Karen Chapman Novakovski - Associate Professor of Nutrition

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October/November 2011

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In This Issue

Diabetes - The Medical Perspective

Anemia is a condition where there is not enough red blood cells. With too few red blood cells not enough oxygen gets carried to organs. Being tired is a symptom of anemia, but not everyone who is tired has anemia.

Diabetes does not cause anemia. Kidney disease can be caused by diabetes. In kidney disease there is increased risk for anemia. The kidneys secrete a hormone to stimulate red blood cell production in the bone marrow. In kidney disease enough of this hormone might not reach the bone marrow.

Metformin is a common drug for those with type 2 diabetes. Metformin may lead to anemia by causing a malabsorption of vitamin B12.  Red blood cells need vitamin B12 to develop correctly. You normally have vitamin B12 stored in your liver. So even if you have been taking metformin for years, and it has caused a malabsorption of the vitamin, you may not have a vitamin B12 deficiency or anemia.

A simple blood test can check for anemia. Your doctor will look at your hemoglobin and hematocrit, and the size of your red blood cells. In vitamin B12 deficiency the red blood cells grow larger than normal, but are not functioning well. If you have been taking metformin for many years, ask your doctor your hemoglobin and hematocrit are normal, especially if you have been unusually tired. Or just ask your doctor if your blood is anemic.

There are many causes for anemia besides kidney disease or vitamin B12 malabsorption. They can all be diagnosed by the blood tests your doctor may order.

Treating anemia depends on the cause of the low red blood cells. The treatment will be different for people with kidney disease than for those who may have a vitamin B12 deficiency.

Diabetes and Food

Vitamin B12 is found in all meats. That includes pork, beef,  and seafood. There is also vitamin B12 in milk, cheese, poultry and eggs, although in lower amounts. These foods have vitamin B12 bound to protein. The acid in the stomach helps to cleave the protein from the vitamin B12 so it can be absorbed. People with low stomach acid may not be able to use animal forms of vitamin B12 well. Older people sometimes have less stomach acid production and may be at a higher risk for being unable to use the vitamin B12 in animal products.

Foods that are fortified with vitamin B12 have vitamin B12 in a form that does not bind to protein.

Many ready-to-eat breakfast cereals are fortified with vitamin B12.  Frozen waffles and pancakes, and breakfast bars may also be fortified with vitamin B12. Not all of these foods are fortified, so be sure to read the Nutrition Facts label.

Supplements may also contain vitamin B12. Again, not all do, and you will need to read the supplement label.

Medication Update

Some medications used to treat peptic ulcer disease or gastric reflux may interfere with vitamin B12 absorption. These medications are called proton pump inhibitors. Common types are omeprazole (Prilosec) and lansoprazole (Prevacid).

Although it is known that histamine H2 receptor antagonists for treating peptic ulcer disease can slow the release of acid in the stomach and inhibit with vitamin B12 absorption, no cases have been found where this is true. If you take these, cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac), you may want to check with your doctor about whether your blood is anemic or not.

The possibility of metformin causing vitamin B12 malabsorption has already been discussed.

If you take any of these medications on a regular basis, ask your doctor about your hemoglobin status and your vitamin B12 levels.  Vitamin B12 deficiency not only can lead to anemia but also to mental changes.

Recipes To Try

Carrot Mushroom Loaf
6 servings

  • 1 small onion, chopped
  • 8 ounces mushrooms, chopped
  • 1 tablespoon olive oil
  • 2 cups grated carrots, chopped
  • 2 eggs
  • .5 cups plain bread crumbs
  • .5 cups shredded cheddar cheese
  • .5 teaspoon garlic powder
  • dash dried basil
  • cooking spray
  1. Preheat oven to 350 degrees. Spray loaf pan with non-stick cooking spray.
  2. Sauté onions and mushrooms in olive oil over medium heat. Cover to prevent drying.  
  3. Combine remaining ingredients with mushrooms and onions, saving .25 cup bread crumbs and .25 cup cheese for top.
  4. Spread into loaf pan. Top with remaining bread crumbs and cheese.
  5. Cover. Bake to 30 minutes; uncover and bake for 10 additional minutes.

Nutrition facts per serving:

Calories 150
Protein 7 grams
Carbohydrate 14 grams
Fiber 2 grams
Fat 8 grams
Calories from fat 45%
Cholesterol 80 mg
Sodium 172 mg

Preparation time 20 minutes; cooking time 40 minutes

Peach Raisin Tart
16 servings

  • 1 cup raisins
  • 1/3 cup Splenda® 2 tablespoons flour
  • ½ teaspoon cinnamon
  • ¼ teaspoon salt
  • 1 bag (16-ounce) frozen,unsweetened peaches, thawed
  • 1 tablespoon lemon juice
  • 1 (9-inch) unbaked pie shell
  1. Preheat oven to 425 degrees.
  2. Combine raisins, Spenda®, flour, cinnamon, and salt.
  3. Combine peaches and lemon juice. Toss peaches with raisins/flour mixture.
  4. Put peach mixture in middle of pie shell. Fold edges toward center of pie and crimp together.
  5. Bake for 10 minutes. Reduce heat to 350 degrees and bake 20-25 minutes more until crust is golden brown.

Nutrition facts per serving

Calories 167
Protein 2 grams
Carbohydrate 30 grams
Fiber 2 grams
Fat 5 grams
Calories from fat 27%
Cholesterol 0 mg
Sodium 178 mg

Preparation time 20 minutes; baking time 30 minutes.

Menu Suggestions

BREAKFAST

Amount/Portion

1 cooked egg or egg substitute

1 egg

Cranberry scones†

1

Margarine, whipped

1 tablespoon

Cranberry juice

6 ounces

Skim milk

8 ounces

 

439 Calories, 59 Carbohydrates, 4 Carbohydrate Choices

 

SNACK

Low-fat cottage cheese .5 cup
Pineapple chunks .5 cup
 
142 Calories, 18 Carbohydrates, 1 Carbohydrate Choice
 

LUNCH

Carrot mushroom loaf†

1 slice

Tossed salad with turkey slices

1 cup; 2 ounces

Low fat salad dressing

1 tablespoon

Soft breadsticks 2
Skim milk 8 ounces

 

589 Calories, 70 Carbohydrates, 4.5 Carbohydrate Choices

 

DINNER

Pork chop, broiled

3 ounces

Red beans and rice

1 cup

Broccoli, steamed

1 cup

Peach raisin tart†

1 serving

 

612 Calories, 80 Carbohydrates, 5 Carbohydrate Choices

 

 

Total: 1782 Calories, 227 Carbohydrates, 15 Carbohydrate Choices

 

† recipes from Diabetes Lifelines or Recipes for Diabetes at http://urbanext.illinois.edu/diabetesrecipes/intro.cfm


About Diabetes | Food & Diabetes | Medications & Diabetes | Current Issue | Archive | En Español

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