontline workers, moving away from a largely age-based rollout as the country tries to get a handle on the raging third wave of the pandemic.

Canada‘s approach thus far has left unvaccinated many so-called “essential workers,” like daycare providers, bus drivers and meatpackers, all of whom are among those at higher risk of COVID-19 transmission. Provinces are now trying to adjust their strategy to tackle the surge driven by new variants.

Targeting frontline workers and addressing occupation risk is vital if Canada wants to get its third wave under control, says Simon Fraser University mathematician and epidemiologist Caroline Colijn, who has modelled Canadian immunization strategies and found “the sooner you put essential workers [in the vaccine rollout plan], the better.”

Initially, Canada prioritized long-term care residents and staff for the vaccines, as well as the very elderly, health workers, residents of remote communities and Indigenous people.

Targeting vaccinations by age made sense early on in a pandemic that ravaged Canada‘s long-term care homes, Colijn said. But now, immunizing those at highest risk of transmission brings the greatest benefit.

“If you protect these individuals you also protect someone in their 60s whose only risk is when they go to the store. … The variants are here now. So if we pivot now, but it takes us two months to do it, then we will lose that race.”

Data released on Tuesday from the Institute of Clinical and Evaluative Sciences showed that Toronto’s neighbourhoods with the highest rates of COVID-19 infections had the lowest vaccination rates, underscoring the disparities in vaccination.


On Wednesday, Ontario Premier Doug Ford announced a plan to have mobile vaccine clinics target COVID-19 “hotspots” and high-risk worksites, although he stopped short of giving people paid time off to get the shot.

Karim Kurji, medical officer of health in York Region north of Toronto, characterizes the shift in vaccination priority from age to transmission risk as moving from defence to offence.

“It’s a juggernaut in terms of the immunization machinery, and turning it around takes a lot of effort,” Kurji said.

Meanwhile, officials in the western province of Alberta say they are offering vaccines to more than 2,000 workers at Cargill’s meatpacking plant in High River, site of one of Canada‘s largest workplace COVID-19 outbreaks. Provincial officials said in a statement they are looking to expand the pilot to other plants.

Quebec will start vaccinating essential workers such as those in education, childcare and public safety in Montreal, where neighbourhoods with the highest vaccination rates have been among those with the lowest recorded infection rates.

The people doing the highest-risk jobs, from an infectious disease perspective, are more likely to be poor, non-white and new Canadians, health experts say. They are less likely to have paid leave to get tested or vaccinated or stay home when sick and are more likely to live in crowded or multi-unit housing. They need to be prioritized for vaccination and their vaccination barriers addressed, experts say.

Naheed Dosani, a Toronto palliative care physician and health justice activist, said making vaccines available to high-risk communities is not enough without addressing barriers to access.

“The face of COVID-19 and who was being impacted changed dramatically. The variants seemed to take hold in communities where essential workers live. … This [pivot] is a step in the right direction and will hopefully save lives.”


(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Aurora Ellis)

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Canada finance minister: Pandemic an opportunity to bring in national childcare



OTTAWA (Reuters) – The COVID-19 pandemic and its damaging impact on women has underlined the need for a national childcare plan, which would also help the economic recovery, Finance Minister Chrystia Freeland said on Thursday.

Since taking up her job in August, Freeland has repeatedly spoken about a “feminist agenda,” and has said childcare will be part of a stimulus package worth up to C$100 billion ($79.6 billion) over three years. She will unveil details in her April 19 budget.

“I really believe COVID-19 has created a window of political opportunity and maybe an epiphany … on the importance of early learning and childcare,” Freeland told a online convention of Canada‘s ruling Liberal Party.

The budget is set to be a springboard for an election that Liberal insiders say is likely in the second half of the year.

Canadian governments of various stripes have mused about a national childcare program for decades but never acted, thanks in part to the cost and also the need to negotiate with the 10 provinces, which deliver many social programs.

Freeland said a childcare program would help counter “an incredibly dangerous drop” in female employment since the start of the pandemic.

“It is a surefire way to drive jobs and economic growth … you have higher participation of women in the labor force,” Freeland said. “My hope … is that being able to make that economic argument as well is going be to one of the ways that we get this done.”

Freeland, who is taking part this week in meetings of the Group of Seven leading industrialized nations and the International Monetary Fund, said U.S. Vice President Kamala Harris and Treasury Secretary Janet Yellen had told her they saw early learning and child care as a driver for economic recovery.

($1=1.2560 Canadian dollars)


(Reporting by David Ljunggren; Editing by Leslie Adler)

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